Removal Of Diverticulum Research Articles

Treatment of urinary bladder diverticulums

Diverticulums are divided into congenital and acquired ones. The causes of the congenital diverticulums include detrusor weakness and bladder sphincter hypertrophy. The causes of the acquired diverticulums are considered to be prostate adenoma, sclerosis of the bladder‘s neck, urethral stricture. According to our data, BPH does not lead to the appearance of the diverticulum, it is only an additional cause of the infravesical obstruction, which leads to the appearance of a clinical picture of congenital diverticula). Among 26 patients there are only 8 who underwent surgery for the removal of the large diverticula, but even after the removal of diverticula, 75% of the patients were again forced to be consulted by the urologist. Therefore, even after the surgical treatment, an active monitoring is needed to prevent the development of a renal insufficiency.

Endoscopic surgery for benign diseases and injuries of the esophagus (with commentary)

To analyze the results of surgical treatment of patients with benign diseases and injuries of the esophagus. We summarized the experience of different endoscopic interventions in 159 patients with various benign diseases and perforation of the esophagus. Patients with achalasia (72 cases) underwent videolaparoscopic Geller's esophagomyotomy with anterior hemiesophagofundoplication by Dor. Video-assisted thoracoscopic extirpation of the esophagus with simultaneous or delayed esophagocolo/gastroplasty was performed in 56 patients with post-ambustial cicatricial stenosis of the esophagus. Patients with esophageal perforation (14 cases) underwent videolaparoscopic transhiatal mediastinal drainage. Esophageal leiomyoma has been excised through thoracoscopic (9 cases) or laparoscopic access (4 cases). Removal of esophageal diverticulum was made via VATS-access in 4 patients. Satisfactory early and remote results were achieved in all patients with achalasia. Mortality rate was 5.4% (3 out of 56 patients) and 14.3% (2 out of 14 patients) in groups of cicatricial esophageal stenosis and esophageal perforation respectively. Sutures failure after removal of the diverticulum and leiomyoma occurred in 2 and 1 patient respectively and has been successfully cured. Endoscopic technologies allow to perform successfully complex reconstructive interventions for dysphagia in patients with cicatricial esophageal stenosis and achalasia even at late stages, to remove benign tumors and diverticula of thoracic esophagus and provide adequate drainage of posterior mediastinum in case of esophageal perforation.

Endosurgery of benign diseases and injuries of esophagus

To analyze the results of endoscopic interventions for benign diseases and injuries of the esophagus. 159 patients with benign diseases and perforation of the esophagus were operated. There were 72 (45.3%) cases of achalasia, 56 (35.2%) with post-ambustial stenosis of esophagus, 14 (8.8%) with esophageal perforation, 13 (8.2%) with leuomyoma of esophagus and 4 (2.5%) with diverticulum of thoracic esophagus. In long-term period 56 patients with achalasia were followed-up after laparoscopic Heller cardiomyotomy with Dor fundoplication. Good results were observed in all cases. Three patients died in early postoperative period after thoracoscopic extirpation of esophagus with esophagoplasty via laparotomy at the stage of development of the technique. There were no deaths after thoracoscopic extirpation of esophagus with simultaneous laparoscopic gastroplasty. Postoperative period was significantly less after thoracoscopic extirpation of esophagus with simultaneous laparoscopic esophagogastroplasty using whole stomach compared with esophagogastroplasty and esophagocoloplasty via laparotomy. In long-term postoperative period different complications occurred in 17 cases. Two patients with esophageal perforation died after video-assisted laparotranshiatal drainage of posterior mediastinum. Scarring of esophageal defect was observed in others. Seam failure after esophageal leuomyoma removal was diagnosed in 2 patients that required video-assisted laparotranshiatal drainage of posterior mediastinum and Maydl jejunostomy. Seam failure in thoracic esophagus after thoracoscopic removal of diverticulum was observed in 1 case. The complication was cured by video-assisted laparotranshiatal drainage of posterior mediastinum.

Primary Translocation of Aberrant Left Subclavian Artery for Children With Symptomatic Vascular Ring

The standard operation for vascular ring with right aortic arch and aberrant left subclavian artery is ligamentum arteriosum division. A new surgical approach with primary translocation of the aberrant left subclavian artery to the left carotid artery, removal of the Kommerell diverticulum, and division of the ligamentum through left thoracotomy was recently applied. This study assessed the early outcomes of this approach. This is a retrospective review of all patients having an operation for right aortic arch with aberrant left subclavian artery and the Kommerell diverticulum between January 2001 and April 2011 at a single institution. Eight patients had a division of the ligamentum and 10 had a primary translocation of an aberrant left subclavian artery with diverticulum removal and ligamentum division. The median operative age and weight for each surgical technique group were, respectively, 2.2 and 1.8 years (p = 0.56) and 10.7 and 12.6 kg (p = 0.30). All patients were symptomatic preoperatively. No deaths occurred. One patient from each group had chylous effusion that was medically treated. The median hospital stay for each group was 4 and 5 days (p = 0.45). During the median follow-up of 47 months, 3 patients in the division of ligamentum group required albuterol aerosol or oral antiinflammatory medication for respiratory symptoms. All patients in the primary translocation group remained asymptomatic and required no medication (p = 0.069). Primary translocation of aberrant left subclavian artery with removal of the diverticulum and division of the ligamentum had excellent early outcomes and can potentially eliminate residual symptoms and late complications.

Treatment of Epiphrenic Diverticula

Epiphrenic diverticulum is a rare disorder of the lower esophagus, thought to be related to an esophageal motility disorder. Treatment should involve removal of diverticulum and myotomy. Although the surgery is technically a difficult one, the long-term outcome should be excellent.

Pharyngeal-esophageal diverticulum.

The most adequate process to cure the pharyngeal-esophageal diverticulum seems to be its surgical removal. In Brazil, we must emphasize the work of E. Vasconcelos, who studied the subject very thoroughly. Nowadays, the surgical removal of the diverticulum can be done safely, owing to antibiotics. The era when one small opening in the neck of the diverticulum represented an almost certain mediastinitis, with great risk to the patient's life, is now over. Thus the surgical removal of the pharyngealesophageal diverticulum has been done by many outstanding surgeons in all countries. Sometimes it is not easy to reach the diverticulum which extends into the chest, especially in patients with short necks. In order to make the surgery easier we suggest the following technique: Before the patient goes under general anesthesia we locally anesthetize one of the nostrils in order to pass a Nelaton catheter (No. 12 or 14) through it.

Diverticulum of female urinary bladder a modified operative technic: Case report

A case of diverticulum in the bladder in the female is reported. This diverticulum was found to be made up of all the true bladder layers and must therefore have been a congenital anomaly. A modified technique for the removal of diverticulum is presented. The method used here and suggested by Young is applicable only to such diverticula as are of good size, with thick wall and a distinct narrow neck, where there is no other reason for opening the bladder. Under such conditions it is technically less difficult, traumatizes the bladder less and should give a shorter convalescence than the more frequently described extra- or intravesical methods of excision.