Occurrence Of Fistula Research Articles

Successful treatment of a persistent air leak with an endobronchial valve in a 17-year-old patient with necrotizing pneumonia.

Pleural empyema is a severe condition associated with high morbidity and mortality. Treatment usually consists of pleural drainage with chest tube or surgery, in combination with antimicrobial treatment. Severe pneumonia can evolve in a necrotizing pneumonia, given a higher susceptibility to the occurrence of bronchopleural fistulas with persistent air leaks. This complicates recovery, and surgery may not always be the optimal treatment. We present a case involving a 17-year-old female patient who experienced a post-operative persistent air leak due to necrotizing pneumonia after video-assisted thoracic surgery decortication for empyema, which was successfully treated using an endobronchial valve. After 6 months the valve was removed without complications. Follow-up imaging and lung function revealed a limited area of atelectasis and minimal pleural thickening with normal lung volumes.

Comparative Analysis of Fistula Development After Parotid Gland Surgery: Lateral Parotidectomy Versus Extracapsular Dissection Technique.

The primary objective of this study was to explore the potential disparity in postoperative fistula occurrence rates between patients who undergo (partial) lateral parotidectomy and those who undergo the extracapsular dissection technique for the management of benign parotid gland tumours. A consecutive series of 363 patients treated with (partial) lateral parotidectomy and extracapsular dissection technique for benign parotid gland tumours at one tertiary centre between 2018 and 2022 were included. To evaluate the impact of the surgical technique and possible other risk factors (tumour location, tumour size, Body Mass Index, age, smoking, diabetes mellitus, arterial hypertension) for the development of fistulas, multivariate logistic regression analyses using backward lection were applied to estimate odds ratios (ORs) and 95%-confidence intervals (CIs). In 363 patients, 21 patients (5.8%) developed a fistula. Patients who underwent (partial) lateral parotidectomy had three times higher chance of developing a fistula compared to patients who were operated using the extracapsular dissection technique (ORadjusted = 2.6, 4.1% vs. 12.5%, p = 0.044). In the multivariate analyses, no other risk factors for the development of fistulas were statistically significant in this cohort. The incidence of facial nerve paralysis was not significantly different between the extracapsular dissection and lateral parotidectomy group (5/73 = 6.8% vs. 11/290 = 3.8%, p = 0.333). Fistulas occur more often in patients treated by means of a (partial) lateral parotidectomy approach compared to patients treated using the extracapsular dissection technique. Therefore, surgeons should be vigilant about postoperative fistula risks in lateral parotidectomy and consider preventive measures.

Impact of the Prognostic Nutritional Index on the Development of Sialocele or Salivary Fistula, After Parotidectomy.

Sialocele or salivary fistula formation is common after parotidectomy. This study aims to evaluate the predictive value of the prognostic nutritional index in the development of salivary fistulas and sialoceles after parotidectomy. Patients who underwent parotidectomy at our clinic and were diagnosed with benign salivary gland masses were included in the study. Patients who developed postoperative sialoceles or salivary fistulas were identified. Various factors were assessed, including surgical technique, tumour size, gender, age, prognostic nutritional index, and the volume of the excised mass. Variables associated with sialocele or salivary fistula were later included in a multiple logistic regression model. Possible factors related to the formation of sialocele or salivary fistulas were analysed. The study comprised 158 patients (95 male and 63 female). The frequency of sialocele or salivary fistula development was 13.9% (n = 22). The multiple logistic regression model found that the prognostic nutritional index(PNI) was linked to the occurrence of sialocele or salivary fistula (ORs = 0.9, 95% CI = [0.9], p = 0.003). Warthin tumour was associated with an elevated risk of sialocele or salivary fistula (ORs = 0.38, 95% CI = [0.184, 0.79], p = 0.009). ROC analysis demonstrated that the PNI had a specificity of 90% and a sensitivity of 68%. No significant associations were observed between the excised tumour size, surgical technique with the development of sialocele or salivary fistula. Prognostic nutritional index can be utilised as an independent risk factor for the development of sialocele, or salivary fistula.

Intraperitoneal administration of a thermogel combined with an anticancer agent for the prevention of peritoneal carcinomatosis in a pig model

BackgroundSurgeons may discover perioperative clinical situations associated with an increased risk of peritoneal carcinomatosis recurrence after primary resection. We developed a thermogel that can be used as a drug carrier to deliver an anticancer agent in the peritoneal cavity as a rescue solution. The spatial distribution of the thermogel and pharmacokinetics of chemotherapy have been studied in pigs. The safety of the thermogel was assessed based on the healing of bowel sutures. MethodsNine pigs received gel with oxaliplatin at 130 mg/200 mL (TG-Ox group), and 4 pigs received the gel alone (TG group). Digestive tract and bladder wounds were made and sutured. Pigs were sacrificed at different times after surgery to monitor the distribution of the thermogel and to detect the occurrence of bowel fistulas. Oxaliplatin plasma and tissue concentrations were determined via mass spectrometry. ResultsAfter 3 h, 100 % of the regions of interest were covered by the gel, 78 % were covered after 2 days, and 38 % were covered after 4 days. The thermogel delayed the release of oxaliplatin into the systemic circulation and significantly prolonged tissue impregnation. Anastomotic fistulas were observed in the TG-Ox group (10 %) versus 0 % in the TG group (p = 0.31). ConclusionsA homogeneous distribution of the thermogel throughout the peritoneal cavity was observed, and the thermogel fulfilled its functions as a drug carrier, including ensuring safety and delaying chemotherapy delivery. Treatment-induced toxicity due to oxaliplatin was identified. The concept of a rescue solution being available in operating rooms was demonstrated.

Pharyngostoma reconstruction after laryngectomy and radiotherapy: A retrospective study and literature review

BackgroundThe occurrence of pharyngocutaneous fistula or pharyngostoma after oncologic head and neck surgery is a serious complication. It is the most common complication after major hypopharyngeal and laryngeal ablative surgery. AimThe purpose of this study is to review the surgical approach and evaluate the results regarding reconstruction methods of pharyngostoma, caused after laryngectomy and radiotherapy. Patients & MethodsThe total patient number is 15. Pharyngostoma caused swallowing difficulties, as well as frequent aspiration pneumonia. The intervention interval from laryngectomy to pharyngeal reconstruction varied between one to three years, depending on the symptoms’ severity and after the complete failure of conservative rehabilitation methods. Pharyngostoma reconstruction was performed mainly with pectoralis major myocutaneous flap in eleven cases. The radial forearm free flap (RFF) and the anterolateral thigh free flap (ALT) were also used in the rest four cases. ResultsThe postoperative course was uncomplicated and in most cases the feeding with soft food started after a barium meal between 15-20 days postoperatively. Complications include wound dehiscence and leak treated conservatively and one case of carotid rupture. ConclusionsThe gold standard for pharyngostoma reconstruction, after laryngectomy and cervical radiotherapy, remains the use of pectoralis major myocutaneous flap. In cases of extensive neck radionecrosis free flaps are preferable. Reliable and stable cover of the large vessels of the neck beside with the reconstruction of the digestive tract and the function of swallowing are issues, which are analysed in corelation with the avoidance of stenosis and swallowing difficulties.

Chronic lower abdominal pain in an elderly female patient: a case report about sigmoid colon fistula and pelvic abdominal infection

An elderly woman patient presented with a history of recurrent right lower abdominal pain accompanied by fever and abnormal vaginal discharge for 36 years worse for two weeks. Conservative medical treatment was ineffective, by laparoscopic exploration combined with intraoperative colonoscopy, the presence of a sigmoid colon fistula and pelvic abdominal infection with foreign bodies were confirmed. It was hypothesized that the occurrence of recurrent right lower abdominal pain and intestinal fistula may be potentially associated with tubal injection sterilization performed 36 years ago.

Clinical study on the establishment of radio-cephalic autogenous arteriovenous fistulas in small blood vessels by multi-segment balloon dilation technique.

To investigate the effect of dilating small blood vessels using a balloon dilation (BD) technique on the occurrence of radio-cephalic autogenous arteriovenous fistulas in terms of patency, blood flow, and vein diameter (VD). The subjects included in this study were all patients with chronic renal failure and required radio-cephalic arteriovenous fistula surgery for the first time and had not received dialysis before. Patients with VDs <2 mm were included as study subjects. They were either assigned treatment using a BD group or a control group that received hydrostatic dilation. The differences between the 2 groups were analyzed in terms of patency, blood flow, and VD. A total of 22 patients were enrolled in the balloon dilatation group and 20 patients in the control group. The diameters of cephalic veins (mm) of the experimental and control group were compared at various time points: immediately postoperation, 2.89 ± 0.42 versus 1.99 ± 0.28 (P < .001); 1 week later, 3.16 ± 0.59 versus 2.66 ± 0.60 (P = .022); 1 month later, 3.76 ± 0.91 versus 3.18 ± 0.83 (P = .087); and 2 months later, 4.08 ± 1.15 versus 3.38 ± 1.13 (P = .169). Brachial artery flows (mL/min) of the 2 groups at various time points were given as follows: immediately postoperation, 413.49 ± 145.09 versus 235.61 ± 87.77 (P < .001); 1 week later, 563.26 ± 206.83 versus 331.30 ± 126.78 (P < .001); 1 month later, 679.34 ± 218.56 versus 376.79 ± 156.25 (P < .001); and 2 months later, 736.31 ± 202.61 versus 394.60 ± 161.96 (P < .001). The primary patency at 1 year for the experimental group was 61.9% compared to 11.1% for the control group (P = .045). Similarly, the secondary patency rates at 1 year were 90.5% for the experimental group and 55.6% for the control group (P = .030). The results showed that the functional primary patency rate within 1 year was 57.1% versus 16.7% (P = .032), and the functional secondary patency rate within 1 year was 85.7% versus 50.0% (P = .038). BD has obvious advantages over hydrostatic dilation for chronic renal failure patients with small veins in establishing arteriovenous fistula in terms of patency and blood flow.

Surgical management of aorto-right atrial fistula induced by Stanford type A aortic dissection: a case report

BackgroundThe occurrence of aorto-right atrial fistula in a patient with Stanford type A aortic dissection is exceedingly rare, and the treatment has not been established.Case presentationA 60-year-old male presented to the emergency department with acute lumbar pain and, based on contrast-enhanced computed tomography, was diagnosed with Stanford type A aortic dissection. Emergency surgery was performed. Transesophageal echocardiography during the surgery did not reveal an aorto-right atrial fistula. After establishing cardiopulmonary bypass, circulatory arrest was induced, and the primary entry in the proximal ascending aorta for the aortic dissection was identified. The aorta was dissected between the right brachiocephalic artery and the left common carotid artery, and an artificial conduit was anastomosed. After re-establishing circulation, venous blood flow from the dissected area at the base of the aortic root was observed, indicating communication between the aorta and the right atrium. Circulatory arrest was induced again, and the ruptured outer aortic adventitia was repaired by continuous suturing using 5–0 prolene. The atrial fistula was repaired from within the right atrium using 5–0 prolene with felt reinforcement. Thus, successful closure was achieved. Proximal anastomosis and right brachiocephalic artery reconstruction were subsequently performed. Postoperative transesophageal echocardiography revealed no shunt flow and no bleeding from the aortic root. The patient recovered smoothly and was discharged without significant complications.ConclusionsAorto-right atrial fistula associated with Stanford type A aortic dissection is rare, and in this case, the shunt blood flow was low, making preoperative diagnosis difficult. However, after intraoperative diagnosis, direct suture was used to complete the treatment, which was a simple and effective method.

The use of an autologous platelet-rich fibrin membrane in urethroplasty for cases of distal hypospadias

BackgroundAmong pediatric surgical procedures, hypospadias surgery is one of the most difficult. The most prevalent complication following hypospadias repair is urethrocutaneous fistula. Numerous procedures have been developed to prevent and resolve this issue. One such method is platelet-rich fibrin (PRF) membrane preparation, which is a straightforward process requiring only the patient’s serum. It has already been utilized successfully in plastic and reconstructive surgeries, where it significantly enhances the healing capacity and decreases the risk of infections. The purpose of this study is to assess the efficacy of an autologous PRF membrane in promoting healing and reducing fistula occurrence in cases of de novo distal hypospadias.MethodsForty patients with primary distal hypospadias underwent TIP repair, as a part of a prospective controlled randomized study from April 2017 to February 2018. The cases were randomly allocated into two categories. TIP repair done in all cases by the same surgeon. Twenty cases comprised group A, which utilized a preputial or local dartos flap as an additional protective layer over the urethroplasty. In contrast, group B comprised 20 cases in which the urethroplasty was covered with a PRF membrane. The initial follow-up duration was 6 months. Each group’s fistula incidence and other associated complications were documented.ResultsTwo groups were compared during the initial 6-month follow-up period. There were seven cases of urethrocutaneous fistula in group A, representing a 35% incidence rate. In group B, there were two cases that had fistula with an incidence of 10% in the early postoperative period. Two patients (10%) in group A developed meatal stenosis and only one patient in group B (5%) developed meatal stenosis. Glandular dehiscence occurred in one patient (5%) in group B. There was no skin wound infection in both groups.ConclusionThe PRF membrane may be a promising method as a coverage layer over the urethroplasty aiming to reduce the fistula rate after the repair. A larger comparative study is needed to evaluate the efficacy of PRF membranes in promoting wound healing.

Aorto-pulmonary artery fistula with Laubry-Pezzi syndrome: A diagnostic enigma

Usually diagnosed post-mortem, aortopulmonary artery fistula is an exceptionally rare and often highly lethal condition. Here, we present a unique case of a 29-year-old woman with no history of aortic aneurysm or previous aortic surgery, referred for surgical management of Laubry-Pezzi syndrome in whom an aorto-pulmonary artery fistula bridging the ascending aorta and the main pulmonary artery was discovered intra operatively. The patient was successfully managed with an uneventful postoperative recovery. Our case outlines the inaugural reported occurrence of an aortopulmonary artery fistula coinciding with Laubry-Pezzi syndrome. Unique features include subtle onset of heart failure over months due to occult left ventricular volume overload, challenging diagnosis alongside known intracardiac shunts, emphasizing the need for vigilance, and demonstration of successful surgical outcomes despite high morbidity and mortality.

Practical use of transanal decompression tube following the repair of fourth-degree perineal tears associated with vaginal delivery

BackgroundFourth-degree perineal tears associated with vaginal delivery (PTAVD) occur in approximately 0.25 to 6% of vaginal deliveries. A persistent challenge in treating fourth-degree PTAVD is the high incidence of anastomotic leakage, leading to impaired quality of life, marked by incontinence, rectovaginal fistula, and painful sexual intercourse. Thus, effective interventions are necessary. Herein, we report our successful approach in repairing a fourth-degree PTAVD, involving the placement of a transanal decompression tube (TDT) during the early postoperative period.Case presentationFive patients underwent the repair of fourth-degree PTAVD by suturing the mucosal and muscular layers of the rectum, and the vaginal wall in layers. Subsequently, a TDT was placed in the rectum, positioned 10–15 cm from the anal verge. The TDT was allowed to drain spontaneously without suction. Gastrografin enema examination was performed through a TDT, followed by a computed tomographic scan on postoperative days 3–4. After unfavorable complications were ruled out, the TDT was removed and the patients were transitioned to a normal diet.ResultAll patients showed favorable outcomes with no occurrence of vaginal fistula or incontinence.ConclusionThis simple intervention demonstrates potential efficacy in reducing anastomotic leakage following the repair of fourth-degree PTAVD.

Acinar cells of the pancreas as an independent predictor of the development of postoperative pancreatic fistula: A review

Analysis of data published in the modern literature on the role of the number of functioning acinar cells of the pancreas as a prognostic marker of the development of pancreatic fistula. The search for sources was carried out in the systems Clinicaltrials.gov, PubMed, Medline, NCCN, Scopus, Elibrary. In writing the literature review, 52 sources published from 2004 to 2022 were used. Included are studies reflecting the importance of functioning acinar cells at the edge of pancreatic resection, as well as other factors associated with the development of pancreatic fistula and other post-resection complications. A large number of acinar cells (40%) and a low collagen content (15%) in the edge of pancreatic resection significantly correlates with the development of pancreatic fistula. The content of adipose tissue in the edge of pancreatic resection showed no connection with the development of pancreatic fistula and other complications after surgery. Palpatory assessment of the structure of the pancreatic parenchyma is subjective and can lead to erroneous interpretation and adoption of inadequate tactics of preventive measures. Intraoperative counting of acinuses at the edge of pancreatic resection is easy to use, while not yielding to more complex methods for assessing the risk of post-resection complications and can be recommended as a routine method for predicting the occurrence of pancreatic fistula

Equivalence between physicians and associate clinicians in the frequency of iatrogenic urogenital fistula following cesarean section in Tanzania and Malawi

BackgroundPhysicians and associate (non-physician) clinicians conduct cesarean sections in Tanzania and Malawi. Urogenital fistulas may occur as complications of cesarean section. Location and circumstances can indicate iatrogenic origin as opposed to ischemic injury following prolonged, obstructed labor.MethodsThis retrospective review assessed the frequency of iatrogenic urogenital fistulas following cesarean sections conducted by either associate clinicians or physicians in Tanzania and Malawi. It focuses on 325 women with iatrogenic fistulas among 1290 women who had fistulas after cesarean birth in Tanzania and Malawi between 1994 and 2017. An equivalence test compared the proportion of iatrogenic fistulas after cesarean sections performed by associate clinicians and physicians (equivalence margin = 0.135). Logistic regression was used to model the occurrence of iatrogenic fistula after cesarean section, controlling for cadre, date, maternal age, previous abdominal surgery and parity.ResultsAssociate clinicians attended 1119/1290 (86.7%) cesarean births leading to fistulas, while physicians attended 171/1290 (13.3%). Iatrogenic fistulas occurred in 275/1119 (24.6%) cesarean births by associate clinicians and in 50/171 (29.2%) cesarean births by physicians. The risk difference and 90% confidence interval were entirely contained within an equivalence margin of 13.5%, supporting a conclusion of equivalence between the two cadres. The odds of iatrogenic fistula after cesarean section were not statistically significantly different between associate clinicians and physicians (aOR 0.90; 95% CI 0.61–1.33).ConclusionsAssociate clinicians appear equivalent to physicians performing cesarean sections in terms of iatrogenic fistula risk. Lower iatrogenic proportions for associate clinicians could reflect different caseloads. The occurrence of iatrogenic fistulas illustrates the importance of appropriate labor management and cesarean section decision-making, irrespective of health provider cadre. Given the noninferior performance and lower costs of employing associate clinicians, other countries with insufficient and/or unequally distributed health workforces could consider task-shifting cesarean sections to associate clinicians.

Pharyngeal Mucosal Margin Vessel Counts Predict Pharyngocutaneous Fistula in Salvage Laryngectomy.

We evaluated vessel counts in the pharyngeal mucosal margins of patients who underwent salvage laryngectomy to establish whether mucosal vascularity might predict fistula risk. Retrospective cohort. Tertiary Medical Center. Patients who underwent salvage total laryngectomy at our institution between 1999 and 2015 were identified. Pharyngeal mucosal margins from laryngectomy specimens were evaluated histologically for each patient, and vessel counts were performed on 5 ×10 images. The primary outcome measure was fistula within 30 days of surgery and mean vessel counts were assessed as the principle explanatory variable. Seventy patients were included and 40% developed a postoperative fistula. There was a large difference in the mean vessel count in patients who did develop fistula (48.6 vessels/×10 field) compared to those who did not (34.7 vessels/×10 field). A receiver operative characteristic curve found that a cutoff value of 33.9 vessels/×10 field provided a sensitivity of 75% and specificity of 62% to predict the likelihood of fistula occurrence (area under the curve = 0.71, 95% confidence interval [CI]: 0.59-0.83). In a binary logistic regression, patients with vessel counts greater than 33.9 had a 5-fold increased risk of developing fistula (95% CI: 1.8-16.45). Histologically, vessels in the pharyngeal mucosa of patients who developed fistulas were more disorganized. After salvage laryngectomy, patients with higher mean mucosal margin vessel counts are at increased risk of fistula. The mechanism is unknown, but the disorganization of the vasculature may contribute to poor wound healing. Vessel counting may allow for fistula risk stratification and guide postoperative care.

Early and Long-Term Morbidity and Mortality Following Pancreaticoduodenectomy for Periampullary Tumors in Elderly Patients.

The growing elderly population is facing an increasing risk of cancers, consequently raising the pancreatic cancer surgery rate. This study aimed to determine whether advanced age is a risk factor for morbidity and mortality following pancreaticoduodenectomy (PD) for periampullary tumors. The present study included 90 patients who underwent PD for periampullary tumors. Patients were divided into two age-related groups, including those aged 60-74 years (n = 60) (Group 1) and those aged ≥75 years (n = 30) (Group 2). Each patient's characteristics, perioperative features, morbidity, and long-term results were evaluated retrospectively. In both univariate and multivariate logistic regression analyses, old age (≥75 years) was not a risk factor for morbidity and hospital mortality. The multivariate analysis demonstrated that male gender (p = 0.008), pancreatic duct diameter (<3 mm) (p < 0.001), and length of hospital stay (p = 0.005) were independent risk factors for pancreatic fistula post-operation and reoperation. Additionally, hospital mortality was significantly associated with reoperation (p = 0.011). The overall median survival was 27 ± 4.1 (18.8-35.1) months. Lymph node positivity (p < 0.001), neural tumor invasion (p = 0.026), and age ≥75 years (p = 0.045) were risk factors affecting the overall survival rate. Moreover, there was no statistically significant difference in terms of PD rates during the Coronavirus disease-19 (COVID-19) period among groups, and PD during this period was not related to the occurrence of pancreatic fistula. PD can be performed effectively in selected elderly patients with tolerable morbidity and mortality rates.

Postoperative pancreatic fistula after pancreaticogastrostomy versus pancreatojejunostomy after pancreatic resection, a comparative systematic review and meta-analysis.

In patients undergoing pancreaticoduodenectomy (PD), there has been some evidence favoring pancreaticogastrostomy (PG) over pancreatojejunostomy (PJ) in the occurrence of postoperative pancreatic fistulas (POPF) and considering PG as a safer anastomotic technique. However, other publications revealed comparable incidences of POPF attributed to both techniques. The current work attempts to reach a more consolidated conclusion about such an issue. This is a systematic review and meta-analysis that analyzed the studies comparing PG and PJ during PD in terms of the rate of POPF occurrence. Studies were obtained by searching the Scopus, PubMed Central, and Cochrane Central Register of Controlled Trials databases. 35 articles published between 1995 and 2022 presented data from 14,666 patients; 4547 underwent PG and 10,119 underwent PJ. Statistically significant lower rates of POPF (p=0.044) and clinically relevant CR-POPF (p=0.043) were shown in the PG group. The post-pancreatectomy hemorrhage (PPH) was significantly higher in the PG group, while no significant difference was found between the two groups in the clinically significant PPH. No statistically significant differences were found regarding the amount of intraoperative blood loss, length of hospital stay, DGE, overall morbidity rates, reoperation rates, or mortality rates. The percentage of male sex in the PG group and the percentage of soft pancreas in the PJ group seem to influence the odds ratio of CR-POPF (p=0.076 and 0.074, respectively). The present study emphasizes the superiority of PG over PJ regarding CR-POPF rates. Higher rates of postoperative hemorrhage were associated with PG. Yet, the clinically significant hemorrhage rate was comparable between the two groups.

The impact of ultrasound-guided vascular access for catheter ablation of left atrial arrhythmias in a high-volume centre.

Vascular complications are a common occurrence during atrial fibrillation ablation. Observational studies indicate that the utilization of ultrasound (US)-guided puncture may decrease the incidence of vascular complications; however, its routine use is not established in many centres. Patients undergoing catheter ablation for atrial fibrillation were included sequentially. All patients receiving US-guided punctures were prospectively enrolled (US group), while patients who underwent the procedure with standard puncture technique served as control group (No-US group). Periprocedural vascular complications requiring intervention within 30days of the procedure were defined as the primary endpoint. A total of 599 patients (average age: 69 ± 11years, 62.9% male) were analysed. The incidence of vascular complications was lower with the US-guided puncture than with the anatomic landmark-guided puncture (14/299 [4.7%] vs. 27/300 [9%], p = 0.036). The US-guided vascular access significantly reduced the rate of false aneurysms (3/299 [1%] vs. 12/300 [4%], p = 0.019). In addition, the occurrence of arteriovenous fistula (2/299 [0.7%] vs. 4/300 [1.3%], p = 0.686) and haematoma requiring treatment (9/299 [3%] vs. 11/300 [3.7%], p = 0.655) were also lower in the US group. US-guided puncture did not prolong the procedure time (mean procedure time: 57.48 ± 24.47min vs. 56.09 ± 23.36min, p = 0.478). Multivariate regression analysis identified female gender (OR 2.079, CI 95% 1.096-3.945, p = 0.025) and conventional vascular access (OR 2.079, CI 95% 1.025-3.908, p = 0.042) as predictors of vascular complications. The implementation of US-guided vascular access for left atrial catheter ablation resulted in a significant decrease of the overall vascular complication rate.

Prediction of malignant esophageal fistula in esophageal cancer using a radiomics-clinical nomogram

BackgroundMalignant esophageal fistula (MEF), which occurs in 5% to 15% of esophageal cancer (EC) patients, has a poor prognosis. Accurate identification of esophageal cancer patients at high risk of MEF is challenging. The goal of this study was to build and validate a model to predict the occurrence of esophageal fistula in EC patients.MethodsThis study retrospectively enrolled 122 esophageal cancer patients treated by chemotherapy or chemoradiotherapy (53 with fistula, 69 without), and all patients were randomly assigned to a training (n = 86) and a validation (n = 36) cohort. Radiomic features were extracted from pre-treatment CTs, clinically predictors were identified by logistic regression analysis. Lasso regression model was used for feature selection, and radiomics signature building. Multivariable logistic regression analysis was used to develop the clinical nomogram, radiomics-clinical nomogram and radiomics prediction model. The models were validated and compared by discrimination, calibration, reclassification, and clinical benefit.ResultsThe radiomic signature consisting of ten selected features, was significantly associated with esophageal fistula (P = 0.001). Radiomics-clinical nomogram was created by two predictors including radiomics signature and stenosis, which was identified by logistic regression analysis. The model showed good discrimination with an AUC = 0.782 (95% CI 0.684–0.8796) in the training set and 0.867 (95% CI 0.7461–0.987) in the validation set, with an AIC = 101.1, and good calibration. When compared to the clinical prediction model, the radiomics-clinical nomogram improved NRI by 0.236 (95% CI 0.153, 0.614) and IDI by 0.125 (95% CI 0.040, 0.210), P = 0.004.ConclusionWe developed and validated the first radiomics-clinical nomogram for malignant esophageal fistula, which could assist clinicians in identifying patients at high risk of MEF.

Reducing fistula rate in hypospadias repair: A comparative study between standard tubularized incised plate repair and incorporation of a layer of spongiosum tissue

The most prevalent complication in hypospadias repair is fistula formation. Adhering to the principle of providing urethroplasty coverage to mitigate fistula occurrence, we implemented a modification by integrating a spongiosum layer between the urethroplasty and the dartos flap. Our hypothesis posited that this approach would result in a reduced fistula formation rate. This study is a comparative analysis involving patients under 18 years of age who underwent primary hypospadias repair. The cases were allocated into two groups. In the study group, in addition to performing tubularized incised plate (TIP) repair, a spongiosum layer harvested from both sides of the urethra was used to cover the urethroplasty (modification of the Y-to-I urethroplasty). The control group underwent a standard TIP repair. The primary outcome was to assess urethrocutaneous fistula formation. Secondary outcomes included evaluating the development of meatal stenosis and glans dehiscence, along with assessing cosmetic results by the Hypospadias Objective Penile Evaluation (HOPE) score. Overall, 154 hypospadias cases were included in the study. Eighty-seven patients (56%) were allocated to the study group, and 67 (44%) were allocated to the control group. Urethrocutaneous fistula developed in 3 (3.4%) and 11 (16.4%) patients in the study and control group, respectively (p=0.006). Glans dehiscence occurred in 2 (2.3%) patients in the study group and 4 (6%) patients in the control group (p=0.198). Meatal stenosis was observed in 4 (4.6%) patients in the study group and 5 (7.5%) patients in the control (p=0.452). The mean HOPE score was 59 in both groups (p=0.36). This study details our encounters with the novel modification and compares the results with standard TIP. Our data suggest that adding a layer of spongiosum tissue over the urethroplasty reduces the complication of urethrocutaneous fistula without increasing the occurrence of dehiscence, significant meatal stenosis, or compromising cosmetic outcomes. We advocate for implementing the described surgical modification as a viable option for hypospadias repair.

Analysis of Risk Factors for Velopharyngeal Insufficiency and Palatal Fistula After Sommerlad-Furlow Palatoplasty.

This study aimed to introduce a surgery technique-Sommerlad-Furlow palatoplasty (SFP) and analyze the risk factors of velopharyngeal insufficiency (VPI) and palatal fistula after SFP. Cases after SFP under the age of 5 between 2011 and 2021 were reviewed, and the cases with complete follow-up information were included. Univariate and multivariate logistic regression were used to evaluate the effects of surgical age, surgery technique, surgeon's experience, and cleft type on velopharyngeal function and the occurrence of palatal fistula. SFP is a safe and effective procedure to increase the palatal length and reconstruct the levator veli palatini sling. The speech outcome after SFP was associated with cleft type and age at operation. Age = 1.285 years is the best cutoff value. The fistula occurrence was associated with cleft type only.