Postoperative Fistula Research Articles

Pancreatoduodenectomy within 2 weeks after endoscopic retrograde cholangio-pancreatography increases the risk of organ/space surgical site infections: a 5-year retrospective cohort study in a high-volume centre.

Organ/space surgical site infections (OSSI) after pancreaticoduodenectomy (PD) are not rare events. The role of diagnosis and treatment for pancreatic and biliary diseases with an endoscopic retrograde cholangio-pancreatography (ERCP) procedure is currently controversial. However, the ERCP procedure might play a role in surgical outcomes after PD. We conducted a retrospective cohort study for patients who underwent PD in the First Affiliated Hospital with the Nanjing Medical University from 1st September 2012 to 31st January 2018. The relationship between ERCP exposure and OSSI after PD was analyzed by univariate and forward stepwise multivariate logistic regression model. Of the 1,365 patients who underwent PD, 136 developed OSSI (10.0%). We found that ERCP exposure before PD (EEBPD) was significantly associated with an increased incidence rate of post-operative pancreas fistula (POPF) [24.2% (23/95) vs. 14.9% (189/1,270), risk ratio (RR) =1.63, 95% confidence interval (CI), 1.11-2.38, P=0.015]. Hypertension, a higher level of preoperative low-density lipoprotein (LDL) and creatinine (Cr) were associated with elevated risks of post-operative OSSI [adjusted odds ratio (Adj-OR) (95% CI) were 1.59 (1.09-2.32), 1.70 (1.16-2.51), 1.99 (1.36-2.92)], whereas a preoperatively higher level of aspartate aminotransferase (AST) would decrease the risk [Adj-OR (95% CI), 0.62 (0.42-0.91)]. Remarkably, EEBPD would significantly increase and more than double the OSSI risk [Adj-OR (95% CI), 2.56 (1.46-4.47)] especially if it was within 14 days before surgery (Spearman =-0.698, P<0.001). ERCP, as an independent risk factor, significantly increased the risk of post-operative OSSI after PD if it is performed within 14 days prior to surgery. Our findings would assist clinical decision-making, and improve OSSI control and prevention.

P447 Combined fibrin glue with infliximab therapy of postoperative anastomotic fistula in patients with Crohn’s disease: A Pilot study

Abstract Background Postoperative anastomotic fistula is one of the most frequent and potentially life-threatening complications following gastrointestinal resections in patients with Crohn’s disease. The purpose of this study was to report the results of infliximab promoting healing of postoperative anastomotic fistula in patients with Crohn’s disease. Methods In this randomized controlled trial, 37 patients with postoperative fistula were assigned to combined(n=18) or control(n=19) groups and followed up for 6 months. The combined group received usual management protocol for fistula plus an intravenous infliximab therapy for 6 months. The control group received usual fistula protocol. The primary outcome was fistula closure time. The secondary outcome was any infectious complication such as recurrence of ECF, abdominal abscess, pneumonia, infectious diarrhea and other signs of infection. Results Thirty-seven patients with postoperative anastomotic fistula were evaluated. There were18 patients randomized to the combined group who received fibrin glue combined with infliximab therapy. There were 19 patients randomized to the control group who received fibrin glue sealant therapy alone. No significant differences in demographic or clinical characteristics were found between the two groups( P&amp;gt;0.05). The combined group had a shorter closure time than the control group(50.5±11.1 vs 76.2±26.2 days, P=0.011). The combined group did not show higher infectious complications than the control group(P=0.167). Conclusion Infliximab strategy with combining fibrin glue is a safe and effective treatment alternative in the management of postoperative anastomotic fistula in Crohn’s disease, offering the advantage of reduced heal time of fistula.

P510 Postoperative enterocoutaneous fistula after surgery for Crohn’s disease performed in a tertiary centre over 15 years: analysis of the long-term outcomes and predictors of fistula closure

Abstract Background Patients with Crohn’s disease (CD) have an increased risk to develop enterocoutaneous fistula (ECF) after surgery. Although conservative therapy could be advisable, in some cases surgery is unavoidable, despite there might be greater risks of intestinal failure associated with redo surgery. Methods CD patients affected by postoperative ECF (within 90 days from surgery) between 2004 and 2020, and followed for at least 3 months after the onset of the ECF, were retrospectively included. Variables were presented as median (range) or number (%).Chi-square, Fisher’s exact and Wilcoxon rank sum tests were used as appropriate. The Kaplan-Meier method was performed to analyse the rate of ECF closure over the follow-up time, and to compare the outcome between subgroups of patients. Results Eighteen patients were included in the study. The perioperative variables are reported in Figure 1. The median follow-up time was 29.5 months (range 0–204), and the median time to ECF closure was 104 days (24–954), although a clinical remission (defined as an ECG non requiring hospitalization) was obtained after a median time of 41 days (15–768). The comparison of the rates of ECF closure between subgroups of patients over the follow-up are reported in Figure 2 and 3. Conclusion The ECF output is the only variable which is significantly associated with the rate of ECF closure. The origin of ECF from an ileo-colic or a colo-colic anastomosis seems to be associated with a faster progression towards fistula healing as compared to an origin from the small bowel (ECF closure at 3 and 6 months: 56.3% vs 22.2% and 70.8% vs 33.3%, respectively; p=0.19). The use of NPWT and, when feasible, an early surgical treatment, might increase the chance of ECF closure within 3 months (55.5% vs 12.5%, p=0.43 and 66.7% vs 29.9%, p=0.32, respectively). Although postoperative ECF represents a challenging complication in CD, the present study shows that a complete closure is obtainable in the long-term in all patients treated in a referral centre.

Postoperative enterocutaneous fistulas: Management outcomes in 23 consecutive patients

BackgroundAbout 75%–85% of enterocutaneous fistulas are postoperative. Such fistulas are still disastrous and frustrating complication for surgeon and the patient and their management remains one of major challenge and dilemma in general surgical practice. Strict adherence to treatment guideline according to SOWATS protocol could results in better outcomes. The objectiveof this study was to assess the management outcomes of 23 patients with postoperative enterocutaneous fistulas. MethodsA total of 23 consecutive patients with postoperative enterocutaneous fistulas during the period of study were included. These fistulas were classified anatomically and physiologically. The predictive factors for spontaneous closure, management outcomes and mortality rate factors for were studied. ResultsOverall Closure of the fistulas was accomplished in 16 patients (69.6%). Spontaneous closure after successful conservative management was seen in 4 patients (17.4%). The average time between fistula development and spontaneous closure was 32 days (range12–66 days). Of 19 patients underwent corrective surgery, closure was achieved in 12 patients (52.2%), thus the surgical success rate was 63.2%. Surgical intervention was performed after an average period of 28 days (range 18–42 days) from diagnosis of the fistula. Five patients with high output (21.7%) died because of sepsis, severe malnutrition and organ failure. Conclusionadherence to standardized protocol and multidisciplinary approach of patients with enterocutaneous fistulas could results in good outcomes. A reasonable period of conservative treatment is always required to optimize patient's general conditions and for spontaneous closure of fistula. Operative correction is usually required for proximal high output and complex fistulas. The complexity of the fistulas, sepsis, high output effluent and comorbidities are the main factors affecting healing rates and fistula related mortality.

Colgajo de túnica vaginal en la prevención de fístulas postoperatorias tras reparación de hipospadias severos: ¿ha terminado la búsqueda del Santo Grial?

IntroductionFistula following hypospadias repair remains a bane for the hypospadiologist resulting in the evolution of various techniques. Despite all these, the incidence of postoperative fistula varies between 10 to 30% and it increases with the severity of the hypospadias. Hence, a study was conducted to evaluate the efficacy of tunica vaginalis flap in preventing fistula formation following severe hypospadias repair. Materials and methodsAn observational study was carried out in a tertiary center between 2008 and 2017. The study included children with severe hypospadias (proximal penile, penoscrotal, scrotal, and perineal). In all the patients, a tunica-vaginalis flap was used to buttress the urethroplasty. All the patients were followed up for at least a year after the completion of treatment. ResultsA total of 210 patients were included in the study. Bracka's 2-stage repair was performed in 180 patients who had either penoscrotal hypospadias or a meatus even more proximal. The rest 30 patients with proximal penile hypospadias underwent a single-stage Snodgrass repair. Four (2%) patients developed a fistula, all following 2-stage repairs, and half of them required surgical repair. Two (1%) patients had a partial breakdown of repair and underwent a residual repair after 6 months. ConclusionThe tunica-vaginalis flap is an excellent buttress in severe hypospadias repair. It is readily available, easy to harvest, with its good vascularity helps to significantly reduce the incidence of postoperative fistula.

27 Do Microbiology Swabs Taken During Incision and Drainage of Acute Perianal Abscess Affect Clinical Management and Future Clinical Course?

Abstract Introduction This study assesses whether microbiology swabs taken during incision and drainage of perianal abscesses have any impact on the post-operative clinical course and management. Method Data from emergency operative theatre lists were interrogated for patients undergoing incision and drainage of perianal abscess in the period March 2019 – March 2020. Each electronic medical record for patients who had perianal abscess surgery was interrogated for age, sex, smoking status, diabetic status, whether microbiology swab was taken for analysis, what organism was grown and any post-operative fistula development. Results 71 patients met inclusion criteria. 55 (77.5%) patients had pus swabs sent at incision and drainage for microbiological analysis. Of the 55 patients swabbed, 20 (36%) had no organism growth, 22 (40%) had anaerobes growth – the most common organism in this study. Of all 55 swabs sent, only 14 (25%) were acknowledged. The presence of smoking (p &amp;lt; 0.05) was statistically significantly associated with development of fistula-in-ano longer term. Conclusions Our data may indicate that microbiology swabs do not influence management of patients with acute perianal abscess. There are discrepancies in whether swabs are taken and acted upon. No organism was associated with fistula development. We would suggest national scale studies to explore our conclusions.

Perspective: Early diagnosis and treatment of postoperative recurrent cerebrospinal fluid fistulas/ dural tears to avoid adhesive arachnoiditis.

Background: Intraoperative traumatic cerebrospinal fluid (CSF) fistulas/dural tears (DT) occur in up to 8.7–9.5% of primary lumbar surgical procedures. Further, they recur secondarily in between 8.1% and 17% of cases. It is critical to diagnose and treat these recurrent lumbar DT early (i.e. within 3–4 weeks of the index surgery) to avoid the evolution of adhesive arachnoiditis (AA), and its’ permanent neurological sequelae.Methods: Postoperative lumbar CSF fistulas/DT should be diagnosed on postoperative MR scans, and confirmed on Myelo-CT studies if needed. They should be definitively treated/occluded early on (e.g. within 3–4 postoperative weeks) to avoid the evolution of AA which can be readily diagnosed on MR studies, and corroborated, if warranted, on Myelo-CT examinations. The most prominent MR/Myelo-CT findings include; nerve roots aggregated in the central thecal sac, nerve roots peripherally scarred/adherent to the surrrounding meningeal wall (“empty thecal sac sign”), soft tissue masses in the subarachnoid space, and/or multiple loculated/scarred compartments.Results: Percutaneous interventional procedures (i.e. epidural blood patches, injection of fibrin glue (FG)/fibrin sealants (FS)) are rarely effective for treating postoperative recurrent lumbar CSF fistulas. Rather, direct surgical occlusion is frequently warranted including the use of; an operating microscope, adequate surgical exposure, 7-0 Gore-Tex sutures, muscle/dural patch grafts or suture anchors, followed by the application of microfibrillar collagen, and fibrin sealant/glue.Conclusion: Lumbar AA most commonly results from the early failure to diagnose and treat recurrent postoperative CSF fistulas. Since the clinical course of lumbar AA is typically one of progressive neurological deterioration, avoiding its’ initial onset is key.

The role of interventional pulmonology for the postoperative bronchopleural fistula.

: Postoperative bronchopleural fistula (BPF) remains a serious complication due to its high morbidity and mortality. Although various endoscopic techniques have been defined for the closure of BPF previously, no standard algorithm yet exists. To study the effectiveness and safety of various endoscopic procedures in an interventional pulmonology unit. The medical data of 15 postoperative BPF patients, who were undergone endoscopic intervention were retrospectively investigated. The mean size of the fistulas determined by bronchoscopic evaluation was 7.93 ± 3.26 mm (range 3-15 mm). Applied procedures were as follows: stent implantation (n: 8, 53.3%), stent implantation and polidocanol application (n: 4, 26.7%), only Argon Plasma Coagulation (APC) application (n: 2,13.3%), polidocanol application (n: 1,6.7%). Complete fistula closure was achieved in three of the 15 patients (20%). The procedures were partly successful in five (33.3%) patients and failed to be successful in seven (46.6%) patients. Survival rates in regard to procedural success were determined and a statistically significant difference was found in five-year survival rates (P = 0.027, P < 0.05). Our results demonstrated that bronchoscopic procedures can be safely and effectively performed in patients who were not eligible for surgery for various reasons.

Technique of neo-pharynx reconstruction with supra-clavicular artery island flap in a case of pharyngeal stricture

&lt;p class="abstract"&gt;Pharyngeal stenosis frequently occurs after laryngectomy or laryngo-pharyngectomy, more commonly in patients complicated with a post-operative pharyngo-cutaneous fistula. Oral feeding becomes challenging, restricted to liquids. In such cases, dilatations can be futile if there is a complete stricture necessiating surgery. We present a case of 72 -year-old man who underwent total laryngectomy with partial pharyngectomy with pectoral major myocutaneous flap reconstruction for second primary of hypopharyngeal T3N0M0, after primary laryngeal T1N0M0 treated with RT presented with nearly 4 cm pharyngeal stricture causing him absolute dysphagia. Multiple dilations failed to create adequate passage, pharyngeal stricture was then excised, and a neopharynx was constructed with supraclavicular artery island flap. The outcome was uneventful with restoration of normal pharyngeal permeability and swallowing by 12&lt;sup&gt;th&lt;/sup&gt; post-operative day. Post-operative follow-up after 8 months remained satisfactory. Resection of limited height pharyngeal stenosis can be successfully performed as end-to-end anastomosis whereas reconstruction of a long segment pharyngeal stricture utilizing a loco-regional flap gives satisfactory outcome.&lt;/p&gt;

Preliminary study of superselective lymph node dissection in regional lateral cervical lymph node metastasis of papillary thyroid carcinoma

Objective: To explore the applied value of super-selective cervical lymph node dissection in papillary thyroid carcinoma (PTC) patients with clinically suspicious lateral lymph node metastasis (LNM). Methods: We retrospectively analyzed the clinical data of 232 cN1b PTC patients who underwent surgery from September 2013 to May 2018 in the Department of Head and Neck Surgical Oncology, National Cancer Center. Among them, 90 cases received super-selective neck dissection (level Ⅲ and IV) and 142 cases underwent selective neck dissection (level Ⅱ-Ⅳ). The LNM of two groups were analyzed. Results: Postoperative pathological results showed that 173 cases had LNM in the central compartment. The LNM cases of level Ⅱ-Ⅳ were 47, 147 and 130, respectively. Eight patients of super-selective neck dissection and 6 of selective neck dissection had postoperative lymphatic fistulas (P=0.146). No patients in super-selective neck dissection group while 9 patients in the selective lymph node dissection group had postoperatively permanent impairment of shoulder mobility, the difference was statistically significant (P=0.015). In the super-selective neck dissection group, 2 patients had long-term postoperative incision discomfort, and 5 cases had obvious cicatrix after surgery. In the patients with selective neck dissection, 27 cases experienced long-term incision discomfort after surgery, and 26 patients had apparent scar tissue, the differences were statistically significant (P<0.005). There was no recurrence during the follow-up. Conclusions: Super-selective neck dissection is a feasible, safe and effective treatment for cN1b PTC patients. It can improve the quality of postoperative life and avoid the over treatment for patients.

Pancreatic fistula risk assessment after distal pancreatectomy: a retrospective controlled study

Background. Despite declining mortality, postoperative pancreatic fistula (PPF) remains a common complication of distal pancreatic resection surgery challenging to clinical prediction.Objectives. Prognostic analysis of the postoperative pancreatic fistula risk factors in patients with previous distal pancreatectomy.Methods. A retrospective controlled assay enrolled 107 patients, including 63 (58.9%) male and 44 (41.1%) female patients. All patients underwent distal pancreatectomy followed by a morphological examination of resected material. All patients had a general and biochemical blood panel profiling. Pancreatic tissue density at a putative resection zone was assessed with computed tomography. The patients were allocated to two cohorts: (1) not developing PPF (77 patients) and (2) having postoperative PPF complications (30 patients.Results. No statistically significant differences by age, gender, ASA and BMI scores were observed in study cohorts. Multivariate analysis revealed a statistically significant correlation of the PPF rate with the following factors: main pancreatic duct diameter &lt;3 mm (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05, p = 0.01), pancreatic density at putative resection zone &lt;30 HU in CT (OR 3.18, 95% CI 1.38–7.74, p &lt; 0.01) and differential albumin of postoperative day 1 vs. pre-surgery &gt;14 g/L (OR 3.13, 95% CI 1.19–8.24, p &lt; 0.01).Conclusion. A main pancreatic duct diameter &lt;3 mm, pancreatic density at putative resection zone &lt;30 HU in CT and differential albumin of postoperative day 1 vs. pre-surgery &gt;14 g/L are independent risk factors of postoperative fistulae.

Perforator-Based Intercostal Artery Muscle Flap: A Novel Approach for the Treatment of Tracheoesophageal or Bronchoesophageal Fistulas.

Postoperative tracheoesophageal or bronchoesophageal fistulas represent a major surgical challenge. The authors report the description of an original perforator-based intercostal artery muscle flap, aiming to cover all types of intrathoracic fistulas, from any location, in difficult cases such as postoperative fistulas after esophagectomy in an irradiated field. Between June of 2016 and January of 2019, eight male patients were treated with a perforator-based intercostal artery muscle flap. All had previous surgery for esophageal cancer and developed a tracheoesophageal or bronchoesophageal fistula during the perioperative course. The mean patient age was 55.9 ± 8.8 years. All patients received neoadjuvant chemotherapy and seven received neoadjuvant radiation therapy. A perforator-based intercostal artery muscle flap, with a mean skin paddle size of 9.86 × 5 cm, was harvested. The median operative time was 426.50 minutes. The tracheoesophageal or bronchoesophageal fistula was successfully and definitively occluded in three patients; two patients experienced recurrence; and one patient underwent re operation. At 1 year, five patients were alive (62.5 percent), and among them, three (37.5 percent) were free from any intrathoracic complications. Three patients died, because of massive digestive bleeding, mesenteric ischemia, and multiorgan failure, respectively. The perforator-based intercostal artery muscle flap, like the Taylor flap in abdominoperineal reconstruction, could become a workhorse flap for all intrathoracic reconstructions, as it can always be harvested, even if a previous thoracotomy has ruined most of the options. This surgical technique, easily feasible, reliable, and reproducible, became our first option for all postoperative tracheoesophageal or bronchoesophageal fistula patients during the postoperative course following esophagectomy. Therapeutic, IV.

Transanal fistulectomy for postoperative persistent rectourethral fistula in patients with ARM: is simple resection enough?

BackgroundPostoperative rectourethral fistula (RUF) in patients with congenital anorectal malformation (ARM) remains a challenge for paediatric surgeons, among them persistent fistula is the most common. Various techniques have been proposed, only a few reports based on different causes are available, and there is no consensus so far. This study is to evaluate the application, advantages and limitations of transanal fistulectomy approach in repairing persistent RUF in ARM patients.MethodsFrom January 2007 to July 2019, 78 ARM patients who received revisional surgery for RUF were reviewed, 34 persistent fistulas were identified. Examination under anaesthesia included patients with fistulas that were located within 3 cm from the anus verge, good appearance of the anus and sphincter function, and no urethral and rectoanal obstruction. Three patients were excluded because of complex urologic pathologic defects. In total, thirty-one patients underwent transanal fistulectomy to repair RUF.ResultsAll cases were approached with transanal incision and fistulectomy to repair RUF. The average operative time was 91 ± 35 min. At a minimum six-month follow-up, 29 patients healed after the first attempt, the success closure rate was 93.5%. Two patients received redo transanal fistulectomy and healed. Two patients had postoperative complications: one patient had urethral stenosis and it was managed by dilation; one patient had urethral diverticulum but it did not require revisional surgery. No patient in this study was incontinent because of the surgery.ConclusionsTransanal fistulectomy provides a simple, straightforward, and safe approach to repair persistent RUF in ARM patients, especially in those with a low-lying fistula, good anus appearance and sphincter function without obstruction in the rectum or urethra.Trial registration: Retrospectively registered.

Postauricular Cutaneous Mastoid Fistula Closure with Combination of Bilobed Flap and Fibro-Muscular-Periosteal Flap

Chronic suppurative otitis media (CSOM) with cholesteatoma can present with intratemporal complications such as postauricular subperiosteal abscess with or without fistula. In some postauricular cutaneous mastoid fistula cases, direct closure of the wound is not possible due to skin tension, leading to skin necrosis and postoperative recurrent cutaneous fistula. Here, we describe a surgical technique using a combination of a bilobed flap and a fibro-muscular-periosteal flap for fistula closure on a 31-year-old and a 35-year-old female with postauricular cutaneous mastoid fistula due to CSOM. All patients were successfully managed with no fistula recurrence.

Early diagnosis of chyle fistula with SD LipidoCare after neck dissection.

This study aimed to analyse the results of chyle fistula testing using the SD LipidoCare system in patients who had undergone neck dissections performed in our hospital in 2019. Sixty patients who underwent neck dissections from March 2019 to November 2019 were identified based on their medical records. Post-operative chyle fistulas were observed in 3 of 60 patients (5 per cent). All patients who developed chyle fistulas had undergone left-sided neck dissections. Within 3 minutes, the SD LipidoCare test had produced triglyceride results of 49, 56 and 207 mg/dl in the three patients. The remaining 57 patients measured 'low' for triglycerides on the SD LipidoCare test system. The SD LipidoCare test quickly and accurately diagnosed chyle fistulas in patients who had undergone neck dissections. All patients improved with conservative treatment following the early diagnosis of chyle fistulas.

Thoracoscopic Bilobectomy after Bilateral Single Sequential Lung Transplantation in a Cystic Fibrosis Patient with Post-Transplant Airway Stenosis

Introduction Airway complications following lung transplantation are associated with significant morbidity and mortality; they can result to significant functional impairment, poor quality of life and frequent hospitalizations. Anastomotic stenosis remains the commonest post-transplant airway complication with an estimated incidence between 1.6-32%. Non-anastomotic bronchial stenosis is rare and is not reported frequently. Case Report We present the case of a 46-year-old female cystic fibrosis patient requiring right lower bilobectomy following bilateral sequential lung transplant in April 2018, which was complicated by stricture of the right main bronchus requiring serial dilatations. Recurrent chest infections related to chronic Achromobacter xylosoxidans lead to complete right middle and lower lobe consolidation and collapse, with a ventilation/perfusion scan demonstrating almost complete absence of lobar ventilation and perfusion. Subsequent fibrotic narrowing of the bronchus intermedius resulted in bi-lobar failure and right lower bilobectomy in June 2020. Stenting of the bronchus intermedius was not considered feasible because the stenosis was in close proximity to the right upper lobar orifice. Thus, lung resection was undertaken utilizing a 2-port video assisted thoracoscopic technique. Intra-operatively the lung was found to be densely adhered to the chest wall and the diaphragm. Division of adhesions and lung mobilisation was challenging and utilization of various surgical techniques to avoid lacerations and prolonged leakage. Careful dissecting of the atrial cuff anastomosis was done to preserve the upper lobe venous supply. The pulmonary artery branches were dissected through their regular anatomical locations by accessing the oblique fissure. The middle and lower lobe bronchi were divided en bloc within their respective fissures to limit disruption of the vasculature of the bronchial stumps and prevent post-operative fistulae. Summary Treatment of stenotic anastomosis after lung transplantation can be challenging. Our case demonstrates that surgical management may be indicated when more conservative techniques have failed. Limits for surgery in lung failure need constant revisit; our experience shows that management in highly specialized centres improves overall outcomes.

Postoperative bronchopleural fistula successfully treated by intrabronchial omentoplasty: Two case reports

Postoperative bronchopleural fistula successfully treated by intrabronchial omentoplasty: Two case reports

Endoscopic negative pressure therapy (ENPT) in head and neck surgery: first experiences in treatment of postoperative salivary fistulas and cervical esophageal perforations.

Iatrogenic cervical esophageal perforations (CEP) and postoperative salivary fistulas (PSF) are some of the complications requiring treatment in head and neck surgery. Conservative, surgical and endoscopic therapeutic techniques are used. Both CEP and PSF are potentially life-threatening complications and require intensive treatment. Endoscopic negative pressure therapy (ENPT) is an innovative endoscopic surgical procedure for the treatment of transmural intestinal defects throughout the gastrointestinal tract (GIT). In this retrospective study, we demonstrate its application in head and neck surgery. In ENPT, open-pore drains are placed endoscopically in the wound area. The drains can be inserted in an intraluminal position spanning the length of the defect (intraluminal ENPT), or through the defect into the extraluminal wound cavity (intracavitary ENPT). An electronic suction pump applies and maintains a continuous negative pressure of - 125mmHg over a period of several days. The endoscopic drains are changed at regular intervals every few days until stable intracorporeal wound healing by secondary intention or defect closure is achieved. Between 06/2008 and 05/2019 ten patients (f = 3, m = 7; 46-78years old) were treated with ENPT for CEP or PSF. Five patients had postoperative wound defects with consecutive PSF after total laryngectomy or floor of mouth resection. In five patients iatrogenic CEP was found following endoscopic procedures. In all patients treated with ENPT, healing of the perforation defect or fistula was achieved (cure rate 100%). The median treatment duration was 13.7days (range 4-42days). No relevant treatment-associated complications were observed. ENPT is a new, minimally invasive method for treating PSF and CEP.

The role of perioperative ureteral stenting for urologic complications in radical surgery of cervical cancer.

This study aimed to establish the urologic complications of radical type C2 hysterectomy in cervical cancer patients with or without ureteral stenting. This prospective randomized study included 76 (100%) patients with clinically and pathologically established cervical cancer stages I and II treated with radical type C2 hysterectomy with pelvic lymph node dissection for the last 5 years (2014-2019). Patients were randomized into two groups (2:1 ratio): group II received perioperative ureteral stenting (n = 24, 31.6%) and group I did not (n = 52, 68.4%). Urologic complications observed during follow-up include intraoperative ureter and urinary bladder lesions and postoperative ureterovaginal and vesicovaginal fistulas. Of the 52 patients in group I who underwent surgery for cervical cancer, urologic complications were observed in 8 (10.5%) patients, 2 (2.6%) of whom underwent preoperative radiation therapy. In group II, urologic complications were observed in 2 (2.6%) patients, of which 1 (1.3%) received preoperative radiation therapy. Intraoperative urologic complications in group I (6.6%) included 3 (3.9%) ureteral lesions cases and 2 (2.6%) cases of urinary bladder lesions, wherein 1 patient received preoperative radiation therapy. One case of (1.3%) urinary bladder lesion was observed in group II. Postoperative complications were observed in 3 patients (3.9%) in group I, including 2 (2.6%) ureterovaginal fistula cases, wherein 1 (1.3%) patient received preoperative radiation therapy, and 1 (1.3%) case of vesicovaginal fistula. In group II, 1 (1.3%) patient who received perioperative radiotherapy developed postoperative vesicovaginal fistula. Urologic complications are extremely common during and after radical surgery (hysterectomy type C2) for cervical cancer. The cervical cancer stage had a significant effect on intra- and postoperative urologic complication rates in this study; however, no such effect was observed for preoperative radiation therapy and ureteral stenting, and significant differences were observed between the two study groups.

A Novel Anastomosis Technique for Laparoscopic Pancreaticoduodenectomy: Case Series of Our Center's Experience.

Background: Laparoscopic pancreaticoduodenectomy has developed rapidly in recent years. Postoperative pancreatic fistula is still the most dangerous complication of laparoscopic pancreaticoduodenectomy. Baumgart pancreaticojejunostomy is considered one of the safest anastomosis procedures, with low rates of pancreatic fistula. We modified Blumgart pancreaticojejunostomy and applied the modified procedure during laparoscopic pancreaticoduodenectomy. The modified procedure entailed a longitudinal U-shaped suture through the pancreas for anastomosis of the pancreatic duct and the jejunal mucosa.Methods: We prospectively collected and retrospectively analyzed the data of 120 patients who underwent laparoscopic pancreaticoduodenectomy from January 2016. The total operative time, time for complete pancreaticojejunostomy, postoperative pancreatic fistula rate, postoperative delayed gastric emptying, postoperative bleeding, postoperative length of hospital stays, and mortality within 90 days after surgery were analyzed. An analysis of laparoscopic pancreaticojejunostomy compared with open pancreaticojejunostomy is also reported.Results: In the laparoscopic pancreaticojejunostomy group, the average total operative time, the average time for complete pancreaticojejunostomy, and the average intraoperative blood loss were 271 min, 35.3 min, and 184 ml, respectively. The total postoperative clinically relevant pancreatic fistula rate was 9.2% (Grade B and C fistulas). The incidence rates of postoperative delayed gastric emptying and postoperative biliary fistula were ~2.5 and 1.7%, respectively. The postoperative bleeding rate was 0.83%, and the average postoperative indwelling time of the abdominal drainage tube was 7.3 days. The postoperative length of hospital stay was 10.8 days, and the mortality rate within 90 days after surgery was 0.83%. The rates of clinically relevant postoperative clinically relevant pancreatic fistula are comparable between laparoscopic and open surgery, there were no other severe postoperative complications in either group. The mean postoperative length of hospital stay was significantly shorter in the laparoscopic pancreaticojejunostomy group.Conclusion: The modified laparoscopic-adapted Blumgart anastomosis simplifies and facilitates the creation of the pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy. The rates of clinically relevant postoperative pancreatic fistula are comparable with those obtained by open surgery, and length of stay are shoter.