Anastamosis

BACKGROUND: Multi-segment thoracic aortic disease typically requires total aortic arch replacement, affects a heterogenous population, and carries a high risk even at centers of excellence. Risk has been associated with duration of operation and complexity of repair. A novel branched stented anastomosis frozen elephant trunk repair (B-SAFER) technique has been developed at our center, and is being studied as a physician-sponsored investigation device exemption (PS-IDE). OBJECTIVE: Of this study is to assess early safety of using this investigational technique to treat the proximal aorta in subjects with aortic disease involving multiple segments...

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) remains the preferred surgical option for medically refractory ulcerative colitis. Management of individuals with an IPAA prior to and during pregnancy presents challenges that can have serious consequences. Infertility, mechanical obstructive and inflammatory pouch complications are frequently encountered in pregnant women with an IPAA. Mechanical obstructions occur due to a variety of underlying aetiologies, including stricturing disease, adhesions and pouch twists...

Thyroid cancers invading the critical structures like trachea, oesophagus, recurrent laryngeal nerve and major vessels are uncommon. Even though uncommon, patients with large thyroid lesion (> 4 cm) or aggressive histology can present with features of invasion. Careful evaluation and appropriate surgical management is needed for optimal outcome. This case is presented to make our otolaryngology-head and neck surgeons aware of such unique situation where an incidental thyroid nodule presenting as haemoptysis due to tracheal invasion...

Improved utilization of surgical interventions to improve patient outcomes has led to an increased need to endoscopically evaluate and treat the bowel after surgery. The best outcomes are attained when the endoscopist coordinates with the surgeon, and in some cases the pathologist or radiologist to plan the procedure. Understanding the anatomy and pathology anticipated can allow planning for sedation, bowel cleanse and equipment needed. Surgically altered anatomy can create challenges that with planning can be overcome...

We present a clinical case of a patient with a post radical robot-assisted prostatectomy recurrent vesicourethral anastamotic stenosis. Successful simplified transvesical correction with buccal mucosa graft fixed by self-anchoring automated V-Loc suture through the needle for epidural anestesia without knot formation was the unique feature of case presented.

No abstract text is available yet for this article.

Intrinsic ureteral endometriosis is a very rare presentation of deep infiltrating endometriosis. It can lead to urinary tract obstruction and loss of renal function. Clinical suspicion and radiologic assessment can aid in preoperative diagnosis and help plan surgical treatment. Herein we report a case of a 29-year-old female who presented with left-sided pelvic and flank pain. Imaging revealed left obstructive uropathy and a left ureteral mass. She underwent laparotomy and resection of the diseased ureter with primary re-anastomosis...

Cutaneous reactive angiomatosis, a group of disorders defined by benign vascular proliferation, is associated with a number of systemic processes, including intravascular occlusion by cryoproteins. We report a case of a 64-year-old female patient who presented with a one-year history of non-tender petechiae of the bilateral arms and lower legs. Dermoscopic evaluation showed increased vascularity with a globular pattern. Over a period of months, her findings progressed to erythematous to violaceous plaques with admixed hypopigmented stellate scarring of the bilateral lower extremities, forearms, and lateral neck...

INTRODUCTION: Pancreaticojejunal anastomosis is a technically challenging stage of the pancreaticoduodenectomy procedure for even the most experienced surgeon. We illustrate a buttressed duct-to-mucosa anastomosis (modified Blumgart technique) during laparoscopic pancreaticoduodenectomy using an articulating needle holder (FlexDex) (Video, Supplemental Digital Content 1, https://links.lww.com/SLE/A299). MATERIALS AND METHODS: While performing a minimally invasive pancreaticoduodenectomy, an articulating needle holder (FlexDex) is introduced through an 8 mm laparoscopic port and used to perform the duct-to-mucosa pancreaticojejunal anastomosis...

Aneurysms of descending thoracic aorta following surgical repair of coarctation have been reported in literature. Almost always, they are seen in repairs involving prosthetic patch aortoplasty. We report a neonate who underwent resection and an extended end to end anastomosis repair of coarctation and subsequently developed a huge pseudoaneurysm at a 3-month follow-up. He underwent a repair of the same through a sternotomy approach under hypothermic low flow cardiopulmonary bypass. An autologous pericardial patch aortoplasty was done successfully...

We present a case of a premature infant who had an initial diagnosis of an innominate artery compression syndrome. This was approached by a median sternotomy for an aortopexy. However, the patient was found to have a distal tracheal stenosis due to a tracheal cartilage deficiency and was treated by a tracheal resection and primary anastamosis.

Aneurysms of the cervical internal carotid artery (ICA) are a rare entity1,2 accounting for less than 0.2% to 0.5% of all carotid surgeries3 and less than 1% of all arterial aneurysms.4 There are several types of aneurysms, which include dissecting aneurysms, pseudoaneurysms, mycotic aneurysms, and fusiform and saccular aneurysms.5 The causes can include atherosclerosis, trauma, infection, and dysplasia. We present the case of a 70-yr-old otherwise healthy female found to have a neck mass. She was referred from a peripheral vascular surgeon to a head and neck surgeon for potential biopsy...

Permanent pacemaker (PPM) implantation is required in a subset of patients (∼10%) for sinus node dysfunction or atrioventricular block both early and late after heart transplantation. The incidence of PPM implantation has decreased to <5% with the advent of bicaval anastamosis transplantation surgery. Pacing dependence upon follow-up has been variably reported. An even smaller percentage of transplantation recipients (1.5% to 3.4%) undergo implantable cardioverter-defibrillator (ICD) placement. Rigorous data are lacking for the use of ICDs in the transplantation population and is largely derived from cohort studies and case series...

Intussusception in adults is a rare condition. Unlike in children, it is often associated with a pathologic lesion that serves as a lead point. We report an unusual case of ileo-caecal intussusception due to lipoma. A 51-year-old male presented with symptoms and signs of intestinal obstruction. CT scan revealed bowel obstruction, resulting from ileo-caecal intussusception with the lead point being a lipoma of the terminal ileum. Ileocaecal resection with primary anastamosis was performed with histology confirming lipoma...

Pancreatoduodenectomy is the procedure of choice for treating periampullary and pancreatic head malignancy. The procedure has been standardized and the mortality has reduced considerably to fewer than 5% in high volume centers specializing in pancreatic surgeries. Unfortunately, the morbidity still hovers around 40%. The Achiles heal of pancreatoduodenectomy is the pancreatoenteric anastamosis, the failure of which leads to significant morbidity. Literature is flooded with a plethora of techniques of reconstruction, and the results are variable...

Although colonic volvulus is a relatively rare cause of large bowel obstruction, accounting for up to 5% of all cases of intestinal obstruction, transverse colon volvulus is extremely uncommon compared with volvulus of the sigmoid colon or caecum and is responsible for only 3% of all reported cases. We report an unusual case of spontaneous volvulus of the transverse colon in a young man with sickle cell disease who underwent resection with primary anastamosis. Having a high index of suspicion and early operative intervention allowed for this patient to have an uneventful postoperative course...

BACKGROUND: Adenocarcinomas can arise in a variety of circumstances in which intestinal segments have been used for urinary diversions. Whereas ureterosigmoidostomy is the oldest and simplest form of continent urinary diversion it also seems to be the most dangerous in this regard. Herein we present a case of colonic neoplasia complicating a non-functioning ureterosigmoidostomy after 55 years; the longest latent period documented to date. CASE PRESENTATION: A 56-year-old lady born with congenital bladder exystrophy and who had a functional ileal conduit presented to us with a 6 month history of change in bowel habit and rectal bleeding...

No abstract text is available yet for this article.

Background & objectives: Polyethylene terephthalate (PET) graft, designed and developed at our institute for vascular reconstruction, is porous to promote optimal incorporation and neointima formation, requiring pre-clotting or biomodification by sealing the pores before implantation. The objective of this study was to characterize, test and perform preclinical evaluation of hydrogel (alginate dialdehyde cross-linked gelatin) sealed fluoropassivated PET vascular prosthesis in pig model, so as to avoid pre-clotting, for its safety and efficacy before employing the indigenous and less expensive graft for clinical use...

A 7-year-old boy presented to Paediatric outpatient with worsening lethargy and tiredness. On examination he had extreme pallor. Blood investigations confirmed severe iron deficiency anaemia. He was started on iron supplements and received blood transfusion. However, the response to iron treatment was suboptimal, he therefore underwent extensive workup for the cause of iron deficiency anaemia. The barium meal showed dilated segments of ileum with two distal stenoses. The surgical resection of the involved segment was performed with end to end anastamosis...