Internal Stent Research Articles

Ureteral stents for malignant extrinsic ureteral obstruction: outcomes and factors predicting stent failure.

This study investigated the clinical outcomes of stent placement for malignant extrinsic ureteral obstruction (MUO) and predictive factors for stent failure. We retrospectively analyzed clinical data for 91 patients with radiologically significant hydronephrosis due to MUO who underwent successful stent placement. In total, 132 ureters were stented for the decompression. Factors related to stent failure were analyzed with a Cox proportional hazards model. Stent failure occurred in 25 ureters in 20 patients. The median interval to failure was 63 days. The multivariate analysis showed that the significant predictors of stent failure were bladder invasion and severe hydronephrosis before the stent insertion. The patients were divided into three groups based on these two factors: low-risk (neither factor; 85 patients), intermediate-risk (one factor; 37), and high-risk (both factors; 10). The median stent failure-free survival rate at 3 months was 94.8% in the low-risk, 71.8% in the intermediate-risk and 55.6% in the high-risk group, respectively. Of the ureters with stent failure, there was successful re-replacement of internal stents in 3 low-risk, 6 intermediate-risk and no high-risk ureters. Replacement by nephrostomy was done in 2 low-risk, 5 intermediate-risk and 7 high-risk ureters. The patients considered at low-risk could be managed without stent failure by internal stenting. However, the patients at high-risk may require the consideration of nephrostomy or other alternatives as the initial treatment. Our stratification model may allow better risk stratification for patients with regard to ureteral stenting, helping to identify patients for whom ureteral stenting is indicated.

Pancreatoscopy in Undiagnosed Pancreatic Disease

Pancreatic pathology encompasses a broad differential and requires a multitude of diagnostic studies to accurately diagnose a specific condition. ERCP has been shown to be extremely helpful and accurate in the diagnosis and treatment of pancreatic ductal disease. However in the event in which pancreatography reports conflicting data, additional work-up should be considered with pancreatoscopy which allows for the direct visualization of the pancreatic duct. Its utility in this situation has been previously demonstrated in the literature with discrepancies on ERCP and CT imaging. We present a case in which a patient had been diagnosed with a pancreatic stricture by ERCP was ultimately found to have stone disease using pancreatoscopy. A 72-year-old female with no significant past medical history presented to the hospital with complaints of abdominal pain radiating to her back accompanied by nausea and vomiting. Laboratory studies noted a lipase of 6,570U/L with normal liver function tests. An abdominal contrast-enhanced CT reported a 5mm pancreatic duct (PD) stone within the mid-PD causing acute distal pancreatitis without evidence of gallstones or biliary dilation which was confirmed via ultrasound. The patient failed conservative management and thus underwent endoscopic intervention with an ERCP. A pancreatogram noted a stricture within the mid-PD (Figure 1) without the presence of a stone. Thus an internal flanged external pigtail stent was placed spanning the stricture. Her symptoms gradually improved. Approximately 4 weeks later, repeat endoscopic evaluation was performed to evaluate for an underlying malignant pathology. Endoscopic ultrasound (EUS) failed to note any intraparenchymal pancreatic disease. A repeat ERCP was performed and her stent was removed. A pancreatoscopy then was performed which discovered an obstructing stone within the mid-PD (Figure 2). A balloon catheter was unable to be passed, thus the stone was fragmented using electrohydraulic lithotripsy (EHL) and the PD was subsequently swept clean. A stent was replaced, and is currently scheduled for removal in 8 weeks. Within the large realm of pancreatic medicine, there are multiple modalities which exist to accurately diagnose pancreatic pathology. When faced with conflicting evidence between imaging results, especially involving ductal disease, performing a pancreatoscopy is a great diagnostic tool which may help guide the management of patients with undiagnosed disease.1309_A.tif Figure 1: Pancreatogram revealing a stricture within the mid-pancreatic duct. No filling defects are noted.1309_B.tif Figure 2: Pancreastoscopy noting an obstructing mid-pancreatic duct stone.

Cystoscopic ureteral stent placement: techniques and tips

We present a video demonstrating technical considerations and tips for cystoscopic placement of external, lighted, and internal ureteral stents. Cystoscopic ureteral stent placement is useful in cases where difficult pelvic periureter dissection is expected or encountered. In this video, we review cystoscopy basics, our approach to various types of retrograde stent placement, and performing retrograde pyelograms. Traditional external ureteral stent and lighted stent placement for prophylactic purposes are discussed, with attention to understanding stent markings, appropriate resistance, and steps for externalization. Internal, double-J ureteral stent placement with the use of fluoroscopy is initiated with placement of a guidewire. An open-ended ureteral catheter is advanced over the wire in the pelvic portion of the ureter, and a retrograde pyelogram is performed. The wire is reintroduced and the stent advanced to the renal pelvis under fluoroscopy. The proximal curl is confirmed to be in the appropriate position with fluoroscopy. The string attached to the stent is then cut and removed, the guidewire is removed, and the stent is deployed with the distal curl in the bladder. This video reviews key steps for cystoscopic ureteral stent placement in a prophylactic setting, cases of challenging anatomy, or ureteral injury.

External versus internal pancreatic duct stenting in duct-to-mucosa pancreaicojejunostomy after pancreaticoduodenectomy: a prospective randomized study

Background: A pancreatic duct stent is often placed across the pancreaticojejunostomy after pancreaticoduodenectomy to decrease the incidence rate of postoperative pancreatic fistula. However, there are few reports in the literatures compared between external and internal pancreatic duct stents. Methods: We conducted a prospective randomized study with 30 patients who underwent pancreaticoduodenectomy and we compared the effects of using external stent versus internal stent in pancreaticojejunostomy on postoperative course, particularly on incidence of postoperative pancreatic fistula. Results: The incidence rate of pancreatic fistula according to the International Study Group on Pancreatic Fistula criteria was significantly higher in external stent group (external, 26.7%; vs internal, 13.3%). In subgroup analysis of patients with soft pancreas, we found similar rates of pancreatic fistula in the two studied groups. The incidence of overall morbidity was similar between both groups while mortality was higher in external stent group. The mean postoperative hospital stay was not significantly different between the two studied groups. Conclusions: Both external stent and internal pancreatic duct stents were safely used for pancreaticojejunostomy. Internal stent had less incidence of postoperative pancreatic fistula and simplifies postoperative management and it might be a better option than external stent in pancreaticojejunostomy after pancreaticoduodenectomy.

Post pancreatico-duodenectomy pancreatitis (PPDP) – A ten years audit from a tertiary care hospital in North India

Introduction: A poor outcome of patients developing PPDP prompted this audit to define factors influencing PPDP. Methods: Audit of our prospectively maintained database of patients undergoing PD from 2005 to Feb 2015, comparing patients developing PPDP (group 1) with those without, PPDP being defined as serum amylase of more than 3 times of upper normal of laboratory value between post-operative day 0-2. The demographic, intraoperative and post-operative variables and outcomes were compared. Results: 523 patients undergoing PD were analyzed. PPDP occurred in 47(9%). On univariate analysis all preoperative factors were comparable between the two groups. The mortality in PPDP group was 13/47 (27.6%) compared to 28/476(5.9%) in the other. Among intraoperative factors soft pancreas (p=.001), pancreatic duct diameter ≤3 mm (p = .000113), use of internal pancreatic stent (p = .011), and continuous duct to mucosa pancreaticojejunostomy v/s interrupted (p=.005) duct to mucosa v/s dunking (p = .062) were significantly affecting PPDP. In the post-operative period, almost all complications except DGE were significantly higher in group 1 patients. On multivariate regression analysis, soft pancreas (p = .018), pancreatic duct diameter ≤3 mm (p = .047), internal pancreatic stent(p = .020) emerged significant. PPDP development led to an increase in the incidence of POPF (p=.035), post-operative new onset diabetes (p = .028), wound dehiscence (p = .046) and mortality (p = .002). Conclusion: Avoiding continuous suture duct to mucosa anastomosis and use of internal pancreatic stent appear to be the only controllable factors to reduce the incidence of PPDP which is a common complication after PD with serious consequences.

Duct penetrating method for pancreatojejunostomy with lost stent placement by push & pull technique

Introduction: We developed a novel anastomotic technique (duct penetrating method: DPM) using a suture-assistant device for the reliable performance of duct-to-mucosa pancreaticoenterostomy. Although whether the placement of lost stent is superior to no stent or external stent remains controversial, we performed duct-to-mucosa pancreaticojejunostomy with lost stent placement using “push and pull technique”. Method: An atraumatic needle is purposely driven to penetrate both walls of the duct, while sparing the stump of the pancreas and incorporating an amount of pancreatic parenchyma with adequate depth and width around the duct. Suture placement is established by simple rotation of the needle driver along the curvature of the needle. A 5-0PDSII string is tied around a part of a pancreatic duct stent (4Fr).One side of the string is cut short, and the other side is cut long. The proximal and distal side of the stent should be cut 1.5cm apart from the knot. The lost stent is entirely pushed into the main pancreatic duct, then the proximal side of the stent is gradually induced into the jejunum side by holding the 5-0PDSII string until the string appears from the main pancreatic duct. Result: We performed DPM on 44 patients, and there was no cases of Grade C fistula. Over 100 patients were performed push and pull technique, the failure rate of this procedure is approximately 2%. Conclusion: A safe and reliable pancreaticojejunostomy is guaranteed by duct penetrating method. With push and pull technique, an appropriate insertion of an internal short stent would be guaranteed.

The modified duct-to-mucosa pancreaticojejunostomy for small pancreatic duct during pancreaticoduodenectomy

Purpose: Postoperative pancreatic fistulas(POPFs) due to anastomotic leak are closely related to significant morbidity and mortality following pancreaticoduodenectomy(PD).The aim of this study is to introduce modification of the conventional duct-to-mucosa (DM) pancreaticojenunostomy(PJ) and the improved outcomes of this modified PJ technique for small main pancreatic duct. Methods: The modified DM anastomosis is characterized that matching internal stent was inserted into the pancreatic duct remnant and secured with suture at the opening of the pancreatic duct to enhance sealing, prior to the anastomosis. From January 2012 to October 2017, 102 patients underwent PD for small main pancreatic duct (≤ 3mm). In total, 33 cases received conventional DM pancreaticojejunal anastomosis and 69 cases received modified DM pancreaticojejunal anastomosis. Results: The postoperative stay time, diet resumption time and timing of drain removal in the modified DM group were lower than those in conventional DM group. The overall incidence of POPFs was not significantly different between two groups. But, the clinical POPFs (grade B/C) in the modified DM group occurred less frequently than those in the conventional DM group. (4.3 % vs. 24.2 %, p=0.002). Moreover, neither grade C POPF nor in-hospital mortality occurred in the modified DM group. In addition, multivariate analysis showed a significant difference between both groups on significant POPFs (OR 0.211, 95% CI 0.09 to 0.51, P=0.001). Conclusion: The modified DM anastomosis technique in our study is a safer anastomotic method than the traditional DM pancreaticojejunostomy technique. This new technique could effectively reduce the incidence of POPF.

Comparison of long-term clinical outcomes of external and internal pancreatic stents in pancreaticoduodenectomy: randomized controlled study

BackgroundTo determine the most appropriate pancreatic drainage method, by investigating differences in 12-month clinical outcomes in patients implanted with external and internal pancreatic stents as an extension to a previous study on short-term outcome. MethodsThis prospective randomized controlled trial enrolled 213 patients who underwent pancreaticoduodenectomy with duct to mucosa pancreaticojejunostomy between August 2010 and January 2014 (NCT01023594). Of the 185 patients followed-up for 12 months, 97 underwent external and 88 underwent internal stenting. Their long-term clinical outcomes were compared. ResultsOverall late complication rates were similar in the external and internal stent groups (P = 0.621). The percentage of patients with >50% atrophy of the remnant pancreatic volume after 12 months was similar in both groups (P = 0.580). Factors associated with pancreatic exocrine or endocrine function, including stool elastase level (P = 0.571) and rate of new-onset diabetes (P = 0.179), were also comparable. There were no significant between-group differences in quality of life, as evaluated by the EORTC QLQ-C30 and QLQ PAN26 questionnaires. ConclusionExternal and internal stents showed comparable long-term, as well as short-term clinical outcomes, including late complication rates, preservation of pancreatic duct diameters, pancreatic volume changes with functional derangements, and quality of life after surgery.

Аntegrade uterolithotripsy in the treatment of proximal urolithiasis

Study purpose: to assess the possibility of antegrade percutaneous ureterolithotripsy as an alternative treatment for patients with large calculi of the proximal part of ureter. Patients and methods Results of 75 mini percutaneous antegrade ureterolithotripsy with contact lithotripsy were studied. The mean size of the ureteral calculus was 1,8±0,7 cm. At the same time, in 4 (5,3%) cases, concrements of the proximal ureter of the single kidney. The operations were performed with epidural anesthesia with intravenous sedation, in the patient’s position «on the abdomen» in 62 (82,7%) cases and in the patient’s position «on the back» in 13 (17,3%) cases. Puncture of the renal cavity system was performed with combined ultrasound and fluoroscopic guidance. Accesses were performed through the lower calix group in 24 (32,0%) cases, through the middle calix group in 39 (52,0%), and through the upper calix group in 12 (16,0%) cases. Results. The mean time of antegrade mini percutaneous ureterolithotripsy was 58.5±15.4 min, while the stone free rate was achieved in all 75 (100%) of patients. The mean level of hemoglobin drop was not more than 15,5±5.4 GM/DL In the postoperative period, aggravation of pyelonephritis was noted in 6 (8,0%) patients. The operations were ended with the installation of nephrostomy drainage in 29 (38,7%) cases, nephrostomy drainage and internal ureteral JJ stent in 35 (46,7%), and the operation was ended with a tubeless method with installation only ureteral JJ stent in 11 (14,6%) cases. Nephrostomy drainage were removed in 1–3 days. Ureteral stent removed in 14,0±7,0 days. The mean period of postoperative stay of patients in the hospital was 2,3 ± 0,8 days. It was noted that antegrade fibroureteropyeloscopy is an extremely time-consuming and cost-demanding method, which alternative may be percutaneous antegrade ureterolithotripsy with use of mini-nephroscope tubes. Conclusions. Analysis of the treatment of proximal ureterolithiasis with the method of antegrade mini percutaneous ureterolithotripsy indicates that this method is an attractive direction in the treatment of patients with large calculi of the proximal parts of ureter that allows achievement of the full state of the stone free rate, reduction of the time of surgical treatment and hospital stay for patients with this pathology.

Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy

Minimally invasive pancreatic resections are technically demanding but rapidly increasing in popularity. In contrast to laparoscopic distal pancreatectomy, laparoscopic pancreatoduodenectomy (LPD) has not yet obtained wide acceptance, probably due to technical challenges, especially regarding the pancreatic anastomosis. The study describes and demonstrates all steps of LPD, including the modified Blumgart pancreaticojejunostomy. Indications for LPD are all pancreatic and peri-ampullary tumors without vascular involvement. Relative contra-indications are body mass index >35 kg/m2, chronic pancreatitis, mid-cholangiocarcinomas and large duodenal cancers. The patient is in French position, 6 trocars are placed, and dissection is performed using an (articulating) sealing device. A modified Blumgart end-to-side pancreaticojejunostomy is performed with 4 large needles (3/0) barbed trans-pancreatic sutures and 4 to 6 duct-to-mucosa sutures using 5/0 absorbable multifilament combined with a 12 cm, 6 or 8 Fr internal stent using 3D laparoscopy. Two surgical drains are placed alongside the pancreaticojejunostomy. The described technique for LPD including a modified Blumgart pancreatico-jejunostomy is well standardized, and its merits are currently studied in the randomized controlled multicenter trial. This complex operation should be performed at high-volume centers where surgeons have extensive experience in both open pancreatic surgery and advanced laparoscopic gastro-intestinal surgery.

Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy.

Minimally invasive pancreatic resections are technically demanding but rapidly increasing in popularity. In contrast to laparoscopic distal pancreatectomy, laparoscopic pancreatoduodenectomy (LPD) has not yet obtained wide acceptance, probably due to technical challenges, especially regarding the pancreatic anastomosis.The study describes and demonstrates all steps of LPD, including the modified Blumgart pancreaticojejunostomy. Indications for LPD are all pancreatic and peri-ampullary tumors without vascular involvement. Relative contra-indications are body mass index >35 kg/m2, chronic pancreatitis, mid-cholangiocarcinomas and large duodenal cancers.The patient is in French position, 6 trocars are placed, and dissection is performed using an (articulating) sealing device. A modified Blumgart end-to-side pancreaticojejunostomy is performed with 4 large needles (3/0) barbed trans-pancreatic sutures and 4 to 6 duct-to-mucosa sutures using 5/0 absorbable multifilament combined with a 12 cm, 6 or 8 Fr internal stent using 3D laparoscopy. Two surgical drains are placed alongside the pancreaticojejunostomy.The described technique for LPD including a modified Blumgart pancreatico-jejunostomy is well standardized, and its merits are currently studied in the randomized controlled multicenter trial. This complex operation should be performed at high-volume centers where surgeons have extensive experience in both open pancreatic surgery and advanced laparoscopic gastro-intestinal surgery.

Функциональная оценка состояния верхних мочевыводящих путей у пациентов с гидронефрозом внутрипочечной лоханки, оперированных методом аутопластики

To investigate the functional state of the upper urinary tract in patients undergoing autoplastic surgery for a hydronophrosis of the intrarenal pelvis. The study comprised 78 patients with the intrarenal pelvis and impaired urinary outflow due to stricture of the ureteropelvic junction and vascular conflict (interatrial and arteriovenous narrowing), who underwent pyeloplasty using autologous tunica vaginalis. All patients underwent an incision of ureteropelvic stricture and resection of the parietal layer of the tunica vaginalis which was used to repair the obstruction site and internal stenting of the upper urinary tract. The patients were examined at baseline and during follow-up ranging from 3 months to 3 years. At three months after surgery, there was a decrease in the size of the renal pelvis and calyces with an improvement of all parameters of uro- and hemodynamics. At three years after surgery, the structural and functional parameters of the upper urinary tract were completely restored. Obstructive uropathy, resulting from the intrarenal pelvis, leads to persistently impaired urinary outflow from the upper urinary tract. Surgical intervention is the only curative treatment able to restore the urinary flow. In men with the intrarenal pelvis, the autoplastic surgery of the ureteropelvic junction obstruction using a parietal layer of the tunica vaginalis is an effective surgical modality improving renal pelvis capacity and contributing to the recovery of urinary outflow from the upper urinary tract.

Outcomes of externalized pyeloureteral versus internal ureteral stent in pediatric robotic-assisted laparoscopic pyeloplasty

After pyeloplasty, urinary drainage options include internal double-J (DJ) ureteral stents or externalized pyeloureteral (EPU) stents, which can avoid bladder symptoms and additional anesthetic exposure from stent removal. Comparative outcome studies, however, are lacking following primary pediatric robotic-assisted laparoscopic pyeloplasty (RALP). To compare operative success, operative time, hospitalization, and postoperative complications of EPU versus DJ stents following RALP. Consecutive children undergoing primary RALP from 10/2013 to 9/2015 were retrospectively identified. Data collected included patient demographics, stent type and duration, postoperative complications, and operative success. To control for confounding by indication for EPU stent, propensity score weighting was used to balance baseline covariates. Weighted regression analyses compared between-group differences in study outcomes. At median follow-up of 12.3 months, 44 and 17 patients underwent DJ and EPU stenting, respectively. At baseline, DJ stent patients were older than EPU stent patients (median 7.7 vs 1.2 years, P=0.01) and were less likely to be on postoperative antibiotic prophylaxis (25 vs 76%, P<0.001). After weighting, these differences disappeared. All EPU stents were removed in the outpatient clinic; all DJ stents were removed under anesthesia. On weighted regression analyses (Summary Fig.), EPU stents had no different associations than DJ stents with operative success (95 vs 94%, between-group difference 1%, 95% CI -11, 13; P=0.86), complications, or operative time, but did have 0.6 of a day more hospitalization (95% CI 0.04, 1.2; P=0.04). Patients receiving EPU stents were different at baseline from those receiving DJ stents. After propensity score weighting balanced these covariates, EPU stents were associated with similar operative success, complications, and operative time to DJ stents. Further study is warranted in larger prospective cohorts. Use of EPU stents provided a viable alternative, particularly in younger patients, to DJ stenting with comparable success and complications, while avoiding the need for an additional anesthetic.

Efficacy and safety of the use of infant feeding tubes as internal ureteral stents at Muhimbili National Hospital, Tanzania

Background: Infant feeding tubes are inexpensive, readily available, and have been used as urinary tract stents with some uncertainty about their effectiveness and safety. Double J ureteral stents are available on the market, but among other factors, availability and affordability limit their use in developing countries, including in our hospital. We aimed to compare the efficacy of infant feeding tubes compared to standard double J ureteral stents in patients undergoing open ureteral stenting at Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods: We conducted a hospital-based cross-sectional analytical study over 12 months. Patients included in the study required open ureteral stenting for different indications and were divided into 2 groups: those for whom infant feeding tubes were inserted during surgery (study group) and those whose surgery used double J stents (control group). After surgery, patients were recruited and observed to ascertain the duration of hospital stay, as well as the presence of haematuria, dysuria, urinary frequency, flank and suprapubic pain, stent migration, and stent encrustation. Observations continued until the day of discharge, after which patients were followed up to the day of stent removal. Results: A total of 44 patients were enrolled in the study. The mean age of participants was 40 years (range 1 to 75). The majority of participants were female (n = 26; 60%). Among the 44 operations, 19 (43.2%) used the infant feeding tube as a stent whereas the remainder (n = 25; 56.8%) used the standard double J ureteral stent. The mean hospital stay among patients who underwent surgery with the infant feeding tube as a stent was 9.6 days, whereas those who used the standard double J stent stayed for 8.8 days (P = 0.37). Postoperatively, haematuria was observed in 19 (43.2%) of the patients; among these, 15 (79%) of them received infant feeding tube stents and 4 (4.3%) received standard double J stents (Χ2 = 17.4; P = 0.001). The postoperative prevalences of dysuria, flank pain, and suprapubic pain were 6.8%, 20.4%, and 9.1%, respectively. These outcomes did not show association with the type of surgical stent used. None of our study patients experienced postoperative urinary frequency. Imaging studies showed that 57.8% of the infant feeding tube stents were in the normal position postsurgery, whereas all of the standard double J stents were in the normal position (Χ2 = 12.86; P = 0.005). Further, we found that among the 44 patients, only 1 patient (who underwent surgery that used double J stenting) had postoperative stent encrustation (Χ2 = 0.7; P = 0.4). Conclusions: Despite producing significantly higher incidences of haematuria and malposition, infant feeding tube as ureteral stents were comparable to double J stents in terms of hospital stay post-stenting, dysuria, flank pain, suprapubic pain and encrustation. Future larger prospective studies are needed to confirm these findings. https://dx.doi.org/10.4314/ecajs.v22i3.5 This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.

External stent in laparoscopic pyeloplasty: The K-wire technique

The majority of surgeons leave internal stents following laparoscopic pyeloplasty, which necessitates a second anaesthetic for removal. A novel technique of placing external nephro-ureteric stents, thus obviating a second procedure for retrieval, is shown in this video bank. As demonstrated in the video, a Kirschner wire (K-wire) is used to thread the stent in place. Although, there are few reports of using externalised stents in laparoscopic pyeloplasty, it is believed that this technique has not been previously described. So far this technique has been used in 22 patients without any stent-related complications. The technique is feasible, safe and reproducible. It obviates the need for a further anaesthetic and avoids potential risks of another procedure. Secondary benefits include avoiding another hospital admission.

Pancreatic duct obstruction after pancreaticojejunostomy: implications for early prediction and prevention of long-term pancreatic complications

BackgroundPancreatic duct obstructions are common in patients with pancreaticoduodenectomy. However, it is often neglected in follow up. This study was to review the outcomes of pancreatic duct obstruction and explore the prevention of pancreatic duct obstruction.MethodsA retrospective analysis of 78 patients undergoing pancreaticojejunostomy without reccurence of disease within 24 months between 2004 and 2014. Pancreatic duct obstruction and long-term pancreatic complications were analysed.ResultsTwenty-five patients developed pancreatic duct obstruction following pancreaticojejunostomy, 13 of whom were found to have long-term pancreatic complications. The presence of pancreatic duct obstruction and early pancreatic obstruction were associated with long-term pancreatic complications, respectively (p = 0.002, p = 0.002). There are 10 patients with pancreatic duct stent more than 24 months, the postoperative median pancreatic parenchymal thickness in these 10 patients (17.1 mm, range 8.0 to 24.7 mm) was not significantly change than the median in them preoperative (16.4 mm, range 7.2 to 24.7 mm; p = 0.747). All of them have no long-term pancreatic complications, though the difference was not significantly (p = 0.068).ConclusionsEarly pancreatic duct obstruction is associated with postoperative pancreatic long-term complications. Sustained internal pancreatic stent may improve pancreatic duct obstruction.

Internal Carotid Artery Stenting in a Case of Recurrent Transient Ischemic Attacks: A Road Less Taken

Internal Carotid Artery Stenting in a Case of Recurrent Transient Ischemic Attacks: A Road Less Taken

EVALUATION OF KIDNEY DRAINAGE OF THE IN ACUTE OBSTRUCTIVE PYELONEPHRITIS

Introduction . Currently, there are no generally recognized indications for the choice of methods of drainage of the upper urinary tract in obstructive uropathy. Both external and internal drainage involve a number of shortcomings affecting the quality of life of the patient. Purpose of research . To evaluate the effectiveness of internal stenting (IC) and puncture nephrostomy (PN) as a method of temporary drainage of the upper urinary tract in acute obstructive pyelonephritis. Materials and methods . During 2012-2017 we observed 156 patients of both sexes aged from 25 to 74 years with the clinic of acute obstructive pyelonephritis against the background of urolithiasis. To restore the passage of urine is made stenting jj-stent or puncture nephrostomy. Materials and methods. During 2012-2017, we observed 156 patients of both sexes aged 25 to 74 years with a clinical picture of acute obstructive pyelonephritis on the background of urolithiasis. To restore the passage of urine is made stenting jj-stent or puncture nephrostomy. Results . Clinically, fever in the PN group was stopped for 1.8±0.5 days, and in the IC group this indicator was 5.5±2.8. In the IC group, 18 (58.1%) patients complained of irritative symptoms of varying severity, and in 9 (29.0%) patients pain syndrome in the lower back associated with myction was noted. No similar complications were observed in the PN group. The inability to install and inadequate function of the IC group in 45.5% of cases required conversion in the PN group. The need for revision of the kidney after the PN group was noted in 0.8% of cases (p<0.01). Conclusion . Subject to adequate techniques of puncture of the kidney and the combined (ultrasonic and radiographic) control the conduct of puncture nephrostomy is a safe method of drainage of the kidney in acute obstructive pyelonephritis, ensuring laying of drainage is of adequate diameter that allows you to get the best results for the relief of pyelonephritis in comparison with the inner stent.

Internal biliary stenting in liver transplantation.

Internal biliary stenting (IBS) was reported to decrease biliary complications after liver transplantation (LT) but data in literature is scarce. The aim of the present study was to evaluate our experience with end-to-end choledoco-choledocostomy during liver transplantation with special focus on the influence of IBS on patient and biliary outcomes. Between 2009 and 2013, 175 patients underwent deceased donor LT with end-to-end choledoco-choledocostomy and were included in the study. Supra-papillary silastic stent was inserted in 67 patients (38%) with small-size (< 5mm) bile ducts (recipient or donor). Endoscopic retrograde cholangiopancreatography (ERCP) was scheduled for IBS removal, 6months after LT. Operative outcomes and survival of patients who received internal stenting (IBS group) were compared with those of patients who did not (no-IBS group). Risk factors for biliary anastomotic complications were identified. Ten patients died (6%) and 104 (59%) experienced postoperative complications. Five-year patient and graft survival rates were 77 and 74%, respectively. Biliary complications were recorded in 61 patients (35%) and were significantly decreased by IBS insertion (p = 0.0003). Anastomotic fistulas occurred in 23 patients (13%) and stenoses in 44 patients (25%). On multivariate analysis, high preoperative MELD scores (p = 0.02) and hepatic artery thrombosis (p < 0.0001) were predictors of fistula; absence of IBS was associated with both fistula (p = 0.014) and stricture (p = 0.003) formation. IBS insertion during LT decreases anastomotic complication.

Treatment of ureterolithiasis with the use of percutaneous antegrade ureterolithotripsy

Study purpose – to assess the possibility of percutaneous antegrade ureterolithotripsy as an alternative treatment for patients with large calculi of the proximal part of ureter. Patients and methods. Results of 75 mini percutaneous antegrade ureterolithotripsy with contact lithotripsy were studied. The mean size of the ureteral calculi was 1.8 ± 0.7 cm. The operations were performed with epidural anesthesia with intravenous sedation, in the patient's position “on the abdomen” in 62 (82.7 %) cases and in the patient's position “on the back” in 13 (17.3 %) cases. Puncture of the renal cavity system was performed with combined ultrasound and fluoroscopic guidance. Accesses were performed through the lower calices group in 14 (18.7 %) cases, through the middle calices group in 39 (52.0 %), and through the upper calices group in 22 (29.3 %) cases. Results. The mean time of mini percutaneous antegrade ureterolithotripsy was 58.5 ± 15.4 min, while the stone free rate was achieved in all 100% of patients. The mean level of hemoglobin drop was not more than 15.5 ± 5.4 GM/DL In the postoperative period, aggravation of pyelonephritis was noted in 8 (10.6 %) patients. Nephrostomy drainage followed percutaneous antegrade ureterolithotripsy in 24 (32.0 %) cases, nephrostomy drainage and internal ureteral JJ stent in 33 (44.0 %), and the operation was ended with a tubeless method with only ureteral JJ stent placement in 14 (18.7%) cases. Nephrostomy drainage, as well as ureteral stants (with tubeless method), were removed in 1–2 days. The mean period of postoperative stay of patients in the hospital was 2.3 ± 0.8 days. It was noted that antegrade fiberureteropyeloscopy is an extremely time-consuming and cost-demanding method, as an alternative to which may be percutaneous antegrade ureterolithotripsy with use of mini-nephroscope tubes. Conclusions. Analysis of urolithiasis treatment with the method of mini percutaneous antegrade ureterolithotripsy indicates that this method is an attractive direction in the treatment of patients with large calculi of the proximal parts of ureter that allows achievement of the full stone free rate state, time of surgical treatment and hospital stay for patients with this pathology reduction.