Intrathoracic gastric fistula after bariatric surgery: a systematic review and pooled analysis

Even in the hands of highly experienced bariatric surgeons, perioperative complications are inevitable. Of these, leaks and fistulas are amongst the scariest complications. Intrathoracic gastric fistulas (ITGF) can be associated with serious morbidity, mostly when cases are misdiagnosed or detected with delay. This is a systematic review of the literature to investigate the clinical and surgical outcomes of morbidly obese adult patients with a confirmed diagnosis of ITGF following bariatric surgery. A pooled analysis of 25 articles, encompassing 76 patients with post-bariatric ITGF, showed that the clinical outcome depends on the initial presentation, timing of the diagnosis in relation to symptom onset, and prompt and effective treatment. Any septic or unstable patient must undergo urgent surgical intervention, while stable patients might tolerate a step-up approach and watchful waiting for nonsurgical treatment. Among those who undergo surgery, treatment failure and the mortality rate are substantially high. Contingent upon a prompt management strategy, patients with postbariatric ITGF can generally have a favorable outcome in the long term.     

CZES型食管支架硬式改软式的临床意义

目的：改进Z型被膜食管支架的结构，使之具有更好的顺应性，稳定性和耐受性。方法：将被膜Z型食管支架的上下钢丝节段之间的交错连接（硬式支架）改为间隙连接（软式支架），并植入治疗43例食管狭窄或食管瘘患者，观察疗效和并发症，并与46例植入硬式支架者比较。结果：两组均取得显著疗效。软式支架组胸痛，呕吐等症状显著减轻，持续时间缩短，未发生支架移位，穿孔等重大并发症。结论：软式食管支架在顺应性，稳定性和耐受性等方面明显优于硬式支架。     

To compare the outcomes of pancreaticojejunostomy and pancreaticogastrostomy reconstruction after pancreaticoduodenectomy: A prospective observational study

BackgroundWe have been in constant search of novel innovations to decrease the high morbidity after Pancreaticoduodenectomy (PD). Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) are the two different methods of reconstruction after PD. However, the existing data is ambiguous in supporting either of them as the preferred technique of reconstruction.MethodsThis was a single-center prospective observational study that included 64 patients who underwent PD over two years. We compared PG with PJ as a method of reconstruction after PD. The primary objective was to assess whether PG decreases the rate of postoperative pancreatic fistula (POPF) rates or not. Secondary objectives comprised analysis of perioperative outcomes, 30-day and 90-day mortality.ResultsPancreatic fistula was significantly lower in PG as compared to the PJ group (24% vs. 47%) with a p-value of 0.027. The incidence of clinically pertinent (grade B) fistula was only 3% in the PG group and 32% in the PJ group. PG group had a higher incidence of post pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE). No statistically significant difference was seen between either group need for blood transfusion, re-exploration, re-admissions, ICU stay, or length of hospital stay, and 30-day and 90-day mortality. Pancreatic texture and high BMI were independent predictors for pancreatic fistula.ConclusionPG when compared to PJ for reconstruction after PD, decreases the rate of POPF significantly; however, it is associated with an elevated risk of DGE and PPH. There was no difference in 30-day and 90-day mortality between both the treatment groups.     

Resolution of spinal epidural vascular pseudotumor following balloon occlusion of a postoperative vertebral arteriovenous fistula

Summary We describe a case of a vascular mass arising secondary to a postoperative vertebral arteriovenous fistula mimicking recurrent cervical neurofibroma on CT in a patient with neurofibromatosis. Angiography was required for diagnosis. The recurrent tumor resolved following balloon embolization of the fistula.     

高位复杂性肛瘘的解剖学切除术

目的 探索治疗高位复杂性肛瘘较理想的手术方式。方法 应用解剖学原理,行瘘管切除、保留括约肌、内口缝合、创面开放术式,对高位复杂性肛瘘进行手术治疗。结果 45例一期治愈,1例二期治愈,无肛门失禁、肛门狭窄等并发症。结论 解剖学切除术是一种治疗高位复杂性肛瘘较理想的手术方式。     

胰十二指肠切除术的技术改进

目的 探讨改进胰十二指肠切除术,预防术后并发症,提高手术疗效的方法。方法 采用保留幽门、胰管空肠粘膜吻合＋胰肠遮盖套入式吻合、胰管支撑外流充分切除胰钩突的术式,并观察其疗效。结果 全组未发生胰瘘及胰断面出血。保留幽门胰十二批肠切除术（ＰＰＰＤ）者有１例术后发生胃潴留,其余胃排空正常。结论 ＰＰＰＤ只要操作得当,可避免术后胃潴留。胰肠遮盖套入式吻合操作简便,可防止术后胰瘘、胰断面出血等并发症。