Percutaneous Drainage Procedures Research Articles

426. TAILORED MANAGEMENT OF ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY IN A SPECIALISED UNIT IN THE ERA OF HYBRID AND ENDOSCOPIC NOVELTIES

Abstract Tailored management of anastomotic leak after esophagectomy in a specialised unit in the era of hybrid and endoscopic novelties. Triantafyllou Alexandra1, Theodoropoulos Charalampos2, Eleni Kitsou1, Saliaris Konstantinos1, Karikis Ioannis1, Pachos Nikolaos1, Katsila Sofia3, Kakounis Konstantinos3, Triantafyllou Tania1, Xiromeritou Vasiliki3, Theodorou Dimitrios1 1. 1st Propaedeutic Surgical Department, Hippocratio General Hospital of Athens, University of Athens, Greece 2. Surgical Department, Tzaneio Hospital, Greece 3. Department of Gastroenterology, Hippocratio General Hospital of Athens, Greece Background Anastomotic leak following esophagectomy remains one of the most dreadful complications with high rates of morbidity and mortality. This study aims to delineate the incidence, therapeutic strategies, and associated outcomes of esophagogastric anastomotic leak in our unit. Methods We retrospectively analyzed prospectively collected data of patients diagnosed with anastomotic leak following esophagectomy. The treatment modalities and the patient outcomes are presented. Results 199 patients underwent esophagectomy between 2019 and 2023. Among them, 21 patients (10.6%) were diagnosed with anastomotic leakage. 17 out of these 21 patients (81.0%) were male, and the mean age was 58.6 years. 14 out of the 21 patients had cervical anastomosis (leak rate: 8.6%) and 7 patients intrathoracic anastomosis (leak rate: 18.9%). Significant reduction of the intrathoracic anastomotic leak rate was recorded within 2013 (0%) following revision of the anastomotic technique. No deaths were observed, and the average time to healing was 29.1 days. Endoscopic stenting was employed in 12 patients (57.1%), reoperation in 5 (23.8%), bedside wound exploration in 7 (4.8%) and one patient was treated conservatively. Besides stenting, 4 patients (19.0%) underwent percutaneous drainage procedures under radiological guidance. Conclusions Managing esophageal anastomotic leakage presents significant challenges. Optimal outcomes for anastomotic healing and patient survival are achieved through a multidisciplinary and individualised approach encompassing interventional radiology or endoscopy and/or reoperation in selected patients.

Analysis of factors affecting the diagnostic yield for microbiologic diagnosis from percutaneous abdominal abscess drainage.

This study aimed to investigate the factors influencing the diagnostic yield of microbiologic diagnosis obtained through percutaneous abdominal abscess drainage procedures. We analyzed the influence of diverse clinical, radiological, and pre-procedural factors on the success of microbiologic diagnosis in this context. A retrospective analysis of patients who underwent percutaneous abdominal abscess drainage was performed to assess the factors affecting the diagnostic yield for microbiologic diagnosis. A total of 174 patients undergoing percutaneous abdominal abscess drainage was included. The use of antibiotics during the procedure and the spread of the abscess to other organs significantly increased the likelihood of obtaining a positive culture. Specifically, antibiotic use during the procedure raised the risk by up to 3.30-fold (OR = 3.30, 95% CI 1.48-7.65, p = 0.004), while abscess spread to another organ increased the risk by approximately 1.87-fold (OR = 1.87, 95% CI 0.98-3.61, p = 0.057). Additionally, abscesses containing air and abscesses with an air-fluid level were more common in patients with positive culture results. Other factors, such as gender, age, malignancy prevalence, and surgical history, did not significantly impact culture results. This study provides valuable insights into the factors affecting the diagnostic yield of microbiologic diagnosis from percutaneous abdominal abscess drainage. The findings underscore the importance of considering patient-specific variables and procedural aspects when planning and executing abscess drainage procedures. Further research can build upon these insights to develop evidence-based guidelines for optimizing the diagnostic yield of percutaneous abdominal abscess drainage procedures.

Clinical and Economic Implications of Interventions in Pancreatic Fluid Collections: An Assessment From a National Claims Database.

To compare clinical and economic implications of percutaneous and endoscopic treatment approaches in patients with pancreatic fluid collections (PFCs). This is a retrospective claims analysis of Medicare beneficiaries who underwent inpatient endoscopic or percutaneous PFC drainage procedures (2016-2020). We performed longitudinal analysis of claims for all-cause mortality and rehospitalization during 180-day follow-up. Main outcome was mortality. Other outcomes were rehospitalization and direct costs. A total of 1311 patients underwent endoscopic (n = 727) or percutaneous (n = 584) drainage. Percutaneous as compared with endoscopic approach was associated with higher mortality (23.08% vs 16.7%, P = 0.004), rehospitalization (58.9% vs 53.3%, P = 0.04), and mean direct hospital costs ($37,107 [SD = $67,833] vs $27,800 [SD = $43,854], P = 0.004). On multivariable analysis, percutaneous drainage (adjusted hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.02-1.86; P = 0.039), older age (hazard ratio [HR], 1.04; 95% CI, 1.01-1.04; P < 0.001), intensive care unit stay (HR, 1.02; 95% CI, 1.01-1.03; P < 0.001), and multiple comorbidities (HR, 1.07; 95% CI, 1.05-1.09; P < 0.001) were significantly associated with mortality. Percutaneous drainage (adjusted odds ratio [OR], 1.30; 95% CI, 1.04-1.63; P = 0.027) and older age (OR, 0.98; 95% CI, 0.97-0.99; P < 0.001) were significantly associated with rehospitalizations. As percutaneous drainage may be associated with higher mortality, rehospitalization, and costs, when requisite expertise is available, endoscopy should be preferred for treatment of PFC amenable to such an approach. Randomized trials are required to validate these findings.

EFFECT OF COVID 19 PANDEMIC ON PANCREATIC CANCER SURGERY

Abstract&#x0D; Aim: The chaos experienced during the Covid-19 pandemic caused disruptions in the treatments of pancreatic cancer patients; both the ones who were newly diagnosed and the ones who had ongoing treatments. It also caused delays in the diagnosis of pancreas tumors and thus changes in the treatments which would be planned. For these reasons, more problems might arise in patients who had pancreatic surgeries during this interval. In this study, we aim to compare postoperative morbidity and mortality of patients who had pancreatic surgery due to diagnosis or suspect of cancer before and during Covid-19 pandemic.&#x0D; Material and Method: Data of patients who had pancreatic surgery due to pancreas cancer between 2017-2022 were recorded prospectively. A total of 226 patients were included. There were 142 patients in Pre-Covid group, and 84 patients with pancreas cancer in the Post-Covid group. Patients who were accepted as inoperative during surgery or the ones who had palliative surgery were excluded.&#x0D; Results: Preoperative biliary stent or percutaneous biliary drainage procedures were compared in patients with pancreatic cancers and these were performed more often in Post-Covid group than in Pre-Covid group during pandemic period. Biliary drainage was performed to 31 patients in Pre-Covid group (28.1%), and 32 (46.3%) patients in Post-Covid group (p=0.013). Five patients (3.5%) in Pre-Covid group, 15 patients (17.8%) in Post-Covid group had neoadjuvant therapy (p=0.000). Patients in Post-Covid group had significantly more neoadjuvant chemotherapy. Vascular resection was performed for 14 patients (9.8%) in Pre-Covid group, and 16 (19%) patients in Post-Covid group. Rate of vascular resection was significantly higher in Post-Covid group (p=0.049). Nine (6.3%) patients in Pre-Covid group, and 12 (14.2%) patients in Post-Covid group had extra-organ resection. Extra-organ resection was significantly higher in Post-Covid group than in Pre-Covid group (p=0.047).

Association Between Common Empiric Antibiotic Regimens and Clostridioides Difficile Infection in Pediatric Appendicitis

BackgroundClostridioides Difficile Infection (CDI) is a serious antibiotic related complication that has been reported among children undergoing treatment of appendicitis. CDI likelihood amongst different empiric antibiotic regimens for appendicitis remains unclear but likely has important implications for antibiotic stewardship. MethodsA retrospective cohort study of the Pediatric Health Information System was used to examine patients ages 1 through 18 who received operative management of acute appendicitis. Common empiric antibiotic regimens 1) Ceftriaxone & Metronidazole (CM) 2) Piperacillin & Tazobactam (PT) and 3) Cefoxitin were compared. Study outcomes were CDI within 28 days post-appendectomy and 30-day post-appendectomy percutaneous drainage procedures. Subset analyses were repeated to only include hospitals that standardized empiric antibiotic choice. ResultsOf 105,911 patients, 220 (0.21 %) developed CDI. CDI was more common in patients that received CM (CM 0.29 % vs PT 0.15 % vs Cefoxitin 0.18 %; P < 0.01). On adjusted analysis, PT was associated with a lower likelihood of CDI (OR, 0.48; 95%CI, 0.31–0.74) compared to CM which was consistent in hospitals with standardized antibiotic choice. Exposure to more unique antibiotic regimens (OR, 1.70; 95 % CI, 1.50–1.93) and higher total antibiotic days (OR, 1.17; 95 % CI 1.13–1.21) were associated with an increased likelihood of CDI. There was no significant difference in the likelihood of post-appendectomy percutaneous drainage between antibiotic regimens. ConclusionsCDI is rare following appendectomy for pediatric appendicitis. While PT was associated with statistically lower rates of CDI compared to CM, antibiotic stewardship efforts to avoid mixed regimens and decrease overall antibiotic exposure warrant exploration. Level of EvidenceLevel III.

Bilateral Wunderlich syndrome causing Page kidney during pregnancy: a rare case report.

The patient presented with complaints of left flank pain and breathlessness. After stabilization, an emergency lower cesarean delivery was performed, and a percutaneous drainage procedure was carried out to alleviate the compression on the left kidney. The patient was treated with blood transfusion, methyldopa, and perindopril. Follow-up examinations performed 3 months later revealed a significant decrease in fluid volume surrounding the left kidney. Lenk's triad provides the primary description of the classical manifestations of this syndrome. Some instances have been connected to the Page kidney phenomenon. The relationship between pregnancy and Wunderlich syndrome has not been extensively studied, primarily because the symptoms can resemble other complications related to pregnancy. Due to the scarcity of evidence in the literature, there is no definitive guideline for managing Wunderlich syndrome during pregnancy. Consequently, each patient is treated on an individual basis. Conservative treatment is recommended once malignancy has been ruled out. The case highlights the importance of considering Wunderlich syndrome as a differential diagnosis in pregnant patients with abdominal or flank pain, a palpable mass, and hypovolemia. Furthermore, the case illustrates the successful management of Wunderlich syndrome during pregnancy.

Validating the American Association for the Surgery of Trauma Pancreas Injury Grade Using Trauma Quality Improvement Program Data.

The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for the pancreas was created in 1990. Our aim was to validate the ability of the AAST-OIS pancreas grade to predict adjuncts to operative management, including endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous drain placement. We analyzed the Trauma Quality Improvement Program (TQIP) database from 2017 to 2019, including all patients with a pancreas injury. Outcomes included the rates of mortality, laparotomy, ERCP, and peri-pancreatic or hepatobiliary percutaneous drain placement. Outcomes were analyzed by AAST-OIS, and odds ratios (ORs) and 95 confidence intervals (CIs) were calculated for each. 3571 patients were included in the analysis. The AAST grade was associated with increased rates of mortality and laparotomy at every level (P < .05). Endoscopic retrograde cholangiopancreatography rates increased from grade 2 to 3 (OR 4.685, 95% CI 3.254-6.745), were similar between grades 3 and 4 (P > .05), and decreased from grades 4 to 5 (OR .443, CI .250-.788). Likewise, rates of percutaneous drain placement increased from grade 2 to 3 (OR 1.999, CI 1.192-3.353), were similar between grades 3 and 4 (P > .05), and decreased from grades 4 to 5 (OR .266, .076-.934). Increasing pancreatic injury grade is associated with increased mortality and laparotomy rates at all levels. Endoscopic retrograde cholangiopancreatography and percutaneous drainage procedures are used most in mid-grade (3-4) pancreatic trauma. The decrease in nonsurgical procedures in grade 5 pancreatic trauma is likely secondary to increased rates of surgical management (resection and/or wide drainage). The AAST-OIS for pancreatic injury is associated with mortality and interventions.

Evaluation of Blood and Biliary Drainage Cultures and Mortality after Percutaneous Transhepatic Biliary Drainage Procedure

Introduction: Bacteremia and bile duct infection following percutaneous transhepatic biliary drainage (PTBD) are severe complications. Thus, the aim of this study was to investigate the risk factors of mortality and to evaluate the differences between blood and biliary drainage culture positive patients after PTBD. Materials and Methods: This is a retrospective study of 90 patients without any signs of infection prior to the PTBD procedures. Of these patients, we further divided them into three groups based on culture results: 1) first group was only bacteremic, 2) second group was only bile drainage culture-positive, and 3) third group was both bacteremic and bile drainage culture-positive. We compared clinical and laboratory parameters between these three groups and also evaluated the culture results in a high-resistance setting. Results: There were 90 patients who developed bacteremia, bile duct infections or both. In the laboratory findings, bacteremic patients showed significantly higher serum level of alanine aminotransferase (ALT) (p=0.001). Elevated neutrophil counts, lipase levels and carbapenem-resistant isolates were found to be the independent risk factors for 30-day mortality after PTBD. (p=0.01, p=0.01, and p=0.04, respectively). Gram-negative organisms were present in 71.2% of the cases; Escherichia coli was the most common species (28.1%) followed by Enterococcus faecium (18.1%), Klebsiella pneumoniae (15.8%) and Pseudomonas aeruginosa (9.9%). 51 (41.8%) of the cultured gram-negative bacteria were extended spectrum beta-lactamases positive and carbapenem resistance was found in 27 (15.8%) isolates. Conclusion: Elevated ALT level was only difference between three groups. Therefore, bacteremic and bile culture positive patients should be treated with the same care. Elevated neutrophil counts, lipase levels and carbapenem-resistant isolates were the independent risk factors for mortality. Finally, the choice of antibiotic prophylaxis should be reviewed according to the antimicrobial resistance profiles.

STUDY OF ETIOLOGY OF LIVER ABSCESS AND IT'S DIFFERENT WAYS OF MANAGEMENT

Background: Liver abscess are cystic, space occupying lesion within liver parenchyma. It has become one of the most common disease with more prevalence in underdeveloped and developing countries. Pyogenic liver abscess more common in western world while amoebic liver abscess are more common in underdeveloped countries and people living with lower socio-economic conditions. Liver abscess, undiagnosed and untreated, has a very high mortality rate. With early diagnosis and prompt institution of specic therapy, the prognosis is good and the mortality is very low. Surgical management was the mainstay for treating liver abscess earlier. However, USG guided percutaneous needle aspiration and percutaneous drainage procedure shown a favorable outcome with less average length of stay in hospital. In this study we aimed to study etiology of liver abscess and its different ways of management. To study the etiology of liver abscess Aim: Materials And Methods: and its different ways of management. This is a prospective, observational study was conducted in GSVM Medical College, LLR &amp; Associated Hospitals, Kanpur (UP).Study was done on 100 patients with different types of liver abscess. Patient with ruptured liver abscess were not included. Outcomes were assessed on the basis of recurrence (with regular follow ups at one month, three months, six months and one year); relieving of symptoms and length of stay in hospital. Results: Out of 100 patients majority of patients were in the age range of 31-45 (56.0%) followed by 46-60 (22.0%) with mean age of 40.74±10.53 years. Most of the cases were males (98%), and females (2.0%). Majority of patients were with lower socioeconomic status (96%). Most of the patient having amoebic liver abscess (66%) with positive ELISA for antibodies, while 34 % of patient having pyogenic liver abscess with 10% having bacterial growth on culture examination having E.coli . 84% of cases having liver abscess in right lobe and were single (66.0%). On the basis of their personal history, comorbidities and clinical features, 14.05 were diabetic, 44.0% were alcoholic, 98% were having fever with 60% cases have chills and rigor and 100% having pain in right upper quadrant. Majority of cases undergone pigt Conclusion: ail treatment were pyogenic (76.4%) and majority of amoebic abscess were treated with aspiration (72.7%) and difference was found statistically signicant with p value of 0.001. Reduction in size of abscess cavity was observed in all the cases but recurrence was higher in conservative treatment (p=0.007) and length of stay was higher in pigtail (p&lt;0.001).

The American Association for the Surgery of Trauma (AAST) Liver Injury Grade Does Not Equally Predict Interventions in Blunt and Penetrating Trauma

The AAST liver injury grade has a validated association with mortality and need for operation. AAST liver injury grade is the same regardless of the mechanism of trauma. A 5-year retrospective review of all liver injuries at an urban, level-one trauma center was performed. Totally, 315 patients were included (29% blunt, 71% penetrating). In blunt trauma, AAST grade was associated with need for laparotomy (0%, 7%, 5%, 33%, 29%, Grade 1-5, p = 0.01), angiography (0%, 7%, 25%, 40%, 57%, p < 0.001), embolization (0%, 7%, 15%, 33%, 43%, p = 0.01), and percutaneous drainage procedures (13% use in Grade 4, otherwise 0%, p = 0.04), but not ERCP (0% for all grades). In penetrating trauma, AAST grade was associated with need for angiography (7%, 4%, 15%, 24%, 30%, p < 0.01) and percutaneous drainage (7%, 2%, 14%, 18%, 26%, p = 0.03) and had a marginal association with embolization (0%, 4%, 11%, 13%, 22%, p = 0.06). Laparotomy, ERCP, sphincterotomy, and stenting rates increased with AAST grade, but this was not statistically significant. AAST grade is associated with the need for surgical hemostasis, angioembolization, and percutaneous drainage in both penetrating and blunt trauma. Operative, endoscopic, and percutaneous procedures are utilized more in penetrating trauma. Angioembolization was used more in blunt trauma. Mechanism should be considered when using AAST grade to guide management of liver injuries.

Outcomes of Highest Grade (IV and V) Liver Injuries in Blunt and Penetrating Trauma

High-grade hepatic trauma can be devastating, with complications being common if patients survive. Studies comparing outcome differences between blunt and penetrating mechanism are lacking. This study aimed to describe and evaluate the association of traumatic mechanism with complications in patients sustaining grades IV and V liver injuries. A retrospective review of all adults who suffered grades IV and V liver injury from 2015-2020 was performed at a level I trauma center in an urban area. Outcomes in patients with blunt and penetrating mechanisms were compared. A total of 103 patients were included, of which 44 (43%) were penetrating and the remainder blunt. Patients with penetrating injuries were younger, more often male, and more likely to undergo initial operative management (82% vs 40%, P < .001). Regardless of mechanism, high grade liver injuries had similar rates of complications, including bile leak (17% vs 23%, P = .559) and intrabdominal abscess (7% vs 16%, P = .239), and similar need for endoscopic retrograde cholangiopancreatography (12% vs 19%, P = .379). Penetrating injuries required more re-interventions (42% vs 19%, P = .033), specifically more percutaneous drainage procedures (36% vs 12%, P = .016). Overall mortality was 29% and did not differ by mechanism. Morbidity and mortality are high for grades IV and V liver injuries. Penetrating high-grade hepatic injuries are more likely to be managed operatively, but mortality and overall complications are similar to blunt mechanisms. This may allow for uniform algorithms to define management strategies regardless of mechanism.

31: UTILITY OF ABDOMINAL DRAIN IN GASTRECTOMY (ADIGE) TRIAL: STUDY PROTOCOL FOR A MULTICENTER NON-INFERIORITY RANDOMIZED TRIAL

Abstract Background and aim Prophylactic use of abdominal drain in gastrectomy has been questioned in the last 15 years and a 2015 Cochrane meta-analysis on four RCTs concluded that there was no convincing evidence to the routine drain placement in gastrectomy. Nevertheless, the Authors evidenced the moderate/low quality of the included studies and highlighted how 3 out of 4 came from Eastern countries. After 2015 only retrospective studies have been published, all with inconsistent results. Methods ADiGe (Abdominal Drin in GastrEctomy) Trial is a multicenter prospective randomized non-inferiority trial with a parallel design. It aimed to verify whether avoiding routine use of abdominal drain is burdened with complications, particularly an increase in postoperative invasive procedures. Patients with gastric cancer, scheduled for subtotal or total gastrectomy with curative intent, are eligible for inclusion, irrespective of previous oncological treatment. The primary composite endpoint is reoperation or percutaneous drainage procedures within 30 postoperative days. The primary analysis will verify whether the incidence of the primary composite endpoint is higher in the experimental arm, avoiding routine drain placement, than control arm, undergoing prophylactic drain placement, in order to falsify or support the null hypothesis of inferiority. Secondary endpoints assessed for superiority are overall morbidity and mortality, Comprehensive Complications Index, incidence and time for diagnosis of anastomotic and duodenal leaks, length of hospital stay, readmission rate. Trial registration Prospectively registered (last updated on October 29, 2020) at Clinicaltrials.gov with the identifier NCT04227951, https://clinicaltrials.gov/ct2/show/NCT04227951. Results Assuming one-sided alpha of 5%, and cumulative incidence of the primary composite endpoint of 6.4% in control arm and 4.2% in the experimental one, 364 patients allow to achieve 80% power to detect a non-inferiority margin difference between the arm proportions of 3.6%. Considering a 10% drop-out rate, 404 patients are needed. In order to have a balanced percentage between total and subtotal gastrectomy, recruitment will end at 202 patients for each type of gastrectomy. The surgeon and the patient are blinded until the end of the operation, while postoperative course is not blinded to patient and caregivers. Conclusion ADiGe Trial could contribute to critically re-evaluate the role of prophylactic drain in gastrectomy, a still widely used procedure.

Successful treatment of an iatrogenic biliary stricture using holmium laser "recanalization" and multistenting technique.

A 55-year-old woman admitted for jaundice 2 months after cholecystectomy underwent magnetic resonance imaging, which showed a common bile duct (CBD) stricture. Cholangiography during endoscopic retrograde cholangiopancreatography ([Fig. 1]) confirmed a tight stricture of the proximal CBD and lack of visualization of the intrahepatic bile ducts (IHBD). At cholangioscopy using SpyGlass DS (Boston Scientific), a complete stricture of the proximal CBD was observed with a metallic clip visible inside the CBD ([Fig. 2]). The on-call interventional radiologist performed a percutaneous transhepatic biliary drainage (PTBD) procedure in order to try a rendezvous approach. Percutaneous contrast medium injection confirmed dilated IHBD with complete absence of the proximal CBD lumen for a length of at least 5 mm. Multiple attempts to pass a guidewire through the stricture, both percutaneously and endoscopically, failed.

Ultrasound-guided Percutaneous Drainage of Intra-abdominal Collection and its Clinical Outcome: A Prospective Interventional Study

Introduction: Intra-abdominal collections are abscesses that occur within the peritoneal cavity, the pelvis or behind the peritoneum (retroperitoneum) or intra-parenchymal. They are common complications of colorectal disease, particularly inflammatory bowel disease, malignancy and trauma. Ultrasound is very useful in establishing the diagnosis, quantification and localisation of intraabdominal abscesses. Open Surgical Drainage (SD) used to be the traditional treatment protocol. Recently however, percutaneous drainage procedures are becoming an essential therapeutic strategy in the treatment of this condition. Aim: To study the therapeutic efficacy of ultrasound-guided drainage of abdominal abscess and to compare it with open SD. Materials and Methods: A prospective interventional study was conducted in 94 patients with intra-abdominal abscess at Gauhati Medical College and Hospital, Guwahati, Assam, India, in between July 2019 to June 2020 who were randomly allocated into two groups and underwent respective procedures. The first group was Percutaneous Catheter Drainage (PCD) and second group was open Surgical Drainage (SD) group. Patient demographics, symptoms, aetiologies and locations of the collections as well as duration of hospital stay, success rate, and complications were analysed. Results of radiological findings were tabulated, evaluated and collated between both the groups. Statistical Package for Social Sciences (SPSS) software 21.0 version was used for analysing data and p-value &lt;0.05 was considered significant. Results: For abdominal collections and abscesses, ultrasound guided percutaneous drainage was successful in 96.8% of the patients whereas it was successful in 80% cases in the SD group. Complications were more frequently encountered in patients who underwent open SD (16.70%) compared to percutaneous drainage (12.40%) which was significant (p-value 0.0136). The average duration of stay for the group undergoing percutaneous drainage was 9.13±1.62 days which was shorter than for the group undergoing SD was 11.10±1.75 days (p-value &lt;0.001). The overall rate of failed percutaneous drainage was 3.2% as compared to SD where it was 20%. Conclusion: This study concluded that image-guided percutaneous drainage has lesser complications and higher success rate for abdominal collections/abscesses as compared to SD. Due to lower mortality rates as well as shorter duration of hospitalisation than open SD it can replace the traditional open or laparoscopic approach of drainage in most cases.

Incidence and impact of postoperative pancreatic fistula after minimally invasive and open distal pancreatectomy

BackgroundPrevious studies reported a higher rate of postoperative pancreatic fistula after minimally invasive distal pancreatectomy compared to open distal pancreatectomy. It is unknown whether the clinical impact of postoperative pancreatic fistula after minimally invasive distal pancreatectomy is comparable with that after open distal pancreatectomy. We aimed to compare not only the incidence of postoperative pancreatic fistula, but more importantly, also its clinical impact. MethodsThis is a post hoc analysis of a multicenter randomized trial investigating a possible beneficial impact of a fibrin patch on the rate of clinically relevant postoperative pancreatic fistula (International Study Group for Pancreatic Surgery grade B/C) after distal pancreatectomy. Primary outcomes of the current analysis are the incidence and clinical impact of postoperative pancreatic fistula after both minimally invasive distal pancreatectomy and open distal pancreatectomy. ResultsFrom October 2010 to August 2017, 252 patients undergoing distal pancreatectomy were randomized, and data of 247 patients were available for analysis: 87 minimally invasive distal pancreatectomy and 160 open distal pancreatectomies. The postoperative pancreatic fistula rate after minimally invasive distal pancreatectomy was significantly higher than that after open distal pancreatectomy (28.7% vs 16.9%, P = .029). More patients were discharged with an abdominal surgical drain after minimally invasive distal pancreatectomy compared to open distal pancreatectomy (30/87, 34.5% vs 26/160, 16.5%, P = .001). In patients with postoperative pancreatic fistula, additional percutaneous catheter drainage procedures were performed less often (52% vs 84.6%, P = .012), with fewer drainage procedures (median [range], 2 [1–4] vs 2, [1–7], P = .014) after minimally invasive distal pancreatectomy. ConclusionIn this post hoc analysis, the postoperative pancreatic fistula rate after minimally invasive distal pancreatectomy was higher than that after open distal pancreatectomy, whereas the clinical impact was less.

Total Fluoroscopy Time Reduction During Ultrasound- and Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage Procedure: Importance of Adjusting the Puncture Angle.

BackgroundThe purpose of this observational cohort study was to assess patient and operator-dependent factors which could have an impact on total fluoroscopy time during ultrasound and fluoroscopy-guided percutaneous transhepatic biliary drainage (PTBD).Material/MethodsBetween October 2016 and November 2020, 127 patients with malignant biliary obstruction underwent ultrasound- and fluoroscopy-guided PTBD with the right-sided intercostal approach. The initial bile duct puncture was ultrasound-guided in all patients, and the puncture angle was measured by ultrasound. Any subsequent steps of the procedure were performed under continuous fluoroscopy (15 fps). The patients were divided in 2 groups based on the puncture angle: ≤30° (group I) and >30° (group II). In a retrospective analysis, both groups were compared for inter- and intragroup variability, technical success, total fluoroscopy time, and complications.ResultsIn group II, the recorded total fluoroscopy time (232.20±140.94 s) was significantly longer than that in group I (83.44±52.61 s) (P<0.001). In both groups, total fluoroscopy time was significantly longer in cases with a lesser degree of bile duct dilatation, intrahepatic bile duct tortuosity, presence of liver metastases, and multiple intrahepatic bile duct strictures.ConclusionsThe initial bile duct puncture angle was identified as an operator-dependent factor with the possible impact on total fluoroscopy time. The puncture angle of less than 30° was positively correlated with overall procedure efficacy and total fluoroscopy time reduction.

Complications of percutaneous transhepatic cholangiography and biliary drainage, a multicenter observational study

ObjectivesOver 2500 percutaneous transhepatic cholangiography and biliary drainage (PTCD) procedures are yearly performed in the Netherlands. Most interventions are performed for treatment of biliary obstruction following unsuccessful endoscopic biliary cannulation. Our aim was to evaluate complication rates and risk factors for complications in PTCD patients after failed ERCP.MethodsWe performed an observational study collecting data from a cohort that was subjected to PTCD during a 5-year period in one academic and four teaching hospitals. Primary objective was the development of infectious (sepsis, cholangitis, abscess, or cholecystitis) and non-infectious complications (bile leakage, severe hemorrhage, etc.) and mortality within 30 days of the procedure. Subsequently, risk factors for complications and mortality were analyzed with a multilevel logistic regression analysis.ResultsA total of 331 patients underwent PTCD of whom 205 (61.9%) developed PTCD-related complications. Of the 224 patients without a pre-existent infection, 91 (40.6%) developed infectious complications, i.e., cholangitis in 26.3%, sepsis in 24.6%, abscess formation in 2.7%, and cholecystitis in 1.3%. Non-infectious complications developed in 114 of 331 patients (34.4%). 30-day mortality was 17.2% (N = 57). Risk factors for infectious complications included internal drainage and drain obstruction, while multiple re-interventions were a risk factor for non-infectious complications.ConclusionBoth infectious and non-infectious complications are frequent after PTCD, most often due to biliary drain obstruction.

Experience with Percutaneous Drainage of Body Fluids in a Tertiary Center in Benin City

Background: Percutaneous drainage is the evacuation of body fluids either using needle aspiration or by catheter placement under imaging guidance. Abnormal collections in the body which may be idiopathic, postinfectious, posttraumatic, or postsurgical (iatrogenic) can be free (e.g., ascites) or loculated (e.g. cysts and abscesses). Most cases of significant fluid accumulation require evacuation. Interventional radiology offers treatment and even cure to such patients who may be too ill to withstand surgery or not able to afford the cost of open surgery. The aim of this article is to review the common percutaneous drainage procedures done in the Radiology department of the University of Benin teaching hospital. Materials and Methods: A retrospective analysis of percutaneous drainage requests to the department of radiology of the hospital from January 2017 to march 2020 was performed. Data on age, gender, clinical diagnosis, the radiologic findings, procedures, and instrumentation utilized were retrieved and analyzed using IBM SPSS version 23. Results: A total of 49 patients' data were recruited for this study; 40 (81.6%) were female. The most common indication for intervention was liver abscess (14.3%), followed by liver cyst, endometriosis, obstructive jaundice, and pelvic abscess. The IV cannula/sheath was the most widely used instrument, followed by the pigtail catheter. All patients had their procedures done under antibiotic cover and the cases of hepatic cysts had albendazole added to their drug regimen. Conclusion: Despite the limited availability of resources for interventional radiology, basic procedures like cyst and abscess drainages can be successfully carried out using available materials and catheters.

The percutaneous tandem drainage technique for radical treatment of intractable hepaticojejunostomy leakage.

The principal concept of the percutaneous tandem drainage procedure for an intractable hepaticojejunostomy (HJ) leakage is to decrease the amount of fluid and divide the fluid-filled cavity into several small cavities, which can then be drained individually. Percutaneous abscess drainage (PAD) has a role in drainage of the fluid cavity, whereas percutaneous trans-anastomotic jejunum drainage (PTAJD) has a role in drainage to reduce the bile fluid and digestive juices. A decrease in fluid induces effective drainage of the fluid cavity by PAD. A negative pressure suction drain accelerates reduction of the fluid cavity. PAD is removed when the localized fluid cavity has collapsed. PTAJD is finally removed after a clamping test is performed. Since 2020, we performed the percutaneous tandem drainage for two patients, and an intractable HJ leakage was gently resolved within 3 months without any adverse event. The percutaneous tandem drainage technique is safe for steady drain management of an intractable HJ leakage.

Abstract No. 580 Lower risk of major arterial hemorrhage after percutaneous biliary drainage with primary stent versus primary catheter placement

To compare the incidence of arterial hemorrhage requiring embolization after percutaneous biliary drainage with a primary biliary stent (PBS) vs. a primary biliary drainage catheter (PBDC) placement. This IRB-approved retrospective study included 524 consecutive cancer patients who underwent 548 percutaneous biliary drainage procedures with a PBDC or a PBS between January 2016 and November 2019. Demographic, laboratory, and procedure data were collected after chart and PACS review. Biliary drainage was performed with 278 PBDC in 260 (50%) patients and 270 PBS in 264 (50%) patients. In 65/270 (24%) PBS, a covering catheter was left to ensure decompression. There was no statistically significant difference between the groups in the number of left-sided biliary interventions, INR, and platelet count. Major arterial bleeding requiring embolization occurred after 20/278 (7%) PBDC placements (8/20 in the left side) in 18 patients after a median of 9 days (range, 1–18 days). Only 1/270 (0.4%) PBS, with a covering catheter present, was followed by arterial bleeding requiring embolization after 10 days. There were no patients with PBS only (no covering catheter) that required embolization. The difference in major bleeding episodes after biliary drainage with PBDC vs. PBS was statistically significant (P < .001). Percutaneous biliary drainage with PBS is associated with a lower incidence of major arterial bleeding compared with PBDC. A covering catheter may increase the risk of bleeding after PBS placement.