scholarly journals Endoscopic recanalization with an incision using a needle knife after identifying the oral‐side lumen in complete anastomotic stenosis

2021 ◽  
Author(s):  
Yuki Murakami ◽  
Katsuyoshi Ando ◽  
Mikihiro Fujiya
Keyword(s):  
Anastomotic Stenosis ◽  
Oral Side ◽  
Needle Knife

scholarly journals Surgical Resection of Anastomotic Stenosis after Rectal Cancer Surgery Using a Circular Stapler and Colostomy with Double Orifice

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Toru Imagami ◽  
Satoru Takayama ◽  
Yohei Maeda ◽  
Taku Hattori ◽  
Ryohei Matsui ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Balloon Dilation ◽  
Circular Stapler ◽  
Anastomotic Stenosis ◽  
Endoscopic Balloon Dilation ◽  
Oral Side ◽  
Double Stapling ◽  
Double Orifice ◽  
Endoscopic Balloon

The double stapling technique has greatly facilitated intestinal reconstruction, particularly for anastomosis after anterior resection. However, anastomotic stenosis may occur, which sometimes requires surgical treatment. Redo surgery with reresection and reanastomosis presents a high risk of complications. Treatment methods need to be selected depending on the degree and location of stenosis. In an effort to propose a new resolution, reporting new cases and sharing valid experiences are necessary. An 82-year-old man diagnosed with rectal cancer had undergone laparoscopic anterior resection. Endoscopic balloon dilation performed for anastomotic stenosis had failed. Therefore, colostomy with double orifice was constructed on the oral side at 10 cm from the stenosis. Approaching from the anal and stoma side, the anastomotic stenosis was resected using a circular stapler. The colostomy was closed 1 month after surgery. Stenosis resection using a circular stapler requires the following steps: (1) passing the center shaft through the stenosis, (2) inserting the anvil head into the oral side of the stenosis, and (3) attaching the anvil head to the center shaft. This method can resect the stenosis using a circular stapler without being affected by postoperative adhesion in the pelvis. Compared to endoscopic balloon dilation, resection of the stricture by the circular stapler is thought to be reliable. This technique is particularly effective for localized stenosis, including anastomotic stenosis. It is considered that this method is minimally invasive and is low risk for complications. This method can contribute to the useful surgical option for refractory anastomotic stenosis after anterior resection.

Endovascular stent-graft treatment for graft-vein anastomotic stenosis in haemodialysis patients with arteriovenous grafts

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 466-472 ◽  
Author(s):  
Chia-Hsun Lin ◽  
Yen-Yang Chen ◽  
Chai-Hock Chua ◽  
Ming-Jen Lu
Keyword(s):  
Risk Factors ◽  
Stent Graft ◽  
Target Lesion ◽  
Primary Patency ◽  
Anastomotic Stenosis ◽  
Secondary Patency ◽  
Endovascular Stent ◽  
Stent Grafts ◽  
Venous Anastomosis ◽  
Arteriovenous Grafts

Abstract. Background: In this study, we investigated the patency of endovascular stent grafts in haemodialysis patients with arteriovenous grafts, the modes of patency loss, and the risk factors for re-intervention. Patients and methods: Haemodialysis patients with graft-vein anastomotic stenosis of their arteriovenous grafts who were treated with endovascular stent-grafts between 2008 and 2013 were entered into this retrospective study. Primary and secondary patency, modes of patency loss, and risk factors for intervention were recorded. Results: Cumulative circuit primary patency rates decreased from 40.0 % at 6 months to 7.3 % at 24 months. Cumulative target lesion primary patency rates decreased from 72.1 % at 6 months to 22.0 % at 24 months. Cumulative secondary patency rates decreased from 81.3 % at 12 months to 31.6 % at 36 months. Patients with a history of cerebrovascular accident had a significantly higher risk of secondary patency loss, and graft puncture site stenosis jeopardised the results of stent-graft treatment. Conclusions: Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.

scholarly journals Oral side effects of COVID-19 vaccine

BDJ ◽  
2021 ◽  
Vol 230 (2) ◽  
pp. 59-59
Author(s):  
A. Riad
Keyword(s):  
Side Effects ◽  
Oral Side

scholarly journals Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Michio Itabashi ◽  
Yoshiko Bamba ◽  
Hisako Aihara ◽  
Kimitaka Tani ◽  
Ryousuke Nakagawa ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Anterior Wall ◽  
Middle Part ◽  
Presacral Space ◽  
Previous Surgery ◽  
Afferent Limb ◽  
Radiographic Findings ◽  
Oral Side

Abstract Background Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later. Case presentation A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged. Conclusion Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.

scholarly journals Biliary cannulation in endoscopic retrograde cholangiography: How to tackle the difficult papilla

2021 ◽  
Author(s):  
Mark op den Winkel ◽  
Jörg Schirra ◽  
Christian Schulz ◽  
Enrico N. De Toni ◽  
Christian J. Steib ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Guide Wire ◽  
A Priori ◽  
Endoscopic Retrograde Cholangiography ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Increased Risk ◽  
Difficult Biliary Cannulation ◽  
Needle Knife ◽  
Transpancreatic Sphincterotomy

Background: In the setting of a naïve papilla, biliary cannulation is a key step in successfully performing endoscopic retrograde cholangiography (ERC). Difficult biliary cannulation (DBC) is associated with an increased risk of post-ERCP-pancreatitis and failure of the whole procedure. Summary: Recommendations for biliary cannulation can be divided in (a) measures to reduce the likelihood of a difficult papilla-situation a priori and (b) rescue techniques in case the endoscopist is actually facing DBC. (a): careful inspection of the papillary anatomy and optimizing its accessibility by scope-positioning is fundamental. A sphincterotome in combination with a soft-tip hydrophilic guide-wire rather than a standard catheter with a standard guide-wire should be used. (b): The most important rescue techniques are needle-knife precut, double-guidewire technique and transpancreatic sphincterotomy. In few cases, anterograde techniques are needed. To this regard, the EUS-guided biliary drainage (EUS-BD) followed by rendezvous is increasingly used as an alternative to percutaneous-transhepatic biliary drainage. Key Messages: Biliary cannulation can be accomplished with alternative retrograde or less frequently by salvage-anterograde techniques, once conventional direct cannulation attempts have failed. Considering recent favorable data for the early use of transpancreatic sphincterotomy, an adopted version of the 2016 European-Society-for-Gastrointestinal-Endoscopy (ESGE)-algorithm on biliary cannulation is proposed.

scholarly journals Long-term outcomes after endoscopic retrograde pancreatic drainage for symptomatic pancreaticojejunal anastomotic stenosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Akihiko Kida ◽  
Yukihiro Shirota ◽  
Taro Kawane ◽  
Hitoshi Omura ◽  
Tatsuo Kumai ◽  
...  
Keyword(s):  
Adverse Events ◽  
Anastomotic Stenosis ◽  
Technical Success ◽  
Long Term Outcomes ◽  
Endoscopic Retrograde ◽  
Technical Success Rate ◽  
Registration Number ◽  
Clinical Trial Register

AbstractThere is limited evidence supporting the usefulness of endoscopic retrograde pancreatic drainage (ERPD) for symptomatic pancreaticojejunal anastomotic stenosis (sPJS). We examined the usefulness of ERPD for sPJS. We conducted a retrospective analysis of 10 benign sPJS patients. A forward-viewing endoscope was used in all sessions. Following items were evaluated: technical success, adverse events, and clinical outcome of ERPD. The technical success rate was 100% (10/10) in initial ERPD; 9 patients had a pancreatic stent (no-internal-flap: n = 4, internal-flap: n = 5). The median follow-up was 920 days. Four patients developed recurrence. Among them, 3 had a stent with no-internal-flap in initial ERPD, the stent migrated in 3 at recurrence, and a stent was not placed in 1 patient in initial ERPD. Four follow-up interventions were performed. No recurrence was observed in 6 patients. None of the stents migrated (no-internal-flap: n = 1, internal-flap: n = 5) and no stents were replaced due to stent failure. Stenting with no-internal-flap was associated with recurrence (p = 0.042). Mild adverse events developed in 14.3% (2/14). In conclusions, ERPD was performed safely with high technical success. Recurrence was common after stenting with no-internal-flap. Long-term stenting did not result in stent failure.Clinical trial register and their clinical registration number: Nos. 58-115 and R2-9.

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