Results Of Endoscopic Treatment Research Articles

Endoscopic versus minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials

Background/Aims Acute pancreatitis is a common condition of the digestive system, but sometimes it develops into severe cases. In about 10–20% of patients, necrosis of the pancreas or its periphery occurs. Although most have aseptic necrosis, 30% of cases will develop infectious necrotizing pancreatitis. Infected necrotizing pancreatitis (INP) requires a critical treatment approach. Minimally invasive surgical approach (MIS) and endoscopy are the management methods. This meta-analysis compares the outcomes of MIS and endoscopic treatments. Methods We searched a medical database until December 2022 to compare the results of endoscopic and MIS procedures for INP. We selected eligible randomized controlled trials (RCTs) that reported treatment complications for the meta-analysis. Results Five RCTs comparing a total of 284 patients were included in the meta-analysis. Among them, 139 patients underwent MIS, while 145 underwent endoscopic procedures. The results showed significant differences (p < 0.05) in the risk ratios (RRs) for major complications (RR: 0.69, 95% confidence interval (CI): 0.49–0.97), new onset of organ failure (RR: 0.29, 95% CI: 0.11–0.82), surgical site infection (RR: 0.26, 95% CI: 0.07–0.92), fistula or perforation (RR: 0.27, 95% CI: 0.12–0.64), and pancreatic fistula (RR: 0.14, 95% CI: 0.05–0.45). The hospital stay was significantly shorter for the endoscopic group compared to the MIS group, with a mean difference of 6.74 days (95% CI: −12.94 to −0.54). There were no significant differences (p > 0.05) in the RR for death, bleeding, incisional hernia, percutaneous drainage, pancreatic endocrine deficiency, pancreatic exocrine deficiency, or the need for enzyme use. Conclusions Endoscopic management of INP performs better compared to surgical treatment due to its lower complication rate and higher patient life quality.

Salvage treatment for local recurrence after endoscopic resection for superficial nonampullary duodenal epithelial tumors

Background and AimsLocal recurrence is a significant concern in endoscopic resection of superficial nonampullary duodenal tumors (SNADTs). Our objective was to elucidate the clinical outcomes of salvage endoscopic treatment. MethodsThis retrospective study included consecutive patients who underwent endoscopic resection of SNADTs between January 2013 and December 2021. Four hundred thirty-three patients were observed, excluding those with familial adenomatous polyposis and those who did not undergo surveillance endoscopy. Local recurrence was defined as histologically proven adenoma or adenocarcinoma in contact with a prior endoscopic resection scar. The clinicopathological characteristics of patients with local recurrence and outcomes of salvage endoscopic treatment were evaluated. ResultsLocal recurrence occurred in 33 (8%) of the 433 patients after endoscopic resection for SNADT. Multivariate analysis identified older age (≥63 years), larger lesion size (≥13 mm), and piecemeal resection as significant independent predictors of local recurrence. Among the 33 patients with 33 recurrent lesions, 10 lesions (30%) disappeared after forceps biopsy. Three patients (9%) remained untreated. Sixteen lesions (48%) disappeared after one session of salvage endoscopic treatment, and four lesions (12%) disappeared after two sessions of treatment. Among these 24 treatment sessions, underwater endoscopic mucosal resection was performed in 19 sessions. The median post-procedural hospitalization period was four days (interquartile range, 3–4.25 days). Delayed bleeding occurred in three sessions. No recurrences have been detected in the 30 salvaged patients. The median recurrence-free survival time was 24.5 months (interquartile range, 14–48.75 months). ConclusionsLocal recurrence after endoscopic resection of SNADT can be managed endoscopically.

The correlation between ureteric orifice morphology and primary vesicoureteral reflux grade and the impact on the effectiveness of endoscopic reflux correction

Early diagnosis and treatment of primary vesicoureteral reflux (VUR) are essential for preserving renal function. The study explored whether preoperative cystoscopic grading of refluxing ureteric orifices (UO) correlated with their shape in an institution with non-performance of hydrodistention of the UO in the diagnosis and grading of VUR. We also assessed the relationship between the UO shape and VUR grade with the effectiveness of endoscopic correction of primary VUR in children. This retrospective study included consecutive patients ≤15 years treated for primary VUR. The reflux grade was based on the results of preoperative voiding cystourethrography as mild, moderate, or severe. Fifty-one patients with 77 renal refluxing units (RRU) underwent endoscopic treatment with Deflux®. VUR was bilateral in 51% of patients. VUR was mild in 13%, moderate in 53%, and severe in 34% of cases. The patients with mild and moderate VUR had stadium-shaped UOs in 60% and 54% RRUs, respectively. Horseshoe-shaped UOs constituted 42% of UOs in patients with severe VUR, followed by 31% of golf-hole UOs. The reflux resolution rate after the first endoscopic injection was 84%. The preoperative VUR grade correlated with UOs shape (p<0.001). No significant correlation between UOs configuration and the outcome of endoscopic treatment was seen (p=0.452). The preoperative VUR grade negatively correlated with a favorable endoscopic treatment (p=0.043). Our data indicate ureteral orifice shapes are closely related to preoperative VUR grade. There was no correlation between the UO configuration and the success rate of endoscopic treatment of VUR, in contrast to the significant negative correlation between the VUR grade and the success rate of endoscopic treatment.

Gluteal Complex is important in External Snapping Hip: intraoperative identification of syndrome origin and endoscopic stepwise release–a case series.

PurposeExternal snapping hip syndrome (ESHS) was historically attributed to isolated iliotibial band (ITB) contracture. However, the gluteus maximus complex (GMC) may also be involved. This study aimed to intraoperatively identify the ESHS origin and assess the outcomes of endoscopic treatment based on the identified aetiological type.MethodsFrom 2008-2014, 30 consecutive patients (34 hips) with symptomatic ESHS cases refractory to conservative treatment underwent endoscopic stepwise “fan-like” release, gradually addressing all known reasons of ESHS: from the isolated ITB, through the fascial part of the GMC until a partial release of gluteus maximus femoral attachment occurred. Snapping was assessed intra-operatively after each surgical step and prospectively recorded. Functional outcomes were assessed via the MAHORN Hip Outcome Tool (MHOT-14).ResultsTwenty seven patients (31 hips) were available to follow-up at 24-56 months. In all cases, complete snapping resolution was achieved intra-operatively: in seven cases (22.6%) after isolated ITB release, in 22 cases (70.9%), after release of ITB + fascial part of the GMC, and in two cases (6.5%) after ITB + fascial GMC release + partial release of GM femoral insertion. At follow-up, there were no snapping recurrences and MHOT-14 score significantly increased from a pre-operative average of 46 to 93(p<0.001).ConclusionIntraoperative identification and gradual addressing of all known causes of ESHS allows for maximum preservation of surrounding tissue during surgery while precisely targeting the directly involved structures. Endoscopic stepwise “fan-like” release of the ITB and GMC is an effective, tailor-made treatment option for ESHS regardless of the snapping origin in the patients with possibility to manually reproduce the snapping.

Outcomes of endoscopic treatment for early correction of craniosynostosis in children: a 26-year single-center experience.

Surgery is the cornerstone of craniosynostosis treatment. In this study, two widely accepted techniques are described: endoscope-assisted surgery (EAS) and open surgery (OS). The authors compared the perioperative and reconstructive outcomes of EAS and OS in children ≤ 6 months of age treated at the Napoleón Franco Pareja Children's Hospital (Cartagena, Colombia). According to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement, patients with defined criteria who underwent surgery to correct craniosynostosis between June 1996 and June 2022 were retrospectively enrolled. Demographic data, perioperative outcomes, and follow-up were obtained from their medical records. Student t-tests were used for significance. Cronbach's α was used to assess agreement between estimated blood loss (EBL). Spearman's correlation coefficient and the coefficient of determination were used to establish associations between the results of interest, and the odds ratio was used to calculate the risk ratio of blood product transfusion. A total of 74 patients met the inclusion criteria; 24 (32.4%) belonged to the OS group and 50 (67.6%) to the EAS group. There was a high interobserver agreement quantifying the EBL. The EBL, transfusion of blood products, surgical time, and hospital stay were shorter in the EAS group. Surgical time was positively correlated with EBL. There were no differences between the two groups in the percentage of cranial index correction at 12 months of follow-up. Surgical correction of craniosynostosis in children aged ≤ 6 months by EAS was associated with a significant decrease in EBL, transfusion requirements, surgical time, and hospital stay compared with OS. The results of cranial deformity correction in patients with scaphocephaly and acrocephaly were equivalent in both study groups.

Long-term follow-up of a cohort with post sleeve gastrectomy leaks: results of endoscopic treatment and salvage surgery.

Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide. The most challenging postoperative complication is gastric leak. The objectives of this study are to examine the efficacy and morbidity of different therapeutic strategies addressing leakage, and the long-term outcomes of a cohort of LSG leaks. A retrospective review of patients treated for LSG leaks between September 2014 and January 2023 at our high-volume bariatric surgery center was performed. The charts of 37 patients (29 women and 8 men) were reviewed, with a mean age of 43years and a median follow-up of 24months. The mean preoperative body mass index was 45.1kg/m2. Overall, 30/37 (81%) patients were successfully treated with endoscopic management, and 7/37 (19%) ultimately underwent salvage surgery. If the leak was diagnosed earlier than 6weeks, endoscopic treatment had a 97% success rate. The median number of endoscopic procedures was 2 per patient, and included internal pigtails, stents, septoplasty, endoluminal vacuum therapy and over-the-scope clips. Complications included stent-related ulcers (10), esophageal stenosis requiring endoscopic dilatations (4), stent migrations (2) and kinking requiring repositioning (1), and internal pigtail migration (3). Revisional surgery consisted of proximal gastrectomy and Roux-en-Y esophago-jejunal anastomosis, Roux-en-Y fistulo-jejunostomy or classic Roux-en-Y gastric bypass proximal to the gastric stricture. In 62% of the cases, the axis/caliber of the LSG was abnormal. Beyond 4 attempts, endoscopy was unsuccessful. The success rate of endoscopic management dropped to 25% when treatment was initiated more than 45days after the index surgery. Purely endoscopic management was successful in 81% of cases; with 97% success rate if diagnosis earlier than 6weeks. After four failed endoscopic procedures, a surgical approach should be considered. Delayed diagnosis appears to be a significant risk factor for failure of endoscopic treatment.

Endoscopic Management of Benign Airway Stenosis in Coronavirus Disease 2019 Patients.

The aims of this study were to evaluate the results of endoscopic dilation for simple benign airway stenosis in coronavirus disease 2019 (COVID-19) patients and whether COVID-19 infection was associated with higher rate of recurrence compared with a control group. It was an observational multicenter study including consecutive patients with simple benign airway stenosis undergoing endoscopic dilatation with at least 6 months of follow-up. The outcome of patients with COVID-19 infection was compared with that of a control group in relation to patient and stenosis characteristics, and procedure type. Then, univariable and multivariable analyses identified the risk factors for recurrence. Seventy-nine patients were included in the study; 56 (71%) of these developed airway stenosis after COVID-19 infection. COVID-19 patients presented a higher rate of stenosis due to prolonged intubation (82 vs. 43%; p = 0.0014); no other differences were found regarding demographic data, characteristics of stenosis, and procedure type. Twenty-four (30%) patients had recurrence after first dilatation (32% for No-COVID-19 vs. 26% for COVID-19 group; p = 0.70), and in 11 (35%) of these, the stenosis recurred after repeated endoscopic treatment (65% for No-COVID-19 vs. 45% for COVID-19 group; p = 0.40). Subglottic stenosis (p = 0.013) and the use of laser (p = 0.016) were significant predictive factors for stenosis recurrence. COVID-19 infection did not affect the outcome of endoscopic treatment of simple airway stenosis, and the treatment of these subsets of patients should not differ from that of general population.

Posterior Ankle Impingement Syndrome in a Nonathletic Population: Causes, Treatment Modalities, and the Results of Endoscopic Treatment.

A common cause of posterior ankle pain is posterior ankle impingement syndrome (PAIS). Many studies about PAIS have been conducted on special groups such as athletes and dancers; there has been no previous study of a nonathletic population. This study aimed to evaluate the causes and treatment methods of PAIS in the nonathletic population and compare it with the athletic population. A retrospective review was performed and 28 of 46 patients (60.9%) recovered from two-staged conservative therapy. In the 18 patients (39.1%) who did not benefit from 3 months of conservative treatment, hindfoot endoscopy was applied. Patient data, including sex, age, occupation, and sports activity level, were recorded. Visual analog scale, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, and Tegner scores were recorded. Patient satisfaction was assessed with a 4-point Likert scale. Complications were recorded. Mean follow-up was 27.4 months. At final follow-up, the AOFAS hindfoot score had significantly improved from 66.4 to 96.8 (P < .001). The Tegner score improved significantly from 4.6 to 8.8 (P < .001). The visual analog scale score was 6.4 and increased to 0.9 (P < .001). Using the 4-point Likert scale for patient satisfaction, 13 (72.2%) stated that the surgical procedure was excellent and five (27.8%) good. Mean time to return to work was 4.2 weeks. Sural nerve dysesthesia was seen in two patients (11.1%). This is the first study to evaluate PAIS in the nonathletic population. Conservative treatment showed good results as nearly two-thirds of the patients recovered. Hindfoot endoscopy in those not responding to conservative therapy is a successful treatment with low complication rates.

Adult-onset megacolon with focal hypoganglionosis: A detailed phenotyping and prospective cohort study.

In this prospective cohort study, we evaluated features of "adult-onset megacolon with focal hypoganglionosis." We assessed the radiologic, endoscopic, and histopathologic phenotyping and treatment outcomes of 29 patients between 2017 and 2020. Data from community controls, consisting of 19,948 adults undergoing health screenings, were analyzed to identify risk factors. Experts reviewed clinical features and pathological specimens according to the London Classification for gastrointestinal neuromuscular pathology. The median age of the patients with adult-onset megacolon with focal hypoganglionosis at symptom onset was 59 years (range, 32.0-74.9 years), with mean symptom onset only 1 year before diagnosis. All patients had focal stenotic regions with proximal bowel dilatation (mean diameter, 78.8 mm; 95% confidence interval [CI], 72-86). The comparison with community controls showed no obvious risk factors. Ten patients underwent surgery, and all exhibited significant hypoganglionosis: 5.4 myenteric ganglion cells/cm (interquartile range [IQR], 3.7-16.4) in the stenotic regions compared to 278 cells/cm (IQR, 190-338) in the proximal and 95 cells/cm (IQR, 45-213) in the distal colon. Hypoganglionosis was associated with CD3+ T cells along the myenteric plexus. Colectomy was associated with significant symptom improvement compared to medical treatment [change in the Global Bowel Satisfaction score, -5.4 points (surgery) vs. -0.3 points (medical treatment); p < 0.001]. Adult-onset megacolon with focal hypoganglionosis has distinct features characterized by hypoganglionosis due to inflammation. Bowel resection appears to benefit these patients.

Antimigration versus conventional fully covered metal stents in the endoscopic treatment of anastomotic biliary strictures after deceased-donor liver transplantation.

Migration of fully covered metal stents (FCMS) remains a limitation of the endoscopic treatment of anastomotic biliary strictures (ABS) following orthotopic liver transplantation (OLT). The use of antimigration FCMS (A-FCMS) might enhance endoscopic treatment outcomes for ABS. Single center retrospective study. Consecutive patients with ABS following OLT who underwent ERCP with FCMS placement between January 2005 and December 2020 were eligible. Subjects were grouped into conventional-FCMS (C-FCMS) and A-FCMS. The primary outcome was stent migration rates. Secondary outcomes were stricture resolution, adverse event, and recurrence rates. A total of 102 (40 C-FCMS; 62 A-FCMS) patients were included. Stent migration was identified at the first revision in 24 C-FCMS patients (63.2%) and in 21 A-FCMS patients (36.2%) (p = 0.01). The overall migration rate, including the first and subsequent endoscopic revisions, was 65.8% in C-FCMS and 37.3% in A-FCMS (p = 0.006). The stricture resolution rate at the first endoscopic revision was similar in both groups (60.0 vs 61.3%, p = 0.87). Final stricture resolution was achieved in 95 patients (93.1%), with no difference across groups (92.5 vs 93.5%; p = 0.84). Adverse events were identified in 13 patients (12.1%) with no difference across groups. At a median follow-up of 52 (IQR: 19-85.5) months after stricture resolution, 25 patients (24.5%) developed recurrences, with no difference across groups (C-FCMS 30% vs A-FCMS 21%; p = 0.28). The use of A-FCMS during ERCP for ABS following OLT results in significantly lower stent migration rates compared to C-FCMS. However, the clinical benefit of reduced stent migration is unclear. Larger studies focusing on stricture resolution and recurrence rates are needed.

Endoscopic and surgical treatment outcomes of colitis-associated advanced colorectal neoplasia: a multicenter cohort study.

Inflammatory bowel disease (IBD) patients are at increased risk of advanced neoplasia (high-grade dysplasia or colorectal cancer). The authors aimed to (1) assess synchronous and metachronous neoplasia following (sub)total or proctocolectomy, partial colectomy or endoscopic resection for advanced neoplasia in IBD, and (2) identify factors associated with treatment choice. In this retrospective multicenter cohort study, the authors used the Dutch nationwide pathology databank (PALGA) to identify patients diagnosed with IBD and colonic advanced neoplasia (AN) between 1991 and 2020 in seven hospitals in the Netherlands. Logistic and Fine & Gray's subdistribution hazard models were used to assess adjusted subdistribution hazard ratios for metachronous neoplasia and associations with treatment choice. The authors included 189 patients (high-grade dysplasia n =81; colorectal cancer n =108). Patients were treated with proctocolectomy ( n =33), (sub)total colectomy ( n =45), partial colectomy ( n =56) and endoscopic resection ( n =38). Partial colectomy was more frequently performed in patients with limited disease and older age, with similar patient characteristics between Crohn's disease and ulcerative colitis. Synchronous neoplasia was found in 43 patients (25.0%; (sub)total or proctocolectomy n =22, partial colectomy n =8, endoscopic resection n =13). The authors found a metachronous neoplasia rate of 6.1, 11.5 and 13.7 per 100 patient-years after (sub)total colectomy, partial colectomy and endoscopic resection, respectively. Endoscopic resection, but not partial colectomy, was associated with an increased metachronous neoplasia risk (adjusted subdistribution hazard ratios 4.16, 95% CI 1.64-10.54, P <0.01) compared with (sub)total colectomy. After confounder adjustment, partial colectomy yielded a similar metachronous neoplasia risk compared to (sub)total colectomy. High metachronous neoplasia rates after endoscopic resection underline the importance of strict subsequent endoscopic surveillance.

Nearest and ling-time outcomes of endoscopic treatment of patients with esophageal achalasia

The purpose of the study is analyze of the results of peroral endoscopic myotomy in patients with esophageal achalasia. Material and methods. In the period 2017-2022 years peroral endoscopic myotomy in esophageal achalasia was performed in 110 patients (43 - men, 77 - women). Mean aged from 7 to 75 years. The duration of the disease ranged from 6 months to 40 years. Results. In 109 cases, the intervention was technically successful. The intervention was not successful due to the severity of fibrosis in the submucosal layer in 1 patient. The operation time ranged from 45 to 195 minutes. Complications during the intervention were in 9 (8,18%) patients. In the postoperative period, in 4 (3,63%) patients had complications that were eliminated by using flexible endoscopes. Patients were discharged from the hospital 3-5 days after the operation. There were not re-interventions performed. Erosive reflux esophagitis is the most common condition in the postoperative period. This condition was successfully stopped by inhibitors proton pump taking. When examining in the postoperative period and assessing the level quality of life using questionnaires SF-36, GIQLI and the Eckardt scale noted relief of dysphagia and a significant improvement in the main indicators. Conclusion. Peroral endoscopic myotomy in patients with esophageal achalasia can be the operation of choice in terms of efficiency, safety and long-term results, the level of quality of life in the postoperative period. To assess the long-term results of the intervention in this category of patients, further monitoring is required.

Long-term results of treatment of achalasia cardia by combined balloon dilation. The role of high-resolution manometry in the diagnosis of achalasia. Endoscopic and manometric parallels

The aim. To analyze the results of treatment of achalasia cardia by balloon dilatation with an accent on hydrodilatation, to compare the types of achalasia cardia according to high-resolution manometry with endoscopic semiotics and to evaluate the effectiveness of endoscopic balloon dilatation depending on the type of achalasia. Materials and methods. The article details an additional method of endoscopic balloon dilatation of the cardia - hydrodilatation (42 patients). The results of endoscopic balloon dilatation were analyzed according to high-resolution manometry data (37 patients). High-resolution manometry data were also evaluated in correlation with endoscopic efficacy criteria (11 patients). Results. Hydrodilatation is used as an additional method after pneumodilatation to increase efficiency of treatment (39 patients) or as an independent method (3 patients) with a combination of achalasia cardia and cicatricial changes of the esophageal-gastric junction, as well as after surgery on the cardia. The combined balloon dilatation technique gives good immediate results in 89.7% (35/39), as an independent method - 100%. Of the total number of patients, 90.5% (38/42) completed the course of endoscopic dilatation with good results, despite the fact that this is a more complex group of patients resistant to standard intervention - balloon pneumodilatation. It is not known which high-resolution manometry data should be used to assess the effectiveness of balloon dilatation: the dilatation efficiency is 75% according to the resting pressure of the lower esophageal sphincter, 83.3% according to the total relaxation pressure, 66.7% according to the cumulative analysis, strictly adhering to the reference values, and 100% according to the tendency to lower pressure. Conclusion. Endoscopic balloon dilatation is a highly effective minimally invasive method of treating achalasia cardia. Hydrodilatation is used to improve the results of endoscopic treatment. For an objective assessment of the effectiveness of balloon dilatation, high-resolution manometry should be performed before and after treatment.

Clinical outcome of endoscopic treatment of symptomatic Hepaticojejunal anastomotic strictures after pancreatoduodenectomy

BackgroundHepaticojejunostomy anastomotic stricture (HJAS) is an adverse event after pancreatoduodenectomy (PD) which can result in jaundice and/or cholangitis. With endoscopy, HJAS can be managed. However, few studies report the specific success and adverse event rates of endoscopic therapy after PD. MethodsPatients with symptomatic HJAS, who underwent an endoscopic retrograde cholangiopancreatography at the Erasmus MC between 2004-2020, were retrospectively included. Primary outcomes were short-term clinical success defined as no need for re-intervention <3 months and long-term <12 months. Secondary outcome measures were cannulation success and adverse events. Recurrence was defined as symptoms with radiological/endoscopic confirmation. ResultsA total of 62 patients were included. The hepaticojejunostomy was reached in 49/62 (79%) of the patients, subsequently cannulated in 42/49 (86%) and in 35/42 patients (83%) an intervention was performed. Recurrence of symptomatic HJAS after technically successful intervention occurred in 20 (57%) patients after median time to recurrence of 7.5 months [95%CI, 7.2–NA]. Adverse events were reported in 4% of the procedures (8% of patients), mostly concerning cholangitis. DiscussionEndoscopic treatment for symptomatic HJAS after PD has a moderate technical success rate and a high recurrence rate. Future studies should optimize endoscopic treatment protocols and compare percutaneous versus endoscopic treatment.

Bariatric endoscopic antral myotomy: first-in-human proof of concept of a novel therapeutic method to delay gastric emptying and induce weight loss

Bariatric endoscopic antral myotomy: first-in-human proof of concept of a novel therapeutic method to delay gastric emptying and induce weight loss

Pediatric endoscopic pilonidal sinus treatment (PEPSiT): report of a multicentric national study on 294 patients.

This study aimed to report a multicentric national experience about the outcomes of pediatric endoscopic pilonidal sinus treatment (PEPSiT). The medical records of all pediatric patients, aged up to 18years, who underwent PEPSiT in the period 2019-2021, were retrospectively reviewed. Patients' demographics, operative details, and post-operative outcomes were assessed. A total of 294 patients (182 boys), with median age of 14years (range 10-18), receiving PEPSiT in the study period, were enrolled. Pilonidal sinus disease (PSD) was primary in 258 (87.8%) and recurrent in 36 (12.2%). The median operative time was 36min (range 11-120). The median VAS pain score was 0.86 (range 0-3) and the median duration of analgesic use was 27h (range 12-60). The overall success rate was 95.2% (280/294) and the median time to full healing was 23.4days (range 19-50). Six/294 (2.0%) patients developed Clavien 2 post-operative complications. The recurrence rate was 4.8% (14/294) and all recurrences were re-operated using PEPSiT. Redo-surgery for wound debridement was performed in one (0.3%) patient with late healing. On multivariate analysis, hirsutism and typology of sinus (pits ≥ 2, paramedian and more proximal to the anus) were predictors of PSD recurrence (p = 0.001). To date, this is the largest series of PEPSiT published in the pediatric population. The outcomes reported after a 3years experience confirm that PEPSiT is a safe, effective, and real minimally invasive procedure to treat adolescents with PSD. It provides patients quick and painless recovery, satisfactory success, and high quality of life.

Midterm results of endoscopic treatment of spontaneous primary pneumothorax at Dong Nai General Hospital

Introduction: Primary spontaneous pneumothorax is a common illness among young people. Currently, thoracic surgery in the treatment of primary spontaneous pneumothorax is routinely performed at central hospitals and some provincial hospitals. At the Department of Thoracic and Cardiovascular Surgery, Dong Nai General Hospital, thoracoscopic surgery for this illness has been performed from 2017 to present, the study aimed to evaluate the preliminary results of this technique.&#x0D; Subjects and methods: Retrospective, descriptive study of 49 patients who underwent thoracic surgery for primary spontaneous pneumothorax at Dong Nai General Hospital from April 2019 to April 2021.&#x0D; Results: There were 49 patients in the study with a mean age 35.24 ± 14.74, of which 90.2% were male. The common symptoms were chest pain (78.4%) and massive pneumothorax on chest X-ray (72.5%) with the higher prevalence of right side than left (54.9% vs 41.2%). Total thoracoscopic surgery accounted for 84.3%, video-assisted thoracoscopic surgery (VATS) accounted for 13.7%, there was one case of open surgery accounting for two percent. Pleurodesis was performed in 35.3% of cases. The average surgical time was 70.78 ± 50.22 minutes and the mean postoperative time was 4.76 ± 3.10 days. There were two cases of prolonged air leak requiring reoperation (3.9%). Mid-term results (follow-up ≥ 12 months), there were 2 cases of recurrence (3.9%) including 1 case of reoperation, there was no death in our study population.&#x0D; Conclusion: Thoracoscopic surgery for primary spontaneous pneumothorax at Dong Nai General Hospital is highly effective with the following advantages such as ease of performance, small scars, postoperative pain relief, reduced length of stay and low recurrence rate.

ENDOSCOPIC REMOVAL OF A RARE LARGE OCCLUSIVE TRACHEAL TUMOR WITH LIMITED TECHNICAL CAPABILITIES

Relevance: Tracheal tumors often do not cause symptoms until they grow to a size that causes significant airway obstruction, which is the reason for the delay in diagnosis. Diagnosis may also be delayed due to non-specific symptoms, such as cough, wheezing, and shortness of breath, which can occur in other conditions such as asthma and chronic obstructive pulmonary disease. The symptoms that appear may vary depending on the type and location of the tumor. The literature does not sufficiently cover the experience of treating large occlusive tracheal tumors using segmental tracheal resection, endoscopic treatment, or radiation therapy. In scientific literature, the number of published studies with long-term results of endoscopic treatment or radiation therapy of such occlusive tracheal tumors is limited, and this problem requires further study. This article describes the first recorded case of endoscopic removal of a large occlusive tracheal tumor.&#x0D; The study aimed to show the possibility and effectiveness of endoscopic treatment using a minimum set of endoscopic equipment.&#x0D; Methods: This article presents a case of successful minimally invasive endoscopic treatment of a large occlusive tracheal tumor.&#x0D; Results: A large obstructing tumor of the trachea that almost completely blocked the trachea lumen was removed in one block by endoscopic loop resection.&#x0D; Conclusion: The presented clinical case describes the experience of successful endoscopic removal of a rare occlusive tumor of the trachea, which caused shortness of breath at rest and during exercise. For the first time in Kazakhstan, based on the National Scientific Cancer Center, we performed a unique minimally invasive operation to remove a tracheal tumor, while other clinics offered thoracotomic surgical resection methods.

ENDOSCOPIC REMOVAL OF A RARE LARGE OCCLUSIVE TRACHEAL TUMOR WITH LIMITED TECHNICAL CAPABILITIES

Relevance: Tracheal tumors often do not cause symptoms until they grow to a size that causes significant airway obstruction, which is&#x0D; the reason for the delay in diagnosis. Diagnosis may also be delayed due to non-specific symptoms, such as cough, wheezing, and shortness&#x0D; of breath, which can occur in other conditions such as asthma and chronic obstructive pulmonary disease. The symptoms that appear may&#x0D; vary depending on the type and location of the tumor. The literature does not sufficiently cover the experience of treating large occlusive&#x0D; tracheal tumors using segmental tracheal resection, endoscopic treatment, or radiation therapy. In scientific literature, the number of&#x0D; published studies with long-term results of endoscopic treatment or radiation therapy of such occlusive tracheal tumors is limited, and this&#x0D; problem requires further study. This article describes the first recorded case of endoscopic removal of a large occlusive tracheal tumor.&#x0D; The study aimed to show the possibility and effectiveness of endoscopic treatment using a minimum set of endoscopic equipment.&#x0D; Methods: This article presents a case of successful minimally invasive endoscopic treatment of a large occlusive tracheal tumor.&#x0D; Results: A large obstructing tumor of the trachea that almost completely blocked the trachea lumen was removed in one block by&#x0D; endoscopic loop resection.&#x0D; Conclusion: The presented clinical case describes the experience of successful endoscopic removal of a rare occlusive tumor of the&#x0D; trachea, which caused shortness of breath at rest and during exercise. For the first time in Kazakhstan, based on the National Scientific&#x0D; Cancer Center, we performed a unique minimally invasive operation to remove a tracheal tumor, while other clinics offered thoracotomic&#x0D; surgical resection methods

ENDOSCOPIC SURGERY FOR THE TREATMENT AND DIAGNOSIS OF HAGLUND'S DEFORMITY AND ACHILLES BURSITIS

In presented article the history of terminology, the mechanism of occurrence of impingement syndrome with the appearance of bone exostosis and Achilles bursitis, and the first steps in the diagnosis and treatment of Haglund's deformity and Achilles bursitis are considered. The results of endoscopic treatment of 40 patients with Haglund's deformity and achilobursitis are described. Clinical methods and methods of radiation diagnostics were used to examine patients.