Surgical Management of Autosomal Dominant Polycystic Kidney Disease: Principles and Current Practice.

Autosomal dominant polycystic kidney disease is the third most common cause of renal failure with no definitive treatment available that can directly target the development and growth of the cysts. Endeavours are being made to retard the growth of the cysts and preservation of renal function through medical treatment. However, 50% of the autosomal dominant polycystic kidney disease-affected persons develop complications and end-stage renal disease by the age of fifty-five and need surgical intervention for the management of complications, creation of dialysis access and renal transplantation. This review highlights the principles and current practice pertinent to the surgical management of autosomal dominant polycystic kidney disease. Keywords: polycystic kidney disease; nephrectomy; transplantation.

Endoscopic treatment of lumbar ligamentum flavum cyst by interlaminar approach: a minimally invasive and effective alternative to open surgery.

BACKGROUND AND OBJECTIVES: Lumbar ligamentum flavum cyst is a rare spinal condition that can cause significant morbidity and neurological deficits. Traditional surgical treatment involves open surgery, which can be associated with prolonged recovery time and significant morbidity. In recent years, endoscopic treatment of lumbar ligamentum flavum cyst has emerged as a minimally invasive and effective alternative to open surgery, but only a few cases have been reported in the literature. This paper describes our experience with endoscopic resection of an L4/5 ligamentum flavum cyst through an interlaminar approach and reviews the literature on the treatment of lumbar ligamentum flavum cyst. METHODS: An 87-year-old man presented with lameness in the left leg, and magnetic resonance imaging (MRI) showed nerve compression by a ligamentum flavum cyst at the L4/5 intervertebral plane. The patient underwent endoscopic resection of the ligamentum flavum cyst through a left interlaminar approach with the facet joint preserved. The present study was approved by the Ethics Committee of our hospital. The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Text regarding patient consent is not applicable for this case. RESULTS: Postoperative clinical results improved significantly, and postoperative MRI showed complete cyst resection. CONCLUSION: Total endoscopic resection via an interlaminar approach provides a new minimally invasive approach for the surgical treatment of lumbar ligamentum flavum cyst, which can be used as a reference by clinicians.

[Application of 3D printing modified tooth-supported cyst plug in decompression of mandibular cystic lesions].

PURPOSE: To evaluate the application value of 3D printing modified dental support cyst plug in fenestration of large jaw cystic lesions. METHODS: Forty patients with mandibular cystic disease in Xuzhou Central Hospital from October 2019 to April 2021 were selected. They were randomly divided into experimental group(3D printing group) and control group (traditional plug group), with 20 cases in each group. All enrolled patients underwent preoperative digital modeling of cystic lesions of the jaw, obtained the cystic cavity volume data of preoperative lesions, designed the windowing site according to the plan and performed decompression for jaw cysts. Three days after surgery, the patient's postoperative CBCT and Oral-scan data in the experimental group was obtained, and a digitally modified tooth-supported cyst plug with porous column channel was designed, and titanium alloy material for 3D printing was selected. In the control group, the plug was manually molded by experienced physicians. The visual analogue scale(VAS) score of pain, retention, mechanical properties of the plug and its effect on the adjacent teeth were compared between the two groups during the process of model preparation, and the changes of the cyst volume 1, 3 and 6 months after operation were compared between the two groups. SPSS 25.0 software package was used for data analysis. RESULTS: Compared with the control group, the patients in the experimental group who made titanium alloy as printing material by digital impression complained more comfortable, and the mechanical strength and stability of the cyst plug were better than those in the control group(P＜0.05). There was no significant difference in retention between the two groups(P＞0.05). The reduction rate of cyst volume in the experimental group was significantly higher than that in the traditional plug group 3 and 6 months after operation(P＜0.05). CONCLUSIONS: The modified tooth-supported titanium alloy cyst plug with digital 3D printing has good mechanical properties and stability. It has little damage to the abutment and no lateral force, and has the advantages of precision, individualization and comfort. The improved irrigation and injection channel can fully flush the cavity and speed up the narrowing of the cyst and reduce the waiting time before the second operation, which is worth promoting in clinical practice.

[Reverse partial pulmonary resection: a new surgical approach for pediatric pulmonary cysts].

OBJECTIVE: To evaluate the safety and efficacy of reverse partial lung resection for treatment of pediatric pulmonary cysts combined with lung abscesses or thoracic abscess. METHODS: We retrospectively analyzed the clinical data of children undergoing reverse partial lung resection for complex pulmonary cysts in our hospital between June, 2020 and June, 2021.During the surgery, the patients lay in a lateral position, and a 3-5 cm intercostal incision was made at the center of the lesion, through which the pleura was incised and the fluid or necrotic tissues were removed.The anesthesiologist was instructed to aspirate the sputum in the trachea to prevent entry of the necrotic tissues in the trachea.The cystic lung tissue was separated till reaching normal lung tissue on the hilar side.The proximal end of the striated tissue in the lesion was first double ligated with No.4 silk thread, the distal end was disconnected, and the proximal end was reinforced with continuous sutures with 4-0 Prolene thread.The compromised lung tissues were separated, and the thoracic cavity was thoroughly flushed followed by pulmonary inflation, air leakage management and incision suture. RESULTS: Sixteen children aged from 3 day to 2 years underwent the surgery, including 3 with simple pulmonary cysts, 11 with pulmonary cysts combined with pulmonary or thoracic abscess, 1 with pulmonary cysts combined with tension pneumothorax and left upper lung bronchial defect, and 1 with pulmonary herpes combined with brain tissue heterotaxy.All the operations were completed smoothly, with a mean operation time of 129 min, an mean hospital stay of 11 days, and a mean drainage removal time of 7 days.All the children recovered well after the operation, and 11 of them had mild air leakage.None of the children had serious complications or residual lesions or experienced recurrence of infection after the operation. CONCLUSION: Reverse partial lung resection is safe and less invasive for treatment of complex pediatric pulmonary cysts complicated by infections.

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst.

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled "microscopic epididymal exploration and cystectomy". The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (>0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.

Unilateral Buccal Bifurcation Cyst: A Rare Cystic Lesion in Children and Adolescents.

A buccal bifurcation cyst (BBC) is a rarely occurring, distinct lesion that is limited exclusively to the buccal bifurcation area of mandibular first and second molars in children and adolescents. A definitive diagnosis is formulated based on specific clinical and radiographic features. Management of such cysts depends on the presence of symptoms and the size of the lesion. This case report details the common features of a BBC in a 13-year-old patient and outlines the surgical approach to managing the cystic entity. The importance of a comprehensive clinical examination and appropriate supplemental investigations is emphasized to facilitate accurate diagnosis.

Non-traumatic False Cyst of the Spleen: A Case Report and Review of the Literature.

False cysts have no cellular lining and usually originate from past abdominal trauma. We herein report a 23-year-old woman with an asymptomatic splenic false cyst. She had no history of abdominal trauma. Abdominal computed tomography showed a cystic lesion without internal structure. In contrast, magnetic resonance imaging and ultrasonography revealed an inhomogeneous internal structure without fluid/debris level. Although the images were not typical of a splenic false cyst, the surgically excised mass histologically showed a splenic false cyst (no epithelial element). Non-traumatic splenic false cysts are rare and show nonspecific clinical findings and symptoms. The recommended treatment is splenectomy.

Endoscopic treatment of periampullary duodenal duplication cyts in an 18-month-old girl.

BACKGROUND: Duodenal duplication cysts (DDC) are rare congenital anomalies of the gastrointestinal tract and periampullary localization with anatomical variants including biliary and pancreatic duct anomalies remains a surgical challenge. Endoscopic treatment of the periampullary DDC (PDDC) communicating with the pancreaticobiliary duct in an 18-month-old girl is presented to discuss the endoscopic treatment options in children. CASE: An 18-month-old girl with a normal prenatal ultrasound (US) was asymptomatic until complaining of abdominal pain and vomiting at 10-months of age. Abdominal US revealed a 1.8 × 2 cm cystic mass adjacent to the second part of the duodenum. The amylase and lipase levels were slightly increased while she was symptomatic. Magnetic resonance cholangiopancreaticography (MRCP) showed a thick cyst wall measuring 1.5 × 2 cm at the second part of the duodenum, consistent with DDC that was suspected to be communicating with the common bile duct. Upper gastrointestinal endoscopy confirmed a bulging cyst in the duodenum lumen. The puncture and injection of the cyst with contrast material confirmed the communication of the duplication cyst with the common bile duct. The unroofing of the cyst was performed with endoscopic cautery. The biopsy obtained from the cystic mucosa revealed normal intestinal histology. Oral feeding was initiated six hours after the endoscopy. The patient has been followed for the last 8 months uneventfully. CONCLUSIONS: Endoscopic treatment of PDDC with various anatomical variants can be considered an alternative to surgical excision in children.

Giant pars plana cysts and a diagnostic approach to peripheral retinal elevation with the assistance of multimodal imaging.

A man in his 50s was referred for a suspected superotemporal retinal tear in the right eye. Fundus examination showed multiple areas of elevated retina temporally in both eyes which were immobile and did not reappose with scleral depression. No retinal breaks were present. Ultra-widefield colour fundus photography with Optos captured these areas of elevated retina in both eyes temporally, which on fundus autofluorescence where hypoautofluorescent with no leading hyperautofluorescent edge. On ultrasound biomicroscopy, an immobile lesion with a single hyperechoic convexity towards the vitreous body was noted. The patient was diagnosed with bilateral giant pars plana cysts which were managed conservatively.The multimodal imaging in our case is its distinguishing feature which can be used to help ensure accurate diagnosis when one is presented with an area of peripheral retina elevation.

A Review and Summary of Patients with Symptomatic Postoperative Discal Pseudocysts of the Lumbar Spine.

OBJECTIVE: Postoperative discal pseudocyst (PDP) is a rare complication after discectomy. This study aimed to summarize the characteristics, pathological mechanisms and management of PDPs. METHODS: Nine patients with PDP who received surgical treatment at our institution from January 2014 to December 2021 were retrospectively reviewed. A systematic review of the literature on PDP was performed. The demographic data, clinical and imaging features, surgical options and patient prognosis were analyzed. RESULTS: Among the nine patients treated at our center, seven were male and two were female. The mean patient age (± standard deviation) at the time of surgery was 28.3 ± 5.7 years (range 18-37 years). The first operation performed on seven patients was percutaneous endoscopic transforaminal discectomy (PETD) and two patients underwent microdiscectomy. The time to conservative treatment before surgical intervention was 20 ± 9.2 days. In three cases, the disc cysts were located in L4/5 and in six cases the lesions were located in L5/S1. Intervertebral disc cyst interventions included foraminal scope (three cases), open discectomy (three cases), conservative treatment with a quadrant channel (one case) and CT-guided puncture (one case). All patients fully recovered after surgery and the mean follow-up time was 3.5 ± 2.1 years. A literature review identified 14 relevant articles that reported 43 PDP cases of PDP. CONCLUSION: PDP occurs in Asian males with mild intervertebral disc degeneration and occurs 1 month after discectomy. Treatment should be based on specific patient scenarios. Conservative treatment is necessary and surgery should be performed with caution.

Management of ventriculoperitoneal shunt complications in children: A review of 34 cases.

Objectives: The primary objective of this study was to analyse the demographics of the children who presented with ventriculoperitoneal shunt (VPS) complications. The secondary objectives were to review the clinical characteristics, surgical procedures performed for the management of VPS complications and the final outcome. Materials and Methods: This is a single-institution observational study that included children below 12 years of age who required VPS revisions during the study period. Results: During the study period of 10 years, n = 336 VPS catheters were implanted for the treatment of hydrocephalus in children. Forty (11.90%) children developed various VPS complications and required VPS revisions in the follow-up period. A total of n = 30 (8.92%) children (n = 21 boys and n = 9 girls) were selected/recruited for the present study, and they required n = 34 revision procedures. The mean interval from VPS insertion to the diagnosis of the complication was 7.29 months. VPS complications that required revisions occurred in the following order of frequency: (1) VPS catheter, cerebrospinal fluid (CSF) or shunt tract infection n = 8 (2.38%); (2) malfunction of distal VPS catheter n = 7 (2.08%); (3) coiling of distal VPS catheter at abdominal area n = 6 (1.78%); (4) extrusion of VPS catheter n = 5 (1.48%); (5) CSF leak from abdominal wound site/umbilicus n = 4 (1.19%); (6) malfunction of ventricular catheter n = 3 (0.89%) and (7) CSF pseudocyst peritoneal cavity n = 1 (0.29%). Surgical procedures were performed for the treatment of abovementioned complications in the following order of frequency: (1) revision of distal VPS catheter n = 14 (4.16%), (2) removal of entire VPS catheter ± external ventricular drainage (EVD) n = 7 (2.08%), (3) distal VPS catheter converted as EVD n = 6 (1.78%), (4) revision of proximal VPS catheter n = 3 (0.89%), (5) revision of entire VPS catheter n = 3 (0.89%) and (6) CSF pseudocyst excision n = 1 (0.29%). This study also documented n = 2 (6.6%) deaths during the post-operative period. Conclusion: VPS insertion done for the treatment of hydrocephalus in infants and children was associated with various complications. Seventy per cent of the complications occurred within the first 6 months after the VPS insertion. Two-thirds of the complications were related to the distal VPS catheter.

[Incidentally Detected Right Atrial Blood Cyst].

A 48-year-old man underwent computed tomography for the examination of lower back pain, which incidentally detected a cardiac tumor in the right atrium. On echocardiography, the tumor was identified as a 30 mm round mass with a thin wall and iso- and hyper-echogenic contents that originated from the atrial septum. The tumor was successfully removed under cardiopulmonary bypass, and the patient was discharged in good health. The cyst was filled with old blood, and focal calcification was observed. Pathological examination revealed that the cystic wall was composed of thin-layered fibrous tissue lined with endothelial cells. Regarding a treatment, it is reported that early surgical removal is preferable to avoid embolic complications, however it is controversial. Furthermore, it needs to discuss about the difference between fetal/neonatal and adult cases.

Evaluation of the factors influencing the choice of laparoscopic echinococcectomy in liver echinococcosis (LE) and its impact on postoperative outcomes.

The aim of this article is to evaluate the factors influencing the choice of laparoscopic echinococcectomy (LapEE) in liver echinococcosis (LE) and its impact on postoperative outcomes. The article presents a retrospective analysis of the effectiveness of LapEE depending on gender, age, cyst location, size and stage of echinococcal cysts (EC) development, also taking into account the performance of drainage or abdominal interventions in relation to the residual cavity (RC). The study included patients with the primary form of LE - 46 patients who underwent LapEE at the State Institution "Republican Specialized Scientific and Practical Medical Center for Surgery, named after the academician V. Vakhidov", between 2019 and 2020. Taking into account the stage of cyst development, various difficulties with aspiration or removal of the cyst contents occurred in only 14 (30.4%) cases, more often with type II-IV cystic echinococcosis (CE). Another problem was the difficulty with adequate revision and treatment of RC (in 6 (13.0%) patients) with predominantly intraparenchymal localization. Difficulties with performing percytectomy with sufficient excision of the fibrous capsule were noted in 9 (19.6%) cases. In the period up to a week after the operation, the drainage was removed for cysts up to 8 cm in 11 (36.7%) cases, with more than 8 cm - in 5 (31.3%). By 3 weeks of observation, the drains were removed in all cases with cysts up to 8 cm, while with large sizes in 12.5% (2 patients) cases, the drainage was removed on days 21-28 and in 1 (6.3%) patient at a later period. In general, in the group, complications from the RC on days 9-27 after LapEE were noted in 10 (21.7%) of 46 patients, fluid accumulation in 8 (17.4%) and suppuration in 2 (4.3%). Most complications were resolved conservatively - 13.0% (in 6 patients), a minimal invasive drainage of the RC was performed in 6.5% (3 patients), 1 (2.2%) patient was operated on with a RC abscess. Among the main factors that technically complicate LapEE, in addition to localization, difficulties with aspiration or removal of cyst contents in CE II, III, and IV are highlighted due to the presence of many daughter cysts that completely fill the maternal membrane (CE II, III) or thick viscous discharge (CE IV), as well as difficulties in performing a pericystectomy for adequate elimination of the RC when the hydatid is located 3/4 or more in the liver parenchyma.

Preputial cyst in the newborn: A case report from Africa.

Cysts of the prepuce are rare, and documented reports from the English literature are mostly from Asia. Presentations in children are worrisome to the parents. We report a case of a preputial cyst occurring in a neonate who was brought to our facility due to parental anxiety. After a thorough clinical evaluation, a freehand circumcision technique was performed which allowed exposure of the full extent of the cyst, the external urethral meatus and the glans, thus ensuring complete excision and minimising the risk of injury to the adjoining structures. We postulate that preputial cysts are rare in Africa due to the universality of circumcision, which is one of the options of treatment. Preputial cysts are benign foreskin cystic lesions that can be effectively treated with circumcision. This is probably the first reported case of a benign epithelioid preputial cyst from Africa. The paucity of reported cases may be due to the universal practice of circumcision in most of Africa.

An extradural cyst in a French Bulldog.

CASE HISTORY: A 7-year-old, male neutered French Bulldog was referred to a specialist veterinary hospital for evaluation of progressive paraparesis of 6-months' duration. The owners reported both faecal and urinary incontinence at home. CLINICAL FINDINGS: The dog presented with ambulatory paraparesis and pelvic limb ataxia that was more pronounced in the right pelvic limb. The pelvic limb withdrawal response and sciatic myotatic response were reduced bilaterally. Postural reaction responses were delayed in both pelvic limbs, and this was more obvious in the right pelvic limb. The anal tone and perineal sensation were normal at the time of examination.An L4-S3 myelopathy was suspected. CT of the spine revealed a compressive, bilobed, extramedullary, cyst-like structure within the vertebral canal, between L7 and S3. Surgical removal of the cyst via a L7-S1 dorsal laminectomy was performed. Histopathological examination and additional immunohistochemistry of the excised structure indicated a probable ependymal cyst with a ciliated lining. The dog recovered well post-operatively, and at follow-up 3 weeks later had some improvement of his neurological signs. The paraparesis and pelvic limb ataxia had improved; however, the remaining neurological examination was similar to the pre-surgical examination. DIAGNOSIS: Extradural cyst. CLINICAL RELEVANCE: Spinal cysts can contribute to clinical signs that resemble other common chronic spinal cord diseases, such as intervertebral disc disease. Therefore, this disease should be considered as a differential when dealing with cases of progressive paraparesis and pelvic limb ataxia. This case report may potentially provide opportunities in the future for further understanding of the pathogenesis, behaviour, outcomes and subclassification of spinal cysts in dogs.

Laparoscopic resection of presacral benign tumors with rectum preservation.

Multiple surgical approaches are available for the treatment of presacral tumors. In patients with presacral tumors, surgical resection is currently the only curative treatment option. However, the anatomical structures of the pelvis are not readily accessible using traditional approaches. Herein, we present a surgical technique for laparoscopic presacral benign tumor resection with rectal preservation. Surgical videos of two patients were used to introduce the laparoscopic procedure. First, the tumor of a 30-year-old woman with presacral cysts was observed during physical examination. As the tumor continued to enlarge, it increased rectal compression and altered bowel habits. The patient's surgical video was used to present complete laparoscopic presacral resection. Several video clips of a second 30-year-old woman with cysts were used to present the details and precautions of the resection. Neither of the patients required conversion to an open surgical approach. Complete surgical excision of the tumors was achieved, without rectal injury. Both patients had no postoperative complications and were discharged on postoperative 5-6 days. The laparoscopic approach for presacral benign tumors is superior in terms of manipulability compared with the conventional approach. Therefore, we recommend that the laparoscopy approach should be considered as the standard surgical approach for presacral benign tumors.