Outcomes Of Ligation Research Articles

Varicocele treatment - outcomes of ligation and embolisation in the treatment of 281 men with a clinically palpable varicocele

Varicocele treatment - outcomes of ligation and embolisation in the treatment of 281 men with a clinically palpable varicocele

Varicocele treatment - outcomes of ligation and embolisation in the treatment of 281 men with a clinically palpable varicocele

<h3>Objectives</h3> Treatment options for varicoceles include surgical ligation (SL) and radiological embolisation (RE). RE has the advantages of being performed under LA. The EAU guidelines quote the recurrence rate with RE of 3.8-10%, hence SL is often performed despite the potential for increased morbidity. Our objective was to compare the outcomes of SL and RE with respect to improvement in semen analyses and sonographic findings. <h3>Methods</h3> This was a retrospective study investigating men who had varicocele treatment from 2017-2020. We assessed their pre-and post-treatment SA and ultrasound. The results were analysed using Wilcoxon, Mann-Whitney and t-test. <h3>Results</h3> 281 patients were treated; 168 with RE, 113 with SL. 124 had pre-and post-treatment SA (RE n=78, SL n=46). Both groups showed statistically significant improvement in count; RE 63% (p=<0.001), SL 52% (p=0.009) and Morphology; RE 45% (p=0.003), SL 46% (p=0.005). Neither group showed a statistically significant improvement in Motility; RE 47% (p=0.156), SL 46% (p=0.032). There was no statistically significant difference between the two groups. 83 patients had a pre-and post-treatment US performed (RE n=56; SL n=27). Vein diameter decreased in 68% following RE (3.7±0.86 mm to 3.1±0.80 mm, p<0.0001), 84% following SL (3.91±1.0 mm to 3.1±0.72 mm, p=0.001). Doppler US demonstrated cessation of reflux in 56% treated by RE (n=32) and 52% following SL (n=23). Technical failure for embolization included 11 single sided failures and 1 bilateral. <h3>Conclusions</h3> Neither RE and SL are superior for improving semen analysis parameters. Vein diameter decreases significantly after both. RE is a LA, day case procedure versus a GA and groin incision. We would favour the less invasive technique in the light of these findings. <h3>Conflicts of Interest</h3> n/a

Evaluation of Outcomes of Ligation of Intersphincteric Fistula Tract in Treatment of Transsphincteric Perianal Fistula

Evaluation of Outcomes of Ligation of Intersphincteric Fistula Tract in Treatment of Transsphincteric Perianal Fistula

Management of Brachial Artery Pseudoaneurysms in Intravenous Drug Abusers

Aim: To assess the outcomes of ligation and excision of brachial artery pseudoaneurysm without revascularization in IV drugs users. Place &amp; duration of study: From Jan 2021 to Jan 2022 at the department of Surgery of Doctors Hospital &amp; Medical Centre Lahore. Methodology: A retrospective observational study was conducted at the surgery department of Doctors Hospital &amp; Medical Centre Lahore for 1 year. Intravenous drug abusers, aged between 18-65 years diagnosed with brachial artery pseudoaneurysm were included in the study whereas pseudoaneurysm was caused due to arteriovenous fistula, hemodialysis, and trauma or in patients who had undergone revascularization were excluded from the study. The data were processed using SPSS 20.0. Results: A total of 15 intravenous drug users were enrolled in the study. The mean age of the participants was 33.4±5.4 years, and the mean period of addiction was 1.9±2.5 years. Majority of patients (65%) presented with an affected right arm. The most common presentations were: bleeding pseudoaneurysm (73.3%), oozing pulsatile mass (20%), and infected pulsatile mass (6.6%). Following the intervention, limb salvage was achieved in all patients. Ischemia was reported in none of the patients. Conclusion: The excision and ligation of the pseudoaneurysm can be an effective treatment option for the pseudoaneurysm of a brachial artery caused due to drug addiction. Keywords: The brachial artery, pseudoaneurysm, intravenous drug users, drug addiction

Outcomes of Fluoroscopy-Guided Percutaneous High Ligation of the Great Saphenous Vein Combined With Foam Sclerotherapy for Symptomatic Great Saphenous Veins

PurposeTo evaluate the effectiveness and safety of fluoroscopy-guided percutaneous high ligation (FPHL) combined with fluoroscopy-guided foam sclerotherapy (FGFS) to treat varicose veins of the great saphenous veins (GSVs). Materials and MethodsThis was a retrospective study of 113 patients (mean age, 62.1 ± 10.8 years; 60 men) with varicose veins of the GSVs (133 limbs) that were treated with FPHL combined with FGFS between April 1 and October 31, 2019. Demographic and clinical data were collected from these patients before the FPHL procedure, after which FGFS was performed. The preterminal GSV was ligated percutaneously by a percutaneously-positioned polypropylene ligature under fluoroscopic guidance. The outcome of ligation was confirmed by venography. Then, foam sclerotherapy was performed under fluoroscopy. At 1-year follow-up, GSV occlusion was evaluated by ultrasound. The venous clinical severity scores (VCSSs) were compared between the preoperative and 1-year follow-up periods. ResultsThe technical success rate was 100% (133 limbs). Complete 12-month follow-up was available for 112 limbs (84.2%) and 103 of these limbs (92.0%) remained occluded during this period. The VCSS improved from 4.71 ± 2.15 to 0.74 ± 0.60 (V = 6328, P < .001). During follow-up, there were 16 limbs with thrombophlebitis and 38 limbs with saphenous junction pain; these events were alleviated within 2 weeks of the procedure. There was no deep venous thrombosis or other severe adverse events. ConclusionsFPHL combined with FGFS to treat varicose veins in the GSVs achieved an occlusion rate of 92% and improved the clinical symptoms within 1 year; this minimally-invasive procedure was safe and effective.

Ligation of the inferior vena cava in penetrating pediatric trauma

Abstract Penetrating trauma in children is on the rise in the United States, often leading to severe injuries. Destructive injuries to the inferior vena cava (IVC) are rare in children, and outcomes of ligation are not well-described. This is a retrospective chart review of the cases and outcomes of two young children who required IVC ligation following abdominal gunshot wounds. The children's ages ranged from 3 to 6 years old. They both had concomitant duodenal injuries and additional intestinal injuries. The first patient also had a spinal cord injury. Their course was complicated by profound shock, breakdown of intestinal repairs, renal failure, and a necrotizing groin soft tissue infection, but they ultimately made a near-complete recovery. The second patient had a smooth postoperative course. Neither patient developed significant lower extremity edema. Ligation of the IVC in pediatric penetrating trauma patients is a viable and life-saving option but can be associated with complications.

Outcomes of Ligation without Revascularization in Pseudoaneurysms of Peripheral Arteries in Intravenous Drug Users

Management of pseudoaneurysms in intravenous drug users is complex and challenging due to an associated infection and unavailability of autologous vein grafts. Here we observe the outcomes of ligation and local debridement as a primary modality of treatment in this subset of patients with pseudoaneurysms. This is a descriptive cross sectional study of 15 patients over a period of 4 years who presented with pseudoaneurysm of peripheral artery from intravenous drug use. In this study, we describe the presentations and management outcomes in 15 patients with peripheral arterial pseudoaneurysmfrom IV drug use. The most common site involved was common femoral artery among 12 (80%) patients followed by superficial femoral artery among 8 (13.3%) patients and external iliac artery in 1 (6.7%) patient. Twelve (80%) patients were having signs of infection. All patients underwent surgical intervention which comprised of excision of pseudoaneurysm and ligation of artery without revascularization among 12 (80%) patients and with revascularization with autologous venous graft among 3 (20%) patients. There was no mortality or a major bleeding requiring re-exploration. None of the patients developed limb ischemia necessitating amputation.One patient with femoral artery ligation without revascularization at one year of follow up is having claudication on brisk walking.There was one saphenous vein graft thrombosis in immediate postoperative period. With the use of ligation without revascularization technique, there was no mortality or major bleeding requiring re-exploration. None of the patients developed limb ischemia necessitating amputation so this treatment modality seems promising in treatment of pseudoaneurysms in intravenous drug users.

PE02 - Outcomes of ligation vs bipolar coagulation of dorsal vascular complex during RARP: A single-institution retrospective analysis

PE02 - Outcomes of ligation vs bipolar coagulation of dorsal vascular complex during RARP: A single-institution retrospective analysis

Outcome of ligation of the persistently patent arterial duct in neonates as performed by an outreach surgical team

Our aim was to review the outcome of ligation of the persistently patent arterial duct in neonates as performed outside a paediatric cardiothoracic centre by an outreach surgical team. A retrospective observational study of all ligations of the persistently patent arterial duct performed in Cambridge between January, 1988, and December, 2002. Over the period of 15 years studied, a persistently patent arterial duct was ligated in 43 neonates. The median gestational age at birth was 26 weeks, with a range from 23 to 35 weeks, and median weight at birth was 722 grams, with a range from 500 to 2100 grams. Median age at ligation, was 25 days, with a range from 10 to 89 days, and their weight was 963 grams, with a range from 568 to 2221 grams. Ligation was successful in 42 babies (98%), mortality at 30 days of 5%, and 29 of the babies (67%) surviving to be discharged from the hospital. The late deaths were due to complications of prematurity, rather than the procedure of ligation. The persistently patent arterial duct can successfully be ligated by an outreach surgical team outside a paediatric cardiothoracic centre. There was an excellent 30 day survival.

The Rebleeding Course and Long-Term Outcome of Esophageal Variceal Hemorrhage after Ligation: Comparison with Sclerotherapy

Background: Endoscopic variceal ligation is widely accepted as the optimum endoscopic treatment for esophageal variceal hemorrhage. However, the rebleeding course and long-term outcome of patients with esophageal variceal hemorrhage after ligation have been poorly defined. Therefore, we conducted a long-term follow-up study to delineate the outcome of ligation and compare it with that after sclerotherapy. Methods: One hundred and eighty-five liver cirrhotic patients with endoscopically proven esophageal variceal hemorrhage were randomized to undergo endoscopic variceal sclerotherapy or ligation. These patients received regular follow-up and detailed clinical assessment. Results: Two patients developed hepatoma within 6 months of entry in each group and were excluded. Another six patients in the sclerotherapy group and seven patients in the ligation group were excluded because of poor compliance or lost to follow-up. Therefore, 84 patients in each group were analyzed. In this long-term follow-up (55.3 - 12.5 months) the rebleeding rate for ligation was lower than that for sclerotherapy, regardless of whether the rebleeding was analyzed by patient number or Kaplan-Meier analysis. With regard to the rebleeding risk of various periods, the sclerotherapy risk was higher than that of ligation within 4 weeks of the initial endoscopic treatment or before variceal eradication. Multifactorial analysis showed hematemesis, poor hepatic function, and sclerotherapy were the risk factors determining rebleeding. The annual hepatocellular carcinoma incidence was 4.9%. There was no difference in survival between sclerotherapy and ligation. Multifactorial analysis showed that poor hepatic function was the only factor determining survival. Conclusions: The rebleeding risk was higher in sclerotherapy than in ligation before variceal eradication, especially within 4 weeks of the initial endoscopic treatment. Long-term survival was dependent on hepatic reserve regardless of the treatment method.

Effects of prostaglandin E2, propranolol and nitroglycerine with halothane, pethidine or pentobarbitone anaesthesia on arrhythmias and other responses to ligation of a coronary artery in rats.

The effects of various cardiovascular drugs (prostaglandin E2 (PGE2), propranolol and nitroglycerine) and anaesthetic regimens (halothane, pethidine and pentobarbitone), upon the outcome of coronary artery ligation in acutely prepared rats were determined. Effects upon arrhythmias, blood pressure, heart rate, mortality, ECG and the size of the occluded zone were determined for each drug in the presence of each anaesthetic. PGE2 and nitroglycerine had no statistically significant effects on the outcome of ligation whatever the anaesthetic. Propranolol had limited antiarrhythmic actions. The anaesthetic used had major effects upon the outcome of ligation, regardless of the cardiovascular drugs administered. Pentobarbitone anaesthesia resulted in the highest mortality, and most arrhythmias. Pethidine-N2O anaesthesia was associated with fewer arrhythmias. Halothane-N2O anaesthesia markedly decreased the incidence and severity of arrhythmias, independent of the cardiovascular drug. It was concluded that the anaesthetic used can have a major influence on ligation-induced arrhythmias in acutely prepared anaesthetized rats.