Mass Ligation Research Articles

Relationship between postoperative biliary complications and biliary anatomical aspects in performing right anterior- or central bisectionectomy: Single-center retrospective observational study.

Central liver resections are considered to be high-risk procedures due to postoperative biliary complications. However, anatomical aspect-related causes are underreported. Focusing upon right anterior sectionectomy (H58) and central bisectionectomy (H458), we assessed risk factors for postoperative biliary complications. We retrospectively reviewed patients who underwent H58 or H458 in our hospital between April 2008 and June 2023 (n = 58). We conducted univariate and multivariate analysis of risk factors of postoperative biliary complications among perioperative factors and anatomical factors including the branching type of the right posterior hepatic duct (RPHD) and the length of the right hepatic duct (RHD). Twenty-six patients (44.8%) had postoperative biliary complications. Potent risk factors in univariate analysis were the tumor proximity to the right anterior Glissonean branch and longer RHD (both P < 0.01). In multivariate analysis, longer RHD was the only independent risk factor and its hazard (95% confidence interval [CI] was 1.19 (1.05-1.35). Receiver operating characteristics curve (ROC) analysis and the area under the ROC showed that 10 mm was the optimal cutoff value with high discriminatory power (0.72). Considering intraoperative procedures of the right anterior segment Glissonean branch dissection, mass ligation at the second-order branch had marginal risk, especially in patients with RHD >10 mm; its hazard (95% CI) was 5.83 (0.95-35.7). Anatomical factors of RPHD and RHD influenced postoperative biliary complications in this cohort. The supraportal with RHD type was most common anatomy but considered to be hazardous if the RHD was >10 mm.

DNA-Compatible Copper/TEMPO Oxidation for DNA-Encoded Libraries.

Aldehydes are important synthons for DNA-encoded library (DEL) construction, but the development of a DNA-compatible method for the oxidation of alcohols to aldehydes remains a significant challenge in the field of DEL chemistry. We report that a copper/TEMPO catalyst system enables the solution-phase DNA-compatible oxidation of DNA-linked primary activated alcohols to aldehydes. The semiaqueous, room-temperature reaction conditions afford oxidation of benzylic, heterobenzylic, and allylic alcohols in high yield, with DNA compatibility verified by mass spectrometry, qPCR, Sanger sequencing, and ligation assays. Subsequent transformations of the resulting aldehydes demonstrate the potential of this method for robust library diversification.

Step-wise ligation of hilum vs mass ligation during lobectomy of the lung- is it time for a change?

The standard technique for lobectomy followed now is using the superior hilar approach and the bronchus first technique, where the pulmonary artery (PA) vessels are first divided. However, there are certain scenarios where adhesions or extensive lymphadenopathy at the hilum have distorted the vessels. Also, in case of tumors and fistulae, the bronchus and vessels may be in close proximity. Hence, it may be necessary to perform a mass ligation of the hilar structures. The separate dissection of the lobe's vein, artery, and airway forms the basis of lobectomy. The anterior approach, often known as the anterior mediastinum, is currently the most common. To our knowledge, there is limited data to compare the outcomes of step-wise ligation with mass ligation at the hilum for lobectomy. Hence we performed this study where we compared the step-wise with mass ligation of hilar structures during a lobectomy.

Laparoscopic Varicocelectomy by Artery Preserving and Mass Ligation Technique- A Comparative Study

Background- There are multiple methods of varicocele treatment. No single approach is adopted as the best therapeutic option. Laparoscopic varicocelectomy (LV) is one of them. Artery sparing laparoscopic varicocelectomy was found to have high recurrence in literature. Retroperitoneal mass ligation of testicular vein and artery was first done in original Palomo operation. Chance of missing some veins are also less if mass ligation is done in LV. Testes get blood supply from testicular artery, cremasteric artery and artery to the vas. For this reason ligation of the testicular artery in the abdomen do not cause ischemia to testes. We present our experience on comparative study between LV with mass ligation (ML) and artery preserving (AP) technique. We compared the operation time, outcome, and complication in two groups of patients. Methods-Forty-eight varicoceles, both unilateral and bilateral, were operated over a period of three years. Twenty three underwent ligation of veins alone and twenty-five underwent ligation of testicular veins and artery en-mass. They were followed up for a period of three months after surgery. We collected all data in a prospective manner. Results: The average operation time for the artery-preserved and the mass ligated group was 41±5 minutes and 27±3 minutes respectively. Average post-operative hospital stay was 46±12 hrs. and 32±7 hours respectively. There were no technical failures in either group. Complications and recurrence were less in the mass-ligation than in the artery-preserved group. On an average follow-up of 3 months all patients remained asymptomatic and had complete reduction in the size of the varicoceles. There were no incidence of testicular atrophy in either group. Conclusion: Laparoscopic varicocelectomy with mass ligation technique is safe, effective, less time consuming and easy to perform. Recurrence and post-operative complications are minimum. This should preferably be done with mass ligation with an attempt to spare lymphatics.

Prospective Randomized Controlled Trial Comparing Laparoscopic Palomo Surgery versus Scrotal Antegrade Sclerotherapy in Adolescent Varicocele.

Varicocele is a common condition in adolescence and the most common correctable cause of infertility. This study aimed to analyze and compare the outcomes of scrotal antegrade sclerotherapy (SAS) and laparoscopic Palomo surgery (LPS) in a tertiary referral centre. Patients with left grade 3 varicocele indicated for surgery were prospectively enrolled and randomly allocated to the SAS and LPS groups, with their respective contralateral normal testes taken as controls. The primary outcome measures were clinical varicocele recurrence, testicular catch-up growth, and post-operative hydrocele. All patients were evaluated clinically and using Doppler ultrasound by radiologists. From 2015 to 2020, 113 patients completed the study and were statistically analyzed (SAS, n = 57; LPS, n = 56). All patients had significantly smaller testes pre-operatively that the testicular volume differences with control testes were -23% in SAS and -19% in LPS. At 12-month follow-up, there were no statistical significant difference in clinical recurrences between the 2 groups (SAS = 5.3% vs LPS = 5.4%, P>.05, non-inferiority test). Testicular catch-up growths were observed in both groups, the mean testicular volume difference between the treatment and control testes reduced from -23% to -8.1% in SAS (P<.001) and -19% to -9.3% in LPS (P<.001) at 12-month follow-up. There was no post-operative hydrocele in SAS compared to 7 in LPS (0% vs 13%, P = .006). Both SAS and LPS are safe and effective procedures for treatment of adolescent varicocele with significant positive effect on testicular catch-up growth. SAS is not inferior to LPS in terms of clinical recurrence rate and with significantly less post-operative hydrocele.

Transhiatal bilateral thoracic duct ligation for duplicated thoracic duct injury after esophagectomy: a case report

BackgroundThe treatment of duplicated thoracic ducts (TDs) injury after esophagectomy generally requires a bilateral transthoracic approach. We present the cases of two patients with postoperative chylothorax who underwent transhiatal bilateral TD ligation for duplicated TDs.Case presentationTwo patients diagnosed with chylothorax after esophagectomy performed for thoracic esophageal cancer underwent transhiatal TD ligation. Although supradiaphragmatic mass ligation was performed on the fat tissue of the right side of the aorta containing the TD, chyle leakage persisted. To tackle this, the fat tissue of the left side of the aorta was ligated, after which the chyle leakage stopped.ConclusionCompared to the conventional transthoracic approach, the transhiatal approach enables the ligation of both left- and right-sided TD in a single surgical operation, without the need to change the patient’s posture. This approach may be appropriate for the treatment of chylothorax after esophagectomy, considering the possibility of duplicated TDs.

Incidence of chylothorax over nineteen years of transhiatal esophagectomy: A case series and review study.

Chylothorax (CTx) is the leak and accumulation of lymphatic fluid within the pleural cavity. The incidence of CTx has the highest rate after esophagectomy. This study aimed to present three cases of post-esophagectomy chylothorax among 612 esophagectomies that were performed over 19 years, in which post-esophagectomy chylothorax was reviewed in terms of risk factors, diagnosis, and management. Six hundred and twelve patients were included in the study. Transhiatal esophagectomy was used for all patients. In three cases, chylothorax was detected. In all of the three cases, secondary surgery was performed for the management of chylothorax. Mass ligation was performed for the first and third cases having leak from the right side. In the second case, the leak was from the left side without prominent duct; and despite mass ligation that was done several times, no significant reduction in chyle was observed. In the first case, in spite of reduced output, the patient gradually progressed to respiratory distress. His condition deteriorated over time and he died after three days. In the second case that needed third surgery, the patient's condition deteriorated and she died after two days due to respiratory failure. The third patient had postoperative recovery. The patient was discharged on fifth day after the second operation. In post-esophagectomy chylothorax, the key to preventing high mortality rates can be the identification of risk factors as well as timely detection of symptoms and proper management. Besides, early surgical intervention should be considered to prevent early complications of chylothorax.

Post-esophagectomy chylothorax refractory to mass ligation of thoracic duct above diaphragm: a case report

BackgroundPost-esophagectomy chylothorax is a relatively rare but potentially lethal complication. The treatment strategy of post-esophagectomy chylothorax remains a subject of debate which mainly focuses on the indication and timing of surgical intervention. For cases in which the leakage site is not localized, a mass ligation of the thoracic duct above diaphragm is advocated as the surgical procedure is believed to ensure sealing all the accessory ducts that could be the source of the chylothorax. But in this paper, we report a case of post-esophagectomy chylothorax which was refractory to mass ligation of thoracic duct above diaphragm.Case presentationA 59-year old man suffered from high output chylothorax (> 1000 ml/24 h for more than 30 days) after esophagectomy through left thoracotomy. Considering the failure of lymphangiography, we performed mass ligation of thoracic duct above diaphragm. However, we failed to close the chylous leakage. Finally, we found that a rare variated tributary of thoracic duct was the resource of the chylous output. Both the variation of lymphatic system and the coincidence of injured site lead to the invalidness of reoperation. After definitely ligating the variated tributary, chylothorax was cured.ConclusionThis case supplies a direct evidence that mass ligation of thoracic duct is of no avail in some refractory chylothorax, which indicates the importance of chylous leakage localization.

Anatomical study of the thoracic duct and its clinical implications in thoracic and pediatric surgery, a 70 cases cadaveric study

Given the high variability and fragility of the thoracic duct, good knowledge of its anatomy is essential for its repair or to prevent iatrogenic postoperative chylothorax. The objective of this study was to define a site where the thoracic duct is consistently found for its ligation. The second objective was to define an anatomically safe surgical pathway to prevent iatrogenic chylothorax in surgery for aortic arch anomalies with vascular ring, through better knowledge of the anatomical relationships of the thoracic duct. Seventy adult formalin-fixed cadavers were dissected. The anatomical relationships of the thoracic duct were reported at the postero-inferior mediastinum, at levels T3 and T4. The thoracic duct was consistently situated between the left anterolateral border of the azygos vein and the right border of the aorta between levels T9 and T10, whether it was simple, double, or plexiform. It was located medially, anteromedially, or posteriorly to the left subclavian artery in 51%, 21%, and 28% of the cases, respectively, at the level of T3. At T4, it was posteromedial in 27% of the cases or had no direct relationship with the aortic arch. These results favor mass ligation of the thoracic duct at levels T9-T10 between the right border of the aorta and the azygos vein, eventually including the latter. To prevent iatrogenic postoperative chylothorax in aortic arch anomalies with vascular ring surgery, we recommend remaining strictly lateral to the left subclavian artery at the level of T3 to reach the aortic arch anomalies with vascular ring at T4.

Clinical profile of patients with Inguinal hernia subjected for Lichtenstein’s and Desarda’s technique

The first evidence of operative repair of a groin hernia dates to the first century AD. The original hernia repairs involved wide operative exposures through scrotal incisions requiring orchiectomy on the involved side. Centuries later, around 700 AD, principles of operative hernia repair evolved to emphasize mass ligation and en bloc excision of the hernia sac, cord, and testis distal to the external ring. Over a period of one and half year patients selected with inguinal hernia as per inclusion and exclusion criteria were included in this prospective study. Patients were randomly divided into two groups’ i.e. Group 1(Control group): were subjected to Lichtenstein Tension free mesh repair. Group 2(Study group): were subjected to Desarda repair. 60% and 56% percent of sample patients were having right side Inguinal hernia respectively in LTF and Desarda group. Whereas 40% and 44% of sample patients of LTF and Desarda group respectively were diagnosed to of having left sided Inguinal hernia.

A new technique of doppler dearterialization for hemorrhoidal disease: arterial detection ligation (ADL)

We describe the arterial detection ligation (ADL) technique, designed to find arteries at time-appropriate depth for ligating, and report our preliminary results of using this technique to treat patients with the hemorrhoidal disease (HD). The subjects of this retrospective analysis were patients with symptomatic grades 2 or 3 HD. We analyzed the clinical characteristics, postoperative complications, recurrence, and patient satisfaction of the patients treated with ADL. A total of 75 patients were included in the study (male/female ratio 1.88; mean age 48 ± 19years; mean BMI 24 ± 3kg/m2). Thirty-nine patients (52%) did not require hospitalization and were discharged from the day clinic approximately 4h postoperatively. Four patients (5.3%) suffered tenesmus for about 1week postoperatively and two (2.7%) suffered temporary rectal bleeding. The mean VAS scores 1day postoperatively, then at 1week, 1month and 1year were 2.9, 1.5, 0.4, and 0, respectively. At the 1-month follow-up, there was no sign of recurrence and the satisfaction rate was 78.6% (n = 59). At the 1-year follow-up, three patients (4%) had a recurrence and the satisfaction rate was 86.7% (n = 65). Based on our preliminary findings, ADL is an effective technique for treating HD, generally as an outpatient procedure, without serious morbidity. We anticipate that the incidence of tenesmus, which is encountered frequently after other dearterialization methods, will be lower after the ADL technique, which avoids both mass ligation of hemorrhoidal arteries deeper than 12mm and running a long mucopexy suture line.

Comparative analysis of voice changes after thyroidectomy; mass versus individual ligation of superior thyroid artery with reference to identification of external branch of superior laryngeal nerve

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The external branch of the superior laryngeal nerve innervates the cricothyroid muscle to promote lengthening and thinning of the vocal fold, thus increasing voice pitch. The close relation with the superior thyroid vessels puts the external branch of the superior laryngeal nerve in risk every time the superior pole of the thyroid is dissected.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; : This randomized controlled study was undertaken at SMS Medical College, Jaipur between February 2013 to November 2014 to evaluate the impact of isolating and ligating the superior thyroid vessels near the upper pole of the gland as compared to conventional mass ligation of the superior pole regarding external branch of superior laryngeal nerve injury in hemi or subtotal thyroidectomy. Total 120 patients were taken and divided into two groups A and B. Group A including mass ligation of superior pole of thyroid and group B includes individual ligation of superior thyroid vessels. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Our study observed normal voice in 51 cases (85%) in individual ligation of superior thyroid vessel group and 27 cases (45%) in mass ligation group on auditory perceptual test by GRBAS scale one month postoperatively. Normal electromyography findings after 1 month post-operatively was observed in 57 cases (95%) in individual ligation group as compared to 40 cases (66.67%) in mass ligation group.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study conclude that careful ligation of superior thyroid vessels is a safe technique to preserve the external branch of superior laryngeal nerve than mass ligation of superior pole of thyroid.&lt;/p&gt;

Outcome of laparoscopic varicocelectomy with mass ligation technique for symptomatic varicocele

Outcome of laparoscopic varicocelectomy with mass ligation technique for symptomatic varicocele

Prevention and Surgical Therapy of Chylothorax

Chylothorax is a rare complication after thoracic trauma or surgery, especially oesophagectomy, which, if left untreated, can be potentially life-threatening. This article provides an overview of the existing literature on the prevention and surgical therapy of chylothorax. The risk of chyle leakage after oesophagectomy increases with the difficulty of mediastinal dissection and is reported to be around 3% for oesophagectomy. With this risk, there is the possibility of a prophylactic intraoperative ligature of the thoracic duct, either as a selective or mass ligation. Meta-analyses confirm the effectiveness of this measure, with a reduction in the risk to less than 1%. In the case of postoperative chylothorax, a conservative therapeutic trial may be undertaken with drainage of up to 1000 ml per day for up to one week. If there is any indication of persistent leakage, rapid surgical reintervention appears appropriate. This can be either transthoracic or transhiatal as a selective or mass ligation and has a probability of success of over 90%. The prophylactic primary or therapeutic secondary ligature of the thoracic duct is an effective surgical preventive measure and therapy of postoperative chyle leakage.

Torsion of a Communicating Hydrocele Presented as Acute Scrotum: A Case Report and Literature Review.

Torsion of a communicating hydrocele is extremely rare, and the cause is unclear. We report the case of a 3-year-old boy referred to us with acute scrotum. Operative findings revealed torsion of a communicating hydrocele with a 360-degree rotation of the distal end. We performed surgical excision of the necrotic cystic mass and high ligation of the peritoneal communication. A high index of suspicion is required for the correct diagnosis and treatment of this condition, which should be included among the causes of acute scrotum in childhood.

Anatomic variability of the thoracic duct in pediatric patients with complex congenital heart disease

ObjectiveThoracic duct mass ligation (TDML) through a right thoracotomy (RT), regardless of the side of the pleural effusion, is a standard procedure for chylothorax that is refractory to medical treatment. This procedure may be unsuccessful in patients with complex congenital heart disease, which necessitates additional left thoracotomy (LT) for left periaortic mass ligation. We hypothesized that failure of the right-sided approach is attributable to the anatomic variation of the path of the thoracic duct. MethodsOf the children who underwent surgery for congenital heart disease between 1992 and 2014, a total of 70 of 8880 (0.8%) underwent TDML by RT (n = 57) or LT (n = 13; LT after RT in 10, and primary LT in 3). ResultsPersistent chylothorax was successfully resolved in 65 patients (65 of 70; 93%) within 15 days (2-79 days) after the first or second TDML; 5 patients died with a chest-tube(s) in situ. After excluding mortality without chest-tube removal, we sought to identify the risk factor(s) necessitating LT in 65 patients (RT group: 54; LT group: 11). On logistic regression analysis, the LT group was more likely to have dextrocardia (odds ratio: 6.38; 95% confidence interval: 1.09-37.25; P = .04). The incidence of abnormal atrial situs, great arterial malposition, right descending thoracic aorta, and bilateral superior vena cavae were comparable in the 2 groups. ConclusionsThe path of the thoracic duct may vary in pediatric patients with complex congenital heart disease. Left periaortic mass ligation should be considered in patients with chylothoraces that persist after the right-sided approach, especially in patients with dextrocardia.

Interleukin-6 Receptor rs7529229 T/C Polymorphism Is Associated with Left Main Coronary Artery Disease Phenotype in a Chinese Population

Left main coronary artery disease (LMCAD) is a particular severe phenotype of coronary artery disease (CAD) and heritability. Interleukin (IL) may play important roles in the pathogenesis of CAD. Although several single nucleotide polymorphisms (SNPs) identified in IL related genes have been evaluated for their roles in inflammatory diseases and CAD predisposition, the investigations between genetic variants and CAD phenotype are limited. We hypothesized that some of these gene SNPs may contribute to LMCAD phenotype susceptibility compared with more peripheral coronary artery disease (MPCAD). In a hospital-based case-only study, we studied IL-1A rs1800587 C/T, IL-1B rs16944 G/A, IL-6 rs1800796 C/G, IL-6R rs7529229 T/C, IL-8 rs4073 T/A, IL-10 rs1800872 A/C, and IL-10 rs1800896 A/G SNPs in 402 LMCAD patients and 804 MPCAD patients in a Chinese population. Genotyping was done using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and ligation detection reaction (LDR) method. When the IL-6R rs7529229 TT homozygote genotype was used as the reference group, the CC or TC/CC genotypes were associated with the increased risk for LMCAD (CC vs. TT, adjusted odds ratio(OR) = 1.46, 95% confidence interval (CI) = 1.02–2.11, p = 0.042; CC + TC vs. TT, adjusted OR = 1.31, 95% CI = 1.02–1.69, p = 0.037). None of the other six SNPs achieved any significant differences between LMCAD and MPCAD. The present study suggests that IL-6R rs7529229 T/C functional SNP may contribute to the risk of LMCAD in a Chinese population. However, our results were limited. Validation by a larger study from a more diverse ethnic population is needed.

Transabdominal mass ligation of the thoracic duct for the prevention of chylothorax following en bloc oesophagectomy

The occurrence of a postoperative chylothorax after en bloc oesophagectomy for cancer is a severe and potentially life-threatening complication. In this study, we describe the technique of transabdominal mass ligation of the thoracic duct as an elective, simple and safe method for the prevention of postoperative chylothorax.

Giant Epidermal Cyst on Posterior Scalp

Giant Epidermal Cyst on Posterior Scalp

Intraoperative fluorescence lymphography using indocyanine green in a patient with chylothorax after esophagectomy: report of a case

We report a case of chylothorax treated successfully by a new diagnostic tool: indocyanine green (ICG) fluorescence lymphography. The patient, a 65-year-old man with adenocarcinoma of the esophagogastric junction, underwent radical esophagectomy, which was followed by the development of chylothorax. On postoperative day 10, we performed transabdominal ligation of the thoracic duct. During the re-operation, we injected ICG into the mesentery of the small bowel. We then performed mass ligation of the tissue right and dorsal of the aorta, including the thoracic duct, after which a near-infrared camera system revealed a fluorescent stripe on the caudal part of the ligation. The remnant thoracic duct appeared to be dilated as a result of lymphatic stasis. The patient was discharged 35 days after his initial surgery. We report this case to demonstrate the usefulness of intraoperative ICG lymphography as a tool to identify and confirm ligation of the thoracic duct transabdominally.