ABSTRACT
Extracorporeal membrane oxygenation (ECMO) is used as a rescue therapy in severe ARDS. We propose its use as a bridge therapy for surgical repair of complex tracheobronchial fistulas. We report the case of a 56-year-old man with tracheoesophageal fistula after esophagectomy. The defect in the left main bronchus was repaired with a vascularized plasty of the dorsal muscle but the patient could not be extubated immediately. As a result, the plasty migrated and required emergency surgery, this time under ECMO support, to ensure full ventilatory support and protection of the plasty until the sutures had scarred
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Subject(s)
Humans , Male , Middle Aged , Bronchial Fistula/etiology , Esophageal Fistula/etiology , Bronchial Fistula/therapy , Esophageal Fistula/therapy , Extracorporeal Membrane Oxygenation , Esophagectomy/adverse effects , Treatment OutcomeABSTRACT
BACKGROUND: The laparoscopic approach to bowel obstruction is still controversial. OBJECTIVE: To evaluate our initial results in the laparoscopic treatment of bowel obstruction. MATERIAL AND METHODS: A retrospective study on patients diagnosed with bowel obstruction that underwent laparoscopic surgery within the time frame of January 2008 to June 30, 2012. The variables employed were: age, sex, occlusion etiology, previous surgeries, clinical progression, pneumoperitoneum creation, use of an auxiliary incision, anesthesia duration, conversion rate, postoperative hospital stay, time needed to tolerate liquids, and complications. RESULTS: Twenty-six patients, 18 women (69.2%) and 8 men (30.8%), with a mean age of 64.35 years (range: 21-92 years) were analyzed. The most frequent obstruction etiology was secondary to adhesions and presented in 12 cases. Nine patients (34.6%) underwent a completely laparoscopic approach and laparoscopy was complemented by an auxiliary incision in another 9 patients (34.6%), resulting in 18 cases (69.2%) of successful laparoscopic approach. Eight patients (30.8%) required conversion to open surgery. The mean anesthesia duration was 95min (range: 55-165min), mean postoperative hospital stay was 6 days (range: 3-72 days), and the mean amount of time needed to tolerate liquids was 3 days (range: 1-10 days). The patients that underwent complete laparoscopic approach presented with shorter hospital stay, they were able to ingest liquids earlier, and they presented with a lower number of postoperative complications; this latter variable was the only one that was statistically significant. CONCLUSIONS: The initial results of our experience were good, although more patients are needed in order to standardize and extend the use of this technique.
Subject(s)
Digestive System Surgical Procedures/methods , Intestinal Obstruction/surgery , Laparoscopy/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Intestinal Obstruction/etiology , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Thoracic duct injury is an infrequent (1-2.5%) but severe complication after neck surgery, leading to nutritional, metabolic and immunologic deficiencies. We report a case of a 34-year-old woman with a right thoracic duct injury after surgery of a thyroid medullar cancer effectively treated with conservative management (parenteral nutrition and intravenous somatostatin). Optimal treatment of these patients is unclear, without a clear limit between conservative and surgical treatment (AU)
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