ABSTRACT
The study presented a case of a gastrocutaneous fistula, as a result of bariatric sleeve gastrectomy. The discussion considered the main pathogenesis, etiology, diagnostics and endoscopic treatment using the implantation of covered esophageal stents. Special attention was placed upon the multifactorial origin of this life-threatening clinical condition, typical for bariatric surgery.
Subject(s)
Bariatric Surgery/adverse effects , Esophagus/surgery , Gastric Fistula/etiology , Gastric Fistula/surgery , Obesity, Morbid/surgery , Postoperative Complications/surgery , Stents , Endoscopy/methods , Female , Humans , Middle Aged , Treatment OutcomeABSTRACT
INTRODUCTION: A method of treatment for malignant bile duct strictures depends on early diagnosis, location and extent of tumor infiltration. Patients eligible for radical surgery should be operated. AIM OF THE STUDY: The authors used plastic and metal prostheses in the treatment of biliary tract cancer cholestasis. MATERIAL AND METHODS: Retrospective analysis was done in 2730 endoscopies performed in the Laboratory of the Department of Endoscopic Surgery, 4th Military Hospital in Wroclaw in 2008-2011. The authors analyzed 441 cases of prosthetic biliary cancer. RESULTS: 223 patients (51%) were treated for pancreatic head tumor, 98 pts (22%)--for papilla of Vater tumor, 85 pts (19%)--due to Klatskin tumor and 35 pts (8%)--due to tumor of the gallbladder. Plastic prostheses were inserted in 228 (65.4%) patients, self-expanding metal prostheses--in 21 patients (4.9%). Dilatation of the bile duct or the inserted prosthesis was performed in 48 (11.1%) pts. 27 patients (6.1%) had endoscopic treatment failure. 32 patients (7.3%) had following complications of biliary prosthesis: bleeding into the bile duct, into the digestive tract--4 cases (1%), the migration of the prosthesis--7 (1.6%), cholangitis--21 cases (4.7%). CONCLUSIONS: Palliative biliary stenting is a safe method that provides efficient drainage of bile. It shows a definitive advantage over percutaneous, biliary transhepatic drainage.
Subject(s)
Biliary Tract Neoplasms/complications , Biliary Tract Surgical Procedures/methods , Cholestasis/therapy , Jaundice, Obstructive/therapy , Stents , Cholestasis/etiology , Drainage/instrumentation , Endoscopy, Digestive System/methods , Female , Gallbladder Neoplasms/complications , Humans , Jaundice, Obstructive/etiology , Male , Metals , Military Personnel , Pancreatic Neoplasms/complications , Plastics , Poland , Prosthesis Design , Prosthesis Implantation , Retrospective Studies , Treatment FailureABSTRACT
This paper describes a case of a patient suffering from Hodgkin's disease and treated by means of minimally invasive surgery: laparoscopic splenectomy. The performance of laparoscopic splenectomy led to a complication in the form of a pancreatic cyst. The cyst was subjected to endoscopic procedures (endoscopic retrograde cholangiopancreatography, with a shaft to the pancreatic tract) and percutaneous drainage. The application of the above methods allowed for a quick introduction of causative treatment. Because in the case in question open surgery methods would impede the introduction of systemic treatment, minimally invasive surgery techniques (laparoscopy and endoscopy) were applied and are discussed below.
ABSTRACT
Extra hepatic bile ducts with the gallbladder are the center place for many disease processes. In extreme cases of significant strictures of bile ducts and impairment of bile flow, obstructive jaundice occurs. There are benign and malignant biliary strictures. The treatment of obstructive jaundice depends on the removal of blockage using endoscopic and surgical methods which return the efficient bile flow to the digestive tract. The endoscopic treatment from Vater's papilla access using plastic and metal stents is the method of choice. The choice of proper prosthesis depends on the reason for biliary strictures. The plastic stents (straight, pigtail) are applied the most. Due to their low cost, easy insertion to biliary ducts and exchangeability, they are applied in benign and malignant strictures. However, metal stents (Wallstent, Diamond, Z-stent, InStent), due to the wide diameter after expansion and no possibility of removal, are applied only in malignant strictures. Endoscopic insertion of biliary endoprostheses can be burdened with complications. There have been reports of occlusion, migration with duodenal wall injury and hemorrhaging.
