Ultrasound-guided Sclerotherapy Research Articles

Ultrasound-guided Sclerotherapy of a Hemorrhagic Splenic Cyst

Ultrasound-guided Sclerotherapy of a Hemorrhagic Splenic Cyst

Preliminary analysis of clinical effect observation and prognostic recurrence factors of ultrasound-guided sclerotherapy of renal and hepatic cysts

Preliminary analysis of clinical effect observation and prognostic recurrence factors of ultrasound-guided sclerotherapy of renal and hepatic cysts

Prise en charge des endométriomes en France : enquête de pratiques

ObjectivesTo present an overview of French practices for the management of endometriomas. MethodsWe carried out a nationwide survey of practices concerning the management of endometriomas between October 2021 and January 2022. This study was carried out by means of two questionnaires sent to surgical centers used to treat endometriosis (n=62) and to Assisted Reproductive Technology (ART) centers (n=102). ResultsAt the end of the survey, 39/62 (62.9%) surgical teams from the centers contacted had given a response and 51/102 (50.0%) from ART centers. Laparoscopic cystectomy was the technique most frequently used by almost two thirds of the surgical teams (61%) when there was no known infertility, whereas it was the most common technique for only 14% of the ART teams. On the contrary, ultrasound-guided sclerotherapy was the most frequent technique for more than half of the ART teams (56%) and for only 8% of the surgical teams. In case of recurrence, 49% of surgical teams would choose ultrasound-guided sclerotherapy. Prior to IVF, 73% of ARP teams stated that they ‘rarely’ treated endometriomas. ConclusionThe results of our study show a certain variability in practices between different centers and depending on the presence or absence of infertility for the management of endometriomas in France.

Comparison of the Efficacy and Safety of Ultrasound-Guided Sclerotherapy versus Cystectomy for the Treatment of Ovarian Endometriomas: A Systematic Review and Meta-Analysis

Background: Ultrasound-guided sclerosis has been used to treat ovarian endometriotic cysts since 1988. However, compared with cystectomy, sclerotherapy's effectiveness and safety are questionable. Objective: To compare ultrasound-guided sclerotherapy and ovarian cystectomy in the treatment of ovarian endometriosis through a systematic review and meta-analysis. Methods: PubMed-MEDLINE, EMBASE, Cochrane, and Scopus databases were searched, and related literature was collected. The two treatments' recurrence rate, pain relief rate, pregnancy rate, technical success rate, and complication rate were directly compared. Results: Six studies (386 patients) were included. The risk of recurrence with sclerotherapy was higher than that with cystectomy (OR 1.57, p = 0.52). Subgroup analysis showed that an indwelling time > 10 min was not significantly different regarding recurrence risk between sclerotherapy and cystectomy (OR 1.01, p = 0.99). When the indwelling time was ≤ 10 min, the risk of recurrence with sclerotherapy was significantly higher than that with cystectomy (OR 22.01, p = 0.001). The pregnancy rate after cystectomy was lower than that after sclerosis (OR 1.67, p = 0.22). Complications in the study were graded according to the Clavien‒Dindo classification and statistical analysis showed that the probability of serious complications (Grade III-V) with cystectomy was higher than that with sclerosis (16.67% vs. 0%). Conclusion: Ultrasound-guided sclerotherapy was not inferior to cystectomy in terms of recurrence rate or pregnancy rate, and the incidence of severe complications was lower than that in the cystectomy group. Sclerotherapy is a safe and effective alternative treatment for ovarian endometriosis.

Effects of lauromacrogol injection under contrast-enhanced ultrasound guidance on cesarean scar pregnancy: a prospective cohort study.

Compared with the current commonly used pretreatment approaches, the therapeutic effect of contrast-enhanced ultrasound-guided sclerotherapy with lauromacrogol injection (CEUSL) on cesarean scar pregnancy (CSP) is not clear. This study aimed to investigate the clinical efficacy and safety of CEUSL compared with gelatin sponge uterine artery embolization (UAE) and UAE combined with methotrexate (UAEM) in the pretreatment of CSP to prevent massive bleeding during subsequent curettage. Sixty-four patients were divided into the CEUSL (n=20), UAE (n=22), and UAEM (n=22) groups. All patients with CSP underwent curettage and hysteroscopy after CEUSL, UAE, or UAEM pretreatment. The efficacy and safety indicators after pretreatment were analyzed. Time for pretreatment [95% confidence interval (CI): 31.92-39.28] and hospitalization cost (95% CI: 7,852.32-9,063.23) were significantly decreased in the CEUSL group compared with that in the UAE (95% CI: 53.55-59.99% and 95% CI: 12,901.42-15,166.63, respectively) and the UAEM group (95% CI: 52.90-58.83 and 95% CI: 11,324.66-13,302.69, respectively; P<0.001). The beta human chorionic gonadotropin (β-hCG) percentage decrease 24 hours later and the hospital stay were significantly decreased in the CEUSL group (95% CI: 0.65-0.70 and 95% CI: 3.32-4.58 days, respectively) compared with those in the UAE (95% CI: 0.67-0.74 and 95% CI: 4.06-5.84, respectively) or UAEM (95% CI: 0.62-0.68 and 95% CI: 4.12-5.88, respectively) groups (P<0.05). After pretreatment, there were significantly fewer patients (P<0.05) with fever (95% CI: -0.52 to -0.093), pelvic pain (95% CI: -0.427 to -0.018), increased white blood cell count (95% CI: -0.359 to 0.040), and hypersensitive C-reactive protein (hs-CRP) elevation (95% CI: -0.572 to -0.118) in the CEUSL group than in the UAE or UAEM groups. At follow-up, all patients resumed normal menstruation, with no residual gestational sac on ultrasound imaging or sequel. The pretreatment procedures were all technically successful, with good outcomes in different pretreatment procedures. Compared with UAE with or without methotrexate, CEUSL may be as effective and safe for pretreatment of CSP, with fewer adverse effects and shorter pretreatment time and hospital stay.

Low Complication Rates Studied in a Large US-Based Series of Ultrasound-guided Sclerotherapy Procedure For Varicose Veins

Low Complication Rates Studied in a Large US-Based Series of Ultrasound-guided Sclerotherapy Procedure For Varicose Veins

Efficacy and preliminary dose studies of ultrasound-guided sclerotherapy with lauromacrogol for the treatment of implanted hepatic tumors in rabbits.

To study the curative effect of sclerotherapy with lauromacrogol on a rabbit VX2 implanted liver tumor model, the effect of ultrasound-guided sclerotherapy with different doses of lauromacrogol in the treatment of the rabbit VX2 implanted liver tumor model and the degree of damage to the surrounding liver tissue was compared and observed. The relationship between the sclerosing effect and drug dose of lauromacrogol in the treatment of liver cancer is preliminarily discussed. Thirty rabbit models of liver cancer were randomly divided into 5 groups. Control Group A was injected with normal saline, control Group B was injected with absolute ethanol, experimental Group C was injected with lauromacrogol (Z =2.885D); the injection volume in experimental Group D was 1.5-fold higher than that in Group C; and the injection volume in experimental Group E was 2-fold higher than that in Group C. Changes in tumor volume were followed up by ultrasound before and 7 and 14 days after the operation; contrast-enhanced ultrasonography was used to measure the volume of the ablation area and volume rate. For pathological anatomy, hematoxylin and eosin (H&E) staining were used to observe tumor cell necrosis and the degree of damage to surrounding normal liver cells. The expression levels of the apoptosis-related protein cleaved-caspase 3 and the cell proliferation antigen Ki67 were examined by immunohistochemistry. The volumes in Groups A and C increased significantly. The volumes in Groups B, D, and E remained the same or slightly expanded, tumor growth in the three groups was significantly inhibited after sclerotherapy. Contrast-enhanced ultrasonography showed that the ablation volume and ablation volume rate in Groups B, D, and E were similar. Group C were smaller than those in the other treatment groups. Large coagulative necrotic foci were observed in the central area of tumors in Groups B, D, and E. The experiment demonstrates that lauromacrogol can inhibit tumor growth in the rabbit VX2 tumor model and cause VX2 tumor cell apoptosis. The sclerosing effect of the 1.5-fold amount of lauromacrogol is equivalent to that of absolute ethanol, with little effect on normal liver tissue.

Establishment of an interdisciplinary vascular anomalies program in Tanzania, East Africa.

The aim of this project is the sustainable implementation of a vascular anomalies (VA) program in Tanzania. In 2021 the first interdisciplinary VA program was initiated at Muhimbili National Hospital (MNH), Dar Es Salaam, Tanzania in a stepwise approach. During the planning phase the clinical need for minimally-invasive therapies of VAs and the preexisting structures were assessed by the local Interventional Radiology (IR) team at MNH. During the initiation phase, an IR team from two German VA centers joined the interdisciplinary team at MNH for clinical workup, image-guided procedures and follow-up. VA patients were recruited from existing patient records or seen at clinics as de novo presentations following nationwide advertisement. In the post-processing phase joined online conferences for follow-up and support in management of new patients were established. Further follow-up was supported by attending providers from other established VA centers, traveling to bolster the primary operators of MNH. The first interdisciplinary VA program was successfully launched in Tanzania. Minimally-invasive treatments were successfully trained, by performing ultrasound-guided sclerotherapy with polidocanol and bleomycin in twelve patients with slow-flow malformations, one endovascular embolization of a high-flow malformation, and medical treatment of an aggressive infantile hemangioma. Regular online follow-up presentations have been initiated. Follow-up evaluation and required treatment was sustained when appropriate. The presented "hands-on" training set the ground for the first interdisciplinary VA program in Tanzania. This framework is expected to establish comprehensive and sustainable care of patients with VAs in East Africa and can serve as a blueprint for other sites.

Klippel-Trenaunay Syndrome of the Extremities- A Report of Two Cases

Klippel-Trenaunay Syndrome (KTS) is a rare disorder, with an incidence of 1 in 100,000 people worldwide. The hallmark features of this syndrome include venous malformations, capillary malformations, and soft tissue hypertrophy. There is no gender or racial predilection and it manifests in childhood. It usually involves one limb, predominantly the lower limb. But, in rare incidences, upper limb involvement is also reported. The common presentation of KTS is pain with spontaneous cutaneous haemorrhage, soft tissue enlargement, venous thrombosis, leg length discrepancy, cortical thickening, macular patches and phleboliths. The present case report described two patients (both females) with KTS, who visited the hospital. One of them was an adult female, presented with left lower limb swelling. Computed Tomography (CT) showed, multiple dilated lower limb veins, draining into the internal iliac and deep femoral veins. Following this, the patient had undergone one cycle of Ultrasound Guided Sclerotherapy (UGS) and was advised to follow-up. The patient underwent subsequent two cycles of UGS at an interval of three months. Another patient was of the paediatric age group, presented with swelling and pain in the left lower limb. Magnetic Resonance Imaging (MRI) revealed, multiple veno-capillary malformations with a Persistent Sciatic Vein (PSV). Liposuction of the bilateral gluteal region was performed with the application of topical Neosporin and was advised to follow-up. After five months, Ultrasonography (USG) of the bilateral gluteal region was done, which was normal with no obvious residual disease.

Endoscopic ultrasound guided lauromacrogol sclerotherapy for a large splenic cyst.

Symptomatic splenic cyst is usually managed by surgical resection or ultrasound-guided percutaneous sclerotherapy. In the present case, we demonstrated the safety and feasibility of endoscopic ultrasound-guided sclerotherapy for treatment of splenic cyst. As far as we known. This is the first case report concerning EUS-guided sclerotherapy for splenic cyst.

Routine use of concurrent fluoroscopic imaging during superficial endovenous interventions: A position statement of the International Union of Phlebology, the Australasian College of Phlebology, the Australia and New Zealand Society for Vascular Surgery, the American Venous Forum, the American Vein and Lymphatic Society, the European College of Phlebology and the Interventional Radiology Society of Australasia.

International evidence-based guidelines recommend preoperative duplex ultrasound mapping in the assessment of chronic venous disease, and concurrent ultrasound imaging to guide superficial endovenous interventions such as endovenous laser ablation, radiofrequency ablation, cyanoacrylate adhesive closure, and sclerotherapy (ultrasound-guided sclerotherapy). Other imaging modalities such as venography, alone or in combination with computed tomography scan or magnetic resonance imaging, may be included in the preoperative assessment of a small and select group of patients to exclude central venous obstruction, certain deep venous pathologies, pelvic origin extrapelvic varices, and complex vascular malformations. The signatory scientific and medical societies recommend against the routine use of fluoroscopy and other radiation-based imaging in the investigation and treatment of superficial venous disease.

S2847 Long-Term Follow-Up of Hepatic Cyst After Endoscopic Ultrasound-Guided Sclerotherapy

Introduction: Hepatic cysts can be found in up to 18% of the population. (1) In most cases they are benign, asymptomatic and do not require any intervention. For symptomatic cysts, management includes surgical unroofing or sclerotherapy. Endoscopic ultrasound (EUS)-guided sclerotherapy with ethanol has emerged as an alternative to surgical intervention and percutaneous drainage (PCD) with sclerotherapy. There is few long-term data and randomized control trials comparing the efficacy of these interventions. This case highlights the outcome of EUS-ablation with ethanol for hepatic cyst after long-term follow up. Case Description/Methods: Patient is a 47-year-old female with a history of Systemic Lupus Erythematous who initially presented with dyspnea and intermittent right upper quadrant pain then found to a large hepatic cyst on echocardiogram. Her cardiopulmonary workup was otherwise unremarkable. Liver function tests were within normal limits. She underwent liver MRI which showed a 6.9cm left lobe (segment III) unilocular hepatic cysts. Tumor markers were negative. She was referred to GI and EUS-guided cyst ablation with ethanol was performed. Analysis of cyst fluid was benign. CT 1 month after ablation showed decreased hepatic cyst to 3.5cm and patient reported significant improvement in symptoms. Two months later, a second EUS-guided ablation was done in attempt to achieve complete cyst eradication. MRI after second ablation demonstrated further decrease in size of hepatic cyst to 2.6cm. Seventeen months after initial ablation imaging showed stable reduction in size of hepatic cyst (1.8cm). Discussion: Prior to interventions for simple hepatic cysts, it is necessary to ensure that symptoms are not from alternative etiologies. The approach to management of symptomatic simple hepatic cysts depends on location, comorbidities and patient preference. EUS-guided sclerotherapy is a promising alternative to surgery and PCD with sclerotherapy. A single center retrospective study reported 100% cyst reduction at 15 month follow up in the group that received EUS guided sclerotherapy. EUS-guided ablation allows for easier access to the left, caudate and posterior segments of the liver compared to PCD and is overall safe. (2)

Routine use of concurrent fluoroscopic imaging during superficial endovenous interventions: A position statement of the International Union of Phlebology (UIP), the Australasian College of Phlebology (ACP), the Australia and New Zealand Society for Vascular Surgery (ANZSVS), the American Venous Forum (AVF), the American Vein and Lymphatic Society (AVLS), the European College of Phlebology (ECoP) and the Interventional Radiology Society of

International evidence-based guidelines recommend preoperative duplex ultrasound mapping in the assessment of chronic venous disease, and concurrent ultrasound imaging to guide superficial endovenous interventions such as endovenous laser ablation, radiofrequency ablation, cyanoacrylate adhesive closure, and sclerotherapy (ultrasound-guided sclerotherapy). Other imaging modalities such as venography, alone or in combination with computed tomography scan or magnetic resonance imaging, may be included in the preoperative assessment of a small and select group of patients to exclude central venous obstruction, certain deep venous pathologies, pelvic origin extrapelvic varices, and complex vascular malformations. The signatory scientific and medical societies recommend against the routine use of fluoroscopy and other radiation-based imaging in the investigation and treatment of superficial venous disease.

Options in the treatment of superficial and deep venous disease in patients with Klippel-Trenaunay syndrome

ObjectiveKlippel-Trenaunay syndrome (KTS) is a congenital mixed mesenchymal malformation syndrome that includes varicose veins, capillary and venous malformations, lymphatic abnormalities, and hypertrophy of various connective tissue elements. The purpose of the present study was to describe the clinical characteristics and outcomes in a subset of patients with KTS in whom venous interventions, including iliofemoral venous stenting, were performed after failure of conservative therapy. MethodsA single-center retrospective data review of 34 patients with KTS who had undergone interventions for venous disease between January 2000 and December 2020 was performed. ResultsTheir mean age was 38.4 ± 17.5 years (range, 12-80 years). No gender predilection was found. Of the 34 patients, 61% had had all three features of the classic triad for KTS. Varicose veins were present in all 34 patients (100%), and 30% had had a history of bleeding varicosities. Most patients (79%) had CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) class ≥C4. Of the 34 patients, 30% had a history of deep vein thrombosis and/or pulmonary embolism. Factor VIII elevation was the most common thrombophilia condition (12%). The venous filling index was elevated at baseline (5.9 ± 5.1 mL/s) and did not normalize despite intervention (3.5 ± 2.3 mL/s; P = .04). The superficial venous interventions (n = 35) included endovenous laser therapy; stripping of the great saphenous vein, small saphenous vein, anterior thigh vein, or marginal vein; ultrasound-guided sclerotherapy; and stab avulsion of varicose veins. One coil embolization of a perforator vein was performed. Deep interventions (n = 19) included endovenous stenting (n = 15), popliteal vein release (n = 3), and valvuloplasty (n = 1). The venous clinical severity score had improved from 9.4 ± 4.5 to 6.2 ± 5.6 (P = .04). The visual analog scale for pain score had improved from 5.5 ± 2.7 to 2.5 ± 3.3 (P = .008). Healing of ulceration was noted in 75% of the patients. Significant improvements in the total pain (P = .04) and total psychological (P = .03) domains were noted in the 20-item chronic venous disease quality of life questionnaire. ConclusionsSuperficial and deep venous interventions are safe and effective in patients with KTS when conservative therapy has failed. Iliofemoral venous stenting is a newer option that should be considered in the treatment of chronic deep venous obstructive disease in patients with KTS in the appropriate clinical context. An aggressive perioperative deep vein thrombosis prophylaxis protocol should be in place to reduce thromboembolic complications in these patients.

Incompetent perforators do care!

The problem with all reviewed papers is that the results are influenced by concomitant treatments and the assumption that the incompetent perforating veins were treated properly. The study of van Gent and Wittens 1 van Gent W. Wittens C. Influence of perforating vein surgery in patients with venous ulceration. Phlebology. 2015; 30: 127-132 Crossref PubMed Scopus (14) Google Scholar showed that, if you treat the incompetent perforators well, the recurrence rate of an ulcer decreases significantly. This finding shows the importance of persistent incompetent perforating veins in ulcer recurrence. Therefore, in this well-performed systematic review we miss the information; for if indeed all incompetent perforators were occluded and we can only conclude that, with the existing techniques and gathered documentation, we do not have proof that incompetent perforators need to be treated. However, the right conclusion needs to be that incompetent perforators do matter in the pathophysiology of a venous leg ulcer, but that we failed to treat them properly with existing techniques. Therefore, we need to improve existing techniques and especially we need to check after 3 months and 1 year to determine whether the treated incompetent perforators remain occluded and if so document what the outcome is. 2 Ho V.T. Adkar S.S. Harris E.J. Systematic review and meta-analysis of management of incompetent perforators in patients with chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2022; 10: 955-964 Google Scholar Systematic review and meta-analysis of management of incompetent perforators in patients with chronic venous insufficiencyJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 10Issue 4PreviewIncompetent perforator veins (IPVs) contribute to venous pathology and are surgically treated based on hemodynamic measurements, size, and the CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) classification. The objective of the present study was to systematically review and synthesize the current literature regarding the surgical management of IPVs, including open ligation, subfascial endoscopic perforator surgery (SEPS), endovascular laser ablation, ultrasound-guided sclerotherapy, and radiofrequency ablation. Full-Text PDF

Sclerotherapy of Symptomatic Nonparasitic Splenic Cysts: Excellent Long-Term Treatment Response'

Abstract Background Splenic cysts are rare and occur in 0.5 to 2% of the population. They are usually asymptomatic and do not require therapy. In case of symptomatic nonparasitic splenic cysts, potential therapy includes partial splenectomy or laparoscopic cyst de-roofing as well as ultrasound-guided sclerotherapy with 1% polidocanol or 10% sodium chloride (NaCl) as an interventional alternative. So far, single-session sclerotherapy of symptomatic nonparasitic cysts is recommended only if clear-transparent cyst fluid is aspirated. Materials and Methods We report a case series of 17 patients with symptomatic macroscopically turbid nonparasitic splenic cyst fluid who underwent ultrasound-guided fine needle sclerotherapy with either polidocanol ± 10% NaCl (n = 12) or 10% NaCl alone (n = 5) and a follow-up of a maximum of 12 years after first intervention. Clinical, sonographic, and laboratory chemistry data were recorded at baseline and during the follow-up. Results The mean follow-up time was 43.65 ± 40.18 months. At the end of the follow-up, a 79% reduction of cyst size was achieved. The maximum size reduction in the polidocanol group was 76 ± 18% and 84 ± 21% in the sodium chloride group (p &gt;0.05). At the end of follow-up, 15 out of the 17 patients did not have any further symptoms. Despite the cystic fluid being turbid, it was hardly possible to detect a microbiological superinfection. Conclusion Sclerotherapy of splenic cysts leads to a significant size regression in all patients, independent of the sclerotherapy agent used with fewer systemic toxic side effects of polidocanol treatment. It was shown that in a tertiary care center with significant experience, sclerotherapy of splenic cysts is also safe and successful and can lead to a drastic regression of cyst size and symptoms. This shows that interventional therapy is a good alternative to surgical procedures.

Nursing and Curative Effect Observation of Ultrasound-guided Puncture Sclerotherapy of Ovarian Cyst

Nursing and Curative Effect Observation of Ultrasound-guided Puncture Sclerotherapy of Ovarian Cyst

Efficacy of Ultrasound Guided Foam Sclerotherapy of Incompetent Ankle Perforators on Healing of Chronic Venous Ulcers with Deep Venous Reflux. (A Comparative Study)

Abstract Background Compression therapy is the standard of care for venous ulcers and chronic venous insufficiency, but the treatment of underlying venous disease to relieve venous hypertension appears to improve wound healing and to decrease recurrence. Benefits of saphenous ablation have been well demonstrated; however, evidence for the treatment of incompetent perforating veins is less clear. Objective To assess the benefit of ultrasound-guided sclerotherapy (USGS) of incompetent perforator on healing of chronic venous ulcers. Patients and Methods This is a prospective cohort study which is a double arm clinical study to assess the healing rate for patients after USGFS vs standard compression therapy of patients with incompetent perforators veins within 6 month. Results Our preliminary data add further weight to the suggestion that eradication of SVR by means of UGFS improves CVU outcomes when compared to compression alone. In this regard, UGFS appears to be more effective more than compression therapy does, therefore, appear the more attractive option in this elderly patient population. Furthermore, the follow-up data presented here does suggest long-term healing following UGFS probably requires careful follow-up and, if required. Encouraged by these promising early results the authors have embarked upon a larger study to look at the role of UGFS in the treatment of CVU in greater depth. Conclusion Ultrasound guided foam sclerotherapy of perforator incompetent veins is a welltolerated and effective outpatient procedure. This study presents a patient cohort with limited exclusion criteria, allowing a representative cross section of VLU in general. Because of its higher healing rate and lower RR compared to other therapeutic options, and the improvement in quality of life that it brings, this minimally invasive, easily repeatable procedure may become the treatment of choice for VLU. Foam sclerotherapy is a simple procedure, compared to surgical intervention, no hospitalization, no anesthesia, can be done in outpatient clinic and the patient can return home after 45 min and no work off period. The relative freedom from serious complications and its evident success, makes this modality as a possible candidate for being the first line treatment for venous ulcers.

Ultrasound-guided sclerotherapy for the treatment of ovarian endometrioma: an updated systematic review and meta-analysis.

To determine the efficacy and safety of ultrasound (US)-guided sclerotherapy for the treatment of ovarian endometrioma through a systematic review and meta-analysis. MEDLINE and EMBASE databases were searched for studies reporting outcomes in patients with endometrioma who were treated with US-guided sclerotherapy. Meta-analyses of recurrence, pain resolution, pregnancy, technical success, and complication rates were analyzed. Subgroup analyses were conducted regarding the indwelling time of sclerotherapy (≤ 10min vs > 10min). Twenty-eight studies (1301 patients) were included. The pooled technical efficacy was 98.3%. The pooled estimates of recurrence, pain resolution, and pregnancy rate were 13.8%, 85.9%, and 37.6%, respectively. The pooled major complication rate was 1.7%. A sclerotherapy time > 10min had a lower pooled recurrence rate than a time ≤ 10min (11.2% vs 20.9%; p = 0.106). Direct comparisons showed that the recurrence rate was significantly lower with sclerotherapy > 10min than with sclerotherapy ≤ 10min (OR, 0.2; p = 0.015). Regarding pregnancy rates, sclerotherapy of > 10min showed no significant difference compared with sclerotherapy of ≤ 10min (35.9% vs 38.8%; p = 0.664). Direct comparisons with surgery showed that sclerotherapy increased the pregnancy rate compared with surgery (OR, 2.0; p = 0.042). There was no significant difference in AMH level before and after sclerotherapy (p = 0.951). There was no significant difference in major complication rates between sclerotherapy > 10min and ≤ 10min (p = 0.837). US-guided sclerotherapy seems to be an effective and safe therapeutic option regarding recurrence, pain resolution, and pregnancy for patients with ovarian endometrioma. • US-guided sclerotherapy seems to be an effective and safe therapeutic option regarding recurrence, pain resolution, and pregnancy for patients with ovarian endometrioma. • Sclerotherapy of more than 10min had a lower recurrence rate than sclerotherapy less than or equal to 10min. There was no significant difference in major complication rates between sclerotherapy of > 10min and ≤ 10min. • Future randomized controlled trials are warranted to compare the outcomes of US-guided sclerotherapy with surgery.

Ultrasound in pediatric surgery; intraoperative applications of the growing technology

BackgroundUltrasonography is increasingly used in pediatric surgery. Intraoperatively, ultrasonography can be used to confirm the preoperative diagnosis, guide the surgical approach, and enhance decision-making. We aimed to report our experience with intraoperative ultrasonography in different neonatal and pediatric procedures. So, a retrospective study was designed. It included all pediatric patients who had intraoperative ultrasound between January 2018 and October 2020 in a single center.ResultsWe used intraoperative ultrasonography in 208 pediatric patients for various types of surgery. The authors compared ultrasound-guided central line insertion (n = 139) to the landmark method (n = 153). The number of trials was significantly lower in the ultrasound-guided method (P < 0.001). Conversion to cut-down was significantly lower with the ultrasound-guided technique (4 (2.8%) vs. 13 (8.5%); P = 0.047) and insertion-related complications were lower with ultrasound (0 vs 13 (8.5%); P < 0.001). We used ultrasound-guided sclerotherapy for cystic hygroma in 15 patients. Nine patients had successful treatment with a single injection (60%).ConclusionThe application of intraoperative ultrasound in pediatric patients is increasing in our institution. The technique is safe and could effectively reduce central line insertion complications and enhance cystic hygroma sclerotherapy’s success with a single injection. Ultrasonography should be an essential part of residents’ and fellows’ training in pediatric surgery.