Distal radius fracture after Sauvé-Kapandji procedure in a rheumatoid arthritis patient

Abstract

We report a case of distal radius fracture after a Sauvé-Kapandji procedure combined with synovectomy and tendon transfer in a rheumatoid arthritis patient. This case shared several unusual features that were also seen in a previously reported case. Based on these features, we discuss favorable surgical treatment for the rheumatoid wrist with extensor tendon rupture, and also the optimal treatment for distal radius fracture after such procedures.     

Laparoscopy-assisted total gastrectomy with trans-orally inserted anvil(OrVilTM):A single institution experience

AIM:To investigate the feasibility of laparoscopyassisted total gastrectomy(LATG)using trans-orally inserted anvil(OrVilTM)in terms of operative characteristics and short term outcomes. RESULTS:Characteristics of 27 patients with gastric cancer who underwent LATG from October 2009 to October 2012 in the Foshan Affiliated Hospital of South Medical University were retrospectively reviewed. Among these patients,six were reconstructed by minilaparotomy and 21 by OrVilTM.The clinicopathological characteristics,total operation time,total blood loss, abdominal incision and complications of anastomosis including stenosis and leakage,were compared between the groups undergoing LATG with OrVilTM and the group undergoing minilaparotomy. RESULTS:The operations were successfully performed on all the patients without intraoperative complications or conversion to open surgery.Two(10%)patients received palliative procedure under laparoscope who were prepared for LATG preoperatively.One case had hepatic metastatic carcinoma and 1 case had tumor recurrence near the anastomosis 8 mo after surgery.The mean follow-up duration was 10 mo(range,2-24 mo). Operation time was significantly reduced by the use of OrVilTM(198.42±30.28 min vs 240.83±8.23 min). The postoperative course with regard to occurrence of stenosis and leakage was not different between the two groups.There were no significant differences in estimated blood loss.The upper abdominal incision was smaller in OrVilTM group than in minilaparotomy group (4.31±0.45 cm vs 6.43±0.38 cm). CONCLUSION:LATG using OrVil TM is a technically feasible surgical procedure with sufficient lymph node dissection,less operation time and acceptable morbidity.     

Impact on sleeve gastrectomy in patients with esophageal motor disorder

BackgroundGastroesophageal reflux disease (GERD) and esophageal motor disorders (EMD) are frequent conditions among patients with obesity. The effects of sleeve gastrectomy (SG) on esophageal function can worsen GERD, but little is known about its effects on EMD and the consequences of preexisting EMD on GERD after SG.ObjectivesTo study the postoperative outcomes of SG in a population of patients displaying preexisting EMD.SettingUniversity Hospital, France.MethodsPatients with EMD confirmed by high-resolution manometry who underwent a laparoscopic SG between 2010 and 2019 were retrospectively included in this monocenter study. GERD symptoms and high-resolution manometry results were recorded before surgery and during follow-up. Conversion to gastric bypass were also recorded.ResultsThirty-seven patients were included. Mean age was 52.6 ± 12.9 years. Most patients were female (70%). EMD were achalasia (19% of patients), hypercontractile (22%), hypocontractile (30%) and nutcracker esophagus (22%), and ineffective esophageal motility (8%). GERD symptoms were present in 10 patients (27%) preoperatively and 18 (49%) postoperatively. Achalasia was not resolved after SG and was constantly associated with disabling food blockage or GERD symptoms after surgery, and 3 of 4 patients with nutcracker esophagus had postoperative GERD symptoms and underwent gastric bypass.ConclusionsThis study is the largest to describe the course of GERD and EMD after SG in patients displaying preoperative EMD. Achalasia and nutcracker esophagus are associated with poorer postoperative outcomes, and another procedure such as a gastric bypass should be performed.     

Duodenogastric biliary reflux assessed by scintigraphic scan in patients with reflux symptoms after sleeve gastrectomy: preliminary results

BackgroundBile reflux is a factor in the appearance of severe esophagitis and Barrett’s esophagus, which have been reported after sleeve gastrectomy (SG). Incompetent lower esophageal sphincter and increased gastroesophageal acid reflux have been demonstrated after this operation. Some reports have shown bile content in the antrum during endoscopic control, but no investigations objectively confirm the presence of duodenogastric bile reflux in these patients.ObjectivesTo evaluate the presence of duodenogastric bile reflux (DGR) after SG in patients presenting reflux symptoms.SettingUniversity hospital.MethodsProspective study of 22 patients presenting reflux symptoms who underwent SG for morbid obesity and who received endoscopic evaluation and scintigraphic study to confirm esophagitis and duodenogastric bile reflux.ResultsErosive esophagitis was observed in 11 patients and Barrett’s esophagus in 2 patients. Seven patients (31.8%) presented positive DGR. Among them, 3 had type B and C esophagitis. The other 4 patients did not present esophagitis in spite of reflux symptoms.ConclusionDGR may be present in patients with gastroesophageal reflux after SG. This line of investigation requires further studies to confirm this hypothesis.     

Urethral advancement in hypospadias with a distal division of the corpus spongiosum: Outcome in 158 cases

ObjectiveOutcome of urethral mobilization and advancement (Koff procedure) in hypospadias with a distal division of the corpus spongiosum and redo cases with distal urethral failure.Materials and methodsFrom January 1999 to November 2012, 158 children with a distal hypospadias (115 primary cases and 43 redo cases) underwent surgical repair using the Koff technique with a median age at surgery of 21 months (range, 12–217 months).ResultsMean follow-up was 19 months (median, 14 months). Thirty patients (19%) presented with a complication (13.9% in primary cases and 32.5% in redo surgery) mostly at the beginning of our experience. Meatal stenosis was the most common one (3.5% in primary case, 6% overall). Ventral curvature (>10°), which is considered as a possible long-term iatrogenic complication of the Koff procedure, was not found in patients with fully grown penis except in one redo patient who had, retrospectively, an inadequate indication for this type of repair. Of 158 patients, 33 reached the age of puberty (>14 years old) with a mean follow-up of 34 months, only one presented with a significant ventral curvature.ConclusionUrethral mobilization and advancement is a reasonable alternative for anterior hypospadias and distal fistula repair in selected cases. It has two major advantages compared to other techniques: it avoids any urethroplasty with non-urethral tissue and eliminates dysplastic tissues located beyond the division of the corpus spongiosum, which may not grow at the same pace as the rest of the penis. Significant iatrogenic curvature in fully grown penis is not supported by this series.     

早期胃癌治疗方式合理选择：争议与共识

早期胃癌有其独特的行为特点，治疗的诸多方面都存在争议与共识。既往早期胃癌治疗以传统追求肿瘤根治的开腹标准胃切除和淋巴结清扫手术为主。近年来，随着我国早期胃癌检出率的提高以及外科手术器材的进步，针对早期胃癌所实施的外科治疗逐步转变为以内镜及腹腔镜机器人为代表的微创手术，以及在肿瘤根治条件下最大限度地保留胃的正常解剖和生理功能以改善治疗后病人生活质量的功能保留性胃切除术。早期胃癌的治疗模式呈现多学科化、精准化特点，对符合适应证的早期胃癌病人，内镜治疗是首选，其微创优势更加明显。对于非内镜治疗适应证的病人，内镜与腹腔镜的双镜联合手术是未来的发展方向。