Low Long-term Complication Rate Research Articles

Long-Term Outcome After Canaloplasty and Phacocanaloplasty in Primary Open Angle Glaucoma.

Canaloplasty and phacocanaloplasty achieve a statistically significant intraocular pressure (IOP)-reduction for up to 11 years and decrease the long-term need for glaucoma medications. Both procedures have a low long-term complication rate. To evaluate the long-term outcome of canaloplasty with and without cataract surgery in primary open angle glaucoma (POAG) patients. In all, 48 eyes of 34 patients with POAG who successfully received canaloplasty alone (group A, n=28) or with phacoemulsification (group B, n=20) were retrospectively analyzed. Demographic data, IOP, and IOP-lowering medication were recorded presurgery and postsurgery with a follow-up of up to 14 years. The mean follow-up time in group A was 91.4±45.0 months. Mean IOP dropped from 22.0±3.8mmHg at baseline to 14.0±3.3, 14.3±3.1, 14.4±3.8, and 16.5±1.2mmHg at 1, 4, 7, and 10 years, respectively. IOP-lowering medication count decreased from 1.5±1.0 at baseline to 0.1±0.4, 0.3±0.6, 0.6±0.9, and 0.9±1.1 at 1, 4, 7, and 10 years, respectively. The mean follow-up time in group B was 109.1±25.7 months. Mean IOP dropped from 24.5±6.0 at baseline to 13.8±2.9, 14.9±3.6, 15.3±2.9, and 14.8±2.0mmHg at 1, 4, 7, and 10 years, respectively. IOP-lowering medication count decreased from 2.2±1.2 before surgery to 0.0, 0.1±0.3, 0.1±0.2, and 0.5±0.9 at 1, 4, 7, and 10 years, respectively. Canaloplasty and phacocanaloplasty achieved a comparable decrease in IOP and glaucoma medication count with a low complication rate. Both procedures showed a high long-term success rate.

Laparoscopic totally extraperitoneal hernia repair in patients with a history of previous abdominopelvic surgery

A retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic surgery, aiming to determine the feasibility of totally extraperitoneal (TEP) repair within this population. All patients who underwent elective TEP inguinal hernia repair by one consultant surgeon across three London hospitals from January 2017 to May 2023 were retrospectively analysed to assess perioperative outcomes. Two hundred sixty-two patients were identified, of whom two hundred forty-three (93%) underwent laparoscopic TEP repair. The most frequent complications were haematoma (6.2%) and seroma (4.1%). Recurrence occurred in four cases (1.6% of operations, 1.1% of hernias). One hundred eighty-four patients (76%) underwent day-case surgery. There were no mesh infections or explanations, vascular or visceral injuries, port-site hernias, damage to testicle, or persisting numbness. There were no requirements for blood transfusion, returns to theatre, or readmissions within 30 days. There was one conversion to open and one death within 60 days of surgery. Eighty-three (34%) had a history of previous AP surgery. There was no significant difference in perioperative outcomes between the AP and non-AP arms. This finding carried true for subgroup analysis of 44 patients whose AP surgical history did not include previous inguinal hernia repair and for those undergoing repair of recurrent hernia. In expert hands, laparoscopic TEP repair is associated with excellent outcomes and low rates of long-term complications, and thus should be considered as standard for patients regardless of a history of AP surgery.

Long-term mesh-related complications from minimally invasive intraperitoneal onlay mesh for small to medium-sized ventral hernias

IntroductionIntraperitoneal onlay mesh (IPOM) placement for small to medium-sized hernias has garnered negative attention due to perceived long-term risk of mesh-related complications. However, sparse data exists supporting such claims after minimally invasive (MIS) IPOM repairs and most is hindered by the lack of long-term follow-up. We sought to report long-term outcomes and mesh-related complications of MIS IPOM ventral hernia repairs.Methods and proceduresAdult patients who underwent MIS IPOM ventral hernia repair at our institution were identified in the Abdominal Core Health Quality Collaborative database from October 2013 to October 2020. Outcomes included hernia recurrence and mesh-related complications or reoperations up to 6 years postoperatively.ResultsA total of 325 patients were identified. The majority (97.2%) of cases were elective, non-recurrent (74.5%), and CDC class I (99.4%). Mean hernia width was 4.16 ± 3.86 cm. Median follow-up was 3.6 (IQR 2.8–5) years. Surgeon-entered or patient-reported follow-up was available for 253 (77.8%) patients at 3 years or greater postoperatively. One patient experienced an early small bowel obstruction and was reoperated on within 30 days. Two-hundred forty-five radiographic examinations were available up to 6 years postoperatively. Twenty-seven patients had hernia recurrence on radiographic examination up to 6 years postoperatively. During long-term follow-up, two mesh-related complications required reoperations: mesh removed for chronic pain and mesh removal at the time of colon surgery for perforated cancer. Sixteen additional patients required reoperation within 6 years for the following reasons: hernia recurrence (n = 5), unrelated intraabdominal pathology (n = 9), obstructed port site hernia (n = 1), and adhesive bowel obstruction unrelated to the prosthesis (n = 1). The rate of reoperation due to intraperitoneal mesh complications was 0.62% (2/325) with up to 6 year follow-up.ConclusionIntraperitoneal mesh for repair of small to medium-sized hernias has an extremely low rate of long-term mesh-related complications. It remains a safe and durable option for hernia surgeons.

Total İmplante Venöz Erişim Portlarında İnternal Juguler ve Subklavian Ven Yaklaşımlarının Karşılaştırılması

The purpose of this study was to retrospectively review the outcome and complications of totally implantable venous-access ports (TIVAPs) inserted via low internal jugular vein (IJV) approach under ultrasound guidance versus subclavian vein (SCV) approach.304 cancer patients who could be followed up to the time of catheter removal or to the end of the study period were enrolled in the study. 200patients had the placement of TIVAPs via IJV and 104 patients via SCV. Statistical analysis showed that there were no differences with regard to the patient characteristics and to the site of primary malignancy in two groups, while the large majority of the TIVAPs had been inserted in the right side. The average port dwelling time was higher in the IJV group compared to the SCV group, the difference was statistically significant (p<0.001). Complications were more frequent in the SCV than in the IJV approach (12 patients vs. 3 patients). Our analysis revealed that TIVAP is a safe and effective route for long-term administration of chemotherapy, and the placement of TIVAPs via the right IJV is associated with a low long-term complication rate.

Revitalizing Hands: A Comprehensive Review of Anatomy and Treatment Options for Hand Rejuvenation.

Dorsal hand rejuvenation is gaining popularity as a solitary procedure and adjunct to face and neck rejuvenation treatments. As the hands age, the skin loses elasticity and becomes more translucent, the veins, joints, and tendons appear more prominent, and the bones become more noticeable. These changes are due to intrinsic and extrinsic factors. Current treatment methods include the injection of dermal fillers and autologous fat grafting. Anatomic studies to ensure the successful implementation of rejuvenation procedures identified three separate fascial layers in the dorsum, from superficial to deep. More recent re-evaluations revealed a less distinct, inseparable, sponge-like fascial layer. All authors agree that the superficial dermal layer is probably the optimal location for the injection of volumizing materials because it is free of anatomical structures. Many methods for harvesting, preparing, and injecting fat grafts to the dorsum of the hand have been described in the past three decades. Both filler and fat-graft procedures are performed on an ambulatory basis under local anesthesia. Good results with low postoperative and long-term complication rates and high patient satisfaction have been reported.

Long-Term Outcomes after Adolescent Bariatric Surgery.

Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for adolescents with severe obesity, but no long-term studies are available with more than10 years of follow-up data to document sustained improved outcomes. A total of 96 patients who completed MBS at 21 years of age or younger in a tertiary academic center 2002 to 2010 were contacted for a telehealth visit. Body weight, comorbidity status, social/physical function status, and long-term complications were evaluated 10 to 18 years after surgery. Mean participant (83% female, 75% Hispanic) age at MBS was 18.8 (±1.6) years (median age 19 years, range 15-21 years), and median pre-MBS BMI was 44.7 kg/m 2 (SD 6.5). At follow-up (mean 14.2 [±2.2] years) post-MBS (90.6% Roux-en-Y gastric bypass [RYGB] or 8.3% laparoscopic adjustable gastric banding [LAGB]) mean total body weight decreased by 31.3% (interquartile range [IQR] 20.0% to 38.9%); 32.0% (IQR, 21.3% to 40.1%) among RYGB participants and 22.5% (IQR, 0.64% to 28.3%) among LAGB participants. Patients with pre-MBS hyperlipidemia (14.6%), asthma (10.4%), and diabetes/hyperglycemia (5.2%) reported 100% remission at follow-up (p < 0.05 for all). Pre-post decrease in hypertension (13.5% vs 1%, p = 0.001), sleep apnea (16.7% vs 1.0%, p < 0.001), gastroesophageal reflux disease (13.5% vs 3.1%, p = 0.016), anxiety (7.3% vs 2.1%, p = 0.169), and depression (27.1% vs 4.2%, p < 0.001) were also found. Significant sustained reductions in weight and comorbidities, and low rates of long-term complications, a decade or more after completing MBS as an adolescent were found. These findings have important implications for adolescents who may be considering MBS for weight reduction and overall health improvements that extend into adulthood.

Digital model of radiocephalic arteriovenous fistula for decision support and improvement of maturation

The native arteriovenous fistula (AVF) is the recommended first intention vascular access in dialysis patients. This non-physiological surgical construction implies many anatomical and hemodynamic parameters. Radio-cephalic AVFs are preferred due to a low rate of long-term complications. The early rates of thrombosis and failure of maturation of the distal AVFs remain high, between 20 and 50%. The aim of this work was to obtain a faithful digital model simulating the flow of a radiocephalic AVF to guide the surgeon in the choice and the technical realization of AFVs in order to improve maturation.

A novel laparoscopic non-resective technique for the management of strangulated Richter's hernia.

The incidence of Richter's hernias has risen in part due to the increment use of laparoscopic surgery. The standard technique to manage a strangulated Richter's hernia is bowel resection with anastomosis. Alternatively, invagination of the necrotic area in the enterocele maintains a clean surgical field and allows for the use of a mesh when closing the abdominal wall. In a sterile surgical field, the use of a prosthetic reinforcement has shown advantages, including low rates of long-term complications and reduced rates of hernia recurrence. A 35-year-old male presented with a strangulated Richter's hernia in a periumbilical abdominal wall defect. In the Operating Theatre, the necrotic segment was managed laparoscopically by plication with invagination allowing for abdominal wall reconstruction with a mesh. We propose the laparoscopic repair of Richter's hernia with plication and invagination whenever feasible, therefore avoiding a bowel resection and maintaining a clean surgical field; which allows for use of prosthetic mesh. • Richter hernias are becoming more common, mostly as a result of port-site closure defects after laparoscopic surgery • Avoiding bowel resection will increase the likelihood of a successful long-term mesh implant and decrease hernia recurrences. • Likewise, avoiding a bowel anastomosis will prevent additional contamination while simplifying the procedure.

Sacral-Alar-Iliac (SAI) Fixation in Children With Spine Deformity: Minimum 10-Year Follow-Up.

Sacral-alar-iliac (SAI) screws are utilized to achieve pelvic fixation in spine deformity patients. The primary purpose of this study is to investigate the long-term outcomes of pediatric patients with scoliosis treated with posterior spinal fusion and SAI fixation at 10-year clinical and radiographic follow-up. We reviewed the clinical and radiographic records of patients aged 18 years or below treated for scoliosis with posterior spinal fusion using SAI fixation. Pelvic obliquity and the major coronal curve were determined at the preoperative visit and 6-week, 1-year, 5-year, and 10-year postoperative visits. SAI screw-specific data collected included screw dimensions, rate of screw revision, pain at the SAI screw sites, presence of lucency >2 mm around the screw, screw loosening or breaking, and deep surgical site infections. Ninety-seven of 151 patients (75%) were included. The average age at index surgery was 13.5±3.1 years, and the most common diagnosis was cerebral palsy (67%). The mean duration of follow-up was 11±3 years. The mean pelvic obliquity measured 20±8.0 degrees preoperatively, and 8.7±4.0 degrees at the 10-year follow-up. There were no significant difference in pelvic obliquity when comparing the 10-year follow-up visit with the 6-week postoperative follow-up. Average screw dimensions were 8.4×68.8 mm. By the 10-year follow-up, 4 patients (4%) had at least 1 SAI screw-related complication. Of these patients, 2 (2%) had pain at 1 SAI screw, 4 (4%) had lucency around the screw, and 3 (3%) had broken or loose screws. Two (2%) required SAI screw revision because of late deep wound infection, and underwent exchange with a longer screw. There were no intrapelvic protrusions, vascular, or neurological complications. SAI screws are a safe and effective method for pelvic fixation in children with spinal deformity. The outcomes at ≥10 years are satisfactory, with low rates of long-term complications and excellent postoperative correction and subsequent maintenance of coronal curvature and pelvic obliquity over time. Level IV.

“Long-term outcome in endometrial cancer patients after robot-assisted laparoscopic surgery with sentinel lymph node mapping”

ObjectiveSentinel Lymph Node (SLN) mapping is increasingly used as an alternative to lymphadenectomy in endometrial cancer. There is, however, limited data regarding the clinical outcome and survival after SLN mapping. The aim of the study was to determine long-term outcome data in endometrial cancer patients undergoing robot-assisted laparoscopic surgery and SLN mapping.Study design: Retrospective cohort study of 108 patients with primary endometrial cancer who underwent robot-assisted laparoscopic surgery and sentinel lymph node mapping using the Memorial Sloan Kettering Cancer Center (MSKCC) algorithm with near-infrared fluorescence detection of indocyanine green for endometrial cancer, from November 20th 2012 to January 1st 2016 at St. Olav’s Hospital in Norway. The primary endpoint was recurrence-free survival. Secondary endpoints were overall survival and treatment complications. ResultsAmong 108 patients operated in accordance with the SLN algorithm, 17 (16%) had lymph node metastases. Adjuvant chemotherapy was administered on indication endometrial cancer to 36 (33%) of the patients. After a median follow up of 75 months (range 61–98), five (4.6%) patients had recurrence, and three patients had died from the disease. Four of the patients who had recurrence had lymph node metastasis at diagnosis. The 5-year recurrence-free survival was 95.4% (95% CI, 91.5 – 99.3). The 5-year disease-specific survival was 97.2% (95% CI, 94.1 – 100.3). The 5-year overall survival was 92.6% (95% CI, 87.7 – 97.5). Peripheral neuropathy after chemotherapy was the most common complication (9.3%), followed by lower limb lymphedema (2%) and postoperative hernia (2%). ConclusionThe present study demonstrated excellent oncologic outcome and low long-term treatment complication rate in patients treated according to the SLN algorithm more than five years after diagnosis.

Effect of Age on Complications Rate and Surgical Outcomes in Women Undergoing Laparoscopic Sacrohysteropexy and Sacrocolpopexy

Study ObjectiveTo compare perioperative and long-term outcomes of laparoscopic sacrohysteropexy/sacrocolpopexy in different groups of age. DesignThis was a retrospective cohort study. Patients were evaluated preoperatively and postoperatively (starting from 1 month after surgery and then annually). SettingThe department of functional pelvic surgery and oncology, a tertiary care center. PatientsAll patients who underwent laparoscopic sacrohysteropexy/sacrocolpopexy, between July 2005 and December 2019. InterventionsLaparoscopic sacrohysteropexy/sacrocolpopexy. Measurements and Main ResultsThe study population was divided into 3 groups, according to age at the time of surgery: group 1, <65 years; group 2, between 65 and 75 years, and group 3, >75 years. The primary outcome was the rate of perioperative complications. The secondary outcome was the comparison of long-term results among the groups. A total of 330 patients were included: in group 1, 183 patients (mean age 53.4 ± 8.2), in group 2, 92 patients (mean age 69.2 ± 2.9), and in group 3, 55 patients (mean age 79.3 ± 3.5). The overall perioperative complications rate (up to 30 days after surgery) was 5.7%. No differences among the groups in operative details and rates of perioperative complications were observed. During the follow-up period, 37 patients (11.2%) presented with prolapse recurrence (objective and/or subjective); the rates of prolapse recurrence and long-term complications were similar among the groups. Similarly, the groups did not differ in postoperative functional results except for postoperative stress urinary incontinence. A surgery for stress urinary incontinence was more common among patients in group 3 (group 1, 13.4%; group 2, 11.9%; group 3, 31.3%; p = .008). ConclusionLaparoscopic sacrohysteropexy/sacrocolpopexy is associated with low rates of perioperative and long-term complications. We did not find a difference in rates of complications and/or long-term outcomes, between different age groups.

Surgical Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in Patients with Open-Angle Glaucoma - A Retrospective Case Series.

To evaluate the outcome of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG). A retrospective case series of patients with uncontrolled OAG treated by GATT at the cantonal Hospital Lucerne, a tertiary referral center, between October 2018 and July 2019 with a minimal 6-month follow-up period. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, and complications. Thirty-one eyes of 29 patients with a mean age of 70.9 years and a minimal follow-up period of 6 months were included in this study. Twenty eyes were treated for pseudoexfoliation (64.5%), seven for primary open-angle (22.6%), three for pigmentary (9.7%), and one for traumatic (3.2%) glaucoma. Twenty-six eyes had data at the 6-month follow-up and 12 eyes at the 12-month follow-up. Twenty-two eyes (70.9%) were pseudophakic prior to the operation. Mean preoperative IOP was 33 mmHg (standard deviation [SD] 8.0 mmHg). The postoperative IOP was 13.9 mmHg [SD 2.2] at the 6- and 13.9 mmHg [SD 3.1] at the 12-month follow-up. The postoperative IOP evolution translated into a 58% decrease between 6 and 12 months (p < 0.001). Thirteen patients (41.9%) were treated with oral Diamox prior to GATT. The number of antiglaucoma medications decreased from a preoperative average of 2.9 [SD 1.2] to postoperative 1 [SD 1] drug (p < 0.001). The most frequent adverse event was the occurrence of postoperative hyphema. Hyphema was observed in 21 (68.0%), 7 (22.6%), and 2 (6.4%) eyes at days 1, 7, and 30 after GATT, respectively. Intraocular hypertension over 25 mmHg was seen in eight eyes (25.8%), and in four of them, a steroid response was suspected. One patient developed an anterior uveitis and a macular edema. GATT is an effective and safe intervention for OAG, particularly in pseudoexfoliation glaucoma (PEX). The advantages of GATT compared to filtration surgery are the low rate of long-term complications and that the intervention is feasible even when difficult conjunctival conditions are encountered.

A watchful waiting approach for newly diagnosed Crohn’s disease patients with an inflammatory phenotype

An early treat-to-target approach in Crohn's disease (CD) patients is recommended to avoid complications. However, CD may not always progress despite lack of treatment, thus exposing some patients to unnecessary side effects. We aimed to examine whether newly diagnosed CD patients with an inflammatory phenotype can benefit from a watchful waiting approach. This retrospective cohort study followed CD patients with an inflammatory phenotype who were diagnosed between 2010 and 2015 and followed for at least 1year. A watchful waiting approach was defined as maintenance therapy with 5-ASA medication only or no treatment during the first year of diagnosis or longer. Disease complications were defined as need for surgery or change in disease phenotype. Eighty-six patients were included and followed-up for 57.0 ± 29.0months. Thirty-seven patients were managed with a watchful waiting approach and 49 with an early therapeutic intervention. The majority of patients (83.8%) in the watchful waiting group did not develop disease complications. In this group, there was no difference in clinical disease severity (stools per day, 2.7 ± 1.7 vs 3.3 ± 1.0, P = 0.39; abdominal pain, 74.2 vs 50.0%, P = 0.24) between those who did not develop complications and those who did. Smoking was associated with a complicated course (multivariate analysis: OR = 1.98, 95% CI 1.06-3.71, P = 0.03). A watchful waiting approach of newly diagnosed CD patients with an inflammatory phenotype may be a feasible option, with low long-term complication rate specifically in nonsmoking patients.

Physiologic Decompression of Lumbar Spinal Stenosis Through Anatomic Restoration Using Trans-Kambin Oblique Lateral Posterior Lumbar Interbody Fusion (OLLIF): A Retrospective Analysis.

IntroductionLumbar spinal stenosis (LSS) is one of the most common indications for spinal surgery. Traditionally, decompression is achieved by removing bony and ligamentous structures through open surgery. However, recent studies have shown that symptomatic relief can be accomplished in many patients by increasing intervertebral and interpedicular height using fusion alone. In this study, we evaluate whether trans-Kambin oblique lateral lumbar interbody fusion (OLLIF) can effectively and safely relieve symptoms of LSS when an indication for fusion is present.MethodsThis is a retrospective single surgeon cohort study of 187 patients with LSS who underwent 189 OLLIF procedures between 2012 and August 2, 2019. Inclusion criteria for this study were age >18 years with symptoms of LSS, including pain, sensory, and motor deficits, and an additional indication for fusion, which included spondylolisthesis, degenerative disk disease, disk herniation, or scoliosis. Exclusion criteria were the bony obstruction of the approach, osteogenic spinal canal stenosis, large facet hypertrophy, and listhesis grade II or greater. The primary outcome was a change in the Oswestry Disability Index (ODI) one year after surgery. Secondary outcomes were the resolution of radiculopathy at the first follow-up visit and one year after surgery, complication rates, surgery time, blood loss, and hospital stay.ResultsODI improved from 52% pre-op to 37% at the one-year follow-up. At the first follow-up, radiculopathy had resolved in 39% of patients, and 72% of patients experienced improvement of 50% or greater. One year after surgery, radiculopathy had resolved in 52% of patients and 74% experienced improvement of 50% or greater. Single-level surgeries required 56.4±21.5 minutes, with a mean hospital stay of 1.6‑±2.4 days. Nerve irritation occurred in 12% of patients at the first postoperative follow-up and persisted in 6.8% of patients one year after surgery. There was one case each of persistent weakness at one year, infection, and cage subsidence.ConclusionTrans-Kambin OLLIF delivers anatomic restoration of intradiscal and interpedicular distance, which results in physiologic decompression of lumbar spinal stenosis in patients undergoing lumbar fusion for degenerative or herniated disk disease, spondylolisthesis, or scoliosis. Amongst patients with LSS, OLLIF results in significant improvement of radiculopathy and patient-reported disability in the majority of patients with low rates of long-term complications. Unlike other minimally invasive surgery (MIS) fusions, OLLIF can be safely used from T12-S1.

Percutaneous treatment of vascular access-site complications: a ten years\u2019 experience in two centres

BackgroundThe spread of percutaneous arterial catheterization in diagnostic and therapeutic procedures has led to a parallel increase of vascular access site complications. The incidence of these events is between 0.2–1%. A detailed analysis of injuries by type of procedure shows a higher incidence of injuries after therapeutic procedures (3%) than those observed for diagnostic ones (1%), due to the greater size of the vascular devices used and the necessity to frequently administer anticoagulant and antiplatelet therapy during procedures. The iatrogenic arterial injuries requiring treatment are the pseudoaneurysm, arteriovenous fistula, arterial rupture and dissection. Less frequent complications include distal embolization of the limbs, nerve damage, abscess and lymphocele.Moreover, the use of percutaneous vascular closure devices (VCD) has further expanded the types of complications, with an increased risk of stenosis, thrombosis, distal embolism and infection. Our work aims to bring the personal 10 years’ experience in the percutaneous treatment of vascular access-site complications.ResultsNinety-two pseudoaneurysms (PSA), 12 arteriovenous fistulas (AVF), 15 retrograde dissections (RD) and 11 retroperitoneal bleedings (RB) have been selected and treated. In 120/130 cases there were no periprocedural complications with immediate technical success (92.3%). Nine femoral PSA, treated with percutaneous ultrasound-guided thrombin injection, showed a failure to close the sac and therefore they were treated by PTA balloon inflation with a contralateral approach and cross-over technique. Only one case of brachial dissection, in which the prolonged inflation of the balloon has not led to a full reimbursement of the dissection flap, was then surgically repaired. At the 7 days follow-up, complications were two abscesses in retroperitoneal bleedings, treated by percutaneous drainage. At 3 months, acute occlusion of 3 covered femoral stents occurred, then treated by loco-regional thrombolysis and PTA. A total of 18 major complications was recorded at 2 years, with a complication rate at 2 years of 13.8%.ConclusionsThe percutaneous treatment of vascular access-site complications is the first-choice treatment. It represents a safe and effective option, validated by a high technical success rate and a low long-term complication rate, that allows avoiding the surgical approach in most cases.

Five-year results after resleeve gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) has become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable severe acid reflux after primary LSG can necessitate further interventions. The aim of our study was to evaluate long-term results 5 years after resleeve gastrectomy (ReSG). Private hospital, France. The study included all patients with failure after LSG who underwent ReSG between October 2008 and January 2014. The patients underwent radiologic evaluation, and an algorithm of treatment was proposed. We analyzed the 5-year outcomes concerning weight loss and long-term complications after ReSG. A total of 52 patients (46 women; mean age 40.2 yr) with a mean body mass index (BMI) of 39.4 kg/m2 underwent ReSG. The mean interval time from the primary LSG to ReSG was of 27.8 months (11-72 mo). The indication for ReSG was inadequate weight loss (28 patients; 53.8%), weight regain (22 patients; 42.3%), and gastroesophageal reflux disease (2 patients; 3.8%). In 35 cases the contrast agent (diatrizoate meglumine/diatrizoate sodium solution [Gastrografin]) swallow results were interpreted as primary dilation and in the remaining 17 cases as secondary dilation. One patient died from gynecologic cancer. Of the remainder, 3 patients underwent single-anastomosis duodenoileal bypass, 5 patients underwent Roux-en-Y gastric bypass, and 1 patient underwent a second ReSG for reflux. A total of 39 of 42 patients with ReSG as definitive procedure had available data at 5-year follow-up. The mean percentage of excess BMI loss was 63.7%. Of the 39 patients, 28 (71.8%) had >50% excess BMI loss at 5 years. Eight of the 11 patients with weight loss failure (<50% excess BMI loss) after ReSG were diagnosed with secondary or diffuse dilation on preoperative imaging; the remaining 3 patients had been operated in our early initial experience with the resleeve procedure. All cases were completed by laparoscopy with no intraoperative incidents. In terms of complications, we recorded 1 leak, 2 stenoses, and 2 cases of bleeding with no mortality. At 5 years postoperative, the ReSG as a definitive bariatric procedure remained effective for 53.8%. The results appear to be more favorable especially for the non-super-obese patients and for those with primary dilation. ReSG is a well-tolerated bariatric procedure with a low long-term complication rate. Further prospective clinical trials are required to compare the outcomes of ReSG with those of Roux-en-Y gastric bypass or single-anastomosis duodenoileal bypass for weight loss failure after LSG.

Life beyond 5 Years after TAVI: Patients' Perceived Health Status and Long-Term Outcome after Transcatheter Aortic Valve Implantation.

Background Transcatheter aortic valve implantation (TAVI) is currently recommended for patients with severe aortic stenosis at intermediate or high surgical risk. The decision process during TAVI evaluation includes a thorough benefit-risk assessment, and knowledge about long-term benefits and outcomes may improve patients' expectation management. Objective To evaluate patients' perceived health status and self-reported long-term outcome more than 5 years after TAVI. Methods and Results Demographic and procedure data were obtained from all patients treated with TAVI at our institution from 2006 to 2012. A cross-sectional survey was conducted on the patients alive, measuring health status, including the EQ-5D-5L questionnaire, and clinical outcomes. 103 patients (22.8%) were alive at a median follow-up period of 7 years (5.4–9.8). 99 (96%) of the 103 patients were included in the final analysis. The mean age at follow-up was 86.5 years ± 8.0 years, and 56.6% were female. Almost all patients (93.9%) described an improvement of their quality of life after receiving TAVI. At late follow-up, the mean utility index and EQ-VAS score were 0.80 ± 0.20 and 58.49 ± 11.49, respectively. Mobility was found to be the most frequently reported limitation (85.4%), while anxiety/depression was the least frequently reported limitation (19.8%). With respect to functional class, 64.7% were in New York Heart Association (NYHA) class III or IV, compared to 67.0% prior to TAVI (p=0.51). Self-reported long-term outcomes revealed mainly low long-term complication rates. 74 total hospitalizations were reported after TAVI, and among those 43% for cardiovascular reasons. Within cardiovascular rehospitalizations, new pacemaker implantations were the most frequently reported (18.9%), followed by cardiac decompensation and coronary heart disease (15.6%). Conclusion The majority of the patients described an improvement of health status after TAVI. More than five years after TAVI, the patients' perceived health status was satisfactory, and the incidence of clinical events and hospitalizations was very low.

Long-Term Evaluation of Percutaneous Groin Access for EVAR

BackgroundPercutaneous endovascular aneurysm repair (PEVAR) has been shown to have high success rates, shorter operating times and length of stay compared to open access. However, there exists a lack of long-term follow-up data on these patients, and questions remain regarding longer-term outcomes. This study aims to assess the long-term complications and evolution of accessed vessels post-PEVAR.MethodsSixty-one cases of bilateral PEVAR (122 groins) with > 36 months follow-up were analysed. Vessel diameter, calcification, dissection, lymphocele, pseudoaneurysm and thrombus formation were reviewed at 30th day and at the most recent follow-up CT. Notes were reviewed for groin infections, haematomas and nerve injury. Complications were considered ‘major’ if they required intervention or treatment.ResultsMean follow-up time from procedure to most recent scan was 49.9 months. There were no major short- or long-term complications. The early complication rate was 9.8%, with six pseudoaneurysms, four dissections, one thrombus, one nerve injury and no lymphoceles, haematomas or groin infections. The long-term complication rate was 0.8%, with only one pseudoaneurysm. The remainder of early complications resolved naturally without intervention. Accessed vessel showed significantly (P ≤ 0.05) increased diameter and calcification between 30th day and last follow-up scan.ConclusionThis study provides the largest clinical cohort and the longest mean follow-up time reported in the literature and demonstrates the long-term safety of PEVAR. PEVAR has a very low long-term complication rate, without any major complications in our cohort. The accessed common femoral arteries do not show stenosis or thrombosis. Minor short-term complications appear to gradually resolve without intervention. Larger multi-centre studies are recommended.

Stenting in Palliation of Unresectable Esophageal Cancer

BackgroundThe aim of this study was to analyze the safety and effectiveness of stenting using partially covered self-expandable stents in palliation of dysphagia in patients with unresectable esophageal cancer.MethodsRetrospective analysis of hospital records of all patients who underwent esophageal stenting in the period 2008–2015 was performed. The study included patients with unresectable esophageal and esophagogastric cancer.ResultsThere were 442 patients included. Mean age was 56 years (range 28–89), and 379 were males. In 40 (9.0%) patients, stenting was performed in the cervical, in 150 (39.3%)—in the middle thoracic, in 141 (31.9%)—in lower thoracic esophagus and in 111 (25.1%)—in the esophagogastric junction. Stenting resulted in significant alleviation of dysphagia grade (3.0 vs. 1.0, p = 0.00001). During the follow-up, 55 (12.4%) patients experienced recurrent dysphagia due to tumor or granulation tissue overgrowth, and in 18 (4.1%) patients, migration of the stent occurred, for which an independent risk factor was adjuvant chemo- and/or radiation therapy (p = 0.001). Minor complications included chest pain (54.5%), delayed complete stent expansion (12.0%), feeling of a foreign body (25.3%), hiccup (1.6%), gastroesophageal reflux (45.6%) and post-discharge pneumonia (2.5%). A feeling of a foreign body in the esophagus was significantly more common after stenting of the cervical esophagus (p = 0.0001), and hiccup was more common after stenting of the esophagogastric junction (p = 0.02). Major complications included bleeding (1.3%), respiratory insufficiency (0.7%), esophageal perforation (0.9%) and irregular heartburn (2.3%). Overall procedure-related mortality was 0.4%. The median survival time was 117.8 days (range 2–732).ConclusionsStenting is an effective procedure in relieving dysphagia in patients with unresectable malignant esophageal stenosis and is associated with low rate of postoperative and long-term complications.

Surgical Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy (GATT) in Patients With Open-angle Glaucoma.

To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma. A retrospective chart review of adult patients who underwent GATT due to inadequately controlled intraocular pressure (IOP) or intolerance to medication. Main outcome measures were success rate, IOP, and number of glaucoma medications. Success was defined as IOP reduction >20% from baseline or IOP between 5 to 21 mm Hg, and no need for further glaucoma surgery. When success criteria were not met for any postoperative visit >3 months after surgery, failure was determined. In total, 66 patients, average age 62.9±14.9 years (50.8% female) were included in the analysis. Average follow-up was 11.9 months (range, 3 to 30 mo) and overall success rate was 63.0%. Mean IOP was 26.1±9.9 mm Hg preoperatively and 14.6±4.7 mm Hg at 12 months (44% IOP decrease; P<0.001). Mean number of medications decreased from 3.1±1.1 preoperatively to 1.2±0.9 at 12 months (P<0.001). No significant differences between patients with primary open-angle glaucoma and other types of glaucoma were found.The rate of hyphema at 1 week and 1 month postoperatively was 38% and 6%, respectively. Overall GATT success rate among white and black patients was 69% and 42%, respectively, which was statistically significant (P<0.05). The future of GATT as a minimally invasive glaucoma surgery in adults seems promising. This position is supported by its low rate of long-term complications and the conjunctiva-sparing nature of the surgery.