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Karen Zaghiyan, Jan P Kamiński, Galinos Barmparas, Phillip Fleshner
The risk of de novo Crohn's disease (CD) after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) versus inflammatory bowel disease unclassified (IBDU) or indeterminate colitis (IC) remains debatable. Here, we present updated results after long-term follow-up of a previously studied cohort of 334 patients with UC, IBDU, or IC who underwent IPAA during a 10-year period ending 2007. Of 334 study patients, 56 per cent were male and median age was 38 years (range: 8-81). Patients were classified as UC (n = 237) or IBDU (n = 97) preoperatively and UC (n = 236) or IC (n = 98) postoperatively...
October 2016: American Surgeon
Eugene Wang, Kenji Inaba, Jayun Cho, Saskya Byerly, Vincent Rowe, Elizabeth Benjamin, Lydia Lam, Demetrios Demetriades
Thrombosis is a devastating complication after repair of traumatic vascular injury. Although thrombosis rates have been described, the value of anticoagulation in preventing postrepair thrombosis is unknown. We hypothesize that postoperative anticoagulation reduces thrombosis rates. A total of 1524 consecutive patients with traumatic arterial injuries from January 2005 to June 2015 were identified, and 381 patients underwent the following repair types: direct suture of vessel wall, primary anastomosis, extra-anatomic reconstruction, tissue and synthetic interposition reconstruction...
October 2016: American Surgeon
Bradley Genovese, Steven Yin, Sohail Sareh, Michael DeVirgilio, Laith Mukdad, Jessica Davis, Veronica J Santos, Peyman Benharash
With changes in work hour limitations, there is an increasing need for objective determination of technical proficiency. Electromagnetic hand-motion analysis has previously shown only time to completion and number of movements to correlation with expertise. The present study was undertaken to evaluate the efficacy of hand-motion-tracking analysis in determining surgical skill proficiency. A nine-degree-of-freedom sensor was used and mounted on the superior aspect of a needle driver. A one-way analysis of variance and Welch's t test were performed to evaluate significance between subjects...
October 2016: American Surgeon
Seidai Wada, Etsuro Hatano, Tomoaki Yoh, Satoru Seo, Kojiro Taura, Kentaro Yasuchika, Hideaki Okajima, Toshimi Kaido, Shinji Uemoto
PURPOSE: Prophylactic abdominal drainage is performed routinely after liver resection in many centers. The aim of this study was to examine the safety and validity of liver resection without abdominal drainage and to clarify whether routine abdominal drainage after liver resection is necessary. METHODS: Patients who underwent elective liver resection without bilio-enteric anastomosis between July, 2006 and June, 2012 were divided into two groups, based on whether surgery was performed before or after, we adopted the no-drain strategy...
October 24, 2016: Surgery Today
Zuhair Ahmed, Jessie A Elliott, Sinead King, Claire L Donohoe, Narayanasamy Ravi, John V Reynolds
BACKGROUND: Benign anastomotic strictures occur frequently after esophagectomy, and impact on postoperative recovery, nutritional status, and quality of life. This large cohort study explored the incidence of stricture after transthoracic (2- and 3-stage) and transhiatal resections with uniform single-layer sutured anastomotic technique, and aimed to identify independent risk factors. METHODS: Patients undergoing esophagectomy with gastric conduit reconstruction between February 2001 and October 2014 were studied prospectively...
October 24, 2016: World Journal of Surgery
Ajit Pai, Saleh Mohamed Eftaiha, George Melich, John J Park, Pey-Yi Kevin Lin, Leela M Prasad, Slawomir J Marecik
BACKGROUND: Today, extralevator abdominoperineal resection is the standard of care for low rectal cancers with sphincter involvement or location precluding anastomosis. This procedure, while effective from an oncologic point of view, is morbid, with a high incidence of wound complications and genitourinary, and sexual dysfunction. We present a modification of this procedure via a robotic approach, which maintains the radicality while reducing the soft tissue loss and potentially the morbidity...
October 24, 2016: World Journal of Surgery
C W Michalski, P Tramelli, M W Büchler, T Hackert
Postoperative pancreatic fistulas represent the most frequent complication after distal and segmental pancreatectomy and occur with a frequency of up to 50 %. There are many technical variations of pancreatic stump treatment for reduction of fistula rates after distal resection. Most of these techniques have only been analyzed in retrospective studies and the evidence for or against a specific technique is low. Several retrospective trials have been conducted with good results to compare suturing with stapled closure of the remnant and to assess the effect of a vascularized falciform ligament patch in reducing postoperative pancreatic fistula; however, in a recently published randomized trial, which analyzed closure of the remnant with a pancreaticojejunostomy compared to standard closure, these results could not be confirmed...
October 24, 2016: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Deepa Prasad, James P Strainic, Khyati Pandya, Peter C Kouretas, Ravi C Ashwath
We report a rare causal association between obstructed supracardiac totally anomalous pulmonary venous drainage and coronary sinus ostial atresia. Our 12-week-old patient developed venous myocardial infarction secondary to coronary venous hypertension because her sole route of coronary venous drainage was obstructed. She recovered after the obstruction was relieved by balloon dilation. Surgical repair then included anastomosis of the pulmonary venous confluence to the left atrium, ligation of the vertical vein, and unroofing of the coronary sinus...
October 2016: Texas Heart Institute Journal
Marianne Abouyared, Mikhaylo Szczupak, Eric Barbarite, Zoukaa B Sargi, David E Rosow
PURPOSE: The purpose was to assess the success of open tracheal resection and re-anastomosis for non-malignant tracheal stenosis in adults. Successful operations were defined as T-tube or tracheostomy-free status by 6months post-operatively. MATERIALS AND METHODS: Retrospective chart review was performed and data were recorded in a de-identified manner. The primary outcome was T-tube or tracheostomy-free status by 6months following tracheal resection. Clinical and demographic characteristics were evaluated as potential prognostic variables...
September 7, 2016: American Journal of Otolaryngology
G Alonso Ciodaro, J I Santamaría Ossorio, S Sanjuán Rodríguez
INTRODUCTION: Cecal duplications are rare, representing 0.4% of all gastrointestinal duplications, with few cases reported in the literature. CLINICAL CASE: A 48 hours-old newborn presented with bilious vomiting and abdominal distension; the ultrasound revealed a cystic mass in the right abdomen; ileocolic resection was performed with end to end anastomosis. Microscopy confirmed cecal duplication cyst. COMMENTS: In patients with intestinal obstruction, contrast enema allows differential diagnosis with other colonic pathologies in the newborn; when the cecal duplication cyst is connected to the lumen of the colon, enema reveals a filling defect, and cecal duplication can be suspected...
October 10, 2016: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
H Delgado Bartra, F M Lapouble Ramírez, J Bonilla Pabón, S T Vega Centeno
INTRODUCTION: The Rubinstein-Taybi syndrome and pancreas divisum are uncommon diseases in children. The Rubinstein-Taybi syndrome diagnosis is only clinical, and mental retardation and dysmorphic features mainly characterize it. The PD relates to idiopathic pancreatitis in 7.5% of patients suffering from this disorder. It has not been found any cases reported where these diseases are associated and the management of patients with pancreatitis associated with PD is still a challenge. CLINICAL CASE: A patient diagnosed with Rubinstein-Taybi syndrome has recurrent abdominal pain of six months and elevated pancreatic enzymes, he underwent a magnetic resonance imaging where pancreas divisum is suspected...
January 15, 2016: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
Allison R Schulman, Walter Chan, Aiofe Devery, Michele B Ryan, Christopher C Thompson
BACKGROUND AND AIMS: Marginal ulceration, or ulceration at the gastrojejunal anastomosis, is a common complication of Roux-en-Y gastric bypass (RYGB). Acidity likely contributes to the pathophysiology, and proton pump inhibitors (PPIs) are frequently prescribed for treatment. However, patients with gastric bypass only have a small gastric pouch and rapid small bowel transit, which limits the opportunity for capsule breakdown and PPI absorption. Soluble PPIs (open capsules, OCs) might be more easily absorbed than intact capsules (IC)...
October 20, 2016: Clinical Gastroenterology and Hepatology
Anna M Ciccone, Camilla Vanni, Giulio Maurizi, Antonio D'Andrilli, Stylianos Korasidis, Mohsen Ibrahim, Claudio Andreetti, Federico Venuta, Erino A Rendina
Idiopathic subglottic stenosis is the most challenging condition in the field of upper airway reconstruction. We describe a successful novel technique for enlarging the airway space at the site of the laryngotracheal anastomosis in very high-level reconstructions.
November 2016: Annals of Thoracic Surgery
Masao Takahashi, Akira Uchino, Chihiro Suzuki
The accessory middle cerebral artery (MCA) is a common variation of the MCA that arises from the anterior cerebral artery. We report a patient with anastomosis of the accessory MCA with the main MCA, an extremely rare variant that we diagnosed by magnetic resonance (MR) angiography. Both partial maximum-intensity-projection and partial volume-rendering MR angiographic images obtained at 3 T are useful to identify such rare vascular variation.
October 22, 2016: Surgical and Radiologic Anatomy: SRA
Paul I Heidekrueger, Denis Ehrl, Albrecht Heine-Geldern, Milomir Ninkovic, P Niclas Broer
INTRODUCTION: Free tissue transfers are a highly reliable procedure routinely performed for reconstruction of a wide range of defects. Main complication in free flap surgery is usually venous thrombosis. Many technical controversies exist regarding the technical details of the microvascular anastomosis in order to prevent occurrence of thrombosis and optimize outcomes. We therefore evaluated our results regarding the execution of one versus two venous anastomoses in a variety of free flaps (fasciocutaneous- or muscle free flap) utilized for lower limb reconstruction...
October 17, 2016: Injury
Manuel Guerrero-Hernandez, Carlos A Hinojosa, Javier E Anaya-Ayala, Erika Elenes, Aldo Torre
Portal vein (PV) thrombosis (PVT) in the absence of liver disease or thrombophilia is rare. We report a 57-year-old male with a history of stage 3 chronic kidney disease who presented at the emergency department 18 months after abdominal surgery with progressive abdominal pain and distention. Computed tomography revealed PVT with multiple collaterals and moderate ascites. He had undergone partial gastrectomy and gastrojejunal anastomosis at an outside facility for gastrointestinal stromal tumors that caused an iatrogenic stenotic lesion in the PV...
October 20, 2016: Vascular and Endovascular Surgery
Collin W Blackburn, Sarah R Vossoughi, Bukola Ojo, Prakash Gorroochurn, Charles C Marboe, Yelena Akelina, Robert J Strauch
Background During microvascular anastomosis, needle placement is facilitated by inserting the tips of the forceps into the lumen of the vessel, rather than grasping and everting the luminal wall, to minimize trauma to the vessel. This study examines whether the vessel wall can be grasped and everted during microvascular anastomosis without compromising surgical outcomes. Methods A total of 20 Sprague-Dawley rats weighing between 252 and 483 g were used. Bilateral anastomoses of the animals' femoral arteries (mean size: 0...
October 21, 2016: Journal of Reconstructive Microsurgery
Felipe Donoso, Helene Engstrand Lilja
Background Since 2005, infants with esophageal atresia (EA) in our unit are given prophylactic proton pump inhibitors (PPI) after repair until 1 year of age. The aims of this study were to identify risk factors for anastomotic strictures (AS) and to assess the efficacy of postoperative PPI prophylaxis in reducing the incidence of AS compared with symptomatic PPI. Methods Patients who underwent EA repair from 1994 to 2013 in our unit were included in this retrospective observational study approved by the local ethics review board...
October 21, 2016: European Journal of Pediatric Surgery
Anders J Davidson, Lucas P Neff, Joseph J DuBose, James B Sampson, Christopher M Abbot, Timothy K Williams
Peripheral vascular injuries carry significant risk for permanent functional impairment, limb loss, and death. Definitive correction of these injuries requires significant operative time and has traditionally been resource and skill set intensive. In the initial surgical treatment of the physiologically depleted trauma patient, faster techniques may prove more appropriate. Damage control techniques, including vascular shunting, rapidly restore distal flow but require additional vascular intervention and risk shunt thrombosis with prolonged use...
November 2016: Journal of Trauma and Acute Care Surgery
Qingbin Wu, Chengwu Jin, Tao Hu, Mingtian Wei, Ziqiang Wang
AIM: To compare intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in laparoscopic right colectomy (LRC) in terms of intraoperative and postoperative outcomes. METHODS: A systematic literature search with no limits was performed in PubMed and Embase. The last search was performed on April 9, 2016. The outcomes of interests included intraoperative outcomes (operative time, blood loss, length of incision, conversion, lymph nodes harvested, and intraoperative complications) and postoperative outcomes (time to first flatus, time to first defecation, time to liquid diet, length of hospital stay, postoperative complications, mortality, ileus, anastomotic leakage, anastomotic bleeding, wound infection, hernia, and intra-abdominal abscess)...
October 21, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
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