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Spiral Enteroscopy Assisted ERCP in Patients with Surgically Altered Anatomy: A Meta-Analysis and Systematic Review
Manjusha Das,
Watcoun-Nchinda Pisoh,
Srinivas Puli
Issue:
Volume 8, Issue 4, August 2020
Pages:
104-108
Received:
1 April 2020
Accepted:
6 May 2020
Published:
9 June 2020
Abstract: Endoscopic retrograde cholangiopancreatography (ERCP) is a well-described technique for diagnosis and treatment of hepatobiliary and pancreatic disorders. Spiral enteroscopy assisted ERCP (SE-ERCP) is a well-described technique for reaching and cannulating the ampulla and performing diagnostic and therapeutic interventions. The aim of the meta-analysis is to evaluate the procedural success rate of SE-ERCP in patients with altered upper gastrointestinal anatomy. A search was conducted in Medline, Pubmed, and Ovid and extracted data into an abstraction form. Meta-analysis for success rates was analyzed by calculating pooled proportion with inverse variance. A total of 172 SE-ERCPs were included in this analysis from five relevant studies. The pooled success rate of reaching the ampulla by spiral enteroscopy was 75%. SE-ERCP is a viable technique for diagnostic and therapeutic intervention of biliary disorders.
Abstract: Endoscopic retrograde cholangiopancreatography (ERCP) is a well-described technique for diagnosis and treatment of hepatobiliary and pancreatic disorders. Spiral enteroscopy assisted ERCP (SE-ERCP) is a well-described technique for reaching and cannulating the ampulla and performing diagnostic and therapeutic interventions. The aim of the meta-anal...
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Laparoscopic Access Techniques: Experience in a Developing Country, Sudan
Mohanned Omer Abass,
Elssayed Osman Elssayed,
Abdelrahman Babekir Mhammed
Issue:
Volume 8, Issue 4, August 2020
Pages:
109-113
Received:
6 May 2020
Accepted:
26 May 2020
Published:
16 June 2020
Abstract: Background: Minimal access surgery has revolutionized the field of surgery. Access to the abdominal cavity represents a critical step in laparoscopic procedures. Various techniques have been used to obtain safe access into the abdominal cavity, with no apparent superiority of one technique over another. Aim: This study was conducted to assess the different types of laparoscopic access techniques used at Almak Nimir University Hospital in the period from January to December 2019. Methodology: This descriptive cross-sectional study compared the use and outcomes of different laparoscopic access techniques in various laparoscopic procedures performed at Almak Nimir University Hospital, (Shendi University, Shendi, Sudan). Results: The study included 324 patients with a mean age of 26.2±15.3 years (range 1–85 years). Most of the patients were female (266 patients, 82.1%). Of the laparoscopic procedures, 77.2% were laparoscopic appendicectomy while 18.8% were laparoscopic cholecystectomy. The Veress needle technique was used in 158 patients (49.7%), the open technique was used in 97 patients (29.9%) and direct trocar insertion was used in 66 patients (20.4%). Direct trocar insertion showed a statistically shorter procedure duration (mean 2.9±0.9 min) compared to the other techniques (p=0.001). Access-related complications occurred in five patients (0.6%), but there was no statistically significant difference between the three access techniques. Conclusion: This study confirms the safety of various access techniques used in laparoscopic procedures; however, the choice of access type should be individualized.
Abstract: Background: Minimal access surgery has revolutionized the field of surgery. Access to the abdominal cavity represents a critical step in laparoscopic procedures. Various techniques have been used to obtain safe access into the abdominal cavity, with no apparent superiority of one technique over another. Aim: This study was conducted to assess the d...
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A Unique Presentation of Splenic Artery Aneurysm During Pregnancy
Thomas Kania,
Samuel Hawkins,
Vasiliy Sim,
Jonathan Deitch,
Asaf Gave
Issue:
Volume 8, Issue 4, August 2020
Pages:
114-117
Received:
27 April 2020
Accepted:
1 June 2020
Published:
16 June 2020
Abstract: Visceral arterial (VAA) and, specifically, splenic arterial aneurysms (SAA) are rare entities often associated with pregnancy. When ruptured, they can be fatal and require emergent management. This case report includes a review of the relevant literature and describes a unique, multidisciplinary approach to managing such an aneurysm. We describe the difficult situation of an already rupturing aneurysm and the careful coordination of obstetric, surgical, vascular, and interventional radiology teams. The distinctiveness of this case continues with the intraoperative finding of metallic coils freely protruding into the peritoneum from a recently coil-embolized ruptured splenic artery aneurysm. Such iatrogenic foreign bodies are a product of the integration of multiple specialities that can provide life-saving care when managing critical surgical disease such as ruptured splenic artery aneurysms. Multidisciplinary approaches should be considered depending upon the resources available at one’s institution.
Abstract: Visceral arterial (VAA) and, specifically, splenic arterial aneurysms (SAA) are rare entities often associated with pregnancy. When ruptured, they can be fatal and require emergent management. This case report includes a review of the relevant literature and describes a unique, multidisciplinary approach to managing such an aneurysm. We describe th...
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Modification of Step in Difficult Laparoscopic Cholecystectomy to Minimize the Conversion Rate
Deepak Verma,
Nemi Chand,
Sarthak Sharma,
Mahesh Malani,
Parul Yadav
Issue:
Volume 8, Issue 4, August 2020
Pages:
118-122
Received:
26 April 2020
Accepted:
19 June 2020
Published:
4 July 2020
Abstract: Gall stone disease is a common gastrointestinal surgical problem and symptomatic patients needs appropriate and timely treatment in the form of cholecystectomy else the disease process becomes complicated because of recurrent chronic infection, dislodgement of stone to common bile duct, acute infection and more severe complications like perforation of gall bladder. In recent years, Laparoscopic Cholecystectomy is considered as gold standard treatment for symptomatic as well as for few categories of asymptomatic cholelithiasis. Reduced postoperative pain, early return of mobility and to work, cosmetic results and brief hospital stay are distinct advantages of the procedure. Laparoscopic Cholecystectomy becomes difficult in patients with male sex, age above 50 years, obese, history of previous hospitalization due to attacks, previous abdominal surgery scar, palpable gall bladder, impacted stone, overdistended/contracted gall bladder. Various scoring systems have been reported to predict difficult laparoscopic cholecystectomy preoperatively. These difficult cases required longer operating time and hospital stay. The incidence of postoperative complications are also higher as compared to easy Laparoscopic Cholecystectomy Of the total 430 cases included in this study, 200 (46.5%) cases were difficult cases. For performing Laparoscopic Cholecystectomy in these patients successfully i.e. with minimum conversion to open, certain modifications in the classical four-port technique were done. As a result, conversion rate in difficult laparoscopic cholecystectomy could be limited to 7% only. Postoperative complication were pyrexia (21.5%), paralytic ileus (9.5%), bile stained subhepatic discharge (6.5%), port site infection (8%) and respiratory complications (8%). Late complication was port-site hernia (0.5%). Operating time 58.7+12.4 minutes in difficult laparoscopic cholecystectomy as compared to 36.5+9.2 minutes in easy cases and postoperative hospital stay was of 6.9+1.8 days against 2.3+0.8 days as compared to easy cases. Unclear anatomy (3%), haemorrhage (4%), dense adhesions (2%) and anaesthesia issue (1%) were the reasons of conversion to open cholecystectomy. It is concluded from this study that preoperative difficult laparoscopic cholecystectomy can be predicted and modifications of the steps of four-port cholecystectomy can be done to minimize the conversion rate.
Abstract: Gall stone disease is a common gastrointestinal surgical problem and symptomatic patients needs appropriate and timely treatment in the form of cholecystectomy else the disease process becomes complicated because of recurrent chronic infection, dislodgement of stone to common bile duct, acute infection and more severe complications like perforation...
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Impact of Tumor Size as a Prognostic Factor After One Stage Liver Resection for Solitary Hepatocellular Carcinoma in Cirrhotic Patients
Alhassan Mohamed Hassan,
Amir Fawzy Abdelhamid,
Hosam Barakat Barakat,
Soliman Mohamed Soliman,
Hossamaldin Mohamed Soliman,
Mohamed Abdalla Hablus,
Mahmoud Mostafa Alshareef
Issue:
Volume 8, Issue 4, August 2020
Pages:
123-131
Received:
27 May 2020
Accepted:
28 June 2020
Published:
7 July 2020
Abstract: Aim: This study is to assess tumor size as a prognostic factor predicting outcomes after one staged hepatectomy for cirrhotic patients with solitary hepatocellular carcinoma. Patients and methods: The study included 41 patients with single hepatocellular carcinoma (HCC) of different sizes who underwent single-stage hepatectomy. Patients were divided according to their tumor size into 2 groups, group A involved patient with tumors ≤ 5 cm and group B which involved patients with tumors > 5 cm. The effect of the tumor size on overall survival and disease-free survival was studied in both groups. Results: The mean age of the studied groups was 59.60±6.89 years. Hepatitis C infection was found 82.9% of patients. Six patients (17.1%) received treatment of HCV. All patients were of Child-Pugh class A (77.1% were scores 5 and 22.9% were score 6). The median Alpha-fetoprotein (AFP) level was 240 ng/ml. The mean operative time was 186.4±52.4 min. During the follow-up period (12-24 months), 12 patients (34.3%) developed recurrence. The mean time of recurrence was 15.50±4.23 months. Cumulative disease-free survival (DFS) at the end of the study was 65.7%. The cumulative overall survival (OAS) proportion at the end of the study was 74.3%. Conclusion: Our results suggest that surgical resection for large HCC is safe and effective and that the first-line treatment for large HCC to be considered is surgical resection in selected patients. Our study showed that hepatectomy for large HCC could be performed with an acceptable morbidity and mortality rate. With the improvement in patient selection and treatment strategy, solitary large HCC is not a contraindication to surgical therapy.
Abstract: Aim: This study is to assess tumor size as a prognostic factor predicting outcomes after one staged hepatectomy for cirrhotic patients with solitary hepatocellular carcinoma. Patients and methods: The study included 41 patients with single hepatocellular carcinoma (HCC) of different sizes who underwent single-stage hepatectomy. Patients were divide...
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A 2-year Review of Wound Outcome Following Primary Skin Closure After Laparotomy for Typhoid Ileal Perforation in Bida, Nigeria
Adekunle Adedapo Abiodun,
Alexander Gomna,
Emmanuel Adewale Eletta,
Michael Adewale Ayeni,
Adedeji Adekanye,
Taofeeq Abdulrahman,
Sunday Akintunde Okinbaloye
Issue:
Volume 8, Issue 4, August 2020
Pages:
132-135
Received:
17 June 2020
Accepted:
20 July 2020
Published:
4 August 2020
Abstract: Introduction: Laparotomy wound for typhoid ileal perforation is a dirty wound and is usually associated with wound complications and prolonged hospital stay. Delayed primary wound closure which for long has been the most common practice after laparotomy for typhoid peritonitis is now considered to be of little significance in preventing surgical site infection (SSI). We aimed to document the incidence, severity and management of wound complications when primary closure of abdominal wounds was performed following laparotomy for typhoid ileal perforation. Patients and Methods: This was a retrospective study of all patients who had primary abdominal wound closure following laparotomy for typhoid ileal perforation in Federal Medical Centre, Bida from January 2017 to December 2018. Results: There were 71 patients with the age ranges from 2 to 41 years and their median age was 15 years who had laparotomy for typhoid ileal perforation during the study period. All 71 patients had primary closure of their abdominal wounds, however two of them died within 72 hours of operation and were excluded from the study. There were males 38 (55.1%) and females 31 (44.9%) with a male to female ratio of 1.2:1. There was primary wound healing in 23 (33.3%) patients while 44 (63.8%) of them developed incisional surgical site infections (SSI) and 2 (2.9%) developed organ space SSI. Of the 44 patients that had incisional SSI, 33 (75.0%) were superficial and 11 (25.0%) were deep. Other complications noted from the study were faecal fistulae 3 (4.3%) and incisional hernia (4.3%). Conclusion: Though a high incidence of wound morbidity is not unexpected in situation of primary closure of laparotomy wound for bacteria peritonitis, an aggressive wound management may help to reduce the incidence and severity of wound complications in such situations.
Abstract: Introduction: Laparotomy wound for typhoid ileal perforation is a dirty wound and is usually associated with wound complications and prolonged hospital stay. Delayed primary wound closure which for long has been the most common practice after laparotomy for typhoid peritonitis is now considered to be of little significance in preventing surgical si...
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The First Implantation of the Novel Biological Heart Valve, the Inspiris Resilia Aortic Tissue Valve in Africa
Isaac Okyere,
Sanjeev Singh,
Perditer Okyere,
Baffoe Gyan,
Nana Addo Boateng,
Enoch Akowuah
Issue:
Volume 8, Issue 4, August 2020
Pages:
136-139
Received:
3 July 2020
Accepted:
15 July 2020
Published:
4 August 2020
Abstract: The durability of artificial bioprosthestic or tissue heart valves is limited by structural valve deterioration (SVD) due to long-term calcification especially in young patients and in Africa. A novel bioprosthestic valve, the Resilia Inspiris Aortic Tissue Valve has been developed which, in preclinical studies, has shown reduced calcification thus improving durability. The Inspiris Resilia Aortic Valve is a stented tri-leaflet valve made from bovine pericardial tissue. The tissue is created by treating bovine pericardial tissue with Edwards Integrity Preservation. It incorporates a stable capping anticalcification process, which blocks residual aldehyde groups known to bind with calcium. Tissue preservation with glycerol allows the valve to be stored without a traditional liquid-based solution, such as glutaraldehyde. Therefore, the valve is stored under dry packaging conditions and consequently does not require rinsing prior to implantation. The novel tissue preservation technology significantly improves hemodynamic and anticalcification properties compared with the standard artificial bioprosthestic aortic valve, the Perimount tissue valve. The experience of the implantation of this valve in Africa is limited for there seems to be no published experience of the behaviour of the implantation of this special long lasting bioprosthestic valve in Africa and therefore the purpose of this paper is to share our initial experience of the first successful implantation of this Inspiris Resilia Aortic Valve™ in Ghana, Africa. The implantation was done in a 57-year-old patient who presented with symptomatic moderate to severe aortic valve regurgitation with adequate left ventricular systolic function. He has been followed-up for a year now with well-healed wounds and a transthoracic echocardiography revealing a well-seated valve with no regurgitant flow or paravalvular leak. This is the first report describing the use of the new Inspiris Resilia Aortic valve which has increased durability and does not require anticoagulation in Africa as far as we know.
Abstract: The durability of artificial bioprosthestic or tissue heart valves is limited by structural valve deterioration (SVD) due to long-term calcification especially in young patients and in Africa. A novel bioprosthestic valve, the Resilia Inspiris Aortic Tissue Valve has been developed which, in preclinical studies, has shown reduced calcification thus...
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