Management Of Leaks Research Articles

426. TAILORED MANAGEMENT OF ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY IN A SPECIALISED UNIT IN THE ERA OF HYBRID AND ENDOSCOPIC NOVELTIES

Abstract Tailored management of anastomotic leak after esophagectomy in a specialised unit in the era of hybrid and endoscopic novelties. Triantafyllou Alexandra1, Theodoropoulos Charalampos2, Eleni Kitsou1, Saliaris Konstantinos1, Karikis Ioannis1, Pachos Nikolaos1, Katsila Sofia3, Kakounis Konstantinos3, Triantafyllou Tania1, Xiromeritou Vasiliki3, Theodorou Dimitrios1 1. 1st Propaedeutic Surgical Department, Hippocratio General Hospital of Athens, University of Athens, Greece 2. Surgical Department, Tzaneio Hospital, Greece 3. Department of Gastroenterology, Hippocratio General Hospital of Athens, Greece Background Anastomotic leak following esophagectomy remains one of the most dreadful complications with high rates of morbidity and mortality. This study aims to delineate the incidence, therapeutic strategies, and associated outcomes of esophagogastric anastomotic leak in our unit. Methods We retrospectively analyzed prospectively collected data of patients diagnosed with anastomotic leak following esophagectomy. The treatment modalities and the patient outcomes are presented. Results 199 patients underwent esophagectomy between 2019 and 2023. Among them, 21 patients (10.6%) were diagnosed with anastomotic leakage. 17 out of these 21 patients (81.0%) were male, and the mean age was 58.6 years. 14 out of the 21 patients had cervical anastomosis (leak rate: 8.6%) and 7 patients intrathoracic anastomosis (leak rate: 18.9%). Significant reduction of the intrathoracic anastomotic leak rate was recorded within 2013 (0%) following revision of the anastomotic technique. No deaths were observed, and the average time to healing was 29.1 days. Endoscopic stenting was employed in 12 patients (57.1%), reoperation in 5 (23.8%), bedside wound exploration in 7 (4.8%) and one patient was treated conservatively. Besides stenting, 4 patients (19.0%) underwent percutaneous drainage procedures under radiological guidance. Conclusions Managing esophageal anastomotic leakage presents significant challenges. Optimal outcomes for anastomotic healing and patient survival are achieved through a multidisciplinary and individualised approach encompassing interventional radiology or endoscopy and/or reoperation in selected patients.

Factors associated with leakage after reversal of protective stoma in patients with locally advanced rectal cancer following curative resection and anastomosis

IntroductionAnastomotic leakage (AL) is a significant complication in colorectal surgery with numerous general and specific risk factors. The determinants of colorectal AL following the reversal of a protective defunctioning ileostomy remain unclear and warrant further investigation. Material and methodsData from April 2008 to December 2014 were collected and retrospectively reviewed for 361 consecutive patients who underwent protective ileostomy reversal following curative resection with anastomosis for rectal cancer. The baseline, treatment, and oncological variables of patients associated with post-reversal AL were evaluated using univariate and multivariate logistic regression analysis. The impact of AL on long-term survival outcomes was assessed using Kaplan-Meier survival analyses. ResultsIn a study of 361 patients, 52 (14.4 %) experienced leakage following stoma reversal, manifesting at a median of 5.7 months. Multivariable logistic regression analysis revealed that an anastomosis located less than 7 cm from the anal verge (OR 2.82, p = 0.008), a side-to-end anastomotic configuration (OR 2.02, p = 0.036), involvement of the circumferential resection margin (OR 6.46, p = 0.043), and adjuvant radiotherapy (OR 4.69, p = 0.003) significantly predicted post-reversal AL. Notably, five-year overall survival (63.4 % vs. 90.3 %, p < 0.0001) and disease-free survival (46.9 % vs. 71.1 %, p = 0.001) were significantly lower in patients with post-reversal AL. ConclusionsOur analysis identified several clinicopathological factors associated with post-reversal AL, which is linked to a significant decrease in long-term survival and oncological outcomes. Alleviating these adverse effects necessitates ensuring early detection and effective management of leaks among high-risk patients.

Simplified mini-review of management of recurrent leak after peptic ulcer perforation.

Simplified mini-review of management of recurrent leak after peptic ulcer perforation.

The Evolving Role of Endoscopy in Revisional Metabolic and Bariatric Surgery

AbstractThe obesity epidemic continues to be a global health concern impacting over 890 million adults worldwide. These numbers have quadrupled since 1990, and global health surveys estimate another 2.5 billion adults are overweight. The disease of obesity is chronic in nature and difficult to treat. The number of metabolic and bariatric surgeries performed today continues to increase and with it the number of revisional surgeries and management of complications. Upper gastrointestinal endoscopy has played an important role in diagnosing and managing patients with obesity. Endoscopy is a safe and minimally invasive technique to address surgical complications and explore new techniques for the management of obesity. In this article, we aim to review the evolving role of endoscopy in revisional bariatric surgery: management of immediate complications, including bleeding, strictures, leaks, and erosion of bands; techniques to access the gastric remnant after a gastric bypass; and management of weight regain.

Risk Assessment and Management of Radionuclide Leakage in Nuclear Power Plants

Risk Assessment and Management of Radionuclide Leakage in Nuclear Power Plants

Economically Optimal Leak Management: Balancing Pressure Reduction, Energy Recovery, and Leak Detection and Repair

Economically Optimal Leak Management: Balancing Pressure Reduction, Energy Recovery, and Leak Detection and Repair

Esophageal leak management using nasocavity drain and banded fenestrated stent

Esophageal leak management using nasocavity drain and banded fenestrated stent

Transcatheter closure management of mitral paravalvular leakage: A single center experience.

Paravalvular leakage (PVL) is a common complication after artificial valve replacement. Transcatheter paravalvular leak closure (PVT), an efficient, safe, and minimally invasive treatment for PVL patients. The purpose of this study was to present our experience with transcatheter closure of mitral paravalvular leakage (PVL) after surgical valve replacement in our center. A cohort of 81 consecutive patients with mitral PVLs was treated with transcatheter closure between September 2014 and December 2022. We reviewed the demographics, clinical features, therapeutic modalities and follow-up results. The patients' charts were used for retrospective analysis. Eighty-one patients from one center were enrolled in this study. The median age of the patients was 63 ± 11 years. The median LVEF was 51% ± 7%, and the median regurgitation volume was 11.5 ± 10.1 mL. Sealing with occlusion was successful in 70 patients, and the technical success rate was 86.5%. The median regurgitation volume was reduced to 1.95 ± 2.6 mL. The major adverse event was hemolysis, which affected 19 patients, 17 of whom required blood transfusion. Three patients required secondary open surgery due to bleeding. Three patients died during the hospital stay, and all of their deaths were caused by hemolysis-related complications. The median hospital stay was 10.3 ± 6.3 days. During the follow-up period, 2 patients died, and none of their deaths were caused by surgery. The New York Heart Association classification increased in all patients during the 6-month follow-up. Transcatheter mitral PVL closure requires complex catheter techniques. However, this technique is minimally invasive and has a shorter hospital stay. Interventional mitral PVL closure is a safe and efficacious technique for high-risk surgical patients with symptomatic paravalvular regurgitation.

Endoscopic techniques for management of large colorectal polyps, strictures and leaks

The implementation of screening colonoscopy with polyp removal has significantly decreased mortality rates associated with colorectal cancer (CRC), although it remains a major cause of cancer-related deaths globally. CRC typically originates from adenomatous polyps, and increased removal of these growths has led to reduced CRC incidence and mortality. Endoscopic polypectomy techniques, including hot and cold snare polypectomy, play a pivotal role in this process. While both methods are effective for small polyps (<10 mm), recent evidence favors cold snare polypectomy due to its superior safety profile and comparable complete resection rates. Large polyps (>10 mm), particularly those with advanced features, pose increased cancer risks and often require meticulous assessment and advanced endoscopic techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for resection.This chapter also provides a practical overview of endoscopic techniques for managing colonic obstructions and pericolonic fluid collections, detailing their indications, advantages, disadvantages, and complications. The goal is to improve understanding and application in clinical practice. Additionally, we provide a summary of endoscopic closure techniques that have revolutionized the management of perforations and fistulas, offering safe and effective alternatives to surgery.

1225 Endoluminal Stenting for Sleeve Gastrectomy Leak: Case Report, Literature Review and Atlas of Endoscopic Management

Abstract Introduction One of the most serious complications of bariatric surgery is post-operative leak and it can result in significant risk on the patient. Early detection and management of postoperative leak is essential to reduce the morbidities and mortality of such complication. Endoluminal Stent placement is a less invasive alternative to surgical intervention for management of bariatric surgical leak. We are reporting a case of post sleeve gastrectomy leak that has been managed by inserting self-expandable metal stents (SEMS) via endoscopy. Case presentation A 55-year-old woman presented with gradual onset of epigastric pain and high temperature with reduced oral intake. She had had a Laparoscopic sleeve gastrectomy done in another country as a form of “medical tourism” 10 days ago. She had a CT scan revealed an irregular 4.5 cm paraoesophageal collection suggesting post-operative leakage. Discussion Endoscopic management of GI leaks provides a minimally invasive, safe, and efficient alternative for surgery in selected cases. Endoscopic management is then proven to be the least invasive method to control and repair post LSG leak. Conclusions The clinical presentation of post LSG leak can vary from mild abdominal pain to severe sepsis. Endoscopic management, with its different types, has been widely used because its less invasive yet very effective way of managing such feared complication.

Managing a Major Lube Oil Leak on a 150 MW Steam Turbine Power Plant

This paper focuses on the management of a major lube oil leak from bearing box No. 2 at the Sumsel-5 Power Plant. The steam turbine, a super high-pressure has been operational since April 2016. Overhauls in 2019 and 2023 addressed issues such as wear on oil deflectors, abnormal gland sealing clearances, and oil sealing wear. However, oil leakage persisted, necessitating further interventions. Rectification efforts included replacing oil deflectors, adjusting clearance, installing additional venting lines, the addition of a fiber gasket at bearing box No. 2 aimed to reduce and manage oil leakage. These measures resulted in a significant reduction in the oil leakage rate, from approximately 2826 ml/hr to 75 ml/hr during full load operation, representing a decrement of around 97.3%. Additionally, the frequency of lube oil top-ups decreased dramatically, leading to substantial cost savings for the plant. From a safety and environmental perspective, rectification measures mitigated fire hazards and reduced oil wastage, minimizing environmental impact. Regular monitoring of lubrication oil quality further ensures operational reliability. Although complete elimination of the oil leak was not achieved, the turbine continues to operate smoothly under manageable oil leakage conditions.

Incidence of anastomotic leakage using powered circular staplers versus manual circular staplers for left colorectal anastomosis: a cost-effectiveness analysis

BackgroundColorectal anastomotic leakage causes severe consequences for patients and healthcare system as it will lead to increased consumption of hospital resources and costs. Technological improvements in anastomotic devices could reduce the incidence of leakage and its economic impact. The aim of the present study was to assess if the use of a new powered circular stapler is cost-effective.MethodThis observational study included patients undergoing left-sided circular stapled colorectal anastomosis between January 2018 and December 2021. Propensity score matching was carried out to create two comparable groups depending on whether the anastomosis was performed using a manual or powered circular device. The rate of anastomotic leakage, its severity, the consumption of hospital resources, and its cost were the main outcome measures. A cost-effectiveness analysis comparing the powered circular stapler versus manual circular staplers was performed.ResultsA total of 330 patients were included in the study, 165 in each group. Anastomotic leakage rates were significantly different (p = 0.012): 22 patients (13.3%) in the manual group versus 8 patients (4.8%) in the powered group. The effectiveness of the powered stapler and manual stapler was 98.27% and 93.69%, respectively. The average cost per patient in the powered group was €6238.38, compared with €9700.12 in the manual group. The incremental cost-effectiveness ratio was − €74,915.28 per patient without anastomotic complications.ConclusionThe incremental cost of powered circular stapler compared with manual devices was offset by the savings from lowered incidence and cost of management of anastomotic leaks.

Surgical Management of Spontaneous Lateral Skull Base Cerebrospinal Fluid Leaks: The Middle Cranial Fossa Approach

Surgical Management of Spontaneous Lateral Skull Base Cerebrospinal Fluid Leaks: The Middle Cranial Fossa Approach

Biliary Leaks: Multidisciplinary Approach to Diagnosis and Treatment.

Bile leaks arise from various causes such as trauma, complications after hepatobiliary surgery, and intrahepatic malignancies or their associated liver-directed treatments. Bile leaks can result in significant morbidity and mortality. Delayed diagnosis is not uncommon due to nonspecific manifestations; therefore, a high clinical suspicion is needed. A multidisciplinary approach for treatment of biliary leaks with prompt referral to tertiary care centers with experienced hepatobiliary surgeons, advanced endoscopists, and interventional radiologists is needed to address these challenging complications. Management of biliary leaks can range from conservative management to open surgical repair. Minimally invasive procedures play a crucial role in biliary leak treatment, and the interventional radiologist can help guide appropriate management on the basis of a clear understanding of the pathophysiology of biliary leaks and a current knowledge of the armamentarium of treatment options. In most cases, a simple diversion of bile to decompress the biliary system may prove effective. However, persistent and high-output biliary leaks require delineation of the source with tailored treatment options to control the leak. This may be done by additional diversions, occluding the source, reestablishing connections, or using a combination of therapies to bridge to more definitive surgical interventions. The authors describe the different treatment options and emphasize the role of interventional radiology. ©RSNA, 2024.

Leak Detection in Urban Hydraulic Systems Using the K-BiLSTM-Monte Carlo Dropout Model

Utility companies lose approximately 35 liters of water for every 100 produced due to incorrect, illegal connections and the poor condition of pipes. This study develops an intelligent model to detect leaks using the Kalman filter, BiLSTM neural networks, and the Monte Carlo Dropout algorithm. Using data from the Empresa de Acueductos y Alcantarillados de Bogotá (EAAB), Colombia, autocorrelation analysis, PCA, cluster analysis, ADF and Durbin-Watson tests, Hurst exponent, spectral analysis, and wavelet transform were performed. Then, Kalman filtering techniques were applied, and a BiLSTM architecture controlled with Monte Carlo dropout was implemented. The results showed an accuracy of 87.48% in training and 80.48% in validation. Temporal analysis revealed a stationary behavior in the flow series, and the decrease in spectral intensity around 0.25 Hz was related to pressure perturbations caused by leaks. A detailed evaluation of pressure and flow signals identified leak patterns with high precision, demonstrating the effectiveness of the wavelet spectrogram in detecting energy disturbances. The novelty of the study lies in the integration of advanced artificial intelligence and combinatorial optimization techniques to improve water resource management, allowing early and accurate detection of leaks, significantly improving compared to traditional methods. Doi: 10.28991/CEJ-2024-010-07-01 Full Text: PDF

Chyle Leak Management in the Setting of Tissue Expander Breast Reconstruction with Acellular Dermal Matrix: Case Series and Literature Review.

Chylous leakage is a rare surgical complication most frequently encountered following operations involving the neck and thorax. Even more rare are axillary chyle leaks secondary to breast cancer involving the axillary lymph nodes. Anatomic variability in the termination of the thoracic duct may play a role in the susceptibility some individuals may have to this type of leakage. There is no consensus on the definitive management of these complications, especially in the context of breast reconstruction. Here, we report our experience in the management of chylous leakage in three patients who underwent left axillary lymph node dissection and immediate breast reconstruction with the use of tissue expanders and acellular dermal matrix. Descriptions of each case are followed by a review of the relevant literature. We also present an original treatment algorithm. Two of three patients with suspected chylous leakage secondary to intraoperative injury to the axillary region underwent definitive diagnosis by clinical examination and drain fluid triglyceride analysis, followed by conservative management with a low-fat diet. The third patient was diagnosed clinically with no fluid analysis. All leakages resolved through conservative means, with no need to return to the operating room for surgical exploration and repair. Based on our experience, we believe that patients with suspected chylous leakage secondary to axillary lymph node dissection in the context of breast reconstruction can be safely and effectively managed by conservative management in the acute postoperative period. If these measures are insufficient, surgical management may be necessary.

How to improve patient outcomes following TAVI in 2024? Recent advances.

Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of aortic stenosis, particularly among elderly patients. The world's first TAVI procedure was performed in 2002 by Professor Cribier. It was approved for clinical use in Europe in 2007, followed by approval in the United States in 2011. It has since been introduced into clinical practice throughout Europe, and there has been a remarkable increase both in the number of procedures and in the number of centers performing TAVI. Recent findings endorse its additional application in lower-risk populations, suggesting a transformative shift in the field of interventional cardiology. This review article thoroughly explores the recent advances and key considerations aimed at enhancing patient outcomes following TAVI. Key areas of focus include valve durability, paravalvular leak management, valve-in-valve procedures, and the implications and management of coronary artery disease in these patients. We highlight the importance of selecting valves with favorable hemodynamics, minimal coronary risk, and optimal durability, especially for younger, lower-risk patients. Paravalvular leak remains a significant concern; thus, pre-procedural planning and immediate corrective measures are crucial to mitigate its impact. The increasing need for valve-in-valve interventions underscores the importance of the strategic initial valve choice with a forward-looking perspective. Additionally, emerging strategies such as transcatheter leaflet laceration to prevent coronary obstruction during reinterventions, are examined. This review synthesizes current research and clinical practice, providing a roadmap for enhancing TAVI outcomes through technological advances and strategic procedural planning. The findings and recommendations presented aim to optimize long-term patient prognosis, ensuring that TAVI remains a leading solution for aortic stenosis in an increasing variety of patients.

Transient urine leakage following cryoablation: case report

Urinary complications are uncommon after percutaneous cryoablation for the treatment of small cell carcinoma. This minimally invasive treatment results in less urothelial damage than other thermal ablation techniques. However, urine leakage can occur from the cryoablation track on which the applicator is placed during the procedure. However, only a small number of studies have investigated the clinical outcomes of post-cryoablation urinary complications. Recently, we encountered a case of urine leakage following computed tomography-guided cryoablation. The purpose of this case report is to describe the causes, findings, and management of post-cryoablation urine leakage.

VacStent as an Innovative Approach in the Treatment of Anastomotic Insufficiencies and Leakages in the Gastrointestinal Tract-Review and Outlook.

Anastomotic insufficiencies are severe complications of abdominal surgery, often leading to prolonged hospitalization, serious tissue inflammation, and even sepsis, along with the need for recurrent surgery. Current non-surgical treatments such as self-expanding metal stents (SEMSs) and endoscopic vacuum therapy (EVT) have limitations, including stent migration or perforation. This review evaluates the effectiveness of the VacStent GITM (Möller Medical GmbH, Fulda, Germany), a novel medical device combining SEMS and negative-pressure wound therapy in treating gastrointestinal leaks. Data were gathered from four prospective studies and compared with existing treatments. Studies on the VacStent GITM application demonstrate technical success and competitive closure rates in upper gastrointestinal leaks, with minimal complications reported. Comparative analyses with SEMS and EVT reveal promising and most importantly equally good outcomes while maintaining the possibility for sustained enteral nutrition and reducing the risk of stent migration. The VacStent GITM presents a promising alternative to current non-surgical treatments. Ongoing research aims to validate its efficacy in lower gastrointestinal leaks and comprehensively establish its role in leak management. Further investigation is necessary to confirm these findings and optimize treatment protocols. Future usages of the VacStent GITM in colonic anastomotic insufficiencies promise an effective approach and might be able to lower the rates of necessary implementations of a stoma.

The diversity we breath: Community diversity and gas leak management

Diversity might reduce the ability of small-scale communities to protect local resources through its adverse impact on collective action and individual attachment. Using geocoded data on more than 1500 Grade-3 gas leaks in 2016 across Boston and Cambridge, MA, we show that when a leak emerges in a narrowly-defined area with higher ethno-racial fractionalization it enjoys lower chances of end-year reparation. After accounting for socio-economic and infrastructural factors, our preferred estimate suggests that moving from the 10th to the 90th percentile of the fractionalization distribution is associated to a 5.7 percentage point decrease in the probability of reparation, compared with an already low average of 3.7%. This result is robust to different definitions of the community surrounding a leak and to the inclusion of competing measures of diversity. Consistent with our framework, social capital appears to be especially lower in communities fragmented across ethno-racial lines. In turn, lower social capital is negatively associated to leak reparation.