In this editorial,a commentary on the article by Chang et al has been provided,the course of treatment of anorectal fistulas,especially complex and recurring ones,require accurate diagnostic procedures for determining...In this editorial,a commentary on the article by Chang et al has been provided,the course of treatment of anorectal fistulas,especially complex and recurring ones,require accurate diagnostic procedures for determining ideal surgical procedures.Conventional ways of imaging sometimes fall short,offering insufficient insights in aggravated instances.In this editorial,a novel application of hydrogen peroxide-enhanced magnetic resonance imaging(HP-MRI)that promises significant improvements in the imaging of anorectal fistula.Study is based on a retrospective investigation of 60 patients,contrasts the new HP-MRI with conventional diagnostic techniques such as physical examination,trans-perineal ultrasonography and poor spatial resolution MRI.The findings demonstrate HP-MRI's incredible diagnostic performance,with sensitivity and specificity rates of 96.08%and 90.91%,respectively,and unparalleled interobserver agreement(Kappa values ranging from 0.80 to 0.89).It has been a significant advancement for assessment of anorectal fistulas providing a better roadmap for surgical planning,lowering recurrence rates as well as reduced personal and financial burden on patients by reducing the need for repeated treatment and extended hospital stays.The remaining funds can be utilized for treatment of other medical need.Ultimately HP-MRI provides us a healthier&more efficient society by improvising patients well-being&optimized healthcare infrastructure.展开更多
BACKGROUND Surgically created arterio-venous fistulas(AVFs)are the gold standard for haemodialysis access for patients with end-stage renal disease.Standard practice of AVF creation involves selecting the non-dominant...BACKGROUND Surgically created arterio-venous fistulas(AVFs)are the gold standard for haemodialysis access for patients with end-stage renal disease.Standard practice of AVF creation involves selecting the non-dominant upper limb and starting with most distally with radio-cephalic arterio-venous fistula.The primary patency rate of radio-cephalic arterio-venous fistula varies from 20%-25%.It has been suggested the neointimal hyperplasia at the mobilized venous segment causes stenosis of the anastomosis.Therefore,the radial artery deviation and reimplantation(RADAR)technique,in which the vein is minimally mobilized,should result in a higher success rate.AIM To compare the RADAR technique with classical technique in creation of AVF including:(1)Success rate;(2)Time to maturation;(3)Duration of surgery;and(4)Complication rate.METHODS In our study we recruited 94 patients in two randomized groups and performed the AVF by the classical method or the RADAR method.RESULTS The RADAR group had higher primary success rate(P=0.007),less rate of complications(P=0.04),shorter duration of surgery(P=0.00)and early time to maturation(0.001)when compared with the classical group.The RADAR procedure is a safe and a more efficient alternative to the current classical method of AVF creation.Longer duration of follow-up is required to assess the long-term outcomes in the future.CONCLUSION The RADAR procedure is a safe and more efficient alternative to the current classical method of AVF creation.Longer duration of follow-up is required to assess the long-term outcomes in the future.展开更多
BACKGROUND Mirizzi syndrome is a rare complication of chronic gallstone disease in which an impacted stone causes compression or erosion of the common hepatic duct.Accurate preoperative diagnosis is crucial but often ...BACKGROUND Mirizzi syndrome is a rare complication of chronic gallstone disease in which an impacted stone causes compression or erosion of the common hepatic duct.Accurate preoperative diagnosis is crucial but often challenging.We report a case that was preoperatively diagnosed as type 1 Mirizzi syndrome but was found intraoperatively to be type 4,involving a cholecysto-biliary fistula and complete erosion of the common hepatic duct.CASE SUMMARY A 74-year-old woman presented with right upper quadrant discomfort.Initial workup including ultrasound and magnetic resonance cholangiopancreatography suggested Mirizzi syndrome type 1 due to extrinsic compression of the common hepatic duct.Endoscopic retrograde cholangiopancreatography confirmed a large stone without evidence of fistula.The patient underwent robotic-assisted cholecystectomy,during which a 4 cm stone was found eroding into the common hepatic duct,consistent with type 4 Mirizzi syndrome.Intraoperative cholangioscopy confirmed the fistula and allowed primary repair.The patient recovered uneventfully and was discharged on postoperative day one.CONCLUSION Preoperative imaging may fail to identify fistula formation in Mirizzi syndrome.Intraoperative assessment remains critical for accurate diagnosis and safe surgical management.展开更多
Objectives:To assess outcomes of rectourethral fistula repair utilizing a gracilis flap in a largely radiated cohort.Patients and Methods:We performed a retrospective review of all gracilis interposition flap reconstr...Objectives:To assess outcomes of rectourethral fistula repair utilizing a gracilis flap in a largely radiated cohort.Patients and Methods:We performed a retrospective review of all gracilis interposition flap reconstruction surgeries performed for RUF at a university hospital in South Carolina between January 2010 and June 2023.All repairs utilized a multidisciplinary approach with urology,colorectal,and plastic surgery teams.Postoperatively,patients were maximally drained with foley catheter and suprapubic tube(SPT).Initial voiding cystourethrogram(VCUG)was performed at 4 weeks post-repair.If there was a persistent leak,catheter drainage was maintained for 4 additional weeks and VCUG was repeated.Success was defined as absence of leak on VCUG within 3 months after surgery.Results:22 patients met inclusion criteria.68%of patients had history of external beam radiation therapy(EBRT),13.6%had brachytherapy,and 40.9%had cryotherapy.Initial post-operative VCUG was negative in 10 patients(45.5%).Of the 12 patients with a persistent fistula,5(42%)had no evidence of fistula on subsequent VCUG after 4 weeks.Overall,68%of patients were successfully treated with gracilis interposition flap.There was a significant difference of repair success based on EBRT status(p<0.05).Conclusions:We report a success rate of 68%for gracilis flap repair of RUF.Our cohort had a higher rate of prior radiation therapy compared to other studies.A clinically significant portion of patients with an initial positive VCUG will seal their fistula with prolonged catheter drainage.Gracilis interposition flap is a reasonable surgical treatment for RUF.展开更多
BACKGROUND Enterocutaneous(EC)fistula incidence has been increasing in China,along with increases in the volume and complexity of surgeries.The conservative treatment strategy has been analyzed to improve the treatmen...BACKGROUND Enterocutaneous(EC)fistula incidence has been increasing in China,along with increases in the volume and complexity of surgeries.The conservative treatment strategy has been analyzed to improve the treatment outcomes for patients with EC fistulas and reduce the need for reoperation.AIM To analyze the clinical data of patients undergoing conservative treatment for EC fistulas and identify the factors that promote self-healing.These findings provide a reference for improving the clinical cure rate of EC fistulas with conservative treatment.METHODS The clinical data of 91 patients with EC fistulas who underwent conservative treatment were collected.The relationships between the cure rate and characteristics such as age,sex,body mass index,albumin level,primary disease,cause of the fistula,location of the fistula,number of fistulas,nature of the fistula,infection status,diagnostic methods,nutritional support methods,somatostatin therapy,growth hormone therapy,and fibrin glue therapy were analyzed.RESULTS A comparison of the basic patient characteristics between the two groups revealed statistically significant differences in primary disease(P=0.044),location of the fistula(P=0.006),number of fistulas(P=0.007),and use of adhesive sealing(χ2=12.194,P<0.001)between the uncured and cured groups.The use of fibrin glue was a significant factor associated with a cure for fistulas(odds ratio=5.459,95%CI:1.958-15.219,P=0.01).CONCLUSION The cure rate of patients with a single EC fistula can be effectively improved via conservative treatment combined with the use of biological fibrin glue to seal the fistula.展开更多
Traumatic carotid-cavernous arteriovenous fistula(TCCAVF)is a rare but severe cerebrovascular disorder,often resulting from head trauma with temporal bone fractures.The pathogenesis involves vessel wall injury due to ...Traumatic carotid-cavernous arteriovenous fistula(TCCAVF)is a rare but severe cerebrovascular disorder,often resulting from head trauma with temporal bone fractures.The pathogenesis involves vessel wall injury due to traction,frequently associated with fractures near the middle meningeal artery.This case highlights the typical clinical presentation,diagnostic approaches,and therapeutic management of TCCAVF,emphasizing the challenges in treating this condition.Transcatheter embolization proved effective in occluding the fistula,underscoring its role as a key intervention for traumatic meningeal arteriovenous fistulas.展开更多
BACKGROUND Anal fistula is increasingly prevalent due to modern lifestyle factors,and surgery remains the primary treatment.However,the rising incidence of antibiotic resistance,particularly to cefuroxime,complicates ...BACKGROUND Anal fistula is increasingly prevalent due to modern lifestyle factors,and surgery remains the primary treatment.However,the rising incidence of antibiotic resistance,particularly to cefuroxime,complicates perioperative management.The role of gut microbiota in influencing this resistance is not well understood.AIM To investigate the relationship between gut microbiota composition and cefuroxime resistance in anal fistula patients and to assess probiotic intervention impact.METHODS This study included 30 anal fistula patients categorized into cefuroxime-sensitive(Cefur-S)and cefuroxime-resistant(Cefur-NS)groups.Gut microbiota samples were collected during colonoscopy,and 16S ribosomal DNA sequencing was performed to analyze microbial diversity.Patients in the Cefur-NS group received a 7-day course of Clostridium butyricum tablets.Post-intervention,microbial composition and cefuroxime resistance were reassessed.RESULTS Alpha and beta diversity analyses showed no significant differences in microbial diversity between the Cefur-S and Cefur-NS groups.However,effect size analysis identified Roseburia and Butyricicoccus as dominant genera in the Cefur-S group,with higher butyrate production potentially protecting against cefuroxime resistance.Post-intervention,the Cefur-NS group showed a significant reduction in cefuroxime resistance,improved stool consistency,and reduced bowel movement frequency.CONCLUSION This study suggests that specific gut microbiota,particularly Butyricicoccus and Roseburia,may mitigate cefuroxime resistance in anal fistula patients by increasing butyrate production.Probiotic intervention targeting gut microbiota composition presents a promising strategy for reducing antibiotic resistance and improving clinical outcomes.展开更多
Introduction: Obstetric Fistulas (OF) constitute a major public health problem in developing countries in general and in Central African Republic (CAR) in particular because of its numerous consequences. The objective...Introduction: Obstetric Fistulas (OF) constitute a major public health problem in developing countries in general and in Central African Republic (CAR) in particular because of its numerous consequences. The objective of this work is to contribute to the management of OF cases in CAR. Patients and Methods: This was a retrospective, descriptive and analytical study, including data from several OF care services. The study included 245 cases of OF, operated on from 2009 to 2018. The parameters studied were maternal and obstetrical data, sociodemographic data, the specific characteristics of the fistulas as well as the modalities and outcome of surgical treatment. The data collected came from six (6) OF surgical repair campaigns organized by the Ministry of Health and Population with the support of UNFPA. Results: We recorded 245 patients, representing a prevalence of 0.77% of OF per year. Among these patients, almost half (45.3%) were treated at the Sino-Central African Friendship University Hospital Center (CHUASC). The average age of the patients was 30 years (range 14 to 78 years). They were unschooled (53.9%) and primigravidas (35%). The fistulas had an average duration of evolution of 7.58 years. They were vesicovaginal in 25.3%. Types V and I dominated in 17.4% and 9.2%, respectively. In 85.9% of cases, fistulorrhaphy was performed, half of which (50.2%) via the upper route. The cure rate was 83.3%. Note that our study reveals statistically significant links between the evolution after surgery with age (p = 0.04 Conclusion: OF mainly affected women of childbearing age, uneducated, primiparous. Vesicovaginal fistula was the frequently encountered type and was manifested by urine loss clinically with a positive methylene blue test.展开更多
Background:The prediction of postoperative pancreatic fistula(POPF)is important.This study aimed to investigate the role of postoperative serum lipase level in predicting POPF.Methods:Data from 234 consecutive patient...Background:The prediction of postoperative pancreatic fistula(POPF)is important.This study aimed to investigate the role of postoperative serum lipase level in predicting POPF.Methods:Data from 234 consecutive patients who underwent pancreaticoduodenectomy(PD)were collected.The predictive values of serum amylase and serum lipase during postoperative days(PODs)1 to 3 for POPF were compared.Subgroup analyses were performed to determine the prognostic value of different levels and durations of elevated serum lipase.Results:Fifty-six patients developed POPF.The POPF group exhibited increased levels of serum amylase and lipase from PODs 1 to 3(all P<0.001).Compared with serum amylase,serum lipase has greater predictive value for POPF.Specifically,serum lipase had the highest area under the receiver operating characteristic curve(AUC)at POD 1(0.791).Body mass index>24 kg/m2[odds ratio(OR)=2.431,95%confidence interval(CI):1.094–5.404,P=0.029],soft pancreatic texture(OR=3.189,95%CI:1.263–8.056,P=0.014),serum lipase>60 U/L at POD 1(OR=5.135,95%CI:1.257–20.982,P=0.023),and C-reactive protein>167 mg/dL at POD 3(OR=3.607,95%CI:1.431–9.090,P=0.007)were identified as independent risk factors for POPF.Patients with serum lipase≤60 U/L at POD 1(n=104)exhibited lower rates of POPF(3.8%vs.40.0%,P<0.001)and severe complications(Clavien-Dindo≥IIIa)(4.8%vs.25.4%,P<0.001)than those with serum lipase>60 U/L at POD 1.Moreover,no additional elevation or duration of serum lipase offered any further prognostic value.Conclusions:Postoperative serum lipase outperformed serum amylase in the prediction of POPF,and patients with normal serum lipase level at POD 1 had favorable outcomes.A sustained increase in the serum lipase level offers no additional prognostic value.展开更多
BACKGROUND Hem-o-lock clip,a versatile and reliable non-absorbable tissue clip,has gained widespread acceptance in laparoscopic surgeries for vessel ligation and tissue approximation.Its efficacy and safety have been ...BACKGROUND Hem-o-lock clip,a versatile and reliable non-absorbable tissue clip,has gained widespread acceptance in laparoscopic surgeries for vessel ligation and tissue approximation.Its efficacy and safety have been well-documented.CASE SUMMARY This case report describes the occurrence of a bronchopleural fistula following the application of the Hem-o-lock clip for the treatment of a lobar bronchial stump after lobectomy.CONCLUSION This case underscores the importance of exercising caution when using the Hem-o-lock clip for the management of non-vascular tissues during thoracic surgery.展开更多
BACKGROUND Pancreatic fibrosis,which decreases risk of postoperative pancreatic fistula(POPF),can be estimated using extracellular volume fraction(ECVf).AIM To investigate the correlation between ECVf and pancreatic h...BACKGROUND Pancreatic fibrosis,which decreases risk of postoperative pancreatic fistula(POPF),can be estimated using extracellular volume fraction(ECVf).AIM To investigate the correlation between ECVf and pancreatic histology,as well as the usefulness of ECVf in predicting POPF.METHODS In 71 patients who underwent pancreatic resection,we caluculated pancreatic ECVf by comparing absolute enhancements of the pancreas and aorta between pre-contrast and equilibrium phases.Areas of fibrosis,fat,acini,and islets were calculated based on resection specimens.RESULTS ECVf correlated with fibrosis(r=0.724;P<0.001)and negatively correlated with acini(r=-0.510;P<0.001).Among 48 patients who underwent pancreatoduoden ectomy,21 developed POPF.Main pancreatic duct diameter≤2 mm and ECVf<36%were selected as risk factors by multivariate analysis[respective odds ratios(OR)and P values,4.26 and P=0.048;OR=11.07 and P=0.036].Using these factors as a risk score(0-2 points),POPF occurred in 0%,50%,and 70%of patients with 0,1,and 2 points,respectively.CONCLUSION ECVf is useful in predicting acinar loss and pancreatic fibrosis,and ECVf<36%may be a risk factor for POPF.展开更多
BACKGROUND Arteriovenous fistula is a rare cause of refractory heart failure,and corrective measures may lead to dramatic improvement;however,the long-term cardiac remodeling outcomes,particularly after delayed closur...BACKGROUND Arteriovenous fistula is a rare cause of refractory heart failure,and corrective measures may lead to dramatic improvement;however,the long-term cardiac remodeling outcomes,particularly after delayed closure,remain unclear.CASE SUMMARY A 57-year-old man was admitted to the hospital with complaints of exertional dyspnea for more than 10 years.Physical examination revealed wet crackles in the lungs and a continuous machinery murmur in the left lower back and groin area.Asymmetric edema and varicose veins were observed in the lower limbs.Echocar-diography revealed a dilated right ventricle with severe pulmonary hypertension.Computed tomography revealed a left common iliac arteriovenous fistula linked to prior lumbar disc surgery.Surgical repair resolved the symptoms,with echo-cardiography at 4 months showing a reduced right atrium(RA)and ventricular(RV)diameter and tricuspid regurgitation.However,during the 2-year follow-up,gradual RA and RV re-expansion(from 35 mm to 51 mm and from 26 mm to 46 mm,respectively)was observed,despite sustained clinical stability.CONCLUSION This case highlights that delayed arteriovenous fistula closure may result in in-complete right heart reverse remodeling,even after symptomatic relief.Potential mechanisms include persistent hemodynamic stress from subclinical residual shunting or functional impairment due to chronic volume overload.Early inter-vention before irreversible right heart damage is critical for optimal outcomes.展开更多
BACKGROUND Both the etiology and treatment of perianal fistulas present challenges,and there is no standard surgical approach.AIM To present the results of a modified fistulotomy technique that was implemented in a te...BACKGROUND Both the etiology and treatment of perianal fistulas present challenges,and there is no standard surgical approach.AIM To present the results of a modified fistulotomy technique that was implemented in a tertiary coloproctology reference center.METHODS Seventy-two patients who underwent surgical intervention for perianal fistula between August 2019 and January 2023 were treated using a modified fistulotomy technique.In this approach,the fistula tract was excised from the external opening up to the external sphincter fibers.The internal orifice was widened,and the septic focus within the inter sphincteric space was curetted.Partial internal sphincterotomy was performed up to the inter sphincteric plane.The anoderm from the internal orifice to the inter sphincteric space was closed with absorbable suture material,and a loose seton was placed at the level of the external sphincter.RESULTS The 72 patients who underwent modified fistulotomy were 77.8%male and 22.2%female,with a mean age of 42.2±11.5 years.The median follow-up period was 19 months.Preoperatively,93.1%of patients had high trans sphincteric fistulas,and 6.9%were females with anterior low trans sphincteric fistulas.In all cases,setons were placed during surgery using vascular tape.A total of 12.5%of patients experienced incontinence,involving gas(6.9%)or soiling(5.6%).There were no reports of solid or liquid incontinences.Complete healing was achieved in 83.3%of the patients,with a recurrence rate of 4.2%and a non-healing rate of 12.5%.CONCLUSION Our preliminary analysis suggests that this modified fistulotomy technique that targets distalization of the internal orifice is a promising alternative management strategy for perianal fistulas.展开更多
BACKGROUND Lacrimal sac rhinosporidiosis,with nil or minor nasal extensions,rarely presents as an acquired cutaneous fistula in the periocular area.The correct diagnosis in such cases can be challenging,leading to rep...BACKGROUND Lacrimal sac rhinosporidiosis,with nil or minor nasal extensions,rarely presents as an acquired cutaneous fistula in the periocular area.The correct diagnosis in such cases can be challenging,leading to repeated failure of conservative or surgical interventions.CASE SUMMARY A 39-year-old female presented with a 6-year history of swelling in the periocular area,specifically in the left lacrimal sac area.Symptoms were limited to epiphora and constant mucoid discharge from the fistula,clinically mimicking chronic lacrimal sac fistula.She had a history of treatment with multiple antibiotic courses and dacryocystectomy in the past,with no or transient symptomatic relief.On surgical exploration of the site,a large pedunculated polypoidal vascular mass,suspicious of rhinosporidiosis,was noted.En bloc resection of the mass with cauterization of the base and fistulectomy was performed.Histopathology confirmed the diagnosis of lacrimal sac rhinosporidiosis.The patient was further evaluated and treated for the nasal extension of rhinosporidiosis.The patient has been frequently followed up for the last 3 years with a good clinical outcome and no recurrence.CONCLUSION Lacrimal sac rhinosporidiosis,in isolated or limited nasal extension cases,can rarely mimic a chronic discharging fistula.Patients with this disease often face distress due to misdiagnosis and repeated failure of conservative or surgical interventions.A high index of suspicion is needed for early diagnosis.Proper surgical intervention at the right time can lead to an excellent prognosis in such patients.展开更多
BACKGROUND The rising incidence of laryngeal cancer has led to an increasing number of total laryngectomy procedures.While voice prostheses have significantly improved post-laryngectomy rehabilitation,the risk of sali...BACKGROUND The rising incidence of laryngeal cancer has led to an increasing number of total laryngectomy procedures.While voice prostheses have significantly improved post-laryngectomy rehabilitation,the risk of salivary fistula remains a major complication.This study aims to compare the stapler and hand-sewn techniques for esophageal closure and evaluate their impact on fistula formation.AIM To compare stapler-assisted and hand-sewn esophageal closure techniques after laryngectomy regarding their impact on salivary fistula formation.METHODS A total of 52 patients(44 men,8 women),aged 43 to 77 years,underwent total laryngectomy.Esophageal reconstruction was performed using either a stapler(29 patients)or a hand-sewn technique(23 patients).A surgical stapler TA was used for esophageal closure in the stapler group.Patients were clinically monitored for fistula formation during the first 7 days postoperatively and again two weeks after discharge using fiberoptic examination.RESULTS A total of 22 salivary fistulas were recorded:17(77.3%)occurred following the hand-sewn technique,while 5(22.7%)developed in the stapler group.Addi-tionally,preoperative radiotherapy was identified as a statistically significant risk factor for fistula formation.No technical complications related to the stapler device were observed.CONCLUSION Although hand-sewn closure is commonly used after total laryngectomy,stapler-assisted closure shows lower fistula rates and is a viable esophageal reconstruction alternative.展开更多
OBJECTIVE:To explore the clinical efficacy of the Chinese medicine,Neibu Huangqi Youhua formula(内补黄芪汤优化方)combined with Kangfuxin solution(康复新液)for the nursing of patients after anal fistula surgery.METHODS...OBJECTIVE:To explore the clinical efficacy of the Chinese medicine,Neibu Huangqi Youhua formula(内补黄芪汤优化方)combined with Kangfuxin solution(康复新液)for the nursing of patients after anal fistula surgery.METHODS:A total of 160 cases with anal fistula who underwent surgical treatment were recruited,and divided into control group(treated with external application of Kangfuxin liquid gauze)and experimental group(receiving the Neibu Huangqi Youhua formula combined with Kangfuxin liquid gauze)based on a random numbering table.The wound recovery,postoperative pain and inflammation were evaluated and compared between the two groups.RESULTS:At 3,7,and 14 d after the operation,the wound healing rate of the experimental group was significantly higher than that of the control group at any time point.The visual analogue scale scores of the two groups gradually decreased in a time-dependent manner after surgery,while the experimental group showed a more significant downward trend in comparison with the control group.At 14 d after the operation,the experimental group had high levels of epidermal growth factor,fibroblast growth factor-1,secretory Ig A,tissue inhibitor of matrix metalloproteinase-1,5-hydroxytryptamine,prostaglandin E-2,substances P and neuropeptide Y compared with control group,but low levels of C-reactive protein,procalcitonin,and serum amyloid A protein.CONCLUSIONS:The Neibu Huangqi Youhua formula can reduce the levels of inflammatory factors and pain mediators in patients after anal fistula surgery,thereby accelerating the process of wound healing and alleviating the pain of patients.展开更多
BACKGROUND Pancreatic fistula is the most common complication of pancreatic surgeries that causes more serious conditions,including bleeding due to visceral vessel erosion and peritonitis.AIM To develop a machine lear...BACKGROUND Pancreatic fistula is the most common complication of pancreatic surgeries that causes more serious conditions,including bleeding due to visceral vessel erosion and peritonitis.AIM To develop a machine learning(ML)model for postoperative pancreatic fistula and identify significant risk factors of the complication.METHODS A single-center retrospective clinical study was conducted which included 150 patients,who underwent pancreat-oduodenectomy.Logistic regression,random forest,and CatBoost were employed for modeling the biochemical leak(symptomless fistula)and fistula grade B/C(clinically significant complication).The performance was estimated by receiver operating characteristic(ROC)area under the curve(AUC)after 5-fold cross-validation(20%testing and 80%training data).The risk factors were evaluated with the most accurate algorithm,based on the parameter“Importance”(Im),and Kendall correlation,P<0.05.RESULTS The CatBoost algorithm was the most accurate with an AUC of 74%-86%.The study provided results of ML-based modeling and algorithm selection for pancreatic fistula prediction and risk factor evaluation.From 14 parameters we selected the main pre-and intraoperative prognostic factors of all the fistulas:Tumor vascular invasion(Im=24.8%),age(Im=18.6%),and body mass index(Im=16.4%),AUC=74%.The ML model showed that biochemical leak,blood and drain amylase level(Im=21.6%and 16.4%),and blood leukocytes(Im=11.2%)were crucial predictors for subsequent fistula B/C,AUC=86%.Surgical techniques,morphology,and pancreatic duct diameter less than 3 mm were insignificant(Im<5%and no correlations detected).The results were confirmed by correlation analysis.CONCLUSION This study highlights the key predictors of postoperative pancreatic fistula and establishes a robust ML-based model for individualized risk prediction.These findings contribute to the advancement of personalized periop-erative care and may guide targeted preventive strategies.展开更多
A perilymphatic fistula(PLF)is a rare condition in which perilymph leaks from the cochlea or vestibule into the surrounding cavities,most commonly through round and oval windows,and causes cochlear and vestibular symp...A perilymphatic fistula(PLF)is a rare condition in which perilymph leaks from the cochlea or vestibule into the surrounding cavities,most commonly through round and oval windows,and causes cochlear and vestibular symptoms.However,vague symptoms and the lack of a clear diagnostic test have made the existence of PLF a controversial subject for decades.Here,we report a case of definite PLF confirmed by surgery in a patient who underwent mastoidectomy 20 years prior,revealing a specific sign of missing perilymph on MRI.T2-weighted MRI revealed a nodular bright signal in the cochlea and vestibule and a large area of bright signal in the middle ear cavity with a long tail running toward the vestibule in the left ear.MRI via T2-sampling perfection with application-optimized contrasts by using a flip angle evolution sequence revealed a bright signal in the cochlear endolymph but not in the perilymph.The specific sign of a missing perilymph on MRI has a diagnostic role for PLF.展开更多
BACKGROUND Bouveret’s syndrome is a rare(1%-4%)form of cholelithiasis characterized by gastric outlet obstruction.It presents mainly in elderly women with nausea,vomiting,and abdominal pain.On physical examination,co...BACKGROUND Bouveret’s syndrome is a rare(1%-4%)form of cholelithiasis characterized by gastric outlet obstruction.It presents mainly in elderly women with nausea,vomiting,and abdominal pain.On physical examination,common findings include dehydration signs such as tachycardia,decreased urine output,abdo-minal discomfort,and distention.Diagnosis relies on computed tomography(CT)and magnetic resonance imaging,with Rigler's triad(pneumobilia,ectopic gall-stone,gastric distension)being highly specific.This report aims to improve under-standing of Bouveret’s syndrome and inform better management and treatment strategies.CASE SUMMARY A 60-year-old male patient presented with a three-day history of nausea,vomiting,upper abdominal pain,and loss of appetite.An upright abdominal X-ray revealed a gas shadow in the intrahepatic and extrahepatic bile ducts.Endos-copy revealed a brown and black stone measuring approximately 3030 mm in dia-meter in the gastric pylorus,incompletely obstructing the gastric outlet.The diagnosis of Bouveret’s syndrome was accurately confirmed via an abdominal CT scan.Endoscopic removal of the stone was successful,owing to the stone being fragmented and extracted in pieces using a crushing basket.Three weeks later,laparoscopy was attempted but failed because of severe tissue adhesions.Conse-quently,the procedure was converted to a laparotomy,and fistula repair and cholecystectomy were performed.He returned to the outpatient clinic for follow-up,and no further concerns were noted.Core Tip:Bouveret’s syndrome is a rare form of cholelithiasis leading to gastric outlet obstruction.Diagnosis is confirmed through imaging,particularly abdominal computed tomography,with Rigler's triad serving as a key diagnostic indicator.Endoscopic removal of the gallstone is the first-line treatment,but surgery is required if endoscopic methods fail,especially in cases with severe adhesions.In this case,a 60-year-old male had successful endoscopic stone removal.Laparotomy was later performed for fistula repair and cholecystectomy after laparoscopy failed.This case highlights the importance of early diagnosis and flexible treatment,combining endoscopy and surgery for the best outcomes.TREATMENT Endoscopic removal of the stone was successful.The stone was fragmented and removed piecemeal using a crushing basket.Laparoscopy was attempted three weeks later;however,severe tissue adhesions were present.The procedure was converted to a laparotomy,and fistula repair and cholecystectomy were performed.During the surgery,we encountered several challenges.First,the presence of a biliary-enteric fistula complicated the procedure,as inflammation and chronic fistulous communication had altered its anatomy.To address this,we carefully repaired the fistula,ensuring minimal disruption to surrounding structures to avoid additional complications.Additionally,the patient had significant adhesions due to chronic biliary disease,which made dissection challenging.These adhesions involved the gallbladder,bile ducts,and intestines,requiring meticulous separation to prevent injury to critical structures.In areas with severe adhesions,we employed careful dissection techniques and,when necessary,adjusted our surgical strategy to minimize trauma and ensure safe removal of the gallstone and restoration of normal anatomy.展开更多
BACKGROUND Although laparoscopic gastrolithotomy had been widely used in clinical practice,uncommon postoperative complications still require vigilance by medical staff.CASE SUMMARY Here we report a 67-year-old man wh...BACKGROUND Although laparoscopic gastrolithotomy had been widely used in clinical practice,uncommon postoperative complications still require vigilance by medical staff.CASE SUMMARY Here we report a 67-year-old man who suffered for 18 months and underwent surgery several times due to a rare and undetected complication of laparoscopic gastricolithotomy.He presented to multiple hospitals because of sustained left upper quadrant abdominal pain one month after laparoscopic gastricolithotomy due to a large gastric bezoar caused by unrestrained eating of black dates and was diagnosed with possible intercostal neuritis.Many painkillers were used to relieve his symptoms but the condition progressed.Seven months after surgery,he was hospitalized as skin ulceration occurred in the left upper abdominal wall and was subsequently diagnosed with a massive thoracoabdominal wall abscess.One year after surgery,irreversible costal destruction was demonstrated.Both lesions were finally proved to be secondary damage due to a rare chronic gastro-abdominal wall fistula related to laparoscopic gastricolithotomy and the diameter of the gastric fistula reached 2 centimeters(cm).The patient was ultimately cured but underwent multi-regional incisions and drainage of the abscess,drainage of the gastric fistula,partial gastrectomy and removal of damaged ribs,and was followed-up for more than 4 years without recurrence.It is well-known that gastric fistula usually has an acute onset and occurs early after surgery,while chronic gastro-abdominal wall fistula especially with secondary massive thoracoabdominal wall abscess and costal destruction has rarely been reported.CONCLUSION This may be the first reported case of a chronic thoracoabdominal abscess and costal destruction caused by an undetected chronic gastro-abdominal wall fistula.We believe that this is a novel type of gastric fistula and the diagnosis and treatment were challenging.展开更多
文摘In this editorial,a commentary on the article by Chang et al has been provided,the course of treatment of anorectal fistulas,especially complex and recurring ones,require accurate diagnostic procedures for determining ideal surgical procedures.Conventional ways of imaging sometimes fall short,offering insufficient insights in aggravated instances.In this editorial,a novel application of hydrogen peroxide-enhanced magnetic resonance imaging(HP-MRI)that promises significant improvements in the imaging of anorectal fistula.Study is based on a retrospective investigation of 60 patients,contrasts the new HP-MRI with conventional diagnostic techniques such as physical examination,trans-perineal ultrasonography and poor spatial resolution MRI.The findings demonstrate HP-MRI's incredible diagnostic performance,with sensitivity and specificity rates of 96.08%and 90.91%,respectively,and unparalleled interobserver agreement(Kappa values ranging from 0.80 to 0.89).It has been a significant advancement for assessment of anorectal fistulas providing a better roadmap for surgical planning,lowering recurrence rates as well as reduced personal and financial burden on patients by reducing the need for repeated treatment and extended hospital stays.The remaining funds can be utilized for treatment of other medical need.Ultimately HP-MRI provides us a healthier&more efficient society by improvising patients well-being&optimized healthcare infrastructure.
文摘BACKGROUND Surgically created arterio-venous fistulas(AVFs)are the gold standard for haemodialysis access for patients with end-stage renal disease.Standard practice of AVF creation involves selecting the non-dominant upper limb and starting with most distally with radio-cephalic arterio-venous fistula.The primary patency rate of radio-cephalic arterio-venous fistula varies from 20%-25%.It has been suggested the neointimal hyperplasia at the mobilized venous segment causes stenosis of the anastomosis.Therefore,the radial artery deviation and reimplantation(RADAR)technique,in which the vein is minimally mobilized,should result in a higher success rate.AIM To compare the RADAR technique with classical technique in creation of AVF including:(1)Success rate;(2)Time to maturation;(3)Duration of surgery;and(4)Complication rate.METHODS In our study we recruited 94 patients in two randomized groups and performed the AVF by the classical method or the RADAR method.RESULTS The RADAR group had higher primary success rate(P=0.007),less rate of complications(P=0.04),shorter duration of surgery(P=0.00)and early time to maturation(0.001)when compared with the classical group.The RADAR procedure is a safe and a more efficient alternative to the current classical method of AVF creation.Longer duration of follow-up is required to assess the long-term outcomes in the future.CONCLUSION The RADAR procedure is a safe and more efficient alternative to the current classical method of AVF creation.Longer duration of follow-up is required to assess the long-term outcomes in the future.
文摘BACKGROUND Mirizzi syndrome is a rare complication of chronic gallstone disease in which an impacted stone causes compression or erosion of the common hepatic duct.Accurate preoperative diagnosis is crucial but often challenging.We report a case that was preoperatively diagnosed as type 1 Mirizzi syndrome but was found intraoperatively to be type 4,involving a cholecysto-biliary fistula and complete erosion of the common hepatic duct.CASE SUMMARY A 74-year-old woman presented with right upper quadrant discomfort.Initial workup including ultrasound and magnetic resonance cholangiopancreatography suggested Mirizzi syndrome type 1 due to extrinsic compression of the common hepatic duct.Endoscopic retrograde cholangiopancreatography confirmed a large stone without evidence of fistula.The patient underwent robotic-assisted cholecystectomy,during which a 4 cm stone was found eroding into the common hepatic duct,consistent with type 4 Mirizzi syndrome.Intraoperative cholangioscopy confirmed the fistula and allowed primary repair.The patient recovered uneventfully and was discharged on postoperative day one.CONCLUSION Preoperative imaging may fail to identify fistula formation in Mirizzi syndrome.Intraoperative assessment remains critical for accurate diagnosis and safe surgical management.
文摘Objectives:To assess outcomes of rectourethral fistula repair utilizing a gracilis flap in a largely radiated cohort.Patients and Methods:We performed a retrospective review of all gracilis interposition flap reconstruction surgeries performed for RUF at a university hospital in South Carolina between January 2010 and June 2023.All repairs utilized a multidisciplinary approach with urology,colorectal,and plastic surgery teams.Postoperatively,patients were maximally drained with foley catheter and suprapubic tube(SPT).Initial voiding cystourethrogram(VCUG)was performed at 4 weeks post-repair.If there was a persistent leak,catheter drainage was maintained for 4 additional weeks and VCUG was repeated.Success was defined as absence of leak on VCUG within 3 months after surgery.Results:22 patients met inclusion criteria.68%of patients had history of external beam radiation therapy(EBRT),13.6%had brachytherapy,and 40.9%had cryotherapy.Initial post-operative VCUG was negative in 10 patients(45.5%).Of the 12 patients with a persistent fistula,5(42%)had no evidence of fistula on subsequent VCUG after 4 weeks.Overall,68%of patients were successfully treated with gracilis interposition flap.There was a significant difference of repair success based on EBRT status(p<0.05).Conclusions:We report a success rate of 68%for gracilis flap repair of RUF.Our cohort had a higher rate of prior radiation therapy compared to other studies.A clinically significant portion of patients with an initial positive VCUG will seal their fistula with prolonged catheter drainage.Gracilis interposition flap is a reasonable surgical treatment for RUF.
文摘BACKGROUND Enterocutaneous(EC)fistula incidence has been increasing in China,along with increases in the volume and complexity of surgeries.The conservative treatment strategy has been analyzed to improve the treatment outcomes for patients with EC fistulas and reduce the need for reoperation.AIM To analyze the clinical data of patients undergoing conservative treatment for EC fistulas and identify the factors that promote self-healing.These findings provide a reference for improving the clinical cure rate of EC fistulas with conservative treatment.METHODS The clinical data of 91 patients with EC fistulas who underwent conservative treatment were collected.The relationships between the cure rate and characteristics such as age,sex,body mass index,albumin level,primary disease,cause of the fistula,location of the fistula,number of fistulas,nature of the fistula,infection status,diagnostic methods,nutritional support methods,somatostatin therapy,growth hormone therapy,and fibrin glue therapy were analyzed.RESULTS A comparison of the basic patient characteristics between the two groups revealed statistically significant differences in primary disease(P=0.044),location of the fistula(P=0.006),number of fistulas(P=0.007),and use of adhesive sealing(χ2=12.194,P<0.001)between the uncured and cured groups.The use of fibrin glue was a significant factor associated with a cure for fistulas(odds ratio=5.459,95%CI:1.958-15.219,P=0.01).CONCLUSION The cure rate of patients with a single EC fistula can be effectively improved via conservative treatment combined with the use of biological fibrin glue to seal the fistula.
文摘Traumatic carotid-cavernous arteriovenous fistula(TCCAVF)is a rare but severe cerebrovascular disorder,often resulting from head trauma with temporal bone fractures.The pathogenesis involves vessel wall injury due to traction,frequently associated with fractures near the middle meningeal artery.This case highlights the typical clinical presentation,diagnostic approaches,and therapeutic management of TCCAVF,emphasizing the challenges in treating this condition.Transcatheter embolization proved effective in occluding the fistula,underscoring its role as a key intervention for traumatic meningeal arteriovenous fistulas.
基金Supported by the Jiaxing Science and Technology Project,No.2023AD11016 and No.2023AD31028.
文摘BACKGROUND Anal fistula is increasingly prevalent due to modern lifestyle factors,and surgery remains the primary treatment.However,the rising incidence of antibiotic resistance,particularly to cefuroxime,complicates perioperative management.The role of gut microbiota in influencing this resistance is not well understood.AIM To investigate the relationship between gut microbiota composition and cefuroxime resistance in anal fistula patients and to assess probiotic intervention impact.METHODS This study included 30 anal fistula patients categorized into cefuroxime-sensitive(Cefur-S)and cefuroxime-resistant(Cefur-NS)groups.Gut microbiota samples were collected during colonoscopy,and 16S ribosomal DNA sequencing was performed to analyze microbial diversity.Patients in the Cefur-NS group received a 7-day course of Clostridium butyricum tablets.Post-intervention,microbial composition and cefuroxime resistance were reassessed.RESULTS Alpha and beta diversity analyses showed no significant differences in microbial diversity between the Cefur-S and Cefur-NS groups.However,effect size analysis identified Roseburia and Butyricicoccus as dominant genera in the Cefur-S group,with higher butyrate production potentially protecting against cefuroxime resistance.Post-intervention,the Cefur-NS group showed a significant reduction in cefuroxime resistance,improved stool consistency,and reduced bowel movement frequency.CONCLUSION This study suggests that specific gut microbiota,particularly Butyricicoccus and Roseburia,may mitigate cefuroxime resistance in anal fistula patients by increasing butyrate production.Probiotic intervention targeting gut microbiota composition presents a promising strategy for reducing antibiotic resistance and improving clinical outcomes.
文摘Introduction: Obstetric Fistulas (OF) constitute a major public health problem in developing countries in general and in Central African Republic (CAR) in particular because of its numerous consequences. The objective of this work is to contribute to the management of OF cases in CAR. Patients and Methods: This was a retrospective, descriptive and analytical study, including data from several OF care services. The study included 245 cases of OF, operated on from 2009 to 2018. The parameters studied were maternal and obstetrical data, sociodemographic data, the specific characteristics of the fistulas as well as the modalities and outcome of surgical treatment. The data collected came from six (6) OF surgical repair campaigns organized by the Ministry of Health and Population with the support of UNFPA. Results: We recorded 245 patients, representing a prevalence of 0.77% of OF per year. Among these patients, almost half (45.3%) were treated at the Sino-Central African Friendship University Hospital Center (CHUASC). The average age of the patients was 30 years (range 14 to 78 years). They were unschooled (53.9%) and primigravidas (35%). The fistulas had an average duration of evolution of 7.58 years. They were vesicovaginal in 25.3%. Types V and I dominated in 17.4% and 9.2%, respectively. In 85.9% of cases, fistulorrhaphy was performed, half of which (50.2%) via the upper route. The cure rate was 83.3%. Note that our study reveals statistically significant links between the evolution after surgery with age (p = 0.04 Conclusion: OF mainly affected women of childbearing age, uneducated, primiparous. Vesicovaginal fistula was the frequently encountered type and was manifested by urine loss clinically with a positive methylene blue test.
基金supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2019-I2M-5–056)the National Natural Science Foundation of China(81930119,82090050,and 82090053)。
文摘Background:The prediction of postoperative pancreatic fistula(POPF)is important.This study aimed to investigate the role of postoperative serum lipase level in predicting POPF.Methods:Data from 234 consecutive patients who underwent pancreaticoduodenectomy(PD)were collected.The predictive values of serum amylase and serum lipase during postoperative days(PODs)1 to 3 for POPF were compared.Subgroup analyses were performed to determine the prognostic value of different levels and durations of elevated serum lipase.Results:Fifty-six patients developed POPF.The POPF group exhibited increased levels of serum amylase and lipase from PODs 1 to 3(all P<0.001).Compared with serum amylase,serum lipase has greater predictive value for POPF.Specifically,serum lipase had the highest area under the receiver operating characteristic curve(AUC)at POD 1(0.791).Body mass index>24 kg/m2[odds ratio(OR)=2.431,95%confidence interval(CI):1.094–5.404,P=0.029],soft pancreatic texture(OR=3.189,95%CI:1.263–8.056,P=0.014),serum lipase>60 U/L at POD 1(OR=5.135,95%CI:1.257–20.982,P=0.023),and C-reactive protein>167 mg/dL at POD 3(OR=3.607,95%CI:1.431–9.090,P=0.007)were identified as independent risk factors for POPF.Patients with serum lipase≤60 U/L at POD 1(n=104)exhibited lower rates of POPF(3.8%vs.40.0%,P<0.001)and severe complications(Clavien-Dindo≥IIIa)(4.8%vs.25.4%,P<0.001)than those with serum lipase>60 U/L at POD 1.Moreover,no additional elevation or duration of serum lipase offered any further prognostic value.Conclusions:Postoperative serum lipase outperformed serum amylase in the prediction of POPF,and patients with normal serum lipase level at POD 1 had favorable outcomes.A sustained increase in the serum lipase level offers no additional prognostic value.
文摘BACKGROUND Hem-o-lock clip,a versatile and reliable non-absorbable tissue clip,has gained widespread acceptance in laparoscopic surgeries for vessel ligation and tissue approximation.Its efficacy and safety have been well-documented.CASE SUMMARY This case report describes the occurrence of a bronchopleural fistula following the application of the Hem-o-lock clip for the treatment of a lobar bronchial stump after lobectomy.CONCLUSION This case underscores the importance of exercising caution when using the Hem-o-lock clip for the management of non-vascular tissues during thoracic surgery.
文摘BACKGROUND Pancreatic fibrosis,which decreases risk of postoperative pancreatic fistula(POPF),can be estimated using extracellular volume fraction(ECVf).AIM To investigate the correlation between ECVf and pancreatic histology,as well as the usefulness of ECVf in predicting POPF.METHODS In 71 patients who underwent pancreatic resection,we caluculated pancreatic ECVf by comparing absolute enhancements of the pancreas and aorta between pre-contrast and equilibrium phases.Areas of fibrosis,fat,acini,and islets were calculated based on resection specimens.RESULTS ECVf correlated with fibrosis(r=0.724;P<0.001)and negatively correlated with acini(r=-0.510;P<0.001).Among 48 patients who underwent pancreatoduoden ectomy,21 developed POPF.Main pancreatic duct diameter≤2 mm and ECVf<36%were selected as risk factors by multivariate analysis[respective odds ratios(OR)and P values,4.26 and P=0.048;OR=11.07 and P=0.036].Using these factors as a risk score(0-2 points),POPF occurred in 0%,50%,and 70%of patients with 0,1,and 2 points,respectively.CONCLUSION ECVf is useful in predicting acinar loss and pancreatic fibrosis,and ECVf<36%may be a risk factor for POPF.
基金Supported by the Scientific Research Project of Hunan Provincial Health Commission,No.202203012538。
文摘BACKGROUND Arteriovenous fistula is a rare cause of refractory heart failure,and corrective measures may lead to dramatic improvement;however,the long-term cardiac remodeling outcomes,particularly after delayed closure,remain unclear.CASE SUMMARY A 57-year-old man was admitted to the hospital with complaints of exertional dyspnea for more than 10 years.Physical examination revealed wet crackles in the lungs and a continuous machinery murmur in the left lower back and groin area.Asymmetric edema and varicose veins were observed in the lower limbs.Echocar-diography revealed a dilated right ventricle with severe pulmonary hypertension.Computed tomography revealed a left common iliac arteriovenous fistula linked to prior lumbar disc surgery.Surgical repair resolved the symptoms,with echo-cardiography at 4 months showing a reduced right atrium(RA)and ventricular(RV)diameter and tricuspid regurgitation.However,during the 2-year follow-up,gradual RA and RV re-expansion(from 35 mm to 51 mm and from 26 mm to 46 mm,respectively)was observed,despite sustained clinical stability.CONCLUSION This case highlights that delayed arteriovenous fistula closure may result in in-complete right heart reverse remodeling,even after symptomatic relief.Potential mechanisms include persistent hemodynamic stress from subclinical residual shunting or functional impairment due to chronic volume overload.Early inter-vention before irreversible right heart damage is critical for optimal outcomes.
文摘BACKGROUND Both the etiology and treatment of perianal fistulas present challenges,and there is no standard surgical approach.AIM To present the results of a modified fistulotomy technique that was implemented in a tertiary coloproctology reference center.METHODS Seventy-two patients who underwent surgical intervention for perianal fistula between August 2019 and January 2023 were treated using a modified fistulotomy technique.In this approach,the fistula tract was excised from the external opening up to the external sphincter fibers.The internal orifice was widened,and the septic focus within the inter sphincteric space was curetted.Partial internal sphincterotomy was performed up to the inter sphincteric plane.The anoderm from the internal orifice to the inter sphincteric space was closed with absorbable suture material,and a loose seton was placed at the level of the external sphincter.RESULTS The 72 patients who underwent modified fistulotomy were 77.8%male and 22.2%female,with a mean age of 42.2±11.5 years.The median follow-up period was 19 months.Preoperatively,93.1%of patients had high trans sphincteric fistulas,and 6.9%were females with anterior low trans sphincteric fistulas.In all cases,setons were placed during surgery using vascular tape.A total of 12.5%of patients experienced incontinence,involving gas(6.9%)or soiling(5.6%).There were no reports of solid or liquid incontinences.Complete healing was achieved in 83.3%of the patients,with a recurrence rate of 4.2%and a non-healing rate of 12.5%.CONCLUSION Our preliminary analysis suggests that this modified fistulotomy technique that targets distalization of the internal orifice is a promising alternative management strategy for perianal fistulas.
文摘BACKGROUND Lacrimal sac rhinosporidiosis,with nil or minor nasal extensions,rarely presents as an acquired cutaneous fistula in the periocular area.The correct diagnosis in such cases can be challenging,leading to repeated failure of conservative or surgical interventions.CASE SUMMARY A 39-year-old female presented with a 6-year history of swelling in the periocular area,specifically in the left lacrimal sac area.Symptoms were limited to epiphora and constant mucoid discharge from the fistula,clinically mimicking chronic lacrimal sac fistula.She had a history of treatment with multiple antibiotic courses and dacryocystectomy in the past,with no or transient symptomatic relief.On surgical exploration of the site,a large pedunculated polypoidal vascular mass,suspicious of rhinosporidiosis,was noted.En bloc resection of the mass with cauterization of the base and fistulectomy was performed.Histopathology confirmed the diagnosis of lacrimal sac rhinosporidiosis.The patient was further evaluated and treated for the nasal extension of rhinosporidiosis.The patient has been frequently followed up for the last 3 years with a good clinical outcome and no recurrence.CONCLUSION Lacrimal sac rhinosporidiosis,in isolated or limited nasal extension cases,can rarely mimic a chronic discharging fistula.Patients with this disease often face distress due to misdiagnosis and repeated failure of conservative or surgical interventions.A high index of suspicion is needed for early diagnosis.Proper surgical intervention at the right time can lead to an excellent prognosis in such patients.
文摘BACKGROUND The rising incidence of laryngeal cancer has led to an increasing number of total laryngectomy procedures.While voice prostheses have significantly improved post-laryngectomy rehabilitation,the risk of salivary fistula remains a major complication.This study aims to compare the stapler and hand-sewn techniques for esophageal closure and evaluate their impact on fistula formation.AIM To compare stapler-assisted and hand-sewn esophageal closure techniques after laryngectomy regarding their impact on salivary fistula formation.METHODS A total of 52 patients(44 men,8 women),aged 43 to 77 years,underwent total laryngectomy.Esophageal reconstruction was performed using either a stapler(29 patients)or a hand-sewn technique(23 patients).A surgical stapler TA was used for esophageal closure in the stapler group.Patients were clinically monitored for fistula formation during the first 7 days postoperatively and again two weeks after discharge using fiberoptic examination.RESULTS A total of 22 salivary fistulas were recorded:17(77.3%)occurred following the hand-sewn technique,while 5(22.7%)developed in the stapler group.Addi-tionally,preoperative radiotherapy was identified as a statistically significant risk factor for fistula formation.No technical complications related to the stapler device were observed.CONCLUSION Although hand-sewn closure is commonly used after total laryngectomy,stapler-assisted closure shows lower fistula rates and is a viable esophageal reconstruction alternative.
基金a Grant from the National Natural Science Foundation of China:CRL4DCAF4 E3 Ubiquitin Ligase Regulates the Pathogenesis of Colorectal Cancer(No.82172909)。
文摘OBJECTIVE:To explore the clinical efficacy of the Chinese medicine,Neibu Huangqi Youhua formula(内补黄芪汤优化方)combined with Kangfuxin solution(康复新液)for the nursing of patients after anal fistula surgery.METHODS:A total of 160 cases with anal fistula who underwent surgical treatment were recruited,and divided into control group(treated with external application of Kangfuxin liquid gauze)and experimental group(receiving the Neibu Huangqi Youhua formula combined with Kangfuxin liquid gauze)based on a random numbering table.The wound recovery,postoperative pain and inflammation were evaluated and compared between the two groups.RESULTS:At 3,7,and 14 d after the operation,the wound healing rate of the experimental group was significantly higher than that of the control group at any time point.The visual analogue scale scores of the two groups gradually decreased in a time-dependent manner after surgery,while the experimental group showed a more significant downward trend in comparison with the control group.At 14 d after the operation,the experimental group had high levels of epidermal growth factor,fibroblast growth factor-1,secretory Ig A,tissue inhibitor of matrix metalloproteinase-1,5-hydroxytryptamine,prostaglandin E-2,substances P and neuropeptide Y compared with control group,but low levels of C-reactive protein,procalcitonin,and serum amyloid A protein.CONCLUSIONS:The Neibu Huangqi Youhua formula can reduce the levels of inflammatory factors and pain mediators in patients after anal fistula surgery,thereby accelerating the process of wound healing and alleviating the pain of patients.
文摘BACKGROUND Pancreatic fistula is the most common complication of pancreatic surgeries that causes more serious conditions,including bleeding due to visceral vessel erosion and peritonitis.AIM To develop a machine learning(ML)model for postoperative pancreatic fistula and identify significant risk factors of the complication.METHODS A single-center retrospective clinical study was conducted which included 150 patients,who underwent pancreat-oduodenectomy.Logistic regression,random forest,and CatBoost were employed for modeling the biochemical leak(symptomless fistula)and fistula grade B/C(clinically significant complication).The performance was estimated by receiver operating characteristic(ROC)area under the curve(AUC)after 5-fold cross-validation(20%testing and 80%training data).The risk factors were evaluated with the most accurate algorithm,based on the parameter“Importance”(Im),and Kendall correlation,P<0.05.RESULTS The CatBoost algorithm was the most accurate with an AUC of 74%-86%.The study provided results of ML-based modeling and algorithm selection for pancreatic fistula prediction and risk factor evaluation.From 14 parameters we selected the main pre-and intraoperative prognostic factors of all the fistulas:Tumor vascular invasion(Im=24.8%),age(Im=18.6%),and body mass index(Im=16.4%),AUC=74%.The ML model showed that biochemical leak,blood and drain amylase level(Im=21.6%and 16.4%),and blood leukocytes(Im=11.2%)were crucial predictors for subsequent fistula B/C,AUC=86%.Surgical techniques,morphology,and pancreatic duct diameter less than 3 mm were insignificant(Im<5%and no correlations detected).The results were confirmed by correlation analysis.CONCLUSION This study highlights the key predictors of postoperative pancreatic fistula and establishes a robust ML-based model for individualized risk prediction.These findings contribute to the advancement of personalized periop-erative care and may guide targeted preventive strategies.
基金supported by the National Natural Science Foundation of China(81771006).
文摘A perilymphatic fistula(PLF)is a rare condition in which perilymph leaks from the cochlea or vestibule into the surrounding cavities,most commonly through round and oval windows,and causes cochlear and vestibular symptoms.However,vague symptoms and the lack of a clear diagnostic test have made the existence of PLF a controversial subject for decades.Here,we report a case of definite PLF confirmed by surgery in a patient who underwent mastoidectomy 20 years prior,revealing a specific sign of missing perilymph on MRI.T2-weighted MRI revealed a nodular bright signal in the cochlea and vestibule and a large area of bright signal in the middle ear cavity with a long tail running toward the vestibule in the left ear.MRI via T2-sampling perfection with application-optimized contrasts by using a flip angle evolution sequence revealed a bright signal in the cochlear endolymph but not in the perilymph.The specific sign of a missing perilymph on MRI has a diagnostic role for PLF.
文摘BACKGROUND Bouveret’s syndrome is a rare(1%-4%)form of cholelithiasis characterized by gastric outlet obstruction.It presents mainly in elderly women with nausea,vomiting,and abdominal pain.On physical examination,common findings include dehydration signs such as tachycardia,decreased urine output,abdo-minal discomfort,and distention.Diagnosis relies on computed tomography(CT)and magnetic resonance imaging,with Rigler's triad(pneumobilia,ectopic gall-stone,gastric distension)being highly specific.This report aims to improve under-standing of Bouveret’s syndrome and inform better management and treatment strategies.CASE SUMMARY A 60-year-old male patient presented with a three-day history of nausea,vomiting,upper abdominal pain,and loss of appetite.An upright abdominal X-ray revealed a gas shadow in the intrahepatic and extrahepatic bile ducts.Endos-copy revealed a brown and black stone measuring approximately 3030 mm in dia-meter in the gastric pylorus,incompletely obstructing the gastric outlet.The diagnosis of Bouveret’s syndrome was accurately confirmed via an abdominal CT scan.Endoscopic removal of the stone was successful,owing to the stone being fragmented and extracted in pieces using a crushing basket.Three weeks later,laparoscopy was attempted but failed because of severe tissue adhesions.Conse-quently,the procedure was converted to a laparotomy,and fistula repair and cholecystectomy were performed.He returned to the outpatient clinic for follow-up,and no further concerns were noted.Core Tip:Bouveret’s syndrome is a rare form of cholelithiasis leading to gastric outlet obstruction.Diagnosis is confirmed through imaging,particularly abdominal computed tomography,with Rigler's triad serving as a key diagnostic indicator.Endoscopic removal of the gallstone is the first-line treatment,but surgery is required if endoscopic methods fail,especially in cases with severe adhesions.In this case,a 60-year-old male had successful endoscopic stone removal.Laparotomy was later performed for fistula repair and cholecystectomy after laparoscopy failed.This case highlights the importance of early diagnosis and flexible treatment,combining endoscopy and surgery for the best outcomes.TREATMENT Endoscopic removal of the stone was successful.The stone was fragmented and removed piecemeal using a crushing basket.Laparoscopy was attempted three weeks later;however,severe tissue adhesions were present.The procedure was converted to a laparotomy,and fistula repair and cholecystectomy were performed.During the surgery,we encountered several challenges.First,the presence of a biliary-enteric fistula complicated the procedure,as inflammation and chronic fistulous communication had altered its anatomy.To address this,we carefully repaired the fistula,ensuring minimal disruption to surrounding structures to avoid additional complications.Additionally,the patient had significant adhesions due to chronic biliary disease,which made dissection challenging.These adhesions involved the gallbladder,bile ducts,and intestines,requiring meticulous separation to prevent injury to critical structures.In areas with severe adhesions,we employed careful dissection techniques and,when necessary,adjusted our surgical strategy to minimize trauma and ensure safe removal of the gallstone and restoration of normal anatomy.
文摘BACKGROUND Although laparoscopic gastrolithotomy had been widely used in clinical practice,uncommon postoperative complications still require vigilance by medical staff.CASE SUMMARY Here we report a 67-year-old man who suffered for 18 months and underwent surgery several times due to a rare and undetected complication of laparoscopic gastricolithotomy.He presented to multiple hospitals because of sustained left upper quadrant abdominal pain one month after laparoscopic gastricolithotomy due to a large gastric bezoar caused by unrestrained eating of black dates and was diagnosed with possible intercostal neuritis.Many painkillers were used to relieve his symptoms but the condition progressed.Seven months after surgery,he was hospitalized as skin ulceration occurred in the left upper abdominal wall and was subsequently diagnosed with a massive thoracoabdominal wall abscess.One year after surgery,irreversible costal destruction was demonstrated.Both lesions were finally proved to be secondary damage due to a rare chronic gastro-abdominal wall fistula related to laparoscopic gastricolithotomy and the diameter of the gastric fistula reached 2 centimeters(cm).The patient was ultimately cured but underwent multi-regional incisions and drainage of the abscess,drainage of the gastric fistula,partial gastrectomy and removal of damaged ribs,and was followed-up for more than 4 years without recurrence.It is well-known that gastric fistula usually has an acute onset and occurs early after surgery,while chronic gastro-abdominal wall fistula especially with secondary massive thoracoabdominal wall abscess and costal destruction has rarely been reported.CONCLUSION This may be the first reported case of a chronic thoracoabdominal abscess and costal destruction caused by an undetected chronic gastro-abdominal wall fistula.We believe that this is a novel type of gastric fistula and the diagnosis and treatment were challenging.
