Incidence Of Perforation Research Articles

Impact of prophylactic wound closure in colorectal ESD on postoperative wound complications: A meta-analysis.

Endoscopic submucosa dissection (ESD) has been applied extensively in the treatment of large intestine tumours due to its high total excision ratio. Nevertheless, there is a high incidence of adverse reactions in colon ESD, and the efficacy of prophylactic ESD following ESD in prevention of postoperative haemorrhage is still disputed. The purpose of this meta-analysis is to evaluate the effectiveness of prophylaxis of wound closure in large intestine ESD after operation. For eligibility, we looked through three databases: PubMed, Embase and Cochrane Library. Heterogenity was measured by means of a chi-square method of Q-statistic and an I2 test. Fixed or random effects models were used for data processing. Based on the retrieval policy, we found a total of 1286 papers, and then we collected nine papers to extract the data. Regarding postoperative haemorrhage, there was a significant reduction in the risk of wound haemorrhage in the wound closure group than in the control group (OR, 0.29; 95% CI, 0.19-0.44 p < 0.0001). No statistical significance was found in the incidence of perforation in the wound closure and the control group (OR, 0.45; 95% CI, 0.19-1.03 p = 0.06). There was a significant reduction in the incidence of postoperation fever among those in the wound closure group than in the control group (OR, 0.37; 95% CI, 0.15-0.93 p = 0.04). Preventive endoscopic closure decreased the rate of ESD in colon disease, but did not significantly decrease the rate of postoperation perforation and postoperative fever. Future research will be required to clarify the risk factors and classify high-risk individuals in order to formulate a cost-effective prevention strategy.

Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions.

Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in theGCE group were older and had more comorbidities. The medianJ-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups. In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.

Comparison of Locking Plate Alone and Locking Plate Combined with 3D Printed Polymethylmethacrylate Augmentation in Treating Proximal Humerus Fractures in the Elderly

BackgroundLocking plates are widely used in open reduction internal fixation (ORIF) for proximal humeral fracture (PHF). However, the optimal surgical treatment of unstable, displaced PHF in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes of surgical treatment of PHF in the elderly with locking plate (LP) alone and locking plate combined with 3D printed polymethylmethacrylate (PMMA) prosthesis augmentation (LP-PA). MethodsFrom May 2015 to April 2021, a total of 97 patients aged ≥ 60 years with acute unstable PHF who underwent osteosynthesis with either LP (46 patients) or LP-PA (51 patients) were retrospectively analyzed. For the LP-PA group, a customized proximal humeral prosthesis made of PMMA cement was intra-operatively fabricated by a three-dimensional (3D) printed prototype mold for the humeral medial support. Radiological outcomes were analyzed by measuring the value of neck-shaft angle (NSA) and humeral head height (HHH). The clinical outcomes were evaluated using Constant-Murley Score (CMS), Disabilities of the Arm Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, and the shoulder range of motion (ROM). Pain was measured using a visual analogue scale (VAS). ResultsAt the one-year follow-up, all fractures healed radiologically and clinically. The mean changes of NSA and HHH over the follow-up period were markedly smaller in the LP-PA group (3.8 ± 0.9° and 1.7 ± 0.3 mm) than those in the LP group (9.7 ± 2.1° and 3.2 ± 0.6 mm, both P < 0.0001). The LP-PA group also presented lower DASH score (17.1 ± 3.6), higher ASES score (89.5 ± 11.2) and better ROM in forward elevation (142 ± 26°) and external rotation (59 ± 11°) compared to the LP group (28.9 ± 4.8 for DASH score, P < 0.0001; 82.3 ± 9.0 for ASES score, P < 0.001; 129 ± 21° for forward elevation, P = 0.008; and 52 ± 9° for external rotation, P = 0.001). There was no significant difference in overall complication rate between the two groups, although the complication rate of screw perforation was higher in the LP-PA group (P = 0.172). ConclusionsFor PHF in elderly patients, the combination of LP fixation and PMMA prosthesis augmentation effectively improved humeral head support and reduction maintenance, providing satisfactory outcomes both radiologically and clinically. This technique also reduced the incidence of screw perforation associated with plate fixation alone, making it a reasonable option to ensure satisfactory clinical outcomes.

Risk factor analysis and nomogram prediction model construction for NEC complicated by intestinal perforation.

To investigate the clinical characteristics of neonatal necrotizing enterocolitis (NEC) complicated by intestinal perforation and predict the incidence of intestinal perforation in NEC. Neonates diagnosed with NEC at the Affiliated Hospital of Zunyi Medical University from January 2012 to May 2022 were enrolled, and the clinical data were collected and analyzed retrospectively. The patients were divided into two groups based on intestinal perforation occurrence or not. Mann-Whitney U tests, t-tests, chi-squaretests, and fisher's exact tests were performed between-group comparisons. Logistic and lasso regressions were applied to screen independent risk factors for concomitant bowel perforation, and R software (RMS package) was used to formulate the nomogram prediction model. In addition, the receiver operating curve (ROC) and the calibration curve were drawn to verify the predictive power, while decision curve analysis (DCA) was constructed to evaluate the clinical applicability of the nomogram model. One hundred eighty neonates with NEC were included, of which 48 had intestinal perforations, and 132 did not; the overall incidence of intestinal perforation was 26.67% (48/180). Bloody stool (OR = 5.60), APTT ≥ 50s (OR = 3.22), thrombocytopenia (OR = 4.74), and hypoalbuminemia (OR = 5.56) were identified as independent risk variables for NEC intestinal perforation (P < 0.05) through multivariate logistic regression analysis. These factors were then applied to develop a nomogram prediction model (C-index = 0.838) by using the R software. The area under the curve (AUC) for the nomogram in the training and validation cohorts were 0.838 (95% Cl: 0.768, 0.908) and 0.802 (95% CI: 0.659, 0.944), respectively. The calibration curve shown that the nomogram has a good predictive ability for predicting the risk of intestinal perforation occurrence. And the decision curve and clinical impact curve analyses demonstrated good clinical utility of the nomogram model. We found that Bloody stool, APTT ≥ 50s, Thrombocytopenia, and hypoalbuminemia could be used as independent risk factors for predicting intestinal perforation in neonates with NEC. The nomogram model based on these variables had high predictive values to identify NEC patients with intestinal perforation.

Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study.

Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO. Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed. The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p < 0.001; TICI 2b-3: 56.5% vs 88.3%, p < 0.001). Functional outcomes were also worse in the perforation group (mRS 0-1 at 3 months: 22.7% vs 36.6%, p = 0.031; mRS 0-2 at 3 months: 28.8% vs 53.9%, p < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, p = 0.008). This study reveals that while the occurrence of vessel perforation in MT for AIS due to MeVO is relatively rare, it is associated with poor functional outcomes and higher mortality. The findings highlight the need for increased caution and specialized training in performing MT for MeVO. Further prospective research is required for risk mitigation strategies.

Risk factors and management of iatrogenic colorectal perforation in diagnostic colonoscopy: a single-center cohort study

Background and aims Diagnostic colonoscopy plays a central role in colorectal cancer screening programs. We analyzed the risk factors for perforation during diagnostic colonoscopy and discussed the treatment outcomes. Methods We performed a retrospective analysis of risk factors and treatment outcomes of perforation during 74,426 diagnostic colonoscopies between 2013 and 2018 in a tertiary hospital. Results A total of 19 perforations were identified after 74,426 diagnostic colonoscopies or sigmoidoscopies, resulting in a standardized incidence rate of 0.025% or 2.5 per 10,000 colonoscopies. The majority (15 out of 19, 79%) were found at the sigmoid colon and recto-sigmoid junction. Perforation occurred mostly in less than 1000 cases of colonoscopy (16 out of 19, 84%). In particular, the incidence of perforation was higher in more than 200 cases undergoing slightly advanced colonoscopy rather than beginners who had just learned colonoscopy. Old age (≥ 70 years), inpatient setting, low body mass index (BMI), and sedation status were significantly associated with increased risk of perforation. Nine (47%) of the patients underwent operative treatment and ten (53%) were managed non-operatively. Patients who underwent surgery were often diagnosed with delayed or concomitant abdominal pain. Perforations of rectum tended to be successfully treated with endoscopic clipping. Conclusions Additional precautions are required to prevent perforation in elderly patients, hospital settings, low BMI, sedated patients, or by a doctor with slight familiarity with endoscopies (but still insufficient experience). Endoscopic treatment should be actively considered if diagnosis is prompt, abdominal pain absent, and especially the rectal perforation is present.

A88 ADVERSE EVENTS ASSOCIATED WITH ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is a widely utilized procedure for diagnosing and managing various biliary and pancreatic disorders. Despite its established effectiveness, ERCP is associated with a total adverse event (AE) rate exceeding 10%. However, existing literature lacks a comprehensive synthesis of incidence rates pertaining to specific or overall AEs following ERCP procedures. Aims We performed separate systematic reviews and meta-analyses of (1) data from randomized controlled trials (RCTs) and (2) data from observational studies to evaluate the incidence of AEs following ERCPs in adult patients. Methods Two separate systematic literature searches were conducted to identify ERCP AE rates in RCTs and observational studies published between 2000 and 2021, inclusive. Abstracts underwent independent assessment to identify studies for full-text review and subsequent data extraction. DerSimonian and Laird random effects meta-analyses were applied to determine pooled incidence rates of individual post-ERCP AEs, accompanied by 95% confidence intervals (CIs). The Newcastle-Ottawa Scale (NOS) and Risk of Bias 2 (ROB2) tool were used for quality assessment of observational studies and RCTs respectively. Results Our analysis incorporated 242 RCTs and 143 observational studies. Among RCTs, the pooled incidences of post-ERCP pancreatitis (PEP) in patients with native and non-native papillae were 6.9% (CI 6.2% to 7.6%) and 6.1% (CI 5.3% to 7.1%), respectively. In observational studies, the pooled PEP incidences were 5.0% (CI 4.0% to 6.1%) for patients with native papillae and 4.2% (CI 3.6% to 4.8%) for patients with non-native papillae. The incidences of bleeding for patients with native papillae were 1.6% (CI 1.3% to 2.0%) and 2.2% (CI 1.2% to 3.9%) in RCTs and observational studies, respectively. The incidences of perforation for patients with native papillae were 0.3% (CI 0.2% to 0.4%) in RCTs and 0.5% (CI 0.3% to 0.7%) in observational studies. The incidence of cholangitis was 1.4% (CI 1.1% to 1.9%) in RCTs and 1.1% (CI 0.7% to 1.7%) in observational studies. Conclusions This meta-analysis offers comprehensive insights into the incidence of ERCP-associated AEs from 2000 to 2021, both in idealized study settings where procedures are performed by experts, and in ‘real world’ settings. More precise estimates of ERCP-related AEs can help facilitate patient consent, manage appropriate patient expectations, and enhance peri-procedural care. Funding Agencies None

Effect of endoscopic mucosal resection and endoscopic submucosal dissection on postoperative wound bleeding‐related complications in patients with superficial esophageal cancer: A meta‐analysis

AbstractOperative therapy for superficial esophagus carcinoma is the main way to treat the disease. Endoscopic excision of lesions in the esophagus has become an alternative to surgical treatment for patients with esophageal carcinoma. To overcome the disadvantages of endoscope mucosa excision (EMR), an endoscopic submucosal dissection (ESD) technique has been developed. Although ESD is one of the most effective methods of endoscopy in patients with digestive tract tumors, there are potential complications after surgery, including hemorrhage in the surgical area and stenosis of the esophagus. The objective of this study was to evaluate EMR versus ESD based on post‐operative hemorrhage and esophagus stenosis. All the related articles were retrieved from the e‐databases. The main results were postoperative perforation, hemorrhage, and stenosis after surgery. There were no statistically significant differences in the incidence of post‐operative wound hemorrhage (OR, 1.08; 95% CI, 0.36–3.29 p = 0.89). Similarly, there were no statistically significant differences in the rate of perforation after surgery (OR, 0.57; 95% CI, 0.17–1.95 p = 0.37). There were no statistically significant differences in the incidence of esophageal stricture after surgery (OR, 1.15; 95% CI, 0.26–5.15 p = 0.85). This analysis was different from the earlier meta‐analysis because ESD and EMR did not show any notable differences with respect to the incidence of perforation after surgery, the hemorrhage of the wound or the stenosis of the esophagus. These findings must, however, be supported by more high‐quality studies.

Prevalence, Pattern, Mortality, and Morbidity of Traumatic Small Bowel Perforation at King Abdulaziz Medical City: A Retrospective Cohort Study.

Introduction Bowel perforation, whether from trauma or other causes, presents with diverse clinical scenarios. Small bowel perforation (SBP), a potentially fatal condition often linked to blunt trauma like motor vehicle accidents, necessitates prompt detection and intervention, crucial for improved outcomes. This study investigated the prevalence, predictors, presentation, diagnostic findings, morbidity, and mortality of traumatic SBP for comprehensive insights. Methodology This wasa retrospective cohort studyconducted at King Abdulaziz Medical City, Riyadh. A review of 838 cases, which represent all abdominal trauma patientsfrom January 2017 to March 2023, was done. Forty patients who developed SBP and have complete data were included in this study. One case was excluded due to incomplete medical records. Data were collected with the non-probability convenience sampling technique via the BestCare system using a data collection sheet. Data were analyzed with IBM SPSS 29 (IBM Corp., Armonk, NY). Results Out of all abdominal trauma cases (n=838), 40 patients developed SBP (n=40, 4.77%). Males constituted 87.5%, and the most common mechanism was motor vehicle accidents (57.5%). Complications included cardiac arrest, disseminated intravascular coagulation (DIC), and leak (7.5% each). In motor vehicle accidents, SBP primarily affected patients who were in the driver'sposition(78.3%). Clinical signs at presentation revealed abdominal tenderness (52.5%), abdominal distension (22.5%), and abnormal systolic blood pressure (mean 115.3 mmHg). Linear regression showed gender and age positively associated with morbidity (p=0.474, p=0.543)while BMI exhibited a negative relationship (p=0.314). Logistic regression revealed non-significant predictors of mortality, except for mean initial hematocrit (HCT) (p=0.721, aOR=0.098). Conclusion Our study provides crucial findings on the incidence, patterns, mortality, and morbidity of traumatic bowel perforation, contributing to the existing body of research. The identified prevalence of 4.77% and mortality at 17.5% from the studied populationunderline the serious impact of this condition, and the37.5% complication rateobserved demonstrates the potential risks involved. The average hospital stay is found to be 14 days, adding further to the disease burden. These findings underscore the importance of specific preventative measures, particularly related to motor vehicle accidents (MVAs), and highlight potential markers for predicting outcomes, such as age, gender, and mean initial HCT. This substantiates the need for further research involving larger cohorts and prospective designs to gain comprehensive insights and establish more robust preventative and treatment strategies.

Incidence and Outcome of Iatrogenic Gallbladder Perforation during Laparoscopic Cholecystectomy in a Tertiary Care Hospital

Introduction: in developing countries, patients getting admitted into hospital is influenced by gallbladder stone. In this study, the incidence and outcome of iatrogenic gallbladder perforation during laparoscopic cholecystectomy was observed and studied for further development in this sector in a tertiary care hospital. Aim of the study: The aim of this study was to find out the incidence and outcome of iatrogenic gallbladder perforation during laparoscopic cholecystectomy. Methods: This prospective observational study was conducted in Department of Surgery, Combined Military Hospital (CMH) Dhaka, Bangladesh during the period from June 2018 to November 2018. This study had institutional review board approval and informed consent for 100 patients age range 31-70 years (mean 50.3±10.6) in gallbladder perforation group and in no perforation group the range was 25 to 62 years (mean 47.9±12.3). The patients went through laparoscopic cholecystectomy through four port and gallbladder was removed through hepigastric port. The ultrasonographic report of all patients were collected. Result: In the present study, majority 86 patients were found normal body weight (BMI 18.5-24.9 kg/m2) but female patients were high in number of affected list, 14(73.7%) in gallbladder perforation group and 56(69.1%) in no perforation group. A single stone is mainly found in no perforation group which is 32(39.5%). Multiple stone is found less in both of the groups respectively. Staying in the hospital was also higher in gallbladder group in comparison with no perforation group. Conclusion: According to the study, perforation in gallbladder due to laparoscopic cholecystectomy is not deniable (19%). This can result in peroperative pain and more stay in hospital.

Septal perforation

Aim: This study isolates septal perforations due to nasal surgery for clinical analysis and their effect on bilateral mucosal flap repair. Methods: This is a retrospective review of a single surgeon’s 20-year experience with endonasal perforation repair utilizing bilateral mucosal advancement flaps supported with an autologous tissue interposition graft. Patients with a minimum of 4-month postoperative follow-up were included in the study. Comparative analyses of repair failure rates and perforation size of failures between surgical and non-surgical etiologies were performed. Results: Three hundred ninety-two patients met the criteria for inclusion in the study. The incidence of perforation and prior septal surgery was 40.6%. Overall repair closure in patients with a minimum of 4 months follow-up was 94.8%. Failures were noted in 5.7% of surgical and 4.7% of non-surgical perforation etiologies (P = 0.816). Mean differences in perforation length and height in failed repairs between non-surgical and surgical etiologies (19.4 vs. 13.7 and 15.5 vs. 9.3 mm, respectively) were significant (P = 0.048 length, P = 0.006 height). Conclusion: Post-surgical nasal septal perforations can be repaired with a low rate of failure. However, this study found that the size of perforations in failed repairs was significantly smaller in patients with a history of septal surgery, suggesting that prior septal surgery increases the technical difficulty of a bilateral flap perforation repair.

Pneumothorax, Pneumomediastinum, and Cervical and Facial Massive Emphysema Secondary to Colonoscopy: A Rare Complication of Colonoscopy

Background. Colonoscopy is a resource used for the diagnosis, treatment, and monitoring of benign and malignant colorectal pathologies. The incidence of perforation is 0.03%–0.65% in diagnostic colonoscopy; however, the incidence can be up to 10 times higher in therapeutic interventions, such as polypectomies, increasing the risk of complications up to 0.07–2.1%. Materials and methods. Case report of a 71‐year‐old female who presents a rare complication due to a perforation in the sigmoid which developed pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema as a complication of a diagnostic colonoscopy where a biopsy of a friable lesion was performed. Results. A 71‐year‐old female that went to the emergency room due to acute generalized abdominal colic spasm pain with a duration of 7 hours, associated with significant abdominal distension, malaise, diaphoresis, progressive dyspnea, and massive subcutaneous emphysema that developed after performing panendoscopy and colonoscopy for diverticulosis follow‐up. An abdominal CT scan with double contrast was performed, reporting suggestive data of hollow viscus perforation, pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema in the thorax, neck, and skull base. She underwent an exploratory laparotomy finding a perforation in the sigmoid for which sigmoidectomy was performed, and for the pneumothorax and pneumomediastinum, endopleural tubes were placed in both hemithoraxes. The massive subcutaneous emphysema subsided with observation and oxygen. Conclusion. A rare complication of the use of colonoscopy as a diagnostic and therapeutic method is presented. The purpose of presenting this case is for the doctor who performs these interventions to suspect this complication in a timely manner, not delaying the diagnosis and carrying out an urgent therapeutic approach as in this case with exploratory laparotomy, finding the perforation site and carrying out the corresponding surgical management. We demonstrated that massive subcutaneous emphysema can be managed with observation if there is no other alarm data evident that required another surgical approach.

Immediate implant placement in the premolar maxillary area: a cone-beam computed tomography study.

This research aimed to investigate potential factors associated with the risk of perforation of the labial bone plate, nasal floor, or maxillary sinus floor during immediate implant placement (IIP) in the maxillary premolar area, utilizing a cone-beam computed tomography (CBCT) virtual study. CBCT exams from 179 eligible participants, encompassing 716 teeth, were included. Implants were virtually positioned in 2 orientations: along the long axis of the tooth (the prosthetically-driven position) and in an optimal position relative to adjacent anatomical structures (the bone-driven position). Binary logistic regression analysis was employed to assess potential associations between perforation or invasion and various covariates, including sex, age, tooth region, the distance from the tooth apex to the nasal floor or maxillary sinus floor, the angle between the prosthetically- and bone-driven positions (implant-line A angle [ILAA]), and the labial concavity angle (LCA). The mean ILAA was 18.3°±8.0°, and the angle was significantly larger for the second premolar compared to the first premolar. The mean minimum implant length was 13.0±2.1 mm, with a bone anchorage of 4 mm. The incidence of perforation was 84.1% for the prosthetically-driven position and 40.5% for the bone-driven position. Factors associated with a higher risk of cortical bone wall perforation or invasion of the 2-mm safety margin from surrounding anatomical structures (in the bone-driven position) included female sex, older age, shorter distance from the tooth apex to the nasal cavity/maxillary sinus, and smaller LCA. A high prevalence of cortical bone wall perforation or invasion of the 2-mm safety margin is anticipated when performing IIP in the maxillary premolar region.

Outcome of spillage of gallbladder contents during laparoscopic cholecystectomy: a case control study

Background: Bile leakage due to many causes are common during laparoscopic cholecystectomy (LC). We sought to determine prospectively the incidence of gallbladder perforation during LC and to ascertain whether or not spillage of gallbladder contents resulted in overt complications. Methods: Between July 2013 to December 2013, 120 patients underwent LC participated in this study. All patient’s pre-operative ultrasonogram reports were collected. Of the 120 patients, 53 patients had spillage of gallbladder contents due to intra operative perforation. Per operative data were collected. Bile sample of all the hundred twenty patients were sent for culture and sensitivity. All patients were followed-up for two weeks post operatively. Results: Compared with those without GB perforation, there was a larger percentage of men (41.5%) in the spillage group. Spillage also common in patients having acute cholecystitis (32%), pigment stones (26 out of 38 pigment stone), multiple number of stones (77.3%), positive bile culture (30%). Most common complication was port site wound infections (3 in no. out of 53). There was no difference in post-operative amount or type of analgesia administered, duration of post-operative hospital stays in between two groups. Conclusions: Perforation of gallbladder and intra peritoneal spillage of bile and stones during LC is still a common incident, but are not associated with undesirable events and are not indications for conversion. When spilled bile is properly aspirated by peritoneal irrigation the operative and post-operative courses are similar to those of patients without spillage of gallbladder contents.

Applicability of J-CTO channel score to predict microcatheter tracking during retrograde percutaneous coronary intervention of chronic total occlusions: Insights from the SURFING MICRO registry.

The J-chronic total occlusion(CTO) channel score can predict guidewire tracking of the collateral channels(CCs), but its efficacy in predicting microcatheter tracking has never been tested in the setting of retrograde CTO-percutaneous coronary intervention(PCI). Predicting microcatheter collateral tracking during retrograde CTO-PCIs. A total of 189 patients undergoing retrograde CTO-PCI from April 2017 to August 2021 were screened. The primary outcome of interest was a correlation between J-CTO channel score and microcatheter tracking failure (MTF) after successful CC tracking by the guidewire. The independent association between anatomical features of the J-CTO channel score and the primary outcome of interest was explored. After adjustment, only small size (adjusted OR: 12.70, 95% confidence interval [CI]: 1.79-89.82; p = 0.01) and continuous bends (adjusted OR: 14.15, 95% CI: 2.77-72.34; p < 0.001) remained significantly associated with an increased risk of MTF for septal collaterals. The small size was the only predictor of the MTF for epicardial collaterals (OR: 6.39, 95% CI: 1.13-35.96; p = 0.020) at univariate analysis. Patients in the MTF group had a lower incidence of procedural success compared with patients in the microcatheter tracking success (MTS) group (40.0% vs. 93.9%, p < 0.001) and had a higher incidence of collateral perforations (20.0% vs. 3.0%, p < 0.001). Small and tortuous septal collaterals, identified by a score ≥3, are associated with an increased risk of MTF, lower incidence of procedural success, and higher risk of procedural complications driven by collateral perforations.

Esophageal injury, perforation, and fistula formation following atrial fibrillation ablation.

Esophageal perforation and fistula formation are rare but serious complications following atrial fibrillation ablation. In this review article, we outline the incidence, pathophysiology, predictors, and preventative strategies of this dreaded complication. We conducted an electronic search in 10 databases/electronic search engines to access relevant publications. All articles reporting complications following atrial fibrillation ablation, including esophageal injury and fistula formation, were included for systematic review. A total of 130 manuscripts were identified for the final review process. The overall incidence of esophageal injury following atrial fibrillation ablation was significantly higher with thermal ablation modalities (radiofrequency 5-40%, cryoballoon 3-25%, high-intensity focused ultrasound < 10%) as opposed to non-thermal ablation modalities (no cases reported to date). The incidence of esophageal perforation and fistula formation with the use of thermal ablation modalities is estimated to occur in less than 0.25% of all atrial fibrillation ablation procedures. The use of luminal esophageal temperature monitoring probe and mechanical esophageal deviation showed protective effect toward reducing the incidence of this complication. The prognosis is very poor for patients who develop atrioesophageal fistula, and the condition is rapidly fatal without surgical intervention. Esophageal perforation and fistula formation following atrial fibrillation ablation are rare complications with poor prognosis. Various strategies have been proposed to protect the esophagus and reduce the incidence of this fearful complication. Pulsed field ablation is a promising new ablation technology that may be the future answer toward reducing the incidence of esophageal complications.

Factors Affecting Gastric Perforation Patient Outcome with History of Arthritis and Long Term Use of NSAIDs in Dr. Kariadi Semarang Period 2020 – 2022

Background: The incidence of gastric perforation gives a high mortality outcome. The second most common cause of gastric perforation is long-term use of NSAIDs. In cases of arthritis during the COVID-19 pandemic, a conservative therapeutic approach and administration of NSAIDs are preferred. Due to this, researchers want to know the factors affecting gastric perforation cause by NSAIDs. Method: An analytic descriptive study with a retrospective cohort study design, using electronic medical records of patients at RSUP Dr. Kariadi Semarang from January 2020 - December 2022. Data collected was in the form of demographics, diagnoses, procedures, preoperative conditions, scoring system, and outcome. Results: PULP score, one of prognostic factor, has a good level of significance compared to other scoring systems in determining the prognostic mortality of patients with gastric perforation. The combination of variables between the type of NSAIDs and the type of arthritis has a direct correlation with a positive inter-variable power of 86.7% and a significance of 0.049 on patient outcome. Conclusion: NSAIDs pose a risk of gastric perforation in long-term use. tNSAIDs carry a higher risk inducing gastric perforation than selective NSAIDs.

Clinical Characteristics Analysis of Gastrointestinal Peripheral T-Cell Lymphoma:Impact of Non-Emergency Surgery on Overall Survival

Introduction The gastrointestinal tract is the most common extranodal site involved in non-Hodgkin lymphoma (NHL) and most NHL cases are of B-cell origin. Peripheral T-cell lymphoma (PTCLs) involving the gastrointestinal is less commont, comprising only about 4-6% of gastrointestinal lymphomas. This study retrospectively analyzed the clinical characteristics and potential clinical factors influencing survival outcomes in patients diagnosed with PTCLs through gastrointestinal tissue biopsy at our center. Methods Based on the clinical data, patients were reevaluated for clinical staging and risk stratification, including Ann Arbor staging, IPI scoring, and gastrointestinal lymphoma Lugano staging. Patient's follow-up was conducted through outpatient medical records and telephone communication. For the analysis of categorical data, the chi-square test or Fisher's exact test was used. Survival time was estimated using the Kaplan-Meier method. The Cox proportional hazards model was employed to calculate hazard ratios (HR) and their 95% confidence intervals (CI) to analyze prognostic factors. Data analysis was performed using SPSS 23 for Windows software. Results A total of 622 gastrointestinal tissue biopsy samples from October 2014 to September 2022 were retrieved from the medical records system. Among them, 67 cases (10.8%) were diagnosed as PTCLs. Among them, 5 cases had no available clinical data and were excluded. Detailed information regarding patient clinical characteristics can be found in the table. Treatment and Efficacy: Among the 62 patients with available clinical data, 43 received gastrointestinal surgical resection treatment, including 21 cases (33.9%) of elective non-emergency surgery and 22 cases (35.5%) of emergency surgery due to acute abdomen. The median courses of chemotheray was 5 (1~8). 15 patients (31.3%) achieved complete response (CR)/CRu; 10 patients (20.8%) achieved partial response (PR). Among the 59 patients who received chemotherapy and/or surgical treatment, progression-free survival (PFS) was evaluated with a median follow-up time of 48.4 months, and the median PFS was 4.4 months (95% CI: 2.5-6.3) (Figure). Multivariate analysis identified advanced Ann Arbor stage (stage 3/4) (HR=3.53, 95% CI: 1.53-8.17, P=0.003) as independent adverse prognostic factors for PFS. Receiving chemotherapy (HR=0.24, 95% CI: 0.09-0.66, P=0.005) and elective surgery (HR=0.45, 95% CI: 0.22-0.92, P=0.029) were identified as independent favorable prognostic factors for PFS. As of the last follow-up, a total of 49 patients (79.0%) had died and the median overall survival (OS) was 6.4 months (95% CI: 3.8-8.9) (Figure). Multivariate analysis identified Ann Arbor stages 3-4 (HR=3.01, 95% CI: 1.34-6.74, P=0.007) as an independent adverse prognostic factor for OS, and receiving chemotherapy (HR=0.13, 95% CI: 0.05-0.31, P&amp;lt;0.001), elective surgery (HR=0.36, 95% CI: 0.16-0.74, P=0.006) were identified as independent favorable prognostic factors for OS. Conclusion Data from four hematological disease treatment centers located in Zhejiang Province, southeastern China, showed that PTCLs involving the gastrointestinal tract accounted for approximately 10.8% (67/622) of all gastrointestinal lymphoma patients. These patients had a relatively high incidence of gastrointestinal perforation (35.5%). The overall treatment efficacy for patients was poor, with a majority of them succumbing to disease progression. The median PFS and OS were approximately six months. Elective surgery and chemotherapy appeared to improve the patients' outcomes.

Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke.

Endovascular treatment (EVT) of acute ischemic stroke can be complicated by vessel perforation. We studied the incidence and determinants of vessel perforations. In addition, we studied the association of vessel perforations with functional outcome, and the association between location of perforation on digital subtraction angiography (DSA) and functional outcome, using a large EVT registry. We included all patients in the MR CLEAN Registry who underwent EVT. We used DSA to determine whether EVT was complicated by a vessel perforation. We analyzed the association with baseline clinical and interventional parameters using logistic regression models. Functional outcome was measured using the modified Rankin Scale at 90days. The association between vessel perforation and angiographic imaging features and functional outcome was studied using ordinal logistic regression models adjusted for prognostic parameters. These associations were expressed as adjusted common odds ratios (acOR). Vessel perforation occurred in 74 (2.6%) of 2794 patients who underwent EVT. Female sex (aOR 2.0 (95% CI 1.2-3.2)) and distal occlusion locations (aOR 2.2 (95% CI 1.3-3.5)) were associated with increased risk of vessel perforation. Functional outcome was worse in patients with vessel perforation (acOR 0.38 (95% CI 0.23-0.63)) compared to patients without a vessel perforation. No significant association was found between location of perforation and functional outcome. The incidence of vessel perforation during EVT in this cohort was low, but has severe clinical consequences. Female patients and patients treated at distal occlusion locations are at higher risk.

Primary Tumor Resection in Synchronous Metastatic Colorectal Cancer Patients Treated with Upfront Chemotherapy plus Bevacizumab: A Pooled Analysis of TRIBE and TRIBE2 Studies.

The decision to resect or not the primary tumor in asymptomatic patients with synchronous metastatic colorectal cancer (mCRC) is a complex and challenging issue for oncologists, especially when an antiangiogenic-based therapy is planned. Patients enrolled in the phase III TRIBE and TRIBE2 studies that compared upfront FOLFOXIRI + bevacizumab to FOLFIRI or FOLFOX + bevacizumab, respectively, were included. We assessed the association of primary tumor resection (PTR) with progression-free survival (PFS), overall survival (OS), response rate (ORR), rate of grade > 2 adverse events (AEs), and serious gastrointestinal and surgical AEs in the overall population and according to the treatment arm. Of the 999 patients included, 513 (51%) underwent PTR at baseline. Longer PFS and OS were observed in resected patients compared to those with unresected primary tumors: 11.2 vs. 10.0 months (p < 0.001) and 26.6 vs. 22.5 (p < 0.001), respectively. In multivariate models, PTR was confirmed as an independent prognostic factor for better PFS (p = 0.032) and OS (p = 0.018). Patients with PTR experienced a higher incidence of grade 3 or 4 diarrhea (p = 0.055) and lower incidence of anemia (p = 0.053), perforation (p = 0.015), and serious gastrointestinal and surgical AEs (p < 0.001). No statistically significant differences were noted in incidence of bleeding (p = 0.39). The benefit of FOLFOXIRI + bevacizumab in terms of PFS (p for interaction: 0.46), OS (p for interaction: 0.80), ORR (p for interaction: 0.36), and incidence of grade 3 or 4 AEs was independent of PTR. PTR at baseline was independently associated with good prognosis in synchronous mCRC patients and with lower incidence of serious gastrointestinal and surgical AEs during upfront chemotherapy plus bevacizumab. The benefit and toxicity profile of FOLFOXIRI plus bevacizumab was independent of PTR.