Effectiveness of direct needle puncture for complete hepaticojejunostomy anastomotic stricture after pancreaticoduodenectomy (with video).

A 79-year-old Japanese woman, who had undergone pancreaticoduodenectomy 6 months prior to presentation owing to pancreatic cancer, complained of jaundice with high fever. Computed tomography revealed proximal bile duct dilatation with complete hepaticojejunostomy anastomotic stricture (HJAS). We performed a single-balloon endoscopy for biliary drainage. The presence of a scar-like feature surrounding the anastomosis was identified as the HJAS. White-light imaging during single-balloon endoscopy revealed that the HJAS contained a milky whitish area (MWA), suggesting that a membranous and fibrosis layer affected continuous inflammation around the center of the anastomosis (within a scar-like feature). Endoscopic dilatation was performed using an endoscopic injection needle, with the MWA used as an indicator. A 23-gauge endoscopic injection needle was used to penetrate the center of the blind lumen within the MWA, and a pinhole was created in the stricture. After confirming the position of the proximal bile duct using a contrast medium with the needle, an endoscopic guidewire with a cannula was inserted into the pinhole. A through-the-scope sequential balloon dilator was used to dilate the stricture, and a plastic stent was inserted into the proximal bile duct. This endoscopic intervention led to positive outcomes. In cases of complete HJAS occlusion, an endoscopic approach to the bile duct is difficult because the anastomotic opening of the HJAS is not visible. Thus, puncturing within the MWA, which can be used as a scar-like landmark within a complete membranous HJAS, is considered a useful endoscopic strategy.

Unilateral drainage and chemotherapy prolong the patency of a plastic stent placed above the sphincter of Oddi in patients with malignant hilar biliary obstruction.

Objectives: To evaluate the results of inside stent therapy for unresectable malignant hilar biliary obstruction and identify factors related to stent patency duration. Methods: Of 44 patients who underwent initial inside-stent placement above the sphincter of Oddi from April 2017 to December 2022, 42 with the resolution of jaundice (clinical success rate, 95.5%) were retrospectively analyzed. Univariate and multivariate logistic regression analysis identified factors associated with stent patency duration. Results: Univariate analysis revealed significant differences in the drainage method (406 days for unilateral drainage vs. 305 days for bilateral drainage of the right and left liver lobes, p = 0.022) with or without chemotherapy (406 days with vs. 154 days without, p = 0.038). Multivariate analysis (Cox proportional hazards analysis) revealed similar results, with unilateral drainage (p = 0.031) and chemotherapy (p = 0.048) identified as independent factors associated with prolonged stent patency. Early adverse events were observed in two patients (4.8%; one cholangitis, one pancreatitis). Conclusions: Inside-stent therapy was safely performed in patients with malignant hilar biliary obstruction. Simple unilateral drainage and chemotherapy may prolong stent patency.

Role of endoscopic ultrasound-guided biliary drainage for palliation of malignant biliary obstruction.

Endoscopic ultrasound-guided biliary drainage (EUS-BD) directs bile flow into the digestive tract and has been mostly used in patients with malignant biliary obstruction (MBO) where endoscopic retrograde cholangiopancreatography-guided biliary drainage was unsuccessful or was not feasible. Lumen apposing metal stents (LAMS) are deployed during EUS-BD, with the newer electrocautery-enhanced LAMS reducing procedure time and complication rates due to the inbuilt cautery at the catheter tip. EUS-BD with electrocautery-enhanced LAMS has high technical and clinical success rates for palliation of MBO, with bleeding, cholangitis, and stent occlusion being the most common adverse events. Recent studies have even suggested comparable efficacy between EUS-BD and endoscopic retrograde cholangiopancreatography as the primary approach for distal MBO. In this editorial, we commented on the article by Peng et al published in the recent issue of the World Journal of Gastrointestinal Surgery in 2024.

An Atypical Pathogen at an Atypical Location: A Rare Case of Salmonella-Associated Submandibular Abscess.

Salmonella infections commonly cause gastroenteritis and enteric fever but can also result in extraintestinal infections, especially in immunocompromised individuals. Although rare, Salmonella infection in the head and neck region was found to be more common in diabetics and patients with malignancy. We present a unique case of a 52-year-old immunocompromised man with uncontrolled diabetes who developed a submandibular abscess due to Salmonella Paratyphi B. The patient initially presented with pain, swelling, and difficulty swallowing, which worsened over a week. Diagnostic imaging revealed a well-defined abscess with lymphadenopathy. Management included incision and drainage, followed by identification of Salmonella Paratyphi B and targeted antibiotic therapy based on culture and sensitivity analysis. This case highlights the importance of early recognition, appropriate diagnostic imaging, and targeted antimicrobial therapy in managing uncommon manifestations of Salmonella infection in the head and neck. Continued vigilance and multidisciplinary management are essential for favorable patient outcomes in such cases.

Potential for large losses of carbon from non-native conifer plantations on deep peat over decadal timescales.

Peatland drainage is a large source of anthropogenic CO2 emissions. While conversion to agriculture is widely acknowledged to lead to "irrecoverable" carbon (C) losses, in contrast the C impacts of peatland forestry are poorly understood, especially in intensively managed plantations. Losses of C from peat oxidation are highly variable and can be compensated for by gains of C in trees, depending on the lifecycle of the timber and timescale considered. Here, we used ITRAX scanning to enable rapid detection of the Hekla 4 cryptotephra layer as a reliable chronological marker above which peat properties and C stocks could be compared between open and afforested blanket bog cores in the Flow Country of Northern Scotland. At one site, Bad a' Cheò, we combine replicated core pair comparisons (n = 19) with timber extraction data to derive net ecosystem C balance over the lifetime of the plantation. Here the reduction in peat C carbon storage above Hekla 4 in afforested samples (67 t C ha-1) is only partially compensated by tree C sequestration (47 t C ha-1), leading to a net ecosystem C balance indicating a loss of 20 t C ha-1 over the 50 years since the plantation was established. At that site, ~65 % of tree C rapidly returned to the atmosphere, as it was primarily used for heat and power generation. Across the wider Flow country region, a simplified paired sampling method was adopted at eight further sites, finding a either a loss or negligible change in peat C storage above Hekla 4 in afforested samples with a mean loss of 86 t C ha-1 and median loss of 50 t C ha-1. This study suggests that potentially substantial C losses have been an unintended consequence of non-native conifer afforestation over deep blanket bogs.

Same versus separate sessions of endoscopic ultrasound-guided fine-needle biopsy and endoscopic retrograde cholangiopancreatography for distal malignant biliary obstruction: a propensity score-matched study.

BACKGROUND: Same-session endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) is an attractive policy for patients with distal malignant biliary obstruction (DMBO) requiring fine-needle biopsy (FNB) and biliary drainage. However, scanty and conflicting data exists regarding safety and efficacy when comparing these two procedures performed in same versus separate sessions. METHODS: Single-center, retrospective, propensity score-matched study including patients with DMBO who underwent EUS-FNB followed by ERCP during the same or separate sessions. The primary outcome was the safety of the procedure [number of patients experiencing adverse events (AEs), overall AEs, its severity, post-ERCP pancreatitis (PEP)]. Secondary outcomes were successful ERCP, use of advanced cannulation techniques, EUS-FNB adequacy, length of hospital stay, overall procedure time, and time to recurrent biliary obstruction. RESULTS: After propensity matching, 87 patients were allocated to each group. AEs developed in 23 (26.4%) vs. 17 (19.5%) patients in the same and separate sessions group, respectively (p = 0.280). The overall number, the severity of AEs, and the rate of PEP were similar in the two groups. Secondary outcome parameters were also comparable in the 2 groups. CONCLUSIONS: Same-session EUS-FNB followed by ERCP with biliary drainage is safe and does not impair technical outcomes of tissue adequacy and biliary cannulation.

Factors influencing residual air saturation during consecutive imbibition processes in an air-water two-phase fine sandy medium - A laboratory-scale experimental study.

The residual air saturation plays a crucial role in modeling hydrological processes of groundwater and the migration and distribution of contaminants in subsurface environments. However, the influence of factors such as media properties, displacement history, and hydrodynamic conditions on the residual air saturation is not consistent across different displacement scenarios. We conducted consecutive drainage-imbibition cycles in sand-packed columns under hydraulic conditions resembling natural subsurface environments, to investigate the impact of wetting flow rate, initial fluid state, and number of imbibition rounds (NIR) on residual air saturation. The results indicate that residual air saturation changes throughout the imbibition process, with variations separated into three distinct stages, namely, unstable residual air saturation (Sgr-u), momentary residual air saturation (Sgr-m), and stable residual air saturation (Sgr). The results also suggest that the transition from Sgr-u to Sgr is driven by changes in hydraulic pressure and gradient; the calculated values followed the following trend: Sgr > Sgr-u > Sgr-m. An increase in capillary number, which ranged from 1.46 × 10-7 to 3.07 × 10-6, increased Sgr-u and Sgr-m in some columns. The increase in Sgr ranged from 0.034 to 0.117 across all the experimental columns; this consistent increase can be explained by water film expansion at the primary wetting front along with a strengthening of the hydraulic gradient during water injection. Both the pre-covered water film on the sand grain surface and a pore-to-throat aspect ratio of up to 4.42 were identified as important factors for the increased residual air saturation observed during the imbibition process. Initial air saturation (Sai) positively influenced all three types of residual air saturation, while initial capillary pressure (Pci) exhibited a more pronounced inhibitory effect on residual air saturation, as it can partly characterized the initial connectivity of the air phase generated under different drying flow rates. Under identical wetting flow rate conditions, Sgr was higher during the second imbibition than during the first imbibition due to variations in initial fluid state, involving both fluid distribution and the concentration of dissolved air in the pore water. In contrast, NIR did not have an obvious effect on the three types of residual air saturation. This work aims to provide empirical evidences and offer further insights into the capture of non-wetting phases in groundwater environments, as well as to put forward some potential suggestion for future investigations on the retention and migration of contaminants that involves multiphase interface interactions in subsurface environments.

Comparative research on monitoring methods for nitrate nitrogen leaching in tea plantation soils.

Great concern has long been raised about nitrate leaching in cropland due to its possible environmental side effects in ground water contamination. Here we employed two common techniques to measure nitrate leaching in tea plantation soils in subtropical China. Using drainage lysimeter as a reference method, the adaptability of estimating drainage and nitrate leaching by combining the water balance equation with the suction cup technique was investigated. Results showed that the final cumulative leachate volume for the calculated and measured method was 721.43 mm and 729.92 mm respectively during the study period. However, nitrate concentration exerted great influence in the estimation of nitrate leaching from the suction cup-based method. The cumulative nitrate leaching loss from the lysimeter and suction cup-based method was 47.45 kg ha-1 and 43.58 kg ha-1 under lysimeter nitrate concentrations ranging from 7 mg L-1 to 13 mg L-1, 156.28 kg ha-1 and 79.95 kg ha-1 under lysimeter nitrate concentrations exceeding 13 mg L-1. Therefore, the suction cup-based method could be an alternative way of monitoring nitrate leaching loss within a range of 7-13 mg L-1 of nitrate concentrations in leachate. Besides, lower results occurred in suction cup samplers due to lack of representative samples which mainly leached via preferential flow when in strong leaching events. Thus, it is advisable to increase sampling frequency under such special conditions. The results of this experiment can serve as a reference and guidance for the application of ceramic cups in monitoring nitrogen and other nutrient-ion leaching in tea plantation soils.

The efficacy and safety of laparoscopic common bile duct exploration with primary duct closure for cholecystolithiasis combined with choledocholithiasis.

Cholecystolithiasis combined with choledocholithiasis represents a prevalent disease. At present, regarding the management of the common bile duct (CBD), T-tube drainage (TTD) and primary duct closure (PDC) emerge as two prominent approaches for biliary tract repair after laparoscopic CBD exploration (LCBDE). Here, retrospective analysis was conducted on the clinical records of 157 patients who underwent LCBDE at our hospital between January 2019 and January 2022. All patients were categorized into the PDC group or the TTD group based on the chosen CBD treatment approach. A comparative assessment was made across demographic factors, preoperative conditions, surgical particulars, and postoperative complications. The results showed that PDC is recommended for patients with a limited number of small stones, particularly when the CBD is in the 10-15 mm diameter range.

Comparative efficacy of endoscopic ultrasound-guided biliary drainage versus endoscopic retrograde cholangiopancreatography as first-line palliation in malignant distal biliary obstruction: a systematic review and meta-analysis.

Background: Malignant distal biliary obstruction (MDBO) is a challenging clinical condition commonly managed with endoscopic retrograde cholangiopancreatography (ERCP). However, endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative, especially in complex cases where ERCP fails or is deemed risky. This study aimed to compare the efficacy, safety and cost-effectiveness of EUS-BD vs. ERCP in the palliation of MDBO. Methods: We conducted a systematic review and meta-analysis, following PRISMA guidelines. Three databases were searched up to December 2023, including MEDLINE/PubMed, OVID and the Cochrane Central Register of Controlled Trials, for studies comparing EUS-BD with ERCP. Primary outcomes were technical and clinical success rates, while secondary outcomes included procedural times, hospital stay duration, 30-day mortality, reintervention rates, and adverse events such as pancreatitis. Results: Seven studies involving 1245 patients met the inclusion criteria. The meta-analysis revealed that EUS-BD had a technical success rate of 92%, compared to 85% for ERCP. Clinical success rates were similar for both EUS-BD and ERCP, at approximately 89%. EUS-BD was associated with a significantly lower incidence of pancreatitis (2% vs. 10% for ERCP). Conclusions: EUS-BD offers a viable and potentially superior alternative to ERCP for the primary palliation of MDBO, particularly in terms of technical success and a lower risk of pancreatitis. These findings support the adoption of EUS-BD in clinical settings equipped to perform this technique, though future research should focus on long-term outcomes and further economic analysis to solidify these recommendations.

Development of an Evidence-based Care Bundle for Prevention of External Ventricular Drain-related Infection: Results of a Single-center Prospective Cohort Study and Literature Review.

Background: External ventricular drain (EVD)-related infection (ERI) is a common complication in cranial neurosurgery practice with high mortality. The risk factors associated with ERI are not well studied in low- and middle-income countries (LMIC) like India. Identifying the risk variables is a necessity to design robust evidence-based care bundles for ERI prevention. Materials and methods: This is a single-center prospective cohort study. Patients with and without ERI during the 2-year study period were analyzed along with literature review to identify the risk variables associated with ERI. The Institute for Healthcare Improvement (IHI) comprehensive flowchart was used to develop the concept care bundle for ERI prevention. Results: A total of 211 EVD were inserted during the study period. 15 ERI (7.1%) were identified based on IDSA criteria, with an average infection rate of 11.12 per 1000 EVD days. Gram negative bacteria (GNB) were the predominant pathogen (12/15, 80%), with Klebsiella pneumoniae (6/15, 40%) being the most common bacteria isolated. In multivariate analysis, the risk variables associated with ERI were use of broad spectrum pre-surgical antimicrobial prophylaxis for long duration, choice of posterior craniometric points for EVD insertion, EVD duration >7 days, EVD leak and surveillance cerebrospinal fluid (CSF) sampling at periodic intervals. Based on the risk variables identified in this study and literature review, a consensus decision on the care elements for the insertion and maintenance phases was chosen for the concept care bundle for ERI prevention. Conclusion: An evidence-based concept care bundle for ERI prevention is proposed for further multicentric evaluation and validation. How to cite this article: Ponnambath DK, Divakar G, Mamachan J, Biju S, Raja K, Abraham M. Development of an Evidence-based Care Bundle for Prevention of External Ventricular Drain-related Infection: Results of a Single-center Prospective Cohort Study and Literature Review. Indian J Crit Care Med 2024;28(8):760-768.

Surgical outcomes and risk factors for overall mortality in brain arteriovenous malformations patients: a retrospective analysis.

Background: Brain arteriovenous malformations (AVMs) are challenging vascular lesions. Extensive follow-up studies are necessary to refine the therapeutic algorithm, and to improve long-term survival in these patients. The aim of the study was to assess surgical outcomes, and to evaluate overall long-term mortality in patients treated for brain AVMs. Methods: This retrospective single-center study included 191 patients with brain AVMs, admitted between 2012 and 2022. Clinical and angiographical particularities have been analyzed, to identify factors that might influence early outcome and overall long-term mortality. Results: Out of 79 patients undergoing surgery, 51 had ruptured AVMs with total resection achieved in 68 cases (86.1%). Deep venous drainage was associated with incomplete resection. Female sex, admission modified Rankin Scale (mRS) > 2, and eloquent location were independent predictors of poor outcomes. Multiple venous drainage was associated with a higher risk of worsened early outcome. Eloquent brain region involvement, conservative treatment, increasing age, admission mRS > 2, and comorbidities significantly decrease survival in brain AVM patients. Patients treated with interventional treatments had significantly better survival than the conservatively managed ones, when adjusting for age and admission mRS. Conclusion: The study identified female sex, poor neurologic status on admission and eloquence as independent prognostic factors for a negative outcome after surgery. Patients who received interventional treatment had significantly better survival than patients managed conservatively. We recommend employing tailored, proactive management strategies as they significantly enhance long-term survival in brain AVM patients.

Early Versus Delayed Laparoscopic Cholecystectomy, after Percutaneous Gall Bladder Drainage, for Grade II Acute Cholecystitis TG18 in Patients with Concomitant Cardiopulmonary Disease.

Background: The advancement in medical care has led to an increase in patients with acute cholecystitis (AC) and cardiopulmonary comorbidities referred for surgery. Grade II AC, according to Tokyo Guidelines in 2018 (TG18), is characterized by severe local inflammation with no systemic affection. The optimal treatment for patients with high-risk grade II AC has not yet been clearly established, which is still a dilemma. For these patients, laparoscopic cholecystectomy (LC), despite being the only definitive treatment, is still a challenge. The introduction of percutaneous cholecystostomy as a temporary minimally invasive alternative technique allows an immediate gallbladder decompression with a rapid clinical improvement. However, the next step after percutaneous transhepatic gall bladder drainage (PTGBD) in these high-risk patients is still a debate, with no definitive consensus about the ideal treatment of choice as well as its optimal timing. In our study, we followed a treatment algorithm for high-risk patients that involved early gallbladder decompression by PTGBD, followed by LC at different intervals once the patient is considered fit for surgery. Method: A retrospective study of 58 patients with high-risk grade II AC with cardiopulmonary comorbidity from our medical records was included. They were managed initially with PTGBD, an LC was then performed either within 7 days after drain insertion (early group, 26 patients), while an LC was performed later for the remaining patients within 6-8 weeks after PTGBD (late group, 32 patients). The results of the two groups were analyzed. Result: Procalcitonin and C-reactive protein were significantly higher in the late group. No significant difference was found between both groups with regard to operative time, PTGBD-related complications, and major perioperative complications. Timing after PTGBD did not affect the incidence of operative complications. Total hospital stay was significantly shorter in the early group. Conclusion: PTGBD is a safe initial intervention for high-risk patients with AC with a low morbidity and high success rate. Urgent LC after PTGBD can be performed safely for well-selected high-risk patients with the timing of surgery is personalized according to each patient's clinical situation. Early LC (after PTGBD) has the advantage of shorter hospital stay, low cost, as well as avoiding the risk of biliary complications and mortality if waiting a delayed surgery with no significant difference in morbidity compared with late LC.

Elevating water table reduces net ecosystem carbon losses from global drained wetlands.

Drained wetlands are thought to be carbon (C) source hotspots, and rewetting is advocated to restore C storage in drained wetlands for climate change mitigation. However, current assessments of wetland C balance mainly focus on vertical fluxes between the land and atmosphere, frequently neglecting lateral carbon fluxes and land-use effects. Here, we conduct a global synthesis of 893 annual net ecosystem C balance (NECB) measures that include net ecosystem exchange of CO2, along with C input via manure fertilization, and C removal through biomass harvest or hydrological exports of dissolved organic and inorganic carbon, across wetlands of different status and land uses. We find that elevating water table substantially reduces net ecosystem C losses, with the annual NECB decreasing from 2579 (95% interval: 1976 to 3214) kg C ha-1 year-1 in drained wetlands to -422 (-658 to -176) kg C ha-1 year-1 in natural wetlands, and to -934 (-1532 to -399) kg C ha-1 year-1 in rewetted wetlands globally. Climate, land-use history, and time since water table changes introduce variabilities, with drainage for (sub)tropical agriculture or forestry uses showing high annual C losses, while the net C losses from drained wetlands can continue to affect soil C pools for several decades. Rewetting all types of drained wetlands is needed, particularly for those formerly agriculture-used (sub)tropical wetlands where net ecosystem C losses can be largely reduced. Our findings suggest that elevating water table is an important initiative to reduce C losses in degraded wetlands, which could contribute to policy decisions for managing wetlands to enhance their C sequestration.

Splenic abscess caused by Lancefieldella rimae successfully managed with percutaneous drainage and antibiotics: A case report.

A 29-year-old man with diabetic nephropathy presented with fever and chills 4 days postdischarge following hospitalization for hyperglycemia. Abdominal computed tomography revealed a splenic abscess. Percutaneous drainage was performed, and intravenous meropenem was administered. Subsequent culture of the drained abscess identified Lancefieldella rimae. Based on the antimicrobial susceptibility results, the patient was switched to oral levofloxacin. This combined treatment led to the resolution of the abscess, with no recurrence after 6 months. This is the first case of a splenic abscess caused by L. rimae successfully managed by prompt percutaneous drainage and appropriate antibiotics.

Improving the re-use potential of reactive waste rock using sieving: a laboratory geochemical study.

Stockpiles containing sulfide minerals are subject to oxidation reactions when exposed to atmospheric conditions, which can result in the formation of acid mine drainage (AMD). Reactive waste rock has limited re-use potential due to the contamination risk associated with the generated drainage water. The re-use of reactive waste rock could lead to a significant reduction in the volume of waste rock as it mitigates the environmental impact of mine waste deposition. Acid mine drainage generation rate depends on sulfide weathering kinetics which are controlled by many parameters such as the mineralogy and the particle size. Fine fractions of waste rock have higher specific surface areas and degree of liberation of sulfides, resulting in greater reactivity than the coarse fractions. The objective of this research was therefore to evaluate the potential of re-use by controlling particle size using the sieving method. Two different potentially acid-generating waste rocks were divided into six fractions and subjected to both static and kinetic tests. Prediction of the geochemical behavior using static test did not consider the liberation of the minerals, and the long-term prediction was therefore overestimated. Results of the kinetic columns showed there was less oxidation of the sulfide minerals in the coarse fractions than in the fine fractions. Additionally, the distribution of sulfidic minerals and neutralizing minerals with particle size is influencing the potential of the re-use of the reactive waste rock.

Effective surgical drainage of a massive retropharyngeal abscess via an incision in the posterior wall of the oropharynx under local anesthesia.

INTRODUCTION: A retropharyngeal abscess is a deep neck infection, uncommon in adults but more prevalent in children. This report details a rare case of a huge retropharyngeal abscess in an adult female, effectively managed by an incision in the posterior oropharyngeal wall under local anesthesia. CASE PRESENTATION: A 76-year-old woman with hypertension, diabetes, ischemic heart disease, and total thyroidectomy presented with sudden neck swelling, dyspnea, stridor, and dysphagia. Examination and imaging revealed a large retropharyngeal abscess. The abscess was drained through an incision in the posterior wall of the oropharynx using a local anesthetic, yielding immediate symptom relief. Cultures identified Streptococcus and Staphylococcus aureus, leading to adjusted antibiotics. The patient showed significant improvement, with resolution of respiratory distress and reduced inflammation. DISCUSSION: The retropharyngeal space, containing lymph nodes and connective tissue, extends from the skull base to the superior mediastinum, communicating with the carotid sheath and parapharyngeal space. Effective management of a critically ill, immunocompromised patient with a resistant retropharyngeal abscess was achieved using an intraoral approach and intravenous antibiotics. This method avoids general anesthesia and minimizes postoperative complications. CT scans are essential for assessing disease extent and planning surgery. Our case highlights the successful treatment of a large abscess with minimal risks. CONCLUSION: Drainage of retropharyngeal abscesses via the intraoral approach under local anesthesia can be considered a valuable method for high-risk patients who are not candidates for general anesthesia. Additionally, we presented a rare case of an exceptionally large retropharyngeal abscess.

Abdominal drainage after minimally invasive distal pancreatectomy: out of sight, out of mind?

BACKGROUNDS: The use of drains in pancreatic surgery remains controversial. The present study investigated postoperative outcomes in patients undergoing minimally invasive distal pancreatectomy (MIDP) without intraperitoneal drain placement. METHODS: Data of consecutive patients undergoing MIDP between 2013 and 2023 were prospectively collected. Patients were divided in drain group (DG), including patients with prophylactic abdominal drain placed, and no-drain group (NDG) including those without drain. The groups were compared in terms of postoperative outcomes, using a propensity score-matched analysis. RESULTS: 116 patients were selected. After matching, DG and NDG consisted of 29 patients each. The rates of POPF and abdominal collection were lower in NDG in comparison to DG (3.4% vs. 27.6%, p 0.025 and 3.4% vs. 31.0%, p 0.011, respectively). The length of stay was significantly shorter in the NDG (5 vs. 9 days, p < 0.001). No difference between the groups was found for other outcomes. CONCLUSION: Drain omission was associated with lower rates of POPF and abdominal collections, as well as shorter hospital stays, not affecting the rate of severe complication, reoperation and readmission.

Analysis of Risk Factors for Poor Drainage of Ureteral Stents after Radical Cystectomy with Cutaneous Ureterostomy: A Retrospective Study.

OBJECTIVE: Currently, the factors influencing poor drainage of ureteral stents after radical cystectomy with cutaneous ureterostomy are still unclear. Therefore, the aim of this study was to determine the risk factors for poor drainage of ureteral stents after radical cystectomy with cutaneous ureterostomy and to provide evidence for the prevention of this complication. METHODS: This retrospective study included 86 patients who underwent periodic replacement of ureteral stents following radical cystectomy with cutaneous ureterostomy between October 2017 and March 2024. The general data and related indicators of the patients were collected, the risk factors were identified through univariate and multivariate logistic regression analyses, and corresponding interventions were proposed. RESULTS: Among the 86 patients, 26 had poor drainage of ureteral stents, with an incidence rate of 30.23%, and no serious consequences occurred after timely and effective treatment. Univariate and multivariate logistic regression analyses revealed that body mass index (BMI) (p = 0.003, odds ratio (OR) = 2.909, 95% CI: 1.435-5.898), diabetes mellitus (p = 0.012, OR = 14.073, 95% CI: 1.770-111.889), urinary tract infection (p = 0.004, OR = 16.792, 95% CI: 2.402-117.411), and foreign body blockage (p = 0.048, OR = 5.277, 95% CI: 1.012-27.512) were independent risk factors for poor drainage of ureteral stents. CONCLUSIONS: The incidence of poor drainage of ureteral stents after radical cystectomy with cutaneous ureterostomy is relatively high. Maintenance of a healthy weight, strict management of blood glucose levels, active prevention of urinary tract infections, and timely detection and removal of small foreign bodies that may be present are essential to prevent this complication.