Endoscopic repair of post-surgical gastrointestinal complications

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Endoscopic management of patients with post-surgical leaks involving the gastrointestinal tract: a large case series

Background: Post-surgical anastomotic leaks often require a re-intervention, are associated with a definite morbidity and mortality, and with relevant costs. We described a large series of patients with different post-surgical leaks involving the gastrointestinal tract managed with endoscopy as initial approach. Methods: This was a retrospective analysis of prospectively collected cases with anastomotic leaks managed with different endoscopic approaches (with surgical or radiological drainage when needed) in two endoscopic centres during 5 years. Interventions included: (1) over-the-scope clip (OTSC) positioning; (2) placement of a covered self-expanding metal stent (SEMS); (3) fibrin glue injection (Tissucol); and (4) endo-sponge application, according to both the endoscopic feature and patient’s status. Results: A total of 76 patients underwent endoscopic treatment for a leak either in the upper (47 cases) or lower (29 cases) gastrointestinal tract, and the approach was successful in 39 (83%) and 22 (75.9%) patients, respectively, accounting for an overall 80.3% success rate. Leak closure was achieved in 84.9% and 78.3% of patients managed by using a single or a combination of endoscopic devices. Overall, leak closure failed in 15 (19.7%) patients, and the surgical approach was successful in all 14 patients who underwent re-intervention, whilst one patient died due to sepsis at 7 days. Conclusions: Our data suggest that an endoscopic approach, with surgical or radiological drainage when needed, is successful and safe in the majority of patients with anastomotic gastrointestinal leaks. Therefore, an endoscopic treatment could be attempted before resorting to more invasive, costly and risky re-intervention

Endoscopic management of patients with post-surgical leaks involving the gastrointestinal tract: a large case series

Background: Post-surgical anastomotic leaks often require a re-intervention, are associated with a definite morbidity and mortality, and with relevant costs. We described a large series of patients with different post-surgical leaks involving the gastrointestinal tract managed with endoscopy as initial approach. Methods: This was a retrospective analysis of prospectively collected cases with anastomotic leaks managed with different endoscopic approaches (with surgical or radiological drainage when needed) in two endoscopic centres during 5 years. Interventions included: (1) over-the-scope clip (OTSC) positioning; (2) placement of a covered self-expanding metal stent (SEMS); (3) fibrin glue injection (Tissucol); and (4) endo-sponge application, according to both the endoscopic feature and patient’s status. Results: A total of 76 patients underwent endoscopic treatment for a leak either in the upper (47 cases) or lower (29 cases) gastrointestinal tract, and the approach was successful in 39 (83%) and 22 (75.9%) patients, respectively, accounting for an overall 80.3% success rate. Leak closure was achieved in 84.9% and 78.3% of patients managed by using a single or a combination of endoscopic devices. Overall, leak closure failed in 15 (19.7%) patients, and the surgical approach was successful in all 14 patients who underwent re-intervention, whilst one patient died due to sepsis at 7 days. Conclusions: Our data suggest that an endoscopic approach, with surgical or radiological drainage when needed, is successful and safe in the majority of patients with anastomotic gastrointestinal leaks. Therefore, an endoscopic treatment could be attempted before resorting to more invasive, costly and risky re-intervention

Pelvic lymphadenectomy for cervical carcinoma: Laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study

To compare transperitoneal, extraperitoneal and laparoscopic pelvic lymphadenectomy in terms of feasibility and morbidity in patients affected by cervical cancer undergoing radical hysterectomy. Consecutive patients affected by stage IB-IIB cervical carcinoma scheduled for radical surgery entered the study. Patients were randomly assigned to transperitoneal (TPL), extraperitoneal (EPL) or laparoscopic pelvic lymphadenectomy (LPL). All patients underwent classical radical hysterectomy. Perioperative data were recorded. Follow up examinations were performed at the 15th, 30th and 60th day after surgery. 168 patients entered the study. The mean operative times were: 63+/-7.6, 54+/-6.7 and 75+/-8.4 min (TPL vs EPL P<0.001; EPL vs LPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. The feasibility of the procedures, analyzed on an intention-to-treat basis, was 96%, 93% and 95% for TPL, EPL and LPL group respectively (P=ns). The average hospitalizations were: 5.6+/-0.9, 3.2+/-0.4 and 3.1+/-0.3 days (TPL vs EPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. EPL and LPL are as feasible and effective as TPL and can be adequately performed with a reasonable complication rate. LPL showed a statistically significant longer operative time. However, both EPL and LPL can minimize some postoperative complications reducing length of stay

Re: Axelsen SM, Bek KM, Petersen LK. 2007. Urodynamic and ultrasound characteristics of incontinence after radical hysterectomy. Neurourol urodynam

[No abstract available

Urinary Incontinence After Radical Vulvectomy Treated with Macroplastique Implantation

Postradical vulvectomy urinary incontinence is a common surgery-related complication, especially after subtotal urethrectomy. However, only 1 trial has been reported in the previous literature that described a case of total urinary incontinence treated with an Aldridge sling operation. We present 2 cases of patients affected by postradical vulvectomy, with partial urethral resection and total incontinence successfully treated by transurethral Macroplastique injection. This procedure could be considered as a valid, minimally invasive surgical option to improve the well-being of patients with vulvar cancer affected by postradical vulvectomy urinary incontinence, especially in elderly patients at high operative risk. © 2008 AAGL

Where should bulking agents for female urodynamic stress incontinence be injected?

[No abstract available

Successful pregnancy after conservative surgery for stage IC ovarian cancer with serous borderline tumor on controlateral ovary: A case report

Background In invasive ovarian cancer, fertility saving Surgery is confined to early-stage and low-grade disease, and Only few Study reported sparing fertility Lip to FIGO stage IC ovarian cancer. Case. We present a rare case of a 30-year-old woman affected by IC ovarian cancer with borderline tumor on controlateral ovary who Underwent "conservative" debulking surgery followed by adjuvant chemotherapy. A spontaneous planned pregnancy occurred 5 years postsurgery. At 60-month follow-up, patients have no evidence of disease. Conclusions. Nowadays, preservation of ovarian function in women with tumors in early stage Should be evaluated for conservative surgery. It is important to emphasize that patients selected for conservative surgery Should have complete surgical staging. Careful follow-up is mandatory to ensure safety of this procedure. (C) 2005 Elsevier Inc. All rights reserved