ABSTRACT
[This corrects the article DOI: 10.1371/journal.pone.0172754.].
ABSTRACT
Postoperative leak is a serious complication of bariatric surgery and often results in significant morbidity and mortality. Stent placement is a less invasive alternative to surgery for the treatment of bariatric surgical leak. We evaluated the efficacy and complications of covered self-expandable metal stents (SEMS) in the treatment of post-bariatric surgical leak. We retrospectively reviewed patients who underwent stent placement for leak after bariatric surgery. Leak was diagnosed by upper gastrointestinal series or was visualized during the endoscopy. We examined the timing of stent placement, size of the leak, stent migration and its complications, total stent treatment duration, and treatment outcome. Between January 2011 and April 2015, seven patients underwent covered SEMS placement for leak after bariatric surgery, including laparoscopic sleeve gastrectomy (LSG) (n = 5) and laparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) (n = 2). A stent was placed in one patient for infection control and bridging to revisional surgery. Among the other six patients, one patient who received stent placement one year after leak diagnosis failed to achieve leak closure, and five patients with early stent placement achieved leak closure. Three patients with small leak achieved leak closure more quickly. Stent migration was found in six patients, and associated ulcers occurred in five patients. We conclude that stenting is effective in the management of staple-line leaks following LSG and LDJB-SG. Stent migration and associated ulcers are common after stent placement. Early stent removal can be achieved in patients with small leaks.
Subject(s)
Anastomosis, Surgical/methods , Anastomotic Leak/surgery , Bariatric Surgery/methods , Gastrectomy/methods , Obesity, Morbid/surgery , Adult , Anastomosis, Surgical/adverse effects , Anastomotic Leak/diagnosis , Anastomotic Leak/etiology , Anastomotic Leak/pathology , Bariatric Surgery/adverse effects , Duodenum/surgery , Endoscopy, Digestive System , Female , Gastrectomy/adverse effects , Humans , Jejunum/surgery , Male , Middle Aged , Obesity, Morbid/pathology , Retrospective Studies , Stents , Surgical Stapling , Treatment OutcomeSubject(s)
Carcinoma, Hepatocellular/pathology , Chemoembolization, Therapeutic/adverse effects , Duodenal Neoplasms/diagnostic imaging , Duodenal Neoplasms/secondary , Liver Neoplasms/pathology , Aged, 80 and over , Carcinoma, Hepatocellular/therapy , Humans , Liver Neoplasms/therapy , Male , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND AND AIM: The role of computed tomography angiography (CTA) on the management of acute overt obscure gastrointestinal bleeding (OGIB) remains unclear. We designed a study to evaluate the impact of CTA before enteroscopy for acute overt OGIB. METHODS: All patients undergoing CTA followed by enteroscopy for acute overt OGIB were enrolled in this retrospective study. Clinical characteristics and diagnosis were compared between patients with positive and negative CTA findings. We evaluated the impact of CTA on subsequent enteroscopy. RESULTS: From February 2008 to March 2015, 71 patients including 25 patients with positive CTA findings and 46 patients with negative CTA findings, were enrolled. All 25 patients with positive CTA findings were confirmed to have mid GI lesions, a significantly higher proportion than among patients with negative CTA findings (100% vs. 52.2%, respectively; P <0.001). CTA had a higher diagnostic yield for bleeding from tumor origin than from non-tumor origin (80.0% vs. 23.7%, respectively; P <0.001). The diagnostic yield of CTA and enteroscopy was 35.2% and 73.2%, respectively. The lesions could be identified by the initial route of enteroscopy in more patients with positive CTA findings than in those with negative CTA findings (92.0% vs. 47.8%, respectively; P <0.001). Lesions could be identified in seven of the 25 patients (28.0%) with positive CTA findings by using only push enteroscopy instead of single-balloon enteroscopy (SBE), but all 46 patients with negative CTA findings needed SBE for deep small-bowel examination. CONCLUSIONS: CTA is useful in the diagnosis of acute overt OGIB, especially in patients with bleeding from tumors. In addition, it also can show the precise location of bleeding, and guide subsequent enteroscopic management.
Subject(s)
Angiography/methods , Gastrointestinal Hemorrhage/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Female , Gastrointestinal Hemorrhage/surgery , Humans , Male , Middle AgedSubject(s)
Gastrointestinal Hemorrhage/etiology , Ileum/injuries , Wounds, Nonpenetrating/complications , Aged , Fatal Outcome , Humans , Ileal Diseases/complications , Ileostomy , Ileum/microbiology , Ileum/surgery , Male , Shock, Septic/etiology , Tomography, X-Ray Computed , Wounds, Nonpenetrating/diagnostic imagingABSTRACT
An ectopic vaginal ureter is an infrequent cause of urinary incontinence. Most cases are associated with a duplex kidney in which the lower moiety ureter drains into the bladder. Occasionally, some cases of ectopic kidney with single vaginal ectopic ureter can occur. In this study, we present a case of chronic continuous urine incontinence caused by the extremely rare combination of a fused-crossed kidney and a single vaginal ectopic ureter. Laparoscopic nephroureterectomy was carried out smoothly and uneventfully. In our experience, laparoscopic navigation and surgery can be valuable tools to delineate and manage unusual congenital anomalies.
