Postoperative Obstruction Research Articles

Effectiveness of hyaluronic acid/carboxymethylcellulose in preventing adhesive bowel obstruction after laparoscopic radical cystectomy

Adhesive bowel obstruction is one of the most frequent complications after radical cystectomy, prolonging hospital stay and fasting period and increasing medical expenses. This study evaluated the effectiveness of hyaluronic acid/carboxymethylcellulose (HA/CMC) in preventing adhesive bowel obstruction after laparoscopic radical cystectomy. Randomized, controlled, single-blinded study was performed. Of 76 patients who underwent laparoscopic radical cystectomy for bladder cancer, 38 received HA/CMC instillation and 38 did not. The primary endpoint was the rate of postoperative adhesive bowel obstruction. The secondary endpoint was the rate of other postoperative outcomes. None of the patients who received HA/CMC instillation experienced postoperative adhesive bowel obstructions, compared with six (15.79%) patients in the control group (p=0.025). Of the six patients with ileus, two underwent adhesiolysis. There were no significant differences between the two groups in other postoperative outcomes. HA/CMC instillation during laparoscopic radical cystectomy may reduce the incidence of postoperative adhesive bowel obstruction without adverse effects.

Short-term efficacy and safety of the synchronous neoadjuvant chemoradiotherapy with paclitaxel plus carboplatin in stage III adenocarcinoma of esophagogastric junction

To evaluate the short-term efficacy and safety of neoadjuvant synchronous chemoradiotherapy (paclitaxel plus carboplatin regimen) in stage III adenocarcinoma of esophagogastric junction (AEG). Forty cases clinically diagnosed as stage III AEG were prospectively enrolled at the Department of Gastrointestinal Oncology Surgery, the First Affiliated Hospital of Hebei North University from December 2014 to November 2017 and then were randomly divided into paclitaxel plus carboplatin combined with synchronous radiotherapy group(neoadjuvant group) and direct operation group. Inclusion criteria was as follows:(1) AEG was diagnosed by gastroscopic biopsy and III stage was confirmed by ultrasound endoscopy and spiral CT;(2) physical strength score ≥70, and age ≤75 years old; (3) no contraindications of chemoradiotherapy and operation. Exclusion criteria was as follows:(1) patients voluntarily withdrew or refused the treatment;(2) occurrence of severe anaphylaxis; (3) uncontrollable events happened during treatment and treatment was unable to continue;(4) tumor developed obviously during treatment. Preoperative neoadjuvant synchronous chemoradiotherapy used TP regimen: paclitaxel 80 mg/m², drug concentration-time area under curve of carboplatin= 1.5 mg×ml⁻¹×min⁻¹, once per week for 9 weeks; radiotherapy began at the second week, 40 Gy/20 F, completed within 4 weeks. Operative procedure of both groups was radical resection of cardiac cancer(D2). Postoperative chemotherapy regimen was oral Tegafur(Gimeracil and Oteracil potassium). The side effects, diet situation, change of gastroscopic image after treatment in patients of neoadjuvant group were observed and efficacy evaluation of chemotherapy was performed according to solid tumor efficacy evaluation criteria of US National Cancer Institute. Operation-associated parameters, including R0 resection rate, lymph node metastasis, operative mortality and postoperative complications, were compared between two groups. There were no significant differences in baseline information between the two group (all P>0.05). One case in neoadjuvant group was excluded because of perforation at lesion site 7 weeks after chemotherapy. The side effects of 19 cases in neoadjuvant group were mainly alopecia (100%) and marrow inhibition (68.4%), while 3-4 degree side effects were alopecia(8/19,42.1%), leukopenia (3/19, 15.8%) and neutropenia(3/19, 15.8%). Complete remission was observed in 4 cases; partial remission was observed in 13 cases and stable disease in 2 cases, with an objective response rate of 89.5% and a disease control rate of 100%. Before neoadjuvant chemotherapy, 16 cases were difficult to take liquid diet and 3 cases received liquid diet only, while after 12 weeks of neoadjuvant chemotherapy, all the 19 cases received normal diet. Besides, after neoadjuvant chemotherapy, gastroscopic examination showed close healing of cardiac ulcer, disappearance of swelling, and renewal of normal mucosa. Compared to direct operation group, neoadjuvant group had less number of positive lymph node (4.9±3.6 vs. 8.8±2.8, P<0.05) and higher R0 resection rate (94.7% vs. 50.0%, P<0.05). Total number of harvested lymph node was not significantly different between two groups (19.1±2.5 vs. 18.6±7.0, t=0.326, P=0.746). There was no surgical death in either group. One case in direct operation group developed postoperative inflammatory obstruction. No associated complication was found in neoadjuvant group. Paclitaxel plus carboplatin combined with synchronous radiotherapy can elevate the R0 resection rate of patients with stage III esophagogastric junction adenocarcinoma, without increasing operative mortality and postoperative complications.

Is Sutureless Technique Beneficial in the Primary Repair of Total Anomalous Pulmonary Venous Connection? A Systematic Review and Meta-Analysis.

A meta-analysis was performed for a comparison of outcomes between sutureless technique and conventional surgery for primary repair for total anomalous pulmonary venous connection (TAPVC). Electronic databases including PubMed, EMbase, Scopus, and Cochrane Library were searched systematically for the single-arm studies regarding sutureless repair or conventional surgery, and two-arm studies compared the outcomes of sutureless repair and conventional surgery for TAPVC. Corresponding data were extracted and the methodological quality was assessed by two reviewers independently. 26 studies were included, involving a total of 2702 patients. It was observed that compared with conventional surgery, sutureless technique was associated with a lower occurrence rate of post-operative pulmonary veins obstruction (PVO) (4.6% vs. 13.5%, OR 0.54 in favor of sutureless technique) and re-operations due to PVO (3.4% vs. 12.4%, 0.25 in favor of sutureless technique). However, meta-analyses of post-operative early (OR 0.57; 95% CI 0.27-1.19; P = 0.13), late (OR 0.37; 95% CI 0.13-1.06; P = 0.13), and overall (OR 0.61; 95% CI 0.36-1.03; P = 0.07) mortality showed no significant difference between sutureless technique and conventional surgery. Compared with conventional surgery, sutureless technique was associated with a lower occurrence rate of post-operative PVO and re-operations due to PVO. Meanwhile, post-operative early, late, and overall mortality were not statistically different between two surgical approaches. Sutureless technique is beneficial in the primary repair of TAPVC regarding post-operative PVO and re-operations due to PVO. However, the level of evidence was low and randomized controlled trials should be designed to evaluate the safety and effectiveness of sutureless technique for TAPVC.

An Improved Method for Temporary Suture Medialisation of the Middle Turbinates following Endoscopic Sinus Surgery.

Background Middle turbinate (MT) lateralisation with adhesion formation (MiTLAF) is a common complication following endoscopic sinus surgery, frequently resulting in surgical failure, persistence of preoperative symptoms, and delayed secondary complications. Packing materials, splints, or spacers reduce the risk of MiTLAF but often result in postoperative nasal obstruction and discomfort, along with reduced access for irrigation. Temporary suture medialisation of the MTs reduces the risk of MiTLAF and prevents the problems encountered with packing, splints, or spacers. However, the techniques described in the literature are technically challenging and often ineffectual. Methods We describe a method of suture placement that provides a secure temporary MT medialisation, without the technical challenges of traditional techniques, using a 4-0 Monocryl (Poliglecaprone 25, Ethicon, Somerville, NJ, USA) suture on a 19 mm precision point reverse cutting PS-2 curved needle. We review 25 consecutive patients undergoing sinonasal procedures with our new technique and assess for MiTLAF. Results In our cohort, only one patient experienced MiTLAF which was not clinically significant. Conclusions Our method is simple, easy to perform, and highly effective and prevents adhesion formation without the need for postoperative splints or packing.

Late Results of Half-Turned Truncal Switch Operation for Transposition of the Great Arteries

Conventional Rastelli, Lecompte, and Nikaidoh operations are accepted as standard techniques for complete transposition of the great arteries (TGA) with left ventricular outflow tract (LVOT) obstruction. These operations show serious drawbacks, however, including postoperative obstruction of both ventricular outflow tracts. We developed the half-turned truncal switch operation (HTTSO) to address these problems. Between 2002 and 2017, 14 patients underwent HTTSO. Median age was 1.2 years and median body weight was 8.3 kg. Diagnosis was TGA with pulmonary stenosis in 9 cases, TGA-type double-outlet right ventricle in 4, and TGA with degenerative pulmonary valve after pulmonary arterial banding in 1. The coronary artery was Yacoub type A in 13 and type D in 1. Four patients had a small right ventricle. Pulmonary-aortic annular diameter ratio ranged from 0.43 to 1.00. The right ventricular outflow tract was augmented using a monocuspid polytetrafluoroethylene valved patch in 8 cases. Autologous pulmonary annulus was preserved in 6 cases. Median follow-up was 5.2 years. No early mortality was encountered. Only 1 patient was lost due to arrhythmia, 11 months after HTTSO. No patients showed coronary insufficiency and no outflow tract obstruction was identified. Aortic regurgitation was within mild degree in 12 cases. Additional mitral valvular annuloplasty was required in 3 cases late after HTTSO for moderate-to-severe mitral regurgitation. Risk factors for late death and reoperation were low age and body weight at HTTSO. HTTSO is useful for TGA with LVOT obstruction, ensuring wide, straight ventricular outflow tracts and growth potential.

Outcome of endoscopic small-bore naso-jejunal tube stenting in early postoperative jejunal limb obstruction after gastrectomy.

Early postoperative jejunal limb obstruction is a rare complication following gastric surgery with jejunal reconstruction. The condition is mainly attributed to kinking of the jejunal limbs, gastrojejunal or jejunojejunal anastomosis. There has been currently limited information regarding the safety and efficacy of endoscopic treatment in patients with early postoperative jejunal obstruction. We aimed to investigate outcome of endoscopic small-bore naso-jejunal (N-J) tube stenting across the obstructed segment in patients with uncomplicated early postoperative partial jejunal limb obstruction. All patients diagnosed of jejunal limb obstruction within 8 weeks after gastric-related surgery were reviewed. Patients with malignant obstruction, complete closed loop obstruction, sepsis, instability, intestinal strangulation, or perforation were excluded. All patients underwent endoscopic dekinking and stenting for 2 weeks with an N-J tube using 16-French single lumen plastic nasogastric tube across the obstruction segment after failed conservative therapy. Successful N-J tube placement across the obstruction point was confirmed by contrast study. Complications, technical, and clinical success were evaluated. Twenty-one patients met the criteria. The primary operations were 7 partial gastrectomies with Billroth-II reconstruction, 7 total or partial gastrectomies with Roux-en-Y reconstruction and 4 Whipple's operations, 2 bypass procedures, and 1 proximal gastrectomy. Most common site of obstruction was jejunojejunal anastomosis and gastrojejunal anastomosis following Roux-en-Y and Billroth-II reconstruction, respectively. Endoscopic N-J tube placement was technically successful in 20 out of 21 patients (95%). One patient had aspirated pneumonia. There was no procedure-related mortality. After N-J tube removal, clinical success was demonstrated in 19 out of 20 patients (95%) at the median duration of 6 months. One patient underwent reoperation due to repeated tube dislodgement. Endoscopic stenting with a 16-F naso-jejunal tube across the angulated segment is safe and effective for treatment of patients with uncomplicated early postoperative partial jejunal limb obstruction following gastric surgery with jejunal reconstruction.

A population-based comparison of the post-operative outcomes of open and laparoscopic appendicectomy in children.

To assess and compare the post-operative outcomes of open and laparoscopic appendicectomy in children. Record linkage analysis of administrative hospital (Admitted Patient Data Collection) and emergency department (Emergency Department Data Collection) data.Participants, setting: Children under 16 years of age who underwent an appendicectomy in a public or private hospital in New South Wales between January 2002 and December 2013. Association between type of appendicectomy and post-operative complications within 28 days of discharge, adjusted for patient characteristics and type of hospital. Of 23 961 children who underwent appendicectomy, 19 336 (81%) had uncomplicated appendicitis and 4625 (19%) had appendicitis complicated by abscess, perforation, or peritonitis. The proportion of laparoscopic appendicectomies increased from 11.8% in 2002 to 85.8% in 2013. In cases of uncomplicated appendicitis, laparoscopic appendicectomy was associated with more post-operative complications (mostly symptomatic re-admissions or emergency department presentations) than open appendicectomy (7.4% v 5.8%), but with a reduced risk of post-operative intestinal obstruction (adjusted odds ratio [aOR], 0.59; 95% CI, 0.36-0.97). For cases of complicated appendicitis, the risk of wound infections was lower for laparoscopic appendicectomy (aOR, 0.67; 95% CI, 0.50-0.90), but not the risks of intestinal obstruction (aOR, 0.97; 95% CI, 0.62-1.52) or intra-abdominal abscess (aOR, 1.06; 95% CI, 0.72-1.55). Post-appendicectomy outcomes were similar for most age groups and hospital types. Children with uncomplicated appendicitis have lower risk of post-operative bowel obstruction after laparoscopic appendicectomy than after open appendicectomy, but may be discharged before their post-operative symptoms have adequately resolved.

Repair of the Lateral Nasal Wall in Nasal Airway Obstruction: A Systematic Review and Meta-analysis.

While functional rhinoplasty has been broadly studied, to our knowledge no systematic review and meta-analysis of lateral wall repair has been done previously. To evaluate the effectiveness of repair of the lateral nasal wall in adult patients with nasal airway obstruction. Medline, Embase, Cinahl, Central, Scopus, and Web of Science databases and reference lists were searched for clinical and observational studies. The selection criteria were defined according to the PICO (population, intervention, comparison, and outcome) framework. The relevant studies were selected by 2 independent reviewers based on the studies' abstracts and full texts. Data were extracted using standardized lists chosen by the authors according to Cochrane Collaboration guidelines. The effect sizes were first calculated for each study and then pooled together using random effects synthesis. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated by the Egger test. The results were reported as pooled row mean differences in changes from preoperative to postoperative Nasal Obstruction Symptom Evaluation scores at different times of follow-up (≤3 months, >3 to 6 months, and >6 months). Of 1522 initial records, 10 studies were considered relevant-all of them observational. The pooled study sample included 324 participants. When combining all the repeated measures together, the pooled effect size for functional rhinoplasty was -47.7 (95% CI, -53.4 to 42.1) points on the Nasal Obstruction Symptom Evaluation scale with high heterogeneity of 72%. The pooled effect size outcomes were similar in short- (-45.0 points [95% CI, -47.8 to -42.2 points]), mid- (-48.4 points [95% CI, -52.5 to -44.4 points]), and long-term (-49.0 points [95% CI, -62.1 to -35.8 points]) follow-ups. The pooled effect size of 10 observational studies supported the effectiveness of functional rhinoplasty for the treatment of nasal airway obstruction caused by lateral nasal wall insufficiency. To improve the level of evidence, randomized clinical trials are needed. NA.

Incidence of Adhesive Bowel Obstruction After Colon Cancer Surgery and its Risk Factors: A Nationwide Claim Study.

To elucidate the incidence of adhesive postoperative bowel obstruction (PBO) after colon cancer surgery and its risk factors using nationwide claim data. PBO has a significant impact on quality of life and medical costs after colectomy, though most of the literature consists of single-institution analyses. Data from 24,645 patients who underwent regional colectomy for colon cancer from 2010 to 2012 and had at least 3 years of follow up were obtained from the Health Insurance Review and Assessment Service database. Patients who required nasogastric tube insertion or bowel obstruction surgery more than 30 days after index colectomy were defined as having PBO. A total of 3083 (12.5%) patients experienced at least one PBO episode within 3 years after surgery. Logistic regression analysis showed that significant risk factors for PBO were elderly (odds ratio, OR = 1.13), male (OR = 1.27), open colectomy (OR = 1.99), and low-volume institution (OR = 1.17). Among 3083 PBO patients, 50.7% experienced their 1st PBO during the 1st year after the index colectomy, and 7.8% experienced recurrence within 3 years after index colectomy. The 3-year cumulative incidences of PBO according to risk factors of elderly, male, open colectomy, and low-volume institution were 14.6%, 14.3%, 19.5%, and 15.1%, respectively. We report several independent risk factors for PBO and its incidence after regional colectomy for colon cancer. These results are informative for medical providers as patients who will or have had the procedure and could be useful baseline data for further research on the active prevention or treatment of PBO after colectomy.

Sutureless technique versus conventional surgery in the primary treatment of total anomalous pulmonary venous connection: a systematic review and meta-analysis

BackgroudA meta-analysis was performed to compare the differences in outcomes between sutureless technique and conventional surgery for primary repair of Total Anomalous Pulmonary Venous Connection(TAPVC).MethodsElectronic databases, including PubMed, EMbase, Medline, CNKI, Wanfang Data and Weipu Data were searched systematically for the literature aimed mainly at comparing the therapeutic effects for primary repair of TAPVC administered by sutureless technique and conventional surgery. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality.ResultsSeven studies meeting the inclusion criteria were included, involving a total of 1293 subjects. It was observed that sutureless technique entailed a lower occurrence rate of post-operative Pulmonary Veins Obstruction (PVO) (OR, 0.52 95%CI, 0.32–0.86; P = 0.01) and re-operation due to PVO (OR, 0.28;95%CI, 0.09–0.87; P = 0.03). However, meta-analyses of hospitalization time (WMD, 5.92; 95%CI, − 7.97-19.80; P = 0.40) and post-operative mortality (OR, 0.65; 95%CI, 0.41–1.04; P = 0.07) showed no significant differences between sutureless technique and conventional surgery. Meta-analysis of Cardiopulmonary Bypass (CPB) time and aortic cross-clamp time also showed no significant differences between the two surgical approaches (WMD, 5.07; 95%CI, − 9.29-19.42; P = 0.49); (WMD, 5.73; 95%CI, − 7.76-19.23; P = 0.40), but the result remained inconclusive due to pooling result changes after sensitivity analysis.ConclusionsCompared with conventional surgery, a lower occurrence rate of post-operative PVO and re-operation due to PVO were associated with sutureless technique. Meanwhile, hospitalization time and post-operative mortality were not statistically different between the two surgical approaches. Pooling result of CPB and aortic cross-clamp time between the two groups remained inconclusive.

A new modified neuroendoscope technology to remove severe intraventricular haematoma

ABSTRACTBackground: Minimally invasive endoscopic haematoma evacuation is widely used in the treatment of intraventricular haemorrhage. However, its technique still has room for improvement. A new modified neuroendoscope technology (MNT) was used in this study and we explored its safety and efficacy in the treatment of severe acute intraventricular haemorrhage by comparing it with extraventricular drainage plus urokinase thrombolytic (EVD + UT) therapy.Methods: The following parameters were compared between the MNT group and the control group: incision design, operation time, ICU monitoring time, ventricular drainage tube (VDT) placement time, post-operative drainage tube obstruction (PDTO) rate, post-operative complications rate, 6-month mortality and Glasgow Outcome Scale (GOS).Results: A total of 85 patients were enrolled. The ICU monitoring times, VDT placement times, PDTO rate were shorter in the MNT group. Multivariable logistic regression identified that good medium-term outcome (GOS scores 4–5) was significantly associated with MNT applied (OR 1.017, 95% CI 1.005–1.029, p = 0.008), age under 65 years (OR 4.223, 95% CI, 1.322–17.109, p = 0.034) and pre-operation GCS scores more than 10 (OR 3.427, 95% CI 1.048–11.205, p = 0.040).Conclusion: MNT surgery for severe intraventricular haematoma evacuation is a safe and efficient new surgical option. This technique is minimally invasive and may be helpful to provide good outcomes for selected patients.

Postoperative Obstruction of the Pulmonary Veins in Mixed Total Anomalous Pulmonary Venous Connection.

Total anomalous pulmonary venous connection (TAPVC) is a rare form of congenital heart disease in which the pulmonary veins drain by various pathways to the right atrium instead of the left atrium. Postoperative obstruction of the pulmonary veins is a known complication. Identifying risk factors for morbidity and mortality is important for counseling and monitoring. We describe a pattern of postoperative obstruction in a specific arrangement of mixed TAPVC. Five patients with a type of mixed TAPVC, namely, three pulmonary veins connecting to the coronary sinus and the left upper pulmonary vein (LUPV) connecting to the innominate vein, were identified over an 11-year period at our institution. Two additional patients with this TAPVC arrangement were cared for at our institution after having surgery at other institutions. Of these, one patient received only comfort care at birth due to other clinical issues. The six other patients underwent surgical unroofing of the coronary sinus. The anomalous LUPV was not addressed during the initial surgery in any of these cases. Following repair, one patient died from non-cardiac reasons. The remaining five patients all developed obstruction of the repaired pulmonary veins with decompression through the unrepaired LUPV, requiring surgical revision. Three patients underwent a second reoperation as well. Three of the six repaired patients also developed refractory atrial arrhythmias. This cohort suggests that this mixed TAPVC pattern predisposes patients to obstruction after surgical repair. Further investigation may aid pediatric cardiologists in risk-stratifying and counseling these patients. Alternative surgical approaches may need to be considered.

Functional septorhinoplasty in the pediatric and adolescent patient

ObjectivesTo describe pediatric and adolescent patients undergoing functional septorhinoplasty and to analyze both subjective and objective outcomes. MethodsRetrospective review of prospective cohort study of patients ≤18 years old undergoing functional septorhinoplasty between 2013 and 2016 at a tertiary care center. Patient demographics, nasal exam, procedure, and pre- and postoperative nasal obstruction symptom evaluation (NOSE) score, EuroQOL 5-dimension (EQ5D), and peak nasal inspiratory flow (PNIF) scores were analyzed. Results39 patients, 48.7% male, mean age 15.9 years (range 7–18), with nasal obstruction underwent functional septorhinoplasty with mean follow up of 8.5 months. Patients reported a history of allergies (46.5%), nasal fracture (59.0%), and previous nasal surgery (25.6%). Most common exam findings included internal nasal valve narrowing (92.3%), superior/dorsal septal deviation (74.4%), external nasal valve narrowing (43.6%), caudal septal deviation (35.9%), and a narrow middle vault (33.3%). Septal cartilage grafts were placed in 79.5% of patients and PDS plate was used in 28.2%. Most common procedures included spreader grafts (84.6%), columellar strut graft (30.8%), and swinging door (23.1%). Of patients with both baseline and postoperative scores, at last follow up NOSE scores (SD) decreased from 59.0 (23.7) to 21.2 (8.8) (n = 26, p < 0.001), EQ5D VAS scores increased from 76.2 (17.7) to 85.8 (13.5), (n = 19, p = 0.056), and PNIF scores increased from 66.2 (25.3) to 90.8 (46) L/min, (n = 13, p < 0.01); all mean differences met the minimal clinically important difference for each score. 2 patients underwent revision surgery and there was one complication of a nasal abscess. ConclusionsFunctional septorhinoplasty is safe and effective in select pediatric and adolescent patients with significant nasal obstruction and results in significant improvements in both subjective and objective outcomes measures.

Outcomes of total anomalous pulmonary venous drainage repair in neonates with univentricular circulation.

Survival after surgery for isolated total anomalous pulmonary venous drainage has improved in the current era. However, outcomes of total anomalous pulmonary venous drainage repair in patients with univentricular circulation are associated with high mortality. Furthermore, outcomes of surgery in neonates with univentricular circulation are rarely reported among larger studies. Hence, we reviewed our experience (n = 19) with this population at a single institution (between 1986 and 2015) to identify specific subgroups with high mortality. We found patients with right ventricular dominance had the highest early mortality (54%; 7 of 13) when compared with patients (17%; 1 of 6) with left ventricle and biventricular dominance. Five patients (26%; 5 of 19) underwent reoperation for postoperative pulmonary venous obstruction. There were 5 long-term survivors. In conclusion, total anomalous pulmonary venous drainage repair in neonates with univentricular circulation is rare and is associated with high mortality and reoperation.

Conventional repair of total anomalous venous drainage without primary sutureless technique: surgical tips to prevent pulmonary vein obstruction.

Although primary sutureless technique for total anomalous pulmonary venous drainage has been introduced to reduce postoperative pulmonary vein obstruction (PVO), controversy still exists about superiority of the procedure between the conventional repair and primary sutureless technique at the initial repair. In our unit, the conventional repair has been consistently used based on four important surgical policies: (1) mark incision lines between 2 chambers to gain anatomically natural alignment, (2) place precise stitches by "intima-to-intima" using monofilament suture, (3) adequate orifice size should be guaranteed in greater than expected mitral valve size, (4) do not hesitate to undertake a redo additional anastomosis by a different approach when an echocardiography shows the velocity more than 1.5m/s. This study aims to evaluate mid-term outcome of the conventional repair for total anomalous pulmonary venous drainage. Between 2004 and 2016, consecutive 15 patients who underwent the conventional repair without the primary sutureless technique were included in this study. Survival, Freedom from reoperation, and PVO were retrospectively reviewed. Mean follow-up period was 4.6 ± 3.7years. Except for one patient who died of uncontrollable pleural effusion, all other patients survived with 5-year survival rate of 93.3%. For the 14 survivors, there was no PVO, nor reoperation. Following these policies, the mid-term outcome of the conventional total anomalous pulmonary venous drainage repair was excellent without the primary sutureless technique showing no obstruction. The conventional repair can be safely applied at the initial operation when the morphological condition allows for it.

One-stage transanal Swenson procedure for rectosigmoid Hirschsprungs disease in infants and children

Objective: This study aimed to present the outcome of transanal one-stage Swenson pull-through procedure in the management of rectosigmoid Hirschsprung’s disease (HD).Background: HD is a common cause of intestinal obstruction in pediatric age. Several pull-through procedures have been used to treat this pathology.Patients and methods: Between June 2008 and June 2015, 84 children with biopsy-proven HD underwent transanal one-stage Swenson pull-through procedure. Intraoperative details, postoperative complications, and bowel habits were recorded. Follow-up period ranged from 6 to 42 months.Results: The age at the time of surgery ranged from 3 months to 2 years. The length of the resected aganglionic segment ranged from 12 to 34 cm. The operating time ranged from 72 to 180 min. Postoperative hospital stay ranged from 3 to 6 days. There were no anastomotic leaks, no perianal infection, or postoperative bowel obstruction. Twelve patients (14.28%) developed postoperative enterocolitis. Six patients (7.14%) required a posterior internal sphincter myectomy despite repeated dilatations. All patients had less than four times bowel motions per day, 3 months after surgery. No voiding disturbances were encountered at the end of the follow-up period and none of the patients complained of recurrent constipation. Six patients developed perianal dermatitis, which was treated conservatively within 3 months after surgery. Anastomotic circumference could not be felt at digital examination in 78 patients 3 months after surgery.Conclusion: One-stage transanal Swenson pull-through procedure is a safe alternative and simpler procedure for rectosigmoid HD with low morbidities and accepted outcome as regards postoperative bowel habits.Keywords: Hirschsprung’s disease, rectosigmoid Hirschsprung’s, Swenson procedure, transanal pull-through

Laparoscopic Total Mesorectal Excision Following Transanal Endoscopic Microsurgery for Rectal Cancer.

Patients' selection for transanal endoscopic microsurgery (TEM) depends on diagnostic modalities; however, there are still some limitations in the preoperative diagnosis of rectal lesions, and in some reports, up to third of the adenomas resected by TEM were found to be adenocarcinoma; therefore, salvage radical resection (RR) remains necessary for achieving oncological resection. Salvage RR may encounter some technical problems as the violation of the mesorectum and the scar formation. In this study, we aimed to report the outcome in patients undergoing salvage RR in terms of morbidity and oncological results. Demographic and clinical data pertaining to patients undergoing RR following TEM between 2004 and 2014 were retrospectively collected. One hundred forty one TEM were performed in the study period, 53 (38%) for malignant rectal lesions. Indication for TEM: 15 (28%) benign adenoma, 25 (47%) early rectal cancer, and 13 (25%) had clinical complete response after neoadjuvant radiochemotherapy. Ten (19%) patients had no residual tumor in TEM specimen, 15 (28%) had T1, and 2 of them underwent salvage low anterior resection (LAR). Ten (19%) had T2, 4 had LAR, and 1 had abdominoperineal resection (APR). Five (9%) had a T3, 3 underwent LAR, and 2 had APR. Among the 13 (25%) after chemo-radiotherapy (CRT), 4 had salvage AR. The time from TEM to RR was 47 days (range32-70). Of 16 salvage surgeries, 8 (50%) were laparoscopic. The median operative time was 210 minutes (range165-360). Five patients had protective ileostomy. Rectal perforation occurred in 2 (12%) patients; both had a posterior location, one after CRT. Two (12%) postoperative small-bowl obstruction and three wound infections occurred. There was no perioperative mortality in any of the patients who underwent RR. The final pathology was no residual disease in 9, T3N1 in 1, T3N0 in 3, T2N1 in 1, and T2N0 in 2 patients. Eight (50%) had adjuvant chemotherapy. Laparoscopic total mesorectal excision following TEM seems to be safe, and with no negative impact of the completeness of the resection. The concern of intraoperative specimen perforation is real, and should be dealt with meticulous technique and careful dissection, particularly after CRT.

Comparative study of levobupivacaine and bupivacaine for bilateral maxillary nerve block during pediatric primary cleft palate surgery: a randomized double-blind controlled study.

BackgroundCleft lip and palate are common major congenital anomalies. Cleft palate (CP) repair causes pain and needs large doses of intravenous opioids. The risk of postoperative airway obstruction or respiratory depression is high, requiring continuous and vigilant monitoring. The primary outcome was to evaluate the efficacy of using different local anesthetics during bilateral maxillary nerve block (MNB) with general anesthesia on quality of recovery after primary CP repair. We hypothesized that levobupivacaine would be better than bupivacaine. Also, to investigate the potency of bilateral MNB in improving quality of postoperative analgesia.MethodsSixty children undergoing primary CP repair surgery were enrolled in the study. Combined general anesthesia and regional bilateral MNB were used for all patients. Group L (n = 30): children received 0.15 ml/kg of 0.2% levobupivacaine, while in Group B (n = 30): children received 0.15 ml/kg of 0.2% bupivacaine.ResultsFace, Legs, Activity, Cry, and Consolability pain score readings were 0 score in 7 cases of the Group L and 10 cases of Group B, 1 score in 14 cases of the Group L and 12 cases of Group B, and 2 score in 9 cases of the Group L and 8 cases of Group B. We found no statistically significant difference between the two study groups as regarding pain score or serious complications.ConclusionsLevobupivacaine is as effective and safe as bupivacaine to be used for MNB block with a lower incidence of complications. Bilateral suprazygomatic MNB is an effective, easy, and safe method for pain relief in children undergoing primary cleft palate repair surgeries.

PD43-05 CHANGE IN RENAL FUNCTIONS AND RISK OF CHRONIC KIDNEY DISEASE AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY AND URINARY DIVERSION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II1 Apr 2018PD43-05 CHANGE IN RENAL FUNCTIONS AND RISK OF CHRONIC KIDNEY DISEASE AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY AND URINARY DIVERSION Tomoaki Terakawa, Ahmed Aly Hussein, Paul May, Zhe Jing, Youssef Ahmed, Derek Wang, Hijab Khan, Adam Hasasneh, Adam Cole, Omer Rana, Kevin Stone, Alicia Skowronski, Sierra Broad, Gurkamal Chatta, Qiang Li, and Khurshid Guru Tomoaki TerakawaTomoaki Terakawa More articles by this author , Ahmed Aly HusseinAhmed Aly Hussein More articles by this author , Paul MayPaul May More articles by this author , Zhe JingZhe Jing More articles by this author , Youssef AhmedYoussef Ahmed More articles by this author , Derek WangDerek Wang More articles by this author , Hijab KhanHijab Khan More articles by this author , Adam HasasnehAdam Hasasneh More articles by this author , Adam ColeAdam Cole More articles by this author , Omer RanaOmer Rana More articles by this author , Kevin StoneKevin Stone More articles by this author , Alicia SkowronskiAlicia Skowronski More articles by this author , Sierra BroadSierra Broad More articles by this author , Gurkamal ChattaGurkamal Chatta More articles by this author , Qiang LiQiang Li More articles by this author , and Khurshid GuruKhurshid Guru More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2117AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the dramatic increase in the utilization of robot-assisted radical cystectomy (RARC) and urinary diversion, a description of how kidney functions may be affected is yet to be defined. We aimed to describe the changes in renal function after RARC, and determine the risk factors associated with developing chronic kidney disease (CKD). METHODS Retrospective review of 450 patients who underwent RARC and urinary diversion between 2005 and 2016 was performed. Patients who had prior nephrectomy or were on dialysis prior to RARC were excluded from the study. Estimated glomerular filtration rate (eGFR) was computed using the Modified Diet in Renal Diseases (MDRD) formula prior to RARC, at 1, 3, 6, 12 months after RARC and at the last follow up date. CKD was defined as eGFR<45 ml/min/1.73m2. Patients were stratified according to the diversion type received (ileal conduits-IC vs neobladders-NB). Multivariate stepwise regression analysis was used to assess the risk factors for developing CKD. RESULTS ≥405 received ICs and 45 received NBs. IC patients were significantly older (70 vs 57 years, p<0.001), had higher Charlson Comorbidity index (CCI) (3 vs 1, p<0.001), and more ≥pT3 (47% vs 13%, p<0.001). They exhibited lower median preoperative eGFR (69 vs 82 mL/min/1.73m2, respectively, p <0.001) and lower median eGFR at the last follow up (57 vs 71 ml/min/1.73m2, p=0.007). On multivariate analysis, higher CCI (OR 1.33, 95% CI 1.09-1.64, p=0.006), lower baseline eGFR (OR 2.80, 95% CI 1.55-5.06, p<0.001) and postoperative ureteral obstruction (OR 5.80, 95% CI 3.11-10.82, p<0.001) were associated with CKD after RARC. The risk of CKD increases with time after surgery for all patients (adjusting for baseline kidney function and CCI); In the first year following cystectomy CKD rates rose from 19% to 29% for IC patients, and from 5% to 12% for NB patients. CONCLUSIONS Preoperative lower eGFR, CCI and postoperative ureteral obstruction were independent risk factors for CKD after RARC. The risk of CKD increases over time for all patients and is more notable in IC patients, likely because of higher CCI and lower baseline eGFR rather than the type of diversion itself. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e878 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Tomoaki Terakawa More articles by this author Ahmed Aly Hussein More articles by this author Paul May More articles by this author Zhe Jing More articles by this author Youssef Ahmed More articles by this author Derek Wang More articles by this author Hijab Khan More articles by this author Adam Hasasneh More articles by this author Adam Cole More articles by this author Omer Rana More articles by this author Kevin Stone More articles by this author Alicia Skowronski More articles by this author Sierra Broad More articles by this author Gurkamal Chatta More articles by this author Qiang Li More articles by this author Khurshid Guru More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pericardial tunnel technique in the surgical management of the vertical form of scimitar syndrome.

To optimize the surgical strategy and individualized treatment for scimitar syndrome (SS) by summarizing the clinical outcomes of the pericardial tunnel technique for the vertical form of SS at a single centre. The vertical form was defined as an angle of scimitar vein (SV) insertion to the inferior vena cava (θ) ≤ 45°, whereas the horizontal form was defined as θ > 45°. Nine patients with vertical form were operated on from June 2011 to June 2017. The mean age of patients during surgery was 3.1 ± 3.63 (range 0.3-12) years. Five patients were with infantile form and 4 with childhood/adult form per Dupuis' classification. The pericardial tunnel technique entailed attaching the SV to the right lateral pericardium and directing blood flow to the left atrium through a left atriotomy inside the pericardial tunnel. All patients had associated intracardiac anomalies repaired concomitantly; 3 patients had major collateral arteries occluded or ligated. There was no in-hospital postoperative death or residual SV obstruction. The postoperative ventilation time was 88.3 ± 63.8 (range 36-264) h. Eight survivors were followed up for 33.4 ± 19.2 (range 2-72) months, with 1 lost to follow-up. Echocardiography demonstrated that 7 survivors had no pulmonary hypertension and 1 had mild pulmonary hypertension; none developed SV obstruction during the follow-ups. The pericardial tunnel technique is suitable for the vertical form of SS and is a reasonable option for individualized treatment of SS.