DOCSLIB.ORG

Management of Afferent Loop Obstruction: Reoperation Or Endoscopic and Percutaneous Interventions

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Afferent Loop Obstruction: Reoperation Or Endoscopic and Percutaneous Interventions See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/282163026 Management of afferent loop obstruction: Reoperation or endoscopic and percutaneous interventions Article in World Journal of Gastrointestinal Surgery · September 2015 DOI: 10.4240/wjgs.v7.i9.190 CITATIONS READS 32 427 2 authors, including: Konstantinos Tsalis Aristotle University of Thessaloniki 115 PUBLICATIONS 976 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Laparoscopic liver resection using ICG green visualization of hepatic structures View project Laparoscopic liver resection using ICG green visualization of hepatic structures View project All content following this page was uploaded by Konstantinos Tsalis on 26 May 2017. The user has requested enhancement of the downloaded file. Submit a Manuscript: http://www.wjgnet.com/esps/ World J Gastrointest Surg 2015 September 27; 7(9): 190-195 Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx ISSN 1948-9366 (online) DOI: 10.4240/wjgs.v7.i9.190 © 2015 Baishideng Publishing Group Inc. All rights reserved. MINIREVIEWS Management of afferent loop obstruction: Reoperation or endoscopic and percutaneous interventions? Konstantinos Blouhos, Konstantinos Andreas Boulas, Konstantinos Tsalis, Anestis Hatzigeorgiadis Konstantinos Blouhos, Konstantinos Andreas Boulas, Anestis Abstract Hatzigeorgiadis, Department of General Surgery, General Hospital of Drama, 66100 Drama, Greece Afferent loop obstruction is a purely mechanical comp- lication that infrequently occurs following construction Konstantinos Tsalis, D’ Surgical Department, “G. Papanikolaou” of a gastrojejunostomy. The operations most commonly Hospital, Medical School, Aristotle University of Thessaloniki, associated with this complication are gastrectomy 54645 Thessaloniki, Greece with Billroth Ⅱ or Roux-en-Y reconstruction, and pancreaticoduodenectomy with conventional loop or Author contributions: Blouhos K designed the research; Boulas Roux-en-Y reconstruction. Etiology of afferent loop KA performed the literature research and wrote the paper; obstruction includes: (1) entrapment, compression Hatzigeorgiadis A substantially contributed in editing the English and kinking by postoperative adhesions; (2) internal language of the manuscript; Tsalis K and Hatzigeorgiadis A made herniation, volvulus and intussusception; (3) stenosis critical revisions related to important intellectual content of the due to ulceration at the gastrojejunostomy site and manuscript and had the final approval of the version of the article radiation enteritis of the afferent loop; (4) cancer to be published. recurrence; and (5) enteroliths, bezoars and foreign bodies. Acute afferent loop obstruction is associated with Conflict-of-interest statement: None. complete obstruction of the afferent loop and represents a surgical emergency, whereas chronic afferent loop Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external obstruction is associated with partial obstruction. reviewers. It is distributed in accordance with the Creative Abdominal multiple detector computed tomography is Commons Attribution Non Commercial (CC BY-NC 4.0) license, the diagnostic study of choice. CT appearance of the which permits others to distribute, remix, adapt, build upon this obstructed afferent loop consists of a C-shaped, fluid- work non-commercially, and license their derivative works on filled tubular mass located in the midline between the different terms, provided the original work is properly cited and abdominal aorta and the superior mesenteric artery with the use is non-commercial. See: http://creativecommons.org/ valvulae conniventes projecting into the lumen. The licenses/by-nc/4.0/ cornerstone of treatment is surgery. Surgery includes: (1) adhesiolysis and reconstruction for benign causes; Correspondence to: Konstantinos Andreas Boulas, MD, and (2) by-pass or excision and reconstruction for ma- MSc, Department of General Surgery, General Hospital of lignant causes. However, endoscopic enteral stenting, Drama, End of Hippokratous Street, 66100 Drama, transhepatic percutaneous enteral stenting and direct Greece. [email protected] percutaneous tube enterostomy have the principal role Telephone: +30-693-7265675 in management of malignant and radiation-induced Fax: +30-251-3501559 obstruction. Nevertheless, considerable limitations exist as a former Roux-en-Y reconstruction limits endoscopic Received: March 23, 2015 access to the afferent loop and percutaneous appro- Peer-review started: March 26, 2015 aches for enteral stenting and tube enterostomy have First decision: June 3, 2015 Revised: June 21, 2015 only been reported in the literature as isolated cases. Accepted: July 21, 2015 Article in press: July 23, 2015 Key words: Afferent loop; Obstruction; Reoperation; Published online: September 27, 2015 Endoscopy; Enterostomy WJGS|www.wjgnet.com 190 September 27, 2015|Volume 7|Issue 9| Blouhos K et al . Management of afferent loop obstruction © The Author(s) 2015. Published by Baishideng Publishing of ALO (Table 1). Risk factors for ALO include: (1) Group Inc. All rights reserved. Redundant (longer than 30-40 cm) and antecolic afferent loops which are more prone to kinking, volvulus, and Core tip: Management strategy of afferent loop entrapment by adhesions; and (2) Improperly closed obstruction (ALO) depends on: (1) the benign or mesocolic defects which predispose to internal herniation malignant nature of the obstruction. ALO caused by of the retrocolic afferent loop[9]. a benign lesion needs definitive repair of the primary cause by surgery. ALO caused by a malignant lesion needs palliative treatment (percutaneous and endoscopic INCIDENCE interventions, by-pass surgery) or excision; and (2) the The incidence of ALO after distal gastrectomy with site of obstruction. An obstruction at the inframesocolic Billroth Ⅱ or Roux-en-Y reconstruction has been reported portion of the afferent loop can be easily reconstructed, [10] to be 0.3%-1.0% . Although there are several specific whereas an obstruction at the supramesocolic portion predisposing factors for ALO following laparoscopic ga- needs copious mobilization and may require revision strectomy such as partial omentectomy and antecolic of the hepaticojejunostomy or pancreaticojejunostomy anastomosis, the incidence of ALO after open and and/or a modified Puestow procedure in the setting of a laparoscopic surgery is similar. Kim et al[11] in their re- preceded pancreaticoduodenectomy. trospective cohort study, reported 4 (1.01%) patients who developed ALO among 386 gastric cancer patients Blouhos K, Boulas KA, Tsalis K, Hatzigeorgiadis A. Man- submitted to laparoscopic distal gastrectomy with Bi- agement of afferent loop obstruction: Reoperation or endoscopic llrothⅡ reconstruction. The interval between the initial and percutaneous interventions? World J Gastrointest Surg gastrectomy and the operation for ALO ranged from 4 2015; 7(9): 190-195 Available from: URL: http://www.wjgnet. to 540 d (median 33 d). The causes of ALO included com/1948-9366/full/v7/i9/190.htm DOI: http://dx.doi.org/10.4240/ adhesions in 2 patients and internal herniation in 2 wjgs.v7.i9.190 patients. All patients recovered following emergency operations[11]. Aoki et al[12] in their retrospective cohort study, reported 4 (0.2%) patients who developed ALO among 1908 gastric cancer patients submitted to distal DEFINITIONS gastrectomy with Roux-en-Y reconstruction. The causes of the ALO included internal herniation in two patients, Creation of a gastrojejunostomy leaves a segment of adhesions in one patient, and peritoneal recurrence in proximal small bowel, most commonly consisting of one patient. The interval between the initial gastrectomy duodenum and proximal jejunum, lying upstream from and emergency operations for ALO ranged from 3 wk to the gastrojejunostomy. This limb of intestine conducts bile, 2 years (median 5 mo). All patients recovered following pancreatic juices, and other proximal intestinal secretions emergency operations. toward the gastrojejunostomy and is termed the afferent There are limited data on the incidence of ALO after [1] loop . Afferent loop obstruction (ALO) is a purely pancreaticoduodenectomy, especially among long-term mechanical complication that infrequently occurs following pancreatic cancer survivors (> 2 years). In one of the construction of a gastrojejunostomy. The operations most few studies in the literature, Pannala et al[13] evaluated commonly associated with this complication include total the incidence of ALO in pancreatic cancer patients su- gastrectomy with loop esophagojejunostomy and simple bmitted to pancreaticoduodenectomy. Pannala et al[13] or pouch Roux-en-Y reconstruction, partial gastrectomy in their retrospective cohort study, reported 24 (13%) with Billroth Ⅱ and Roux-en-Y reconstruction, and patients who developed ALO among 186 pancreatic pancreaticoduodenectomy with conventional loop and cancer patients treated with pancreaticoduodenectomy. Roux-en-Y reconstruction performed for treatment of Median time to diagnosis was 1.2 years (range 0.03-12.3 [2] benign and malignant causes . years). Obstruction was primarily caused by recurrent pancreatic cancer in 8 patients (33%) and radiation enteritis of the afferent loop in 9 patients (38%)[13]. ETIOLOGY Causes of ALO include: (1) Entrapment, compression and kinking of the afferent loop by postoperative
Load more

Recommended publications
  • Seer Program Code Manual
    THE SEER PROGRAM CODE MANUAL Revised Edition June 1992 CANCER STATISTICS BRANCH SURVEILLANCE PROGRAM DIVISION OF CANCER PREVENTION AND CONTROL NATIONAL CANCER INSTITUTE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE NATIONAL INSTITUTES OF HEALTH Effective Date: Cases Diagnosed January 1, 1992 The SEER Program Code Manual Revised Edition June 1992 Editors Jack Cunningham Lynn Ries Benjamin Hankey Jennifer Seiffert Barbara Lyles Evelyn Shambaugh Constance Percy Valerie Van Holten Acknowledgements The editors wish to acknowledge the assistance of Terry Swenson, Maureen Troublefield, Diane Licitra, and Jerome Felix of Information Management Services, Inc., in the preparation of the SEER Program Code Manual. The editors also wish to acknowledge the assistance of Dr. John Berg in preparation of the section on multiple primary determination for lymphatic and hematopoietic diseases. TABLE OF CONTENTS PREFACE TO THE REVISED EDITION ....................................... vii COMPUTER RECORD FORMAT ............................................ 1 INTRODUCTION AND GENERAL INSTRUCTIONS .............................. 5 REFERENCES .......................................................... 37 SEER CODE SUMMARY .................................................. 39 I BASIC RECORD IDENTIFICATION ...................................... 57 1.01 SEER Participant ........................................... 58 1.02 Case Number .............................................. 59 1.03 Record Number ............................................ 60
    [Show full text]
  • Safe, Simple & Efficient Totally Laparoscopic Billroth II Gastrectomy
    China Gastric Cancer Research Highlight Safe, simple & efficient totally laparoscopic Billroth II gastrectomy by only stapling devices Kirubakaran Malapan1, Chih-Kun Huang1,2 1Department of Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung City, 82445, Taiwan; 2The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China Corresponding to: Chih-Kun Huang, M.D., Director. Department of Bariatric and Metabolic International Surgery Centre, E-da Hospital, No 1, E-Da Rd., Yan-chau District, Kaohsiung City, Taiwan, 82445. Email: [email protected]. Submitted May 08, 2013. Accepted for publication May 28, 2013. doi: 10.3978/j.issn.2224-4778.2013.05.28 Scan to your mobile device or view this article at: http://www.amepc.org/tgc/article/view/2081/2870 Gastric cancer is the fourth most common cancer diagnosis combination of both. Du J et al. reported their experience worldwide in men with an expected incidence of 640,000 of intracorporeal gastrojejunal anastomosis using a two cases and the fifth most common in women with an expected layer hand-sewn technique (9), whereas Ruiz et al. described incidence of 350,000 cases in 2011 (1). Approximately, 8% a 4-layer closure using continuous absorbable sutures (10). of total cases and 10% of annual cancer deaths worldwide Hand-sewn anastomosis requires advanced laparoscopic are attributed to this dreaded disease. Surgical resection skills and is considered to be time-consuming, but has offers the only durable cure from gastric cancer (2). Since the advantage of avoiding the risk of wound infection and the introduction of Billroth’s procedure of gastrectomy and hernias, which occur as a result of manipulation by a circular reconstruction in 1881, surgical techniques in gastric surgery stapler.
    [Show full text]
  • Electrohydraulic Lithotripsy of an Impacted Enterolith Causing Acute Afferent Loop Syndrome
    CASE REPORT Print ISSN 2234-2400 / On-line ISSN 2234-2443 Clin Endosc 2014;47:367-370 http://dx.doi.org/10.5946/ce.2014.47.4.367 Open Access Electrohydraulic Lithotripsy of an Impacted Enterolith Causing Acute Afferent Loop Syndrome Young Sin Cho, Tae Hoon Lee, Soon Oh Hwang, Sunhyo Lee, Yunho Jung, Il-Kwun Chung, Sang-Heum Park and Sun-Joo Kim Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea Afferent loop syndrome caused by an impacted enterolith is very rare, and endoscopic removal of the enterolith may be difficult if a stricture is present or the normal anatomy has been altered. Electrohydraulic lithotripsy is commonly used for endoscopic fragmenta- tion of biliary and pancreatic duct stones. A 64-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy presented with acute, severe abdominal pain for a duration of 2 hours. Initially, he was diagnosed with acute pancreatitis because of an elevated amy- lase level and pain, but was finally diagnosed with acute afferent loop syndrome when an impacted enterolith was identified by comput- ed tomography. We successfully removed the enterolith using direct electrohydraulic lithotripsy conducted using a transparent cap-fitted endoscope without complications. We found that this procedure was therapeutically beneficial. Key Words: Afferent loop syndrome; Enterolith; Electrohydraulic lithotripsy INTRODUCTION cutaneous enterostomy has been considered as a palliative method. However, maturation of the percutaneous tract can Afferent loop syndrome (ALS) is characterized by the ac- occur very slowly prior to the procedure, and may cause dis- cumulation of bile acid and pancreatic juice, and distention comfort and pain.
    [Show full text]
  • Coders' Desk Reference for ICD-10-PCS Procedures
    2 0 2 DESK REFERENCE 1 ICD-10-PCS Procedures ICD-10-PCS for DeskCoders’ Reference Coders’ Desk Reference for ICD-10-PCS Procedures Clinical descriptions with answers to your toughest ICD-10-PCS coding questions Sample 2021 optum360coding.com Contents Illustrations ..................................................................................................................................... xi Introduction .....................................................................................................................................1 ICD-10-PCS Overview ...........................................................................................................................................................1 How to Use Coders’ Desk Reference for ICD-10-PCS Procedures ...................................................................................2 Format ......................................................................................................................................................................................3 ICD-10-PCS Official Guidelines for Coding and Reporting 2020 .........................................................7 Conventions ...........................................................................................................................................................................7 Medical and Surgical Section Guidelines (section 0) ....................................................................................................8 Obstetric Section Guidelines (section
    [Show full text]
  • Subtotal Gastrectomy, Antrectomy, Billroth II and Roux-En-Y
    Subtotal Gastrectomy, Antrectomy, Billroth II and Roux-en-Y Reconstruction and Local Excision in Complicated Gastric Ulcers Joachim Ruh, Enrique Moreno Gonzalez, Christoph Busch Subtotal Gastrectomy Introduction In subtotal gastrectomy, 75% of the stomach is resected. The passage is reconstructed using the proximal jejunum either as an omega loop or as a Roux-en-Y reconstruction. Indications and Contraindications Indications ■ Gastric carcinoma of the intestinal type in the distal part of the stomach ■ Complicated ulcers of the distal part of the stomach and the duodenum Preoperative Investigations/Preparation for the Procedure ■ In gastric carcinoma, the carcinoma should be clearly identified as an intestinal type in histopathological work-up. ■ The location of the carcinoma/ulcerative lesion should be clearly identified by means of endoscopy. 144 SECTION 2 Esophagus, Stomach and Duodenum Procedure STEP 1 Abdominal incision and mobilization of the stomach For laparotomy, a transverse epigastric incision should be chosen. In case of inadequate exposure, this incision should be extended with a midline incision. This approach provides adequate exposure up to the gastroesophageal junction. Alternatively, a midline laparotomy is adequate. Following the exploration of the whole abdomen for metastatic disease in case of gastric cancer, the gastric lesion should be located. The greater omentum of the stomach is dissected from the transverse colon, exposing the posterior wall of the stomach and opening the lesser sac (A). A Subtotal Gastrectomy, Antrectomy, Billroth II and Roux-en-Y Reconstruction and Local Excision in Complicated Gastric Ulcers 145 STEP 1 (continued) Abdominal incision and mobilization of the stomach The pylorus is freed from adjacent connective tissue (B), and the omentum minus is opened along the minor curvature.
    [Show full text]
  • Megaesophagus Was Complicated with Billroth I Gastroduodenostomy in a Cat
    NOTE Surgery Megaesophagus was Complicated with Billroth I Gastroduodenostomy in a Cat Shunsuke SHIMAMURA1), Miki SHIMIZU1), Masayuki KOBAYASHI1), Hidehiro HIRAO1), Ryou TANAKA1) and Yoshihisa YAMANE1) 1)Department of Veterinary Surgery, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3–5–8 Saiwai-cho, Fuchu- shi, Tokyo 183–8509, Japan (Received 3 February 2005/Accepted 10 May 2005) ABSTRACT. A seven-year-old, female, domestic short hair cat was presented with a history of chronic anorexia. Radiographic examination revealed a large space-occupying calcified mass in the abdominal cavity. The mass was located in pylorus and did not extend into the duodenum and surrounding tissues. Billroth I gastroduodenostomy was conducted to remove the mass. Histopathological examination of the mass showed a lymphoma. Although Recovery following the operation was excellent, the patient showed intermittent vomiting unrelated to feeding. Radiographical examination revealed a megaesophagus, which was assumed to be a complication of the Billroth I procedure, since the condition was not observed before the procedure. KEY WORDS: billroth I, complication, megaesophagus. J. Vet. Med. Sci. 67(9): 935–937, 2005 Billroth I is one of the most common gastroduodenos- nature and extent of the lesion. The mass was seen occupy- tomy procedures used to remove the pylorus. After removal ing the upper quadrant of the abdomen and involved the of the affected part, the remaining parts of the stomach and pylorus area. However the mass was not seen infiltrating duodenum are attached together using end-to-end anasto- the duodenum, surrounding tissues, and regional lymph mosis [1, 10, 14]. The procedure is also used to remove gas- node.
    [Show full text]
  • Distal Gastrectomy with Billroth II Reconstruction Is Associated with Oralization of Gut Microbiome and Intestinal Inflammation: a Proof-Of-Concept Study
    Ann Surg Oncol (2021) 28:1198–1208 https://doi.org/10.1245/s10434-020-08678-1 ORIGINAL ARTICLE – TRANSLATIONAL RESEARCH AND BIOMARKERS Distal Gastrectomy with Billroth II Reconstruction is Associated with Oralization of Gut Microbiome and Intestinal Inflammation: A Proof-of-Concept Study Angela Horvath, PhD1, Augustinas Bausys, MD2,3,6 , Rasa Sabaliauskaite, PhD4, Eugenijus Stratilatovas, MD, PhD2, Sonata Jarmalaite, PhD4, Burkhard Schuetz, PhD5, Philipp Stiegler, MD, PhD6, Rimantas Bausys, MD, PhD2,3, Vanessa Stadlbauer, MD, PhD1, and Kestutis Strupas, MD, PhD3 1Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria; 2Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania; 3Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; 4National Cancer Institute, Vilnius, Lithuania; 5Biovis Diagnostik, Limburg, Germany; 6Department of Transplantation Surgery, Medical University of Graz, Graz, Austria ABSTRACT Results. Microbiome oralization following SGB2 was Background. Subtotal gastrectomy with Billroth II defined by an increase in Escherichia–Shigella, Entero- reconstruction (SGB2) results in increased gastric pH and coccus, Streptococcus, and other typical oral cavity diminished gastric barrier. Increased gastric pH following bacteria (Veillonella, Oribacterium, and Mogibacterium) PPI therapy has an impact on the gut microbiome, abundance. The fecal calprotectin was increased in the intestinal inflammation, and possibly patient health. If SGB2 group [100.9 (52.1; 292) vs. 25.8 (17; 66.5); similar changes are present after SGB2, these can be rel- p = 0.014], and calprotectin levels positively correlated evant for patient health and long-term outcomes after with the abundance of Streptococcus (rs = 0.639; padj = surgery.
    [Show full text]
  • Totally Laparoscopic Distal Gastrectomy with D2
    Int. J. Med. Sci. 2013, Vol. 10 1462 Ivyspring International Publisher International Journal of Medical Sciences 2013; 10(11):1462-1470. doi: 10.7150/ijms.6632 Research Paper Totally Laparoscopic Distal Gastrectomy with D2 Lymphadenectomy and Billroth II Gastrojejunostomy for Gastric Cancer: Short- and Medium-term Results of 139 Consecutive Cases from a Single Institution Ke Chen*, Xiaowu Xu*, Yiping Mou, Yu Pan, Renchao Zhang, Yucheng Zhou, Di Wu, Chaojie Huang Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-invasive Surgery, Zhejiang University, Hangzhou, China * Ke Chen and Xiaowu Xu contributed equally to this work. Corresponding author: Yiping Mou, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Mi- cro-invasive Surgery, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China. Tel: +86-571-86006952, Fax: +86-571-86044817, E-mail: [email protected] © Ivyspring International Publisher. This is an open-access article distributed under the terms of the Creative Commons License (http://creativecommons.org/ licenses/by-nc-nd/3.0/). Reproduction is permitted for personal, noncommercial use, provided that the article is in whole, unmodified, and properly cited. Received: 2013.05.07; Accepted: 2013.08.16; Published: 2013.08.28 Abstract Objective: The goal of this study was to investigate the feasibility, safety, and associated 3-year survival outcomes of the totally laparoscopic distal gastrectomy (TLDG) for the treatment of gastric cancer. Methods: Herein, we analyzed the clinical data from 139 consecutive patients with gastric cancer who received TLDG at our institution from March of 2007 to March of 2013.
    [Show full text]
  • Reconstruction Method After Pancreaticoduodenectomy. Idea to Prevent Serious Complications
    JOP. J Pancreas (Online) 2012 Jan 10; 13(1):1-6. REVIEW Reconstruction Method After Pancreaticoduodenectomy. Idea to Prevent Serious Complications Shinji Osada, Hisashi Imai, Yoshiyuki Sasaki, Yoshihiro Tanaka, Kenichi Nonaka, Kazuhiro Yoshida Surgical Oncology, Gifu University School of Medicine. Gifu city, Japan ABSTRACT Pancreatic fistula after pancreaticoduodenectomy represents a critical trigger of potentially life-threatening complications and is also associated with markedly prolonged hospitalization. Many arguments have been proposed for the method to anastomosis the pancreatic stump with the gastrointestinal tract, such as invagination vs. duct-to-mucosa, Billroth I (Imanaga) vs. Billroth II (Whipple and/or Child) or pancreaticogastrostomy vs. pancreaticojejunostomy. Although the best method for dealing with the pancreatic stump after pancreaticoduodenectomy remains in question, recent reports described the invagination method to decrease the rate of pancreatic fistula significantly compared to the duct-to-mucosa anastomosis. In Billroth I reconstruction, more frequent anastomotic failure has been reported, and disadvantages of pancreaticogastrostomy have been identified, including an increased incidence of delayed gastric emptying and of pancreatic duct obstruction due to overgrowth by the gastric mucosa. We review recent several safety trials and methods of treating the pancreatic stump after pancreaticoduodenectomy, and demonstrate an operative procedure with its advantage of the novel reconstruction method due to our experiences.
    [Show full text]
  • FORDS Manual 2003
    ACILITY ONCOLOGY REGISTRY DATA STANDARDS FACILITY ONCOLOGY REGISTRY DATA STANDARDS © 2002 AMERICAN COLLEGE OF SURGEONS All Rights Reserved Table of Contents Preface .............................................................. vii Acknowledgments ......................................................... xiii SECTION ONE: Case Eligibility, Cancer Identification, and Overview of Coding Principles .................................... 1–28 Case Eligibility ......................................................... 3 Malignancies Required by the CoC to be Accessioned, Abstracted, and Followed ... 3 Reportable-by-Agreement Cases ........................................ 4 Cases Not Required by the CoC to be Accessioned .......................... 4 Class of Case ....................................................... 4 Cancer Identification .................................................... 7 Unique Patient Identifier Codes ......................................... 7 Cancer Identification ................................................. 7 Overview of Coding Principles ............................................. 15 Patient Address and Residency Rules ..................................... 15 Comorbidities and Complications ........................................ 15 Stage of Disease at Initial Diagnosis ...................................... 16 First Course of Treatment .............................................. 18 Case Administration .................................................. 26 SECTION TWO: Coding Instructions ........................................29–235
    [Show full text]
  • Management of Difficult Gallstones Obstructing Bile Ducts
    Case report Case series: Management of difficult gallstones obstructing bile ducts Martin Gómez Zuleta MD1, Oscar Gutiérrez MD2, Mario Jaramillo, MD3 1 Gastroenterologist in the Gastroenterology Unit of Abstract the Faculty of Medicine at the National University of Colombia. Gastroenterologist Hospital El Tunal, Standard endoscopic techniques of sphincterotomy combined with Dormia basket and/or balloon catheteriza- UGEC. Bogotá, Colombia tion can manage 85-90% of the gallstones found obstructing bile ducts. However, when there are several large 2 Specialist Assigned to the Gastroenterology calculi, when a stone is in an unusual location, or when there are anatomic abnormalities of the bile duct, they and Digestive Endoscopy in Colsanitas and the Clínica del Occidente, Professor (r) of the National become refractory to standard management. Other therapeutic modalities become essential for management University of Colombia in Bogotá, Colombia of these gallstones. Large or impacted calculi are generally handled with fragmentation techniques such as 3 Internist and Gastroenterology resident (final year) mechanical lithotripsy. When this fails, electrohydraulic lithotripsy (LEH) or laser lithotripsy (LL) guided by at the National University of Colombia in Bogotá, Colombia conventional cholangioscopy are usually resorted to. More recently, a system of direct cholangioscopy called Spyglass has been introduced. Endoscopic papillary dilation with a large balloon has also proven useful for ......................................... management of large and multiple calculi. In cases with altered anatomy that makes access to the papilla diffi- Received: 28-11-14 Accepted: 20-10-15 cult, the preferred technique is a transhepatic approach combined with percutaneous fragmentation. In elderly patients whose overall condition is poor, the placement of a biliary stent is the definite choice of technique because it can improve the patient’s condition to make possible further endoscopic therapy.
    [Show full text]
  • Application of Double Needle-Double Layer Continuous Manual Suture to Complete Digestive Tract Reconstruction in Totally Laparoscopic Distal Gastrectomy
    Application of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy Xinsheng Zhang the second aliated hospital of Dalian Medical University https://orcid.org/0000-0002-8551-3993 weibin zhang the central hospital of jinzhou menglang yuan Dalian Medical University xiaomeng shi Dalian Medical University HONGYI CHEN Dalian Medical University zhen feng Dalian Medical University zihao chen Dalian Medical University dunbo liu Dalian Medical University enjun yan Dalian Medical University shuangyi ren ( [email protected] ) https://orcid.org/0000-0002-5713-6983 Research article Keywords: Distal gastric cancer, Continuous manual suture, Digestive tract reconstruction, Totally laparoscopic distal gastrectomy, Double needle-double layer continuous manual suture Posted Date: May 8th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-24971/v1 Page 1/20 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 2/20 Abstract Background Retrospectively register the clinical data of distal gastric cancer patients who received surgical treatment, discuss the safety and feasibility of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy. Methods Review the clinical data of 41 patients with distal gastric cancer from the gastroenterology department of the Second Aliated Hospital of Dalian Medical University, from September 2018 to August 2019, were accepted the totally laparoscopic distal gastrectomy. During the operation, the method of double needle- double layer continuous manual suture was used for Billroth I type anastomosis to complete digestive tract reconstruction. The peri-operative clinical information and postoperative follow-up information were collected for analysis, and the clinical application value was evaluated.
    [Show full text]