Occurrence Of Fistula Research Articles

Body Composition Predictors of Complicated Crohn’s Disease

Background: High visceral adipose tissue (VAT) and creeping fat (CrF) in Crohn’s disease (CD) have been widely recognized. The VAT to subcutaneous adipose tissue (SAT) ratio and sarcopenia have been associated with CD complications. Studies regarding the influence of body composition predictors on CD complications assessed with magnetic resonance enterography (MRE) are scarce. Aim: The aim of this study was to assess body composition parameters and CrF in opportunistic MRE as predictors of complicated CD. Methods: This was a retrospective study of 114 patients with inflammatory (n = 54) and complicated (n = 60) CD. The semiautomated assessment of body composition and the qualitative evaluation of CrF were performed. Results: Body composition parameters did not differ between both groups regarding the body mass index (p = 0.50), total adipose tissue index (TATI) (p = 0.14), subcutaneous adipose tissue index (SATI) (p = 0.17), visceral adipose tissue index (VATI) (p = 0.33), VAT/SAT ratio (p = 0.77), intramuscular adipose tissue (p = 0.64), skeletal muscle index (p = 0.22), and sarcopenia (p = 0.50). 47 strictures, 18 fistulae, and seven abscesses were identified. Fistulae were more likely to occur in patients with CrF (odds ratio [OR] 5.07, 95% confidence interval [CI] 1.76–14.56; p=<0.001) and high VAT/SAT ratio (OR: 3.82, 95% CI 1.34–10.85; p = 0.01). Conclusion: Body composition measurements in CD patients displayed no statistically significant difference between the groups of inflammatory and complicated disease. Nonetheless, CD patients stratified in the group of high VAT/SAT ratio and the presence of CrF should be recognized as risk groups for the occurrence of fistulae.

Influence of Lip Revision Surgery on Facial Growth in Patients With A Cleft Lip.

Although patients with cleft lip and palate often present with poor maxillary growth because of intrinsic and iatrogenic factors, the surgical influence of lip revision surgery, palatal fistula repair, and pharyngeal flap procedures remains uncertain in contrast to that of primary cleft lip repair and palatoplasty. Therefore, this study aimed to reveal factors inhibiting maxillary growth and inducing later orthognathic surgery. A retrospective analysis was conducted on the data of patients with cleft lip and palate who underwent a series of treatments at Keio University Hospital from 1990 to 2000. We collected data on patient sex, cleft type, number and timing of lip revision surgery, the incidence of palatal fistulae, history of pharyngeal flap procedures, and timing of a repeat bone graft, and reviewed whether these patients underwent orthognathic surgery later in life. Multivariate analysis was conducted using binary logistic regression to extract factors affecting later orthognathic surgery. A total of 52 patients were included in this study. Results showed that revision surgery conducted more than twice was the highest statistically significant predictor of later orthognathic surgery in patients with a cleft lip and palate ( P <0.05, odds ratio=43.3), followed by palatal fistula occurrence after cleft palate repair ( P <0.05, odds ratio=22.3). Therefore, primary surgical procedure is most important for these patients.

Comparison of the Outcome of Interrupted Suture and Continuous Suture in Tubularized Incised-Plate (TIP) Urethroplasty Hypospadias Repair

Introduction: The tubularized incised plate (TIP) urethroplasty has obtained worldwide acceptance for distal hypospadias repair due to its low complication rate, good cosmetic result, and technical simplicity. Aim of the Study: The aim of this study was to compare the surgical outcome between Continuous suture &amp; interrupted suture in case of tabularized incised plate (TIP) urethroplasty. Methods: This prospective randomized comparative study was conducted in the Division of Pediatric Surgery, Bangladesh Institute of Child Health &amp; Dhaka Shishu (Children) Hospital, Dhaka from July 2017 to June 2019. Total 40 patients were included in this study and divided in two groups which are Group A and Group B. Result: In the current study, the mean age of participants was 41.15±24.46 months in group A and 38.05±25.14 months in group B. There was no significant difference between ages of two groups as the p = 0.695. The mean penile length of participants was 31.90±7.04 mm in group A and 27.95±5.04 mm in group B. There was significant statistical difference between penile lengths of two groups as the p value was 0.049. Operation time in group A and group B was 66.86±3.51 minutes and 79.38±5.04 minutes respectively. The result showed that there was strong statistical difference between operation time in two groups as the p=0.0001. Operation cost in group A and group B was 18810.00±818.79 TK and 18385±1962.08 TK respectively. The result showed that there was no statistical difference between operation cost in two groups as the p=0.377. Hospital stay in group A and group B was 8.1±0.45 day and 8.0±0.0 day respectively. The result showed that there was no statistical difference between hospital stay in two groups as the p=0.324. There is no wound infection occurred in group B patient. There was no significant statistical difference between wound infection of two groups as the p value was &gt;0.05. There was no significant statistical difference between occurrence of UC fistula .......

Surgical methods influence on the risk of anastomotic fistula after pancreaticoduodenectomy: a systematic review and network meta-analysis.

Pancreaticoduodenectomy is the first choice surgical intervention for the radical treatment of pancreatic tumors. However, an anastomotic fistula is a common complication after pancreaticoduodenectomy with a high mortality rate. With the development of minimally invasive surgery, open pancreaticoduodenectomy (OPD), laparoscopic pancreaticoduodenectomy (LPD), and robotic pancreaticoduodenectomy (RPD) are gaining interest. But the impact of these surgical methods on the risk of anastomosis has not been confirmed. Therefore, we aimed to integrate relevant clinical studies and explore the effects of these three surgical methods on the occurrence of anastomotic fistula after pancreaticoduodenectomy. A systematic literature search was conducted for studies reporting the RPD, LPD, and OPD. Network meta-analysis of postoperative anastomotic fistula (Pancreatic fistula, biliary leakage, gastrointestinal fistula) was performed. Sixty-five studies including 10,026 patients were included in the network meta-analysis. The rank of risk probability of pancreatic fistula for RPD (0.00) was better than LPD (0.37) and OPD (0.62). Thus, the analysis suggests the rank of risk of the postoperative pancreatic fistula for RPD, LPD, and OPD. The rank of risk probability for biliary leakage was similar for RPD (0.15) and LPD (0.15), and both were better than OPD (0.68). This network meta-analysis provided ranking for three different types of pancreaticoduodenectomy. The RPD and LPD can effectively improve the quality of surgery and are safe as well as feasible for OPD.

Predictors of Adverse Outcomes Following Cleft Palate Repair: An Analysis of Over 2500 Patients Using International Smile Train Data.

The objective of this study was to use data from Smile Train's global partner hospital network to identify patient characteristics that increase odds of fistula and postoperative speech outcomes. Multi-institution, retrospective review of Smile Train Express database. 1110 Smile Train partner hospitals. 2560 patients. N/A. Fistula occurrence, nasal emission, audible nasal emission with amplification (through a straw or tube) only, nasal rustle/turbulence, consistent nasal emission, consistent nasal emission due to velopharyngeal dysfunction, rating of resonance, rating of intelligibility, recommendation for further velopharyngeal dysfunction assessment, and follow-up velopharyngeal dysfunction surgery. The patients were 46.6% female and 27.5% underweight by WHO standards. Average age at palatoplasty was 24.7 ± 0.5 months and at speech assessment was 6.8 ± 0.1 years. Underweight patients had higher incidence of hypernasality and decreased speech intelligibility. Palatoplasty when under 6 months or over 18 months of age had higher rates of affected nasality, intelligibility, and fistula formation. The same findings were seen in Central/South American and African patients, in addition to increased velopharyngeal dysfunction and fistula surgery compared to Asian patients. Palatoplasty technique primarily involved one-stage midline repair. Age and nutrition status were significant predictors of speech outcomes and fistula occurrence following palatoplasty. Outcomes were also significantly impacted by location, demonstrating the need to cultivate longitudinal initiatives to reduce regional disparities. These results underscore the importance of Smile Train's continual expansion of accessible surgical intervention, nutritional support, and speech-language care.

Application of data mining to extract knowledge about the occurrence of fistulas after palatoplasty

Application of data mining to extract knowledge about the occurrence of fistulas after palatoplasty

Long-term evaluation of patients with BMI = 50kg/m2 who underwent Bariatric Surgery.

to determine the risks and benefits of bariatric surgery in patients with super obesity (SO) in comparison with obesity grades II and III. retrospective cohort that included a study group of 178 patients with SO and a control group of 181 patients with BMI 35-49.9Kg/m2. The groups were formed in a 1:1 nearest neighbor matching. The main variables were pre- and postoperative BMI and comorbidities, occurrence of severe postoperative complications, bowel obstruction, marginal ulcer, fistulae and 30-day death, besides the necessity of emergency room (ER) admission and abdominal computed tomography (CT) scans in the postoperative period due to acute abdomen. the study group comprised 74.0% of women while the control group had 56.7%. The mean follow-up time was similar between both groups (5.48 x 6.09 years, p=0.216). There was no statistically significant difference on the prevalence of hypertension and T2D between the groups according to the surgical technique. All deaths occurred in the Study group (BMI = 50kg/m2) who underwent RYGB. There was no difference between the groups regarding the occurrence of severe complications. Data on ER admissions and the need for abdominal CT to investigate postoperative abdominal pain did not show statistically significant difference between the groups. despite the high risk related to bariatric surgery in patients with SO, the benefits related to the remission of comorbidities are significant; although being lower than those found in patients with milder grades of obesity.

Double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula in uncircumcised patients with distal hypospadias.

Urethrocutaneous fistula may complicate hypospadias repair. We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula. The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula. A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital (Amman, Jordan). Boys who were aged between 6 months and 5 years, diagnosed with distal hypospadias, and not circumcised were included. The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The results showed a total of 163 boys with distal hypospadias; among them, 116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap, and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month, 6 months, and 12 months (6.9% vs 0, 10.3% vs 0, and 5.2% vs 0, respectively), and the difference after 6 months was statistically significant (P = 0.02).

Predictive Factors for the Occurrence of Pharyngostoma after Laryngectomy and Total Pharyngo-Laryngectomy in Yaounde and Douala

Introduction and Aims: Pharyngostoma or pharyngo-cutaneous fistula is a frequent complication of totals laryngectomies and pharyngo-laryngectomies. Its incidence varies from one series to another from 13% to 58%. Multiple risk factors are known. The data from our environment concerning this condition are few. Thus, in order to contribute to the study of this complication in our environment, we proposed to carry out this study, whose objective was to determine the predictive factors for the occurrence of pharyngo-cutaneous fistula or pharyngostoma after total laryngectomy and total pharyngo-laryngectomy in Yaounde and Douala. Patients and Methods: This was a retrospective, cross-sectional, descriptive study conducted in the 5 Ear-Nose-Throat (ENT) department of hospital in the city of Yaounde and Douala. The study took place between January 2009 and December 2020. All patients who underwent total laryngectomy or total pharyngo-laryngectomy with a follow-up of at least one month were included in the study. Incomplete records were excluded, as well as those of patients who died before one month of postoperative follow-up. Results: We selected 48 cases of total laryngectomies (TL) and total pharyngo-laryngectomies (TPL), and identified 37 cases of pharyngostoma. 45 men (93.8%) and 3 women (6.3%). The mean age was 56.4 years with extremes ranging from 37 to 86 years. Smoking and alcoholism were noted in 75% and 79.2% of our patients respectively. A tracheotomy before TL and TPL was found in 41.7%. 100% of the tumours found were T3 or T4. The surgery was in 34 cases (70.8%) TL and in 14 cases (29.2%) TPL. Pharyngostomas were observed in 37 cases among 48 patients operated on, i.e. a frequency of 77.1%. The average delay of appearance was 7 to 14 days. We had spontaneous healing with pressure dressing and nasogastric tube feeding in 35 patients (77.8%) and two patients benefited from pectoralis major flap treatment; the healing time was 21 to 30 days. We did not find any correlation between gender, age, tumour site of origin and locoregional extension and the occurrence of pharyngostoma. Preoperative tracheotomy and radiotherapy were not significant risk factors for the occurrence of pharyngostoma. However, preoperative anaemia (p = 0.02), LTP (p = 0.02), early complications (p 0.001) and lack of continuous saliva aspiration postoperatively (p = 0.03) were statistically significant predictors of pharyngostoma in univariate analysis. Conclusion: Pharyngostoma is the most common postoperative complication after TL and TPL. In our setting, the main associated risk factors identified were: preoperative anaemia, LTP, early complications and failure to continuously aspirate saliva postoperatively.

ALTERNATIVE FISTULA RISK SCORE AND FIRST POSTOPERATIVE DAY DRAIN FLUID AMYLASE AS PREDICTORS OF PANCREATIC FISTULA AFTER PANCREATICODUODENECTOMY.

The high morbidity and mortality rates of pancreaticoduodenectomy are mainly associated with pancreaticojejunal anastomosis, the most fragile and susceptible to complications such as clinically relevant postoperative pancreatic fistula. The alternative fistula risk score and the first postoperative day drain fluid amylase are predictors of the occurrence of clinically relevant postoperative pancreatic fistula. No consensus has been reached on which of the scores is a better predictor; moreover, their combined predictive power remains unclear. To the best of our knowledge, this association had not yet been studied. This study assessed the predictive effect of alternative fistula risk score and/or drain fluid amylase on clinically relevant postoperative pancreatic fistula in a retrospective cohort of 58 patients following pancreaticoduodenectomy. The Shapiro-Wilk and Mann-Whitney tests were applied for assessing the distribution of the samples and for comparing the medians, respectively. The receiver operating characteristics curve and the confusion matrix were used to analyze the predictive models. The alternative fistula risk score values were not statistically different between patients in the clinically relevant postoperative pancreatic fistula and non- clinically relevant postoperative pancreatic fistula groups (Mann-Whitney U test 59.5, p=0.12). The drain fluid amylase values were statistically different between clinically relevant postoperative pancreatic fistula and non- clinically relevant postoperative pancreatic fistula groups (Mann-Whitney U test 27, p=0.004). The alternative fistula risk score and drain fluid amylase were independently less predictive for clinically relevant postoperative pancreatic fistula, compared to combined alternative fistula risk score + drain fluid amylase. The combined model involving alternative fistula risk score >20% + drain fluid amylase=5,000 U/L was the most effective predictor of clinically relevant postoperative pancreatic fistula occurrence following pancreaticoduodenectomy.

Postoperative Hyperamylasemia Is an Early Predictor of Pancreatic Fistula Occurrence and Severity after Distal Pancreatectomy: Results from an European Multicentric Study

Postoperative Hyperamylasemia Is an Early Predictor of Pancreatic Fistula Occurrence and Severity after Distal Pancreatectomy: Results from an European Multicentric Study

The methods of prophylaxis of the pancreatic fistula occurrence after pancreato–duodenectomy

Objective. To elaborate the measures system, which permit to reduce the occurrence of pancreatic fistula and other severe complications after performance of pancreato–duodenectomy.&#x0D; Materials and methods. There were analyzed the results of treatment of 327 patients, in whom pancreato–duodenectomy was performed. In accordance to the scheme proposed, using the elaborated scale of risk for the postoperative pancreatic fistula occurrence with estimation of sarcopenia presence and application of certain prophylactic measures 98 patients were operated in period from November 2018 to December 2020 yr. (the main group). Into the control group 229 patients were included, operated on in the clinic from January 2015 to October 2018 yr. without estimation of risk for the pancreatic fistula occurrence and presence of sarcopenia. The method of pancreato–jejunoanastomosis formation was selected by operating surgeon.&#x0D; Results. Postoperative complications have occurred in 94 (41.0%) patients of the control group and in 28 (28.6%) patients of the main group (c 2 = 4.56, p=0.03). Clinically significant postoperative pancreatic fistula of B Degree have occurred in 9 (9.2%) patients of the main group, what was statistically significantly lower, than in the control group, in which postoperative pancreatic fistula of B or C Degree have occurred in 64 (27.9%) patients (c 2 = 11.6, p=0.0007). Lethality was 2.2% in the control group and 1.02% – in the main one.&#x0D; Conclusion. Introduction of the measures system elaborated have permitted to lower the postoperative pancreatic fistula rate statistically significantly from 27.9 to 9.2%, and of other postoperative complications – from 41.0 to 28.6% and lethality from 2.2 to 1.02%.

Risk Factors for Pharyngocutaneous Fistula Following Total Laryngectomy.

Pharyngocutaneous fistula is the leading complication following total laryngectomy. It delays complementary treatments, speech rehabilitation and oral feeding. Despite evolving medical care, fistula incidence remains high. There is no consensus regarding which patients are at higher risk for fistula development. This article comprised a literature review about risk factors for fistula development. All articles published on an on-line database (PUBMED™) using MESH terms "larynx cancer" and "fistula" in a 5-year period (January 1st, 2014 to January 27th, 2019) were included. Further articles were selected due to expert suggestion by one of the senior surgeons. Only articles written in Portuguese or English were included. Animal studies were excluded. 151 articles were selected and abstracts analysed. 82 articles were selected for full text revision. 32 were later excluded because they described single clinical cases, experimental surgical technics, irrelevant data or poor methodology. Final selection comprised 50 studies: 9 systematic reviews, one non-systematic review, 34 unicentric and 4 multicentric retrospective analysis and two prospective studies. There is no consensus regarding risk factors for fistula development. Patients submitted to salvage surgery for advanced disease seem to be at greater risk. Bad nutritional status is a logical contributor, but the ideal surrogate marker is still missing. Several variables are inconsistently pointed as risk factors and should be abandoned unless proved otherwise. There are no standard scores for fistula occurrence despite being a common complication following surgery.

Perianal Abscess Cavity Packing Versus No Packing A Randomized Control Trial

Objective: To compare the outcome of perianal abscess cavity packing versus no packing following I&amp;D. The primary objective is to compare postoperative pain. The secondary outcomes were the number of follow-up visits, fistula formation, wound healing time and abscess recurrence. Methods: A randomized clinical trial was conducted at Dr Ruth K. M. Pfau Civil Hospital Karachi from March 2020 to July 2021. Results: 70 participants' data were analyzed, 35 in the packing group (control) and 35 in the no packing group (intervention). The preoperative and postoperative pain scores at 48 hours are stastatistically not significant. The mean postoperative pain score showed a significant difference at two weeks, showing that the group receiving no packing experienced less intense pain. The mean wound healing time was 44.09 days in the packing group and 26.91 days in no packing group (p=0.001). The occurrence of fistula in ano was 2.8% in the packing group and 5.7% in no packing group (p=0.55). Abscess recurrence was 14.2% in the packing group, while 0% in no packing group (p=0.02). Conclusion: This study revealed that the no-packing technique is superior in decreasing postoperative pain and patient satisfaction. Keywords: Perianal Abscess, Randomized trials, No packing, Packing, Anorectal disease

Image-guided adaptive brachytherapy for advanced cervical cancer spreading to the bladder and/or rectum: Clinical outcome and prognostic factors

IntroductionRefinements of brachytherapy techniques have led to better local control of locally advanced cervical cancer (LACC), especially with the development of image-guided adaptive brachytherapy (IGABT). Data on the efficacy of brachytherapy in cervical cancer spreading to adjacent organs are scarce. We report the experience of our institution in the treatment of these advanced tumors with IGABT. Materials and methodsMedical records of patients treated for a LACC spreading to the bladder and/or rectum between 2006 and 2020 at Gustave Roussy Institute were analyzed. Dosimetric parameters were collected and converted into 2 Gy per fraction equivalent doses, including the minimal dose received by 90% of the high-risk target volume (D90 CTVHR) and intermediate-risk target volume (D90 CTVIR), as well as the dose received by the most exposed 2 cm3 of the organs at risk. A Cox regression model was used to study the potential associations between clinical and dosimetric factors with survival endpoints and fistula formation. Results and statistical analysisA total of 81 patients were identified. All patients received pelvic+/− para-aortic radiotherapy, 45 Gy in 25 fractions +/− boost to gross lymph nodes. Concomitant platinum-based chemotherapy was administered in 93.8% of cases. The median D90 CTVHR dose was 75.5 GyEQD2 (SD: 10.39 GyEQD2) and median CTVHR volume was 47.6 cm3 (SD: 27.9 cm3). Median bladder and rectal D2cm3 dose were 75.04 GyEQD2 (SD: 8.72 GyEQD2) and 64.07 GyEQD2 (SD: 6.68 GyEQD2). After a median follow-up of 27.62 ± 25.10 months, recurrence was found in 34/81 patients (42%). Metastatic failure was the most common pattern of relapse (n = 25). Use of a combined interstitial/intracavitary technique and D90 CTVHR ≥ 75.1 GyEQD2 were prognostic factors for OS in univariate analysis (HR = 0.24, 95%IC: 0.057–1, p = 0.023; HR = 0.2, 95%IC: 0.059–0.68, p = 0.0025, respectively). In multivariate analysis, a D90 CTVHR ≥ 75.1 GyEQD2 was significant for OS (HR = 0.23; 95%IC: 0.07, 0.78, p = 0.018). The occurrence of vesicovaginal fistula (VVF) was the most frequent pattern of local recurrence (HR = 4.6, 95%CI: 1.5–14, p = 0.01). ConclusionAdvances in brachytherapy modalities improved local control and survival while reducing toxicities. Enhancing local control through dose escalation and combined intracavitary/interstitial brachytherapy techniques is a major factor in patients cure probability, together with systemic intensification to better control distant events.

Advantages of using a nanomodified mesh with an antiseptic in the surgical treatment of abdominal hernia

Surgical treatment of open operations for abdominal hernias (AH) using classic techniques of allogeneoplasty (sublay, onlay) is often accompanied by an increase in intra-abdominal pressure (IBP) and a decrease in the volume of the abdominal cavity, which in the postoperative period leads to abdominal compartment syndrome (ACS) In 2 ,4 - 3.6% of cases and mortality in 1.2 - 3.4% of observations. This requires a special method of closing a large defect of the abdominal wall, which would not increase ICP. The use of improved techniques contributes to the creation of the optimal volume of the abdominal cavity and improves the results of treatment, in particular, the frequency of ACS decreases. But it should be noted that the use of combined operations with a classic polypropylene mesh leads to a high frequency of complications from the postoperative wound, such as seroma (30.8 - 60.4%), suppuration of the postoperative wound (4.8 - 6.4%), ligature fistula (1.2 - 3.0%), meshoma (0.06 - 1.60%).&#x0D; Aim – to improve the results of surgical treatment of abdominal hernias (AG) when using a nanomodified polypropylene mesh with an antiseptic.&#x0D; Materials and methods. An analysis of surgical treatment of 400 patients with GJ was carried out. Depending on the type of mesh implant used during surgical treatment, patients were divided into two groups. 200 (50%) patients of group I underwent surgery using a nanomodified polypropylene mesh with an antiseptic, in group II, 200 (50%) patients underwent surgery using a classic polypropylene mesh.&#x0D; Results and discussion. Statistically significantly better results were obtained in patients of group I compared to group II. Thanks to the fact that in patients of group I, a nanomodified polypropylene mesh implant with an antiseptic was used, it was possible to achieve a reduction in the frequency of seroma by 4.2 times, suppuration of the postoperative wound by 8 times, inflammatory infiltrate by 10 times, and the occurrence of ligature fistulas of the anterior abdominal wall by 12.5 times, meshomas in 7.5 times. The long-term results of surgical treatment of AG also confirm the advantages of operations for abdominal hernias using nanomodified polypropylene mesh with an antiseptic compared to the use of classic polypropylene mesh, which is associated with a decrease in the frequency of wound infectious complications, migration and shrinkage of the mesh and prevents recurrence of AG. The duration of inpatient treatment in group I was (7.0±1.0) days, in group II – (12.0±2.2) days.&#x0D; Conclusion. Surgical treatment of abdominal hernias using a nanomodified polypropylene mesh with an antiseptic is more effective compared to the use of a classic polypropylene mesh, as evidenced by a decrease in the frequency of seroma from (30.5±1.2) to (7.3±0.5)%, suppuration postoperative wound - from (9.8±0.5) to (1.2±0.2)%, inflammatory infiltrate - from (12.2±0.6) to (1.2±0.2)%, ligature fistulae of the anterior abdominal wall - from (6.5±0.5) to (0.5±0.1)%, meshomas - from (3.9±0.3) to (0.5±0.1) %, chronic postoperative pain - from (8.0±0.6) to (1.3±0.2)%, hernia recurrence - from (9.3±0.6) to (1.3±0.2 )%.

Influencing factors of biliary fistula after radical resection of hilar cholangiocarcinoma: a prospect cohort

BackgroundBiliary fistula is a common but serious complication after radical resection of hilar cholangiocarcinoma. We aimed to evaluate the influencing factors of biliary fistula after radical resection, to provide insights to the clinical treatment of hilar cholangiocarcinoma.MethodsPatients undergoing radical resection of hilar cholangiocarcinoma from January 1, 2015 to March 31, 2022 were selected. Patients’ personnel characteristics and laboratory test results of patients with and without biliary fistula were collected and compared. Logistic regression analyses were conducted to evaluate the associated risk factors of biliary fistula.Results160 patients undergoing radical resection of hilar cholangiocarcinoma were included, the incidence of postoperative biliary fistulas was 20.63%. There were significant differences in the age, preoperative cholangitis and number of biliary anastomosis between biliary fistula and no biliary fistula patients (all p < 0.05). There were significant differences in the gamma glutamyl transpeptidase (GGT) on the first day after surgery, Klebsiella pneumoniae between biliary fistula and no biliary fistula patients (all p < 0.05). Logistic regression analysis indicated that age ≥ 65 years (OR 2.035, 95%CI 1.131–3.007), preoperative cholangitis (OR 1.584, 95% CI 1.081–2.361), number of biliary anastomosis ≥ 2(OR 2.866, 95%CI 1.942–3.624), GGT on the first day after surgery ≥ 120 U/L (OR 1.823, 95%CI: 1.274–2.906), preoperative bile culture for Klebsiella pneumoniae (OR 3.181, 95%CI: 2.426–3.992) were the risk factors of postoperative biliary fistulas (all p < 0.05).ConclusionsThere are many independent risk factors for postoperative biliary fistula in patients undergoing radical resection of hilar cholangiocarcinoma. Clinical medical workers should take early interventions and treatment measures for these high-risk patients to reduce the occurrence of postoperative biliary fistula.

A safer and more practical tracheotomy in invasive mechanical ventilated patients with COVID-19: A quality improvement study.

The number of infections and deaths caused by the global epidemic of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) invasion is steadily increasing daily. In the early stages of outbreak, approximately 15%-20% of patients with coronavirus disease 2019 (COVID-19) inevitably developed severe and critically ill forms of the disease, especially elderly patients and those with several or serious comorbidities. These more severe forms of disease mainly manifest as dyspnea, reduced blood oxygen saturation, severe pneumonia, acute respiratory distress syndrome (ARDS), thus requiring prolonged advanced respiratory support, including high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), and invasive mechanical ventilation (IMV). This study aimed to propose a safer and more practical tracheotomy in invasive mechanical ventilated patients with COVID-19. This is a single center quality improvement study. Tracheotomy is a necessary and important step in airway management for COVID-19 patients with prolonged endotracheal intubation, IMV, failed extubation, and ventilator dependence. Standardized third-level protection measures and bulky personal protective equipment (PPE) may hugely impede the implementation of tracheotomy, especially when determining the optimal pre-surgical positioning for COVID-19 patients with ambiguous surface position, obesity, short neck or limited neck extension, due to vision impairment, reduced tactile sensation and motility associated with PPE. Consequently, the aim of this study was to propose a safer and more practical tracheotomy, namely percutaneous dilated tracheotomy (PDT) with delayed endotracheal intubation withdrawal under the guidance of bedside ultrasonography without the conventional use of flexible fiberoptic bronchoscopy (FFB), which can accurately determine the optimal pre-surgical positioning, as well as avoid intraoperative damage of the posterior tracheal wall and prevent the occurrence of tracheoesophageal fistula (TEF).

A retrospective review of genital fistula occurrence in nine African countries

BackgroundFemale genital fistulas are abnormal communications that lead to urinary and/or fecal incontinence. This analysis compares the characteristics of women with fistulas to understand how countries differ from one another in the circumstances of genital fistula development.MethodsThis retrospective records review evaluated demographics and circumstances of fistula development for 6,787 women who sought fistula treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia.ResultsMost women developed fistula during childbirth, whether vaginal (3,234/6,787, 47.6%) or by cesarean section (3,262/6,787, 48.1%). Others had fistulas attributable to gynecological surgery (215/6,787, 3.2%) or rare causes (76/6,787, 1.1%). Somalia, South Sudan, and Ethiopia had comparatively high proportions following vaginal birth and birth at home, where access to care was extremely difficult. Fistulas with live births were most common in Kenya, Malawi, Rwanda, Uganda, Tanzania, and Zambia, indicating more easily accessible care.ConclusionsCharacteristics of women who develop genital fistula point to geographic differences in obstetric care. Access to care remains a clear challenge in South Sudan, Somalia, and Ethiopia. Higher proportions of fistula after cesarean birth and gynecological surgery in Kenya, Malawi, Rwanda, Uganda, Tanzania, and Zambia signal potential progress in obstetric fistula prevention while compelling attention to surgical safety and quality of care.

Comparison of the Diagnostic Accuracy of Percutaneous Fistula Contrast-Enhanced Ultrasound Combined with Transrectal 360° 3-D Imaging and Conventional Transrectal Ultrasound in Complex Anal Fistula.

This study compared the diagnostic accuracy of percutaneous fistula contrast-enhanced ultrasound (CEUS) combined with 360° 3-D transrectal ultrasound (TRUS) imaging (CEUS+360°-TRUS) with that of conventional transrectal ultrasound in the diagnosis of complex anal fistulas. A total of 156 patients clinically diagnosed with complex anal fistula from January 2020 to December 2021 were studied and randomly divided into an experimental group (n=82) and a control group (n=74). Patients in the experimental group were examined by percutaneous fistula CEUS combined with CEUS+360°-TRUS, while patients in the control group were examined using TRUS. The detection of fistulas (main tract, branch and internal orifice) and the accuracy of Parks classification were compared between the two groups. Recurrences were followed up at 1, 3 and 6 mo after the surgery. A total of 156 patients were included, aged 23-68 y (average: 37.7 ± 18.2 y). In both groups, the course of disease was &lt;1 mo in 128 cases, 1-2 mo in 22 cases and &gt;3 mo in 6 cases. A total of 474 fistulas were confirmed by surgery in the aforementioned patients, including 224 main fistulas, 250 branch pipes and 254 internal orifices. The CEUS+360°-TRUS group had 96.87%, 90.41% and 90.14% diagnostic accuracy for the main tract, branch and internal orifice, which was statistically significant (p &lt; 0.001) compared with the 85.00%, 70.00% and 72.46% for the TRUS group, respectively. The overall accuracy of Parks classification of anal fistula in the CEUS+360°-TRUS group was significantly higher than that in the TRUS group (90.24% vs. 78.38%, p &lt; 0.001). After 6 mo of follow-up, the recurrence rate in the CEUS+360°-TRUS group was 4.87%, and the recurrence rate in the TRUS group was 18.91%. Percutaneous fistula CEUS combined with transrectal 360° 3-D imaging has significantly higher accuracy than conventional TRUS in the diagnosis of complex anal fistula, especially for anal fistula branches, internal openings and Parks classification and is beneficial in reducing post-operative occurrence of complex anal fistulas.