A novel method for the treatment of localised intrathoracic anastomotic leakage.
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Leakage (economics)
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Objective: To evaluate the safety and effectiveness of esophageal replacement with ileocolon graft. Methods: Totally 34 cases of esophageal replacement with ileocolon graft from July 2015 to November 2017 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University were analyzed retrospectively, including 24 male and 10 female, aging from 7 to 72 years old. Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route except one subcutaneous route. The primary esophageal disease, postoperative complication rate and quality of life were analyzed. Results: The overall postoperative complication rate was 23.5% (8/34), cervical anastomotic leakage rate of 5.9% (2/34), necrosis of colon graft of 5.9% (2/34). There were 3 patients experienced re-operation including 2 patients with colon graft necrosis and 1 patient with intestinal obstruction after ERC. One patient with colon graft necrosis died of septic shock after reoperation. Six cases of cervical esophago-jejunal anastomosis stenosis and 1 case of diarrhea occurred in the later time. All patients were followed up for a median time of 9 months (range: 1 to 28 months), 32 cases survived but 1 patient died until last follow-up by the end of December 2017. Conclusion: Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route was safe and effective.目的： 探讨回结肠代食管术的安全性和有效性。 方法： 回顾性分析2015年7月至2017年11月上海交通大学附属胸科医院胸外科连续施行的34例回结肠代食管术患者的临床资料。男性24例，女性10例，年龄7～72岁。采用结肠右动脉和(或)结肠中动脉作为供血管，经胸骨后径路行回结肠代食管(1例患者采用经皮下径路)。统计围手术期并发症发生率及术后生活质量。 结果： 总体并发症发生率为23.5%(8/34)，围手术期颈部吻合口瘘发生率为5.9%(2/34)、移植结肠坏死发生率为5.9%(2/34)。2例患者因移植结肠坏死、1例患者因肠梗阻接受再次手术，其中1例结肠坏死患者死于二次手术后感染性休克，总体病死率为2.9%。远期并发症包括颈部食管－回肠吻合口狭窄6例、腹泻2例。截至2017年12月，随访1～28个月，中位随访时间9个月，1例死于食管癌术后复发转移，余32例存活。 结论： 采用结肠右动脉和(或)结肠中动脉作为供血管、经胸骨后径路回结肠代食管术较为安全有效，简单易行。.
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Objective To investigate the early diagnosis and therapy of Type Ⅲ Congenital Esophageal Atresia(CEA).Method A retrospective analysis had been adopted to the clinical materials of 16 cases of type Ⅲ CEA during August 2006 to July 2008 in our hospital.All cases had been confirmed by angiography.The Tracheoesophageal Fistula(TF) through outerpleura path were ligated and the anastomosis operation was done.Some cases were added the procedure of Lovaditis for cutting the t.muscularis oesophagi before the anastomosis opertation.Results All 16 cases had been done the surgery and all were cured.Among all the cases,one was conducted a repair operations before fully cured;one was fully cured after anti-infection,nutrition support and fully postoperative drainage.All cases were tracked for 6 months to 2 years.One case died for the infection of lung and the other 11 cases had been in good condition.Conclusion Early diagonosis,prompt surgery,good postoperative nursing and the preventive and therapy of complication were of great importance in improving the survival rate of CEA.In particular,the reducing of anastomotic had decisive effect to anastomotic leakage.The avoidance of pleura rupture was significant for the recovery and prognosis.The early extraction of the pipe of outer pleural of the postoperative drainage near the anstomosis was beneficial for the recovery of the anastomosis.
Tracheoesophageal Fistula
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From August 1989 to August 1994, 173 arteriovenous fistules were constructed in 162 patients for permanent hemodialysis: 49 autogenous and 124 graft fistulas (polytetraflouroethylene (PTFE)-119, others-5). Previous access procedures were noted in 93 graft fistulas (76%) versus 8 autogenous fistulas (16.3%). In the immediate postoperative period, 13 graft fistulas (10.6%) developed complications (5 anastomotic hemorrhages, 4 thrombosis, 3 hypotension without hemorrhage, and 1 sepsis), while 2 (4.1%) autogenous fistulas developed immediate postoperative complications (1 anastomotic hemorrhage and 1 thrombosis). Graft fistulas had a higher, although not statistically significant incidence of immediate postoperative complications versus autogenous fistulas. These graft fistula complications were associated with multiple access procedures and required surgical exploration. Based on these results, we should make every effort to construct the autogenous fistula as the first choice of hemodialysis access procedure in properly selected patients.
Hemodialysis access
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A retrospective analysis of the treatment of 70 patients with obstructed left colonic cancer was undertaken in order to assess whether staged or primary resection was more appropriate. Thirty-four patients had initial colostomy and staged resection (group 1) while 36 patients were treated by primary resection and immediate anastomosis following intra-operative bowel washout (group 2). There were seven deaths (10%), five in group 1 and two in group 2. The wound infection rate and average hospital stay were 44% and 36 days in group 1 and 19.4% and 16.5 days in group 2, respectively. Twenty per cent of patients in group 1 did not complete their staged procedures and had to live with their colostomies. The smoother postoperative recovery and shorter hospital stay was particularly significant in group 2 patients. As primary resection and anastomosis can now be performed with relative safety and reduced morbidity, we conclude that staged procedures can no longer be accepted as standard treatment for left colonic obstruction.
Group B
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Objective To assess the results of PPH in the treatment of heamorroidpexy.Methods We retrospectively reviewed clinical data for 216 patients(male 92 and female 68) who had undergone PPH.Average age was 41.0±24.8 years.Of 216 patients,grade Ⅱ in 26 patients,grade Ⅲand Ⅳ in 68,mixed hemorrhoids in 122.Results Average duration of surgery was 30 minutes.The width of the excised tissue was 2.5cm.Postoperative bleeding occurred in 4 patients,anal pain in 34 patients and urinary retention in 123 patients.There were no patients with fecal incontinence and anastomotic stricture.The mean follow-up was 6 months.There were 13 patients missed follow-up,203 patients remained follow-up,including 196 patients with hemorrhoids block were fully retracted,7 patients were incompletely retraction.Conclusions PPH is a safe,short and effective procedure in the management of hemorrhoids,and patients have few postoperative complications.Anastomotic height and depth of the purse-string suture is an important factor affecting the outcomes.
Urinary retention
Fecal Incontinence
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Surgery for carcinoma of the esophagus and cardia represents potentially curative therapy in early stage of tumor. In the advanced stage of tumor palliation is the only remaining therapeutic aim. In a retrospective study covering the period 1984-1992 we analyzed 51 patients who underwent surgery for esophageal or cardia cancer to determine whether palliation by surgery is feasible. We also analyzed morbidity and mortality of peri- and postoperative complications. In 88% we carried out standard esophagectomy consisting of abdomino-thoracic access, gastric interposition with thoracic anastomosis and extramucous pyloromyotomy. In the light of postresection histology, 53% of the operations were potentially curative (UICC stage I and II) [1], 47% palliative (UICC stage III and IV) [1]. Perioperative 30-days mortality was nil, perioperative 30-days morbidity 11% (3 patients developed pneumonia postoperatively, 2 patients with cervical anastomosis developed dehiscence of anastomosis which in both cases healed completely with conservative therapy, while a further patient with cervical anastomosis suffered persistent paralysis of the recurrent nerve. All patients were fully able to feed themselves at the time of discharge. 43% of patients had recurrent dysphagia and 24% underwent endoscopic dilatation. Three-year survival was 26%. From these results it may be concluded that esophageal resection represents either good palliation with low morbidity for the majority of patients with non-resectable carcinoma of the esophagus or potentially curative therapy with low morbidity in early stage of tumor.
Esophagectomy
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Purpose: Transanal one-stage Soave (TOS) procedure is the most recently reported procedure for Hirschsprung's disease. This study was performed to compare the surgical outcomes of TOS with those of modified Duhamel procedure. Methods: The study populations were 17 consecutive patients who underwent TOS procedure between March, 2003 and February, 2008 (TOS group) and 19 consecutive patients who underwent modified Duhamel procedure between March, 1996 and February, 2001 (Duhamel group) by one pediatric surgeon. Age, gender, length of aganglionic segment, operating time, complications, duration of postoperative hospital stay, and functional results were retrospectively analyzed and compared between the two groups. Results: There was no difference in age, gender, and length of the aganglionic segment between the two groups. The operating time (195 versus 255 minutes, P＜0.05) and the duration of postoperative hospital stay (7 versus 9 days, P＜0.05) were significantly shorter in the TOS group. Postoperative complications occurred in 10 of 17 in the TOS group (4 perianal excoriation, 3 anastomotic stenosis, and 3 postoperative enterocolitis) and 10 of 19 in Duhamel group (2 wound infection, 1 perianal excoriation, 1 anastomotic leakage, 1 rectal bleeding, 2 intestinal obstruction, and 3 postoperative enterocolitis). Two cases in the Duhamel group required operation to treat postoperative complication, one for anastomotic leakage and one for intestinal obstruction. There was no significant difference in the functional results between both groups. Conclusion: TOS shows similar functional results and postoperative complications but has the advantage of a significantly shorter operating time and postoperative hospital stay compared with modified Duhamel procedure.
Enterocolitis
Hirschsprung's disease
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To determine short-term outcomes following middle pancreatectomy with transgastric pancreaticogastric anastomosis.A retrospective analysis of 23 patients who underwent middle pancreatectomy with transgastric pancreaticogastric anastomosis at the Massachusetts General Hospital, Boston, from June 22, 2005, through April 29, 2009.Indications for procedure, operative time, length of stay, morbidity, mortality, and need for readmission, antibiotics, reoperation, additional procedures, or transfusion.The mean age of 15 women and 8 men who underwent middle pancreatectomy with transgastric pancreaticogastric anastomosis was 55.0 years. The median follow-up time was 12.9 months. The most commonly resected tumors were intraductal papillary mucinous neoplasms (n = 9), serous cystadenomas (n = 5), and neuroendocrine tumors (n = 4). The mean (SD) operative time was 191 (39) minutes. No patients required intraoperative transfusion. The median hospital stay was 5 days. The most common complications were pancreatic fistula (n = 6), intra-abdominal abscess (n = 4), and superficial skin infection (n = 4). Three patients had splenic artery pseudoaneurysms. Seven patients required readmission; 2 required reoperation. No patients developed postoperative new or worsening endocrine or exocrine insufficiency. There were no deaths.Middle pancreatectomy with transgastric pancreaticogastric anastomosis offers a safe alternative to the traditional Roux-en-Y pancreaticojejunostomy and may be technically simpler.
Pancreatic fistula
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Objective To analysis the treatment effect of interventional catheter in conservative treatment of esophageal cancer postoperative anastomotic fistula. Methods 24 cases of esophageal cancer patients who occurred postoperative complications of anastomotic fistula admitted by our hospital were selected as the research object, carried out interventional catheter conservative treatment and then the treatment effect. was observed. Results 21 cases were cured that treated by jejunum nutrition tube, gastrointestinal decompression tube and the stoma drainage tube.1 patient dead because of serious infections.2 patients were cured by placing the stoma block stents for treatment. The average time of recover eating was(18.0±8.2) days, the average length of hospital stay was(32.0±10.4) days. The incidence of complications was 20.0%. Conclusion It has good effect that use interventional catheter conservative treatment to treat esophageal cancer postoperative anastomotic fistula. Because it can effectively solve the problem of complications and little operation space, avoid infection and blood supply obstacles, less traumatic, and patients' tolerance is better, shorten the duration.
Stoma (medicine)
Conservative Treatment
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From May 91 to March 99 a consecutive series of 100 acute obstructions or perforations of the left colon or rectum were treated by primary resection with mechanical anastomosis using a double or triple stapling technique without proximal colostomy. There were 8 postoperative deaths (8%) due to sepsis, acute respiratory distress syndrome, pulmonary embolism, stroke, and cachexy. Complications occurred in 29% of surviving patients. Clinical anastomotic leaks were observed in 7%, respiratory infection in 8%, wound infection in 8% and major cardiovascular problems in 4% of patients. The median hospital stay was 19 days. The morbidity and mortality of this series did not exceed the cumulative morbidity and mortality that can be expected after staged surgery. Compared with staged surgery, immediate resection and anastomosis using an entirely mechanical suture, thereby avoiding the problems of colostomy and reducing the length of hospital stay, has significant advantages for patients.
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