Objective: To present our technique of laparoscopic repair of giant para-oesophageal hernia with biological prosthesis (porcine dermis). Method: Our technique involves creating a pneumoperitoneum with standard port pl...Objective: To present our technique of laparoscopic repair of giant para-oesophageal hernia with biological prosthesis (porcine dermis). Method: Our technique involves creating a pneumoperitoneum with standard port placement for anti-reflux surgery, mediastinal sac dissection and excision, crura-plasty, tension free placement of the biological prosthesis for hiatal reinforcement, fundoplication and gastropexy. Conclusion: Our technique of laparoscopic repair of giant para-oesophageal hernia with biological mesh is feasible and safe with acceptable morbidity and outcome.展开更多
Background and aims:Peristomal wound infections are common complications of percutaneous endoscopic gastrostomy(PEG).The Funada-style gastropexy device has two parallel needles with a wire loop and suture thread,and w...Background and aims:Peristomal wound infections are common complications of percutaneous endoscopic gastrostomy(PEG).The Funada-style gastropexy device has two parallel needles with a wire loop and suture thread,and was developed about 20 years ago in Japan.This kit has allowed us to perform dual gastropexy very easily;PEG with gastropexy has become a very popular technique in Japan.The present study aimed to compare the advantages and disadvantages of PEG with the gastropexy technique with the standard‘pull’method.Methods:We retrospectively reviewed 182 consecutive,non-randomized patients undergoing PEG in our hospital,and a comparative analysis was made between the gastropexy(87 patients)and non-gastropexy(95 patients)groups.Results:The rates of patients having erythema(11.6%vs.47.9%;P<0.001),exudates(2.3%vs.14.9%;P<0.01)and infection(0%vs.6.4%;P紏0.01)in the peristomal area were lower in the gastropexy than in the non-gastropexy group.The rate of minor bleeding from the peristomal area was higher in the gastropexy than in the non-gastropexy group(12.8%vs.2.1%;P<0.01),but no patient required a blood transfusion.Mean procedure time was longer in the gastropexy group than in the non-gastropexy group(31 vs.24 min;P<0.001).The 30-day mortality rates were 4.7%and 5.3%respectively,and these deaths were not related to the gastrostomy procedure.Conclusion:PEG with gastropexy markedly reduces peristomal inflammation.Although minor bleeding and a longer procedure time were disadvantages,there were no severe complications.The findings suggested that PEG with Funada-style gastropexy was a safe and feasible method for reducing early complications of PEG.展开更多
Hiatal hernia(HH) contents commonly include stomach, transverse colon, small intestine, and spleen but herniation of the pancreas is an extremely rare phenomenon.79-year-old female with multiple comorbidities presente...Hiatal hernia(HH) contents commonly include stomach, transverse colon, small intestine, and spleen but herniation of the pancreas is an extremely rare phenomenon.79-year-old female with multiple comorbidities presented to emergency department with complaints of weight loss for 6 mo and abdominal pain for one day. Physical examination revealed cachectic and dehydrated female and bowel sounds could be auscultated on the right side of chest. Computed tomography of the chest and abdomen revealed interval enlargement of a massive HH,containing stomach and much of the bowel as well as pancreas and distal extrahepatic biliary duct, probably responsible for obstructive effect upon same. There was increased prominence of the pancreas consistent with pancreatitis. There was a large HH causing obstructive effect with dilated biliary system along gall bladder wall edema and pancreatitis. Patient clinical status improved with conservative treatment.HH presenting with acute pancreatitis is a serious diagnostic and therapeutic challenge. The initial management is conservative, even if the abdominal content has herniated to mediastinum. The incentive spirometry can be utilized in the conservative of the large HH. After stabilization of the patient, elective surgical intervention remains the mainstay of the management. Definitive treatment will vary from case to case depending on the acuity of situation and comorbidities.展开更多
Gastrostomy tube placement is a procedure that achieves enteral access for nutrition,decompression,and medication administration.Preprocedural evaluation and selection of patients is necessary to provide optimal benef...Gastrostomy tube placement is a procedure that achieves enteral access for nutrition,decompression,and medication administration.Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events(AEs).Appropriate indications,contraindications,ethical considerations,and comorbidities of patients referred for gastrostomy placement should be weighed and balanced.Additionally,endoscopist should consider either a transoral or transabdominal approach is appropriate,and radiologic or surgical gastrostomy tube placement is needed.However,medical history,physical examination,and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.展开更多
Background Gastric volvulus (GV) in children is a rare condition.This study reviewed management and outcomes of GV in the pediatric population.Methods MEDLINE/PubMed,Embase,and Google Scholar databases were searched f...Background Gastric volvulus (GV) in children is a rare condition.This study reviewed management and outcomes of GV in the pediatric population.Methods MEDLINE/PubMed,Embase,and Google Scholar databases were searched for studies in English regarding GV in patients < 18 years old between 2008 and 2017,selected by two reviewers.Results were presented as percentages and medians.Fisher's exact test was used to evaluate categorical variables,and Bonferroni correction was applied for multiple comparisons.Results Ninety-seven papers with 125 patients were included.The median age was 24 months,with slightly female preponderance.Vomiting was the most common symptom and acute presentation occurred in the majority of cases.History of previous surgery/abdominal trauma was described in 12 and 3 children,respectively.Radiology was diagnostic for GV in most cases.The initial management was surgical in the majority of cases,with most of them including gastropexy,gastrostomy,or gastric resection.Mesenteroaxial GV was associated with acute presentation (P =0.004) and the latter with ischemia (P < 0.01).Complications occurred in 23 (18.9%) children,esophageal stenosis being the most common.There were eight (6.4%) deaths,and only one recurrence 6 months after endoscopic management.The median follow-up period was 12 months.The inclusion of only case reports/case series,the incomplete reporting from papers,and the short followup were limitations of the study.Conclusions GV occurs at a median age of 24 months and requires high suspicion and prompt management,as mortality is considerable.The preferred surgical approach for GV includes variations of gastropexy.Esophageal stenosis is the most common morbidity post-GV management.展开更多
文摘Objective: To present our technique of laparoscopic repair of giant para-oesophageal hernia with biological prosthesis (porcine dermis). Method: Our technique involves creating a pneumoperitoneum with standard port placement for anti-reflux surgery, mediastinal sac dissection and excision, crura-plasty, tension free placement of the biological prosthesis for hiatal reinforcement, fundoplication and gastropexy. Conclusion: Our technique of laparoscopic repair of giant para-oesophageal hernia with biological mesh is feasible and safe with acceptable morbidity and outcome.
文摘Background and aims:Peristomal wound infections are common complications of percutaneous endoscopic gastrostomy(PEG).The Funada-style gastropexy device has two parallel needles with a wire loop and suture thread,and was developed about 20 years ago in Japan.This kit has allowed us to perform dual gastropexy very easily;PEG with gastropexy has become a very popular technique in Japan.The present study aimed to compare the advantages and disadvantages of PEG with the gastropexy technique with the standard‘pull’method.Methods:We retrospectively reviewed 182 consecutive,non-randomized patients undergoing PEG in our hospital,and a comparative analysis was made between the gastropexy(87 patients)and non-gastropexy(95 patients)groups.Results:The rates of patients having erythema(11.6%vs.47.9%;P<0.001),exudates(2.3%vs.14.9%;P<0.01)and infection(0%vs.6.4%;P紏0.01)in the peristomal area were lower in the gastropexy than in the non-gastropexy group.The rate of minor bleeding from the peristomal area was higher in the gastropexy than in the non-gastropexy group(12.8%vs.2.1%;P<0.01),but no patient required a blood transfusion.Mean procedure time was longer in the gastropexy group than in the non-gastropexy group(31 vs.24 min;P<0.001).The 30-day mortality rates were 4.7%and 5.3%respectively,and these deaths were not related to the gastrostomy procedure.Conclusion:PEG with gastropexy markedly reduces peristomal inflammation.Although minor bleeding and a longer procedure time were disadvantages,there were no severe complications.The findings suggested that PEG with Funada-style gastropexy was a safe and feasible method for reducing early complications of PEG.
文摘Hiatal hernia(HH) contents commonly include stomach, transverse colon, small intestine, and spleen but herniation of the pancreas is an extremely rare phenomenon.79-year-old female with multiple comorbidities presented to emergency department with complaints of weight loss for 6 mo and abdominal pain for one day. Physical examination revealed cachectic and dehydrated female and bowel sounds could be auscultated on the right side of chest. Computed tomography of the chest and abdomen revealed interval enlargement of a massive HH,containing stomach and much of the bowel as well as pancreas and distal extrahepatic biliary duct, probably responsible for obstructive effect upon same. There was increased prominence of the pancreas consistent with pancreatitis. There was a large HH causing obstructive effect with dilated biliary system along gall bladder wall edema and pancreatitis. Patient clinical status improved with conservative treatment.HH presenting with acute pancreatitis is a serious diagnostic and therapeutic challenge. The initial management is conservative, even if the abdominal content has herniated to mediastinum. The incentive spirometry can be utilized in the conservative of the large HH. After stabilization of the patient, elective surgical intervention remains the mainstay of the management. Definitive treatment will vary from case to case depending on the acuity of situation and comorbidities.
文摘Gastrostomy tube placement is a procedure that achieves enteral access for nutrition,decompression,and medication administration.Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events(AEs).Appropriate indications,contraindications,ethical considerations,and comorbidities of patients referred for gastrostomy placement should be weighed and balanced.Additionally,endoscopist should consider either a transoral or transabdominal approach is appropriate,and radiologic or surgical gastrostomy tube placement is needed.However,medical history,physical examination,and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.
文摘Background Gastric volvulus (GV) in children is a rare condition.This study reviewed management and outcomes of GV in the pediatric population.Methods MEDLINE/PubMed,Embase,and Google Scholar databases were searched for studies in English regarding GV in patients < 18 years old between 2008 and 2017,selected by two reviewers.Results were presented as percentages and medians.Fisher's exact test was used to evaluate categorical variables,and Bonferroni correction was applied for multiple comparisons.Results Ninety-seven papers with 125 patients were included.The median age was 24 months,with slightly female preponderance.Vomiting was the most common symptom and acute presentation occurred in the majority of cases.History of previous surgery/abdominal trauma was described in 12 and 3 children,respectively.Radiology was diagnostic for GV in most cases.The initial management was surgical in the majority of cases,with most of them including gastropexy,gastrostomy,or gastric resection.Mesenteroaxial GV was associated with acute presentation (P =0.004) and the latter with ischemia (P < 0.01).Complications occurred in 23 (18.9%) children,esophageal stenosis being the most common.There were eight (6.4%) deaths,and only one recurrence 6 months after endoscopic management.The median follow-up period was 12 months.The inclusion of only case reports/case series,the incomplete reporting from papers,and the short followup were limitations of the study.Conclusions GV occurs at a median age of 24 months and requires high suspicion and prompt management,as mortality is considerable.The preferred surgical approach for GV includes variations of gastropexy.Esophageal stenosis is the most common morbidity post-GV management.
