Postoperative Patency Research Articles

Artery Transposition Using Indocyanine Green for Tarsal Tunnel Decompression

Surgery for idiopathic tarsal tunnel syndrome (TTS) is of limited effectiveness or ineffective. Using indocyanine green video angiography (ICG-VA), we treated idiopathic TTS by posterior tibial artery (PTA) decompression from the posterior tibial nerve (PTN) and evaluated postoperative patency of the PTA. We treated 12 patients (12 feet) with idiopathic TTS by PTA decompression from the PTN and transposed its location. Age range of patients was 70-87 years (mean 77.9 years); all patients were operated on under local anesthesia. After a 2-cm skin incision, the flexor retinaculum was resected, and the PTA was decompressed from the PTN. It was then sutured to the flexor retinaculum for decompression and to prevent compression recurrence. ICG-VA was used to confirm the absence of PTA flow disturbance and to inspect the vasa nervorum of the PTN. We encountered no intraoperative or postoperative complications. Postoperatively, ICG-VA confirmed blood flow in the PTA and intactness of the vasa nervorum in all cases. One patient required adjustment of PTA position. All patients reported symptom improvement. Our surgical method of treating idiopathic TTS under ICG-VA monitoring is simple, safe, and effective.

Impact of surgical volume and resident involvement on patency rates after vasectomy reversal—A 14-year experience in an open access system

ObjectiveEvaluate the influence of fellowship training, resident participation, reconstruction type, and patient factors on outcomes after vasectomy reversals in a high volume, open access system. MethodsRetrospective review of all vasectomy reversals performed at a single institution from January 1, 2002 to December 31, 2016 was conducted. Patient and spouse demographics, patient tobacco use and comorbidities, surgeon training and case volume, resident participation, reconstruction type, and postoperative patency were collected and analyzed. ResultsFive hundred and twenty-six vasectomy reversals were performed during the study period. Follow-up was available in 80.6% of the cohort and overall patency, regardless of reconstruction type was 88.7%. The mean time to reversal was 7.87 years (range of 0–34 years). The majority of cases included resident participation. Case volume was high with faculty and residents logging a mean of 37.0 and 38.7 (median 18 and 37) cases respectively. Bilateral vasovasostomy was the most common reconstruction type (83%) and demonstrated a significantly better patency rate (89%) than all other reconstructions (p=0.0008). Overall patency and patency by reconstruction type were not statistically different among faculty surgeons and were not impacted by fertility fellowship training, resident participation or post-graduate year. Multivariate analysis demonstrated that increased time to reversal and repeat reconstructions had a negative impact on patency (p=0.0023 and p=0.043, respectively). ConclusionsSurgeons with a high volume of vasectomy reversals have outcomes consistent with contemporary series regardless of fellowship training in fertility. Patency was better for bilateral vasovasostomies. Patency was not negatively impacted by tobacco use, comorbidities, resident participation, or post-graduate year.

Assessment of Lymphovenous Anastomosis Patency: Technical Highlights.

Assessment of Lymphovenous Anastomosis Patency: Technical Highlights.

Transjugular intrahepatic portosystemic shunt combined with agitation thrombolysis in treatment of acute portal vein thrombosis

Objective To study the clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with agitation thrombolysis in treatment of acute portal vein thrombosis (PVT) in patients with liver cirrhosis. Methods The clinical data of 37 cirrhotic patients with acute PVT treated from January 2014 to December 2017 at the First Affiliated Hospital of Henan University of Science and Technology was analyzed. There were 20 males and 17 females with age ranging from 29 to 71 years. The patients were divided into the combined group (n=15) and the anticoagulation group (n=22). The combined group was treated with TIPS combined with agitation thrombolysis anticoagulation. The anticoagulation group was treated with anticoagulation. The changes in liver function and hemodynamics of portal vein of the two group were compared. Follow-up studies included postoperative portal vein patency, bleeding and survival rates of patients. Results The postoperative portal vein pressure and maximum burden of PVT in the combined group were significantly lower than those before operation, and the portal vein maximum blood volume and flow velocity of portal vein were significantly higher than those before operation (all P<0.05). At 2 weeks, 6 months and 12 months after operation, the maximum burden of PVT of the combined group was (13.9±5.4)%, (16.1±5.5)% and (13.8±6.2)%, respectively, which was significantly lower than that of the anticoagulant group (84.1±31.3)%, (85.9±27.6)% and (88.2±39.5)% (all P<0.05). At 2 weeks, 6 months and 12 months after operation, the flow velocity of portal vein of the combined group was (21.6±5.7) cm/s, (16.1±6.3) cm/s and (17.6±4.9) cm/s, respectively, which was significantly higher than that of the anticoagulation group (9.7±4.6) cm/s, (8.1±4.3) cm/s and (8.2±3.5) cm/s (all P<0.05). After operation, 3 patients in the combined group developed recurrence of portal vein thrombosis, while the remaining patients had smooth blood flow in the portal vein and shunt. In the anticoagulation group, only 3 patients had unobstructed portal vein blood flow. The cumulative rate of no gastrointestinal bleeding in the combined group was significantly better than the anticoagulant group. The cumulative survival rate of the combined group was also significantly better than the anticoagulation group (P<0.05). Conclusion TIPS combined with agitation thrombolysis was more effective than the traditional anticoagulant therapy in treatment of acute portal vein thrombosis in cirrhotic patients. Key words: Portal vein; Portosystemic shunt, transjugular intrahepatic; Thrombosis; Agitation thrombolysis

Postoperative patency assessment of Cystocisternostomy and Cystoventriculostomy stomas in cases with Arachnoidal cyst.

The goal of this study was to determine stoma and flow patency with 3D SPACE T2 and 3D CISS sequences in cases with cystocisternostomy or cystoventriculostomy. A total of sixty three patients (total 106 MRI examinations) with endoscopic cystocisternostomy or cystoventriculostomy of arachnoid cyst underwent 1.5-3T MRI to determine flow patency between June 2007 and April 2018. Postoperative results, the patients' clinic and arachnoid cyst volume were used to confirm stoma and flow patency in MRI. The stoma was open and functional in forty three patients. Minimal flow was detected in five patients. Fifteen patients with closed stoma (total 17 MR images) were evaluated with the clinician. Patients' clinic, physical examination, and growth (for pediatric patients) were evaluated. Three of fifteen patients were re-operated. Operative findings and postoperative follow-up MR imaging findings were correlated with our preoperative MRI results. The findings were in compliance in both groups (operated-non-operated groups). 3D SPACE T2 and 3D CISS are effective sequences in addition to other routine conventional sequences to evaluate stoma and flow patency.

The influence of hemodynamics on graft patency prediction model based on support vector machine

In the existing patency prediction model of coronary artery bypass grafting (CABG), the characteristics are based on graft flow, but no researchers selected hemodynamic factors as the characteristics. The purpose of this paper is to study whether the introduction of hemodynamic factors will affect the performance of the prediction model.Transit time flow-meter (TTFM) waveforms and 1-year postoperative patency results were obtained from 50 internal mammary arterial grafts (LIMA) and 82 saphenous venous grafts (SVG) in 60 patients. Taking TTFM waveforms as the boundary conditions, the CABG ideal models were constructed to obtain hemodynamic factors in grafts. Based on clinical characteristics and combination of clinical and hemodynamic characteristics, patency prediction models based on support vector machine (SVM) were constructed respectively.For LIMA, after the introduction of hemodynamic factors, the accuracy, sensitivity and specificity of the prediction model increased from 70.35%, 50% and 74.17% to 78.02%, 70% and 78.89%, respectively. For SVG, the accuracy, sensitivity and specificity of the prediction model increased from 63.24%, 40% and 76.91% to 74.41%, 60.1% and 82.73%, respectively.The performance of the prediction model can be improved by introducing hemodynamic factors into the characteristics of the model. The accuracy, sensitivity and specificity of the prediction results are higher with the addition of hemodynamic characteristics.

Pull-through technique combined with percutaneous angioplasty for treating high-grade arteriovenous fistula stenosis.

The aim of this study was to investigate the effectiveness of a new pull-through technique through a brachial artery approach combined with angioplasty for the treatment of arteriovenous fistula. In this retrospective study, a total of 56 arteriovenous fistula patients with high-grade stenosis induced by arteriovenous fistula, which was divided into pull-through technique through a brachial artery approach (pull-through group, n = 28) and solely through a venous approach (control group, n = 28), were analyzed. Both groups underwent percutaneous transluminal angioplasty treatments simultaneously. The success rate of the pull-through group (89.3%, 25 out of 28) was similar to that of the control group (75.0%, 21 out of 28, p = 0.296). Fistula restenosis occurred with time in both groups but no significant differences in the post-operative fistula patency were found between the pull-through and control groups in follow-ups at 3, 6, and 12 months (71.4% vs 67.9%, 57.1% vs 60.7%, and 20.0% vs 30.0%, respectively, p > 0.05). No significant difference in the post-operative patency rate in patients with diabetes, hypertension, or coronary disease was found between the pull-through and control groups in the follow-ups at 3 and 12 months, respectively. The pull-through group had significantly shorter operation times compared with the control group (45 ± 9 min vs 65 ± 15 min, p < 0.001). No surgical complications were reported in the pull-through group in contrast to three cases (11%, 3 out of 28) with puncture hematoma and acute occlusion in the control group. The pull-through technique combined with percutaneous transluminal angioplasty is an effective, safe and lasting option to treat high-grade arteriovenous fistula stenosis in the upper limb.

Catheter Directed Lysis and Thrombectomy Are Equally Effective for Extensive Deep Vein Thrombosis

BackgroundThere is currently little consensus on the role of thrombectomy compared with catheter-directed lysis (CDL) for acute, extensive, proximal deep vein thrombosis (DVT). We sought to determine whether any differences in outcomes exist between thrombectomy and CDL in terms of postoperative venous patency, pulmonary emboli (PE), and bleeding/hematoma. MethodsIn an institutional review board-approved retrospective cohort study, patients from a single academic medical center with confirmed lower extremity DVT were divided into thrombectomy and CDL cohorts. Demographic information, comorbidities and laboratory data, postoperative patency, postoperative bleeding, postoperative PE, popliteal hematoma, and recurrence of DVT were collected. Type I error level was set at 0.05. ResultsEighty-seven patients were identified, 51.7% received CDL, and 48.3% underwent thrombectomy. Patient comorbidities and hypercoagulable states were not significantly different among the groups. The two techniques did not have significantly different postoperative patency (P = 0.472), bleeding (P = 0.598), PE (P = 0.868), popliteal hematoma (P = 0.331), or recurrence of DVT (P = 0.835). ConclusionsIn selecting optimum treatment for acute, extensive, proximal DVT, our retrospective cohort study found no significant differences among treatment groups in safety, efficacy, recurrence, and progression to PE. We conclude that modality of treatment should be decided based on hospital resources, surgeon experience, and comfort with each technique, patient's physiologic status, and associated costs.

Treatment of aortic dissecting aneurysm involving visceral arteries with multi-layer bare stents.

Aortic dissecting aneurysms involving visceral arteries are difficult for clinical treatment. This study aimed to explore the clinical efficacy and safety of multi-layer bare stents technique in the treatment of aortic dissecting aneurysms involving visceral arteries. The clinical data of 16 patients of aortic dissecting aneurysm involving visceral artery treated with multi-layer bare stents technique from March 2013 to March 2017 in Tianjin Medical University General Hospital were retrospectively analyzed. To explore the clinical efficacy, the number of stents applied, postoperative aortic dissecting thrombosis and postoperative cumulative branch arterial patency of the16 patients. The operations of the 16 patients were successfully completed without peri-operative death cases. The 16 patients were implanted with 39 bare stents with an average of 2.44 per person. There were 2 cases with 1 stent, 8 cases with 2 stents and 7 cases with 3 stents. One month after the operation, CTA showed complete thrombosis in the arterial dissection in 4 cases (25.0%), partial thrombosis in 12 cases (75.0%); CTA showed that celiac artery, left and right renal arteries, and superior mesenteric artery were all unobstructed. There were 4 cases (25.0%) of dissecting artery with reduced diameter, 12 patients (75.0%) without changes in the diameter, and no diameter expanding cases. The treatment for aortic dissecting aneurysm involving the visceral arteries using multi-layer bare stents technique is safe and reliable with a higher patency rate of postoperative accumulated branch arteries.

Seminal plasma neutral alpha-glucosidase activity as an early predictor of patency and natural pregnancy after microsurgical vasoepididymostomy.

Microsurgical vasoepididymostomy (MVE) is recommended as a first-line option for treatment of epididymal obstructive azoospermia (EOA). However, early indicators for predicting patency and natural pregnancy are unclear. Our aim was to explore the early predictive value of seminal plasma neutral alpha-glucosidase (NAG) activity for patency and natural pregnancy after MVE. Eighty-four patients with EOA who underwent MVE were enrolled in this study. The post-operative patency and natural pregnancy rates were 60.71% and 33.33% respectively. The presence of motile epididymal spermatozoa at the anastomosis site and NAG activity measured at the first month after MVE were early and independent predictors of patency and natural pregnancy. The areas under the receiver operating characteristic curves (AUCs) of NAG activity for prediction of patency and natural pregnancy were 0.78 (95% confidence interval [CI]: 0.68-0.88) and 0.82 (95% CI: 0.73-0.92). The best cut-off values of NAG activity for predicting patency and pregnancy were 15.9 and 17.0m IU/ejaculate respectively. In conclusion， NAG activity measured at the first month after MVE is an early and independent predictor of patency and natural pregnancy.

Minimally-Invasive Ureteral Reconstruction for Ureteral Complications of Kidney Transplants

ObjectiveTo present the technique, feasibility and results of minimally-invasive reconstruction of the transplanted ureter using the native ipsilateral ureter in post-transplant ureteral strictures and vesicoureteral reflux (VUR) causing graft pyelonephritis. Ureteral complications after kidney transplantation represent a significant cause of morbidity potentially leading to graft dysfunction or loss. MethodsA prospective database from October 2011 to August 2018 identified renal transplant recipients who underwent minimally-invasive pyeloureterostomies or ureteroureterostomies using the ipsilateral ureter. Indications for either transplant ureteral stricture or VUR correction were assessed. Preoperative evaluation included a technetium-99m mercaptoacetyltriglycine renal scan to assess residual native renal function and either a video cysto-urethrogram or cystoscopy and retrograde pyelography. Postoperative patency was evaluated with either cystograms or antegrade nephrograms in conjunction with a technetium-99m mercaptoacetyltriglycine study. ResultsSeven patients were followed with a mean follow-up time of 20.9 months (range 4.7-64.8 months). Three cases of VUR causing graft pyelonephritis and 4 cases of transplant ureteral stricture were identified. Five minimally-invasive transplant-to-native pyeloureterostomies and 2 transplant-to-native ureteroureterostomies were performed. Six cases were performed robotically and 1 laparoscopically. No recurrent episodes of pyelonephritis were observed for patients treated for VUR causing graft pyelonephritis. Postoperative renal scans and contrast studies demonstrated no evidence of obstruction or urinary leaks in all cases. ConclusionMinimally-invasive reconstruction of the transplant ureter by pyeloureterostomy or ureteroureterostomy using the ipsilateral native ureter is feasible and can be safely performed with graft survival and acceptable complication rates.

Angiographic and clinical outcomes of non-patent anastomosis after bypass surgery in adult moyamoya disease

The clinical and radiologic outcomes of symptomatic adult moyamoya disease (MMD) patients who have an occluded anastomosis immediately after bypass surgery are poorly studied. The clinical and angiographic outcomes of non-patent anastomosis in symptomatic adult MMD patients were retrospectively reviewed. From August 2011 to November 2016, 31 revascularization surgeries, consisting of direct and indirect bypass, were performed on 29 adult MMD patients. Primary outcomes were evaluated based on the frequency of transient ischaemic attack (TIA) incidence and the recurrence of cerebral infarction and were assessed as improvement or worsening. Among 31 cases, computed tomography angiography (CTA) on the first day after surgery showed patent anastomosis in 20 hemispheres and non-patent anastomosis in 11 hemispheres. Follow-up conventional angiographies showed spontaneous recanalization of non-patent anastomosis in all occlusion cases. The incidence of TIA decreased in both the non-patent and the patent groups. Two newly developed cerebral infarctions were observed, which occurred in the patent group. Patients in the non-patent group also showed clinical improvement after surgery (p = 0.04), and no significant relationship was found between immediate postoperative patency and the primary outcome (p = 0.53). In our series, regardless of patency immediately after bypass surgery, delayed recanalization and clinical improvement can be expected after bypass surgery for adult MMD.

Mitomycin in Choanal Atresia Repair

Background: choanal atresia is one of congenital anomalies that needs surgical repair. Nasal re-stenosis and obstruction are side effects of endoscopic repair. Mitomycin was proposed to decrease postoperative stenosis and/or obstruction. Aim of the Work: it was to address the efficacy of adjuvant mitomycin therapy application in providing the postoperative patency in choanal atresia. Patients and Methods: this study is a record analysis of surgical outcomes of transnasal endoscopic surgical choanal atresia repair in Al-Azhar University Hospitals (Cairo and Damietta). The study included records of 30 children with either uni- or bi-lateral choanal atresia. Eighteen (18) children of themwereoperated upon with adjuvant mitomycin therapy. Meanwhile, records of 12 children were operated uponwithout adjuvant mitomycin andconsidered as a comparison group. Postoperative stenting was carried out in all participants. The collected information included demographic information, associated co-morbidities, operative details, and endoscopic findings. The outcome measures were: granulation tissue formation, need for postoperative dilation and need for revision surgical intervention. Results: re-stenosis was reported in 11 (28.9%) patients. The need for revision surgery was reported in 10.3%. The postoperative dilatation was required in 10 (25.6%) patients, and there was no significant difference between mitomycin and comparison groups. Conclusion and Recommendation: the use of adjunctive mitomycin therapy with endoscopic repair of choanal atresia seems to be effective and safe approach. Multicenter follow up trials should be done to fully evaluate the value (benefits) of adjuvant mitomycin therapy in choanal atresia repair.

Mitomycin in Choanal Atresia Repair

Background: choanal atresia is one of congenital anomalies that needs surgical repair. Nasal re-stenosis and obstruction are side effects of endoscopic repair. Mitomycin was proposed to decrease postoperative stenosis and/or obstruction. Aim of the Work: it was to address the efficacy of adjuvant mitomycin therapy application in providing the postoperative patency in choanal atresia. Patients and Methods: this study is a record analysis of surgical outcomes of transnasal endoscopic surgical choanal atresia repair in Al-Azhar University Hospitals (Cairo and Damietta). The study included records of 30 children with either uni- or bi-lateral choanal atresia. Eighteen (18) children of themwereoperated upon with adjuvant mitomycin therapy. Meanwhile, records of 12 children were operated uponwithout adjuvant mitomycin andconsidered as a comparison group. Postoperative stenting was carried out in all participants. The collected information included demographic information, associated co-morbidities, operative details, and endoscopic findings. The outcome measures were: granulation tissue formation, need for postoperative dilation and need for revision surgical intervention. Results: re-stenosis was reported in 11 (28.9%) patients. The need for revision surgery was reported in 10.3%. The postoperative dilatation was required in 10 (25.6%) patients, and there was no significant difference between mitomycin and comparison groups. Conclusion and Recommendation: the use of adjunctive mitomycin therapy with endoscopic repair of choanal atresia seems to be effective and safe approach. Multicenter follow up trials should be done to fully evaluate the value (benefits) of adjuvant mitomycin therapy in choanal atresia repair.

Assessment of Single-Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass in Treatment for Adult Patients with Ischemic-Type Moyamoya Disease.

BackgroundMoyamoya disease (MMD) is an idiopathic disease caused by progressive steno-occlusion of the distal internal carotid artery. Ideal surgical treatment for adult patients with ischemic-type MMD has not been achieved. The aim of this study was to evaluate the efficacy of single-barrel superficial temporal artery-middle cerebral artery (STA-MCA) bypass in treatment for adult patients with ischemic-type MMD by analyzing clinical and radiological data retrospectively.Material/MethodsThe present study included 37 patients with non-hemorrhagic MMD, including 21 women and 16 men (21~55 years old, mean age 38.1 years). The bypass surgery was performed on 56 sides in the 37 patients. The clinical charts, angiographic revascularization, and hemodynamic changes were reviewed at 6–60 months after surgery.ResultsAmong the 37 patients, the clinical symptoms and signs of 32 patients were improved or stabilized. Five patients had complications, including 2 cases of acute cerebral infarction, 1 case of epidural hematoma, and 1 case of transient speech disturbance, and 1 patient died. Follow-up computed tomography perfusion (CTP) revealed that cerebral blood flow (CBF) was markedly improved after surgery (P<0.05). Time to peek (TTP) and mean transit time (MTT) were significantly decreased after surgery (P<0.05). No significant change in cerebral blood volume (CBV) was found after surgery (P>0.05). Postoperative patency was clearly verified in 52 bypasses (92.8%) of 56 bypasses on follow-up DSA imaging.ConclusionsSingle-barrel STA-MCA bypass can be considered as an effective surgical treatment, which exhibits satisfactory clinical efficacy in ischemic-type MMD patients.

The Falciform Ligament for Mesenteric and Portal Vein Reconstruction in Local Advanced Pancreatic Tumor: A Surgical Guide and Single-Center Experience.

Background Since local tumor infiltration to the mesenteric-portal axis might represent a challenging assignment for curative intended resectability during pancreatic surgery, appropriate techniques for venous reconstruction are essential. In this study, we acknowledge the falciform ligament as a feasible and convenient substitute for mesenteric and portal vein reconstruction with high reliability and patency for local advanced pancreatic tumor. Methods A retrospective single-center analysis. Between June 2017 and January 2018, a total of eleven consecutive patients underwent pancreatic resections with venous reconstruction using falciform ligament. Among them, venous resection was performed in nine cases by wedge and in two cases by full segment. Patency rates and perioperative details were reviewed. Results Mean clamping time of the mesenteric-portal blood flow was 34 min, while perioperative mortality rate was 0%. By means of Duplex ultrasonography, nine patients were shown to be patent on the day of discharge, while two cases revealed an entire occlusion of the mesenteric-portal axis. Orthograde flow demonstrated a mean value of 34 cm/s. All patent grafts on discharge revealed persistent patency within various follow-up assessments. Conclusion The falciform ligament appears to be a feasible and reliable autologous tissue for venous blood flow reconstruction with high postoperative patency. Especially the possibility of customizing graft dimensions to the individual needs based on local findings allows an optimal size matching of the conduit. The risk of stenosis and/or segmental occlusion may thus be further reduced.

Clinical value of uncinate process resection combined with portal-superior mesenteric vein resection and end-to-end anastomosis in distal pancreatectomy

Objective To explore the clinical value of uncinate process resection combined with portal-superior mesenteric vein resection and end-to-end anastomosis in distal pancreatectomy. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 11 patients who underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis in the Peking University Cancer Hospital (8 patients) and Jilin Guowen Hospital (3 patients) between January 2014 to April 2018 were collected. During the vascular reconstruction, uncinate process of the pancreas was first resected for reducing anastomotic tension, and then end-to-end anastomosis was done after portal-superior mesenteric vein resection. Observation indicators: (1) intraoperative situations; (2) postoperative recovery situations; (3) postoperative pathological examination situations; (4) follow-up and survival situations. Follow-up using outpatient examination and imaging examination was performed to detect patients′ postoperative survival, tumor recurrence and metastasis and postoperative venous anastomotic patency up to May 2018. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). The non-recurrence and non-metastasis survival curve, overall survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method. Results (1) Intraoperative situations: 11 patients received uncinate process resection of the pancreas, and successfully underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis. Eight patients underwent distal pancreatectomy + Appleby combined with celiac axis resection due to pancreatic tumor involving common hepatic artery, including 2 undergoing combined total gastrectomy due to gastric ischemia; 2 patients underwent distal pancreatectomy; 1 patient underwent distal pancreatectomy + distal gastrectomy due to blood supply obstacle of distal stomach. Operation time and volume of intraoperative blood loss of 11 patients were (5.8±1.1)hours and 800 mL (range, 200-2 500 mL). (2) Postoperative recovery situations: there was no grade C of pancreatic fistula of 11 patients. Four patients had grade B of pancreatic fistula, including 2 were cured by drainage-tube indwelling of pancreatic wound > 3 weeks, 1 was cured by continous washing due to pancreatic fistula combined with infection, and 1 was cured by the second abdominal puncture drainage due to pancreatic fistula with fever; 1 of 4 patients was combined with grade C of delayed gastric emptying and cured by conservative treatment, and other 3 patients didn′t occur postoperative complications. Of 5 patients diagnosed as biochemical fistula, 1 had esophagus-jejunum anastomotic leakage, and 1 had changes of hepatic ischemia in S2, S3 and S4b segments by CT examination and recovered normal liver function at 2 weeks postoperatively, with long-term hepatatrophia in S2 and S3 segments. There was no postoperative death and reoperation in 11 patients. Duration of postoperative hospital stay of 11 patients was (22±5)days. (3) Postoperative pathological examination results: tumors of 11 patients were located in neck and body of the pancreas, with a maximum diameter of (4.8±1.7)cm. Among 11 patients, 10 were confirmed with moderate- or low-differentiated ductal adenocarcinoma and 1 with anaplastic carcinoma. The length of portal-superior mesenteric vein resection of 11 patients was (2.6±0.8)cm. Seven of 11 patients occurred different degrees of tumor infiltration in the portal-superior mesenteric vein, and other 4 patients occurred inflammatory adhesion, without tumor infiltration. (4) Follow-up and survival situations: 11 patients were followed up for 3.0-37.6 months, with a median time of 15.7 months. During the follow-up, 8 patients died of tumor recurrence and / or metastasis, and 3 survived; the non-recurrence and non-metastais survival time and overall survival time were respectively 9.0 months (range, 3.0-37.6 months) and 24.6 months (range, 3.0-37.6 months). One patient was complicated with anastomotic stenosis and surrounding varices of portal-superior mesenteric vein by postoperative half-year reexamination, anastomotic vein anomalies and venous thrombosis were not found in other patients before local tumor recurrence and / or death. Conclusion The combined uncinate process resection of the pancreas cannot increase the risk of postoperative pancreatic fistula, and it could effectively reduce the anastomotic tension in the distal pancreatectomy combined with portal-superior mesenteric vein resection and reconstruction, meanwhile, it can also achieve end-to-end anastomosis after longer vein resection. Key words: Pancreatic neoplasms; Distal pancreatectomy; Vascular resection; End-to-end anastomosis; Uncinate process resection of the pancreas

Multifactor analysis of postoperative patency of microsurgical vasoepididymostomy

Objective To analyze the factors which may affect postoperative patency of microsurgical vasoepididymostomy (VE). Methods Ninety-four patients underwent VEs from September 2014 to June 2016 in the Department of Urology, Peking University Third Hospital, with average age of (30.7±4.8)years, and body mass index(BMI) of (25.1±3.0) kg/m2. Semen analyses were performed 1 month, 3 months and 5 to 6 months after the operation. The following semen analyses were performed every 3-6 months thereafter. Patency was defined by finding sperms in twice or more analyses during the follow-up until August 2017. Patients were followed up by face-to-face or telephone interview. Seven factors (age, BMI, bilateral or unilateral anastomosis, anastomosis sites, the adjustment of anastomosis sites, motility and quantity of sperms found in epididymal fluid) were analyzed by Chi-square analysis and multifactor logistic regression analysis. Results Eighty-two patients were followed up (87.2%, 82/94) while 12 patients were lost of follow-up. The mean follow-up time was 19 months. Sperms were found in the ejaculate in 59 patients postoperatively. The overall patency rate was 72.0% (59/82), and natural paternity rate was 32.8% (19/58). Patients ≤28 years old and those >28 years old had patency rates of 89.3% (25/28) and 63.0% (34/54, P=0.012), respectively. Patients with BMI<26.0 kg/m2 and BMI≥26.0 kg/m2 had patency rates of 80.4% (41/51) and 58.1% (18/31, P=0.029), respectively. Patency rate of bilateral surgery was 72.1% (44/61) and of unilateral surgery was 71.4% (44/62, P=0.727). Patency rate of caput anastomosis achieved 75.0% (15/20) and of corpus/caudal anastomosis was 71.0% (44/62, P=0.727). Patency rates of patients with and without adjustment of anastomosis sites were 77.8% (7/9) and 71.2% (52/73, P=0.680), respectively. Patency rates of a lot, a few, motile and seldom-motile sperms in epididymal fluid were 74.3% (55/74) vs. 50.0% (4/8, P=0.146) and 70.0% (28/40) vs. 73.8% (31/42, P=0.701), respectively. Multifactor logistic regression analysis showed that age was well associated with patency rate (OR=4.705, 95%CI 1.181-18.742, P=0.028). Conclusions Age ≤28 years is an independent factor leading to higher patency rates. Patients with lower BMIs and younger could have higher patency rates. Factors of anastomosis sides, anastomosis sites, the adjustment of anastomosis sites, motility and quantity of sperms found in epididymal fluid showed no statistical difference in patency rates. Key words: Infertility, male; Obstructive azoospermia; Microsurgery; Vasoepididymostomy

Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade.

BackgroundIn the era of improving assisted reproductive technology (ART), patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction with intracytoplasmic sperm injection. Vasal repair, including vasovasostomy (VV) and vasoepididymostomy (VE), is the only option that leads to natural conception.MethodsThis article reviews the surgical techniques, outcomes, and predictors of postoperative patency and pregnancy, with a focus on articles that have reported over the last 10 years, using PubMed database searches.Main findingsThe reported mean patency rate was 87% and the mean pregnancy rate was 49% for a patient following microscopic VV and/or VE for vasectomy reversal. Recently, robot‐assisted techniques were introduced and have achieved a high rate of success. The predictors and predictive models of postoperative patency and pregnancy also have been reported. The obstructive interval, presence of a granuloma, and intraoperative sperm findings predict postoperative patency. These factors also predict postoperative fertility. In addition, the female partner's age and the same female partner correlate with pregnancy after surgery.ConclusionIn the era of ART, the physician should present and discuss with both the patient with OA and his partner the most appropriate procedure to conceive by using these predictors.

Vein resection during pancreaticoduodenectomy for pancreatic adenocarcinoma: Patency rates and outcomes associated with thrombosis

Venous patency rates after pancreaticoduodenectomy (PD) with portal vein (PV) resection are not well established, and the oncologic impact of portal vein thrombosis (PVT) is unknown. The primary aim of this study was to determine rates and predictors of PVT after PD with PV resection for pancreatic adenocarcinoma (PDAC). A retrospective cohort study was performed on PDAC patients treated with preoperative therapy and PD with PV resection at a high-volume institution (2008-15). Primary outcomes were early and late PVT (≤ or >90 days of surgery). Secondary outcomes included major complications and OS. Patients undergoing vein resection (N = 120) included 41.7% (N = 50) primary repair or patch venoplasty, 29.2% (N = 35) primary anastomosis, and 29.2% (N = 35) interposition graft. Thirty-four (28.3%) patients developed PVT (early 7.5% [N = 9]; late 20.8% [N = 25]). Late PVT was often detected concurrently with local recurrence (76.0%; N = 19). There was no association of PVT with vascular resection extent or complications (P > 0.05). On multivariable analysis, PVT was associated with worse OS (HR 2.2 [95% CI 1.34-3.5], P < 0.001). Overall postoperative patency rates following PV resection PDAC were high. PVT is associated with worse OS, which appears less likely related to technical issues, but rather representative of disease biology.