Mucosal Eversion Research Articles

Clinical efficacy and safety of Lingnan surgery for the treatment of multiple-quadrant acute incarcerated hemorrhoids: A retrospective study.

In this study, we introduce a surgical procedure for multiple-quadrant hemorrhoid crisis, namely Lingnan surgery, and discuss its clinical efficacy and safety. We performed a retrospective analysis of patients with acute incarcerated hemorrhoids who underwent Lingnan surgery at the Anorectal Department of Yunan County Hospital of Traditional Chinese Medicine of Guangdong Province from 2017 to 2021. The baseline data, preoperative condition, and postoperative condition of each patient were recorded in detail. A total of 44 patients were studied. There were no cases of massive hemorrhage, wound infection, wound nonunion, anal stenosis, abnormal anal defecation, recurrent anal fissure, or mucosal eversion within 30 days after surgery, and no recurrence of hemorrhoids and anal dysfunction occurred during the 6-month follow-up after surgery. The average operation time was 26.5±6.2min (17-43min). The average length of hospital stay was 4.0±1.2 days (2-7 days). In terms of postoperative analgesia, 35 patients took oral nimesulide, 6 did not use any analgesics, and 3 required nimesulide plus tramadol by injection. The mean Visual Analog Scale pain score was 6.8±0.8 preoperatively and 2.9±1.2, 2.0±0.7, and 1.4±0.6at 1, 3, and 5 days postoperatively, respectively. The average basic activities of daily living score was 98.2±2.6 (90-100) at discharge. Lingnan surgery is easy to perform and has obvious curative effects, providing an alternative to conventional procedures for acute incarcerated hemorrhoids.

Multiple Graft Bile Ducts Do Not Affect the Postoperative Outcomes of Right Lobe Living Donor Liver Transplantation

Multiple graft duct openings are associated with a high incidence of biliary complications (BCs), and biliary reconstruction for multiple graft bile ducts (BDs) remains a surgical challenge during living donor liver transplantation (LDLT). In particular, biliary reconstruction using "high biliary radicals (HBR)" of recipients for multiple graft BDs has a high probability of BCs. Herein, we analyzed outcomes by retrospectively reviewing 283 patients who underwent right lobe LDLT from January 2013 to September 2019. In total, 112 LDLT procedures using grafts with multiple BDs have been performed under our policies. In recent cases with 2 orifices located on the same hilar plate, we did dunking with a mucosal eversion technique instead of ductoplasty. When 2 orifices are located far apart on different hilar plates, we attempted to perform separate duct-to-duct anastomosis (DDA) using HBR of the recipient instead of hepaticojejunostomy. Among patients with multiple graft BDs, 20 underwent ductoplasty, 50 were treated using dunking with mucosal eversion technique, and 40 underwent separate DDA using HBR (HBR group). The incidence rates of biliary leakage and stricture were 8.9% and 10.7% in the multiple BD group, respectively, congruent with the outcomes of the single BD group. In subgroup analysis, we compared clinical outcomes between the HBR and single BD groups; the incidence of BCs in the HBR group was 15.0%, comparable to that of the single BD group. In conclusion, multiple graft BDs do not negatively impact the BC rate compared with single-graft BD when applying our technique to prevent BCs.

Eversion technique: A safe anastomosis method of bile duct in living donor liver transplantation without internal or external biliary stent

Biliary stricture (BS) is still a major concern after bile duct anastomosis in living donor liver transplantation (LDLT), even after the technical refinements using a microscope. This study aims to describe our eversion technique without stent insertion of biliary anastomosis and its effects on the incidence of biliary complications. This was a single-center retrospective study of 52 adult LDLT recipients between December 2011 and June 2020. Group 1 consisted of the first 20 patients for whom the standard technique of biliary anastomosis (minimal hilar dissection during donor duct division, high hilar division of the recipient bile duct, and preservation of the recipient duct periductal tissue) was used. Group 2 consisted of 32 patients for whom biliary anastomosis was done with the addition of corner-sparing sutures and mucosal eversion of the recipient duct to the standard technique. Primary outcome measures included biliary complications (biliary leaks and strictures). Biliary complications occurred in 4/20 patients in group 1 (20.0%) and 2/32 patients in group 2 (6.25%). The technical factors mentioned above are aimed at preserving the blood supply of the donor and recipient ducts and hold the key for minimizing biliary complications in adult-to-adult LDLT. The application of eversion technique could be a key for preventing BAS in duct-to-duct biliary reconstruction in LDLT.

Corner sparing mucosal eversion technique of biliary anastomosis: targeting the "Achilles heel" of living donor liver transplant

Presenter: Ashish Singhal MBBS, DNB | Fortis Hospitals Background: Biliary complications (BC) remain the “Achilles heel” of LDLT with reported incidences between 4%-34%. This is probably due to smaller, multiple ducts and difficult ductal anatomy. The present study describes our technique of biliary anastomosis and its effects on incidence of BCs. Methods: Retrospective analysis of 820 primary LDLTs performed at our institute between December 2011 and December 2018. The standard technique of biliary anastomosis (minimal hilar dissection during donor duct division, high hilar division of the recipient bile duct, and preservation of the recipient duct periductal tissue) was used. In addition, modified technique: corner-sparing sutures and mucosal eversion of the recipient duct was done. Results: Primary outcome measures included BCs (biliary leaks and strictures). With a median follow-up of 34 months (range: 1 month-95 months), the overall incidence of BC was 6.7% (n = 55). Thirty-two (58.2%) patients presented with biliary stricture and 23 (42.8%) with biliary leak with/without stricture. Conclusion: The technical factors mentioned above are aimed at preserving the blood supply of the donor and recipient ducts and hold the key for minimizing biliary complications in LDLT.

Biliary Reconstruction Using High Biliary Radical Is Safe Option for Multiple Graft Bile Ducts in Right Lobe Living Donor Liver Transplantation

Multiple small size donor bile ducts (BDs) are related to higher incidence of biliary complications (BCs) and biliary reconstruction for multiple BDs still remains a technical challenge during living donor liver transplantation (LDLT). Especially biliary reconstructions using high biliary radicals (right or left hepatic duct) on the recipient for multiple BDs are associated with very high probability of BCs secondary to devacularization and ischemia. Therefore, hepaticojejunostomy has been preferred in cases with multiple BDs which are not close each other although duct to duct anastomosis (DDA) has more physiological advantages. Herein, we analyzed clinical outcomes through retrospective reviews 227 patients receiving DDA for right lobe grafts LDLT from January 2013 to September 2018. 87 LDLT using grafts with multiple BDs have been performed and among them, 39 patients received DDA using high biliary radicals as recipient's BD using minimal hilar dissection, external biliary stents and mucosal eversion technique. We compared clinical outcomes with those in group using common hepatic duct as recipient's BD for multiple BD (CHD group). The incidence of biliary leakage and stricture were 10.3% and 12.8% and these results were not different to those in CHD group. Moreover, these results were comparable to those in group with single graft BD during the same periods. In conclusion, the choice high biliary radicals as the recipient's BD for multiple graft BDs was not associated with more BCs and could be safe option for biliary reconstruction with multiple BDs under our strategies.

Corner Sparing Mucosal Eversion Technique of Biliary Anastomosis: Targeting the “Achilles' Heel” of Living Donor Liver Transplant

Corner Sparing Mucosal Eversion Technique of Biliary Anastomosis: Targeting the “Achilles' Heel” of Living Donor Liver Transplant

Acute colonic pseudo-obstruction with bowel rupture after caesarean section in HELLP syndrome: a case report

BackgroundOgilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), can occur postpartum after caesarean section (C-section), often resulting in caecal dilatation. The incidence rate is approximately 100 cases in 100,000 patients per year (Ross et al., Am Surg 82:102-11, 2016). Without proper diagnosis and treatment, it may progress to intestinal perforation or other fatal complications.Case presentationA 39-year-old pregnant woman underwent emergency low-segment C-section due to complications of Haemolysis, Elevated Liver enzymes and Low Platelets syndrome (HELLP) syndrome. ACPO was suspected on the third day after C-section based on inability to pass flatus, evident abdominal distension, slight abdominal pain, and computed tomography (CT) scan revealing severe, diffuse colonic distention with caecal dilatation of approximately 9 cm. Based on these findings, conservative treatment was implemented. However, 6 days after C-section, her symptoms worsened, and CT showed possible intestinal perforation; thus, an emergency laparotomy was performed. Due to a 3-cm (diameter) laceration in the anterolateral wall of the ascending colon and a 5-cm tear in the ileocecal junction, in combination with mucosal eversion in the colon, resection of the ileocecum, distal closure of the ascending colon, and a terminal ileostomy were performed. The patient was discharged 2 weeks post-laparotomy and continued to undergo nursing care for the incision and stoma. Ileostomy was performed 4 months later.ConclusionOgilvie syndrome after C-section is an extremely rare but severe condition, which warrants early recognition and treatment to prevent potentially fatal complications, especially in patients with poor health status.

Novel Method for Reconstructing Multiple Graft Bile Ducts During Right Lobe Living Donor Liver Transplant: Dunking With Mucosal Eversion Technique

BackgroundMultiple graft bile ducts (BDs) and anastomoses have been considered as risk factors for biliary complications after living donor liver transplant (LDLT). Various surgical techniques have been introduced, and most surgeons perform unification ductoplasty for multiple adjacent BDs during LDLT. However, this could cause hemobilia and is difficult to perform when 2 ductal orifices are far apart or show a size discrepancy. MethodsHere, we introduce our novel reconstruction technique for multiple adjacent graft BDs and discuss its effects on postoperative outcomes compared with ductoplasty. We compared the clinical outcomes of 2 biliary reconstruction techniques by retrospectively reviewing 58 recipients who underwent LDLT with right lobe grafts using these 2 techniques at our institution between January 2013 and September 2018: group 1 (n = 20) received ductoplasty, and group 2 (n = 38) was treated with dunking with mucosal eversion technique. ResultsOverall biliary complication rates were 20.0% in group 1 and 10.5% in group 2 (P = .32). Biliary stricture in group 2 was not frequent compared with that in group 1 (7.9% vs 15.0%, P = .398). Moreover, incidence of biliary stricture in group 2 was not different than that in the group using graft with single BD during the same period (P > .624). ConclusionsOur novel technique could be a useful method for reconstructing adjacent BDs in LDLT and the best alternative to ductoplasty. Moreover, it seems to be a reasonable option when 2 orifices are far apart or show a size discrepancy.

Anal/anogenital lesion revealing child sexual abuse: A case series of an unusual situation in a black African setting

IntroductionChild sexual abuse (CSA) remains a big taboo in black Africa with an underestimated prevalence. In our context, the majority of cases are known by revelations of the child at least one year after the facts. Presentation of casesWe report three cases of CSA revealed by an anal/anogenital lesion requiring surgery. All of these patients were female with ages ranging from 20 months to 8 years. The lesions encountered were: an anal abscess, a fissure-in-ano with permanent anal mucosal eversion and a complex perineal tear including partial anal sphincter rupture with partial section of the rectovaginal septum. The outcome was favorable in all cases after surgery. The abuser was subsequently able to be identified after the statements of two of these three children. DiscussionDetection of anogenital lesions during a pediatric consultation should make practitioners aware of the possibility of sexual abuse. Surgical repair of these lesions can be simple or complex, requiring major reconstructions. In such cases, it’s important to listening to the child’s voice. ConclusionAnogenital lesions discovered during pediatric consultation must evoke sexual abuse. The silence and the taboo surrounding these abuses in Africa must be break down.

The efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis

Objective To discuss the efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis. Methods From August 2016 to November 2018, 31 patients with prostate cancer underwent laparoscopic radical prostatectomy. The patients were 62-85 years old(mean 74.8 years), and the mean PSA score was 16.5 ng/ml(6.8-34.2 ng/ml). The pathological examination confirmed that the Gleason score was 6-9 and the prostate size was 44-83 ml. All patients underwent laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis. Surgical procedure: After resection of the prostate in laparoscopic radical prostatectomy, the bladder neck was sutured at 6 o'clock position to narrow the bladder neck ( tennis racquet reconstruction). The interval was 1 cm, and 2-3 needles were sutured, the distance between the neck of the bladder and the ureter was extended. The bladder neck mucosa and urethral mucosa eversion were performed. The posterior wall of the bladder neck was sutured at interval of 1 cm on both sides of the midline. After the knot was tightened, the posterior wall of the bladder was folded and bladder neck was elevated. The posterior wall of the bladder and the posterior wall of the urethra were sutured to reduce the distance between the bladder and the urethra. Finally, the bladder and urethra were anastomosed. The postoperative urinary continence recovery and the clinical effect were recorded. Results The operation time of 31 patients ranged from 80 to 210, with an average of 139.7 minutes. Intraoperative bleeding was 50-330 ml, with an average of 144.2 ml. None of the patients switched to open surgery during the operation, and there was no injury to large vessels and rectum, and no anastomotic leakage. Postoperative pathology showed 21 cases of pT2 stage, 10 cases of pT3 stage, 2 cases of positive margin, including 1 case of basal part and 1 case of apex part, both of which received medical castration therapy postoperatively.The surgical margin was positive in 2 cases (6.45%). 31 patients removed the urinary catheter in ten days after surgery. 17 cases (54.8%) recovered instantly urinary continence; 7 cases (22.6%) urinary continence in 1 month after operation; 4 cases (12.9%) urinary continence in 3 months after operation; and 3 cases (9.7%) urinary control in 6 months after operation. One case had urinary retention after removing the urinary catheter, and cathetered for 2 more weeks. After pulling out again, the urinary continence was good. Conclusions Laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis may be helpful for early recovery of urinary continence. Key words: Prostatectomy; Bladder neck extension; Mucosal eversion; Urinary continence

Intestinal surgery in small animals: historical foundations, current thinking, and future horizons.

Intestinal wounds require precise closure after intestinal biopsy, enterotomy, or enterectomy in small animals. Preexisting factors such as intra-abdominal sepsis and hypoalbuminemia as well as poor surgical technique increase the risk of intestinal dehiscence, with considerable negative impact on patient morbidity and mortality. Live dog studies have demonstrated the dangers of mucosal eversion especially in the septic abdomen. Approximating patterns preserve luminal diameter, heal optimally, and have equal bursting strength compared with inverting patterns after 24 hours. Simple interrupted and simple continuous suture patterns and disposable skin staples are established alternatives for manual wound closure. Knotless quilled suture currently used in laparoscopic gastropexy techniques shows bursting strength equal to monofilament sutures in dog cadaveric intestine. Dehiscence rates with hand sewn vs titanium automated stapling anastomosis are similar in uncomplicated cases; however, auto stapling devices may be the preferred method of anastomosis when preexisting abdominal sepsis is present and when patient size allows it. Regardless of the technique, current standard of care involves leak testing and omental wrapping, followed by early postoperative feeding. The past decade has ushered in an exciting new era of laparoscopic assisted techniques that have the potential to reduce postoperative pain and patient morbidity. An understanding of these applications will establish the future of minimally invasive small animal intestinal surgery for veterinary specialists. In summary, surgeons have a variety of methods at their disposal for optimal clinical outcome in small animal intestinal surgery.

Evaluation of surgical models for training veterinary students to perform enterotomies.

To compare surgical models for teaching enterotomies to students. Prospective, randomized study. Second-year veterinary students (n = 59) and faculty surgeons/surgery residents (n = 19). Participants performed an enterotomy on each of 3 models (equine cadaver intestine, SurgiReal small intestine simulator, and SynDaver canine bowel) and completed a survey comparing them to either an enterotomy on an anesthetized pig (students) or intestinal surgery experience (faculty/residents). Surveys results were compiled and analyzed. Both student and faculty/resident groups rated cadaver intestine as more similar to live intestine compared with the synthetic models for incision, tissue handling, mucosal eversion, needle passage, knot tying, and best preparing for live intestine. Students rated SynDaver as more similar to live intestine than SurgiReal for incision and ranked SurgiReal as more similar to live intestine than SynDaver for mucosal eversion. There was no difference between the ranks assigned to SurgiReal and SynDaver for faculty/residents. Faculty/residents responded most often that cadaver intestine would be the model they recommend for training students. Cadaver intestine was the model most similar to live intestine for all variables tested. SurgiReal and SynDaver models were comparable to each other but did not simulate live intestine as well as cadaver intestine. Cadaver intestine more closely approximated live intestine compared with either synthetic model. SurgiReal and SynDaver may be adequate alternatives if cadaver intestine is unavailable.

A novel reconstruction method for adjacent multiple bile duct during living donor liver transplantation; Dunking with mucosal eversion technique

A novel reconstruction method for adjacent multiple bile duct during living donor liver transplantation; Dunking with mucosal eversion technique

Upper Lip Reconstruction after Oncologic Resection by a Sliding Advancement Cheek Flap with Buccal Mucosal Eversion.

Upper Lip Reconstruction after Oncologic Resection by a Sliding Advancement Cheek Flap with Buccal Mucosal Eversion.

Reply.

TO THE EDITOR: We are pleased that the authors read our article with great interest. We strongly disagree with the authors' comment that corner‐sparing and mucosal eversion is essentially the same as the Hilar plate and Glissonian sheath (HPGS) method. The approach previously described by the authors is essentially the method of donor duct division.1 In other words, they have ascribed the improvement of biliary complications essentially to the way they divide the donor duct. There are many ways a donor duct can be divided, and it varies from center to center. The basic principle of duct division is to preserve the hilar plate along with its vascular plexus in periductal tissue. As described in our article, we believe in a precise and sharp division of the donor duct without disturbing the hilar plate. The end result of this method is the same as the HPGS approach. Unlike HPGS, which is one of the methods of donor duct division, our article focuses on anastomosis rather than on donor duct division.2 The high hilar division described in our article is essentially for the recipient duct, with the aim being to get the second‐ or third‐order biliary orifices. These orifices can be tailored and joined together to yield a funnel‐shaped recipient bile duct, which can be easily everted. The authors have further raised anatomic and practical reservations with our concepts. The first issue raised is regarding the eversion of the donor duct. If read carefully, the authors will notice that we have not mentioned donor duct eversion in our article because we are aware that it cannot be everted due to the short stump.2 Mucosal eversion is for the recipient duct. Eversion of the recipient duct is a very important component of our technique in many ways. First, it allows us to anastomose with healthy and well‐vascularized mucosa because the end of the cut stump may be of doubtful vascularity. Second, adventitial tissue does not pop in‐between the sutures, giving us a near perfect mucosal apposition. Third, the overhanging part of the duct forms a supporting cuff around the anastomosis. The second issue raised is about the corner‐sparing component of our technique. Corner‐sparing sutures in our article are mainly for the donor duct rather than for the recipient duct as perceived by the authors. Corner‐sparing sutures in the recipient duct are placed just to match and correspond to the corner‐sparing sutures in the donor duct. Corner‐sparing of the donor duct (avoiding sutures at 3 and 9 o'clock) is a very crucial and important part of our technique for 2 reasons. First, corners are the weakest part of the donor duct because the hilar plate splits at the corners. We have learned from our experience (re‐explorations and endoscopic retrograde cholangiography) that most posttransplant bile leaks are from the corners. Sparing of the corners avoids any cut‐through or necrosis of the donor duct at the corners during or after tying knots. Second, the natural shape of the donor duct is like a slit with 2 ends as corners (to be avoided in sutures). Corner‐sparing anterior and posterior sutures in the donor duct actually convert the slit into a square or rectangle (which further simplifies anterior suturing). On the contrary, if corners are included in the sutures, it further accentuates the slit and makes suturing difficult. This concept of squaring is beautifully shown in the photograph presented in our original article. As mentioned in the original article, we refute the component of a learning curve because we had had significant experience before modifying our technique. At our center, we do not reject or select the donor based on biliary anatomy. We have stopped doing preoperative magnetic resonance cholangiopancreatography in our protocol for selecting a donor for the last 350 patients. The corner‐sparing and mucosal eversion technique is very promising and significantly reduces the overall biliary complications to <4%. We have further used this technique for more than 200 patients since our original publication with a similar low incidence of biliary complications.

Targeting the Achilles' heel of adult living donor liver transplant: Corner-sparing sutures with mucosal eversion technique of biliary anastomosis.

Targeting the Achilles' heel of adult living donor liver transplant: Corner-sparing sutures with mucosal eversion technique of biliary anastomosis.

Targeting the Achilles' heel of adult living donor liver transplant: Corner-sparing sutures with mucosal eversion technique of biliary anastomosis.

Biliary complications are regarded as the Achilles' heel of liver transplantation, especially for living donor liver transplantation (LDLT) due to smaller, multiple ducts and difficult ductal anatomy. Overall biliary complications reported in most series are between 10% and 30%. This study describes our modified technique of biliary anastomosis and its effects on incidence of biliary complications. This was a single-center retrospective study of 148 adult LDLT recipients between December 2011 and June 2014. Group 1 (n = 40) consisted of the first 40 patients for whom the standard technique of biliary anastomosis (minimal hilar dissection during donor duct division, high hilar division of the recipient bile duct, and preservation of the recipient duct periductal tissue) was used. Group 2 (n = 108) consisted of 108 patients for whom biliary anastomosis was done with the addition of corner-sparing sutures and mucosal eversion of the recipient duct to the standard technique. Primary outcome measures included biliary complications (biliary leaks and strictures). Biliary complications occurred in 7/40 patients in group 1 (17.5%) and in 4/108 patients in group 2 (3.7%). The technical factors mentioned above are aimed at preserving the blood supply of the donor and recipient ducts and hold the key for minimizing biliary complications in adult-to-adult LDLT.

“True” Duct-to-Mucosa Pancreaticojejunostomy, with Secure Eversion of the Enteric Mucosa, in Whipple Operation

BackgroundPostoperative pancreatic fistula (POPF) due to anastomotic leak is often associated with significant morbidity and mortality. The aim of this study was to present an improved anastomotic technique for Whipple operation, which we call “true” duct-to-mucosa anastomosis (DMA)—pancreaticojejunostomy. MethodsA novel enteric mucosal eversion at the point of the jejunostomy is constructed prior to the anastomosis with the pancreatic duct in order to enhance sealing. This technique was tested in a series of 38 patients (study group) and compared to the technique used in the preceding 35 patients who served as controls. ResultsThe incidence of POPF was significantly lower in the study group compared to controls: 7.9 % (3/38) vs 34.3 % (12/35), respectively (P = 0.008, odds ratio 6.1). All POPFs in the study group were International Study Group on Pancreatic Fistula (ISGPF) grade A, while in the control group POPFs ISGPF grade B and C occurred in 17.1 %. Additionally, median (interquartile range) postoperative hospitalization was reduced in the study group [16 (14–21) days] compared to controls [20 (16–27) days, P = 0.005]. ConclusionsThe “true” DMA technique appears to be one of the safest techniques reported to date. The modifications presented herein can easily be adopted by experienced surgeons already performing other techniques of duct-to-mucosa anastomosis.

The impact of bladder neck mucosal eversion during open radical prostatectomy on bladder neck stricture and urinary extravasation

To determine whether the bladder neck mucosal eversion (BNM-eversion) during radical retropubic prostatectomy (RRP) reduces the risk of bladder neck stricture (BNS) and of peri-anastomotic extravasation (PAE) in postoperative cystography. Two hundred and eleven patients with clinically localized prostate cancer underwent RRP and were prospectively randomized into patients with BNM-eversion (group I) and without BNM-eversion (group II). All patients underwent an evaluation of PAE by retrograde cystography on postoperative day 8. We assessed BNS after 6 months. Ninety-two patients with and 113 patients without BNM-eversion were included. There was no significant difference in baseline characteristics, including age, TNM-classification, Gleason score, PSA, prostate volume, and blood loss in both groups. A complete follow-up of 6 months for BNS was available for 188 patients (89.1 %). Sixteen BNS out of 188 patients were recorded, 4.7 % (n = 4) in group I and 11.7 % (n = 12) in group II (p = 0.09). Data from 205 out of 211 patients were available for the evaluation of the extravasation by cystography. Peri-anastomotic extravasation was detectable in 11.96 %, (11/205) in group I and in 21.24 % (24/205) in group II (p = 0.08). BNM-eversion does not have a positive influence on the prevention of bladder neck strictures. Peri-anastomotic extravasation detected by cystography does not correlate with a formation of bladder neck stricture.

1797 URETHRAL PRESERVATION AND ANASTOMOTIC TECHNIQUE DURING OPEN ANTEGRADE RADICAL PROSTATECTOMY: FUNCTIONAL AND ONCOLOGICAL RESULTS

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111797 URETHRAL PRESERVATION AND ANASTOMOTIC TECHNIQUE DURING OPEN ANTEGRADE RADICAL PROSTATECTOMY: FUNCTIONAL AND ONCOLOGICAL RESULTS Federico Lanzi, Lorenzo Masieri, Nicola Tosi, Michele Lanciotti, Saverio Giancane, Claudia Giannessi, Marco Carini, and Sergio Serni Federico LanziFederico Lanzi Florence, Italy More articles by this author , Lorenzo MasieriLorenzo Masieri Florence, Italy More articles by this author , Nicola TosiNicola Tosi Florence, Italy More articles by this author , Michele LanciottiMichele Lanciotti Florence, Italy More articles by this author , Saverio GiancaneSaverio Giancane Florence, Italy More articles by this author , Claudia GiannessiClaudia Giannessi Florence, Italy More articles by this author , Marco CariniMarco Carini Florence, Italy More articles by this author , and Sergio SerniSergio Serni Florence, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2147AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of the study is to present our technique of urethral preservation and vesicourethral anastomosis during open antegrade radical retropubic prostatectomy (ARRP) in a series of 936 consecutive patients (pts) evaluating functional and oncological outcome. METHODS From Jan 2000 to Dec 2008, 936 pts underwent ARRP for clinically localized prostate cancer. Mean age (range) was 65.2 (42–78) years. The first step of our technique is the dissection of vesico-prostatic junction preserving completely the bladder neck. Once neurovascular bundles are dissected or resected, cranial traction of the completely mobilized prostate allows an excellent visualization of apex and urethral sphincter so urethra can be transected at its origin from prostatic boundaries. Vesicourethral anastomosis is created using four sutures of 3/0 Polysorb® around a Foley 18 Fr catheter after mucosal eversion of bladder neck. Catheter is usually removed on postoperative day 10. RESULTS Mean follow-up (SD, median, range) was 54.7 months (27.6; 51; 16 121). Of the 936 pts, 55 (5.9%) with pN+ were addressed to adjuvant therapy and excluded from survival analysis. Tumoral involvement of apex was found in 625/881 (70.9%) cases, while apical positive surgical margins were discovered in 42/625 (6.72%) pts. Of those, 15 (35.7%) developed BCR. Overall 892 (95.3%) pts completely fulfilled our continence criteria (no pads) at a minimum follow-up of 12 months; 16 (1.7%) pts developed mid stress incontinence (1 pad/die), while 22 (3.0%) pts used 2–3 pad/die. Continence rates obtained at catheter removal and at 1,3,6,12 months were 54.9% (514/936), 73.5% (688/936), 87.5% (819/936), 93.8% (878/936) and 95.3% (892/936) respectively. Overall 4 pts (0.4%) developed anastomotic contracture at mean 6.5 (5–9) months: of those, 2 pts were non nerve-sparing radical prostatectomized, 1 monolateral and 1 bilateral nerve-sparing (p=NS). All those pts were treated by endoscopic cold incision of anastomotic stricture: 1 pts developed mid urinary incontinence after endoscopic treatment; at a mean follow-up of 27.7 (15–47) months 3 patients were continent and without signs of obstruction at uroflowmetry. CONCLUSIONS Our technique allows an excellent definition of prostatic apex preserving the striated sphincter and saving the maximum of urethra with low risk of leaving prostatic tissue in situ. Contextual respect of anatomical boundaries of bladder neck and the mucosal eversion in creating anastomosis were found to be fundamental in prevention of anastomotic contracture. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e722 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Federico Lanzi Florence, Italy More articles by this author Lorenzo Masieri Florence, Italy More articles by this author Nicola Tosi Florence, Italy More articles by this author Michele Lanciotti Florence, Italy More articles by this author Saverio Giancane Florence, Italy More articles by this author Claudia Giannessi Florence, Italy More articles by this author Marco Carini Florence, Italy More articles by this author Sergio Serni Florence, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...