Bilateral Pulmonary Arteries Reconstruction for Correction of Tetralogy of Fallot with Unilateral Absence of the Pulmonary Artery

Background: Tetralogy of Fallot (TOF) is the most common combined the deformity of unilateral absence of the pulmonary artery (UAPA). The treatment strategy of TOF combined with UAPA is still very controversial. In this study, we analyzed the effect of the bilateral pulmonary reconstruction for patients with TOF combined with UAPA. Methods: A single-institution, retrospective review of all 1713 patients with TOF between January 2009 to November 2021. Eight patients were diagnosed with TOF combined with UAPA, and 7 patients underwent the surgery. Three patients underwent one-stage TOF correction with bilateral pulmonary artery reconstruction. Three patients underwent bilateral pulmonary artery reconstruction, followed by two-stage TOF correction after several months. One patient underwent 2 procedures of left pulmonary artery reconstruction, and the VSD remained open. Results: All 7 patients survived during the postoperative follow-up and showed good cardiac function and normal oxygen saturation >97%. During the follow-up with echocardiograms, it was found that the left pulmonary arteries that were reconstructed with Goretex vessel or direct anastomosis had thrombosis or stenosis. The left pulmonary artery reconstructed with the modified autologous tissue extension technique was unobstructed. Conclusions: In patients with TOF and UAPA, if there is a pulmonary confluence in the affected hilum, it is feasible to implement bilateral pulmonary artery reconstruction for one-stage TOF correction. The use of pulmonary artery extension technique and autologous tissue to bilateral pulmonary reconstruct could reduce the incidence of anastomotic stenosis.

Safety and Feasibility of Novel Reconstruction Method Using Long and Narrow Cobra- Head- Shaped Gastric Tube in Laparoscopic Proximal Gastrectomy for Cancer

Background. To clarify the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with our novel reconstruction methods, clinical outcomes of this LPG were evaluated and compared to those of LPG with our conventional method. Methods. Novel method is a reconstruction with a long and narrow gastric tube with widening of the proximal side of the gastric tube created by linear stapler. Esophagogastrostomy is performed by direct anastomosis with overlap method between the posterior wall of the esophagus and anterior wall of the gastric tube using a linear stapler. In conventional method, direct anastomosis between the esophagus and a gastric tube by a circular stapler was performed. Short- and long-term outcomes of a novel method were compared with those of conventional method. Results. A total of 39 patients whom LPG was performed were enrolled in this retrospective study. The amount of blood loss in the Novel method group (n=30) was significantly less than those in the Conventional method group (n=9) (40 vs. 110 ml, p<0.01). No cases of anastomotic leakage and stenosis were observed in both groups. The cases of postoperative reflux esophagitis at 1 year after operation in the Novel group were less than those in the Conventional group (10% vs. 33%). In the Novel group, postoperative recurrence was observed in 2 patients (7%). Conclusions. LPG with novel reconstruction method using long and narrow cobra- head-shaped gastric tube can be easily performed, and may be feasible for the treatment of gastric cancer in the upper third of the stomach.

Recurrent Pulmonary Embolism Caused by Superficial Femoral Vein Aneurysm

Venous aneurysms (VA), particularly superficial femoral VAs (SFVAs), are rare vascular lesions. A 65-year-old woman with a history of pulmonary embolism (PE), treated with tissue plasminogen activator and oral anticoagulation, was admitted to hospital for dyspnea. Enhanced computed tomography showed recurrent PE and right SFVA with a mural thrombus. The SFVA was not identified during the first PE. The PE was not massive and was treated with direct oral anticoagulants. The thrombus in the SFVA caused the PE, and surgical repair was performed to prevent further embolic events. Under general anesthesia, the SFVA was excised, and direct anastomosis was performed. PE recurrence, venous aneurysmal changes, and thrombosis were not noted at the 1-year follow-up.

Progress in facial reinnervation

Facial nerve injury often results in facial paralysis, which seriously affects the patients both aesthetically and functionally. Facial nerve reinnervation methods, including direct anastomosis, nerve graft, nerve transposition, cross-facial nerve graft, and combined surgeries, have recently become a hot topic with many new procedures being explored. This study summarizes the relevant literatures and discusses the scope of application, advantages, and disadvantages of the different methods. The treatment options or combined surgeries for facial nerve reinnervation should be individualized for specific patients to achieve the best reanimation outcome with good static symmetry, facial tone, and spontaneous, natural, symmetrical, and strong facial movements.

External Iliac Artery Injury and Thrombosis during Laparoscopic Gynecologic Surgery

Although vascular injury during laparoscopic surgery is rare, it is occasionally reported. Previously, several physicians have reported cases of compartment syndrome resulting from a thrombus during gynecologic surgery. However, few reports describe thrombosis occurring in artery vessels as a result of applying angiopressure. Herein, we report the case of a 53-year-old woman with endometrioid carcinoma and a vascular injury that resulted in thrombus formation; this is the first such case to be reported. The complication was successfully treated by means of direct anastomosis following partial resection of the injured iliac artery. This is the first report of a case in which applying angiopressure for a vascular injury during laparoscopic pelvic lymphadenectomy led to an intra-arterial thrombus which was found and treated without sequelae.

Results of venous resections in cancer of the pancreatic head.

e16785 Background: Studies have shown that pancreaticoduodenal resection (PDR) with resection and reconstruction of the venous segment does not interfere with surgical treatment for ductal pancreatic adenocarcinoma with suspected venous invasion. Venous resection improves survival compared to palliative interventions. However, the advantages and disadvantages of marginal resection, segmental resection with direct anastomosis, and venous segment prosthetics are not reflected. Methods: The study included 52 patients (23 women, 29 men) undergoing PDR with venous resection and reconstruction for cancer of the pancreatic head in 2015-2019. The average tumor size was 3.8 cm. Results: Superior mesenteric vein reconstruction (PTFE grafts) was performed in 17 patients (32.7%), sleeve resection with direct anastomosis - 24 (46.2%), marginal resection - 11 (21.1%). Venous reconstruction was planned in 78.8% of patients before the surgery. In the early postoperative period, thrombosis of the reconstructed zone was developed in two patients (3.8%), bleeding from the pancreatic bed - in one case (1.9%). Postoperative mortality was 5.8% (3 patients). After the final pathological examination, macroscopically incomplete resection was diagnosed only in the group with marginal resection and amounted to 3.8%. Microscopically incomplete resection was diagnosed in 9.6% of the studied preparations (in marginal resection of the vein wall - 3.8%, with direct anastomosis - 1.9%, SMV prosthetics - 3.8%). Most often, R1 resection was detected in the retroperitoneal resection margin (80%). The lowest 1-year survival was observed in the group with marginal resection (36.4%). No significant differences in survival rates were found in patients with direct venous anastomosis (62.5%) and venous prosthetics (64.7%) (RR 1.69; 95% CI 0.69-4.12, p > 0.05). Microscopically complete resection R0 improved the survival (RR 2.7; 95% CI 1.45-5.04, p < 0.05). Planning the venous resection was an additional risk factor affecting the completeness of resection (RR 4.6; CI 95% 1.5-14.5, p > 0.05). Conclusions: Expanding the surgery volume in PDR due to venous resection and reconstruction shows acceptable rates of postoperative morbidity and mortality. Planning the venous resection enhances the results of radical surgery.

Moyamoya Disease Superficial Temporal Artery-to-Middle Cerebral Artery Onlay: 2-Dimensional Operative Video

The most frequently performed low-flow bypass procedure is the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass. If available, a suitable M2 or M3 cortical branch is anastomosed to the donor vessel. This patient had severe moyamoya disease with an ipsilateral perfusion deficit and transient ischemic attacks. Given the need for revascularization, an STA-to-MCA bypass was performed. There was no suitable recipient M3 branch for direct anastomosis, and therefore an indirect bypass was performed by onlaying the STA onto the cortical surface and suturing the adventitia of the STA to the arachnoid of the underlying cortex. The dural leaflets were then inverted to potentiate further revascularization of the underlying cortex. The patient remained at their neurological baseline and demonstrated an enhanced perfusion of the ipsilateral MCA territory on follow-up evaluation. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.