Occurrence Of Fistula Research Articles

A rare but troublesome complication of cesarean section: the uterocutaneous fistula. Report of two cases and review of literature

Abstract Objectives The occurrence of a uterocutaneous fistula (UCF) as an uncommon and severe complication of caesarean section (CS). The aim of this study was to describe two cases of UCFs after CS and to discuss about symptoms, diagnosis and treatment. Case presentation Both women few days after CS had surgical site infection, fever and elevation of lab inflammation markers. bacterial culture of the wound drainage was positive for Escherichia Coli and Enterococcus Faecalis. Conclusions Fistula between uterine and skin is a rare condition but should be considered with signs of inflammation after cesarean section; 2D/3D ultrasound evaluation appears to be useful for diagnosis of UCFs when combined with CT fistulography and MRI in order to obtain early diagnosis and, consequently, a conservative surgery.

P077 Different granulocyte subsets are involved in the pathogenesis in Crohn’s disease fistula

Abstract Background Early in inflammation granulocytes migrate from the circulation into inflamed areas and rapidly accumulate. They form an important role in first defense as well as the orchestration of downstream immune responses. In the circulation, several different subsets of granulocytes have been described, for example immature, intermediate and mature granulocytes. Surprisingly, despite their abundance and prominent function, this cell type is rarely studied from a tissue perspective, most likely due to their short lifespan ex vivo. One example of gastrointestinal disease with an extremely high number of granulocytes is the occurrence of perianal fistula which contain a considerable amount of granulation tissue. As curettage of this tissue is part of the treatment, the fistula tract is good source to study tissue derived granulocyte subsets. The aim of this study was to characterize granulocyte subsets in the fistula tract. Methods Curettage material of perianal fistula tracts was obtained during surgical intervention from patients with CD (n=15) and cryptoglandular fistulas (n=5). From 2 CD patients venous blood was taken and a ficoll step was performed. Single-cell suspensions were stained with a 35-antibody panel, including CD66, CD14, CD33, CD16 and CD11b. Samples were analyzed using mass cytometry (CyTOF). Results Granulocytes, characterized as CD45+CD66a+ cells, were the main cellular component of the fistula tract (64%±24) compared to other immune cells. This was more pronounced in cryptoglandular fistula compared to CD fistula (81% vs. 67%; p=0.019). Within these cells we could differentiate between 4 subsets, mature granulocytes (CD33+CD11b+CD16+), intermediate (CD33intCD11b+CD16int), immature granulocytes (CD33intCD11b-CD16int) and eosinophils (CD33-CD11b-CD16-). Immature granulocytes were the most abundant in de fistula tract (31%±15), closely followed by the mature (30%±23) and intermediate (23±9). No significant difference was seen in the percentages of granulocyte subsets between CD and cryptoglandular fistula. Conclusion Here, we show the presence of different subtypes of granulocytes in fistula derived granulation tissue. We show a heterogeneous group of cells ranging from immature neutrophils to mature neutrophils. Due to their high number in active ulcerating tissue, further evaluation of granulocyte subsets and function could be an interesting target for medical treatment options.

Duration of postoperative hyperlactatemia has predictive value in recurrent fistula after major definitive surgery for intestinal fistula

PurposeThe present study aimed to identify the predictive value of duration of postoperative hyperlactatemia in screening patients at high risk of recurrent fistula after major definitive surgery (DS) for intestinal fistula.MethodsIf the initial postoperative lactate (IPL) > 2 mmol/L, DS was defined as major definitive surgery. The 315 enrolled patients with major DS were divided into group A (2 mmol/L < IPL ≤ 4 mmol/L), group B (mmol/L < IPL ≤ 6 mmol/L), and group C (IPL > 6 mmol/L). The characteristics of patients were collected, and the duration of postoperative hyperlactatemia was analyzed. According to the occurrence of recurrent fistula (RF), patients were further divided into RF group A, and Non-RF group A; RF group B, and Non-RF group B; and RF group C, and Non-RF group C.ResultsThe duration of postoperative hyperlactatemia was comparable between the RF group A and the Non-RF group A [12 (IQR: 12–24) vs 24 (IQR: 12–24), p = 0.387]. However, the duration of hyperlactatemia was associated with RF in group B (adjusted OR = 1.061; 95% CI: 1.029–1.094; p < 0.001) and group C (adjusted OR = 1.059; 95% CI: 1.012–1.129; p = 0.017). In group B, the cutoff point of duration of 42 h had the optimal predictive value (area under ROC = 0.791, sensitivity = 0.717, specificity = 0.794, p < 0.001). In group C, the cutoff point of duration of 54 h had the optimal predictive value (area under ROC = 0.781, sensitivity = 0.730, specificity = 0.804, p < 0.001).ConclusionThe duration of postoperative hyperlactatemia has a value in predicting RF in patients with an IPL of more than 4 mmol/L after major definitive surgery for intestinal fistula.

Utility of fistula risk score in assessing the risk of postoperative pancreatic fistula occurrence and other significant complications after different types of pancreatic neuroendocrine tumor resections.

This study was performed to evaluate the utility of the fistula risk score (FRS) and its components in predicting the occurrence of postoperative pancreatic fistula and other significant postoperative complications after resections of pancreatic neuroendocrine tumors. Retrospective analysis of 131 patients operated on for pancreatic neuroendocrine tumors between 2015 and 2021 was performed. The correlation of the FRS scale with the occurrence of postoperative pancreatic fistulas and postoperative complications according to the Clavien-Dindo classification was analyzed; only in 109 cases of distal resections and pancreatoduodenectomies (PD). Soft pancreatic texture and intraoperative blood loss of >700 mL are risk factors for clinically significant pancreatic fistula (P = 0.001 and P = 0.001, respectively) and significant postoperative complications (P = 0.016 and P = 0.001, respectively). Wirsung duct diameter (WDD) was associated only with the occurrence of postoperative pancreatic fistula (P = 0.013). FRS scale is associated with the occurrence of pancreatic fistulas and clinically significant postoperative complications in cases of distal resections and PDs (P < 0.001 and P = 0.005, respectively). Postoperative complications are correlated with the occurrence of fistula type B or C (P < 0.001). Soft pancreatic texture, intraoperative blood loss of >700 mL, and a WDD of ≤3 mm are risk factors for clinically significant postoperative pancreatic fistula. FRS may be applied not only in PDs but also in distal pancreatectomies. Unfortunately, it is not used in total pancreatic resections and enucleations since FRS takes into account the WDD.

Minimally Invasive and Open Distal Pancreatectomy: Case Series

Introduction: This study was performed to describe a series of distal pancreatectomy and compare results between open and minimally invasive surgeries. Methods: Retrospective analysis of patients undergoing distal pancreatectomy from 2002 to June 2021 using standardized and prospectively completed forms, performed at the Surgery Service of the Upper Digestive System at Hospital São Rafael/Rede D'Or in Salvador – Bahia – Brazil. Open distal pancreatectomy in group 1 and minimally invasive (MI) (laparoscopic and robotic surgery) pancreatectomy in group 2. The same staff realized the perioperative in all the patients. The occurrence of fistulas was classified in accordance with the criteria of the International Study Group on Pancreatic Fistula. The Clavien–Dindo classification was used to classify adverse events. Mortality occurred up to 90 days after the procedure were considered surgery-related. The variables were analysed using the Fisher’s exact test, A P value of <0,05 was considered significant. Results: Thirty two patients in the group 1 (35,5%) and fifty eight (64,5%) in minimally invasive group. In both groups, patients were similar in average age, sex, ASA, IMC, nutritional status and comorbidities. There was no statistical significant in the blood transfusion rate. The median operating time was longer in MI (p < 0,05). Pancreatic fistula occurred in 6,6% of the patients in the group 1, and 17,2% in the group 2 (p=0,17). Stay hospital rate was shorter in MI (p<0,05). One death < 90 days in the open surgery group. Conclusion: Both techniques are safe and feasible if realized in specialized center.

Biliary Leakage Following Pancreatoduodenectomy – Experience from a High-Volume Center

Introduction: Hepaticojejunostomy leak and bile fistula following pancreaticoduodenectomy are less frequent than pancreatic leaks. Patients with biliary fistula have an increased risk of serious complications and an extended hospital stay. This study has investigated the occurrence and outcome of biliary fistula.

Improvement of cochleovestibular function in chronic non-inflammatory perilymphatic fistulas of the labyrinth windows: cases from practice

After a brief discussion of the problem of idiopathic sensorineural hearing loss and perilymphatic fistulas of the labyrinth windows, audiometric tests are identified that are informative for the preoperative diagnosis of the latter. Taking into account the own results of surgical treatment, attention is drawn to the feasibility of a wider use of exploratory tympanotomy in cases of suspected occurrence of perilymphatic fistulas of the labyrinth windows.

Could a handbook serve as a useful educational intervention in improving disease knowledge? A cross-sectional study among patients with hidradenitis suppurativa in Poland.

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory skin disease characterized by the occurrence of severe, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas. The disease is of interest to many researchers, however, verified information for patients is still limited. To evaluate the baseline knowledge about acne inversa among patients suffering from the disease as well as to assess whether an educational intervention as a handbook can improve patients' knowledge of their illness. This research study was a cross-sectional survey conducted on HS Facebook support group. The respondents completed an anonymized questionnaire assessing their state of knowledge about acne inversa. After 1 month they were presented with a handbook. Thereafter the patients completed nearly the same anonymized questionnaire assessing the state of knowledge after reading the handbook. We enrolled 102 participants before (group A) and 30 participants after (group B) the educational intervention. The vast majority of the participants (83.3%) appraised the idea of preparing a handbook as 10 points. In both groups, respondents who were aware of their disease severity had significantly superior results than the participants who were not. After reading the handbook extensively, more patients assessed the state of their general HS knowledge as 'good' than before. Our study demonstrated that knowledge about HS among patients is still insufficient. Tools such as handbooks may prove useful in disseminating expertise and helping patients to understand their disease.

Endoscopic management of recurrent tracheoesophageal fistula with trichloroacetic acid in pediatric patients.

Surgical repair of recurrent tracheoesophageal fistula has a high risk of complications. Therefore, various endoscopic techniques have been used to avoid complications. To understand the usefulness of trichloroacetic acid endoscopic application for the treatment of recurrent tracheoesophageal fistula. An observational, descriptive, retrospective, case-series-based study was carried out in a tertiary pediatric hospital. Records of patients with recurrent tracheoesophageal fistula from 2015 to 2021 were reviewed. All patients within this period underwent brushing and trichloroacetic acid application. Mean time of recurrent tracheoesophageal fistula occurrence was 4.8 months (range: 1-19.2). Two patients had a small fistula (less than 4 mm), three patients had a medium fistula (4 mm), and two patients had a large fistula (more than 4 mm). Mean sessions for fistula closure were 2.2 (range: 1-4). Mean time between procedures was 22 days (range: 14-30). Mean follow-up since fistula closure confirmation was 33 months (range: 9-72), during which no recurrences were noted. Endoscopic management of recurrent transesophageal fistula with trichloroacetic acid is a safe and effective procedure. Brushing and trichloroacetic acid combined improve success rates. Fistulas over 4 mm in diameter require more procedures. However, a larger patient cohort and a longer follow-up period are needed to confirm this.

Uterocutaneous fistula - post cesarean section

A uterocutaneous fistula is a rare clinical presentation that usually occurs following caesarean section and other pelvic operations. Only a few articles have been published discussing its treatments(1). We describe a patient with successful surgical management(1). We have described a patient of 21 years old P1L1 post LSCS 9 months back had presented to our OPD with a small opening in the infraumblical region since 2 months. On examination there were multiple serous discharge at LSCS scar site. It was surgically treated by exploratory laparotomy with complete fistulous tract excision. Inspite of the uncommon occurrence of uterocutaneous fistula, it should always be considered following cesearean section or any pelvic operations. It is a rare and late complication following LSCS or any other pelvic operation. Needs proper investigation and timely medical and surgical management. Keywords: Uterine diseases; Cesarean section; Pregnancy; LSCS

Incidence of Facial Nerve Injury and Sialocele Formation Following Mandibular Condylar and Sub-condylar Fracture Fixation.

To study the incidence of sialocele formation in the parotid gland and to study the incidence of facial nerve affliction following treatment of mandibular condylar and sub-condylar fractures. The present study is a retrospective study conducted on a total of 82 patients with 107 sub-condylar and condylar fractures treated in this centre from August 2008 to August 2020. The surgical approaches used to treat the fractures were considered, and the occurrence of sialocele, salivary fistula and facial nerve paralysis was noted. The facial nerve function was analysed using House-Brackmann system of classification. The incidence of sialocele formation was seen in 15.87% of cases, and the incidence was seen more commonly during a preauricular approach (52.94%) followed by retromandibular (41.17%) followed by anterior parotid transmassetric approach (11.76%). The incidence of facial nerve affliction was seen in 17.57% of cases with majority of them showing temporal branch involvement in 21.05% of cases. During the treatment of condylar and sub-condylar fractures, the facial nerve is at considerable risk of damage; however, understanding the anatomy of the nerve is of importance to avoid such complications. Sialocele formation is also an undesirable complication of such surgeries, a prompt diagnosis and early treatment is mandatory to overcome further unwanted sequel.

Association between place of delivery, assistance during delivery and fistula occurrence in Afghanistan.

Obstetric fistula is one of themost serious and devastating childbirth-related injuries women suffer worldwide. This study investigated the association between delivery characteristics and the occurrence of obstetric fistula in Afghanistan. The study analysed data from the 2015 Afghanistan Demographic and Health Survey. The association between place of delivery and assistance during delivery with experience of fistula symptoms was investigated by fitting two binary logistic regression models. Findings from this study revealed that 23.4% of the women surveyed ever heard about obstetric fistula and 3% reported symptoms of fistula. Women whose deliveries were assisted by traditional birth attendants were significantly more likely to experience fistula compared with those whose deliveries were assisted by doctors. Similarly, women whose deliveries were assisted by others were significantly more likely to experience fistula compared with women whose deliveries were assisted by doctors. Regarding place of delivery, women whose deliveries took place at a government hospital were less likely to experience fistula compared with those whose deliveries took place at home. This study highlights the importance of skilled delivery in reducing the risk for obstetric fistula among women in Afghanistan. Therefore, it is important for the various stakeholders in Afghanistan's healthcare delivery system, including healthcare providers, local authorities and international non-governmental organisations, to collaborate and institute measures that will promote health facility deliveries and improve access to skilled delivery.

Clinical effects of negative pressure wound therapy in treating the poor healing of incisions after different abdominal operations

Objective: To investigate the clinical effects of negative pressure wound therapy (NPWT) in treating the poor healing of incisions after different abdominal operations. Methods: The retrospective observational study was conducted. From June 2019 to December 2020, 42 patients with poor healing of incisions after abdominal surgery were admitted to Center of Burns and Trauma of the First Affiliated Hospital of Naval Medical University, including 29 males and 13 females, aged 23-81 years. The disease course of poor healing of abdominal incision was 3-60 d. The preoperative examination of patients was completed after admission, and NPWT was used after debridement. According to the dehiscence level of incision, the negative pressure value of -10.64 to -6.65 kPa was set. The incisions were sutured in the second stage when the incisions had good blood circulation. The cause of abdominal surgery, the dehiscence level and the cause of poor healing of abdominal incision were investigated, and the final healing of abdominal incision and the occurrence of complication were observed. Results: The causes of abdominal operations in this group of patients who ocurred poor healing of abdominal incisions were ranked according to the composition ratio, with the top 4 causes being colon cancer (9 cases, accounting for 21.4%), bile duct disease (8 cases, accounting for 19.0%), liver cancer (5 cases, accounting for 11.9%), and appendicitis (4 cases, accounting for 9.5%). There were 25 cases (59.5%) with dehiscence of abdominal incision in the deep fascia layer, and the other 17 cases (40.5%) with dehiscence of abdominal incision in the superficial fascia layer. The causes of poor healing of abdominal incision were ranked according to the composition ratio, with the top 3 causes being infection (24 cases, accounting for 57.1%), fat liquefaction (11 cases, accounting for 26.2%), and suture reaction (5 cases, accounting for 11.9%). The blood circulation in 40 patients was improved after being treated with NPWT, and the incisions were sutured in the second stage. The incisions healed well when the suture lines were removed in the second to third week. Intestinal fistula and bile leakage developed during the NPWT treatment, respectively in the other 2 patients, in which negative pressure equipment was removed subsequently, and the incisions healed after adequate drainage and conventional dressing changes. Conclusions: NPWT is effective in treating poor healing of abdominal incision after different abdominal surgeries. The clinicians need to comprehensively assess the patient's condition to determine when and how to use NPWT to avoid the occurrence of intestinal fistula, bile leakage, and other complications.

Incidence of urethrocutaneous fistula following distal hypospadias repair with and without caudal epidural block: A randomized pilot study

Recent investigations have raised a doubt regarding the safety of Caudal epidural block (CEB) administered to children with distal hypospadias undergoing tubularised incised plate (TIP) urethroplasty. The primary objective of the study was to investigate whether there is any association between CEB and the occurrence of urethrocutaneous fistula (UCF) in the postoperative period. Fifty ASA 1 and 2 children with distal hypospadias aged 0-8 years were randomly allocated to CEB group (GA with CEB, 0.2% ropivacaine 1ml/kg; n=25) and Non-CEB group (GA without CEB; n=25). Penile measurements were taken before and 20min after administration of CEB to assess penile engorgement. Intraoperative hemodynamics were recorded at 10min intervals after induction of anaesthesia. Consumption of IV fentanyl intraoperatively and postoperatively in first 24h was recorded in both the groups. Rescue analgesia was administered for a score >4 on FLACC scale. After surgery children were followed up monthly for first three months and then at 6-months and yearly in paediatric surgery OPD to assess for development of UCF. UCF was found to occur in only two children, one from each group on follow up, with an overall incidence of 4%. There was no difference in the incidence of UCF in the patients with and without CEB. A 26.8% increase in penile volume from baseline was recorded in CEB group (P=0.000). The intraoperative heart rate and mean arterial pressure was significantly lower in the CEB group as compared to non CEB group at various time intervals. No additional intraoperative IV fentanyl supplementation was required in CEB group. Fentanyl consumption was significantly less in CEB group postoperatively in first 24h (P=0.000). Administration of CEB was not found to have any impact on UCF formation. No relationship between the increase in penile volume after CEB block and occurrence of UCF was noticed. Despite increase in penile volume after CEB, there was no difference between the two groups as regards to the occurrence of post operative UCF. CEB is an effective analgesic modality and can be continued to be used till the results of well powered prospective randomised trials with long follow up are reported.

In-hospital clinical complications of COVID-19: a brief overview.

In-hospital clinical complications of COVID-19: a brief overview.

Risk Factors of Enterostomy Infection Caused by Bacterial Infection through Mathematical Modelling-Based Information Data Analysis.

Objective The study aimed to explore the risk factors of infections after enterostomy through the information data analysis method based on a mathematical model. Methods 156 cases of enterostomy patients admitted to the hospital were retrospectively selected as the study subjects and were divided into the infection group (17 cases) and normal group (139 cases) according to whether they were complicated with infections. Then, the factors of infection and related indexes before and after surgery were analyzed, and the data of the whole hospital were estimated by mathematical modelling. Results The length of hospital stay in the infection group was 21 ± 11.2 days, which is longer than 10.1 ± 7.1 days in the normal group (P < 0.05). The incidence of anastomotic fistula in the infection group was 14%, which is higher than 2% in the normal group. The mortality rate of infection group (44%) was higher than that of normal group (5%). In the infection group, the incidence of single-cavity stoma (69%) was higher than that of double-cavity stoma (31%), the nosocomial infection rate (11%) was significantly higher compared with out of hospital (2%), and there were significant differences (P < 0.05). Conclusions Patients with malnutrition and hypoproteinemia before enterostomy, the use of gastric tube and ventilator in the treatment, single lumen stomy in the operation, and the occurrence of anastomotic fistula were more likely to have concurrent infections.

1354 A Rare Case of Gallstone Ileus Due to Cholecystocolonic Fistula

Abstract Introduction Gallstone Ileus (GI) is an uncommon but potentially lethal complication of cholelithiasis. 50 to 70% of gallstones obstruct in the ileum, the narrowest point of the intestine. More uncommonly the gallstone can travel into the large bowel via an incompetent ileo-caecal valve and impact in the colon at a recto sigmoid junction. GI involving the sigmoid colon is extremely rare cause of large bowel obstruction. The gallstone often enters the large bowel through a fistula formation between the gallbladder and colon, and impacts at a point of narrowing, causing large bowel obstruction. Case Report We describe the case of a 72-year-old man who presented with features of bowel obstruction. CT of abdomen pelvis (CTAP) showed a large 5x5cm intraluminal gallstone obstructing at the rectosigmoid area. It showed presence of pneumobilia and incidental finding of abdominal aortic aneurysm (AAA). An emergency laparotomy revealed a cholecystocolonic fistula. The stone was extracted after milking the stone proximally and loop colostomy formed at colotomy site. The patient made an uneventful recovery. Reversal of stoma was postponed pending endovascular repair of enlarging AAA. Discussion Presenting symptoms of GI are often non-specific, frequently leading to a delay in diagnosis and treatment. Although no fistula was identified in this patient by imaging, the most common cause of GI in most patients is formation of a cholecystoduodenal fistula. Conclusions Compared with biliary enteric fistulae, the occurrence of cholecystocolonic fistulae is remarkably rare. Temporary colostomies can be considered for treating these cases alongside one-stage operations

Comparison of Postoperative complications between Conventional Ferguson’s Hemorrhoidectomy and LigaSureTM Hemorrhoidectomy

Abstract Background For symptomatic grade III and IV haemorrhoids, some form of hemorrhoidectomy remains the accepted modality of treatment. The traditional methods like the Milligan-Morgan method and the Ferguson‘s method have been in practice for more than half a century. Recently we acquired the LigaSureTM device. It is an electro-surgical device, which is an improved version of bipolar diathermy, now widely used for hemorrhoidectomy. This study will give a comprehensive overview on differences between conventional Ferguson‘s haemorrhoidectomy and LigaSureTM haemorrhoidectomy focusing on post-operative complications mainly postoperative pain, bleeding and peri-anal fistulae occurrence Objective To compere between closed hemorrhoidectomy, Ferguson‘s method, and LigaSureTM hemorrhoidectomy as regards post-operative pain, bleeding and peri-anal fistula occurrence. Patients and Methods It is a prospective study conducted over 40 patients with grade III and IV hemorrhoids, randomly divided into two groups to compare between closed hemorrhoidectomy, Ferguson‘s method, and LigaSure™ hemorrhoidectomy as regards post-operative pain, bleeding and peri-anal fistula occurrence. Results An overall favorable trend exists toward LigaSureTM hemorrhoidectomy in all parameters of the current study, in another word, the postoperative complications mainly pain, bleeding and peri-anal fistula occurrence was much lesser in the LigaSureTM group. Conclusion LigaSureTM hemorrhoidectomy is a sutureless, hemorrhoidectomy technique dependent on a modified electro- surgical unit to achieve vessel and tissue sealing. It is safe and effective, has less blood loss, postoperative pain, bleeding and perianal fistula occurrence compared to conventional Ferguson‘s hemorrhoidectomy.

Predictors of Sialocele or Salivary Fistula After Partial Superficial Parotidectomy for Benign Parotid Tumor: A Retrospective Study

Partial superficial parotid (PSP) resection is the mainstay of treatment for benign parotid tumor. Unfortunately, the post-surgical formation of sialocele or salivary fistula is a well-recognized complication of parotid surgery. The aim of this study was to determine the predictors of sialocele or salivary fistula after PSP resection for parotid benign tumor. This retrospective cohort study includes patients who underwent PSP resection for benign parotid tumors from January 1, 2015 to December 31, 2019. The predictor variables were demographic data, systemic disease, smoking history, tumor size and type, surgical approach, and area. The outcome variables were the occurrence of sialocele or salivary fistula after PSP resection. Each possible risk factor was then examined using univariate analysis. Variables associated with sialocele or salivary fistula in the univariate analysis were then included in a multiple logistic regression model, and analyzed for possible factors related to the occurrence of sialocele or salivary fistula after partial superficial parotid resection. The sample was composed of 872 subjects with a mean age of 51.0 ± 8.3, and 59.5% were male. The frequency of sialocele or salivary fistula after partial superficial parotid resection was 10.4% (n=92). Based on the multiple logistic regression model, hypertension and location of the lesion were associated with sialocoele formation. Hypertension was associated with a decreased risk for the formation of sialocele or salivary fistula (ORs=0.6, 95% CI = [0.4,1.003], P=.051). When compared the superior lesions, anterior lesions were associated with a decreased risk for the formation of sialocele or salivary fistula (ORs=0.32, 95% CI=[0.111,0.92], P=.034) and lesions in the middle were associated with an increased risk for sialocele or salivary fistula development (ORs=2.315,95% CI = [1.199,4.469], P=.012). The incidence of sialocele or salivary fistula development was 10.4% in patients undergoing partial superficial parotidectomy in this study. Moreover, middle and anterior tumor location was shown to increase sialocele or salivary fistula risk.

Preserving the eponym: Klinkenbergh technique for bronchial stump suturing

The technique for bronchial stump suturing following lung resection which is currently applied in the Department of Thoracic Surgery at the University Hospitals Leuven, Belgium owes its name to the Dutch surgeon Dr. Klinkenbergh (1891–1985). A true pioneer of cardiothoracic surgery in Europe, Dr. Klinkenbergh dedicated himself to the surgical treatment of pulmonary tuberculosis. His work was praised by his peers for his precision and the reasoning behind every gesture. The Klinkenbergh technique consists in performing two running sutures which cross each other ‘in the same manner as the laces of a shoe’ to close the bronchus, limiting the occurrence of broncho-pleural fistulas. In our experience with more than 100 patients in the last 5 years (2016–2020) who underwent open pneumonectomy for benign or malignant disease, less than 2% developed post-operative broncho-pleural fistulas.