Long-term results of balloon catheter dilation of lower gastrointestinal tract stenoses.

PURPOSE: This study involved a prospective evaluation of the results of the balloon catheter dilation of lower gastrointestinal stenoses. METHODS: First a guide-wire was introduced into the stenosis followed under x-ray control by a double-lumen balloon catheter, or directly through the endoscope a balloon catheter, with progressive dilation under pressures of 1.5 to 3 atm. The result was assessed via the decreased indentation of the balloon and the increased diameter of the stenosis. RESULTS: Between January 1985 and November 2002, 133 dilations were performed on 57 patients. The cause of the stenosis was postoperative stenosis in 44 patients, Crohn's disease in 6, ulcerative colitis in 2, postirradiative stenosis in 1, ischemic stenosis in 1, and scarring of the anus in 3 patients. Four of the stenoses were localized to the anus, 45 to the rectum, 7 to the colon, and 1 to the terminal ileum. The average diameter of the stenosis was increased from 7.2 (range, 1-14) mm to 19.7 (range, 14-25) mm. Colostomies were closed in 11 of 17 cases. In five patients, the ileus state ceased, and the three colocutaneous fistulas healed rapidly. In 17 of 57 patients, reoperation was proposed. In one patient, fever as a complication was treated with antibiotics. CONCLUSIONS: The dilation of benign stenoses of the lower gastrointestinal tract with a balloon catheter is an effective and safe method, which in most cases (70 percent) results in long-term elimination of the obstructive symptoms, so that surgery can be avoided.

[Alternative options for examination of the patency of peritoneo-venous shunts]. / A peritoneo-venosus shuntök vezetoképességének vizsgálati lehetoségei.

For the treatment of refractory ascites we use the saphenoperitoneal shunt described by Pang in 1992 approximately 2 years. This procedure eliminates the most frequent complications of the former synthetic shunts: occlusion of the collector branches and infections as well. In addition, the use of autologous vein is cost-saving. The first Hungarian publications (K. Vincze and Z. Nagy et al.) reported good results, which are confirmed also by us, after we performed 21 operations. The publications until now usually describe the technique. This intervention is now a widely accepted one. On the other hand, just a small number of papers describe the options for the examination of patency and the follow-ups. We report about the algorithm used in our department after surgery to evaluate graft patency and surgical efficacy. A method to determine the volume of ascites developed by ourselves is described. We feel that the successful application of saphenoperitoneal shunts depends on very close follow-up. Considering that no objective method to check the patency does exist, we are sure that decisions about further operations can only be made if simultaneous diverse follow-up methods are available.

[Endoscopic placement of self-expanding metal stent for malignant colorectal obstruction]. / Ontáguló fémstent endoszkópos behelyezése colorectalis malignus elzáródásban.

AIM: 15-20% of the patients with colorectal carcinoma is admitted to hospital with symptoms of colonic obstruction. If urgent, subtotal colectomy can not be done, Hartmann operation is performed, that means diverting colostomy and resection followed by a later re-anastomosis. In this article the authors report on the placement of a self-expandable stent for decompression of a malignant colorectal obstruction, which allows elective one stage resection of the tumour affected segment. PATIENTS AND METHODS: A 63-year-old male patient was admitted with clinical and radiological symptoms of ileus. A total obstruction was found by irrigoscopy at the rectosigmoid transition. An atraumatic guide wire, and a balloon catheter were introduced through the stenotic segment and dilated to 15-mm in diameter. Following that the stenosis was bridged with a SX Ella type, 25-mm diameter, nitiol stent. RESULTS: After the placement of the metal stent the obstruction ceased. Stabilisation of the condition of the patient, proper pre-operative decompression, definition of the tumour stage, appropriate preparation of the patient for the operation became possible. After elective, primary resection the patient recovered without complications. DISCUSSION: There are two main indications for the application of metal stents in colorectal obstructions. One of them is temporary, preoperative decompression in malignant colorectal obstruction. The other one is the palliative treatment of inoperable, malignant large bowel obstructions. In the latter case more complications have to be considered. CONCLUSIONS: Metal stent therapy is an effective and non-invasive, alternative method for preoperative or palliative treatment of malignant colorectal obstructions.

[Experiences with endoscopic thoracic sympathectomy]. / Tapasztalataink endoszkóposan végzett thoracalis sympathectomiával.

PATIENTS AND METHOD: Thoracic sympathectomy using thoracoscopy was performed in 38 cases on 35 patients from January 01. 1996, till December 31. 2000. In 3 cases bilateral sympathectomy was carried out. The youngest patient was 18, the oldest was 76 years old, the average age was 42 years. The indications for surgery were Raynaud syndrome, causalgia, post-traumatic sympathetic dystrophy, thoracic outlet syndrome combined with vasospastic syndrome, Buerger syndrome, obliteration of digital arteries, embolism and hyperhidrosis. This method was chosen if conservative therapy was unsuccessful. Laparoscopic instruments are particularly suitable for minimal invasive interventions. RESULTS: Authors describe their operative technique whereby the postoperative pain and also the duration of hospitalisation can be reduced, and the cosmetic result can be improved. In two cases conversion was the only choice due to pleural adhesions. Pneumothorax occurred in two cases, haemothorax in one case and transient intercostal neuralgy was seen in 3 cases. In four cases sympathetic activity returned during the follow up. Ceasing the sympathetic innervation dilates the arterioles of the skin, and the temperature of the skin increases. During follow-up the complaints of the patients improved significantly, the progression became slower and clear improvement was found with instrumental investigations. CONCLUSION: This method can be recommended to every institute where the conditions for traditional laparoscopic surgery are given and staff is experienced in thoracotomy.

[Balloon catheter dilatation of lower gastrointestinal tract stenoses: long-term results]. / Az alsó béltractus-szúkületek ballonkatéteres tágításának hosszú távú eredményei.

AIM: Benign stenosis of the lower gastrointestinal tract usually develops, due to complication of a surgical intervention or sometimes because of other inflammatory bowel processes. Their reoperation is technically difficult and risky. Therefore the authors use a balloon catheter dilatation in the treatment of lower gastrointestinal tract stenosis since 1985. METHODS: First a guide wire is passed colonoscopically, then under X-ray control a double lumen balloon catheter, or directly through the channel of the endoscope a single or double lumen balloon catheter is introduced into the stenosis, which is then gradually dilated to 12-25 mm diameter. The applied pressure is 1.5-3 atm. Result of the dilatation can be judged from the decreased indentation of the balloon, and from increased diameter of stenosis at colonoscopic, or sometimes colonographic follow up. RESULTS: Between January of 1985 and July of 2001 they performed 123 dilatation on 52 patients. The causes of stenoses were in 40 cases postoperative stenosis, in 5 Crohn disease, in 2 ulcerative colitis, in 1 ischemic stenosis, and in 3 scar of the anus. From all stenosis cases 4 were localised to the anus, 40 to the rectum, 7 to the colon, and 1 to the terminal ileum. Due to the dilatation the average diameter of the stenosis was increased from 7.2 (1-14) mm to 19.7 (14-25) mm. Following the dilatation in 42 patients out of 52 the colonoscope was passed through the stenosis. Colostomies were closed in 11 cases out of 17. In 4 patients the subileus state ceased, and all of our 3 patients colo-cutan fistula healed rapidly. 16 out of 52 patients re-operation was proposed. One patient had fever as complication which was treated with antibiotics. CONCLUSIONS: Dilatation of benign stenosis of the lower gastrointestinal tract with balloon catheter is an effective method, which in most of the cases (69%) will stop the obstructive symptoms and in the long run therefore surgery can be avoided.