Use of Lumen-Apposing Metal Stents (LAMS) in the Management of Gastro Jejunostomy Stricture Following Roux En Y Gastric Bypass for Obesity.

Background Chronic strictures following Roux en Y Gastric Bypass (RYGB) are a troublesome complication that can lead to significant morbidity. The use of stents has been described but the need for X-ray and risk of migration have meant limited use in the management of these strictures. Lumen apposing metal stents (LAMS) have traditionally been used for management of pancreatic pseudocysts. They don’t require X-ray and are easy to deploy with a short learning curve. This paper explores the use of LAMS to treat post RYGB strictures and explores their safety and efficacy.MethodsA prospective study over a 4-year period looking at 14 patients with post RYGB strictures. These patients have been followed up for between 1 and 3 years. We have prospectively collected data on the efficacy and safety of LAMS in these patientsResults421 patients underwent RYGB in the study period. 14 of these patients developed a stricture that resulted in insertion of LAMS. There was no immediate complications and 12 patients had complete resolution of their stricture. There were no migration related issues.ConclusionLAMS are a safe and effective method to manage post RYGB strictures. They have a high rate of resolution of strictures and can be safely deployed across strictures with no immediate complication. Migration does not appear to be a problem. Insertion is straightforward and doesn’t appear to be associated with a long learning curve.

GIWAXS-SIIRkit: scattering intensity, indexing and refraction calculation toolkit for grazing-incidence wide-angle X-ray scattering of organic materials

Grazing-incidence wide-angle X-ray scattering (GIWAXS) has become an increasingly popular technique for quantitative structural characterization and comparison of thin films. For this purpose, accurate intensity normalization and peak position determination are crucial. At present, few tools exist to estimate the uncertainties of these measurements. Here, a simulation package is introduced called GIWAXS-SIIRkit, where SIIR stands for scattering intensity, indexing and refraction. The package contains several tools that are freely available for download and can be executed in MATLAB. The package includes three functionalities: estimation of the relative scattering intensity and the corresponding uncertainty based on experimental setup and sample dimensions; extraction and indexing of peak positions to approximate the crystal structure of organic materials starting from calibrated GIWAXS patterns; and analysis of the effects of refraction on peak positions. Each tool is based on a graphical user interface and designed to have a short learning curve. A user guide is provided with detailed usage instruction, tips for adding functionality and customization, and exemplary files.

Robotic Simple Prostatectomy: Why and How?

Increasingly many studies have presented robotic simple prostatectomy (RSP) as a surgical treatment option for large benign prostatic hyperplasia (BPH) weighing 80–100 g or more. In this review, some frequently used RSP techniques are described, along with an analysis of the literature on the efficacy and complications of RSP and differences in treatment results compared with other surgical methods. RSP has the advantage of a short learning curve for surgeons with experience in robotic surgery. Severe complications are rare in patients who undergo RSP, and RSP facilitates the simultaneous treatment of important comorbid diseases such as bladder stones and bladder diverticula. In conclusion, RSP can be recommended as a safe and effective minimally invasive treatment for large BPH.

Using a 4K-3D Exoscope for Upper Airway Stimulation Surgery: Proof-of-Concept

Objective: Demonstrate the potential of the 4K-3D exoscope during upper airway stimulation surgery (UAS). Methods: A proof-of-concept study was performed to evaluate the feasibility of the exoscope during three consecutive UAS. Results: The exoscope was employed during UAS including cuff electrode and sensing lead placement. Three cases were successfully completed without adverse perioperative event; mean operative time was 200 minutes (range 188-218 minutes) with a successive reduction in operative time. Conclusion: This experience demonstrates the potential viability of the exoscope for UAS; it is a safe, innovative, and effective alternative or adjunct to existing visualization modalities. Notable advantages include improved ergonomics, unobstructed surgical field access, wide depth of field visualization, and short learning curve. Future technological enhancements could allow the exoscope to become a promising next-generation tool in the armamentarium of the contemporary sleep surgeon.

Renal Distraction during Percutaneous Renal Calyceal Access for Prone & Supine PCNL Using a Ureteric Balloon Catheter (UBC).

Special access techniques during percutaneous nephrolithotomy (PCNL) are indicated for challenging stones. Various techniques have been described to inferiorly displace the kidney to facilitate optimal percutaneous access whilst minimizing thoracic complications associated with the supracostal approach. We describe our institution’s technique of using a ureteric balloon catheter to inferiorly distract and immobilize the kidney (UBC Technique) to achieve the optimal calyceal access infracostally during PCNL. This permits effective and safe access in a single puncture whilst additionally stabilizing the renal unit during respiration and reducing the skin-to-calyceal distance by mobilizing the desired calyx in line with the axis of the puncture needle. We reviewed the literature regarding alternative inferior renal displacement techniques permitting infracostal approaches. From May 2012 to October 2017 150 PCNLs were performed in our institution. Out of these, the UBC technique was used in 18 cases during both prone and supine PCNLs. In all cases, the UBC technique was used successfully to access the most desirable calyx. No complications associated with renal distraction were reported. Post operatively, 1 patient required a blood transfusion, 1 patient had a pyrexia of >38 degrees resulting in a longer admission and 1 patient developed sepsis requiring HDU admission for monitoring only. 15 out the 18 patients had complete stone clearance from their PCNL. The UBC technique provides a safe alternative to the supracostal approach in percutaneous renal surgery. It is less traumatic than alternative infracostal access techniques and has a very short learning curve.

Nigam’s inverted curtain hernioplasty: a modified lichtenstein tension free hernioplasty for inguinal hernia

Background: It is an open tension-free hernioplasty for primary inguinal hernias using minimal dissection and only 3 sutures to fix the mesh.Methods: A description of operative technique and patient’s demographics are presented.Results: 362 repairs were done with this technique over a period 18 years (March 2000 to March 2018). All were primary uncomplicated inguinal hernias.Conclusions: NICH tackles the both known aetiological factors for recurrence i.e., weakness in inguinal floor and tension at the suture line. It involves minimal tissue dissection and least number of sutures. Two sutures are used to fix the mesh with inguinal ligament. Third suture is used to make an artificial deep inguinal ring in the mesh as well as used to narrow the natural deep inguinal ring to further avoid recurrence. No suture is applied in main body of mesh which remains free like an inverted curtain covering the whole hernia susceptible region of groin. Prolene mesh is used which completely covers the potentially weak area on the floor of inguinal region irrespective of the size of the area in small or big frame persons. Semi double breasting of external oblique aponeurosis avoids displacement of mesh. NICH is associated with least recurrence, less post-operative pain, less post-operative complications and short learning curve.

Meshplasty treatment for stress urinary: a prospective clinical trial

Background: Stress urinary incontinence is when there is involuntary loss of urine due to increase intra-abdominal and intravesical pressure.Methods: This is a prospective clinical trial which was conducted at a Municipal General Hospital in Mumbai in the Department of Obstetrics and Gynecology for a period of 10 years from January 2005 to December 2015.The study group consisted of 518 cases with clinically demonstrable SUI with or without pelvic floor defects. Meshplasty was performed as a choice of surgery for SUI correction.Results: The study group was divided based on age(25-40,41-55,>55),parity(I,II-III,>IV), symptoms (SUI, Dysfunctional uterine bleeding, prolapse), type of anaesthesia (local, general/spinal anaesthesia), surgery performed (meshplasty alone, meshplasty with cystorectocele repair, meshplasty with vaginal hysterectomy (VH), meshplasty with VH with cystorectocele repair, meshplasty with VH with cystorectocele repair with sacrospinous fixation), complications (mesh rejection, urine retention).Conclusions: Meshplasty is a simple inexpensive procedure with short learning curve. This has a 94% success rate.