The use of 14/16Fr ureter access sheath for safe and effective management of large upper ureteral calculi.

OBJECTIVE: To evaluate the effectiveness of ureteroscopic lithotripsy for the management of large proximal ureteral stones > 10 mm using 14/16 Fr ureteral access sheath (UAS). MATERIALS AND METHODS: Patients' data from prospective database undergoing ureteroscopic laser lithotripsy with a use of 14/16Fr UAS were collected. All patients were pre-stented prior to the procedure. The fragmentation was performed with a semi-rigid ureteroscope using holmium laser energy with a power setting of 35 W (frequency-35 Hz; energy-1 J). Follow-up was scheduled at 4 weeks and 3 months postoperatively. RESULTS: In total 78 patients, 43 males and 35 females, were included in the study. The mean age of the patients was 59.5 ± 13.3 with a mean maximal stone diameter of 13.4 ± 2.1. The mean operative time was 35.7 ± 9.7 and the mean hospital stay was 2 ± 0.7 days. The primary SFR at 4 weeks was 73 patients (93.6%), while all 78 patients (100%) were stone free at 3-month follow-up, 2 of the patients receiving additional treatment. In total, 8 (10.2%) patients experienced Grade II complications. Intraoperative ureteral lesions were observed in 41 (52.6%) cases. Out of them 31 patients (39.7%) developed Grade 1, 8 patients (10.3%) Grade 2 and only 3 patients (2.6%) Grade 3 lesions. CONCLUSION: The use of 14/16Fr ureteral access sheath on pre-stented patients was associated with successful outcomes. A high stone-free rate of 93.6% was achieved at 4-week follow-up. The procedure was not associated with increased rate of postoperative complications and intraoperative ureteral injury.

Endoscopic sphincterotomy with sphincteroplasty for the management of choledocholithiasis: a single-centre experience.

BACKGROUND: Balloon dilatation of the ampulla at endoscopic retrograde cholangiopancreatography (ERCP) is increasingly utilized in the management of large bile duct stones. The aim of this study was to review and compare the outcomes of using endoscopic sphincterotomy with endoscopic balloon dilatation (sphincteroplasty) in a combined approach as a single-stage (immediate) or a two-stage procedure (delayed). METHODS: A retrospective review of medical records for all patients undergoing ERCP and balloon dilatation for choledocholithiasis between January 2010 and December 2012 was undertaken. Outcomes measured included patient demographics, stone size, degree of dilatation performed, success of stone extraction, number of procedures required for duct clearance and procedure-related complications. RESULTS: One hundred and thirty-six ERCPs were performed with balloon sphincteroplasty. One hundred and four had a previous sphincterotomy with a delayed balloon dilatation and 32 had sphincterotomy with immediate dilatation. The overall clearance rate of the common bile duct for immediate and delayed groups was 93% (28/30) and 93% (81/87), respectively. Bile duct clearance after the first procedure was achieved in 70% (21/30) of patients in the immediate group and 74% (64/87) in the delayed group. There were six complications in the delayed group and four in the immediate group. The most frequently used balloon size was 10 mm for both groups with mean sizes of 10.34 (2.93) and 11.73 (2.87) in the immediate and delayed groups, respectively. CONCLUSION: Our study suggests that use of a combined approach is safe and effective and may provide benefits over using endoscopic balloon dilatation or endoscopic sphincterotomy alone in the treatment of choledocholithiasis.

Torsion of the gallbladder: a systematic review.

BACKGROUND: Gallbladder torsion is a rare disease, predominantly affecting elderly women. It is an important differential in the acute surgical abdomen. METHODS: A total of 324 published case reports of torsion of the gallbladder were reviewed. Features in diagnostic imaging suggestive of torsion were reviewed and summarized. RESULTS: Gallbladder torsion is primarily a disease of elderly people; the median age at presentation is 77 years. It is more common amongst women, occurring at a female : male ratio of 4 : 1, although not in childhood, when it occurs at a male : female ratio of 2.5 : 1. CONCLUSIONS: Improved imaging techniques within the last 20 years have enabled the preoperative diagnosis of one quarter of patients with gallbladder torsion. With prompt surgical intervention, the condition has an excellent prognosis.