Effect comparison of three different types of transanal drainage tubes after anterior resection for rectal cancer.

BACKGROUND: Anastomotic leakage (AL) is one of the most severe early complications after rectal cancer surgery. Many studies and meta-analysis results show that the indentation of transanal drainage tubes (TDT) can prevent and reduce the incidence of AL. However, the size and material of drainage tubes are rarely reported. Herein, we compare the effect of three kinds of TDT and analyze the use of TDT material and size to prevent AL, which may better prevent the occurrence of AL. METHODS: The clinical data of 182 patients who underwent laparoscopic anterior resection of rectal cancer were retrospectively analyzed between January 2016 and March 2019. According to the types of indwelling TDT after the operation, they were divided into Fr32 silicone tubes (81 cases), Fr24 silicone tubes (54 cases), Fr24 latex tubes (47 cases). The first drainage, exhaust, defecation, abdominal distension and anastomotic leakage of the patients with three different types of TDT were compared. RESULTS: There was no significant difference in the degree of first exhaust, abdominal distension and anastomotic leakage among three different types of TDT; the time of first drainage and defecation of the Fr32 silicone tube was significantly earlier than that of Fr24 silicone tube and Fr24 latex tube. CONCLUSION: The drainage effect of the Fr32 silicone tube is better than that of Fr24 silicone tube and Fr24 latex tube after anterior resection for rectal cancer, Fr32 silicone may better prevent the occurrence of AL, but randomized controlled studies are needed.

Fluoroscopy-guided foam sclerotherapy for varicose veins in the legs: A retrospective cohort analysis with long-term follow-up.

OBJECTIVE: To examine the long-term effectiveness of fluoroscopy-guided foam sclerotherapy for varicose veins in the legs. METHODS: This retrospective cohort study included consecutive patients who underwent fluoroscopy-guided foam sclerotherapy for varicose veins in the legs at the authors' center during a period from August 1, 2011, to May 31, 2016. The last follow-up was conducted by a telephone/WeChat interactive interview in May 2022. Recurrence was defined as the presence of varicose veins regardless of symptoms. RESULTS: The final analysis included 94 patients (58.3 ± 7.8 years of age; 43 men; 119 legs). The median Clinical-Etiology-Anatomy-Pathophysiology (CEAP) clinical class was 3.0 (interquartile range [IQR]: 3.0, 4.0). C5 and C6 accounted for 5.0% (6/119) of the legs. The average total amount of the foam sclerosant used during the procedure was 35 ± 12 mL (range: 10-75 mL). No patients developed stroke, deep vein thrombosis, or pulmonary embolism after the treatment. At the last follow-up, the median CEAP clinical class reduction was 3.0. All 119 legs except for class 5 achieved the CEAP clinical class reduction by at least one grade. The median venous clinical severity score was 2.0 (IQR: 1.0, 5.0) at the last follow-up vs 7.0 (IQR: 5.0, 8.0) at the baseline (P < .001). The recurrence rate was 30.9% (29/94) in the overall analysis, 26.6% (25/94) for the great saphenous vein and 4.3% (4/94) for the small saphenous vein (P < .001). Five patients received subsequent surgical treatment, and the remaining patients opted to receive conservative treatments. Among the two C5 legs at the baseline, ulcer recurred in one leg at 3 months after the treatment and healed after conservative treatments. In the four C6 legs at the baseline, ulcer healed within a month in all patients. The rate of hyperpigmentation was 11.8% (14/119). CONCLUSIONS: Long-term outcomes in patients undergoing fluoroscopy-guided foam sclerotherapy are satisfying, with minimal short-term safety concerns.

Ultrasound- and fluoroscopy-guided foam sclerotherapy for lower extremity venous ulcers.

OBJECTIVE: In foam sclerotherapy for varicose veins, ultrasound can track the spread of foam in only one direction. We hypothesized that using fluoroscopy in combination with ultrasound can reveal the spread of foam to deep veins through perforator veins and to other varicose veins in different directions. In this study, we examined the safety and effectiveness of ultrasound- and fluoroscopy-guided foam sclerotherapy for lower extremity venous ulcers. METHODS: This retrospective study included all patients receiving ultrasound- and fluoroscopy-guided foam sclerotherapy for varicose ulcers (Clinical, Etiology, Anatomy, and Pathophysiology class 6) of the lower extremities at the Fourth Affiliated Hospital of Jiangsu University (Zhenjiang, China) between May 1, 2016, and April 30, 2018. Polidocanol foam sclerosant was injected through indwelling needles (placed every 20 cm for saphenous veins and every 5-10 cm for others) into the varicose veins. When the contrast medium in the target vessels was replaced by the hypointense foam sclerosant or on signs of foam entry into the perforator veins under fluoroscopy, the injection was stopped and the site was manually pressed. All patients received postprocedure compression with elastic bandages until ulcer healing and compression stockings (30-40 mm Hg) thereafter. RESULTS: A total of 35 patients (42 limbs) were included. The maximal ulcer diameter was 3.6 ± 1.4 cm (range, 1.1-5.8 cm). The number of injection sites ranged from 3 to 10; total foam amount ranged from 4.5 to 35 mL. All 35 patients completed 12-month follow-up. Ulcer healing rate was 100%, and 1-year recurrence rate was 2.9%. The Venous Clinical Severity Score was 12.98 ± 3.91 before treatment, decreasing to 3.02 ± 2.39 at 12 months (P < .01). Superficial thrombophlebitis developed in 21 (50%) limbs. No deep venous thrombosis or pulmonary embolism was observed during follow-up. Among the 33 limbs (27 patients) with ultrasound examination at 12 months, 28 (84.8%) limbs had complete occlusion and the remaining 5 (15.2%) had recanalization. CONCLUSIONS: Ultrasound- and fluoroscopy-guided foam sclerotherapy is safe and effective for the treatment of venous ulcers of the lower extremities.