RESUMO
OBJECTIVES: Endobiliary radiofrequency ablation (RFA) for malignant biliary obstruction is a promising option for improving biliary stent patency, but its efficacy and safety with endoscopic ultrasound (EUS)-guided biliary drainage are uncertain. We examined the feasibility of EUS-guided hepaticoenterostomy with antegrade stenting (EUS-HEAS) and RFA in patients with unresectable malignant biliary obstruction. METHODS: This was a prospective, single-center, single-arm, preliminary study. Twenty patients who met the eligibility criteria for inclusion between August 2018 and January 2020 were enrolled. We evaluated the technical success, functional success, recurrent biliary obstruction (RBO), and adverse events other than RBO associated with EUS-HEAS with RFA. RESULTS: The technical and functional success rates were both 80% (16/20). The procedure was unsuccessful in a total of 4 patients due to failure to insert the RFA catheter through the fistula (2 patients) or failure to pass the RFA catheter through the stricture (2 patients). Early and late adverse events other than RBO occurred in 10% (2/20) and 13% (2/16) of subjects, respectively. The RBO rate was 25% (4/16), and the median time to RBO was 276 days. The success rate of endoscopic reintervention using hepaticoenterostomy was 100% (4/4). DISCUSSION: This preliminary study showed that EUS-HEAS with RFA achieves good results but RFA catheter insertion can be difficult. Further evaluation and device improvements are warranted.
Assuntos
Neoplasias dos Ductos Biliares/complicações , Colestase/cirurgia , Drenagem/métodos , Duodenoscopia/métodos , Enterostomia/métodos , Ablação por Radiofrequência/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/cirurgia , Colestase/etiologia , Colestase/patologia , Drenagem/instrumentação , Duodenoscópios , Duodenoscopia/instrumentação , Endossonografia , Enterostomia/instrumentação , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Prospectivos , Ablação por Radiofrequência/instrumentação , Recidiva , Reoperação/instrumentação , Reoperação/métodos , Estudos Retrospectivos , Stents , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
Objective. The aim of this study is to present a 3-dimensional (3D)-printed device to simply perform abdominal enterostomy and colostomy. Summary Background Data. Enterostomy and colostomy are frequently performed during abdominal surgery. 3D-printed devices may permit the creation of enterostomy easily. Methods. The device was designed by means of a CAD (computer-aided design) software, Rhinoceros 6 by MC Neel, and manufactured using 3D printers, Factory 2.0 by Omni 3D and Raise 3D N2 Dual Plus by Raise 3D. Colostomy was scheduled on a human cadaver and on 6 Pietrain pigs to test the device and the surgical technique. Results. The test on the cadaver showed that the application of the device was easy. Test on porcine models confirmed that the application of the device was also easy on the living model. The average duration of the surgical procedure was 32 minutes (25-40 minutes). For the female pigs, return to full oral diet and recovery of a normal bowel function was observed at postoperative day 2. The device fell by itself on average on the third day. Until day 10, when euthanasia was practiced, the stoma mucosa had a good coloration indicating a perfect viability of tissues. No complications were observed. Conclusions. This is the first study that describes the use of a 3D-printed device in abdominal surgery. End-type colostomy using a 3D-printed device can be safely and easily performed in an experimental porcine model, without postoperative complications. Further studies are needed to evaluate its utility in the clinical setting.
Assuntos
Enterostomia/instrumentação , Impressão Tridimensional , Animais , Colostomia/efeitos adversos , Colostomia/instrumentação , Enterostomia/efeitos adversos , Desenho de Equipamento , Equipamentos e Provisões , Estudos de Viabilidade , Complicações Pós-Operatórias , SuínosRESUMO
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has been the cornerstone in the management of malignant jaundice to provide symptomatic relief and/or to allow chemotherapy. Difficult biliary cannulation or the presence of concomitant duodenal obstruction may lead to its failure. METHOD: An extensive English literature search was done via PubMed and Google Scholar to identify 13 peer-reviewed original articles. RESULTS: Of 92 patients, 98.9% (91/92) successfully underwent EUS-guided biliary drainage by placement of a lumen-apposing metal stent (LAMS) across extrahepatic biliary tree and small bowel. Although technically challenging, a similar technical success was noted for patients with limited dilation of extrahepatic biliary tree (less than 1 cm) and altered gastrointestinal anatomy (Roux-en-Y, Whipple, or Billroth II). Of 91 patients, 98.9% (90/91) had clinical success. Procedure complications included perforation (2/92; 2.2%) and bleeding (1/92; 1.1%). Stent complications included obstruction (7/91; 7.7%), and migration (1/91; 1.1%) with all responding to endoscopic debridement of food or tumor, placement of plastic pigtail stent through the LAMS, or replacement with a new stent. No procedure-related mortality was noted. CONCLUSION: In the hands of an expert, EUS-guided biliary drainage with the use of LAMS is an efficacious and safe option for patients with distal malignant biliary stricture, not amenable to ERCP.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colestase/cirurgia , Ducto Colédoco/cirurgia , Enterostomia/métodos , Neoplasias Pancreáticas/complicações , Colestase/etiologia , Dilatação/métodos , Drenagem/instrumentação , Drenagem/métodos , Enterostomia/instrumentação , Humanos , Cuidados Paliativos/métodos , Stents , Falha de Tratamento , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE. METHODS: This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected. RESULTS: 18 patients (mean age 64.2 years, 72â% post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8â%) and jaundice (33.3â%). Clinical success included resolution of symptoms in 88.9â% and improvement to allow hospital discharge in 11.1â%. Technical success was achieved in 100â% of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2â%). Three adverse events (16.7â%) occurred (two mild, one moderate). When compared with data on EALS, patients treated with EUS-EE needed fewer re-interventions (16.6â% vs. 76.5â%; Pâ<â0.001). CONCLUSION: EUS-EE seems to be safe and effective in the treatment of ALS.âIndirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention.
Assuntos
Síndrome da Alça Aferente , Endossonografia/métodos , Enterostomia , Complicações Pós-Operatórias , Reoperação , Stents , Síndrome da Alça Aferente/epidemiologia , Síndrome da Alça Aferente/etiologia , Síndrome da Alça Aferente/fisiopatologia , Síndrome da Alça Aferente/cirurgia , Enterostomia/efeitos adversos , Enterostomia/instrumentação , Enterostomia/métodos , Feminino , Humanos , Icterícia/diagnóstico , Icterícia/etiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos/epidemiologia , Vômito/diagnóstico , Vômito/etiologiaRESUMO
BACKGROUND: Parastomal hernias (PSH) are one of the most frequent complications of enterostomies with a non-negligible complication rate and a significant socioeconomic effect. Therefore, preventing PSH by placing a mesh at the time of primary surgery has been advocated. The aim of our study was to evaluate the safety and feasibility of the new stomaplasty ring [Koring™, (Koring GmbH, Basel, Switzerland)] and investigate the reason why surgeons are reluctant to take preventive measures. METHODS: A multicenter observational study was conducted on 30 patients between December 2013 and January 2015. In permanent end colostomies and end ileostomies, the Koring™ was implanted. The primary outcome was the 30-day morbidity (infection and other stoma-related complications). Secondary endpoints were the technical feasibility and the time needed to fix the ring. In addition, an online survey of 107 surgeons was performed. RESULTS: Twenty-seven patients received permanent end colostomies, and three received end ileostomies. No stoma-related complication was detected within the first 30 days post-operatively. The Koring™ ring was evaluated by the surgeons as easy and very easy to implant in more than half of the patients. Average additional operating time for ring implantation was 19 min. CONCLUSIONS: Koring™ implantation at the time of creating the stoma is safe, easy and only adds minimally operating time. A long-term follow-up as well as a randomized controlled study is needed to evaluate the impact of the Koring™ on PSH prevention. The ease and rapidity with which Koring™ can be implanted may help surgeons to overcome their apprehension of using a preventative device.
Assuntos
Enterostomia/instrumentação , Hérnia Ventral/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Próteses e Implantes , Estomas Cirúrgicos/efeitos adversos , Idoso , Colostomia/efeitos adversos , Colostomia/instrumentação , Colostomia/métodos , Enterostomia/efeitos adversos , Enterostomia/métodos , Estudos de Viabilidade , Feminino , Hérnia Ventral/etiologia , Humanos , Ileostomia/efeitos adversos , Ileostomia/instrumentação , Ileostomia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , SuíçaRESUMO
Patients with acute cholecystitis sometimes require placement of percutaneous cholecystostomy catheters, either as a bridge to surgery or as primary therapy. In patients who cannot undergo surgery, subsequent removal of the catheter can lead to recurrence of cholecystitis, whereas leaving the drain in place can cause adverse events. We investigated internalization of percutaneous cholecystostomy drainage catheters, using endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stents (LAMS) as an alternative treatment strategy. Seven patients (median age, 57 years; 6 men) underwent EUS-guided cholecystoenterostomy for internalization of gallbladder drainage with EUS-guided placement of a 10- or 15-mm LAMS. All had initially been treated with placement of a percutaneous cholecystostomy catheter for cholecystitis and were later deemed unfit for cholecystectomy. Technical success was achieved in all patients in 1 endoscopic session, with subsequent removal of all percutaneous drains. Two patients required placement of self-expandable metal stents within the LAMS to successfully bridge the gallbladder and gastrointestinal lumen. No adverse events occurred after a median follow-up of 2.5 months. EUS-guided cholecystoenterostomy using a LAMS is therefore a viable option for internal gallbladder drainage in patients who have a percutaneous cholecystostomy catheter and are poor candidates for cholecystectomy.
Assuntos
Colecistite/cirurgia , Drenagem/métodos , Endoscopia/métodos , Enterostomia/métodos , Vesícula Biliar/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Drenagem/instrumentação , Enterostomia/instrumentação , Feminino , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
OBJECTIVE: To compare the performance of an absorbable barbed suture device to absorbable monofilament suture after single layer, appositional gastrotomy and enterotomy closure. STUDY DESIGN: Experimental comparative study. ANIMALS: Purpose-bred adult mongrel hounds (n = 14). METHODS: Bursting strengths up to 250 mmHg of incisional closure with either monofilament or barbed suture in a simple continuous, appositional pattern at sites in the stomach (2), jejunum (4), and colon (4) were compared at postoperative Days 3, 7, and 14. Time for incisional closure was compared between materials. RESULTS: Bursting strength was not significantly different between gastrotomies/enterotomies closed with the monofilament suture or the barbed device. Closure time was significantly reduced with the barbed device in jejunal enterotomy closure. CONCLUSION: The barbed device compared favorably with monofilament suture for gastrotomy and enterotomy (small intestine, colon) closure. Results demonstrate comparable burst strengths between monofilament suture and the barbed device. Closure time was significantly reduced in jejunum closure using the barbed device.
Assuntos
Enterostomia/veterinária , Gastrostomia/veterinária , Técnicas de Sutura/veterinária , Suturas/veterinária , Implantes Absorvíveis/veterinária , Animais , Colo/cirurgia , Cães/cirurgia , Enterostomia/instrumentação , Enterostomia/métodos , Gastrostomia/instrumentação , Gastrostomia/métodos , Jejuno/cirurgia , Estômago/cirurgia , Técnicas de Sutura/instrumentação , Resistência à TraçãoRESUMO
Our objective was to compare survival and complication rates of horses undergoing pelvic flexure enterotomy closure with a TA-90 stapler to those with hand-sewn closure. Medical records of horses undergoing pelvic flexure enterotomy between 2001 and 2008 were reviewed. History, clinical signs, surgical findings, surgical techniques, and post-operative complications were recorded. Long-term outcome was established by telephone questionnaire. Of 84 pelvic flexure enterotomies performed, 70 were stapled and 14 were hand-sewn. Seventy-seven horses survived to discharge (91.7%). There were no significant associations between survival and closure technique (P = 0.69). Follow-up was available for 54 horses; 50 survived long-term (93.0%). No statistical significance was identified between long-term survival and closure method (P = 0.39). Forty horses went on to athletic performance (80.0%). TA-90 stapled closure of pelvic flexure enterotomies is a safe technique resulting in survival and complication rates equivalent to those of hand-sewn closure.
Assuntos
Doenças do Colo/veterinária , Enterostomia/veterinária , Doenças dos Cavalos/cirurgia , Obstrução Intestinal/veterinária , Grampeamento Cirúrgico/veterinária , Animais , Doenças do Colo/mortalidade , Doenças do Colo/cirurgia , Enterostomia/instrumentação , Enterostomia/métodos , Feminino , Doenças dos Cavalos/mortalidade , Cavalos , Obstrução Intestinal/mortalidade , Obstrução Intestinal/cirurgia , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/veterinária , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Our objective was to compare thoracoabdominal (TA Premium™ 90) stapled enterotomy closure to traditional hand-sewn closure, using time to perform the technique, luminal diameter, and bursting pressure in ex-vivo specimens. The pelvic flexures of 13 client-owned horses were harvested. Each pelvic flexure had 1 enterotomy performed; 6 were closed via staples, 7 closures were hand-sewn. Luminal diameter at the enterotomy site was assessed via contrast radiography performed pre-and post-enterotomy. Bursting pressure of the closure was assessed by continuous manometry during rapid infusion. Time to perform stapled closure was significantly shorter than hand-sewn closure (P < 0.0001). Percent reduction of luminal diameters was significantly decreased in stapled specimens (P = 0.034). There was no significant difference in bursting strength between closure techniques (P = 0.196). In conclusion, stapled enterotomy closure offers statistically significant reduction in closure time and better maintains pre-enterotomy luminal diameter without reducing biomechanical strength, compared to a double layer hand-sewn closure.
Assuntos
Enterostomia/veterinária , Doenças dos Cavalos/cirurgia , Grampeamento Cirúrgico/veterinária , Técnicas de Sutura/veterinária , Animais , Cadáver , Enterostomia/instrumentação , Enterostomia/métodos , Cavalos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Pressão , Ruptura Espontânea/epidemiologia , Ruptura Espontânea/veterinária , Grampeamento Cirúrgico/instrumentação , Grampeamento Cirúrgico/métodos , Técnicas de Sutura/instrumentação , Resultado do TratamentoRESUMO
Surgeons often have difficulty in identifying a suitable incision line to enter the peritoneal cavity for stoma mobilization during enterostomy closure. A mini-size test tube that is preoperatively placed into the stoma can act as an efficient guide in finding a free area to enter the peritoneal cavity, by supplying efficient counter traction and a palpable marker of the intestinal wall.
Assuntos
Enterostomia/instrumentação , Enterostomia/métodos , Estomas Cirúrgicos , Colostomia/instrumentação , Colostomia/métodos , Anormalidades do Sistema Digestório/cirurgia , Feminino , Humanos , Ileostomia/instrumentação , Ileostomia/métodos , Lactente , Masculino , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Reoperação/métodos , Estudos de Amostragem , Sensibilidade e EspecificidadeRESUMO
PURPOSE/METHODS: A retrospective review of the medical records of all patients who had a prosthetic placed at the time of stoma creation for the prevention of a parastomal hernia was performed. The purpose of this study was to evaluate the safety, efficacy, and cost-effectiveness of bioprosthetics. RESULTS: A bioprosthetic was used in 16 patients to prevent the occurrence of a parastomal hernia. The median follow-up was 38 months. There were no mesh-related complications, and no parastomal hernias occurred. On value analysis, to be cost-effective, the percentage of patients who would have subsequently needed surgical repair of a parastomal hernia would have to be in excess of 39% or the bioprosthetic would have to cost less than $2,267 to $4,312. CONCLUSIONS: These data show the safety and efficacy of using a bioprosthetic at the time of permanent stoma creation in preventing a parastomal hernia and defines the parameters for this approach to be cost-effective.
Assuntos
Bioprótese , Enterostomia/instrumentação , Hérnia Ventral/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Telas Cirúrgicas , Estomas Cirúrgicos , Adulto , Idoso , Bioprótese/economia , Análise Custo-Benefício , Enterostomia/economia , Enterostomia/métodos , Feminino , Seguimentos , Hérnia Ventral/economia , Hérnia Ventral/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Estudos Retrospectivos , Telas Cirúrgicas/economia , Resultado do Tratamento , Estados UnidosRESUMO
Within any area of nursing, it is possible to encounter an ostomate (person with a stoma). Most ostomates are independent with their stoma needs but some do require advice on which appliance or pouch they should use. The three main types of stoma; the colostomy, ileostomy and urostomy, pass different outputs and so require different appliances, which are discussed. This article then explores the differences between one- and two-piece pouches and provides several short scenarios to explain why the use of one- or two-piece pouches might be more appropriate in specific situations.
Assuntos
Enterostomia/instrumentação , Enterostomia/enfermagem , Colostomia/instrumentação , Colostomia/enfermagem , Drenagem/instrumentação , Desenho de Equipamento , Humanos , Ileostomia/instrumentação , Ileostomia/enfermagemAssuntos
Enterostomia/instrumentação , Perfuração Intestinal/cirurgia , Fístula Pancreática/cirurgia , Cateterismo/métodos , Enterostomia/métodos , Humanos , Perfuração Intestinal/etiologia , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Complicações Pós-Operatórias/cirurgia , Medição de Risco , Resultado do TratamentoRESUMO
AIM: To describe and evaluate a new technique for supporting a loop stoma with a simple removable subcutaneous bridge device. METHODS: Fifty-five patients underwent a procedure resulting in a loop stoma. Thirty patients had a loop colostomy and twenty-five a loop ileostomy. In all cases, the stoma was supported with a removable subcutaneous redivac drain fixed to the skin. RESULTS: There was no incidence of mechanical obstruction, stenosis, retraction, mucosal erosion or subcutaneous infection. Daily cleaning and care of the stoma was very simple, and the removal of the bridge device was carried out without opening the collecting bag. CONCLUSION: Our proposed technique is safe and feasible without considerable complications.
Assuntos
Enterostomia/instrumentação , Enteropatias/cirurgia , Estomas Cirúrgicos , Enterostomia/métodos , Estudos de Viabilidade , Humanos , Próteses e ImplantesRESUMO
BACKGROUND: Control of bowel effluents is imperative in cases of postoperative bowel perforation, and this is best achieved by stoma formation. When stoma formation is impossible, the surgeon is often left with less optimal choices. We have used a Foley catheter enterostomy to provide source control in difficult cases of bowel perforation, and the details are reviewed in this report. METHODS: Three patients underwent reoperation for postoperative bowel perforation. Two patients had leaking ileocolic anastomoses, and one patient had a leak from a serosal tear. In all cases a Foley catheter enterostomy was constructed at the point of the leak. The balloon was filled with 3 ml of saline, and the affected bowel segment was fixed to the inside of the abdominal wall by a purse-string suture supplied with a few additional stitches. Moreover, gentle traction was applied to the balloon by external suture fixation of the catheter. RESULTS: Immediate control of bowel effluents from the leak was achieved in all cases. Early enteral feeding was possible in two of the three patients, and the catheter was removed after 17-28 days. Drainage of bowel contents from the catheter wounds stopped within 2 days. CONCLUSIONS: This report demonstrates an effective and safe technique for sealing a postoperative bowel perforation with a Foley catheter enterostomy. It is useful in cases where a stoma cannot be brought out. The technique provides immediate source control and enables early enteral feeding. The utility of the procedure may be limited when the defect is large, when the surrounding bowel wall lacks integrity, and when it is not possible to mobilize the affected bowel segment toward the inside of the abdominal wall without tension.