Repair Of Obstruction Research Articles

“Gastrointestinal Quality of Life After Congenital Duodenal Obstruction Repair: A Nationwide Long-term Follow-up Study”

BackgroundCongenital duodenal obstruction (CDO) is one of the most common gastrointestinal congenital anomalies. Still, patient-reported long-term results are limited. The aims of this study were to evaluate the long-term gastrointestinal quality of life (QoL), generic QoL, patient-reported scar appearance, and reinterventions after CDO repair. MethodsPatients who underwent surgery for CDO in Norway from 1995 to 2020 were invited to answer the validated questionnaires PedsQL and PedsQL gastrointestinal symptom scale and a study-specific questionnaire on general health and scar assessment. Parent-proxy reports were used for patients <12 years and patients with cognitive impairment. Scores were compared with an American and Norwegian control group for gastrointestinal and generic QoL, respectively. ResultsOf 186 eligible patients, eight were deceased, 25 had unretrievable contact information, and 79 did not respond. There were no significant differences between included (n = 74) and not included (n = 112) patients regarding baseline data. The mean follow-up time was 13.3 (SD = 6.6) years. Patients with CDO had significantly lower overall gastrointestinal QoL than controls (85.9 versus 90.0, p = 0.010). The most common symptoms were gas/bloating, constipation, food/drink limits, and reflux. Generic QoL was similar between the CDO population and controls (84.4 versus 85.3, p = 0.530). Twenty-one (28 %) patients had some degree of pain and/or concern related to the surgical scar. Nine (12 %) patients had reoperations related to the CDO repair; four due to adhesive small bowel obstruction. ConclusionA notable portion of patients report troublesome gastrointestinal symptoms and cosmetic concerns regarding their surgical scar after CDO repair. Even so, generic QoL was good. Level of evidenceIV.

Ventricular Septation of the Double-Inlet Ventricle: Over Three Decades of Follow-Up.

There is renewed interest in septation of the double-inlet ventricle as an alternative to Fontan palliation. We examined our septation experience with over 30years of follow-up. We retrospectively reviewed patients with double-inlet ventricle from 1990 to 2011. Patients with two adequate atrioventricular valves, a volume-overloaded ventricle, and no significant subaortic obstruction were septation candidates. Of 98 double-inlet ventricle patients, 9 (9.2%) underwent attempted septation via a one-stage (n = 2, 22.2%) or two-stage (n = 7, 77.8%) approach. Ages at primary septation were 7.5 and 20.2months. In the staged group, median age at the first and second stage was 8.3months [range 4.1-14.7] and 22.4months [range 11.4-195.7], respectively. There were no operative mortalities. Median follow-up was 18.8years [range 0.4-32.9] and 30-year transplant-free survival was 77.8% ± 13.9%. Both single stage patients are alive and in sinus rhythm; 1 underwent bilateral outflow tract obstruction repair 27years later. Of 7 patients planned for two-stage septation, there was 1 interval mortality and 1 deferred the second stage. Five patients underwent the second stage; 1 required early reintervention for a residual neo-septal defect and 1 underwent right atrioventricular valve replacement 28years later. Three patients required a pacemaker preoperatively (n = 1) or after partial septation (n = 2). At latest follow-up, 7 patients have normal biventricular function and no significant valvulopathy. All remain NYHA functional class I. Select double-inlet ventricles may be septated with excellent long-term outcomes. Reconsideration of this strategy is warranted to avoid the sequelae of Fontan circulation.

The anatomic repair of recurrent aortic arch obstruction in children and adolescents

ObjectiveSurgery for recurrent aortic arch obstruction is highly challenging and publications are rare. The aim of this retrospective, single-center study was to evaluate mortality, complications, and reintervention rate after an anatomic repair. MethodsBetween 1999 and 2022, in total 946 operations on the aortic arch were performed at the Children's Heart Center Linz. In 39 cases, the indication was a recurrent or residual aortic arch obstruction or coarctation in a patient aged 18 years or younger. This is our study cohort. The aorta was reconstructed by a direct anastomosis/autograft in 20 patients, patch in 17 patients, and interposition graft in 2 adolescents. In 32 procedures, cardiopulmonary bypass with whole body perfusion was employed, in 4, antegrade cerebral perfusion was employed, in 2, a left heart bypass was employed, and in 1 no cardiopulmonary bypass was used. ResultsMedian (Q1, Q3) age at operation was 253 days (100, 2198 days), weight 7.5 kg (4.5, 17.8 kg). Median cardiopulmonary bypass time was 177 minutes (115, 219 minutes), crossclamp time 73 minutes (49, 102 minutes). Three infants died during the hospital stay: 1 with Williams syndrome, 1 with hypoplastic left heart syndrome, and 1 with heterotaxia. There was no death due to an arch complication. The main complications were 1 neurologic injury after postoperative resuscitation (Williams syndrome) and 1 permanent recurrent laryngeal nerve paralysis. During the follow-up period of median 8.1 years (2.6, 12 years) 1 re-reintervention on the aortic arch was necessary. ConclusionsSophisticated reoperations on the aortic arch could be performed safely. In children, the growth potential of all segments of the aorta could be sustainably preserved by avoiding interposition or extra-anatomic bypass grafts.

Congenital duodenal obstruction repair with and without transanastomotic tube feeding: a systematic review and meta-analysis

ObjectiveTo determine the impact of transanastomotic tube (TAT) feeding in congenital duodenal obstruction (CDO).DesignSystematic review with meta-analysis.PatientsInfants with CDO requiring surgical repair.InterventionsTAT feeding following CDO repair versus no TAT feeding.Main...

Robot-assisted laparoscopic pyeloplasty is a valid option for ureteropelvic junction obstruction repair in adults with congenital renal abnormalities: a case series study

BackgroundCongenital renal anomalies are rare but may be associated with obstruction of the ureteropelvic junction. Given the rarity of simultaneous ureteropelvic junction obstruction [UPJO] and renal anomalies in the adult population, there is limited literature on approaching these patients. We report our experience with robotic assisted laparoscopic pyeloplasty for UPJO repair in this subset of patients.MethodsData on adult patients with simultaneous congenital renal abnormalities and UPJO who underwent robotic assisted laparoscopic pyeloplasty between 2008 and 2020 was reviewed. Pre-operative data, intraoperative parameters as well as post-operative data including symptom resolution and radiologic findings were recorded.ResultsTen patients, 4 female and 6 males, with a mean age of 47 years were identified as having simultaneous congenital renal abnormalities and UPJO. Anomalies identified were horseshoe kidney in four patients, duplex kidney with obstruction of one moiety in two patients, malrotated kidney in two patients, and pelvic kidney in two patients. Eight out of ten were symptomatic at presentation with flank pain being the most common symptom. Eight patients underwent robotic pyeloplasty via the dismembered technique, while two underwent robotic Y-V pyeloplasty. With a mean follow up time of 13 months, 8/9 (88%) symptomatic patients enjoyed symptom resolution. Post-op renogram was available for nine patients and showed resolution of obstruction in all patients (100%). One patient developed a urine leak which was managed successfully with drainage.ConclusionsRobotic assisted laparoscopic pyeloplasty is a safe, feasible and effective surgical approach in management of adult patients with concomitant UPJO and renal anomalies.

Esophageal Atresia Associated with Congenital Duodenal Obstruction: Turkish Esophageal Atresia Registry (TEAR) Evaluation.

Coexistent congenital duodenal obstruction and esophageal atresia (EA) is known to have significant morbidity and mortality. Management strategies are not well-defined for this association. The data from the Turkish EA registry is evaluated. A database search was done for the years 2015 to 2022. Among 857 EA patients, 31 (3.6%) had congenital duodenal obstruction. The mean birth weight was 2,104 (± 457) g with 6 babies weighing less than 1,500 g. Twenty-six (84%) had type C EA. The duodenal obstruction was complete in 15 patients and partial in 16. Other anomalies were detected in 27 (87%) patients. VACTERL-H was present in 15 (48%), anorectal malformation in 10 (32%), a major cardiac malformation in 6 (19%), and trisomy-21 in 3 (10%). Duodenal obstruction diagnosis was delayed in 10 (32%) babies for a median of 7.5 (1-109) days. Diagnosis for esophageal pathologies was delayed in 2. Among 19 babies with a simultaneous diagnosis, 1 died without surgery, 6 underwent triple repair for tracheoesophageal fistula (TEF), EA, and duodenal obstruction, and 3 for TEF and duodenal obstruction in the same session. A staged repair was planned in the remaining 9 patients. In total, 15 (48%) patients received a gastrostomy, the indication was long-gap EA in 8. Twenty-five (77%) patients survived. The cause of mortality was sepsis (n = 3) and major cardiac malformations (n = 3). Congenital duodenal obstruction associated with EA is a complex problem. Delayed diagnosis is common. Management strategies regarding single-stage repairs or gastrostomy insertions vary notably depending on the patient characteristics and institutional preferences.

Interdigitating Technique for Repair of Aortic Arch Obstruction to Reduce Reintervention Rates

BackgroundThe incidence of reintervention for aortic arch obstruction is 5% to 14% after coarctation or hypoplastic aortic arch repair and 25% after the Norwood procedure. Institutional practice review indicated higher than reported reintervention rates. Our aim was to assess the impact of an interdigitating reconstruction technique on reintervention rates for recurrent aortic arch obstruction. MethodsChildren (<18 years) were included if they had undergone aortic arch reconstruction by sternotomy or the Norwood procedure. Three surgeons participated in the intervention with staggered rollout dates between June 2017 and January 2019, with the study ending December 2020 and review for reinterventions ending February 2022. Preintervention cohorts represented patients who underwent aortic arch reconstructions with patch augmentation, and postintervention cohorts represented patients who underwent an interdigitating reconstruction technique. Reinterventions by cardiac catheterization or operation were measured within 1 year of initial operation. Wilcoxon rank sum and χ2 tests were used to compare preintervention and postintervention cohorts. ResultsOverall, 237 patients were included for participation in this study, with 84 patients in the preintervention cohort and 153 in the postintervention cohort. Patients undergoing the Norwood procedure represented 30% (n = 25) of the retrospective cohort and 35% (n = 53) of the intervention cohort. Overall reinterventions were significantly decreased after the study intervention from 31% (n = 26/84) to 13% (n = 20/153; P < .001). Reintervention rates were decreased for each intervention cohort: aortic arch hypoplasia (24% [n = 14/59] vs 10% [n = 10/100]; P = .019) and Norwood procedure (48% [n = 12/25] vs 19% [n = 10/53]; P = .008). ConclusionsThe interdigitating reconstruction technique for obstructive aortic arch lesions was successfully implemented and is associated with a decrease in reinterventions.

MP42-06 ASSESSING THE ACCURACY OF PREOPERATIVE RADIOGRAPHIC IMAGING IN DETERMINING URETERAL STRICTURE LENGTH AT TIME OF ROBOTIC URETERAL RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023MP42-06 ASSESSING THE ACCURACY OF PREOPERATIVE RADIOGRAPHIC IMAGING IN DETERMINING URETERAL STRICTURE LENGTH AT TIME OF ROBOTIC URETERAL RECONSTRUCTION Labeeqa Khizir, Alain Kaldany, Hiren V. Patel, and Sammy E. Elsamra Labeeqa KhizirLabeeqa Khizir More articles by this author , Alain KaldanyAlain Kaldany More articles by this author , Hiren V. PatelHiren V. Patel More articles by this author , and Sammy E. ElsamraSammy E. Elsamra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: During robotic ureteral reconstruction, accurate measurement of ureteral stricture length is important for surgical planning. We aimed to determine the accuracy of using conventional fluoroscopic imaging compared to ureteroscopy and direct measurement with measuring tape during intra-operative robotic repair. METHODS: A retrospective review was conducted for 15 patients with ureteral stricture disease at a single institution treated with robotic repair. Data was collected regarding etiology of ureteral stricture disease, measured preoperative radiographic stricture length on fluoroscopy, and measured intraoperative robotic stricture length. A Wilcoxon matched-pairs rank test was performed to compare ureteral length measurements. RESULTS: The most common etiologies of ureteral stricture were prior medical history of stone disease (n=10), prior ureteropelvic junction obstruction repair (n=3), and other iatrogenic causes (n=2) (Table 1). A majority of patients had ureteral stricture repair using buccal mucosa (n=7) or appendiceal onlay (n=6) grafts (Table 1). A total of 11 patients (73%) had >1 cm difference in stricture length between radiographic and robotic measurement (Figure 1). Of these patients, 73% (n=8) had prior medical history of stone disease (Table 1). The intraoperative robotic length was significantly longer compared to preoperative radiographic length (Median difference 1.2 cm, 98% CI 0.15-2.3, p<0.05) (Figure 1). CONCLUSIONS: Conventional preoperative radiographic measurement significantly underestimates the ureteral stricture length compared to intraoperative measurement. This may have clinical significance in influencing operative planning, technique, and the length of graft that is harvested. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e568 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Labeeqa Khizir More articles by this author Alain Kaldany More articles by this author Hiren V. Patel More articles by this author Sammy E. Elsamra More articles by this author Expand All Advertisement PDF downloadLoading ...

Surgical Experience With Nine Cases of Obstructed Right Aortic Arch.

Right-sided aortic arch obstruction is an extremely rare congenital anomaly. A variety of surgical approaches have been described. This study reviews our institutional experience over the last 30 years. Our surgical database at the University of Alabama at Birmingham and Children's Hospital of Alabama from 1992 to 2022 was reviewed to include all patients who underwent surgical repair for right-sided aortic arch obstruction. A total of nine patients underwent surgical repair for right-sided aortic arch obstruction. Surgical approach was via thoracotomy (n = 2, 22%), sternotomy (n = 5, 56%), or combined (n = 2, 22%). Primary extended end-to-end anastomosis was utilized for patients with discrete coarctation (n = 1, 11%), reverse subclavian flap for coarctation with associated distal arch hypoplasia (n = 2, 22%), GORE-TEX® tube graft for circumflex aorta (n = 1, 11%), and aortic arch advancement (n = 5, 56%) with or without patch augmentation for those with an interrupted or severely hypoplastic aortic arch. Reintervention was required in one patient (11%) for recoarctation. All patients were discharged in good condition. There was no hospital mortality and at 10.5 years (mean) follow-up there was one late death. Right aortic arch obstruction is a rare entity. Surgical approach should be tailored to the anatomy and associated intracardiac defects. Preoperative imaging with a CT angiogram is useful for operative planning. Sternotomy with single-stage primary repair is safe, effective, and our preferred surgical approach for patients with right aortic arch obstruction and associated intracardiac pathology.

Abstract 12556: Prevalence of Hypertension and Left Ventricular Hypertrophy in Adolescents Following Left Ventricular Outflow Tract Obstruction Repair

Introduction: Left ventricular outflow tract obstructions predispose patients to increased lifetime risk of cardiovascular events even after successful repair (rLVOTO). Left ventricular hypertrophy (LVH) is an adaptive response to elevated afterload and is a predictor of cardiovascular events in adulthood. The prevalence of elevated blood pressure (SBP) and LVH in youths with rLVOTO is limited. Methods: Retrospective analysis of rLVOTO patients between 2012-2019, age 13-17 years with documented body mass index (BMI), SBP, LVOT velocity and left ventricular mass indexed to height (LVMi). Moderate LVOTO was defined as peak velocity ≥ 3 m/s. Patients categorized into normotensive (NT, SBP &lt; 120 mm Hg), elevated (E-BP, 120 ≤ SBP &lt; 130 mm Hg), Stage 1 HTN (HTN-1, 130 ≤ SBP &lt; 140 mm Hg) and Stage 2 HTN (HTN-2, SBP ≥ 140 mm Hg). Prevalence of LVH was reported in each group (pediatric cutoff of LVMi-HT 2.7 ≥ 38.6 g/ht 2.7 ). Results: A total of 193 patients met criteria (age 15.6 ± 1.4 years), 135/193 (70%) male, SBP 120±13 mm Hg, and LVMi-HT 2.7 36.2±9.8 g/ht 2.7 . Half were in the NT group (93/193 (48%)), 55/193 (28%) in E-BP, 32/193 (17%) in HTN-1, and 13/193 (7%) in HTN-2 with no difference in BMI. Prevalence of LVH increased with higher SBP with 24/93 (26%) in NT, 21/55 (38%) in E-BP, 14/32 (43%) in HTN-1, and 4/13 (31%) in HTN-2. 124/193 (64%) had no residual LVOT gradient, 69/193 (36%) with residual LVOT gradient. 52/69 (75%) had LVOT &lt; 3 m/s, of these 12/52 (23%) had ≥ HTN-1. 17/69 (25%) had residual LVOTO ≥ 3 m/s, of these 6/17 (35%) had ≥ HTN-1. No difference in LVMi found between no or mild LVOTO groups (35.9±13 vs 35.6±10 g/ht 2.7 , p = NS). Higher LVMi was found in the LVOTO ≥ 3 m/s group (41.5±13 g/ht 2.7 , p = 0.01 compared to both no or mild LVOTO). Conclusions: Youths with rLVOTO have a high prevalence of elevated BP, HTN, and LVH. When stratified by LVOTO severity, presence of ≥ HTN-1 was common with increased LVMi. No difference in BMI was observed among abnormal SBP groups suggesting BMI is not solely responsible for the increased LVMi. Longitudinal studies are needed to define the impact of rLVOTO and HTN on LVH over time. Our findings support early surveillance and management of hypertension in patients following LVOTO repair to help minimize the risk of future cardiovascular events related to LVH.

The association of bicuspid aortic valve on long-term outcome following one-stage repair of aortic arch obstruction associated with ventricular septal defect.

The aim of this study was to evaluate the association of bicuspid aortic valve on contemporary outcomes, including reoperation rates, after one-stage correction for interrupted aortic arch with ventricular septal defect or for aortic coarctation with hypoplastic aortic arch and ventricular septal defect. Seventy-four consecutive patients (35 boys, 47% and 39 girls, 53%) with interrupted aortic arch (n = 41, 55%) or aortic coarctation with hypoplastic aortic arch (n = 33, 45%) with ventricular septal defect underwent early one-stage correction. Twenty (27%) patients had bicuspid aortic valve, and the remaining 54 (73%) had a tricuspid aortic valve. The median aortic valve annulus diameter was 6.0 mm (IQR: 2.0). Patients' median age was 7 ± 29 days (range, 2-150); median weight was 3.3 ± 0.7 kg (range, 1.5-6.0), with 21 (28%) patients <3.0 kg. Selective brain perfusion through the innominate artery and selective coronary perfusion through the aortic root during aortic arch reconstruction were used in all patients. Statistical analysis was performed using SPSS version 20.0 software (SPSS Inc., Chicago, IL, USA). The early mortality was 1.3%. One premature neonate died in the hospital with extracorporeal membrane oxygenation after aortic coarctation plus ventricular septal defect repair. There was no further mortality. Median follow-up was 5.7 years (IQR: 10.48). Reinterventions occurred in 36 (49%) patients: balloon angioplasty in 18 (24%) patients, reoperations in 4 (5%) patients, and both in 14 (19%) patients. A total of 86 follow-up procedures were required in these 36 (49%) patients: aortic valve valvulopasty (n = 6, 8%), stent implantation (n = 8, 11%), balloon dilatation (n = 39, 53%), and reoperation (n = 33, 45%). The median time to reinterventions was 9.094 years (SE 0.890). A potential risk factor for reintervention after interrupted aortic arch and aortic coarctation with ventricular septal defect repair was bicuspid aortic valve (p = 0.019, Chi2 (1) = 5.457). In addition, a multivariate Cox analysis with backward selection and significance level <0.015 was applied to all variables that showed significant effects in univariable analyzes. This regression confirmed that bicuspid aortic valve (HR = 0.381, p = .016), and interrupted aortic arch (HR = 0.412, p = 0.043) were predictors of late reintervention. All patients had no obvious neurologic impairment in routine examinations at last follow-up. Bicuspid aortic valve was a significant risk factor for valve-related reintervention after one-stage repair for aortic arch obstruction with ventricular septal defect due to later development of stenosis associated with higher late morbidity and mortality. Particularly neonates with bicuspid aortic valve will possibly require reintervention in the future. Regular lifelong cardiac follow-up is recommended.

Laparoscopic Repair and Relief of Obstruction of a Diaphragmatic Hernia after Percutaneous Radiofrequency Ablation: A Case Report

症例は70歳男性．アルコール性肝硬変を背景とした肝細胞癌に対し経皮的ラジオ波焼灼術（radiofrequency ablation；以下，RFAと略記）を計４回施行された．S8病変に対して最終RFAを行った９カ月後，咳嗽および右上腹部痛を主訴に当院に搬送された．来院時，炎症反応の上昇，X線画像・CT画像では右上腹部に拡張した小腸と胸水を伴う右下肺浸潤影を認めた．右横隔膜下の肝表にも拡張した小腸を認めたが，Chilaiditi症候群と判断された．イレウスおよび肺炎の診断で加療したが症状の改善なく，入院６日目に38℃の発熱と炎症反応の上昇を認めた．再検した造影CTでは，Chilaiditi症候群と考えられた小腸は右横隔膜上に位置しており，壁造影効果の減弱を認め，RFA後横隔膜ヘルニアの嵌頓と考えられた．緊急で腹腔鏡下イレウス解除術を行い，壊死小腸切除および横隔膜ヘルニアの修復術を行った．経横隔膜的なRFA施行後の横隔膜ヘルニア嵌頓についての報告は少なく，若干の文献的考察を加えて報告する．

Role of Imaging in Obstetric Interventions: Criteria, Considerations, and Complications.

US has an established role in the prenatal detection of congenital and developmental disorders. Many pregnant women undergo US at 18-20 weeks of gestation for assessment of fetal anatomy and detection of structural anomalies. With advances in fetoscopy and minimally invasive procedures, in utero fetal interventions can be offered to address some of the detected structural and physiologic fetal abnormalities. Most interventions are reserved for conditions that, if left untreated, often cause in utero death or a substantially compromised neonatal outcome. US is crucial for preprocedural evaluation and planning, real-time procedural guidance, and monitoring and assessment of postprocedural complications. Percutaneous needle-based interventions include in utero transfusion, thoracentesis and placement of a thoracoamniotic shunt, vesicocentesis and placement of a vesicoamniotic shunt, and aortic valvuloplasty. Fetoscopic interventions include myelomeningocele repair and tracheal balloon occlusion for congenital diaphragmatic hernia. In rare cases, open hysterotomy may be required for repair of a myelomeningocele or resection of a sacrococcygeal teratoma. Monochorionic twin pregnancies involve specific complications such as twin-twin transfusion syndrome, which is treated with fetoscopic laser ablation of vascular connections, and twin reversed arterial perfusion sequence, which is treated with radiofrequency ablation. Finally, when extended placental support is necessary at delivery for repair of congenital high airway obstruction or resection of lung masses, ex utero intrapartum treatment can be planned. Radiologists should be aware of the congenital anomalies that are amenable to in utero interventions and, when necessary, consider referral to centers where such treatments are offered. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. ©RSNA, 2021.

Endoscopic endonasal repair of complete bilateral choanal atresia in neonates.

Reported success rates of endoscopic choanal atresia (CA) surgery vary substantially due to a high heterogeneity in and between study groups. Comprehensive data on the unique patient cohort of newborns with bilateral CA are scarce. Our study aimed to close this gap by using narrow inclusion criteria and standardized surgical outcome parameters. A total of ten neonates who were diagnosed with bilateral complete CA and underwent endoscopic surgery at the Department of Otolaryngology, Head and Neck Surgery in the University Hospital of Munich between 2008 and 2017 were included. Preoperative findings, surgical procedures, outcome, and follow-up were analyzed. Standardized criteria were used to assess surgical outcome. Almost all patients (90%) required at least one revision procedure within the first 6 months after initial surgery because of symptomatic partial or complete restenosis. After that, all surviving patients remained asymptomatic until the end of the follow-up period.Conclusion: Endoscopic bilateral CA repair in neonates is a safe procedure with a high long-term success rate. However, compared to other patient groups with choanal obstruction, restenosis occurs frequently, and revision procedures are required in a large number of cases. This should be considered during preoperative planning and parent counseling. What is Known: • Bilateral complete choanal atresia (CA) is a neonatal emergency that requires surgical intervention. • Reported success rates of endoscopic choanal obstruction repair are highly variable and mostly derived from heterogenous study groups that do not reflect the situation in neonates adequately. What is New: • This study focuses exclusively on newborns with complete bilateral CA who underwent endoscopic surgery within the first 28 days of life and uses standardized criteria to assess outcome. • The long-term success rate of endoscopic bilateral CA repair in neonates is high; however, almost all patients require at least one revision procedure within the first 6 months.

Yasui Conversion After Biventricular Repair in Patients With Left Ventricular Outflow Tract Obstruction

Surgical re-intervention for progressive left ventricular outflow tract obstruction after a standard biventricular repair of aortic arch obstruction and ventricular septal defect is rare but can occur. In this situation, left ventricular outflow bypass surgery can be performed to relieve left ventricular outflow tract obstruction by creating an intraventricular baffle to channel the re-opened ventricular septal defect to the pulmonary valve, Damus-Kaye-Stansel anastomosis, and right ventricle-to-pulmonary artery connection with a valved conduit. This strategy, termed as “Yasui conversion,” is a safe and useful alternative procedure for selected patients. Surgical re-intervention for progressive left ventricular outflow tract obstruction after a standard biventricular repair of aortic arch obstruction and ventricular septal defect is rare but can occur. In this situation, left ventricular outflow bypass surgery can be performed to relieve left ventricular outflow tract obstruction by creating an intraventricular baffle to channel the re-opened ventricular septal defect to the pulmonary valve, Damus-Kaye-Stansel anastomosis, and right ventricle-to-pulmonary artery connection with a valved conduit. This strategy, termed as “Yasui conversion,” is a safe and useful alternative procedure for selected patients.

Sağ Ventrikül Çıkış Yolu Darlıklarının Tamirinde Homogreft ve Contegra Greft Kullanılan Hastaların Sağ Kalımının Karşılaştırılması

Giriş ve Amaç: Homogreftler veya ksenogreftler sağ ventrikül çıkış yolu (RVOT) darlıklarının tedavisinde günümüzde en sık kullanılan materyallerdir. Çalışmanın amacı RVOT tamirlerinde homogreft ve Contegra® Greft (ksenogreft) kullanılan hastaların mortalite oranlarını belirlemek ve sağ kalımlarını karşılaştırmaktır. Çalışmanın ikincil amacı ise mortalite için risk faktörlerinin belirlenmesidir.&#x0D; Gereç ve Yöntemler: Çalışmaya üçüncü basamak sağlık kuruluşumuzda son yedi yılda RVOT darlığı nedeniyle homogreft veya Contegra® Greft kullanılarak RVOT rekonstrüksüyonu uygulanan hastalar dahil edilmiştir. Toplam 71 hastanın; 18’ine homogreft (%25,4) ve 53’üne (%74,6) ise Contegra® Greft ile RVOT rekonstrüksüyonu uygulanmıştır. Çalışma için yerel etik kurul izni alınmıştır.&#x0D; Bulgular: RVOT darlığının en sık etiyolojik sebebi Fallot Tetralojisiydi. Contegra® Greft grubunun yaş ortalaması ve kullanılan greft çapları (t test, p

Selective Lesser Curvature Augmentation With Geometric Study for Repair of Aortic Arch Obstruction

We repaired aortic coarctation and interrupted aortic arch with extended end-to-end anastomosis (EAA) through median sternotomy and performed lesser curvature augmentation with a pulmonary autograft patch (PAP) in selected patients with a long gap between anastomotic sites. We reviewed these outcomes and geometric implications. All neonates and infants with biventricular morphology who underwent aortic arch reconstruction through median sternotomy between 2005 and 2019 were evaluated. Aortic arch geometry was analyzed with computed tomography routinely performed before and after surgery from 2009 on. There were 91 consecutive patients (median age, 1.2 months). Ten patients received PAP. One early death and no late deaths were noted. Overall survival was 98.9% at 10 years. Two left bronchomalacia and 1 recoarctation occurred in patients with EAA. Freedom from recoarctation was 97.4% at 10 years. We examined 68 patients with computed tomography. We used PAP in patients with a significantly longer gap between anastomotic sites indexed by the square root of the body surface area; its cutoff value was 29.0 mm/m (area under the curve, 0.86 mm/m). The PAP created a significantly greater arch angle (median, 91° versus 83°) and arch/descending diameter ratio (median, 1.2 versus 1.0) and preserved the arch width indexed by the square root of the body surface area (median, before surgery: 35.7 versus 34.4 mm/m; after surgery: 36.5 versus 29.9mm/m), compared withEAA. Aortic arch reconstruction with the current combined strategy provides satisfactory outcomes. Guided by geometric analysis, lesser curvature augmentation can be applied to patients who might experience recoarctation or airway compression with a directly anastomosed aortic arch.

Risk Factors and Management Options for the Adult Failed Ureteropelvic Junction Obstruction Repair in the Era of Minimally Invasive and Robotic Approaches: A Comprehensive Literature Review.

Guidelines for the management of pyeloplasty failure remain elusive given the rarity of this condition and the difficulty of integrating and analyzing reported outcomes given the varying definition of failures. In this article, we aim to review the existing literature on risk factors that may influence the surgical outcomes of reconstructive pyeloplasty for ureteropelvic junction obstruction. Furthermore, we discuss management options and review success outcomes of treatment options for patients with pyeloplasty failure.

Using bespoke 3D-printed models to improve patient understanding of an encrusted ureteric stent

A 22-year-old man underwent a laparoscopic left pelvic ureteric junction obstruction repair, with a covering ureteric stent. At six weeks postoperatively, an unsuccessful attempt at stent removal was attempted because of mild calcification and patient tolerance. Removal under general anaesthetic was arranged, but the patient did not return despite multiple offered appointments, letters and correspondence. He eventually presented to the emergency department with pain and haematuria 21 months later. A computed tomography (CT) scan showed significant stent encrustation, but the patient self-discharged against medical advice. He re-presented several weeks later and was booked for an elective laser cystolithopaxy and percutaneous nephrolithotomy (PCNL) for stent removal. This was performed without complication, and the patient was discharged day two postoperatively when he was stone and stent free...

Outcomes of the arterial switch operation in patients with aortic arch obstruction

ObjectiveTransposition of the great arteries or Taussig–Bing anomaly with concomitant aortic arch obstruction is uncommon, with limited data on long-term outcomes after arterial switch operation and aortic arch obstruction repair. This study sought to determine outcomes of patients undergoing arterial switch operation and aortic arch obstruction repair at a single institution. MethodsFrom 1983 to 2015, 844 patients underwent an arterial switch operation for biventricular repair at The Royal Children's Hospital. Eighty-three (9.8%, 83/844) patients underwent an arterial switch operation and aortic arch obstruction repair. ResultsFifty-five (66%, 55/83) patients had transposition of the great arteries. and 28 (34%, 28/83) patients had Taussig–Bing anomaly. Fifty-nine (71%, 59/83) patients underwent arterial switch operation and aortic arch obstruction repair as a single-stage procedure, and 24 (29%, 24/83) patients underwent arterial switch operation and aortic arch obstruction repair as a 2-stage procedure. There were 5 early deaths (6.0%, 5/83). Follow-up was available for 74 (95%) of the 78 survivors. Median follow-up was 13.3 years (interquartile range, 7.3-19.3 years; range, 1-30 years). There were no late deaths. Freedom from reintervention was 77%, 71%, and 68% at 5, 10, and 20 years, respectively. Reintervention was more common compared with patients without aortic arch obstruction (P < .001). Reintervention for right-sided obstruction was more common compared with patients without aortic arch obstruction (P = .006). ConclusionsPatients with transposition of the great arteries or Taussig–Bing anomaly with associated aortic arch obstruction have a higher reintervention rate, especially for right-sided obstruction. Closer monitoring of this subgroup of patients is warranted.