Management Of Leaks Research Articles

Application of copula-based Bayesian network method to water leakage risk analysis in cross river tunnel of Wuhan Rail Transit Line 3

Water leakage typically infiltrates through bolt holes and segment joints, posing a threat to the stability of tunnel structures. In this paper, we develop a copula-based Bayesian network (CBN) method for dependency modeling of complex systems to conduct risk analysis and management of water leakage in operational tunnels. Thirteen potential factors are used to construct the water leakage risk system, and the permeate water volume is selected as the observation index of water leakage risk. An application to a realistic cross-river tunnel of Wuhan Rail Transit Line 3 is implemented to verify the effectiveness of the developed model. Through correlation analysis, the bolt failure rate and seal breakage and aging rate are diagnosed as critical factors with the greatest impact on the water leakage risk. Forward and backward reasoning enables the model to be dynamically updated to provide decision support for water leakage risk management. This research contributes to the following: (a) expressing the dependence of the factors affecting water leakage; (b) solving the problem of modeling uncertainty and information fusion; and (c) updating the model to realize the safety control of tunnel water leakage.

Management of Leak After Revision of Roux-en-Y Gastric Bypass for Weight Regain by Internal Pigtail Drainage

Management of Leak After Revision of Roux-en-Y Gastric Bypass for Weight Regain by Internal Pigtail Drainage

Endobronchial Valves for Management of Persistent Air Leaks in Patients With Chronic Lung Disease

BackgroundPersistent air leak (PAL) is a challenging problem in patients with spontaneous pneumothorax and chronic lung disease who are poor surgical candidates. Conventional management consists of long-term thoracostomy tube placement; however, in some cases, patients are unable to leave the hospital because of the need for continuous negative pressure. We investigated the application of endobronchial valves (EBVs) in the management of patients with air leak for whom surgical intervention was contraindicated. MethodsEBVs were placed in patients with PALs arising from nonoperative causes. Successful outcomes were defined as the ability to remove the thoracostomy tube from suction, resolution of air leak, and removal of chest tube. ResultsSeventeen patients with PAL requiring negative pressure suction were treated with EBVs. The overall complete successful outcome rate was 82.4%. There was a statistically significant reduction in length of stay after valve placement in the success group compared with the failure group (8.9 days vs 61.7 days; P = .0097). ConclusionsEBVs are a valid option for patients who are not surgical candidates and have failed to respond to conventional management of PAL. This experimental use of EBVs leads to high success rates and shorter length of stay when it is successful.

Novel endoscopic management of gastroenterological anastomosis leakage by injecting gel-forming solutions: an experimental animal study.

Anastomotic leakage (AL) after gastrointestinal surgery remains a challenging complication that requires surgical or non-surgical treatment. Although various therapeutic endoscopic techniques are available, no definitive interventions exist. We developed a therapeutic endoscopic submucosal injection method using novel gel-forming mixed solutions to close AL and evaluated the elasticity of the developed hydrogel. The safety and efficacy of the injection method were explored in porcine AL models. We developed a novel gel-forming solution, and the formed gel lasted approximately oneweek within the gastrointestinal wall. An indentation test evaluated the elasticity of the novel hydrogel. After the confirmation of AL on porcine anterior gastric walls, sodium alginate was endoscopically injected into the submucosal layer around the leakage site circularly, followed by a calcium lactate/chitosan-based solution. After that, the outcomes data were collected, and histopathological effectiveness was evaluated. The increased sodium alginate elasticity with the addition of calcium lactate/chitosan-based solution facilitated long-lasting gel formation. Four pigs with AL underwent this intervention consecutively. Each endoscopic injection was completed in less than 5min. No significant complications were observed for 3weeks after the intervention. All AL sites were macroscopically healed. Histopathologic findings at 3weeks showed that the wall defect was filled with collagen fibers that had grown around the site of the muscle layer tear. No tissue necrosis was observed. This preclinical study demonstrated that the therapeutic injection method for gastroenterological AL using gel-forming solutions could be an alternative endoscopic treatment, especially in patients with severe conditions or comorbidities. The optimal target of this treatment is small size and early AL without poor blood flow or intense hypertrophic scar lesions.

Early chest drain removal on the day of uniportal thoracoscopic segmentectomy.

Although early removal of postoperative chest drains can facilitate recovery, it can be difficult to achieve in segmentectomy due to the management of air leakage in intersegmental planes. This study prospectively examined the feasibility of drain removal on the same day of uniportal thoracoscopic segmentectomy. Twenty patients who underwent uniportal thoracoscopic segmentectomy between July 2021 and May 2022 were enrolled in this prospective study. The indications for drain removal on the day of surgery were absence of air leakage in an intraoperative sealing test, radiographic evidence of lung expansion, and continuous absence of air leakage via a drainage bottle for 4 h after the operation. The primary endpoint was rate of the patients who required re-drainage after the postoperative drainage tube was removed on the day of surgery. The secondary end points were postoperative pain evaluated using a numerical rating scale on postoperative days 1, 7, and 28; morbidity; and postoperative hospitalization period. Fifteen patients successfully underwent drain removal on the day of surgery. None required re-drainage. The mean postoperative hospitalization period was 2.3 ± 1.7 days. Overall, 12 of the 15 (80%) patients were discharged on postoperative day 1 or 2. The mean numerical rating scale scores were 1.2 ± 1.6, 0.4 ± 0.7, and 0.4 ± 1.5 on postoperative days 1, 7, and 28, respectively. In uniportal thoracoscopic segmentectomy, drain removal on the day of surgery is feasible and may reduce pain on postoperative day 1.

Laparoscopy in the management of post-cholecystectomy bile leaks

IntroductionOver 1% of cholecystectomies are complicated by a post-operative bile leak. Most bile leaks are managed with endoscopic retrograde cholangio-pancreatography (ERCP) with decompression of the biliary tree. This paper reports our outcomes of using early re-laparoscopy in the investigation and treatment of post-operative bile leak. Materials/patients and methodsWe analysed our prospectively compiled database to identify all patients suffering a bile leak after cholecystectomy. Demographic data, details of the index cholecystectomy, post-operative investigations and procedures, and readmissions to hospital were analysed. Results4870 cholecystectomies were performed between 2016 and 2020; 1793 (36.9%) were urgent cholecystectomies performed at the index admission. 41 patients were identified with unexpected post-operative bile leaks. 40 patients underwent urgent re-laparoscopy as initial management. 17 patients required ERCP subsequent to re-laparoscopy. Median post-operative stay was 5 days. No cases were converted to open surgery, and there were no mortalities. DiscussionUrgent repeat laparoscopy is an effective tool to manage an unexpected post-cholecystectomy bile leak. Re-laparoscopy allows thorough peritoneal washout and diagnosis of the cause of the leak, and provides definitive treatment for the majority of patients. It is associated with a short hospital stay with minimal morbidity and mortality.

The role of percutaneous radiological guided interventions in the management of biliary leakage

Background Percutaneous image-guided biliary interventions is an important tool to deal with bile leaks. This prospective study was conducted from March 2021 to April 2023 aiming to clarify the role of image-guided interventions in the management of bile leaks, preventing its devastating consequences. Patients and methods We prospectively studied 30 patients diagnosed with bile leakage referred to our department between March 2021 to April 2023. We analyzed cause and time of bile leak presentation, percutaneous biliary drainage technique, and additional procedures when required, the technical and clinical success of the procedures, leak healing timing, and complication rates. Results Bile leak was suspected within a mean of 7 days (range from day 0–17 days) after the initial incident. In all patients image-guided biliary tree percutaneous access was attempted. An external biliary drain was inserted in 13 cases, 17 patients had an internal-external biliary drain crossing the leaking site. Complete leakage healing following PTBD was achieved in 20 of 30 patients (66.7%) which occurred in an average of 87 days (range 45–130 days). No major complications were encountered after the procedure. Conclusions PTBD is an effective, safe and feasible approach to deal with biliary leaks. It can be an alternative to tedious complex surgical attempt when ERCP is not applicable, which entails higher burden regarding patient morbidity and mortality.

ISLAMIC STRATEGIC MANAGEMENT OF VILLAGE OWNED ENTERPRISES IN INCREASING VILLAGE ORIGINAL INCOME

Background. Each Nagari or village has the potential to be developed in order to increase the income and welfare of its people , one of which is the management of Village Owned Enterprises or BUMNag through good managerial skills by the leader of the organization, moreover the leader is based on Islam, according to the philosophy of West Sumatra, "Adat Basandi Syarak, Syarak Basandi Kitabullan", is a reflection of the pattern of behavior in social life and Islamic leadership in the Minangkabau.Purpose. The research aims to determine the factors that influence the increase in the village's original income from the operation of Village-Owned Enterprises based on Islamic Strategic Management.Method. The reseach use the Delphi Method, informants are 6 experts (experts) and carry out a SWOT Analysis to determine the right strategy.Results. Research findings, the factors that influence the increase in the village's original income, from an average strengths score of 4.93 or 96.67, Government policies and Commitment of the Village Head with the same score and an average score of 3.83 or 76.67, administration and cooperation with other agencies with the same score. The Weaknesses factor has an average score of 5.00 or 100, the sanctions are not strict enough for the management of Village-Owned Enterprises and leakage of user fees/consumer contributions with an average score of 2.5 is less effective. Opportunity factor with an average score of 5.00 or 100 for good public services supported by advances in information technology with an average score of 4.17. Threaths of illegal waste disposal with an average score of 4.83 and closure of waste collection points in jorong-jorong with an average score of 4.17 or 46.67 with the criteria of Ineffective.Conclusion. In managing Village Owned Enterprises with the implementation of Islamic strategic management, there are several factors that influence the income of Village Owned Enterprises to increase Village Original Income.

Endoscopic vacuum therapy versus self-expandable metal stent for treatment of anastomotic leaks < 30mm following oncologic Ivor-Lewis esophagectomy: a matched case-control study.

Management of anastomotic leaks after Ivor-Lewis esophagectomy remains a challenge. Although intracavitary endoscopic vacuum therapy (EVT) has shown great efficacy for large dehiscences, the optimal management of smaller leaks has not been standardized. This study aims to compare EVT versus self-expandable metal stent (SEMS) in the treatment of leaks < 30mm in size, due to the lack of current data on this topic. Patients undergoing EVT (cases) or SEMS (controls) between May 2017 and July 2022 for anastomotic leaks < 3cm following oncologic Ivor-Lewis esophagectomy were enrolled. Controls were matched in a 1:1 ratio based on age (± 3years), BMI (± 3kg/m2) and leak size (± 4mm). Cases (n = 22) and controls (n = 22) showed no difference in baseline characteristics and leak size, as per matching at enrollment. No differences were detected between the two groups in terms of time from surgery to endoscopic treatment (p = 0.11) or total number of procedures per patient (p = 0.05). Remarkably, the two groups showed comparable results in terms of leaks resolution (90.9% vs. 72.7%, p = 0.11). The number of procedures per patient was not significant between the two cohorts (p = 0.05). The most frequent complication in the SEMS group was migration (15.3% of procedures). EVT and SEMS seem to have similar efficacy outcomes in the treatment of anastomotic defects < 30mm after Ivor-Lewis esophagectomy. However, larger studies are needed to corroborate these findings.

Technical Review on Endoscopic Treatment Devices for Management of Upper Gastrointestinal Postsurgical Leaks.

Upper gastrointestinal postsurgical leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Nowadays, endoscopy is considered the first-line approach for their management, however, there is no definite consensus on the most appropriate therapeutic approach. There is a wide diversity of endoscopic options, from close-cover-divert approaches to active or passive internal drainage approaches. Theoretically, all these options can be used alone or with a multimodality approach, as each of them has different mechanisms of action. The approach to postsurgical leaks should always be tailored to each patient, taking into account the several variables that may influence the final outcome. In this review, we discuss the important developments in endoscopic devices for the treatment of postsurgical leaks. Our discussion specifically focuses on principles and mechanism of action, advantages and disadvantages of each technique, indications, clinical success, and adverse events. An algorithm for endoscopic approach is proposed.

Management of abdominal gas leakage from surgical trocars in laparoscopic surgery: a preclinical study

Introduction: There is an ongoing concern about the potential infectious risk due to pneumoperitoneal gas leakage from surgical trocars in laparoscopic surgery. We aimed to visually confirm the presence of leakage from trocars and investigate the changes in the leakage scale according to intra-abdominal pressures and trocar types. Material and methods: We established a porcine pneumoperitoneum model and performed experimental forceps manipulation using 5-mm grasping forceps with 12-mm trocars. The gas leakage, if any, was imaged using a Schlieren optical system, which can visualize minute gas flow invisible to the naked eye. For measuring the scale, we calculated the gas leakage velocity and area using image analysis software. Four types of unused and exhausted disposable trocars were compared. Results: Gas leakage was observed from trocars during forceps insertion and removal. Both the gas leakage velocity and area increased as the intra-abdominal pressure increased. Every type of trocar we handled was associated with gas leakage, and exhausted disposable trocars had the largest scale gas leakage. Conclusions: We confirmed gas leakage from trocars during device traffic. The scale of leakage increased with high intra-abdominal pressure and with the use of exhausted trocars. Current protection against gas leakage may not be sufficient and new surgical safety measures and device development may be needed in the future.

Stepping up the management of anastomotic leaks after oesophagectomy: getting a feel through less invasive tentacles.

Stepping up the management of anastomotic leaks after oesophagectomy: getting a feel through less invasive tentacles.

A206 Surgical management of proximal leak after sleeve gastrectomy

A206 Surgical management of proximal leak after sleeve gastrectomy

Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomy.

The most common postoperative complication of laparoscopic sleeve gastrectomy (LSG) is staple-line leak. Even if its rate following LSG has been recently reduced, management of chronic leaks remains challenging. To present a series of patients treated with laparoscopic Roux-en-Y fistulojejunostomy (LRYFJ) for chronic gastric leak (>12 wk) post-LSG. University hospitals; specialized bariatric surgery units. Data were prospectively gathered and retrospectively analyzed. Parameters of interest were patient characteristics, perioperative data, and postoperative outcomes. Hemodynamically unstable patients and/or presentations of signs of severe sepsis were excluded. Surgical technique was standardized. Fourteen patients underwent LRYFJ for chronic gastric leak (12 women, 2 men). The mean age was 49.2 years and the mean weight was 88.7 kg with a mean body mass index of 31.1 kg/m2. All procedures were successfully performed by laparoscopy except 1 (7.1%) converted to open surgery. The mean operative time was 198 minutes, with a mean estimated blood loss of 135.7 mL and 2 patients necessitating transfusion (14.2%). Mortality was null. Five postoperative complications were noted (35.7%): 2 leaks of the fistulojejunostomy treated by antibiotherapy and endoscopic drainage; 1 perianastomotic hematoma treated by relaparoscopy and antibiotherapy; and 1 pleural effusion and 1 hematemesis both medically treated. The mean length of hospital stay was 14 days. The mean follow-up was 40 months, with all patients being in good health at last contact. LRYFJ seems to be a good salvage option in selected patients for the treatment of chronic gastric leaks after LSG. However, it is a challenging procedure and should be performed in experienced bariatric centers by expert bariatric surgeons.

Left Atrial Appendage Closure

This review summarizes the evidence for left atrial appendage closure (LAAC) as an alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation. LAAC reduces hemorrhagic stroke and mortality versus warfarin, but is inferior for ischemic stroke reduction based on randomized data. Whilst a feasible treatment in OAC-ineligible patients, questions remain over procedural safety, and the improvement in complications observed in nonrandomized registries is uncorroborated by contemporary randomized trials. Management of device-related thrombus and peridevice leak remain unclear, and robust randomized data versus direct OACs are required before recommendations can be made for widespread adoption in OAC-eligible populations.

Management of persistent air leak in Neonates: A case series

Background: Autologous blood patch pleurodesis (ABPP) has been used in adults as an efficient and safe technique to address persistent air leak (PAL). A fibrin glue patch is also an alternative, but its elevated cost and technique can limit its routine use. Evidence of their use in the pediatric population, specifically in the neonatal age is scant. Case Presentation: We share our management experience in a series of 3 cases. The first 2 were treated exclusively with ABPP and showed clinical and radiographic improvement. The 3rd case, due to the persistence of the air leak, required extended thoracotomy and fibrin patch placement. Conclusion: The use of ABPP as an alternative for the treatment of neonates with PAL is a safe and efficient technique. The procedure is replicable and can be done at the bedside at a low cost. A fibrin glue patch should be considered as an alternative option when ABPP fails to resolve the leak.

Lymphatic Embolization for the Management of Post-operative Chyle Leaks Following Solid Tumor Resection in Pediatric Patients

Chyle leaks are a common post-operative complication following solid-tumor resection in pediatric patients. Current treatments for persistent chyle leaks are limited, leading many patients to experience prolonged hospitalization, nutritional deficits and/or delays in cancer therapies. Lymphatic embolization is an emerging treatment option for chyle leaks, however, limited reports exist of its use in pediatric populations. We conducted a retrospective review of pediatric patients (<18) who underwent lymphangiogram with intent for lymphatic embolization for the management of chyle leaks following solid-tumor resection between 2017 and 2022. Seven patients underwent a total of 11 attempted lymphatic embolization procedures after current standard of care treatments failed to resolve the leak. Lymphangiograms identified a chyle leak in 6 of 7 patients and embolization had a technical success rate of 73%. The complication rate was 9% and complications were limited to one episode of inadvertent gastric wall perforation that did not result in a gastric leak. Lymphatic embolization was ultimately associated with chyle leak resolution in 100% of patients within a median of 24 days, however, repeat embolization was required in 5 of 7 patients (83%). Lymphatic embolization appears to be a safe and effective treatment for persistent chyle leaks in pediatric patients, leads to a direction reduction in chyle output, and has high rates of technical and clinical success. Complete resolution of the chyle leak may require multiple embolization procedures. Further work is needed to determine whether earlier intervention may offer benefit for the management of pediatric chyle leaks. IV.

Endoscopic management of low output recurrent colonic fistula or leak after anterior resection for rectal cancer: a randomized controlled trial

BackgroundColonic anastomotic leak and fistula following anterior resection surgery for rectal cancer are associated with high mortality rates. The incidence of occurrence varies from 2 to 25% and it is difficult to accurately calculate the incidence of fistula and leak post anterior resection, as most of them are asymptomatic. Endoscopic management of fistula and leak has become the first line of management after conservative management in many gastrointestinal surgical centers with the advantages of being less invasive, shorter length of post-operative hospital stay, effective and rapid recovery in comparison to revision surgery. Effective endoscopic management for colonic fistula or leak depends on the clinical status of the patient and fistula characters (time-to-occur and size and site of defect), and device availability.MethodsThis prospective randomized controlled clinical trial included all patients who developed the manifestations of low output recurrent colonic fistula or leak after colonic anterior resection for rectal cancer at Zagazig University Hospital between (December 2020 and August 2022). Sample size was 78 patients divided into two equal groups. Endoscopic group (EG): included 39 patients who underwent endoscopic management. Surgical group (SG): included 39 patients who underwent surgical management.ResultsThe investigators randomized eligible 78 patients into two groups: 39 patients in SG and 39 patients in EG. The median size of the fistula or leak was nine (range: 7–14) mm in EG, versus ten (range: 7–12) mm in SG. Clipping and Endo-stitch device were used in 24 patients versus 15 patients, respectively, in EG while primary repair with ileostomy, and resection & anastomosis were used in 15 patients versus 24 patients, respectively, in SG. Recurrence, abdominal collection, and mortality were the post procedure’s complications with incidence of occurrence of 10.3, 7.7 and 0%, respectively, in EG versus 20.5, 20.5 and 2.6%, respectively, in SG. Excellent, good, and poor were the parameters for quality of life with incidence of occurrence of 43.6, 54.6 and 0%, respectively, in EG versus 28.2, 33.3 and 38.5%, respectively, in SG. Median hospital stay was one (range: 1–2) day in endoscopic group, and seven (range: 6–8) days in SG.ConclusionEndoscopic intervention may offer a successful modality in managing low output recurrent colonic fistula or leak after anterior resection for rectal cancer that did not respond to conservative measures in stable patients.ClinicalTrials.gov ID: NCT05659446.

Management of leaks following one-anastomosis gastric bypass: an updated systematic review and meta-analysis of 44318 patients.

One-anastomosis gastric bypass (OAGB) complication, such as leakage, can be dangerous and should be managed properly, yet little data exist in the literature regarding the management of leaks after OAGB, and there are no guidelines to date. The authors performed a systematic review and meta-analysis of the literature and 46 studies, examining 44318 patients were included. There were 410 leaks reported in 44318 patients of OAGB published in the literature, which represents a prevalence of 1% of leaks after OAGB. The surgical strategy was very variable among all the different studies; 62.1% of patients with leaks had to undergo another surgery due to the leak. The most commonly performed procedure was peritoneal washout and drainage (with or without T-tube placement) in 30.8% of patients, followed by conversion to Roux-en-Y gastric bypass in 9.6% of patients. Medical treatment with antibiotics, with or without total parenteral nutrition alone, was conducted in 13.6% of patients. Among the patients with the leak, the mortality rate related to the leak was 1.95%, and the mortality due to the leak in the population of OAGB was 0.02%. The management of leaks following OAGB requires a multidisciplinary approach. OAGB is a safe operation with a low leak risk rate, and the leaks can be managed successfully if detected in a timely fashion.

Successful management of late leakage after sleeve gastrectomy: A case of a challenging delayed complication

We report a unique case of delayed complication of a 36-year-old obese female patient who had a very late gastric leak, namely, four years after LSG. Patient presented with worsening abdominal pain and discomfort, anemia, intermittent fever of 39°C, vomiting and a general feeling of illness and anxiety. Clinical, laboratory and instrumental studies (X-Ray, CT, US) revealed the leakage from the gastric remnant at the gastroesophageal junction level and a small left subdiaphragmatic collection. Revisional laparoscopy and intraoperative methylene blue test (MBT) did not reveal a defect and leakage of the suture line. On rehospitalization the surgical intervention was recommended. The successful extirpation of the stomach remnant with resection of distal segment of esophagus and Roux-en-Y reconstruction was performed. The control X-Ray examination was performed at 6th p/o day, which reveals no extravasation and free passage of contrast to the distal part of GI tract. The patient started peroral eating and was discharged the Hospital at 10th p/o day. At control X-Ray examination after 1 month of surgery the patient is doing well. We consider, that this surgical procedure seems to be the most optimal and radical surgical intervention in similar cases.