Transient retrograde interfragmentary compression technique in AO/OTA type 33-C distal femur fractures: A surgical technique and short-term radiographic follow up results

Surgical treatment of AO/OTA type 33-C fractures is a therapeutic challenge despite advances in surgical instruments and techniques. We introduce a novel surgical technique named transient retrograde interfragmentary compression (TRIC) to help intraarticular fragment reduction in AO/OTA type 33-C fracture. We inserted a partial threaded 7.0-cannulated screw with a washer along the transepicondylar axis from the medial femoral epicondyle during the articular block reduction process of AO/OTA type 33-C fractures to strengthen the compressive force between the condylar fragments and to enhance the handling of the articular block fragment in the alignmental correction stage. Following the provisional reduction and fixation using lateral distal femur locking compression plate, TRIC screw was removed. Fifteen AO/OTA type 33-C distal femoral intraarticular fractures of thirteen patients were surgically treated using the TRIC technique. We analyzed the radiographic result of the patients by measuring the horizontal gap and vertical step-off in the postoperative radiographs. Mean horizontal fracture gap was 0.34 mm and mean vertical step-off between bicondylar fragments was 0.63 mm. The median value of the horizontal fracture gap and vertical step off was 0 and 0.46 mm, respectively. Mean time to union in the bicondylar fracture fragment was 9 week. TRIC is considered to be a valuable surgical reduction technique in the treatment of the AO/OTA 33-C type fractures.     

A novel dedicated endoscopic stent for staple-line leaks after laparoscopic sleeve gastrectomy: a case series

BackgroundStaple-line leak is the most serious complication of laparoscopic sleeve gastrectomy (LSG) occurring in .5−7% of cases. Patients with this complication are often managed with an esophageal covered, self-expandable metal stent positioned at endoscopy. Unfortunately, migration of these stents has been reported in 30–50% of cases. A novel fully-covered, self-expanding metal stent (Megastent), specifically designed for post-LSG leaks is now available. The objective of this study was to describe the first case series of patients with a staple-line leak after LSG who were endoscopically managed with such a novel stent.MethodsFour patients who developed a staple-line leak after LSG were treated by positioning a Megastent at endoscopy. The stents were removed after 8 weeks.ResultsA complete leak repair was achieved in all patients. No stent migration occurred. Prokinetic therapy was needed to treat vomiting episodes during stent presence. At endoscopic evaluation after stent removal, a decubitus lesion at the distal part of the duodenal bulb was observed.ConclusionThese preliminary results would suggest the use of the Megastent as an option for stenting of a staple-line leak after LSG. Further studies are still necessary.     

POSSUM and p-POSSUM overestimate morbidity and mortality in laparoscopic bariatric surgery

BackgroundDespite their wide use in surgical audit, the application of the Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and the Portsmouth predictor of mortality (p-POSSUM) in bariatric surgery has been limited. The aim of this study was to evaluate the usefulness of POSSUM and p-POSSUM in bariatric comparative audit.MethodsData were retrospectively collected on consecutive patients who underwent laparoscopic gastric by-pass (LRYGB) and sleeve gastrectomy (SG) at a teaching institute. POSSUM and p-POSSUM equations were applied. The observed to expected ratios for morbidity and mortality were calculated. A Student’s t test was performed to assess if a relationship could be found between the observed and the predicted outcomes.ResultsBetween 2008 and 2013, 504 patients (370 female) with a mean (range) age of 46 (17–69) years underwent LRYGB (n = 383) and SG (n = 121). The operative morbidity was 10.9% and mortality was .2%. POSSUM overpredicted morbidity (30.56%), and no relationship between morbidity risk and the development of complications was found (P = .152). There was a grouping of patients in the low-risk mortality groups for both POSSUM and p-POSSUM. Both equations overpredicted mortality (5.95% and 1.62%, respectively).ConclusionBoth POSSUM and p-POSSUM equations overpredicted morbidity and mortality in this only study in the literature of modern bariatric practice that employed a large representative patient sample receiving the commonest procedures. A multicenter study is needed to address the low incidence of events and enable modification of those equations for use in bariatric surgical audit.     

Laparoscopic Cholecystectomy with Previous Gastrectomy

ABSTRACT

Introduction: To evaluate the safety and efficacy of laparoscopic cholecystectomy (LC) in patients with a history of gastrectomy. Methods: The clinical data of 9,403 consecutive patients who underwent LC from January 2003 to September 2010 in our hospital were retrospectively analyzed; 30 of them had undergone previous gastrectomy. We compared the operative duration, hospitalization, and conversion rate between patients with, and those randomized selected patients without, a history of gastrectomy. Results: All patients were treated by laparoscopic procedure successfully. The mean operative duration (55.00 min vs. 29.63 min, P < .05) and mean hospitalization duration (4.57 days vs. 3.00 days, P < .05) were significantly longer in the patients with a history of gastrecotomy. There are no complications such as bile duct and bowel injury in control group, however two bile duct injuries emerged in the observed group, which required surgical intervention. Conclusions: Although the operation is difficult, LC is a safe and effective treatment for the patients with a history of gastrectomy.