Stentless Technique Research Articles

Step by step technique of Stentless Florence Robotic Intracorporeal Neobladder (FloRIN), does the ureteral management influence functional outcomes?

Benefits and harms of avoid the sent placement during IntraCorporeal Neobladder configuration are still debated. Our objective was to describe the step-by-step technique of Florence intracorporeal neobladder (FloRIN) configuration performed with stentless procedure focusing on perioperative and mid-term functional outcomes. In this single institution prospective randomized 1:1 series all consecutive patients underwent Robot-Assisted Radical Cystectomy (RARC) and FloRIN reconfiguration from January 2021 to March 2021 were enrolled. Functional perioperative and mid-term outcomes were gathered. Postoperative complications were graded according to Clavien-Dindo classification and divided in early (<30 days from discharge) and delayed (>30 days). Overall, 10 patients were included in the analysis. Of these, the 50.0% was treated with Stentless FloRIN. In terms of baseline features, no differences were recorded between the two groups. Median age was 65 and 66 years while median BMI was 27 and 25 in the stentless and in the stent group, respectively. Concerning intraoperative variables, no intraoperative complications as well as open conversion occurred among both groups. As regard introperative features, a shorter console time was associated with stentless procedure (331 min vs 365 min). In terms of perioperative outcomes, canalization and time to drainage removal didn't differ between groups while length of hospital stay was significantly lower in stentless group 10 days versus 14 days. Early and delayed postoperative complication rate was not influenced by the ureteral management at a preliminary assessment with comparable rates of Clavien Dindo ⩾ 3a between the two groups. Mid-term functional outcomes did not differ between groups in terms of kidney function loss. FloRIN with Stentless technique showed functional and perioperative preliminary outcomes comparable with the standard ureteral management strategy. Further series with longer functional follow-up assessment will be needed to confirm our preliminary results.

Minimally invasive pyeloplasty in adults: A systematic review on stent vs. stentless technique

Minimally invasive pyeloplasty in adults: A systematic review on stent vs. stentless technique

Comparison between Stenting and Stentless Technique in Biliary Anastomosis after Living Donor Liver Transplantation

Abstract Background billiary complications is the most common complication after LDLT. Biliary complications include stricture, leakage, cholangitis, biliary stones, hemobilia and ductopenia. Risk factors of complications include advanced donor age multiple anastomoses, long cold and warm ischemia times, hepatic artery thrombosis and duct-to-duct reconstruction. Aim of the Work it is a combined retrospective and prospective analytical study to compare between using stent and stentless technique in biliary anastomosis in living donor liver transplantation. Patients and Methods in this observational study we did comparative study between stented and stentless technique. We compared the main complications; leakage, stricture and cholangitis. Diagnosis of each complications is built up by follow up serum liver profile, and Ultrasonography. We did MRCP to diagnose stricture and follow up drains or aspiration of any collection to confirm leakage. All cases of cholangitis was admitted to our hepatobiliary unit to control the condition and to exclude any concomitant stricture or leakage. Results there is a significant decrease in the previously mentioned postoperative biliary complication using stentless technique by decreasing biliary infection rate and, thus, decreasing stricture and leakage. Managment of complicated case was initially done by hospital admission. ERCP was done for all cases of sticture. Conclusion biliary complications after living donor liver transplant can significantly be reduced by using stentless techinque.

Primary Percutaneous Coronary Intervention by a Stentless Technique for Acute Myocardial Infarction with Idiopathic Thrombocytopenic Purpura: A Case Report and Review of the Literature

A 78-year-old man who had been diagnosed with idiopathic thrombocytopenic purpura (ITP) was admitted to our hospital with chest pain, cold sweating and nausea. An electrocardiogram and echocardiogram revealed an ST elevated acute lateral myocardial infarction. He underwent an immediate cardiac catheterization. An occluded left circumflex artery was detected by coronary angiography. Reperfusion was performed successfully by non-slip element balloon angioplasty alone, without stenting, to avoid prolonged dual anti-platelet therapy. In this report we discussed the management strategies of acute myocardial infarction in a patient with concomitant ITP.

4602 Endoscopic pancreatic sphincterotomy: long-term follow-up.

INTRODUCTION: Endoscopic biliary sphincterotomy has just enjoyed its 25th anniversary, but endoscopic pancreatic sphincterotomy (EPS) has been performed for less than 10 years with little long-term follow-up data. We employ only pull-type EPS, and have described a safe, stentless technique (Gastrointestinal Endosc 1998;47:240-9). We report our long-term results. PATIENTS & METHODS: From 1/91 to 10/99, we performed 397 EPS procedures on 349 patients. There were 144 males, 205 females, age 5 to 90. The indications for sphincterotomy were SOD, recurrent acute pancreatitis, chronic pancreatitis, pancreatic duct stones, ampullary polypectomy, pancreatic fistula, and pseudocyst drainage. 238 EPS (60%) had nasopancreatic drainage, 132 (33%) were accompanied by PD stent placement, and 27 (7%) had no drainage. 332 (84%) EPS were of the major papilla in 293 patients and 65 (16%) were of the minor papilla performed in 56 patients. 10 patients had both major and minor duct sphincterotomies on different occasions. Follow-up has been for a median of 34 months with a minimum follow-up of 6 months. RESULTS: There were 22/397 (5%) shortterm complications consisting of mild pancreatitis (N=13), mild or moderate bleeding (N=2), mild perforation (N=2), cholangitis, stent migration, pain relieved by stent removal, and premature patient removal of a nasopancreatic drain (N=1 each). There were no requirements for surgery and no deaths. Long-Term Follow-Up: 39 of 397 (10%) EPS were repeat sphincterotomies performed in 34 patients for incomplete initial EPS (n=4), for additional therapies, such as stone removal, ampullary polypectomy or pseudocyst drainage (n=19), and for restenosis with recurrent symptoms (n=16). In these last 16 (4%), 6 were minor duct EPS (6/65=9.2%) compared to 10 major duct EPS (10/332=3%; p=0.03). Of the 16, 7 had underlying chronic pancreatitis characterized by ongoing disease and inflammation. There was only 1 complication in the repeat EPS group comprising minor bleeding after EPS extension to remove a migrated PD stent. IMPRESSION: Our previously described technique of pull-type pancreatic sphincterotomy is both safe and effective in moderate to long-term follow-up.We employ nasopancreatic drainage to avoid the risks and costs of pancreatic stenting when post sphincterotomy drainage beyond 24 hours is not anticipated. There is a very low incidence of restenosis. Minor duct sphincterotomy is more likely to restricture compared to major duct EPS. INTRODUCTION: Endoscopic biliary sphincterotomy has just enjoyed its 25th anniversary, but endoscopic pancreatic sphincterotomy (EPS) has been performed for less than 10 years with little long-term follow-up data. We employ only pull-type EPS, and have described a safe, stentless technique (Gastrointestinal Endosc 1998;47:240-9). We report our long-term results. PATIENTS & METHODS: From 1/91 to 10/99, we performed 397 EPS procedures on 349 patients. There were 144 males, 205 females, age 5 to 90. The indications for sphincterotomy were SOD, recurrent acute pancreatitis, chronic pancreatitis, pancreatic duct stones, ampullary polypectomy, pancreatic fistula, and pseudocyst drainage. 238 EPS (60%) had nasopancreatic drainage, 132 (33%) were accompanied by PD stent placement, and 27 (7%) had no drainage. 332 (84%) EPS were of the major papilla in 293 patients and 65 (16%) were of the minor papilla performed in 56 patients. 10 patients had both major and minor duct sphincterotomies on different occasions. Follow-up has been for a median of 34 months with a minimum follow-up of 6 months. RESULTS: There were 22/397 (5%) shortterm complications consisting of mild pancreatitis (N=13), mild or moderate bleeding (N=2), mild perforation (N=2), cholangitis, stent migration, pain relieved by stent removal, and premature patient removal of a nasopancreatic drain (N=1 each). There were no requirements for surgery and no deaths. Long-Term Follow-Up: 39 of 397 (10%) EPS were repeat sphincterotomies performed in 34 patients for incomplete initial EPS (n=4), for additional therapies, such as stone removal, ampullary polypectomy or pseudocyst drainage (n=19), and for restenosis with recurrent symptoms (n=16). In these last 16 (4%), 6 were minor duct EPS (6/65=9.2%) compared to 10 major duct EPS (10/332=3%; p=0.03). Of the 16, 7 had underlying chronic pancreatitis characterized by ongoing disease and inflammation. There was only 1 complication in the repeat EPS group comprising minor bleeding after EPS extension to remove a migrated PD stent. IMPRESSION: Our previously described technique of pull-type pancreatic sphincterotomy is both safe and effective in moderate to long-term follow-up.We employ nasopancreatic drainage to avoid the risks and costs of pancreatic stenting when post sphincterotomy drainage beyond 24 hours is not anticipated. There is a very low incidence of restenosis. Minor duct sphincterotomy is more likely to restricture compared to major duct EPS.

Endoscopic pancreatic sphincterotomy: indications, outcome, and a safe stentless technique

Background: Endoscopic pancreatic sphincterotomy is less widely practiced than biliary sphincterotomy, in part because of the lack of firm data regarding its indications and safety. In addition, recent reports of ductal and parenchymal changes occurring after pancreatic stenting raise concerns about the standard practice of stent placement at the time of pancreatic sphincterotomy. We report our experience with pancreatic sphincterotomy and describe the use of a technique involving overnight nasopancreatic drainage rather than stenting. Methods: We reviewed the records of the 164 pancreatic sphincterotomies performed on 160 patients at our institution between January 1, 1991, and October 1, 1996, comparing procedures done with overnight nasopancreatic catheter placement with those done with stenting or no drainage. We also examined the long-term clinical outcome of patients after pancreatic sphincterotomy. Results: Of the 164 sphincterotomies, 98 were done with overnight nasopancreatic drainage, 50 with stent placement, and 16 with no drainage. Complications (all pancreatitis) were significantly more frequent in the group with no drainage (12.5%) as compared with those with drainage (0.7%); p < 0.003. Nasopancreatic drainage was as safe as stent placement, with no complications after 98 procedures. Pancreatic sphincterotomy was effective when used as primary therapy, with 64% of patients so treated experiencing complete and long-lasting resolution of symptoms after the procedure. Conclusions: Pancreatic sphincterotomy is safe and effective, although pancreatic drainage is required to reduce the incidence of pancreatitis. Overnight nasopancreatic drainage is the method of choice, as it carries as low a complication rate as stent placement, but without the need for a repeat procedure, and presumably without the risk of ductal and parenchymal damage. (Gastrointest Endosc 1998;47:240-9.)

Vasovasostomy — is the microscope necessary?

Many techniques for vasovasostomy have been described, with each author suggesting his technique as the most effective procedure. Theoretical considerations such as leakage of sperm, obstruction, and narrowing of anastomosis suggest that a stentless technique with exact approximation of mucosal edges results in improved success rates. Careful macroscopic surgery with loupes, fine suture material, and experience on the part of the surgeon will give good results and pregnancy rates of 50 per cent. The value of microsurgery, however, becomes obvious when the anastomosis is performed in the convoluted portion of the vas and the epididymis. The microscope allows more mobility in allowing one to determine if the patient has a block proximal to the vasectomy site and then bypass these blocks. The success of vasovasostomy depends greatly on the surgeon's experience with the actual surgical technique. Although technique is of paramount importance, there are factors other than technique that determine the pregnancy rate. Factors important in the success of vasovasostomy, macro- and microscopic techniques, basic concepts, principles and techniques of the various procedures, and the merits and limitations of each procedure, will be discussed.

Vasovasostomy—Microscopic Versus Macroscopic Techniques

Many different surgical techniques of vasovasostomy can be successful. Many factors, both technical and nontechnical, play a role in determining pregnancy. Theoretical considerations such as leakage of sperm, obstruction and narrowing of the anastomosis, suggest that a stentless technique with exact approximation of mucosal edges will result in a better success rate. Careful macroscopic surgery with the use of fine suture material, and experience on the part of the surgeon, will give good results and pregnancy rates of up to 50%. Microsurgery becomes quite important when the anastomosis is performed in the convoluted portion of the vas and epididymis. The microscope allows more mobility in permitting one to determine if the patient has a block proximal to the vasectomy site, and then bypass these blocks. Conventional macroscopic techniques do not allow for this freedom of choice. Factors other than technique are also important and are discussed.