scholarly journals Endoscopic transcecal appendectomy: a new endotherapy for appendiceal orifice lesions

Endoscopy ◽  
2021 ◽  
Author(s):  
Linjie Guo ◽  
Liansong Ye ◽  
Yilong Feng ◽  
Johannes Bethge ◽  
Juliana Yang ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Postoperative Bleeding ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Lesion Size ◽  
Complete Resection ◽  
Technical Success ◽  
Case Series Study ◽  
Submucosal Lesions

Background Endoscopic transcecal appendectomy (ETA) has been reported as a minimally invasive alternative procedure for lesions involving the appendiceal orifice. The aim of this case series study was to evaluate the feasibility, safety, and effectiveness of ETA for lesions at the appendiceal orifice. Methods This retrospective study included consecutive patients with appendiceal orifice lesions who underwent ETA between December 2018 and March 2021. The primary outcome was technical success. The secondary outcomes included postoperative adverse events, postoperative hospital stay, and recurrence. Results 13 patients with appendiceal orifice lesions underwent ETA during the study period. The median lesion size was 20 mm (range 8–50). Lesions morphologies were polypoid lesions (n = 5), laterally spreading tumors (n = 4), and submucosal lesions (n = 4). Technical success with complete resection was achieved in all 13 cases. There were no postoperative bleeding, perforation, or intra-abdominal abscess. The median length of hospital stay after ETA was 8 days (range 6–18). There was no tumor recurrence during a median follow-up of 17 months (range 1–28). Conclusions ETA is feasible, safe, and effective for complete resection of appendiceal orifice lesions. Larger, multicenter, prospective studies are needed to further assess this technique.

scholarly journals Same-Day Discharge After Transcatheter Mitral Valve Repair using MitraClip in a tertiary community hospital—A case series

2021 ◽  
Author(s):  
Medhat Chowdhury ◽  
Rupinder Buttar ◽  
Devesh Rai ◽  
Muhammad Waqas Tahir ◽  
Bryan E-Xin Tan ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Hospital Stay ◽  
Mitral Valve Repair ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Mitral Valve Regurgitation ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Same Day Discharge

Abstract Background Due to the current COVID-19 pandemic, there is a realization for innovation in procedures and protocols to minimize hospital stay and at the same time ensure continued evidence-based treatment delivered to the patients. We present a same-day discharge protocol for transcatheter mitral valve repair (TMVR) using MitraClip under general anesthesia in a six-patient case series. This protocol aims to reduce length of hospital stay, thereby minimizing potential for nosocomial COVID-19 infections and to promote safe discharge with cautious follow-up. Case Summary Six patients with severe symptomatic mitral valve regurgitation underwent successful transfemoral mitral valve repair using standard procedures. Following repair, patients were monitored on telemetry in the recovery area for 3 hours, ambulated to assess vascular access stability and underwent post-procedural transthoracic echocardiogram to assess for any pericardial effusion or post-procedural prosthetic mitral stenosis. Conclusion Same day discharge after TMVR is possible when done cautiously with close Follow-up, can minimize hospital stay, improve resource utilization and reduce risk of nosocomial COVID-19 infection.

Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience

Endoscopy ◽  
2018 ◽  
Author(s):  
Michel Kahaleh ◽  
Jean-Michel Gonzalez ◽  
Ming-ming Xu ◽  
Iman Andalib ◽  
Monica Gaidhane ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Hospital Stay ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Novel Therapy ◽  
Gastric Emptying Scintigraphy ◽  
Post Procedure ◽  
The Mean ◽  
Procedure Duration

Abstract Background Gastroparesis is a difficult-to-treat motility disorder with a poor response to medical therapy. Gastric peroral endoscopic pyloromyotomy (G-POEM) has been offered as a novel therapy in the treatment of refractory gastroparesis. We present a multicenter case series of our experience with G-POEM. Methods This is an international multicenter case series of patients who underwent G-POEM for the treatment of gastroparesis. The severity of gastroparesis was assessed by delayed gastric emptying scintigraphy (GES) and an elevated gastroparesis cardinal symptoms index (GCSI). Patients then underwent G-POEM using the submucosal tunneling technique. The primary endpoint was improvement in the GCSI score and improvement in gastric emptying on repeat scintigraphy. Secondary endpoints were technical success, complication rate, procedure duration, and length of hospital stay post-procedure. Results G-POEM was technically successful in all 33 patients. Symptomatic improvement was seen in 28/33 patients (85 %), with a decrease in symptom score by GCSI from 3.3 to 0.8 at follow-up (P < 0.001). The mean procedure duration was 77.6 minutes (37 – 255 minutes). Mean GES improved significantly from 222.4 minutes to 143.16 minutes (P < 0.001). Complications were minimal and included bleeding (n = 1) and an ulcer (n = 1) treated conservatively. The mean length of hospital stay post-procedure was 5.4 days (1 – 14 days). The mean follow-up duration was 11.5 months (2 – 31 months). Conclusion G-POEM is a technically feasible, safe, and successful procedure for the treatment of refractory gastroparesis. A further multicenter comparative study should be performed to compare this technique to laparoscopic pyloromyotomy.

Solitaire stents for the treatment of complex symptomatic intracranial stenosis after antithrombotic failure: safety and efficacy evaluation

2015 ◽  
Vol 8 (7) ◽  
pp. 680-684 ◽  
Author(s):  
Guoli Duan ◽  
Zhengzhe Feng ◽  
Lei Zhang ◽  
Ping Zhang ◽  
Lei Chen ◽  
...  
Keyword(s):  
Success Rate ◽  
Balloon Angioplasty ◽  
Stent Placement ◽  
Case Series ◽  
Intracranial Stenosis ◽  
Technical Success ◽  
Safety And Efficacy ◽  
Technical Success Rate ◽  
Case Series Study

ObjectivesTo evaluate the feasibility, safety, and efficacy of Solitaire stent placement after balloon angioplasty for the treatment of complex symptomatic intracranial atherosclerotic stenosis (ICAS).MethodsWe retrospectively reviewed the clinical data from 44 patients who underwent Solitaire stent placement for complex symptomatic ICAS at our department between November 2010 and March 2014, with focus on the clinical factors, lesion characteristics, treatment results, and periprocedural complications. We also summarized the early outcomes and imaging findings during the follow-up period.ResultsOverall, the technical success rate was 100% (44/44). Post-stenting residual stenosis ranged from 0% to 40% (mean 15.00±12.94%). The overall 30-day rate of procedure-related complications was 9.09% (4/44). The incidence of recurrent ischemic events related to the territory artery was 4.55% during a mean clinical follow-up period of 25.5 months. Five patients (11.36%) developed in-stent restenosis during a mean angiographic follow-up period of 9.3 months.ConclusionsThis is the first case series study of ICAS treated by Solitaire stent placement. Deployment of a Solitaire stent with balloon angioplasty in the treatment of complex severe intracranial stenosis appears safe and effective, with a high technical success rate, relatively low periprocedural complication rate, and favorable outcome during follow-up.

scholarly journals Peroral Endoscopic Myotomy in the Management of Zenker’s Diverticulum: A Retrospective Multicenter Study

2021 ◽  
Vol 10 (2) ◽  
pp. 187
Author(s):  
Aleksandra Budnicka ◽  
Władysław Januszewicz ◽  
Andrzej B. Białek ◽  
Michal Spychalski ◽  
Jaroslaw Reguła ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Outcome Measures ◽  
Clinical Success ◽  
Length Of Hospital Stay ◽  
Peroral Endoscopic Myotomy ◽  
Technical Success ◽  
Treatment Naïve ◽  
Endoscopic Myotomy ◽  
The Mean

Background: Peroral endoscopic myotomy (POEM) is an emerging technique in the treatment of Zenker’s diverticulum (ZD). This study aimed to analyze the feasibility of Zenker’s POEM (Z-POEM) in a multicenter setting and assess its performance using a validated Kothari-Haber Scoring System newly developed for symptom measurement in ZD. Materials and methods: This was a multicenter retrospective study involving three Polish tertiary referral endoscopic units. The data of consecutive patients with symptomatic ZD treated with Z-POEM in Poland between May 2019 and August 2020 were retrieved and analyzed. Primary outcome measures were technical success and clinical success rate (<3 points in Kothari-Haber Score at 2–3 months follow-up). Secondary outcome measures included procedures’ duration, length of hospital stay, and adverse events. Results: 22 patients with symptomatic ZD were included. The mean age was 67.6 (±10.7) years, and 14 (63.6%) were male. All but two patients were treatment naïve. The average size of the ZD was 30 mm (IQR, 24–40 mm). Technical success was achieved in all patients (100%), whereas clinical success was 90.9%. The average Kothari-Haber Score was 6.35 before treatment and has dropped to 0.65 after the treatment (p < 0.0001). The mean procedure time was 48.8 (±19.3) minutes, and the median length of hospital stay was 2 days (IQR, 2–3). Three patients (13.6%) had post-procedural emphysema, of which two were mild and self-resolving (9.1%), and one was moderate (4.5%) and complicated with laryngeal edema and prolonged intubation. Conclusions: This feasibility study suggests that Z-POEM is a highly effective and safe treatment for ZD, particularly among treatment-naïve patients. Comparative studies with other treatment modalities over longer follow-up are warranted.

scholarly journals Should the rectal defect be sutured following TEMS/TAMIS carried out for neoplastic rectal lesions? A meta-analysis

2020 ◽  
Vol 102 (9) ◽  
pp. 647-653 ◽  
Author(s):  
K Khan ◽  
IA Hunter ◽  
T Manzoor
Keyword(s):  
Hospital Stay ◽  
Statistical Difference ◽  
Operative Time ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Rectal Neoplasm ◽  
Lower Rectum

Introduction Management of the rectal defect following transanal endoscopic microsurgery (TEMS) or minimally invasive surgery (TAMIS) carried out for excision of neoplasm in the lower rectum is controversial. We aimed to extract evidence by carrying out a meta-analysis to compare the peri- and postoperative outcomes following rectal neoplasm excision carried out by TEMS and/or TAMIS, whereby the defect is either sutured or left open. Methods A literature search of Ovid MEDLINE and EMBASE was performed. Full-text comparative studies published until November 2019, in English and of adult patients, whereby TEMS or TAMIS was undertaken for rectal neoplasms were included. The main outcome measures were postoperative bleeding, infection, operative time and hospital stay. Findings Three studies (one randomised controlled trial and two comparative case series) yielded 555 cases (283 in the sutured group and 272 in the open group). The incidence of postoperative bleeding was higher and statistically significant (p = 0.006) where the rectal defect was left open following excision of the neoplasm (19/272, 6.99% vs 6/283, 2.12%). There was no statistical difference between the sutured and open groups regarding infection (p = 0.27; (10/283, 3.53% vs 5/272, 1.84%, respectively), operative time (p = 0.15) or length of stay (p = 0.67). Conclusion Suturing the rectal defect following excision of rectal neoplasm by TEMS/TAMIS reduces the incidence of postoperative bleeding in comparison to leaving the defect open. However, suturing makes the procedure slightly longer but there was no statistical difference between both groups when postoperative infection and length of hospital stay were compared.

scholarly journals TP7.2.15 Superior Mesenteric Artery Syndrome Managed with Laparoscopic Duodenojejunostomy: Case Series and Review of the Literature

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hatem Saber ◽  
Ramy Shaalan ◽  
Carl Kahlin ◽  
Ahmed Elhoofy
Keyword(s):  
Hospital Stay ◽  
Superior Mesenteric Artery ◽  
Conservative Management ◽  
Mesenteric Artery ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Female Ratio ◽  
Presenting Symptoms ◽  
Sma Syndrome

Abstract Aims Superior Mesenteric Artery (SMA) Syndrome is a rare disorder which may be managed surgically when conservative management fails. We present a case series of six patients who underwent laparoscopic duodenojejunostomy in our tertiary centre for treatment of SMA Syndrome. The aim of our case series is to assess and present our outcomes in comparison to the limited available literature on the topic. Methods Retrospectively, we identified all patients who underwent laparoscopic duodenojejunostomy for SMA Syndrome in our tertiary university centre’s surgical database between December 2016 and July 2019. Data collected included demographics, presenting symptoms, co-morbidities, pre and post-operative Body Mass Index (BMI), operative approach, operative blood loss, operative duration, length of hospital stay, clinical and radiological results, in hospital/30 day complications, mortality and post operative follow up outcomes. Results We identified six patients, 1:5 male to female ratio, with a median age 18 years of age (range 17-31 years). All patients had refractory symptoms after a minimum of two months (range 2-5 months) of conservative management and subsequently underwent laparoscopic duodenojejunostomy. Median hospital stay was 7 days and no in hospital/30 day post operative mortality or complications were identified. Follow up data showed no recurrence of symptoms and a BMI median increase of 10.2 (range 8-13.6) at a median follow-up of 18 months (range 12-30 months) Conclusions Laparoscopic duodenojejunostomy is a safe treatment option for SMA syndrome and should be considered when patients do not respond to conservative management.

Our experience in laparoscopic ureterolysis and omental wrapping as a definitive surgical management of ureteric obstruction related to retroperitoneal fibrosis

2021 ◽  
pp. 205141582110222
Author(s):  
MM Uddin ◽  
R Varley ◽  
RD Napier-Hemy
Keyword(s):  
Renal Function ◽  
Hospital Stay ◽  
Retroperitoneal Fibrosis ◽  
Obstructive Uropathy ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Ureteric Obstruction ◽  
Omental Wrapping ◽  
Estimated Blood Loss

Introduction and Objectives: Retroperitoneal fibrosis (RPF) is a rare fibro-inflammatory disease and a cause of ureteric obstruction that leads to obstructive uropathy. Although the mainstay of RPF treatment is medical, ureterolysis becomes a necessity if medical treatment fails or if patients are unable to tolerate side effects of conservative/medical management, including those of ureteric stents. We aimed to investigate our experience of laparoscopic ureterolysis (LU) and omental wrapping as a definitive surgical treatment for RPF. Patients and methods: We conducted a retrospective analysis of 17 patients who underwent LU between September 2009 and October 2018 in a single institution. Mode of presentation, investigation and interventions were reviewed. Outcome measures were stent or nephrostomy-free rates, post-ureterolysis change in estimated glomerular filtration rate (eGFR), operative time, estimated blood loss, length of hospital stay, complications and need for additional procedures. MAG3 renography was performed to assess ureteral patency. Results: Among 17 patients, a total of 23 LU procedures were performed in 20 operative sessions. Median (IQR) length of hospital stay was 4 (2–6) days. Median length of follow-up was 23.5 months (range 4–92 months), where 14 patients completed at least 15 months of follow-up. All patients were either stent ( n=9) or nephrostomy ( n=8) dependent before ureterolysis. Some 82.4% patients ( n=14) remain stent/nephrostomy free after LU. Renal function remains stable after ureterolysis with a median (IQR) change in eGFR at latest follow-up of: +7.5 (−8 to +23), ( P=0.74). Conclusions: LU is safe and effective at halting decline in renal dysfunction secondary to RPF. It has reliably avoided internal or external ureteric drainage in most patients. Consideration should be given to early referral to a specialised centre for ureterolysis in the context of multi-disciplinary management of benign RPF, to preservation of renal function and to render patients stent or nephrostomy free. Level of Evidence: 4 (case series).

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

2020 ◽  
Author(s):  
Jae Ik Lee ◽  
Mohd Shahrul Azuan Jaffar ◽  
Han Gyeol Choi ◽  
Tae Woo Kim ◽  
Yong Seuk Lee
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Instability ◽  
International Knee Documentation Committee ◽  
Predisposing Factors ◽  
Mpfl Reconstruction ◽  
Patellar Tilt ◽  
Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

The case for skin camouflage in the management of upper limb scarring – A case series

Hand Therapy ◽  
2021 ◽  
pp. 175899832110078
Author(s):  
Laura Adamson ◽  
Anna Selby
Keyword(s):  
Upper Limb ◽  
Case Series ◽  
Primary Objective ◽  
Self Confidence ◽  
Published Evidence ◽  
Case Series Study ◽  
Visual Impact ◽  
Series Study ◽  
Increasing Function

Introduction For some people the appearance of their hands is as important as function. Upper limb scarring can cause some patients distress. Skin camouflage is an intervention that can be used to reduce the visual impact of a scar but there is limited published evidence for its use for hand scarring. Methods This is a case series study with a primary objective to determine whether skin camouflage reduces distress in patients with an upper limb scar and to evaluate this new service. Patients experiencing distress from an upper limb scar were recruited from a hand therapy outpatient clinic. The intervention delivered was a one hour skin camouflage session. Photographs of the upper limb pre and post skin camouflage intervention were taken. The patient-rated Michigan Hand Questionnaire (MHQ) and Derriford Appearance Scale (DAS24) were completed before treatment, at 1 week and 1 month after treatment. Results Six participants reporting distress from an upper limb scar received skin camouflage intervention. Only three out of six participants completed all follow-up. All three showed improvement in at least two domains of the MHQ (function and aesthetics) at one month post treatment. Increased confidence during functional and work-based activities was also reported on the DAS24. Participants reported increased engagement in daily activities as a result of being able to camouflage their scars. Conclusions This small case series shows that skin camouflage intervention may be beneficial for some patients who are experiencing distress related to an upper limb scar by increasing function and self-confidence.

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