Management of the complex anal fistula represents a perennial challenge to surgeons.Conventional approaches often upset the balance between recurrence prevention and continence preservation with their high failure rat...Management of the complex anal fistula represents a perennial challenge to surgeons.Conventional approaches often upset the balance between recurrence prevention and continence preservation with their high failure rates and significant associated morbidity.The emergence of minimally invasive treatment in recent years,however,offers a promising paradigm shift.Regenerative solutions like autologous stem cell therapy or fistula plugs with extracellular and synthetic matrices represent new frontiers in anal fistula treatment,harnessing physiological regenerative capacities and avoiding the traditional postoperative burden of open wounds,drains,or setons in situ.Together with novel techniques like fistula laser closure,video-assisted fistula treatment,or over-the-scope clip burgeoning over the last decade,these state-of-the-art approaches have been touted for their total sphincter-sparing nature,preserving functional outcomes and quality of life.Despite gaining much scientific and clinical momentum,do these newer modalities live up to their promise?This review aims to critically appraise the latest evidence surrounding minimally invasive approaches,providing up-todate insights into the constantly evolving landscape of anal fistula management.Further long-term and comparative studies will nevertheless be needed to supplement the significantly heterogenous,retrospective analyses consolidated.展开更多
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
BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gast...BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.展开更多
BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous tract between the gallbladder and the adjacent gastrointestinal tract.Chronic gallbladder inflammation can lead to tissue nec...BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous tract between the gallbladder and the adjacent gastrointestinal tract.Chronic gallbladder inflammation can lead to tissue necrosis,perforation,and fistulogenesis.The most prevalent cause of CEF is chronic cholelithiasis,which rarely results from malignancy.Because the symptoms and laboratory findings associated with CEF are nonspecific,the condition is often misdiagnosed,pre-senting a challenge to the surgeon when detected intraoperatively.Therefore,a preoperative diagnosis of CEF is crucial.We present the case of a 57-year-old male with advanced gallbladder cancer(GBC)who arrived at the emergency room with persistent vomiting,abdominal pain,and diarrhea.An abdominopelvic computed tomography scan revealed a contracted gallbladder with bubbles in the fundus connected to the second por-tion of the duodenum and transverse colon.We suspected that GBC had invaded the adjacent gastrointestinal tract through a cholecystoduodenal fistula(CDF)or a cholecystocolonic fistula(CCF).He underwent multiple examinations,including esophagogastroduodenoscopy,an upper gastrointestinal series,colo-noscopy,and magnetic resonance cholangiopancreatography;the results of these tests con-firmed a diagnosis of synchronous CDF and CCF.The patient underwent a Roux-en-Y gastrojejunostomy and loop ileostomy to address the severe adhesions that were previously observed to cover the second portion of the duodenum and hepatic flexure of the colon.His symptoms improved with supportive treatment while hospitalized.He initiated oral targeted therapy with lenvatinib for further anticancer treatment.CONCLUSION The combination of imaging and surgery can enhance preoperative diagnosis and alleviate symptoms in patients with GBC complicated by CEF.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 This study aimed to compare and analyze risk factors for pancreatic fistula following pancreaticoduodenectomy(PD)using different definition criteria,and to develop a predictive model for standardized pancre...BACKGROUND This study aimed to compare and analyze risk factors for pancreatic fistula following pancreaticoduodenectomy(PD)using different definition criteria,and to develop a predictive model for standardized pancreatic fistula risk assessment.AIM To identify and compare risk factors for postoperative pancreatic fistula(POPF)following PD using both the 2005 International Study Group of Pancreatic Fistula and updated 2016 International Study Group on Pancreatic Surgery diagnostic criteria,and to develop a clinically applicable predictive model based on objective preoperative parameters for standardized pancreatic fistula risk assessment and perioperative management optimization.METHODS We conducted a retrospective analysis of 303 patients who underwent PD at CR&WISCO General Hospital between January 2017 and May 2023.POPF cases were classified according to both previous and updated diagnostic standards.For statistical analysis,we employed t-tests or Mann-Whitney U tests for continuous variables andχ^(2) tests for categorical data.To identify risk factors associated with POPF under both classification systems,we performed univariate and multivariate logistic regression analyses.RESULTS Univariate analysis identified several factors associated with POPF:Main pancreatic duct diameter(χ^(2)=31.641,P<0.001),main pancreatic duct index(χ^(2)=52.777,P<0.001),portal vein invasion(χ^(2)=6.259,P=0.012),intra-abdominal fat thickness(χ^(2)=7.665,P=0.006),preoperative biliary drainage(χ^(2)=5.999,P=0.014),pancreatic characteristics(χ^(2)=5.544,P=0.019),pancreatic resection margin thickness(t=2.055,P=0.032),pancreatic computed tomography(CT)value(t=-3.224,P=0.002),and preoperative blood amylase level(Z=-2.099,P=0.036).Multivariate logistic regression identified three independent risk factors:Main pancreatic duct index[odds ratio(OR)=0.000,95%confidence interval(CI):0.000-0.011],pancreatic cancer[OR=4.843,95%CI:1.285-18.254],and pancreatic CT value[OR=0.869,95%CI:0.806-0.937](all P<0.05).CONCLUSION The main pancreatic duct index and pancreatic CT value are strongly correlated with pancreatic fistula development after PD.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
文摘Management of the complex anal fistula represents a perennial challenge to surgeons.Conventional approaches often upset the balance between recurrence prevention and continence preservation with their high failure rates and significant associated morbidity.The emergence of minimally invasive treatment in recent years,however,offers a promising paradigm shift.Regenerative solutions like autologous stem cell therapy or fistula plugs with extracellular and synthetic matrices represent new frontiers in anal fistula treatment,harnessing physiological regenerative capacities and avoiding the traditional postoperative burden of open wounds,drains,or setons in situ.Together with novel techniques like fistula laser closure,video-assisted fistula treatment,or over-the-scope clip burgeoning over the last decade,these state-of-the-art approaches have been touted for their total sphincter-sparing nature,preserving functional outcomes and quality of life.Despite gaining much scientific and clinical momentum,do these newer modalities live up to their promise?This review aims to critically appraise the latest evidence surrounding minimally invasive approaches,providing up-todate insights into the constantly evolving landscape of anal fistula management.Further long-term and comparative studies will nevertheless be needed to supplement the significantly heterogenous,retrospective analyses consolidated.
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BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.
文摘BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous tract between the gallbladder and the adjacent gastrointestinal tract.Chronic gallbladder inflammation can lead to tissue necrosis,perforation,and fistulogenesis.The most prevalent cause of CEF is chronic cholelithiasis,which rarely results from malignancy.Because the symptoms and laboratory findings associated with CEF are nonspecific,the condition is often misdiagnosed,pre-senting a challenge to the surgeon when detected intraoperatively.Therefore,a preoperative diagnosis of CEF is crucial.We present the case of a 57-year-old male with advanced gallbladder cancer(GBC)who arrived at the emergency room with persistent vomiting,abdominal pain,and diarrhea.An abdominopelvic computed tomography scan revealed a contracted gallbladder with bubbles in the fundus connected to the second por-tion of the duodenum and transverse colon.We suspected that GBC had invaded the adjacent gastrointestinal tract through a cholecystoduodenal fistula(CDF)or a cholecystocolonic fistula(CCF).He underwent multiple examinations,including esophagogastroduodenoscopy,an upper gastrointestinal series,colo-noscopy,and magnetic resonance cholangiopancreatography;the results of these tests con-firmed a diagnosis of synchronous CDF and CCF.The patient underwent a Roux-en-Y gastrojejunostomy and loop ileostomy to address the severe adhesions that were previously observed to cover the second portion of the duodenum and hepatic flexure of the colon.His symptoms improved with supportive treatment while hospitalized.He initiated oral targeted therapy with lenvatinib for further anticancer treatment.CONCLUSION The combination of imaging and surgery can enhance preoperative diagnosis and alleviate symptoms in patients with GBC complicated by CEF.
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 This study aimed to compare and analyze risk factors for pancreatic fistula following pancreaticoduodenectomy(PD)using different definition criteria,and to develop a predictive model for standardized pancreatic fistula risk assessment.AIM To identify and compare risk factors for postoperative pancreatic fistula(POPF)following PD using both the 2005 International Study Group of Pancreatic Fistula and updated 2016 International Study Group on Pancreatic Surgery diagnostic criteria,and to develop a clinically applicable predictive model based on objective preoperative parameters for standardized pancreatic fistula risk assessment and perioperative management optimization.METHODS We conducted a retrospective analysis of 303 patients who underwent PD at CR&WISCO General Hospital between January 2017 and May 2023.POPF cases were classified according to both previous and updated diagnostic standards.For statistical analysis,we employed t-tests or Mann-Whitney U tests for continuous variables andχ^(2) tests for categorical data.To identify risk factors associated with POPF under both classification systems,we performed univariate and multivariate logistic regression analyses.RESULTS Univariate analysis identified several factors associated with POPF:Main pancreatic duct diameter(χ^(2)=31.641,P<0.001),main pancreatic duct index(χ^(2)=52.777,P<0.001),portal vein invasion(χ^(2)=6.259,P=0.012),intra-abdominal fat thickness(χ^(2)=7.665,P=0.006),preoperative biliary drainage(χ^(2)=5.999,P=0.014),pancreatic characteristics(χ^(2)=5.544,P=0.019),pancreatic resection margin thickness(t=2.055,P=0.032),pancreatic computed tomography(CT)value(t=-3.224,P=0.002),and preoperative blood amylase level(Z=-2.099,P=0.036).Multivariate logistic regression identified three independent risk factors:Main pancreatic duct index[odds ratio(OR)=0.000,95%confidence interval(CI):0.000-0.011],pancreatic cancer[OR=4.843,95%CI:1.285-18.254],and pancreatic CT value[OR=0.869,95%CI:0.806-0.937](all P<0.05).CONCLUSION The main pancreatic duct index and pancreatic CT value are strongly correlated with pancreatic fistula development after PD.
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.
