Preoperative Percutaneous Drainage Research Articles

Localized gallbladder perforation: a systematic review of treatment and prognosis.

The optimal management of localized gallbladder perforation (Neimeier type II) has yet to be defined. The aim of this systematic review was to identify factors associated with improved patient outcomes. Systematic review of studies that described the management of Neimeier type II perforation, reported complications of the first intervention, necessity of added interventions, resolution of the pathology, and days of hospital stay were included. The search strategy was conducted in EMBASE, Mayo Journals, MEDLINE, SCOPUS, and Web of Science (December 2020) RESULTS: A total of 122 patients (53% male) from case reports, series, and cohorts were included for analysis. In total 56 (46%) and 44 (36%)patients were treated with open and laparoscopic cholecystectomy respectively. Overall risk of bias was moderate. The need for another intervention was higher in the laparoscopic group (5 vs 17, p=<0.001) as well as prevalence of complications (4 vs 16, p=<0.001), but lower for days of hospital stay (median days 5. vs 15, p=0.008) against open cholecystectomy. Preoperative percutaneous catheter drainage did not influence outcome. Open cholecystectomy has a lower need for further surgical procedures and postoperative complications, but a longer hospital stay. These outcomes did not vary with preoperative percutaneous drainage. The effect of timing of cholecystectomy did not influence the outcomes.

術前の経皮的ドレナージが有効であった胃・十二指腸・横行結腸壊死を合併した重症急性膵炎の1例

術前の経皮的ドレナージが有効であった胃・十二指腸・横行結腸壊死を合併した重症急性膵炎の1例

Preoperative percutaneous drainage of the cystic cavity facilitates resectability in hepatic alveolar echinococcosis

Background: HAE is a parasitic disease. The dense pericystic inflammation caused by this disease makes resection difficult even impossible. The cystic cavity is full with necrotic material and sometimes infected bile or even an abscess. We hypothesised that drainage of the cystic contents can reduce inflammation and facilitate surgery Methods: We retrospectively evaluated our records of HAE cases. Records of patients who had unresectable liver masses at the first diagnosis and further underwent preoperative percutaneous drainage with a subsequent liver resection, were evaluated. All demographic, radiological and clinical data were collected. Results: Between January 2000 and December 2016 237 HAE cases were followed in our clinic. From these 151 had unresectable liver mass at the first diagnosis. Among these patients with unresectable disease 25 had solitary lesions with a cystic cavity. These 25 patients underwent a preoperative percutaneous drainage and re-evaluated for resection and 15 patients underwent a curative resection. The resectability rate was 36.2% at the first evaluation and 42,6% after the drainage. The remaining 10 patients referred for medical treatment. One denied further treatment, three were transplanted and six are still at medical treatment. Conclusion: Preoperative percutaneous drainage of the solitary cystic cavity reduces pericystic inflammation and facilitates resection. Decision for resectability could be made after percutaneous drainage in patients with solitary lesions with cystic cavity.

Preoperative percutaneous drainage of the cystic cavity facilitates resectability in hepatic alveolar echinococcosis

Preoperative percutaneous drainage of the cystic cavity facilitates resectability in hepatic alveolar echinococcosis

Feasibility study of preoperative percutaneous catheter drainage in the treatment of lumbar tuberculosis with psoas abscess

To investigate the effect of preoperative percutaneous drainage in lumbar tuberculosis with psoas abscess, through compare the clinical efficacy of two different methods. Thirty-six patients with lumbar tuberculosis complicated with psoas abscess in corresponding with the inclusion criteria were admitted in Zhejiang Province Traditional Chinese Medicine Hospital from January 2015 to January 2017. The patients were divided into group A and group B according to the different therapeutic methods. All patients were given the standard anti tuberculosis treatment, and percutaneous catheter drainage was used in group A after admission immediately for psoas abscess before operation, while group B with no special treatment. At 3 weeks after anti tuberculosis treatment, 2 patients were excluded in group B, which had to postpone operation because of no reduction in erythrocyte sedimentation rate(ESR) and C reactive protein(CRP). Finally 34 patients were enrolled in this study. There were 18 cases in group A, including 10 males and 8 females, aged from 24 to 73 years old with an average of(42.5±10.2) years. There were 16 cases in group B, including 9 males and 7 females, aged from 23 to 75 years old with an average of(42.3±9.8) years. All patients were treated with posterior pedicle screw fixation, anterior debridement and bone graft fusion. Anterior surgery bleeding volume, operation time, anterior incision length, postoperative anus exhaust time, VAS score, Cobb angle, ESR, CRP changes and postoperative sinus formation were compared between two groups. All patients were followed up for 6 to 21 months with an average of 13 months. At the last follow-up, no mixed infection, tuberculosis recurrence, pedicle screw loosening and nail withdrawal were found. The average operative time, anterior surgery bleeding volume and anterior incision length of group A were less than that of group B(P<0.05). Postoperative anal exhaust time of group A was lower than that of group B(P<0.05). Improvement degree of ESR, CRP at 3 weeks after anti tuberculosis and 1 week after operation, group A was better than group B(P<0.05), and there was no significant difference between two groups in 1 month and 6 months after operation(P>0.05). There was 1 case sinus formation in group A and 5 cases in group B, there was significant difference in sinus formation rate between two groups (P<0.05). VAS score and Cobb angle at 1 month after operation was obvious improved(P<0.05), but there was no significant difference between two groups (P>0.05). Spinal cord nerve injury was obvious improved after operation, but there was no significant difference between two groups. Preoperative percutaneous catheter drainage is a safe and feasible method for the treatment of lumbar tuberculosis with psoas abscess. It can increase the effect of anti tuberculosis before operation, reduce the surgical trauma and reduce the incidence of postoperative complications. It can be recommended in clinical application.

Pancreatic necrosectomy morbid but life saving

Introduction: Pancreatic necrosectomy has high morbidity and hence is the last resort in necrotizing pancreatitis. Retrospective analysis was done to study its morbidity and sequalae Method: Between 2005 to 2017, 110 patients underwent closed pancreatic necrosectomy. After adequate debridement and washes, multiple tube drains were kept for postoperative irrigation. Need for diversion stoma and feeding jejunostomy was decided on clinical, radiological and intraoperative findings. Results: 93 males & 17 females. Mean age was 36 years (21–77). Pancreatic necrosis was due to alcohol-56, biliary -44 , whereas trauma and idiopathic 3 each ,post ercp and autoimmune pancreatitis -2 each. 53/110 ( 48%) pts had diversion stoma . 68/110 (62 %) patients had feeding jejunostomy. Preoperative percutaneous drainage was done in 35 patients. Average time of intervention was 54th day since onset of pancreatitis. Average amount of necrotic material was 62 gms. Necrotic fluid grew e.coli in 48, klebsiella in 26, pseudomonas in 9. Average post op stay 23 days.(8-70). Post op prolonged ventilation(>48 hrs) required in 28 patients. 11 patients required tracheostomy. 12/ 110(11%) patients had mortality. 49/110 (45%) patients had pancreatic fistula, out of which 30 required postoperative ERCP and pancreatic duct stenting, for the fistula to heal. New onset DM and incisional hernia was seen in 10 and 5 patients respectively. Conclusion: Surgical pancreatic necrosectomy done after 6-7 weeks is less morbid. Diversion stoma and feeding jejunostomy are often required. ERCP and PD stenting are required for prolonged pancreatic fistulae to heal.

Selective Necrosectomy for Infected Pancreatic Necrosis

Background: Until recently, a diagnosis of infected pancreatic necrosis (IPN) warranted necrosectomy, which was associated with high morbidity and mortality rates greater than 20%. Preoperative percutaneous drainage delayed the need for necrosectomy with improved outcomes. Methods: In 2008, this institution changed its approach to the management of such cases opting instead for percutaneous drainage with selective deferred necrosectomy. A total of 38 consecutive patients with IPN from January 2008 to December 2014 were included. Results: All 38 underwent percutaneous radiological drainage, and selective necrosectomy was performed on 15 where the infected necrosis did not completely resolve. Twenty-three patients did not require surgery and were managed with pancreatic drain insertion, optimal nutritional support and critical care interventions. Median peak Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores were 10 (range 0-18) and 3 (range 0-10) prior to radiological intervention. Overall mortality was 5% (n = 2). Conclusion: This study demonstrates that radiological-guided drainage of infected pancreatic collections can, in most cases, prove curative and, if not, facilitates delayed surgical intervention with improved outcomes.

Laparoscopic upper pole heminephrectomy in adults for treatment of duplex kidneys.

To present our results of laparoscopic upper pole heminephrectomy in adult patients with duplex kidney. A total of 10 patients with an age range of 27 to 54 years old underwent laparoscopic upper pole heminephrectomy for complete duplication of the renal collecting system. The key point of the technique included the placement of a catheter in the normal ureter at the beginning of the procedure. The patient was positioned in a 45-90 degrees lateral decubitus position and a 4-port transperitoneal or 3-port retroperitoneal technique was applied followed by the mobilization of the upper pole ureter away from the renal hilum. Afterwards, the vasculature supplying the upper pole was precisely identified and ligated. Followed by transection of the ureter and its transposition cephalad to the hilum, the upper pole moiety was fully transected using the harmonic scalpel. Eight patients were operated on using the transperitoneal approach and 2 using the retroperitoneal technique. One patient required preoperative percutaneous drainage due to pyonephrosis. The operation time ranged between 150 to 350 min with minimal blood loss (0-200 mL). Hemostasis was achieved with an Argon laser in one patient. The lower pole calyceal system was perforated in one patient and repaired intracorporally. No major intraoperative complications occurred. All of the patients except two had their drains removed in 72 h after the operation and were generally discharged on postoperative day 3. Laparoscopic upper pole heminephrectomy for an ectopic ureter is safe and reproducible and offers benefits of laparoscopic surgery even in patients with complicated urinary tract infection.

The clinical impact of preoperative percutaneous drainage of abdominopelvic abscesses in patients with Crohn’s disease

Although image-guided percutaneous drainage is increasingly being used to treat Crohn's disease-related abdominopelvic abscesses, surgery is seldom avoided. The aim of this study was to compare outcomes following the treatment of intra-abdominal Crohn's abscesses with percutaneous drainage followed by surgery to those after surgery alone. We retrospectively reviewed the charts of patients treated for Crohn's-related abdominopelvic abscesses at Mount Sinai Medical Center between April 2001 and June 2010. Patients who underwent drainage followed by surgery were compared to those who underwent surgery alone. Differences in operative and postoperative outcomes were compared. Seventy patients with Crohn's disease-related abdominopelvic abscesses were identified, 38 (54%) of whom underwent drainage before surgery. Percutaneous drainage was technically successful in 92% of patients and clinically successful in 74% of patients. No differences in rate of septic complications (p = 0.14) or need for stoma creation (p = 0.78) were found. Patients who underwent percutaneous drainage had greater overall hospital lengths of stay (mean 15.8 versus 12.2 days, p = 0.007); 8.6% of patients had long-term postponement of surgery after percutaneous drainage. In our series, the treatment of Crohn's abscesses with percutaneous drainage prior to surgery did not decrease the rate of postoperative septic complications.

The clinical impact of preoperative percutaneous drainage of abdominopelvic abscesses in patients with Crohn's disease

Bafford, Andrea Chao MD; Coakley, Brian MD; Powers, Sarah BA; Ha, Christina MD; Weintraub, Joshua MD; Gorfine, Stephen R. MD; Chessin, David B. MD; Bauer, Joel J. MD Author Information

Preoperative percutaneous drainage of diverticular abscesses

To define the role of percutaneous catheter drainage in the initial management of diverticular abscess, we reviewed 19 patients who were followed for an average of 17.4 months after drainage. All patients had large paracolic or pelvic abscesses with a mean size of 8.9 cm. There were no complications related to catheter placement, and 15 patients (79 percent) required drainage for less than 3 weeks. Sepsis resolved rapidly, and only two patients (11 percent) had persistent fever or leukocytosis beyond the third day of drainage. Routine sinography revealed fistulous communications to the colon in nine patients (47 percent), but only three (16 percent) had grossly feculent drainage. Fourteen patients (74 percent) completed the treatment plan of preoperative catheter drainage followed by single-stage sigmoid colectomy and primary anastomosis without complications. Two patients refused operation, one of whom died 16 days postoperatively from recurrent sepsis and end-stage pulmonary disease. The three patients with fecal fistulas all had inadequate control of infection, suggesting the need for early operation and fecal diversion in such cases. We conclude that preoperative percutaneous catheter drainage obviates the need for colostomy and multiple-stage surgery in approximately three-fourths of patients with large diverticular abscesses.

Carcinoma of the ampulla of Vater: the endoscopic approach.

Carcinoma of the ampulla of Vater is a rare tumor. Early and accurate diagnosis of carcinoma of the ampulla of Vater will lead to early treatment and subsequent better prognosis. Endoscopy and endoscopic retrograde cholangiopancreaticography (ERCP) has been shown to be one of the best diagnostic modalities. Furthermore an endoscopic biliary drainage procedure can be performed immediately following the diagnostic procedure. The tumors may be seen as large, fleshy, friable exophytic growths, as ulcerated tumors into the duodenal wall or as a mass behind the orifice of the papilla, covered with normal duodenal mucosa. Forceps biopsies do not always suffice to show malignancy. Large snare biopsies often are necessary. Occasionally the final diagnosis of malignancy can only be made by examination of the surgical resection specimen. Tumors arising inside the ampulla form a bulge, covered by normal duodenal mucosa. An impacted stone may mimic this picture. Endoscopic papillotomy is then mandatory to make the final diagnosis. Histologic examination of forceps biopsies reveals malignancy in only 60% of cases. When snare biopsy is used, the diagnostic yield increases to 83%. The optimal treatment of carcinomas of the ampulla of Vater is surgical resection. Preoperative biliary drainage should theoretically be of benefit to the patient. The results of preoperative percutaneous drainage studies are, however, conflicting. Carcinoma of the ampulla of Vater is not resectable in 25-50% of the patients because of metastatic disease, deep extension of the tumor or general contraindications for major surgery. Endoscopic papillotomy or stent placement as a definitive treatment modality should be reserved for poor surgical candidates and for those patients with limited life expectancy due to metastatic disease.

Grey-scale ultrasonography and percutaneous transhepatic cholangiography in biliary tract disease.

Fifty-one patients with suspected obstructive jaundice and 14 without jaundice in whom disease of the biliary tract was suspected but infusion cholangiography had been unhelpful were examined by grey-scale ultrasonography and percutaneous transhepatic cholangiography and the findings analysed retrospectively. Grey-scale ultrasonography distinguished between obstructive and hepatocellular jaundice in 35 out of 46 patients (76%) and indicated the site of the obstruction in 27 (58%) and the cause of the obstruction in 13 (28%). Percutaneous transhepatic cholangiography distinguished between obstructive and hepatocellular jaundice in 42 of the patients (91%) and indicated the site of the obstruction in 42 (91%) and the cause in 29 (63%). In the 14 patients without jaundice percutaneous transhepatic cholangiography showed bile-duct stones in one an ampullary stenosis in three. It is concluded that grey-scale ultrasonography and percutaneous transhepatic cholangiography are complementary examinations and that ultrasonography should always be undertaken first as it is a non-invasive procedure that may provide the surgeon with all the diagnostic information he requires. Percutaneous transhepatic cholangiography should be performed when grey-scale ultrasonography has shown dilated bile ducts but failed to provide adequate diagnostic information. Cholangiography is also required when preoperative percutaneous drainage of the bile duct is contemplated. In those patients in whom grey-scale ultrasonography shows non-dilated ducts endoscopic retrograde cholangiopancreatography is probably the contract examination of choice.