Incidence Of Stricture Research Articles

Risk Factors for Early Urethral Stricture After Mono-Polar Transurethral Prostate Resection: A Single-Center Experience.

AimThis study aimed to investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and the risk factors affecting the development of urethral stricture in patients treated in our clinic.Material and methodsThis retrospective study included patients who underwent TURP due to benign prostate hyperplasia (BPH) and had complete postoperative follow-up data of at least 12 months. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between urethral stricture and eight parameters (age, body mass index [BMI], prostate volume, number of comorbidities, amount of tissue removed, operative time, perioperative blood loss, and catheterization duration).ResultsOf the 3069 patients who underwent TURP in our clinic during the study period, 1740 patients with complete clinical data were included in the study. Mean age was 67.83 ± 5.80 years and mean body mass index (BMI) was 27.63 ± 4.31 kg/m2. Median preoperative prostate volume was 50.0 (range, 41.0-62.0) mm3 and the average amount of tissue removed during surgery was 20.0 (range, 12.0-30.0) g. Urethral stricture was detected in 3.9% (67/1740) of the patients during a minimum of 12 months of follow-up period after TURP. In multivariate analysis, prolonged operative time and high comorbidity burden were found to be risk factors for urethral stricture (p<0.001 for both).ConclusionEarly urethral stricture remains an important complication of TURP. Our results show that prolonged operative time and high comorbidity burden are factors that increase the risk of urethral stricture.

Cautionary tales in the use of magnets for the treatment of long gap esophageal atresia

BackgroundThe use of magnets for the treatment of long gap esophageal atresia or “magnamosis” is associated with increased incidence of anastomotic strictures; however, little has been reported on other complications that may provide insight into refining selection criteria for appropriate use. MethodsA single institution, retrospective review identified three cases referred for treatment after attempted magnamosis with significant complications. Their presentation, imaging, management, and outcomes were reviewed. ResultsAll three patients had prior cervical or thoracic surgery to close a tracheoesophageal fistula prior to magnamosis, creating scar tissue that can prevent magnet induced esophageal movement, leading to either magnets not attracting enough or erosion into surrounding structures. Two patients had a reported four centimeter esophageal gap prior to attempted magnamosis, both failing to achieve esophageal anastomosis, suggesting that these gaps were either measured on tension with variability in gap measurement technique, or that the esophageal segments were fixed in position from scar tissue and unable to elongate. One patient had severe tracheobronchomalacia requiring tracheostomy, with improvement in his airway after eventual tracheobronchopexies, highlighting that magnamosis does not address comorbidities often associated with this patient population. ConclusionsWe propose the following inclusion criteria and considerations for magnamosis: an esophageal gap truly less than four centimeters off tension with standardized measurement across centers, cautious use with a history of prior thoracic or cervical esophageal surgery, no associated tracheobronchomalacia or great vessel anomaly that would benefit from concurrent repair, and ideally to be used in centers equipped to manage potential complications. Level of evidenceLevel IV treatment study.

Incidence, Management, and Long-term Outcomes of Strictures in Patients Undergoing Re-do Ileal Pouch Anal Anastomosis

Incidence, Management, and Long-term Outcomes of Strictures in Patients Undergoing Re-do Ileal Pouch Anal Anastomosis

Incidence, Etiology, Prevention and Management of Ureteroenteric Strictures after Robot-Assisted Radical Cystectomy: A Review of Published Evidence and Personal Experience.

Benign ureteroenteric anastomosis strictures (UESs) are one of many critical complications that may cause irreversible disability following robot-assisted radical cystectomy (RARC). Previous studies have shown that the incidence rates of UES after RARC can reach 25.3%, with RARC having higher UES incidence rates compared to open radical cystectomy. Various known and unknown factors are involved in the occurrence of UES. To minimize the incidence of UES after RARC, our group has standardized the procedure and technique for intracorporeal urinary diversion by applying the following five strategies: (1) wide delicate dissection of the ureter and preservation of the periureteral tissues; (2) gentle handling of the ureter and security of periureteral tissues at the anastomotic site; (3) use of indocyanine green to confirm good blood supply; (4) standardization of the ample ureteral spatulation length for Wallace ureteroenteric anastomosis through objective measurements; and (5) development of an institutional standardized procedure manual. This review focused on the incidence, etiology, prevention, and management of UES after RARC to bring attention to the incidence of this complication while also proposing standardized surgical procedures to minimize its incidence after RARC.

1658 Duodenal Stricture Secondary to Chronic Pancreatitis; A Case Report

Abstract The complications of chronic pancreatitis are well established; however, the incidence of duodenal strictures in the context of previous necrotising pancreas is uncommon. I herein report the case of a 30-year Caucasian woman who presents with reduced oral intake, vomiting and profound cachexia. Medical history of note includes necrotising pancreatitis and umbilical hernia repair. Computed tomography scan revealed multiple cystic collections in the anterior pararenal space. Oesophagogastroduodenoscopy (OGD) revealed a duodenal stricture, which was histologically benign. Endoscopic insertion of a percutaneous jejunostomy (PEJ) unfortunately failed. Upon counselling with the patient, the decision was made to perform a laparotomy with loop gastrojejunostomy and jejunostomy tube insertion. The patient was subsequently able to be fed, initially with the aid of dieticians, and trained for independent care at home. This case highlights the uncommon complication of duodenal stricture in the context of chronic pancreatitis, and the importance of timely diagnosis and management.

MONOPOLAR VS BIPOLAR TRANSURETHRAL RESECTION OF PROSTATE REGARDING THE INCIDENCE OF POSTOPERATIVE URETHRAL STRICTURE: A PROSPECTIVE RANDOMIZED STUDY

INTRODUCTIONBenign prostatic hyperplasia (BPH) is a very common illness affecting aged men, about half of patients will at some time need surgical intervention.Monopolar TURPis considered as the gold standard for the surgical treatment of BPH. Multiple studies showed higher complication rates in M-TURP operations in patients with large prostate volumes. The risk of hemorrhage is also higher specially in patients with blood disorders. Bipolar TURP, an electric current completes its circuit outside the body of the patients. This permits the use of saline as irrigating fluid, preventing the TUR syndrome and hyponatremia. Addionally B-TURP is associated with less bleeding and less operative time.The incidence of urethral stricture after transurethral resection of prostate (TURP) ranges from 2.2 to 9.8%. Most of the cases occurs within 6 months of transurethral surgery. Presentation is likely with weak flow, infection or acute urinary retention.The exact etiology of urethral stricture after TURP is still unknown. Suggested causes after TURP include infection, mechanical trauma, prolonged indwellingcatheter time,local anesthesia, and electrical injury.

Post-transurethral resection of prostate urethral strictures: Are they often underreported? A single-center retrospective observational cohort study.

Objectives:Post-transurethral resection of prostate urethral stricture (PTS) is a well-documented delayed complication following transurethral resection of the prostate (TURP). The aim is to analyze various risk factors of PTS and see if the overall incidence is underreported.Materials and Methods:A retrospective study was conducted in our institution between January 2017 and December 2018 in men who underwent TURP. Data obtained from the medical records department were analyzed. Statistical analysis was done using Fisher's exact test. A two-tailed P < 0.05 is considered statistically significant.Results:Of the 447 men who underwent TURP, 57 developed PTS. Fifteen of 334 patients who underwent calibration before the procedure developed stricture compared to 42 of 137 without calibration (P < 0.01). There was a significantly lesser incidence of stricture with 24 Fr resectoscope compared with 26 Fr sheath (P < 0.04). Two patients with 24 Fr Foley and 30 of 35 (86%) patients with 22 Fr Foley catheter developed stricture of urethra. Distal bulbar urethra was the most common site of narrowing following TURP. Eighteen patients had Salvaris swab placed for traction and 12 patients required full-thigh traction, of which majority developed meatal stenosis.Conclusions:TURP is one of the common surgical procedures performed by urologists. Meatitis and meatal stenosis, if included as complications of TURP, would increase the overall incidence of PTS. Factors such as the size of resectoscope sheath used, size of catheter inserted, placement of Salvaris swab traction, and preoperative calibration of urethra have a significant impact on the ultimate outcome.

Anastomotic stricture after Ivor Lewis esophagectomy: An evaluation of incidence, risk factors, and treatment

BackgroundAnastomotic stricture is a recognized complication after esophagectomy. It can impact the patient’s quality of life and may require recurrent dilatations. Thus, the aim of this study was to evaluate the frequency of strictures, contributing factors, and long-term outcomes of management in patients undergoing esophagectomy with thoracic anastomosis using a standardized circular stapled technique. MethodsAll patients who underwent a 2-stage transthoracic esophagectomy with curative intent between January 2010 and December 2019 at NOGU, Newcastle upon Tyne, UK were included. All patients who underwent a stapled (circular) intrathoracic anastomosis using gastric conduits were included. Stricture incidence, number of dilatations to resolve strictures, and refractory stricture rate were recorded. ResultsOverall, 705 patients were included with 192 (27.2%) developing strictures. Refractory strictures occurred in 38 patients (5.4%). One, 2, and 3 dilatations were needed for resolution of symptoms in 46 (37.4%), 23 (18.7%), and 20 (16.3%) patients, respectively. Multivariable analysis identified the occurrence of an anastomotic leak (odds ratio 1.906, 95% confidence interval 1.088–3.341, P = .024) and circular staple size <28 mm (odds ratio 1.462, 95% confidence interval 1.033–2.070, P = .032) as independent predictors of stricture occurrence. Patients with anastomotic leaks were more likely to develop refractory strictures (13.1% vs 4.7%, odds ratio 3.089, 95% confidence interval 1.349–7.077, P = .008). ConclusionThis study highlights that nearly 30% of patients having a circular stapled anastomosis will require dilatation after surgery. Although the majority will completely resolve after 2 dilatations, 5% will have longer-term problems with refractory strictures.

MP02-16 EFFECT OF ROUTINELY PREOPERATIVE URETHRAL DILATION TO PREVENT URETHRAL STRICTURE AFTER TRANSURETHRAL RESECTION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-16 EFFECT OF ROUTINELY PREOPERATIVE URETHRAL DILATION TO PREVENT URETHRAL STRICTURE AFTER TRANSURETHRAL RESECTION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA Yeong Uk Kim, Jae Young Choi, Young Hwii Ko, Phil Hyun Song, Ki Hak Moon, and Hee Chang Jung Yeong Uk KimYeong Uk Kim More articles by this author , Jae Young ChoiJae Young Choi More articles by this author , Young Hwii KoYoung Hwii Ko More articles by this author , Phil Hyun SongPhil Hyun Song More articles by this author , Ki Hak MoonKi Hak Moon More articles by this author , and Hee Chang JungHee Chang Jung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture is one of the postoperative complications after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) and urethral dilation is simple and effective procedure to treat urethral stricture. However, there are no studies that have evaluated the relationship between preoperative urethral dilation and the incidence of post-TURP urethral stricture. Thus, we retrospectively investigated the effect of routinely urethral dilation just before surgery on preventing urethral stricture after TURP. METHODS: From January 2010 to December 2018, a total of 651 patients who underwent TURP for BPH was included in this study. We divided into two groups: Group A (295 patients, routinely urethral dilation before TURP) and B (356 patients, control group). We used a 26Fr resectoscope sheath, 30-degree telescope, and bipolar resectoscope. Urethral dilation was performed immediately before insertion of resectoscope sheath and 28Fr dilator was used. Urethral stricture after TURP was assessed by cystoscopy. Each patient was evaluated at 1 month, 3 months, and 6 months after TURP. The effect of urethral dilation was assessed based on International Prostate Symptom Score (IPSS), peak urine flow rate, voiding volume, and post-void residual urine. RESULTS: There were no significant differences of clinical variables, such as prostate volume, serum prostate specific antigen (PSA), age, operation time, and duration of catheterization between two groups (p >0.05). However, peak urine flow rate was significantly different between group A and B (19.87±9.12 vs 16.18±9.79, p=0.047). The incidence of urethral stricture after TURP was 4.06% (12/295) and 8.71% (31/356) in group A and B, respectively (p=0.032). CONCLUSIONS: This study demonstrated that the preoperative urethral dilation decreased the incidence of urethral stricture after TURP. We suggested that the routinely preoperative urethral dilation is simple and effective way to prevent urethral stricture after TURP for BPH. Source of Funding: No source of funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e18-e18 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yeong Uk Kim More articles by this author Jae Young Choi More articles by this author Young Hwii Ko More articles by this author Phil Hyun Song More articles by this author Ki Hak Moon More articles by this author Hee Chang Jung More articles by this author Expand All Advertisement Loading ...

Circular Stapled Technique Versus Modified Collard Technique for Cervical Esophagogastric Anastomosis After Esophagectomy: A Randomized Controlled Trial.

This study was performed to investigate the efficacy of the modified Collard (MC) technique for reducing anastomotic stricture after esophagectomy compared with the circular stapled (CS) technique. The currently available techniques of anastomosis after esophagectomy are associated with a significant risk of anasto-motic complications. However, the optimal anastomotic technique after esophagectomy has not yet been established. We randomly allocated patients to either the CS group or the MC group. The primary endpoint was the incidence of anastomotic stricture. The secondary endpoints included the incidence of postoperative complications (including anastomotic leakage) and quality of life (QoL). All anastomoses were performed after indocyanine green evaluation for objective homogeni-zation of blood flow to the gastric conduit between the 2 techniques. Among 100 randomized patients (CS group, n = 50; MC group, n = 50), anastomotic strictures were observed in 18 (42%) patients in the CS group and in no patients in the MC group. There were no significant between-group differences in anastomotic leakage (CS group, 7% vs MC group, 8%; P = 0.94). Quality of life domains of dysphagia and choking when swallowing at 3 months after surgery were significantly better in the MC group than in the CS group. The MC technique reduces the incidence of anastomotic stricture and improves postoperative quality of life. Furthermore, the incidence of anastomotic leakage is comparable between the 2 techniques based on accurate comparison under objective homogenization of the gastric conduit condition.

Integrative analysis of miRNA-mRNA expression profiles in esophageal fibrosis after ESD.

The incidence of esophageal fibrosis and benign esophageal stricture (BES) has increased in recent years due to the curative therapy for early-stage esophageal carcinoma, including partial esophagectomy and esophageal endoscopic submucosal dissection (ESD). The aim of the present study was to identify key genes and associated pathways of esophageal fibrosis after the ESD procedure. During the esophageal ESD procedure, the esophageal tissue in the remaining submucosal layer, referred to as normal esophageal (NE) tissue, was collected, and 1 week thereafter, post-operative esophageal (PE) tissue was obtained. High-throughput sequencing was used to identify dysregulated microRNAs (miRNAs/miRs) between NE and PE tissues. According to the differentially expressed (DE) miRNAs, putative target genes were predicted. Gene Ontology, Kyoto Encyclopedia of Genes and Genomes enrichment analysis and DEmiRNA interaction network analysis were performed. Reverse transcription-quantitative PCR (RT-qPCR) was performed to validate the RNA-sequencing results. A total of 199 miRNAs were determined to be DE between NE and PE tissues. Compared with the expression in the NE group, 83 miRNAs were significantly upregulated, while 116 miRNAs were significantly downregulated. According to these DE miRNAs, forkhead box O1 (FOXO1), paired box 6 (PAX6), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) and adrenoceptor β1 (ADRB1) were DE genes regulated by five DE miRNAs, including miR-223-3p, miR-142-5p, miR-582-5p, miR-21-3p and miR-218-5p. The results suggested that certain pathways were markedly dysregulated, including FOXO, MAPK, AMP-activated protein kinase and signaling pathways regulating the pluripotency of stem cells and proteoglycans in cancer. According to the RT-qPCR results, the expression levels of FOXO1, PAX6, ADRB1, miR-223-3p, miR-582-5p, miR-21-3p and miR-218-5p were consistent with the integrated analysis. In conclusion, FOXO1, PAX6, PIK3CA and ADRB1 may have a role in esophageal fibrosis, regulated by miR-223-3p, miR-142-5p, miR-582-5p, miR-21-3p and miR-218-5p. The present results provided an improved understanding of the changes in the microenvironment during the process of esophageal fibrosis, as well as novel potential targets for the treatment of esophageal fibrosis and BES.

Impact of radiation on the incidence and management of ureteroenteric strictures: a contemporary single center analysis

BackgroundUreteroenteric stricture incidence has been reported as high as 20% after urinary diversion. Many patients have undergone prior radiotherapy for prostate, urothelial, colorectal, or gynecologic malignancy. We sought to evaluate the differences between ureteroenteric stricture occurrence between patients who had radiation prior to urinary diversion and those who did not.MethodsAn IRB-approved cystectomy database was utilized to identify ureteroenteric strictures among 215 patients who underwent urinary diversion at a single academic center between 2016 and 2020. Chart abstraction was conducted to determine the presence of confirmed stricture in these patients, defined as endoscopic diagnosis or definitive imaging findings. Strictures due to malignant ureteral recurrence were excluded (3 patients). Statistical analysis was performed using chi squared test, t-test, and Wilcoxon Rank-Sum Test, logistic regression, and Kaplan–Meier analysis of stricture by cancer type.Results65 patients had radiation prior to urinary diversion; 150 patients did not have a history of radiation therapy. Benign ureteroenteric stricture rate was 5.3% (8/150) in the non-radiated cohort and 23% (15/65) in the radiated cohort (p = < 0.001). Initial management of stricture was percutaneous nephrostomy (PCN) in 78% (18/23) and the remaining 22% (5/23) were managed with primary retrograde ureteral stent placement. Long term management included ureteral reimplantation in 30.4% (7/23).ConclusionsOur study demonstrates a significant increase in rate of ureteroenteric strictures in radiated patients as compared to non-radiated patients. The insult of radiation on the ureteral microvascular supply is likely implicated in the cause of these strictures. Further study is needed to optimize surgical approach such as utilization of fluorescence angiography for open and robotic approaches.

Cumulative incidence of ureteroenteric strictures after radical cystectomy in a population-based Swedish cohort

Objective The incidence of benign ureteroenteric strictures following radical cystectomy (RC) for urinary bladder cancer (UBC) is investigated mainly in single-centre studies from high-volume centres. The aim of this study was to evaluate the cumulative incidence of strictures and risk factors in a population-based cohort. Patients and methods Data was collected from Bladder Cancer Data Base Sweden (BladderBaSe). The primary endpoint was stricture with intervention. Secondary endpoint included hydronephrosis both with/without intervention. Results In total, 5,816 patients were registered as having had RC due to UBC between 1997 and 2014. After a median follow-up of 23.5 months (IQR = 9.0–63.1 months; range = 0.0–214.0 months), we found that 515 (8.9%) patients underwent intervention for stricture. Seven hundred and sixty-one (13.1%) patients were diagnosed with hydronephrosis without intervention. The cumulative incidence of strictures with intervention was 19.7% (95% CI = 16.7–23.1%) during the 17 years of follow-up. In the first year, the cumulative incidence of strictures was 5.6% (95% CI = 5.0–6.2%), and in the first 2 years 8.4% (95% CI = 7.6–9.3%). For the secondary endpoint, the cumulative incidence was 30.4% (95% CI = 26.7–33.1%) after 17 years. Only the year of RC was associated with stricture incidence in Cox regression analysis, whereas hospital cystectomy volume, patient age and patient sex were not. Conclusion Ureteroenteric strictures requiring intervention may be more common than previously reported, affecting nearly one fifth of patients who have undergone RC for UBC. The annual incidence was highest in the first 2 years after surgery but the cumulative incidence increased continuously during 17 years of follow-up.

Modified layered hand-sewn cervical end-to-side anastomosis for minimally invasive McKeown esophagectomy.

Minimally invasive McKeown esophagectomy (MIE McKeown) with cervical anastomosis is a widely used approach for the treatment of esophageal cancer (EC). Anastomotic leak is one of the most serious complications following esophagectomy. This study aimed to summarize the anastomosis procedure and assess the clinical outcomes of our modified layered hand-sewn cervical end-to-side anastomosis for cervical anastomosis during MIE McKeown. We retrospectively reviewed clinical data of 508 consecutive EC patients who underwent MIE McKeown using the modified layered hand-sewn cervical end-to-side anastomosis between June 2016 and June 2020. The incidence of anastomotic leakage in our cohort was 2.0%. The postoperative stricture rate was 6.9% and the incidence of other postoperative complications was less than 9.3%. The mean time for setting up MIE McKeown was approximately 211.0 min and the average duration of postoperative hospital stay was 9.1 days. This modified layered hand-sewn cervical end-to-side anastomosis is a safe and effective method for MIE McKeown with a low incidence of anastomotic leakage, anastomotic stricture, or other postoperative complications.

Different Timing of Cholangiocyte and Hepatocyte Damage in Liver Preservation: Time to Implement Donor Interventions and New Preservation Techniques to Prevent Ischemic-type Biliary Lesions.

We read with interest the article by Gilbo et al1 assessing the impact of donor hepatectomy and implantation time on the incidence of early allograft dysfunction (EAD) and nonanastomotic strictures (NASs) in liver transplantation (LT). Donor hepatectomy and implantation time seem to have a linear negative impact on the incidence of NAS and EAD, respectively. A 10-min increase in either of these times is roughly as detrimental as a 1-h increase of cold ischemia time. This article expands our understanding of the importance of warm ischemia in LT, confirming findings from previous studies.2 We would like to provide further data and share our comments on this inspiring article. In 2016–1017, we collected data about times and graft temperatures in 160 first adult LTs with grafts from brain-dead donors. Liver temperature was measured at different time points using an infrared thermometer. In our experience, we were unable to show a significant impact of donor hepatectomy and implantation time on LT outcome, likely because of limited sample size and different practices that led to very little variability of these parameters. Median (interquartile range) time of donor hepatectomy and portal vein anastomosis was 47 (40–55) and 24 (21–28) min, respectively, and correlated poorly with graft temperature at the end of donor hepatectomy (R = 0.03, P = 0.61) and before graft reperfusion into recipient (R = 0.11, P = 0.16). However, our data (Figure 1) clearly show that liver grafts do suffer from a period of warm ischemia during retrieval and implantation.FIGURE 1.: Boxplot showing liver graft temperature at different time points during retrieval, back table preparation, and implantation. IQR, interquartile range.Analysis of EAD predictors in the study by Gilbo et al was somewhat hampered by the lack of inclusion of potentially important confounders, like macrosteatosis and severity of liver disease. Moreover, blood transfusions and early thrombotic events are also main determinants of EAD, as demonstrated by their incorporation in the recently developed early allograft failure simplified estimation score.3 Nonetheless, this study interestingly suggests that donor and recipient warm ischemia may impact differently on cholangiocytes and hepatocytes. Indeed, donor hepatectomy time had no effect on EAD (which is mainly determined by hepatocytes function), whereas implantation time was irrelevant with regard to NAS, which reflects cholangiocytes damage. Thus, cholangiocyte injury seems to happen at an earlier timing during graft retrieval and preservation, a finding in keeping with observations that histological damage to biliary epithelium and peribiliary glands is already apparent before graft reperfusion. As a logical implication, interventions focused on the earlier phase of organ preservation are likely needed to tackle NAS, especially in donors after circulatory death, a setting in which normothermic regional perfusion and hypothermic oxygenated machine perfusion have been associated with a significant NAS reduction.4,5 Besides underscoring once more the importance of proper training and technique in LT, this study confirms the role of ischemia-reperfusion injury in determining NAS and highlights the need to implement donor and preservation strategies to reduce their incidence. Future studies will have to assess whether the detrimental role of donor hepatectomy and implantation time persists also when alternative retrieval or preservation modalities are used.

Outcomes of Hepaticoduodenostomy over T-tube against Roux-en-Y Hepaticojejunostomy to Restore Bilio-enteric Continuity after Choledochal Cyst Excision in Children:

Introduction: Any surgical procedure which would restore the bilio-enteric continuity after excision of the choledochal cyst with minimal complications would be a feasible alternative to Hepaticojejunostomy using a Roux loop of jejunum. To determine the outcomes of Hepaticoduodenostomy done over T-Tube against Roux-en-Y Hepaticojejunostomy for bilio-enteric reconstruction after excision of choledochal cyst. Materials and Methods: This study was retrospectively done on all patients of choledochal cysts (Types 1 and 4) operated between January, 2014 and December, 2019. The clinical details, intra-operative and post-operative results of patients who underwent Roux-en-Y Hepatico-Jejunostomy (Group-1) and Hepatico-duodenostomy over T-Tube (Group -2) for establishing bilio-enteric continuity after excision of choledochal cyst were compared and analyzed statistically. Results: 78 patients of choledochal cysts were operated during this period with 31 patients in Group-1 and 47 in Group-2; there was no difference in the mean age or size of the cysts in the two groups; Type 1 cysts were the most common with female preponderance in both groups. Group-2 patients had lesser intra-operative time andfewer numbers of sutures were used during surgery. There was no difference in the incidence of anastomotic leaks, strictures, cholangitis or adhesive obstruction and reoperation rates between the two groups. Group 2 showed increased nasogastric bilious aspirates in 19.15% of cases which improved on conservative management. Conclusion: Bilio-enteric reconstruction using Hepaticoduodenostomy over T-Tube is a simpler, lower pressure and less time taking anastomotic technique with comparable complication rates when compared to Roux-en-Y Hepaticojejunostomy in the management of choledochal cysts.

Time to review the role of intraluminal brachytherapy for dose escalation after concurrent chemoradiation in cancer esophagus: A retrospective audit.

e16054 Background: Intraluminal brachytherapy (ILBT) for dose escalation after concurrent chemoradiation (CRT) in cancer esophagus is not routinely practiced. This is particularly attributable to radiotherapy toxicity in terms of strictures and fistulas. Cancer esophagus has poor locoregional control and overall survival rates in comparison to head and neck cancers. Dose escalation may be an option to counteract the high failure rates. Methods: A retrospective analysis was conducted for esophageal cancer patients treated between 2008 to 2016 planned for radical CRT to a minimum dose of 59.4 Gy in 33 fractions along with concurrent cisplatin 35 mg/m2 and 5 FU 375 mg/m2 on weekly basis. Further, the patients who received dose escalation after external beam radiotherapy (EBRT) completion by ILBT to a dose of 6 Gy in a single fraction to the pre EBRT volume were also analysed. The patient, tumor, treatment characteristics along with response rates, survival outcomes, and toxicities were evaluated and compared between the two groups - the patients who received ILBT and those who did not. Statistical significance between variables was analysed with the Chi-Square or Fischer’s exact test and t-test. Survival analysis was done by Log-Rank test. The analysis was done on a worst-case scenario basis where the patients lost to follow-up were considered dead. Results: The total number of patients treated by CRT was 69, out of which 13 patients received ILBT for dose escalation. The median age was 60 years (Range - 40 to 80 years) and the male: female ratio was 1.09, mean tumor length was 6.4 ± 2.4 cms (Range-1.5-12 cms). The commonest tumor site was the middle third observed in 58% patients. The median EBRT dose was 59.4 Gy (Range- 9 to 63 Gy). The median concurrent chemotherapy cycles were 5. The median follow-up period was 15 months (range 1-100 months). In terms of complete response rates, there was a trend towards significant improvement in patients receiving ILBT compared to those receiving EBRT alone (84.61% versus 57.49%, p=0.07). Also, the overall survival (OS) was significantly higher in the ILBT group (45.31 months versus 19.20 months; p = 0.005). The other patient, tumor, and treatment characteristics analyzed showed no significant impact on OS. There was no significant difference in the incidence of strictures (p=0.206) and severity (p=0.764) of strictures amongst both the groups. Grade ≥3 late toxicity was reported in 10 patients (17.85%) receiving EBRT alone and in 3 patients (23.07%) receiving ILBT. None of the patients receiving ILBT developed a fistula. Conclusions: The present study reveals a dramatic increase in OS by dose escalation with ILBT. The limitations of the present study were a small sample size and a lesser number of patients in the ILBT group. Recapitulating the concept of ILBT to increase the local tumoricidal dose may improve the survival rates.

Anastomotic Complications Can Be Reduced Using a Linear Stapler After Total Gastrectomy for Gastric Cancer

The purpose of this retrospective study was to compare the anastomotic complications after radical total gastrectomy using circular and linear stapler. A total of 121 consecutive patients who had undergone radical total gastrectomy at our hospital between 2010 and 2020 were enrolled. Postoperative complications were analyzed according to the baseline characteristics, surgical method, and type of anastomosis. The incidence of anastomotic stricture was significantly higher in the circular stapler group. Multivariate analyses showed that only the type of stapler used was significantly associated with anastomotic complications (odds ratio [OR] 0.11; 95% confidence interval [CI] 0.012–0.986; P = 0.049). The incidence of anastomotic complications, particularly stenosis, is reduced using a linear stapler. Therefore, such as stapler is more suitable for anastomosis after total gastrectomy during both laparoscopic and open surgeries.

Ureteral distal ends combined and inserted into the ileum: a novel anastomotic technique for urinary diversion

BackgroundThis study aimed to introduce a novel method for ureteroileal anastomosis, explore its clinical effectiveness, observe the incidence of postoperative anastomotic stricture, and compare the postoperative complications with those of other types of ureteroileal anastomosis reported in the literature.MethodsBoth ureters were first anastomosed at their distal ends and then inserted into the proximal end of the ileal loop. A postoperative follow-up analysis was performed to evaluate major complication indicators, including anastomotic stricture, anastomotic leak, and hydroureteronephrosis.ResultsWe successfully performed ureteral distal ends anastomosis combined with end-to-end insertion into the ileum for 143 patients. The mean postoperative follow-up lasted 37 months (range: 10–68 months). There was no occurrence of an anastomotic leak. The incidence of anastomotic stricture combined with hydronephrosis, ileal conduit stones, urinary tract infection, and renal dysfunction were 2.1%, 0.7%, 2.1%, and 4.2%, respectively.ConclusionUreteral distal ends combined and inserted into the ileum were simple to perform and helped achieve precise anastomosis with fewer postoperative complications.

The Incidence and Management of Urethral Stricture in Bladder Carcinoma

Background: Urethral stricture disease is one of the oldest and most difficult maladies known to the urologist. While references to the disease and its treatment date back to the writings of the Hindus, Egyptians, and Greeks. Objective: To elicit the incidence of urethral strictures, their severity and management in patients with superficial bladder tumor. Patients and Methods: From January 2018 to January 2020, we followed 98 patients admitted and treated at Baquba Teaching Hospital urology unit for having bladder carcinoma. Theywere all male subjects, their age range from 38-76y with a mean 56.8y. They were required to have a cystoscopically and histologically proven superficial transitional cell carcinoma of the bladder to be enrolled in this study (invasive tumors were excluded). For all the patients and after having the cystoscopic diagnosis ,transurethral resection of the tumor done and in most of them this is followed by six week courses of intravesical chemotherapy (either mitomycin or doxorubicin according to the availability). Intravesical Doxorubicin used in 13 cases (56.5%), Mitomycin C in 6 cases (26.1%) and 3 patients (13.0%) received both drugs (through multiple courses).while 1 patient (4.3%) received no chemotherapy. Thirteen strictures (56.5%) were managed by optical urethrotomy while 10 cases (43.5%) were mild strictures and opened just by introducing the cystoscope. Results: During the period of the study, a total of 23 urethral strictures were identified in the 98 male patients with superficial bladder tumor enrolled in this study, which constitutes an incidence of 23.5% all were diagnosed by the follow -up check cystoscopies . Patient age ranged from 38-75 years with a mean age 59.30+- 10.58 . Among those patients with urethral stricture ,14 patients had also B.P.H (60.9%), but only 7 patients (30.4%) had a history of retention of urine . The urethral stricture was bulbar in all patients and it was mild stricture in 10 cases (43.5%), moderate in 6 cases (26.1%) and severe in 7 cases (30.4%) . Prior to the diagnosis of stricture , 13 patients had been subjected to a single check cystoscopy (56.5%) ,6 patients (26.1%) had twice , while 4 patients (17.4%) had 3 or more cystoscopies prior to the occurence of stricture . Regarding intravesical chemotherapy prior to the occurance of stricture ,4 patients (17.4%) received 1-3 sessions , 10 patients (43.5%) received 4-6 sessions and 9 patients (39.1%) received more than 6 sessions . Intravesical Doxorubicin used in 13 cases (56.5%), Mitomycin C in 6 cases (26.1%) and 3 patients (13.0%) received both drugs (through multiple courses).while 1 patient (4.3%) received no chemotherapy. Thirteen strictures (56.5%) were managed by optical urethrotomy while 10 cases (43.5%) were mild strictures and opened just by introducing the cystoscope. Conclusion: Urethra stricture in patients with bladder carcinoma may be a substantial source of preventable morbidity, implementing a nursing education program may significantly decrease the incidence of stricture. Keywords: bladder carcinoma; urethral stricture; Baquba Teaching Hospital