Endoscopic Dilation with Savary-Gilliard Bougies of Stomal Strictures After Laparosocopic Gastric Bypass in Morbidly Obese Patients

Background Anastomotic strictures after bariatric surgery are a frequent complication that requires endoscopic management, but the optimal technique for dilation remains to be determined. The aim of this study was to evaluate the safety and efficacy of dilation with Savary–Gilliard bougies (SGB) in morbidly obese patients treated with laparoscopic Roux-en-Y gastric bypass (RYGBP). Patients and Methods Retrospective review of prospectively collected data from a series of 474 consecutive patients with laparoscopic bariatric surgery. Four-hundred twenty four of these patients (90%) underwent a laparoscopic RYGBP. A total of 24 patients were referred for anastomotic stricture dilation with SGB from January 1998 to December 2006. Results A total of 24/424 patients (6%) developed a stricture that was successfully dilated with SGB. Patients were 17 females (71%) and seven males (29%) with a mean age of 41 ± 11 years (range 24–63) and a mean BMI of 48 ± 6 (range 40–69). The time between RYGBP and the appearance of stricture-related symptoms ranged from 29 to 154 days (mean, 69 days). The mean number of dilations was 1.6 ± 0.6. The majority of patients required one (n = 11; 46%) or two (n = 12; 50%) dilations and only one patient required three dilations. During the initial dilation, a final diameter of 11 ± 1.7 mm (range 7–12.8 mm) was achieved. In all cases, there was complete resolution of symptoms. There were no complications. Conclusions Dilation with SGB is an effective, safe, and durable method for managing anastomotic strictures after laparoscopic RYGBP. Presented at the 12th World Congress of the International Federation for the Surgery of Obesity, Porto, Portugal, September 7, 2007.     

Consequences of endoscopic inguinal hernioplasty with mesh on subsequent open radical prostatectomy

AIM: To determine the effect of prior endoscopic hernia repair with prosthetic mesh on subsequent open radical prostatectomy. METHODS: A retrospective study from 1990 to 2004 identified nine patients with preperitoneal mesh placement followed by open radical prostatectomy. Case controls (n = 26) were matched for age, type of operation, year of surgery and pathologic stage of prostatic adenocarcinoma. Outcome variables of operating time, number of pelvic lymph nodes excised, duration of hospital stay, duration of urinary catheterization, recurrence rates, and incidence of complications were compared. Data analysis was performed using Wilcoxon's rank sums test. RESULTS: Intraoperatively, subjective difficulty in dissection was documented in all cases by the performing urologist. Duration of hospital stay was significantly increased by 1.3 days (p < 0.05), as compared to the control group. However, no statistically significant increase in mean operating time (173 vs. 172 min, p = 0.925), number of lymph nodes sampled (4.4 vs. 6.6, p = 0.147), duration of urinary catheterization (22 vs. 19 days, p = 0.925), oncologic recurrence (11 vs. 11% at 6.1 and 4.8 years follow-up), or complications was found. CONCLUSIONS: Prior TEP/TAPP did not increase the morbidity or mortality of subsequent prostate surgery. Despite some subjective operative difficulty, open prostatectomy was safe and feasible in all cases with a comparable oncologic outcome. Mesh-associated inflammation may preclude adequate nodal sampling. While endoscopic hernia repair remains an excellent option to fix unilateral, bilateral, and recurrent herniae, consideration of future prostate surgery is important. Inserting less "inflammatory" mesh or using an open, anterior approach may be prudent in some men at high risk for needing subsequent prostate surgery.     

Transaxillary retromammary route approach of video-assisted breast surgery enables the inner-side breast cancer to be resected for breast conserving surgery

BACKGROUND: Endoscopic surgery for inner-side breast cancer usually is performed by periareolar approach, but leaves deformation or malposition, and sensory disturbance. We devised an approach of retromammary route without subcutaneous removal, from an axillary skin incision, to treat distant cancers and also to preserve sensation to skin touch. METHODS: We have performed video-assisted breast surgery on 230 patients. The transaxillary retromammary-route approach was performed on 20 patients with early breast cancer. From a 2.5-cm axillary incision, we dissected the major pectoral muscle fascia to detach retromammary tissue. We cut the proximal side of the gland vertically, and dissected the skin flap over the tumor by the tunnel method. Then we cut each side of the gland vertically and removed it through the axillary port. RESULTS: All surgical margins were negative. The surgical time was 45 minutes longer than the conventional video-assisted breast surgery. The postoperative esthetic results were good. CONCLUSIONS: The transaxillary retromammary-route approach leaves no injury on whole breast, and can become a single standard method for breast-conserving surgery wherever a cancer is situated.     

Endoscopic surgery with curative intent for malignant tumors of the nose and paranasal sinuses

Aim

To assess the efficacy of endoscopic surgical treatment in patients with nasal and paranasal sinus malignancies.

Patients and methods

During the period 1991–2006, 16 patients with nasal and paranasal sinus malignancies underwent endoscopic surgery with curative intent. The lesions included 11 carcinomas, two malignant melanomas, one olfactory neuroblastoma, one hondrosarcoma and one leiomyosarcoma. Tumors originated from the ethmoids in eight, and from the nasal cavity in another eight patients. Oncologic radicality of resection was verified by intraoperative frozen-section examination of biopsy specimens from the margins of the defect site.

Results

Radical resection was accomplished in 15 out of 16 operated patients. There were no major intra- or postoperative complications. Ten patients were postoperatively irradiated. Follow up of the treated patients ranged from 15 to 178 months (median 67 months). One patient with malignant melanoma died of generalized disease nine months after treatment, another with malignant melanoma recurred locally 30 months and again 49 months after first operation and is at the time of evaluation disease free and one died 21 months after operation without evidence of disease.

Conclusions

It seems that in selected cases, endoscopic surgery with curative intent for removal of malignant tumors of the nasal and paranasal cavities in the hands of highly experienced surgeon is justified.     

内镜逆行胰胆管造影术后急性胆管炎的危险因素研究及其列线图的构建

目的探讨内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)后急性胆管炎的危险因素及其列线图的构建。方法回顾性分析2014年1月—2019年12月在兰州大学第一医院因胆总管结石接受ERCP的患者临床资料, 纳入术后发生急性胆管炎的患者95例(胆管炎组), 以1∶3比例通过软件随机抽样选择术后未发生急性胆管炎的患者285例(无胆管炎组)。采用Logistic回归模型分析影响ERCP术后急性胆管炎的独立危险因素, 根据多因素分析结果, 建立预测ERCP术后急性胆管炎发生率的列线图模型。结果单因素比较发现 ERCP术后发生胆管炎患者和未发生胆管炎患者在年龄、合并糖尿病、丙氨酸转氨酶、碱性磷酸酶、葡萄糖、胆囊壁粗糙、胆管直径、胆管下端狭窄、行经内镜胆道内支架放置术比例、行经内镜鼻胆管引流术比例方面差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示, 高龄(OR=1.108, 95%CI:1.079～1.138, P<0.001)、合并糖尿病(OR=4.524, 95%CI:1.299～1...     

de novo早期结直肠癌的临床病理特征及内镜治疗效果观察

目的分析de novo早期结直肠癌的临床病理特征, 并评估内镜治疗的效果。方法纳入2020年6月—2022年5月在首都医科大学附属北京友谊医院行内镜切除且术后病理确诊为de novo早期结直肠癌的患者。回顾性收集患者的基本资料、内镜表现、治疗方式、术后病理结果以及转归等资料。结果共纳入33例de novo早期结直肠癌患者, 年龄(62.67±8.62)岁, 男女比例7.25∶1。病变长径(0.96±0.36)cm;病变形态以浅表型(0-Ⅱ型)为主, 占72.7%(24/33)。29例采用内镜黏膜下剥离术切除, 4例采用内镜黏膜切除术切除。术后病理显示, 11例(33.3%)为高分化管状腺癌, 其中2例侵及黏膜下浅层;20例(60.6%)为中分化管状腺癌, 其中5例侵及黏膜下浅层, 15例侵及黏膜下深层;2例(6.1%)为中-低分化管状腺癌, 均侵及黏膜下深层。病变浸润深度与病变分化程度有显著相关性(P<0.001), 中分化及中-低分化病变更容易发生黏膜下层深浸润。33例(100.0%)病变均达到整块切除, 97.0%(32/33)达到完全切除, 42.4%(14/33)达到治愈...     

肝门胆管恶性梗阻患者肝脏有效引流体积对总体生存时间的影响：一项多中心研究

目的探讨无法手术切除的肝门胆管恶性梗阻患者的肝脏引流体积对其总体生存时间的影响。方法回顾性分析2002年1月—2019年5月期间在3所内镜中心接受支架引流的633例肝门胆管恶性梗阻(Bismuth Ⅱ-Ⅳ型)患者的临床资料。主要观察指标包括临床成功率、支架通畅期、总体生存时间、有效肝脏引流体积、并发症发生率。结果肝脏引流体积<30%、30%～50%、>50%患者的临床成功率分别为56.8%(25/44)、77.3%(201/260)和84.2%(277/329);早期胆管炎发生率分别为31.8%(14/44)、18.8%(49/260)和16.1%(53/329);中位支架通畅期分别为4.5(95%CI:1.8～7.2)个月、5.6(95%CI:5.0～6.2)个月、6.6(95%CI:5.2～8.0)个月;总体生存时间分别为2.4(95%CI:1.8～3.0)个月、4.0(95%CI:3.4～4.6)个月和4.9(95%CI:4.4～5.4)个月。30%～50%肝脏引流体积组的临床成功率(χ2=8.28, P=0.012)、中位支架通畅期(χ2=18.87, P=0.01...     

食管全周浅表癌内镜黏膜下剥离术后长期保留胃管对食管狭窄的预防及治疗作用

为探讨食管全周浅表癌行内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）后长期保留胃管对食管狭窄预防及治疗的影响,回顾性分析2018年1月—2021年12月在南京医科大学第一附属医院行ESD的食管全周浅表癌患者,术后置入胃管患者15例（胃管置入组）,无胃管置入患者23例（无胃管置入组）,比较两组患者基础情况、病变位置、病理分期、术后并发症、食管狭窄程度（进水情况）、疼痛情况、住院次数及医疗费用等资料。结果显示,两组患者在年龄、性别、病变位置及术后病理分期的构成方面差异无统计学意义（P>0.05）。与无胃管置入组相比,胃管置入组患者可进水率较高（11/15比6/23,P<0.05）,发生疼痛次数较少［（7.3±3.1）次比（10.7±3.6）次,t=3.00,P<0.05］,ESD后至食管支架置入前及置入后的住院次数和医疗总费用均明显低于无胃管置入组（P<0.05）。ESD后迟发性出血率、穿孔率以及首次狭窄出现时间,两组差异均无统计意义（P>0.05）。研究结果初步表明食管全周病变患者行ESD后长期保留胃管可减轻食管狭窄程度,具有较良好的安全性。     

Biliary complications after liver transplantation: A computed tomography and magnetic resonance imaging pictorial review

Biliary complications are the most common complications after liver transplantation. Computed tomography (CT) and magnetic resonance imaging (MRI) are cornerstones for timely diagnosis of biliary complications after liver transplantation. The diagnosis of these complications by CT and MRI requires expertise, mainly with respect to identifying subtle early signs to avoid missed or incorrect diagnoses. For example, biliary strictures may be misdiagnosed on MRI due to size mismatch of the common ducts of the donor and recipient, postoperative edema, pneumobilia, or susceptibility artifacts caused by surgical clips. Proper and prompt diagnosis of biliary complications after transplantation allows the timely initiation of appropriate management. The aim of this pictorial review is to illustrate various CT and MRI findings related to biliary complications after liver transplantation, based on time of presentation after surgery and frequency of occurrence.