Site Of Leak Research Articles

Post-traumatic biliopleural fistula treated with endoscopic retrograde cholangiopancreatography: a case report

Thoracobiliary fistulae are a rare disorder caused by iatrogenic injury or trauma. Because these fistulae are uncommon, no standard of care has been established, but non-operative management (NOM) is often advised. As a result, endoscopic retrograde cholangiopancreatography (ERCP) appears to be playing a growing role in the treatment of select cases. A 42-year-old male patient involved in a street fight developed a biliopleural fistula as a result of an abdominal penetrating injury. Even in the lack of a clearly defined site of biliary leak, NOM and ERCP have proven to be safe and effective therapy in this case.

A quantitative deployment scheme of hazardous gas detector

AbstractA hazardous gas detector is an important guarantee for detecting hazardous chemical gas leakage sites, and the traditional detector deployment scheme is inefficient. In this paper, we propose a quantitative deployment scheme of gas detectors by considering various factors that affect gas leakage. First, the leakage scene variables, including leakage source variables and environmental variables, are set. Then, a quantitative deployment model of gas detectors is established to avoid the impact of low‐probability, high‐risk scenes. Then, the artificial bee colony algorithm is improved to solve the model. Finally, the deployment scheme is evaluated from the perspective of economic benefits and risks. The original scheme of a certain chemical industry park is compared with the optimized scheme proposed in this paper. The results show that the cumulative risk value of the optimized scheme is much lower.

Comparison of patterns and rates of cement leakage in percutaneous sacroplasty for sacral insufficiency fractures versus neoplasia.

Percutaneous sacroplasty is a minimally invasive procedure which utilises injection of bone cement into the sacrum for stabilisation of osteoporotic sacral insufficiency fractures (SIF) and neoplastic lesions to relieve pain and improve function. While effective, cement leakage is an important complication associated with the procedure. This study aims to compare the incidence and patterns of the cement leakages following sacroplasty for SIF versus neoplasia and discuss the various patterns of cement leakage and their implications. This retrospective study analysed 57 patients who underwent percutaneous sacroplasty at a tertiary orthopaedic hospital. Patients were divided into 2 groups of SIF (n=46) and neoplastic lesions (n=11) based on their indication for sacroplasty. Pre- and post-procedural CT fluoroscopy was used to assess for cement leakage. The incidence and patterns of cement leakage were both compared among the two groups. A Fisher's exact test was used for statistical analysis. Eleven (19%) patients had cement leakage on post-procedural imaging. The most common sites of cement leakage were into the presacral region (6), followed by sacroiliac joints (4), sacral foramina (3) and posterior sacral (1). There was a statistically significant higher incidence of leakage in the neoplastic group in comparison to SIF group (P-value <0.05). The incidence of cement leakage in the neoplastic group was 45% (n = 5/11) versus SIF 13% (n=6/46). There was a statistically significant higher incidence of cement leak in sacroplasties conducted for the treatment of neoplastic lesions compared to those with sacral insufficiency fracture.

Sacral Dural Tears as a Cause of Spontaneous Intracranial Hypotension

PurposeDural tears at the level of the cervical, thoracic, and lumbar spine cause spontaneous intracranial hypotension (SIH) in patients with a spinal longitudinal extradural CSF collection (SLEC); however, sacral dural tears have rarely been reported so far. This study focuses on sacral dural tears as a cause of SIH.MethodsRetrospective data from SIH patients with confirmed sacral dural tears studied between October 2020 and November 2022 were analyzed with respect to demographic, clinical and imaging features. Digital subtraction myelography (DSM) and lumbar epidural blood patch (EBP) were modified by placing the patient in reversed Trendelenburg position.ResultsOf the SIH patients, 9 (all women; mean age, 38.5 years; mean body mass index, BMI, 22.9) out of 149 had a sacral dural leak (6%) that occurred spontaneously in 7/9, while 2/9 were likely associated with minor trauma. None had a sacral fracture. The mean SIH score was 6.8. All patients showed SLEC on heavily T2-weighted MR myelography (T2-MRM), 4/9 exclusively sacral and 5/9 with partial or complete involvement of the remaining spine. 4/9 had none, but 5/9 had meningeal sacral cysts, 2/5 had large cysts/ectasia. Confirmation of the sacral origin of the leak was provided in 4/9 by T2-MRM, in 2/9 by DSM and 3/9 by CT myelography (CTM) whereas 0/9 revealed the exact site of leak within the sacrum.ConclusionSacral dural tears should be considered as a possible cause for SIH. It is concluded to implement T2-MRM covering the entire sacrum in the standard MRI protocol and propose EBP in the reverse Trendelenburg position as a therapeutic approach.

Safe and secure laparoscopy-assisted jejunostomy tube placement using a percutaneous loop needle device in an infant.

We, herein, report a surgical technique for laparoscopy-assisted jejunostomy tube placement in an infant using a loop needle device to fix the jejunum and abdominal wall. A 3-year-old boy with Down's syndrome underwent nutritional management by gastrostomy due to oral feeding difficulty after radical surgery for congenital duodenal stenosis and following bile duct stenosis. However, intractable gastrostomy site leakage emerged; hence, laparoscopy-assisted gastrostomy takedown and simultaneous laparoscopy-assisted jejunostomy tube placement were planned. After laparoscopy-assisted gastrostomy closure was performed, the jejunum was extracted through the umbilical trocar wound. A jejunostomy tube kit was inserted at the left side of the umbilicus. After tube insertion into the jejunum, the jejunostomy tube was wrapped with four interrupted sutures using the Witzel technique. Suture threads were extracted by percutaneous insertion of a loop needle device, and then, the jejunum was fixed to the abdominal wall. The post-operative course was uneventful. Percutaneous insertion of a loop needle device is useful for fixing a jejunostomy tube to the abdominal wall using the Witzel technique. Our technique is safe, secure and expected to reduce the risk of dislodgement of tube and peritonitis associated with jejunostomy tube placement.

The effect of mechanical bowel preparation on postoperative complications in laparoscopic right colectomy: a retrospective propensity score matching analysis.

To assess whether full bowel preparation affects 30-day surgical outcomes in laparoscopic right colectomy for colon cancer. A retrospective chart review of all elective laparoscopic right colectomies performed for colonic adenocarcinoma between Jan 2011 and Dec 2021. The cohort was divided into two groups-no bowel preparation (NP) group and patients who received full bowel preparation (FP), including oral and mechanical cathartic bowel preparation. All anastomoses were extracorporeal stapled side-to-side. The two groups were compared at baseline and then were matched using propensity score based on demographic and clinical parameters. The primary outcome was 30-day postoperative complication rate, mainly anastomotic leak (AL) and surgical site infection (SSI) rate. The original cohort included 238 patients with a median age of 68 (SD 13) and equal M:F ratio. Following propensity score matching, 93 matched patients were included in each group. Analysis of the matched cohort showed a significantly higher overall complication rate in the FP group (28 vs 11.8%, p = 0.005) which was mostly due to minor type II complications. There were no differences in major complication rates, SSI, ileus, or AL rate. Although operative time was significantly longer in the FP group (119 vs 100min, p ≤ 0.001), length of stay was significantly shorter in the FP group (5 vs 6days, p = 0.001). Aside from a shorter hospital stay, full mechanical bowel preparation for laparoscopic right colectomy does not seem to have any benefit and may be associated with a higher overall complication rate.

Photoelectrochemical detection of superoxide anions released from mitochondria in HepG2 cells based on the synergistic effect of MnO2@Co3O4 core-shell p-n heterojunction

The detection and comparison of the amount of superoxide anion (O2.-) released by different complexes in mitochondrial electron transport chain (ETC) can locate the main electron leakage sites in mitochondria. In order to realize this, we designed an ultrasensitive photoelectrochemical (PEC) sensor by in situ hydrothermal growth of MnO2 nanosheets on Co3O4 nanowires array modified Ti substrate (NWA|Ti). Due to the formation of a core-shell p-n heterojunction with high specific surface area, tight surface contact and plentiful oxygen vacancies (OVs), MnO2@Co3O4 NWA|Ti possesses a strong visible light absorption, high charges transfer and separation ability. The proposed PEC sensor exhibited a wide linear range of 0.1–50000 nM and a low detection limit of 0.025 nM towards H2O2. Due to the rapid conversion of O2.- to H2O2 inside mitochondria, the PEC sensor can indirectly monitor the electron leakage in the ETC. Specifically, four selected mitochondrial inhibitors specifically inhibited the corresponding complex in mitochondria extracted from living HepG2 cells (hepatocellular carcinoma cells), and the H2O2 levels converted from O2.- was measured by the PEC sensor. It is evident that IQ (ubiquinone binding) site of complex I and Qo (ubiquinol oxidation) site of complex III are the key sites at which electron leakage occurred. This study could provide meaningful information for the diagnosis and treatment of certain disease caused by oxidative stress due to the electron leakage.

O031 A systematic review and meta-analysis of the relationship between alcohol consumption and postoperative outcomes in gastrointestinal surgery

Abstract Introduction Alcohol is a modifiable risk factor in patients having planned surgery and problematic drinking is an increasing problem. To date, no systematic review solely focuses on outcomes following gastrointestinal surgery and their relationship with alcohol use. This study aimed to summarize the evidence of the association between preoperative alcohol consumption and postoperative complications in gastrointestinal surgeries. Methods Comprehensive searches of MEDLINE, EMBASE, and Cochrane databases was undertaken to identify original studies investigating the association between preoperative alcohol consumption and postoperative complications occurring within 30 days of surgery. The primary outcome was 30-day mortality risk and secondary outcomes included postoperative complications such as surgical site infections and risk of anastomotic leak. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random effects model. Results In total, 3182 reports were identified and reviewed for eligibility, and data was extracted from 26 studies that met inclusion criteria. 14 studies were included in the meta-analysis. Clearly defined high preoperative alcohol consumption was associated with an increased risk of 30-day mortality (Odds ratio (OR)=1.56; 95% confidence interval (CI):1.07–2.28). High alcohol intake was also associated with an increased risk of anastomotic leak following colorectal surgery (OR 2.17 (95% CI: 1.74–2.72) and an increase in risk of surgical site infections (OR=1.32; 95% CI: 1.15- 1.53). Conclusion Preoperative alcohol consumption was associated with an increased risk of 30-day mortality, risk of anastomotic leakage and surgical site infections. Preoperative modulation of alcohol intake may influence post-operative complications after gastrointestinal surgery.

Complications Rate of Conventional Percutaneous Nephrolithotomy (PCNL) in a tertiary care center

Aim: To observe the complication rate of conventional percutaneous nephrolithotomy (PCNL) in a tertiary care Hospital. Methods: This Retrospective study conducted from January 2016 to January 2020 in the Department of Urology at Lady Reading Hospital in Peshawar, Pakistan.The research included a total of 449 patients who underwent conventional PCNL.Non-contrast CT KUB was performed on all patients before surgery. After passing 6fr Ureteric catheter through a cystoscope in lithotomy position patient was then shifted into prone position. Under the guidance of fluoroscopy, all procedures were carried out while the patient was lying flat and conventional 30FR amplatz sheath was used as working channel. Results: Complications were reported in 46.9% of cases.The majority of the complications occurred in patients with clavien grades I and II, with 120(27%) and 54(12%) patients, respectively. In Grade I complicationstransient feveroccurred in 67(15%) patients treated with antipyretics while 53(12%) patients had nephrostomy site leakage managed with simple pressure dressing at bed site. In grade II complication 45(10%) patients had bleeding which required transfusion and 9(2%) patients developed sepsis treated with parenteral antibiotics. 10(2%) patients developed grade IIIa complication such as persistent bleeding in 4(0.8%) patients managed with percutaneous angioembolization and 6(1.2%) patients required percutaneous drainage of perinephric collection. 25(5.5%) patients had grade IIIb complications, in 24( 5.3%) patients DJ stenting was done for PCS injury or persistent leakage from nephrostomy site while 1(0.2%) patient needed colostomy for colonic injury. Conclusion: The chance of serious complications during percutaneous nephrolithotomy is very minimal. It is also safe, cost effective and well-tolerated. Transient fever or nephrostomy site leakage are the most frequently occurring minor complications often subside spontaneously. Keywords: Nephrostomy, percutaneous nephrolithotomy

Incremental diagnostic yield and clinical outcomes of lateral decubitus CT myelogram immediately following negative lateral decubitus digital subtraction myelogram.

Spontaneous intracranial hypotension (SIH) caused by a spinal cerebrospinal fluid (CSF) leak classically presents with orthostatic headache. Digital subtraction myelography (DSM) has a well-established diagnostic yield in the absence of extradural spinal collection. At our institution, DSM is followed by lateral decubitus CT myelogram (LDCTM) in the same decubitus position to increase diagnostic yield of the combined study. We evaluated the incremental diagnostic yield of LDCTM following negative DSM and reviewed patient outcomes. Retrospective review of consecutive DSMs with subsequent LDCTM from April 2019 to March 2021 was performed. Combined reports were reviewed, and studies with positive DSMs were excluded. Of the exams with negative DSM, only studies with LDCTM reports identifying potential leak site were included. Interventions and follow-up clinical notes were reviewed to assess symptoms improvement following treatment. Of the 83 patients with negative DSMs, 11 (13.2%) had positive leak findings on LDCTMs, and 21 (25.3%) were equivocal. Of 11 positive LDCTMs, 6 leaks were nerve sheath tears (NSTs) and 5 were CSF-venous fistulas (CVFs). 10/11 (90.9%) had intervention and follow-up, with 9/10 (90%) having positive clinical outcome. Of the 21 equivocal LDCTM patients (19 CVFs and 2 NSTs), 15 (71.4%) had interventions and follow-up, with 3/15 (20.0%) with positive clinical outcomes. LDCTM following negative DSM has an incremental diagnostic yield up to 38.6%, with up to 14.5% of positive patient outcomes following treatment. LDCTM should be considered after DSM to maximize diagnostic yield of the combined exam.

Meningoencephalitis Secondary To Cerebrospinal Fluid Leakage From Nasopharyngeal COVID-19 Swab (P6-10.006)

<h3>Objective:</h3> NA <h3>Background:</h3> The WHO regarded the novel coronavirus as an outbreak on January 2020. The preferable initial testing to detect SARS-CoV-2 RNA was from the upper respiratory tract using nucleic acid amplification testing (NAAT) through nasopharyngeal, oropharyngeal, nasal mid-turbinate, or anterior nasal specimen. Although specimen collection is considered safe and adverse events are rare, some reported cases of cerebrospinal fluid leakage were attributed to pharyngeal swab procedures. Therefore, increased awareness of nasal and pharyngeal swab complications is necessary. <h3>Design/Methods:</h3> A 36 years old female known to have chronic idiopathic intracranial hypertension brought to the emergency department with a history of fever, altered level of consciousness, and generalized tonic-clonic seizure. She had unilateral rhinorrhea for three months following a nasopharyngeal COVID-19 swab as part of an in-vitro fertilization workup. Upon assessment in the ED, she was stuporous due to sedation effect. There was no clear rhinorrhea, no papilledema on the fundus exam, and the remaining cranial nerves examination was unremarkable. She had positive meningeal signs. A cloudy cerebrospinal fluid analysis revealed findings of bacterial meningitis with high WBC and protein. She was started on empirical antimeningeal coverage. MRI brain showed a small CSF containing space at the left inferior frontal in the olfactory groove, which is continuous with the adjacent sulci concerning for the CSF leak site. Beta-transferrin was requested by the otolaryngology team and came back positive. After fourteen days of antibiotics, she regained her baseline cognitive and functional status then was discharged in stable condition with close follow-up with neurology, otolaryngology, and MRI cisternography. <h3>Results:</h3> NA <h3>Conclusions:</h3> Our case emphasizes that awareness of potential adverse events related to nasopharyngeal swabs that became part of daily clinical practice and hospital policies must be improved. It also supports existing scattered evidence that an existing idiopathic intracranial hypertension can be associated with cerebrospinal fluid leakage. <b>Disclosure:</b> Dr. Alnafisah has nothing to disclose. Dr. Altowairqi has nothing to disclose.

Effect of injury degree of osteoporotic vertebral compression fracture on bone cement cortical leakage after percutaneous kyphoplasty

To analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications. A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed. Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra ( r=0.493, P<0.001). The incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.

Gd-EOB-DTPA-MRCP to localize bile leakage after liver trauma and surgery: impact on treatment and outcome

ObjectivesBile leakage (BL) is a challenging complication after hepatobiliary surgery and liver trauma. Gadolinium ethoxybenzyl (Gd-EOB-DTPA)–enhanced magnetic resonance cholangiopancreatography (MRCP) is used to diagnose BL non-invasively. We assessed the value of Gd-EOB-DTPA-MRCP in the detection of postoperative and post-traumatic BL hypothesizing that exact identification of the leakage site is pivotal for treatment planning and outcome.MethodsWe retrospectively enrolled 39 trauma and postoperative patients who underwent Gd-EOB-DTPA-MRCP for suspected BL. Three readers rated the presence of BL and leakage site (intraparenchymal, central, peripheral ± aberrant or disconnected ducts). Imaging findings were compared to subsequent interventional procedures and their complexity and outcome.ResultsBL was detected in Gd-EOB-DTPA-MRCP in 25 of patients and was subsequently confirmed. Sites of BL differed significantly between postoperative (central [58%] and peripheral [42%]) and trauma patients (intraparenchymal [100%]; p < 0.001). Aberrant or disconnected ducts were diagnosed in 8%/26% of cases in the postoperative subgroup. Inter-rater agreement for the detection and localization of BL was almost perfect (Κ = 0.85 and 0.88; p < 0.001). Intraparenchymal BL required significantly less complex interventional procedures (p = 0.002), whereas hospitalization and mortality did not differ between the subgroups (p > 0.05).ConclusionsGd-EOB-DTPA-MRCP reliably detects and exactly locates BL in postoperative and trauma patients. Exact localization of biliary injuries enables specific treatment planning, as intraparenchymal leakages, which occur more frequently after trauma, require less complex interventions than central or peripheral leaks in the postoperative setting. As a result of specific treatment based on exact BL localization, there was no difference in the duration of hospitalization or mortality.Clinical relevance statementGd-EOB-DTPA-MRCP is a reliable diagnostic tool for exactly localizing iatrogenic and post-traumatic biliary leakage. Its precise localization helps tailor local therapies for different injury patterns, resulting in comparable clinical outcomes despite varying treatments.Key Points• Gd-EOB-DTPA-MRCP enables adequate detection and localization of bile leakages in both postoperative and post-traumatic patients.• The site of bile leakage significantly impacts the complexity of required additional interventions.• Intraparenchymal bile leakage is commonly seen in patients with a history of liver trauma and requires less complex interventions than postoperative central or peripheral bile leakages, while hospitalization and mortality are similar.

Rational Gastric Conduit Stump Closure Method Using Endo GIA Radial Reload in End-to-Side Anastomosis of the Esophagogastric Conduit.

Background: The lack of tension at the anastomosis site and the blood flow of the gastric conduit are important to prevent anastomotic leakage in the anastomosis of the esophagogastric conduit. This study reports a gastric conduit stump closure method using Endo GIA™ Radial Reload in end-to-side anastomosis of the esophagogastric conduit, especially focusing on blood flow. Methods: A 4-cm conduit was created to ensure an intramural vascular network. The gastric conduit was elevated to the neck through the posterior mediastinal route, and end-to-side anastomosis of the esophagus and gastric conduit was performed using a circular stapler. Closure of the gastric stump with an Endo GIA Radial Reload was performed 2 cm proximal to the anastomosis on the end side of the esophagogastric conduit. The lesser curvature of the stump of the gastric conduit is the most frequent site of anastomotic leakage as it has the least blood flow, and the pressure is highest when the pressure inside the gastric conduit increases. Therefore, the gastric conduit stump was closed using the Endo GIA Radial Reload to resect the intersection of the gastric stump and lesser curvature from which the gastric conduit was created. The gastric conduit stump is gently curved; therefore, the pressure applied to the gastric conduit stump could be dispersed when the intragastric pressure increases. Results: No anastomotic leakage was observed among the 21 patients who underwent this method. Conclusion: This method is a novel anastomosis method to prevent anastomotic leakage in an end-to-side anastomosis of the esophagogastric conduit.

Rapid on-site detection of underground petroleum pipeline leaks and risk assessment using portable gas chromatography-mass spectrometry and solid phase microextraction

Locating underground pipeline leaks can be challenging due to their hidden nature and variable terrain conditions. To sample soil gas, solid-phase microextraction (SPME) was employed, and a portable gas chromatography/mass spectrometry (GC/MS) was used to detect the presence and concentrations of petroleum hydrocarbon volatile organic compounds (pH-VOCs), including benzene, toluene, ethylbenzene, and xylene (BTEX). We optimized the extraction method through benchtop studies using SPME. The appropriate fibre materials and exposure time were selected for each BTEX compound. Before applying SPME, we preconditioned the soil vapour samples by keeping the temperature at around 4 °C and using ethanol as a desorbing agent and moisture filters to minimize the impact of moisture. To conduct this optimisation, airbags were applied to condition the soil vapour samples and SPME sampling. By conditioning the samples using this method, we were able to improve analytical efficiency and accuracy while minimizing environmental impacts, resulting in more reliable research data in the field. The study employed portable GC/MS data to assess the concentration distribution of BTEX in soil vapour samples obtained from 1.5 m below the ground surface at 10 subsurface vapour monitoring locations at the leak site. After optimization, the detection limits of BTEX were almost 100 µg/m3, and the measurement repeatabilities were approximately 5% and 15% for BTEX standards in the laboratory and soil vapour samples in the field, respectively. The soil vapour samples showed a hotspot region with high BTEX concentrations, reaching 30 mg/m3, indicating a diesel return pipeline leak caused by a gasket failure in a flange. The prompt detection of the leak source was critical in minimizing environmental impact and worker safety hazards.

Ring annuloplasty, optionally combined with edge-to-edge leaflet plications, should be amended with subvalvular repair techniques to efficaciously treat tricuspid regurgitation with severe tethering.

This study aimed to evaluate the outcomes of tricuspid annuloplasty with/without additional edge-to-edge plications in patients with functional tricuspid regurgitation and to clarify the impact of tethering on surgical outcomes. This retrospective observational study included patients with moderate or greater functional tricuspid regurgitation who underwent initial tricuspid valve repair between January 2008 and December 2021. The patients were divided into two groups based on whether they had tethering (preoperative tethering area ≥0.75 cm2). All patients underwent annuloplasty, and edge-to-edge plications were added at the regurgitant leakage site identified by saline tests. The surgical outcomes of each group, and the effect of tethering on recurrent moderate or greater tricuspid regurgitation were evaluated. One-hundred and thirty-three patients were included in this study. During the follow-up period of 55.3 (standard deviation: 44.9) months, the 5-year survival rates were 78.4% in patients without tethering and 76.1% in patients with tethering (P = 0.78). The 5-year cumulative incidence rates of readmission for heart failure and recurrent tricuspid regurgitation were 10.8% and 1.3% in patients without tethering and 23.0% and 29.5% in patients with tethering, respectively (P = 0.12 and <0.001). Multivariable analyses revealed that the preoperative and predischarge tethering areas predicted recurrent tricuspid regurgitation. A large tethering area remained postoperatively in patients with tethering. In patients without tethering, annuloplasty and additional edge-to-edge plications are effective in avoiding recurrent tricuspid regurgitation with satisfactory midterm clinical outcomes. However, in patients with tethering, these procedures resulted in residual tethering, which could be leading to recurrent tricuspid regurgitation.

Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study.

To compare leakage pressures of vesicourethral anastomosis (VUA) performed with conventional and unidirectional barbed sutures in canine cadaveric tissue. Experimental, ex-vivo, randomized study. A total of 24 male canine bladders with the urethra. Specimens after prostatectomy were randomly divided into a unidirectional barbed suture (UBS) or a conventional suture (C) group. For the UBS group, the VUA was performed with 4-0 unidirectional barbed sutures. For the C group, the VUA was performed with 4-0 monofilament absorbable suture. The VUA was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and the number of suture bites were recorded. The median suturing time was 12.70 minutes (range: 7.50-16.10min) for the UBS group and 17.30 minutes (range: 14.00-21.30 min) for the C group (p < .0002). The median leakage pressure was 8.60 mmHg (range: 5.00-17.20 mmHg) for the UBS group and 11.70 mmHg (range: 6.00-18.50 mmHg) for the C group (p=.236). The median number of suture bites was 14 (range:11-27) for the UBS group and 19 (range:17-28) for the C group (p=.012). Unidirectional barbed suture does not statistically affect the acute leakage pressure of VUA in normal cadaveric specimen. It resulted in a shorter surgical time and fewer suture bite placements. A urinary catheter will still be required when a unidirectional barbed suture is used to complete a VUA in dogs to prevent extravasation of urine in the postoperative period.

Evaluation of Chylothorax Using Dynamic Contrast-Enhanced Magnetic Resonance Lymphangiography After Lung Cancer Surgery.

Background: To determine the role of dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) in the management of postoperative chylothorax after lung cancer surgery. Methods and Results: Between July 2017 and November 2021, patients who developed postoperative chylothorax following pulmonary resection and mediastinal lymph node dissection were assessed and those who underwent DCMRL for the evaluation of chyle leak were evaluated. The findings of DCMRL and conventional lymphangiography were compared. The incidence of postoperative chylothorax was 0.9% (50/5587). Among the patients with chylothorax, a total of 22 patients (44.0% [22/50]; mean age, 67.6 ± 7.9 years; 15 men) underwent DCMRL. Treatment outcomes were compared between patients with conservative management (n = 10) and those with intervention (n = 12). The patients demonstrated unilateral pleural effusion, ipsilateral to the operation site, and showed right-sided dominance. The most frequent site of thoracic duct injury showing contrast media leakage was visualized at the subcarinal level. No DCMRL-related complication occurred. DCMRL showed comparable performance to conventional lymphangiography in visualizing the central lymphatics, including cisterna chyli (DCMRL vs. conventional lymphangiography, 72.7% vs. 45.5%, p = 0.25) and thoracic duct (90.9% vs. 54.5%, p = 0.13), and in localizing thoracic duct injury (90.9% vs. 54.5%, p = 0.13). On follow-up, the amount of chest tube drainage after lymphatic intervention showed a significant difference over time from that after medical treatment only (p = 0.02). Conclusion: DCMRL can provide detailed information about the leak site and the central lymphatic anatomy in patients with chylothorax after lung cancer surgery. The findings of DCMRL can guide subsequent treatment planning for optimal outcomes.

The "Crossing Collection Sign": A Diagnostic Tool on Spine Magnetic Resonance Imaging For Localizing Cerebrospinal Fluid Leak.

The aim of the study is to determine whether the site of "cross" between ventral and dorsal spinal longitudinal extradural CSF collections (SLECs) seen on magnetic resonance imaging during initial workup of patients with suspected CSF leaks can predict the subsequently confirmed leakage site on computed tomography myelography or surgical repair. This was an institutional review board-approved, retrospective study performed from 2006 to 2021. Patients with SLECs who underwent total spine magnetic resonance imaging at our institution, followed by myelography and/or surgical repair for CSF leak, were included. Patients with incomplete workup including lack of computed tomography myelography and/or surgical repair and patients severely motion degraded imaging were excluded from our study. The site of cross between ventral and dorsal SLECs was defined as the "crossing collection sign" and was compared with the anatomically confirmed site of leak on myelography and/or at surgical repair. Thirthy-eight patients met inclusion criteria with 18 females and 11 males ranging in age from 27 to 60 years (median, 40 years; interquartile range, 14 years). The crossing collection sign was seen in 76% of patients (n = 29). The distributions of confirmed CSF leak were as follows: cervical (n = 9), thoracic (n = 17), and lumbar spine (n = 3). The crossing collection sign predicted the site of CSF leak in 14 of 29 patients (48%) and was within 3-vertebral segments in 26 of 29 cases (90%). The crossing collection sign can help prospectively identify spinal regions with highest likelihood for CSF leak in patients with SLECs. This can potentially help optimize the more invasive subsequent steps in the workup for these patients, including dynamic myelography and surgical exploration for repair.

Efficacy of indocyanine green systemic administration for bile leak detection after hepatectomy: a protocol for a prospective single-arm clinical trial with a historical control group

IntroductionBile leakage (BL) after hepatectomy cannot always be detected with conventional methods; moreover, BL cannot be completely prevented. Recently, navigation procedures with indocyanine green (ICG) have been reported. Furthermore, we...