Management Of Leaks Research Articles

Risk factors and management of biliary leakage after Endocystectomy for hepatic cystic echinococcosis

Background Endocystectomy is a conservative surgical approach to managing cystic echinococcosis. Bile leakage is the main complication of this technique. The aim of this study was to evaluate the factors associated with bile leakage and to assess the outcomes and cost efficiency of strategies used to treat bile leakage. Methodology/Principal findings Patients who underwent endocystectomy between 2005 and 2020 were included. The preoperative characteristics, intra- and postoperative outcomes, hospital costs, and cost efficiency (the Diagnosis-Related Group reimbursement minus the overall cost) were evaluated prospectively. A total of eighty patients with 142 cysts were included. Postoperative complications occurred in 17 patients (21%), including 11 patients with bile leakage (type A: 1, type B: 6 and type C: 4 patients, total 13%). Bile leakage was more frequent in patients with preoperative MRI signs of cysto-biliary fistulas or intraoperative visible cysto-biliary fistulas (p = 0.03 and p = 0.04, respectively) and in patients with cysts larger than 8 cm (p = 0.03). Patients with bile leakage who underwent reoperation (type C) had significantly shorter hospital stays (9 vs. 16 days, p<0.01) and better cost efficiency than those who received radiologic or endocscopic interventions (€2,072 vs. -€2,097 p = 0.01). No mortality was observed, and recurrence was seen in two patients. Conclusions/Significance Endocystectomy is a safe and efficient technique. Preoperative and intraoperative cysto-biliary fistulas and a cyst diameter larger than 8 cm are correlated to postoperative bile leakage. Early operative management of bile leakage reduces hospital stay and improves cost efficiency compared with radiologic or endoscopic treatments.

Managing Spontaneous Pneumothorax and Treating Severe Community-Acquired Pneumonia

THE FIRST European guidelines for the management of primary spontaneous pneumothorax (PSP) were presented in a symposium session delivered at the European Respiratory Society (ERS) International Congress 2023 on the 9th–13th of September in Milan, Italy. The novel guidelines covered new recommended approaches to acute pneumothorax, optimal management of persistent air leak (PAL), and analysed the evidence for the changing use of co-adjuvants in severe community-acquired pneumonia (SCAP).

Diagnosis and management of anastomotic leaks after Ivor Lewis esophagectomy: a single-center experience.

Esophageal anastomotic leaks (ALs) after esophagectomy are a common and serious complication. The incidence, diagnostic approach, and management have changed over time. We described the diagnosis and management of patients who developed an esophageal AL after an Ivor Lewis esophagectomy at our center. After IRB approval, we queried our prospectively maintained database for patients who developed an esophageal AL after esophagectomy from August 2016 through July 2022. Data pertaining to demographics, comorbidities, surgical and oncological characteristics, and clinical course were extracted and analyzed. During the study period, 145 patients underwent an Ivor Lewis esophagectomy; 10 (6.9%) developed an AL, diagnosed a median of 7.5days after surgery, and detected by enteric contents in wound drains (n = 3), endoscopy (n = 3), CT (n = 2), and contrast esophagogram (n = 2). Nine patients (90%) had an increasing white blood cell count and additional signs of sepsis. One asymptomatic patient was identified by contrast esophagography. All patients received enteral nutritional support, intravenous antibiotics, and antifungals. Primary treatment of ALs included endoscopic placement of a self-expanding metal stent (SEMS; n = 6), surgery (n = 2), and SEMS with endoluminal vacuum therapy (n = 2). One patient required surgery after SEMS placement. The median length ofICU and total hospital stays were 11.5 and 22.5days, respectively. There was no 30-day mortality. The incidence of esophageal ALs at our center is similar to that ofother high-volume centers. Most ALs can be managed without surgery; however, ALs remain a significant source of postoperative morbidity despite clinical advancements that have improved mortality.

S3334 A Unique Solution to a Common Medical Problem: Use of Endoscopic Overstitch Purse-String Suture for the Management of Leak Around the Venting Jejunostomy Tube

S3334 A Unique Solution to a Common Medical Problem: Use of Endoscopic Overstitch Purse-String Suture for the Management of Leak Around the Venting Jejunostomy Tube

The significance of digital drainage devices on standardization of air leak management after pulmonary resection

The significance of digital drainage devices on standardization of air leak management after pulmonary resection

A REVIEW OF INTERNATIONAL CONVENTIONS REGARDING THE RESPONSIBILITIES CAUSED BY OIL POLLUTION OF THE SEAS

The goal of this study was to thoroughly evaluate international conventions concerning the responsibilities caused by oil pollution in marine environment The research takes an analytical-descriptive approach, with a detailed analysis of relevant literature and research in this topic. The findings emphasize the importance of thorough environmental control across all stages of offshore oil and gas resource development, including exploration, production, transportation, and relocation. Inadequate management of oil and gas leaks in saltwater causes pollution, resulting in severe environmental consequences and eventual accountability. Such responsibility takes the form of both pollution control, and in cases of negligence, civil liability imposed on polluters. Notably, international accords addressing duties arising from maritime oil contamination are critical subjects in oil legislation. This article critically examines the provisions of these treaties that relate to oil pollution-related duties in marine ecosystems, as documented in international legal instruments. In conclusion, the research shows that relying solely on the traditional civil liability foundation for marine oil contamination not only fails to compensate for real-world harms but also jeopardies human rights. This undermines the values expressed in international frameworks advocating for a healthy environment, putting future generations' well-being at risk, as outlined in successive international treaties

Endoscopic vacuum therapy as a first-line treatment option for gastric leaks after bariatric surgery: evidence from 10 years of experience.

Gastric (anastomotic or staple-line) leaks after bariatric surgery are rare but potentially life-threatening complications. Endoscopic vacuum therapy (EVT) has evolved as the most promising treatment strategy for leaks associated with upper gastrointestinal surgery. The aim of this study was to evaluate the efficiency of our gastric leak management protocol in all bariatric patients over a 10-year period. Special emphasis was placed on EVT treatment and its outcome as a primary treatment or as a secondary treatment when other approaches failed. This study was performed at a tertiary clinic and certified center of reference for bariatric surgery. In this retrospective single-center cohort study, clinical outcomes of all consecutive patients after bariatric surgery from 2012 to 2021 are reported, with special emphasis placed on gastric leak treatment. The primary endpoint was successful leak closure. Secondary endpoints were overall complications (Clavien-Dindo classification) and length of stay. A total of 1046 patients underwent primary or revisional bariatric surgery, of whom 10 (1.0%) developed a postoperative gastric leak. Additionally, 7 patients were transferred for leak management after external bariatric surgery. Of these, 9 patients underwent primary and 8 patients underwent secondary EVT after futile surgical or endoscopic leak management. The efficacy of EVT was 100%, and there were no deaths. Complications did not differ between primary EVT and secondary treatment of leaks. Length of treatment was 17 days for primary EVT versus 61 days for secondary EVT (P = .015). EVT for gastric leaks after bariatric surgery led to rapid source control with a 100% success rate both as primary and secondary treatment. Early detection and primary EVT shortened treatment time and length of stay. This study underlines the potential of EVT as a first-line treatment strategy for gastric leaks after bariatric surgery.

Management of a gastric pouch staple-line leak and its adverse events with multimodal endoscopic techniques including endoscopic vacuum therapy.

Video 1Management of a gastric pouch staple-line leak and its adverse events with multimodal endoscopic techniques including endoscopic vacuum therapy.

Zero Leak Management of New Energy Ammonia - "Don't Leak Safety"; Preventing Leakage and Ensuring Safety and Security

Zero Leak Management of New Energy Ammonia - "Don't Leak Safety"; Preventing Leakage and Ensuring Safety and Security

713 The Role of Enteral Feed Composition on Chyle Leak Prevalence and Severity in Post-Oesophagectomy Patients

Abstract Aim Chyle leak presents as an uncommon yet significant complication for post-oesophagectomy patients. This study aims to evaluate the role of enteral feed in the prevalence and severity of chyle leaks post-oesophagectomy. Method We identified 334 patients who underwent an open or minimally invasive oesophagectomy for oesophageal cancer at a single institution between 2015-2022. The prevalence, classification (ECCG scale) and respective management of chyle leaks were retrospectively recorded. Patients who had significant post-operative complications and did not start enteral feed on post-operative day 1 were excluded from the study. Results The median age at operation was 68 (31-82), of which 82% comprised of males. In patients who were started on Nutrison standard feed (high energy or high protein), 22% of patients developed a chyle leak (ECCG IA – IIB). In contrast, in patients who were initially started on Nutrison high energy and high protein feed (HEHP), 11% developed a chyle leak (ECCG IA-IIA). All cases were initially managed conservatively (ECCG I) with a success rate of 81%, before escalating to parenteral nutrition. Moreover, patients with a chyle leak demonstrated an increased length of stay (14.4±7.4 days) in comparison to patients without a chyle leak (12.3±8.7 days; p = 0.03). Conclusions The heterogenous management of post-oesophagectomy patients is heavily influenced by centre and surgeon-specific preferences. This study suggests a potential correlation between enteral feed composition and its role in preventing and minimizing chyle leaks following an oesophagectomy. Further prospective, multicentre studies are required to elucidate an optimal nutritional approach in managing post-oesophagectomy patients.

Management of Leakage after Gastroesophageal Anastomosis

Abstract Background Esophagectomy is needed for a variety of esophageal disorders, the most common indication is cancer esophagus, however, it is needed in benign disorders as postcorrosive strictures & endstage achalasia with esophageal dilatation. Anastomotic leakage is one of the most severe complications leading to significant morbidity and increased risk of mortality. Objective To evaluate different approaches in management of leakage after gastroesophageal anastomosis in Upper GIT surgery unit in Ain Shams University Hospitals. Patients and Methods This study was conducted at General surgery department, Ain Shams University Hospitals. Approval of the Ethical Committee was obtained. The study was conducted over patients with postoperative gastroesophageal leakage during the period from 3/2019 to 3/2021. Results Patients managed after cervical anastomosis leakage needed less time to start oral intake& had shorter hospital stay in comparison to those managed after thoracic leakage. There was a higher perioperative morbidity and mortality in patients who underwent surgical intervention as compared with patients who underwent conservative treatment. Conclusion Anastomotic leak after surgery for esophageal diseases can vary in location, onset time, size, and extent. For local management, personalized treatment should be decided based on patient’s particular situations. Cervical anastomosis leakage has less morbidity & mortality compared to thoracic anastomosis. Conservative treatment is safe and successful in many cases, in cervical leakage conservative management is effective in most cases. Stent implantation is an effective method with other emerging endoscopic techniques. Resurgery should be considered carefully and reserved to uncontrolled leakage or patients with failed conservative management.

ThTP7.7 Anastomotic leakage in colorectal cancer resections: A 15 year cohort study

Abstract Aims Anastomotic leakage is serious event in restorative colorectal cancer resections, reported incidence of < 10%. Aim of study is to assess management of anastomotic leakage at single centre. Methods Single-centre cohort study was carried out: Jan' 08 to Feb' 23. Descriptive demographics + post-op outcomes were analysed for colorectal cancer resections with “non-leaks” as controls. Results Conclusion Anastomotic leakage rate 3.5 % of colorectal cancer resections, surgical intervention in 1.5 %. Type C leakage are believed to have worst prognosis (recurrence & shorter survival). Despite prolonged hospital stay (p < 0.0001), there was no reduced survival or increased mortality rate with anastomotic leaks. Early diagnosis & intervention is crucial in the management of anastomotic leakage. A diversion stoma reduces the adversity of anastomotic leakage.

Endoscopic transesophageal retrograde drainage tandem with endoscopic closure for management of esophageal leak after peroral endoscopic myotomy for Zenker diverticulum

Video 1Endoscopic transesophageal retrograde drainage tandem with endoscopic closure for management of esophageal leak after peroral endoscopic myotomy for Zenker diverticulum.

Commentary on 'Management of anastomotic leaks after elective colorectal resections: The East of England experience. A retrospective cohort' [Int J Surg 2021; 96:106167

Commentary on 'Management of anastomotic leaks after elective colorectal resections: The East of England experience. A retrospective cohort' [Int J Surg 2021; 96:106167

Direct impact of the COVID-19 pandemic on rhinology practice.

The pandemic caused an increase in computed tomography imaging in patients with sinusitis, which persisted post-COVID. Nasal endoscopies significantly decreased during COVID but returned to pre-COVID levels in 2022. The management of cerebrospinal fluid leaks, tumors, and orbital pathology was not impacted by the pandemic.

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

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

Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010-2020 national registry.

Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.

The Usefulness of Resistant Maltodextrin and Chitosan Oligosaccharide in Management of Gut Leakage and Microbiota in Chronic Kidney Disease.

Microbiota-dysbiosis-induced gut leakage is a pathophysiologic change in chronic kidney disease (CKD), leading to the production of several uremic toxins and their absorption into the bloodstream to worsen the renal complications. We evaluate the benefits of resistant maltodextrin (RMD) and chitosan oligosaccharide (COS) supplements in cell culture and CKD-induced rats. The RMD exerted a significant anti-inflammatory effect in vitro and intestinal occludin and zonula occluden-1 up-regulation in CKD rats compared with inulin and COS. While all prebiotics slightly improved gut dysbiosis, RMD remarkably promoted the relative abundance and the combined abundance of Lactobacillus, Bifidobacteria, Akkermansia, and Roseburia in CKD rats. Supplements of RMD should be advantageous in the treatment of gut leakage and microbiota dysbiosis in CKD.

Management of Anastomotic Leakage after Colorectal Resection: Survey among the German CHIR-Net Centers.

(1) Background: A widely accepted algorithm for the management of colorectal anastomotic leakage (CAL) is difficult to establish. The present study aimed to evaluate the current clinical practice on the management of CAL among the German CHIR-Net centers. (2) Methods: An online survey of 38 questions was prepared using the International Study Group of Rectal Cancer (ISREC) grading score of CAL combined with both patient- and surgery-related factors. All CHIR-Net centers received a link to the online questionary in February 2020. (3) Results: Most of the answering centers (55%) were academic hospitals (41%). Only half of them use the ISREC definition and grading for the management of CAL. A preference towards grade B management (no surgical intervention) of CAL was observed in both young and fit as well as elderly and/or frail patients with deviating ostomy and non-ischemic anastomosis. Elderly and/or frail patients without fecal diversion are generally treated as grade C leakage (surgical intervention). A grade C management of CAL is preferred in case of ischemic bowel, irrespective of the presence of an ostomy. Within grade C management, the intestinal continuity is preserved in a subgroup of patients with non-ischemic bowel, with or without ostomy, or young and fit patients with ischemic bowel under ostomy protection. (4) Conclusions: There is no generally accepted therapy algorithm for CAL management within CHIR-Net Centers in Germany. Further effort should be made to increase the application of the ISREC definition and grading of CAL in clinical practice.

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.