Over-the-Scope Clip Application Yields a High Rate of Closure in Gastrointestinal Perforations and May Reduce Emergency Surgery

Background

Perforation of the gastrointestinal tract may cause various complications and may require emergency surgery, even in patients with significant comorbidities.

Methods

Seventeen consecutive patients with indication for surgery due to a visible gastrointestinal perforation were treated with OTSC application. In this study, cause of perforation, estimated size, location, rate of perforation closure, outcome and complications were reported.

Results

In 11 of 17 patients (64.7?%), OTSC application resulted in permanent closure of perforations, thus avoiding surgery. All 11 successful cases had smaller perforation lengths (5.5?±?1.9?mm, p?<?0.02), widths (3.7?±?0.9?mm) or area (21.1?±?9.1?mm²), had vital margins of perforations and 1.1?±?0.3 OTSC per patient were necessary. The six unsuccessful cases (35.3?%) showed larger perforation lengths (13.4?±?8.8?mm, p?<?0.02), widths (5?±?4.5?mm) and area (97.6?±?149?mm²), had necrotic or soft inflammatory margins and significantly more OTSC (2.3?±?0.5, p?=?0.018) were tried.

Conclusions

OTSC application yields a high rate of endoscopic perforation closure in patients with macroscopic gastrointestinal perforation, even in an emergency setting, representing an alternative to surgery, especially when the size of the lesion is not too large and when vital or solid perforation margins are expected.     

Does bladder wall thickness decrease when obstruction is resolved?

Introduction and hypothesis

The aim of the current study was to determine if sonographic bladder wall thickness diminishes after symptomatic obstruction is resolved in female patients after stress incontinence surgery.

Methods

Between December 2008 and December 2010, 62 female patients with symptomatic bladder outlet obstruction, as defined by Blaivas, who had undergone prior surgery for urinary stress incontinence were included in the study. The patients’ history was taken and symptoms were noted. Patients underwent gynaecological examination, and multichannel urodynamic assessment was performed. Vaginal sonographic assessment of the bladder wall thickness (BWT) was performed before and after urethrolysis.

Results

62 patients were included in this study, 55 of whom had undergone suburethral sling insertion and seven had Burch colposuspension. Postoperatively, BWT decreased significantly from 9.1?mm?±?2.1 to 7.6?mm?±?2.2 (p?p?Conclusions If obstruction is resolved, bladder wall thickness decreases. Preoperatively elevated residual urine may increase the risk of persistent obstruction after urethrolysis.     

A safety,length of stay,and cost analysis of minimally invasive microsurgery for anterior circulation aneurysms

Objectives

The aim of our study was to evaluate minimally invasive techniques for the treatment of anterior circulation aneurysms versus standard surgery, and to calculate the impact of these techniques on health resources, length of stay, and treatment costs.

Methods

A consecutive series of 24 patients with ruptured and 30 with unruptured anterior circulation aneurysms treated with minimally invasive microsurgery (MIM) by the same surgeon was compared with a matched series of standard microsurgeries (SM) conducted for 23 ruptured and 22 unruptured aneurysms. Complication rates, aneurysm obliteration, modified Rankin Scale (mRS) outcomes, length of stay, and treatment costs were assessed.

Results

Surgical complications, aneurysm obliteration rates and mRS outcomes were comparable between MIM and SM groups in ruptured and unruptured aneurysm cohorts. MIM resulted in shorter operative times both in unruptured (102.7?±?4.35 vs 194.7?±?10.26 min, p?<?0.0001) and ruptured aneurysms (124.3?±?827 vs 209?±?13.84 min, p?<?0.0001). Length of stay was reduced in patients with MIM for unruptured aneurysms (1.55?±?24 vs 4.28?±?0.71 days, p?<?0.000,1) but not in those with ruptured aneurysms. MIM reduced treatment costs of unruptured aneurysm patients, mainly through reduced utilization of inpatient resources (non-acute bed costs in CAD: 371.2?±?80.99 vs 1440?±?224.1, p?<?0.0001), whereas costs were comparable in patients with ruptured aneurysms.

Conclusion

Minimally invasive surgery is a safe and effective approach for the treatment of ruptured and unruptured aneurysms of the anterior circulation. In patients with unruptured aneurysms, reduced invasiveness and shorter operative times decreased length of stay, which reflects improved patient postoperative recovery. Overall, this translated into bed resource economy and cost reduction.     

Using stress MRI to analyze the 3D changes in apical ligament geometry from rest to maximal Valsalva: a pilot study

Introduction and hypothesis

A method was developed using 3D stress magnetic resonance imaging (MRI) and was piloted to test hypotheses concerning changes in apical ligament lengths and lines of action from rest to maximal Valsalva.

Methods

Ten women with (cases) and ten without (controls) pelvic organ prolapse (POP) were selected from an ongoing case–control study. Supine, multiplanar stress MRI was performed at rest and at maximal Valsalva and was imported into 3D Slicer v. 3.4.1 and aligned. The 3D reconstructions of the uterus and vagina, cardinal ligament (CL), deep uterosacral ligament (USL_d), and pelvic bones were created. Ligament length and orientation were then measured.

Results

Adequate ligament representations were possible in all 20 study participants. When cases were compared with controls, the curve length of the CL at rest was 71 ±16 mm vs. 59?±?9 mm (p?=?0.051), and the USL_d was 38?±?16 mm vs. 36?±?11 mm (p?=?0.797). Similarly, the increase in CL length from rest to strain was 30?±?16 mm vs. 15?±?9 mm (p?=?0.033), and USL_d was 15?±?12 mm vs. 7?±?4 mm (p?=?0.094). Likewise, the change in USL_d angle was significantly different from CL (p?<?0.001).

Conclusions

This technique allows quantification of 3D geometry at rest and at strain. In our pilot sample, at maximal Valsalva, CL elongation was greater in cases than controls, whereas USL_d was not; CL also exhibited greater changes in ligament length, and USL_d exhibited greater changes in ligament inclination angle.     

Analysis of Microscopic Tumor Spread Patterns According to Gross Morphologies and Suggestions for Optimal Resection Margins in Bile Duct Cancer

Background/purpose

Surgical resection is the only curative treatment for extrahepatic bile duct (EHBD) cancer, but guidelines for optimal resection margins have not yet been established. Therefore, the purpose of this study is to analyze the patterns of microscopic tumor spreads and their lengths according to gross morphology and to suggest optimal resection margins for EHBD cancer.

Methods

A total of 79 patients with EHBD cancers who underwent curative resection at Seoul National University Hospital between 2007 and 2010 were reviewed. Pathologic findings were reviewed by a single specialized pathologist.

Results

Mucosal and mural/perimural spreads were seen in 37.3 and 62.3 %, respectively. The mean length of tumor spreads in the papillary (n?=?13), nodular/nodular infiltrative (n?=?43), and sclerosing types (n?=?23) were 4.5?±?6.3, 1.8?±?6.4, and 6.4?±?6.7 mm, respectively. Spread patterns correlated with gross morphologies (P?<?0.001). The lengths of tumor spreads at the 90th percentile were 15.6, 10.0, and 15.6 mm, respectively.

Conclusions

The patterns of tumor spreads correlated with gross morphologies. Optimal resection margins in EHBD cancers should be 16 mm in the papillary and sclerosing types and 10 mm in the nodular/nodular infiltrative type.     

Angulated locking plate in periprosthetic proximal femur fractures: biomechanical testing of a new prototype plate

Introduction

To improve proximal plate fixation of periprosthetic femur fractures, a prototype locking plate with proximal posterior angulated screw positioning was developed and biomechanically tested.

Methods

Twelve fresh frozen, bone mineral density matched human femora, instrumented with cemented hip endoprosthesis were osteotomized simulating a Vancouver B1 fracture. Specimens were fixed proximally with monocortical (LCP) or angulated bicortical (A-LCP) head-locking screws. Biomechanical testing comprised quasi-static axial bending and torsion and cyclic axial loading until catastrophic failure with motion tracking.

Results

Axial bending and torsional stiffness of the A-LCP construct were (1,633?N/mm?±?548 standard deviation (SD); 0.75?Nm/deg?±?0.23?SD) at the beginning and (1,368?N/mm?±?650?SD; 0.67?Nm/deg?±?0.25?SD) after 10,000 cycles compared to the LCP construct (1,402?N/mm?±?272?SD; 0.54?Nm/deg?±?0.19?SD) at the beginning and (1,029?N/mm?±?387?SD; 0.45?Nm/deg?±?0.15) after 10,000 cycles. Relative movements for medial bending and axial translation differed significantly between the constructs after 5,000 cycles (A-LCP 2.09°?±?0.57?SD; LCP 5.02°?±?4.04?SD; p?=?0.02; A-LCP 1.25?mm?±?0.33?SD; LCP 2.81?mm?±?2.32?SD; p?=?0.02) and after 15,000 cycles (A-LCP 2.96°?±?0.70; LCP 6.52°?±?2.31; p?=?0.01; A-LCP 1.68?mm?±?0.32; LCP 3.14?mm?±?0.68; p?=?0.01). Cycles to failure (criterion 2?mm axial translation) differed significantly between A-LCP (15,500?±?2,828?SD) and LCP construct (5,417?±?7,236?SD), p?=?0.03.

Conclusion

Bicortical angulated screw positioning showed less interfragmentary osteotomy movement and improves osteosynthesis in periprosthetic fractures.     

Gallbladder Lesions Identified on Ultrasound. Lessons from the Last 10?Years

Background

Possible mass lesions identified on ultrasound (US) of the gallbladder may prompt an aggressive surgical intervention due to the possibility of a malignant neoplasm.

Aim

This study aims to utilize a large modern series of patients with gallbladder lesions identified on US to evaluate imaging characteristics consistent with malignancy.

Methods

A retrospective review was conducted of gallbladder ultrasound reports and clinicopathologic data of patients with a mass identified on US.

Results

Approximately 59,271 abdominal ultrasounds and 9,117 cholecystectomies were performed between February 2000 and February 2010. We identified 213 patients with a questionable gallbladder neoplasm on ultrasonography who underwent surgical exploration. Median age was 52?years (range?=?11?C87?years) and 147 (69%) were females. Final pathology demonstrated no neoplasm in 130 patients (61%), while 32 patients (15%) had a wall adenomyoma, 36 (17%) had a polyp (five of which were malignant), 14 (7%) had an adenocarcinoma not arising from a polyp, and one patient had a cystic papillary neoplasm. The smaller the lesion, the more likely it was to be a pseudo-mass. For lesions measuring <5?mm on US, 83% had no lesion found on final pathology. Significant predictors of malignancy were age >52?years (p?p?=?0.004), size >9?mm (p?p?5?mm (p?Conclusions Despite improvements in imaging, most apparent lesions measuring <5?mm on US are not identified in the surgical specimen. US size >9?mm, age >52?years, US suggestion of invasion at the liver interface, and wall thickening >5?mm, especially in the presence of gallstones, should raise the suspicion of malignancy.     

Laparoscopic appendectomy as a teaching procedure: experiences with 1197 patients in a community hospital

Purpose

Since laparoscopic procedures have become more common, resident surgeons have to learn complex laparoscopic skills at an early stage of their career. The aim of this study was to compare the short-term clinical outcome parameters of laparoscopic appendectomy (LA) performed by resident surgeons (RS) or attending surgeons (AS).

Methods

A total of 1197 LA and 57 open appendectomies were performed in a Swiss community hospital between 1999 and 2009. RS performed 684 operations. Parameters including the duration of the operation and hospital stay, intraoperative complications, surgical reinterventions, and a 30-day morbidity and mortality were observed.

Results

The mean age of the patients was 35.6?±?18.17?years. The duration of the operation was longer (61.34?±?25.73?min [RS] vs. 53.65?±?29.89 [AS]?min; p?=?0.0001), but the hospital stay was shorter, in patients treated by RS (3.92?±?2.61?days [RS] vs. 4.87?±?3.23 [AS]?days; p?=?0.0001). The rate of intraoperative complications was not significantly different between the two groups (1.02?% [RS] vs. 0.8?% [AS]; p?=?0.6). The need for surgical reintervention (0.6?% [RS] vs. 2.5?% [AS]; p?=?0.005) and the 30-day morbidity were higher in patients treated by AS (3.7?% [AS] vs. 1.8?% [RS]; p?=?0.04). There was no postoperative mortality.

Conclusions

Under appropriate supervision, surgical residents are able to perform LA with results comparable to those of experienced surgeons.     

Evaluation of cerebral aneurysm wall thickness in experimental aneurysms: Comparison of 3T-MR imaging with direct microscopic measurements

Background

Thin aneurysm wall thickness (AWT) is thought to portend an elevated risk of intracranial aneurysm rupture. Magnetic resonance imaging (MRI) is biased by AWT overestimations. Previously, this suspected bias has been qualitatively described but never quantified. We aimed to quantify the overestimation of AWT by MRI when compared to the gold standard of AWT as measured by light microscopy of fresh aneurysm specimens (without any embedding procedure). This analysis should help to define the clinical potential of MRI estimates of AWT.

Methods

3-Tesla (3T) MRI (contrast-enhanced T1 Flash sequences; resolution: 0.4x0.4x1.5 mm³) was performed in 13 experimental aneurysms. After MR acquisition, the aneurysms were retrieved, longitudinally sectioned and calibrated micrographs were obtained immediately. AWT at the dome, AWT at the neck and parent vessel wall thickness (PVT) were measured on precisely correlated MR-images and histologic micrographs by blinded independent investigators. Parameters were statistically compared (Wilcoxon test, Spearman's correlation).

Results

AWT was assessed and reliably measured using MRI. Interobserver variability was not significant for either method. MR overestimation was only significant below the image resolution threshold: AWT at the dome (0.24?±?0.06 mm vs. MR 0.30?±?0.08 mm; p?=?0.0078; R?=?0.6125), AWT at the neck (0.25?±?0.07 mm vs. MR 0.29?±?0.07 mm; p?=?0.0469; R?=?0.7451), PVT (0.46?±?0.06 mm vs. MR 0.48?±?0.06 mm; p?=?0.5; R?=?0.8568).

Conclusion

In this experimental setting, MR overestimations were minimal (mean 0.02 mm) above the image resolution threshold. When AWT is classified in ranges defined by the MR resolution threshold, clinical usage may be beneficial. Further quantitative and comparative experimental and human studies are warranted to confirm these findings.     

Micro-finite element analysis applied to high-resolution MRI reveals improved bone mechanical competence in the distal femur of female pre-professional dancers

Summary

Micro-finite element analysis applied to high-resolution (0.234-mm length scale) MRI reveals greater whole and cancellous bone stiffness, but not greater cortical bone stiffness, in the distal femur of female dancers compared to controls. Greater whole bone stiffness appears to be mediated by cancellous, rather than cortical bone adaptation.

Introduction

The purpose of this study was to compare bone mechanical competence (stiffness) in the distal femur of female dancers compared to healthy, relatively inactive female controls.

Methods

This study had institutional review board approval. We recruited nine female modern dancers (25.7?±?5.8 years, 1.63?±?0.06 m, 57.1?±?4.6 kg) and ten relatively inactive, healthy female controls matched for age, height, and weight (32.1?±?4.8 years, 1.6?±?0.04 m, 55.8?±?5.9 kg). We scanned the distal femur using a 7-T MRI scanner and a three-dimensional fast low-angle shot sequence (TR/TE?=?31 ms/5.1 ms, 0.234 mm?×?0.234 mm?×?1 mm, 80 slices). We applied micro-finite element analysis to 10-mm-thick volumes of interest at the distal femoral diaphysis, metaphysis, and epiphysis to compute stiffness and cross-sectional area of whole, cortical, and cancellous bone, as well as cortical thickness. We applied two-tailed t-tests and ANCOVA to compare groups.

Results

Dancers demonstrated greater whole and cancellous bone stiffness and cross-sectional area at all locations (p?<?0.05). Cortical bone stiffness, cross-sectional area, and thickness did not differ between groups (>0.08). At all locations, the percent of intact whole bone stiffness for cortical bone alone was lower in dancers (p?<?0.05). Adjustment for cancellous bone cross-sectional area eliminated significant differences in whole bone stiffness between groups (p?>?0.07), but adjustment for cortical bone cross-sectional area did not (p?<?0.03).

Conclusions

Modern dancers have greater whole and cancellous bone stiffness in the distal femur compared to controls. Elevated whole bone stiffness in dancers may be mediated via cancellous, rather than cortical bone adaptation.     

Effects of single dose methylprednisolone on patient recovery after cardiopulmonary bypass

Background

Ischaemic reperfusion injury, systemic inflammatory response and multi-organ dysfunction are not infrequent following Cardiopulmonary Bypass (CPB). We investigated the role of methylprednisolone in minimizing this state.

Subject and Methods

Hundred consecutive patients undergoing elective single heart valve replacement surgery were randomized to receive methylprednisolone 30?mg/kg (M group) or placebo (P group) after induction of anaesthesia. Data were analyzed using the??t?? test and Fischer test.

Results

The cardiac indices in the M and P group were 2.79?±?0.13?L/min/m² and 2.52?±?0.26?L/min/m² respectively (p?<?0.0001). The amount of blood loss in the test versus control group was 268.3?±?65.78?ml/24 hours versus 318.7?±?55.5?ml/24?h respectively (p?<?0.0001) and the amount of blood transfused in the test versus control group was 1.26?±?0.57 units versus 1.76?±?0.8 units respectively (p?=?0.005). Patients in the test group had a lower incidence of early postoperative fever and new-onset atrial fibrillation during the first 3?days postoperatively. There was a statistically significant reduction in the intensive care unit stay (3.52?±?1.16?days versus 4.14?±?1.29?days in the M versus P group, p?=?0.01) but not in hospital length of stay (13.7?±?1.78?days versus 14.2?±?1.52?days in the M versus P group, p?=?0.13), or in overall morbidity and mortality.

Conclusions

The use of methylprednisolone prior to initiation of CPB is associated with a more stable postoperative course with a higher cardiac index, shorter duration of Intensive Care Unit (ICU) stay and fewer blood transfusions. Methylprednisolone use also appears to be associated with a lower incidence of early postoperative fever and new-onset atrial fibrillation.     

Post Roux-en-Y Gastric Bypass Biliary Dilation: Natural Process or Significant Entity?

Background

Changes in the biliary system after gastric bypass are not well defined. Dilation may be normal or due to biliary tract pathology. The purpose of this study is to review patients who underwent imaging of their biliary system both before and after Roux-en-Y gastric bypass in an effort to elucidate the effect this operation has on hepatic duct diameter.

Methods

Patients with imaging both before and at least 3?months after gastric bypass were analyzed. Hepatic duct was measured at the level of the porta hepatis to determine interval changes.

Results

Thirty-three patients had postoperative imaging at least 3?months following gastric bypass. Mean hepatic duct diameter was 5.2?±?2 and 7.1?±?2.6?mm preoperatively and postoperatively, respectively (p?<?0.01). Patients with prior cholecystectomy had hepatic duct diameters of 7.9?±?1.3 and 9.5?±?3.5?mm preoperatively and postoperatively, respectively (p?=?0.3). Patients who had not previously undergone cholecystectomy had hepatic duct diameters of 4.3?±?1.1 and 6.4?±?1.8?mm preoperatively and postoperatively, respectively (p?<?0.01).

Conclusions

Hepatic duct diameter increases after Roux-en-Y gastric bypass. A better understanding of this phenomenon may limit the need for further work-up in patients with incidentally detected biliary dilation.     

Laparoscopic Greater Curve Plication in Asia: Initial Experience

Background

This study aimed to evaluate the effectiveness and safety of laparoscopic greater curve plication (LGCP) for the treatment of obesity in ethnic Chinese in Hong Kong.

Methods

Twenty-seven consecutive Chinese patients (23 females; mean age 37.6?±?8.9 years) received LGCP for the treatment of obesity from September 2010 to December 2011. Mean baseline body weight (BW) and body mass index (BMI) were 84.6?±?17.5 kg and 31.2?±?4.7 kg/m², respectively.

Results

All procedures were performed laparoscopically with conversion to open surgery in one patient. There was neither mortality nor any postoperative complications. Mean follow-up was 10.6?±?6.5 months. Mean procedure time was 117.9?±?22.3 min and mean hospital stay was 2.6?±?0.7 days. Mean BMI loss was 4.1?±?1.6, 4.8?±?2.0 and 5.2?±?2.5 kg/m² at 3, 6 and 12 months. Mean % EBL was 67.3?±?42.1, 66.4?±?35.9 and 60.2?±?25.5 % at 3, 6 and 12 months. Mean % EBL in BMI >35 group (n?=?7) was 38.2?±?11.1, 43.5?±?14.0 and 50.6?±?21.6 % at 3, 6 and 12 months. Mean % EBL in BMI <35 group (n?=?20) was 76.5?±?44.2, 76.5?±?38.2 and 65.0?±?27.0 % at 3, 6 and 12 months.

Conclusions

LGCP is safe and effective in achieving significant weight loss in obese ethnic Chinese patients. However, weight loss in BMI <35 is more pronounced. It is a very valid alternative to other procedures in Asian population.     

Laparoscopic cholecystectomy—comparison of early postoperative results in an Australian rural centre and a German university hospital

Background

Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. Cultural as well as organisational differences can result in significant variations of postoperative length of stay.

Aim of the present study

The aim of this study is to evaluate whether differences in postoperative length of stay and early postoperative outcome can be observed by comparison of an Australian rural centre and a German university hospital.

Results

Between February 2006 and August 2007 (18 months), 359 patients (140 Australia, 219 Germany) underwent laparoscopic cholecystectomy. Mean patient age was 50.4?±?1.5 and 53.5?±?1.0 years, respectively. Seventy-seven percent of the Australian and 62% of the German patients were female. Twenty-one percent and 20% of the procedures were emergencies, respectively. Median American Society of Anaesthesiologists score of all patients was two. The conversion rate was 8% in both centres. A 4% complication rate was observed in Australia (N?=?5, 3× bile leak, 1× postoperative bleeding and 1× wound infection) as opposed to 3% in Germany (N?=?7, 2× bile leak, 2× postoperative bleeding and 3× wound infection). Postoperative length of stay in Australia was 1.8?±?0.1 days (median 1 day) and was significantly longer in patients after emergency surgery (1.6?±?0.1 versus 2.6?±?0.3 days, p?<?0.018). Postoperative length of stay in Germany was 3.7?±?0.2 days (median 3 days), and no significant differences were observed when elective and emergency procedures were compared (3.5?±?0.2 versus 3.9?±?0.5 days, p?>?0.05). Comparison of treatment results indicates a significantly shorter postoperative stay in Australia (3 days versus 1 day, p?<?0.001).

Discussion/conclusion

In rural Australia, a median postoperative stay of 1 day after laparoscopic cholecystectomy can be safely achieved. Postoperative length of stay is significantly longer in the German setting with otherwise comparable patients and surgical techniques. Simple changes of pre- and postoperative management of elective as well as emergency laparoscopic cholecystectomy will allow, for substantial cost savings, for the German health system.     

Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer

Background

Laparoscopically assisted total gastrectomy (LATG) is technically difficult. Robot surgery has theoretical advantages such as increased degrees of freedom of instruments and a three-dimensional view. The current study aimed to determine whether a robot-assisted total gastrectomy (RATG) has a real benefit over LATG in terms of surgical and oncologic outcomes.

Methods

A single-center case–control study was conducted. The study included 36 patients who underwent RATG and 65 patients who underwent LATG at the National Cancer Center in Korea between February 2009 and May 2011. No patients were excluded from the analysis within the study period. Clinicopathologic data, operative data, postoperative morbidity, and pathologic data were analyzed by Student’s t-tests and Chi-square tests, as indicated.

Results

The mean age of the patients was 53.9?±?11.7?years in the RATG group and 56.9?±?12.3?years in the LATG group (P?=?0.236). The mean BMI was 23.2?±?2.5?kg/m² in the RATG group and 23.6?±?3.4?kg/m² in the LATG group (P?=?0.494). The mean postoperative hospital stay was 8.8?±?3.3?days in the RATG group and 10.3?±?10.8?days in the LATG group (P?=?0.416). The mean operative time was 305.8?±?115.8?min in the RATG group and 210.2?±?57.7?min in the LATG group (P?P?=?0.209). Postoperative complications were experienced by 6 patients (16.7%) in the RATG group and 10 patients (15.4%) in the LATG group (P?=?0.866).

Conclusion

Despite early experiences, RATG was shown to be comparable with LATG in terms of surgical and oncologic outcomes. However, no apparent benefit is associated with RATG to date.     

Does Intramesorectal Proctectomy with Rectal Eversion Affect Postoperative Complications Compared to Standard Total Mesorectal Excision in Patients with Ulcerative Colitis?

Introduction

Proctectomy for ulcerative colitis (UC) can be performed via intramesorectal proctectomy with concomitant rectal eversion (IMP/RE) or total mesorectal excision (TME). No data exists comparing the outcomes of the two techniques.

Methods

All UC patients undergoing J-pouch surgery at a single institution over 10.5 years were included. Postoperative complications with IMP/RE vs. TME were analyzed using univariable and multivariable statistics.

Results

One hundred nineteen of 201 (59 %) patients underwent IMP/RE. Demographic and disease characteristics were similar between groups. On univariable analysis, IMP/RE had fewer total perioperative complications than TME (p?=?0.02), but no differences in postoperative length of stay or readmissions. Multivariable regression accounting for patient age, comorbidities, disease severity, preoperative medications, operative technique, and follow-up time (mean 5.5?±?0.2 years) suggested that both anastomotic leak rate (OR 0.32; p?=?0.04) and overall postoperative complications (2.10?±?0.17 vs. 2.60?±?0.20; p = 0.05) were lower in the IMP/RE group.

Conclusions

IMP/RE may be associated with fewer overall postoperative complications compared to TME. However, further studies on functional and long-term outcomes are needed.     

A modified liver-hanging maneuver focusing on the ligamentum venosum for left hepatic lobectomy

Purpose

The liver-hanging maneuver (LHM) is a useful technique in major hepatectomy. We made modifications to this technique with special reference to the ligamentum venosum for performing a left hepatectomy (LH). The aim of this study was to clarify the usefulness of our new technique.

Methods

Between August 2007 and May 2009, five patients underwent LH using our modified LHM and 12 patients underwent LH using a conventional procedure. The two groups were compared in terms of the patient characteristics, preoperative hepatic functions, surgical records, and outcomes.

Results

The characteristics and preoperative hepatic function tests were similar between the modified LHM and non-LHM groups. Intraoperative blood loss was significantly reduced in the modified LHM group compared with the non-LHM group (193?±?133 vs. 375?±?167?ml, P?Conclusion Our modified LHM can reduce the intraoperative blood loss during LH, and our results have shown the usefulness of this modified technique for LH.     

Modified laparoscopic extraperitoneal uterine suspension to anterior abdominal wall: the easier way to treat uterine prolapse

Introduction and hypothesis

To report the outcomes of modified laparoscopic extraperitoneal uterine suspension to anterior abdominal wall for uterine prolapse using mesh.

Methods

Twenty-two patients with uterovaginal prolapse, stage 2 or greater according to pelvic organ prolapse quantification (POP-Q), and with desire for uterine preservation, underwent modified laparoscopic extraperitoneal uterine suspension to the anterior abdominal wall bilaterally using mesh. The outcomes were measured by POP-Q and quality-of-life questionnaires. Intraoperative or postoperative complications were also observed.

Results

Patient age was 61.4?±?12?years, and parity was 3.3?±?1.8. After surgery, there was significant improvement in POP-Q measurements of Ba, Bp, and C (P?P?Conclusions Modified laparoscopic extraperitoneal uterine suspension to the anterior abdominal wall using mesh is a feasible and effective method for treating uterine prolapse and is easy to perform.     

Intraoperative low-field MR-guided frameless stereotactic biopsy for intracerebral lesions

Background

To present our intraoperative low-field magnetic resonance imaging (ioMRI) technique for stereotactic brain biopsy in various intracerebral lesions.

Method

Seventy-eight consecutive patients underwent stereotactic biopsies with the PoleStar N-20/N-30 ioMRI system and data were evaluated retrospectively. Biopsy technique included ioMRI before surgery, followed by insertion of the biopsy cannula in the lesion, and ioMRI before and after biopsy. Statistical analysis was performed to compare subgroups using Excel and SPSS statistic software.

Results

In all patients, stereotactic biopsy was possible, with a mean intraoperative surgery time of 86.2?±?28.6 min and a mean hospital stay of 11.6?±?4.6 days. In 97.4 % (n?=?76), histology was conclusive, representing 58 brain tumors and 18 other pathologies. Five patients were biopsied previously without conclusive diagnosis, and all biopsies were conclusive this time. Mean cross-sectional lesion size in MRI T1 with contrast (n?=?64) was 6.9?±?5.7 cm², and in lesions without T1 contrast enhancement (n?=?14), T2 mean cross-sectional lesion size was 5.5?±?3.9 cm². Mean distance from the cortex surface to the lesion was 3.4?±?1.2 cm. One patient suffered from a postoperative wound dehiscence; neither clinically or radiologically significant hemorrhage after surgery, nor intraoperative complications occurred.

Conclusions

Low-field ioMR-guided frameless stereotactic biopsy accurately diagnosed different intracerebral lesions without major complications for the patients, and within an acceptable surgery time and hospital stay. In repeated non-conclusive biopsies in particular, low-field ioMRI offers a technique for arriving at a diagnosis.