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Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas:Basic principles and recommendations

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World Journal of Gastroenterology 2023年第7期29卷 1173-1193页

作者： Victor Lira de Oliveira Alexandre Moraes Bestetti Roberto Paolo Trasolini Eduardo Guimaraes Hourneaux de Moura Diogo Turiani Hourneaux de Moura Serviço de Endoscopia Gastrointestinal Departamento de GastroenterologiaHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403010Brazil Division of Gastroenterology Hepatology and EndoscopyHarvard Medical SchoolBrigham and Women's HospitalBostonMA 021115United States

Post-surgical leaks and fistulas are the most feared complication of bariatric surgery.They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat.These two related conditions must be distinguished and characterized to guide the appropriate treatment.Leak is defined as a transmural defect with communication between the intra and extraluminal compartments,while fistula is defined as an abnormal communication between two epithelialized surfaces.Traditionally,surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates.However,with the development of novel devices and techniques,endoscopic therapy plays an increasingly essential role in managing these conditions.Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas.Several endoscopic techniques are available with different mechanisms of action,including direct closure,covering/diverting or draining.The treatment should be individualized by considering the characteristics of both the patient and the defect.Although there is a lack of high-quality studies to provide standardized treatment algorithms,this narrative review aims to provide a summary of the current scientific evidence and,based on this data and our extensive experience,make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.

关键词： Endoscopy Surgery Bariatric Gastrointestinal Fistulas leaks

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Endoscopic Management of leaks Following Laparoscopic Sleeve Gastrectomy: The Experience of IRCAD Taiwan

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Surgical Science 2020年第11期11卷 347-353页

作者： Chien-Hua Lin Jing-Jim Ou Yueh-Tsung Lee Hurng-Sheng Wu Sheng-Lei Yan Department of Surgery IRCAD Taiwan Chinese Taipei Department of Surgery Tri-Service General Hospital Chinese Taipei Division of Gastroenterology Department of Internal Medicine Chang-Bing Show Chwan Memorial Hospital Chinese Taipei

Background: To present the experience of management of leaks following laparoscopic sleeve gastrectomy for morbid obesity in Show-Chwan memorial Hospital. Patients and Methods: Laparoscopic sleeve gastrectomy is considered one of the surgical options for morbid obesity. It is effective, with an average loss of 50% of excessive weight after 2 years of follow-up. The first laparoscopic sleeve gastrectomy was performed in January 2010 at Show-Chwan Memorial Hospital. Between January 2010 and October 2016, 300 patients underwent laparoscopic sleeve gastrectomy for morbid obesity. There were 218 women and 82 men with a mean age of 35.4 years. Preoperative mean body weight was 90.7 kg and mean body mass index (BMI) was 37.3 kg/m2. Results: Mean operative time was 85 minutes. Mean hospital stay was 3.5 days. There were no deaths. There were 5 complications (1.67%): leakage of gastroesophageal junction. One patient was conservative treatment. Two patients were successfully treated by self-expandable metallic stents and the other two patients were treated with esophageal stent also, but failed and further treated with fibrin (Histoacryl) injection to the leak site to try to seal the fistula. In six months follow-up, mean BMI decreased from 37.3 to 29.2 kg/m2, and mean excess weight loss reached 42.8%. Conclusions: Laparoscopic sleeve gastrectomy is a beneficial operation in terms of excessive weight loss, with acceptably complications. The leaks were located in gastroesophageal junction mostly, and could be resolved with esophageal stent. For the patients failed in esophageal stents, we try Histoacryl injection to improve it.

关键词： Bariatric Surgery leaks Stent Histoacryl

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Quantitative Analysis Method for Corrosion and Patina Progression on Plumbing Components during Long-Term Connection leaks from Potable Water Supply Systems

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World Journal of Engineering and Technology 2019年第1期7卷 100-113页

作者： Abel Crean Geo Hazards Inc. Gainesville FL United States of America

The modern field of Forensic Engineering evaluates the origin, cause, and duration of failed building components. As many failed components are subject to insurance claims and legal probes, a scientific methodology for evaluating such events is inherently valuable. Due to the potential for widespread interior finish damage, failed plumbing supply components are commonly encountered during forensic evaluations. Plumbing pipes?themselves and properly soldered fittings rarely fail. Consequently, many failures correspond to mechanical fittings which form connections from pipes to plumbing fixtures.?The results of this study provide a scientific methodology to evaluate the duration of connection leaks by quantifying the extent of corrosion, patina, and accumulated deposits on various components?by creating and evaluating slow plumbing supply component connection leaks.

关键词： Building Science Forensic Engineer Plumbing leaks Corrosion Patina

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Effect of non-steroidal anti-inflammatory drugs on post-surgical complications against the backdrop of the opioid crisis

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Burns & Trauma 2018年第3期6卷 190-198页

作者： Hannah Zhao-Fleming Audrey Hand Kelly Zhang Robert Polak Armand Northcut Daron Jacob Sharmila Dissanaike Kendra P.Rumbaugh Department of Surgery Texas Tech University Health Sciences Center3601 4th StreetSTOP 8312LubbockTX 79430USA Burn Center of Excellence Texas Tech University Health Sciences CenterLubbockTXUSA School of Medicine Texas Tech University Health Sciences CenterLubbockTXUSA

The USA is currently going through an opioid crisis, associated with tremendous economic and societal impacts. In response to this crisis, healthcare professionals are looking for alternative pain management methods, and non-steroidal anti-inflammatory drugs (NSAIDs) are a sensible choice because of their effectiveness after surgical procedures. However, before surgeons start prescribing NSAIDs in place of opioids, it is crucial to first understand their potential post-surgical complications. The goal of this review is to summarize the data obtained through both animal and human studies, which suggest how a dramatic increase in NSAID use may affect these post-surgical complications. We first provide a short review outlining the mechanisms of action of NSAIDs, followed by a summary of animal studies, which show a trend towards the negative effects of NSAIDs on wound healing and an association between NSAID use and wound infections. Lastly, we present evidence from human studies on the association of NSAIDs with the following complications:anastomotic leaks, necrotizing soft tissue infections, bleeding complications, orthopedic injuries, wound healing, and cancer care. The human studies are much more variable in their conclusions as to whether NSAIDs are beneficial or not, with the only strong evidence showing that NSAIDs inhibit bone healing. This may partially be explained by male and female differences in response to NSAIDs as many animal studies showing the inhibitory effects of NSAIDs were performed on females, while al the human studies were performed with both sexes. We conclude that strong caution should be used in the prescription of NSAIDs, especially in female patients, but larger scale studies are warranted before solid recommendations can be made.

关键词： NSAIDs Opioids Anastomotic leaks Necrotizing soft tissue infections Bleeding Orthopedic injuries Wound healing Cancer care non-steroidal anti-inflammatory

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Evaluation of fully covered self-expanding metal stents in benign biliary strictures and bile leaks

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World Journal of Gastrointestinal Endoscopy 2013年第7期5卷 332-339页

作者： David Lalezari Inder Singh Sofiya Reicher Viktor Ernst Eysselein Department of Medicine St Mary Medical Center Long BeachCalifornia CA 90802 United States Harbor-UCLA Medical Center Division of Gastroenterology TorranceCalifornia CA 90502 United States

AIM: To investigate the use of fully covered metal stents in benign biliary strictures (BBS) and bile leaks. METHODS: We studied 17 patients, at Harbor-UCLA Medical center (Los Angeles), with BBS (n=12) and bile leaks (n=5) from July 2007 to February 2012 that had received placement of fully covered self-expanding metal stents (FCSEMs). Fourteen patients had endoscopic placement of VIABIL (Conmed, Utica, New York, United States) stents and three had Wallflex (Boston Scientific, Mass) stents. FCSEMS were 8 mm or 10 mm in diameter and 4 cm to 10 cm in length. Patients were followed at regular intervals to evaluate for symptoms and liver function tests. FCSEMS were removed after 4 or more weeks. Resolution of BBS and leak was documented cholangiographically following stent removal. Stent patency can be defined as adequate bile and contrast flow from the stent and into the ampulla during endoscopic retrograde cholangiopancreatography (ERCP) without clinical signs and/or symptoms of biliary obstruction. Criterion for bile leak resolution at ERCP is defined as absence of contrast extravasation from the common bile duct, cystic duct remanent, or gall blad-der fossa. Rate of complications such as migration, and instent occlusion were recorded. Failure of endoscopic therapy was defined as persistent biliary stenosis or continuous biliary leakage after 12 mo of stent placement. RESULTS: All 17 patients underwent successful FC- SEMS placement and removal. Etiologies of BBS included: cholecystectomies (n=8), cholelithiasis (n=2), hepatic artery compression (n=1), pancreatitis (n=2), and Whipple procedure (n=1). All bile leaks occurred following cholecystectomy. The anatomic location of BBS varied: distal common bile duct (n=7), common hepatic duct (n=1), hepaticojejunal anastomosis (n=2), right intrahepatic duct (n=1), and choledochoduo-denal anastomatic junction (n=1). All bile leaks were found to be at the cystic duct. Twelve of 17 patients had failed prior stent placement or exchange. Resolution of the biliary strictures

关键词： Bile leaks Benign biliary stricture Fully covered metal stents Biliary disease

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Endoluminal solutions to bariatric surgery complications:A review with a focus on technical aspects and results

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World Journal of Gastrointestinal Endoscopy 2017年第3期9卷 105-126页

作者： Raquel Souto-Rodríguez María-Victoria Alvarez-Sánchez Department of Gastroenterology Complejo Hospitalario Universitario de PontevedraInstituto de Investigación Sanitaria Galicia Sur36071 PontevedraSpain

Obesity is a growing problem in developed countries,and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients.Despite the advances in surgical techniques,some patients still develop acute and late postoperative complications,and an endoscopic evaluation is often required for diagnosis.Moreover,the high morbidity related to surgical reintervention,the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery,and,in many cases,a suitable first-line treatment of bariatric surgery complications.There is now evidence in the literature supporting endoscopic management for some of these complications,such as gastrointestinal bleeding,stomal and marginal ulcers,stomal stenosis,leaks and fistulas or pancreatobiliary disorders.However,endoscopic treatment in this setting is not standardized,and there is no consensus on its optimal timing.In this article,we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment.Based on a thorough review of the literature,we evaluated the performance and safety of different endoscopic options for every type of complication,highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

关键词： Bariatric surgery Bariatric complications Endoscopic treatment leaks Stenosis Sleeve gastrectomy Gastric Roux-en-Y bypass

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Outcome of stenting in biliary and pancreatic benign and malignant diseases:A comprehensive review

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World Journal of Gastroenterology 2015年第30期21卷 9038-9054页

作者： Benedetto Mangiavillano Nico Pagano Todd H Baron Carmelo Luigiano Unit of Gastroenterology and Digestive Endoscopy General Hospital of Sanremo Unit of Gastroenterology Department of Medical and Surgical SciencesS. Orsola-Malpighi HospitalUniversity of Bologna Division of Gastroenterology and Hepatology University of North Carolina Unit of Digestive Endoscopy San Paolo Hospital

Endoscopic stenting has become a widely method for the management of various malignant and benign pancreatico-biliary disorders. Biliary and pancreatic stents are devices made of plastic or metal used primarily to establish patency of an obstructed bile or pancreatic duct and may also be used to treat biliary or pancreatic leaks,pancreatic fluid collections and to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. In this review,relevant literature search and expert opinions have been used to evaluate the outcome of stenting in biliary and pancreatic benign and malignant diseases.

关键词： Endoscopic stenting Self-expandable metalstent Plastic stent Strictures leaks Complications

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Oil/Gas Pipeline Leak Inspection and Repair in Underwater Poor Visibility Conditions: Challenges and Perspectives

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Journal of Environmental Protection 2012年第5期3卷 394-399页

作者： Agbakwuru Jasper Offshore Engineering Faculty of Science and Technology University of Stavanger Stavanger Norway

Mechanical pressure clamps are examples of innovative tools commonly used in the oil and gas industry for arresting leaks from damaged oil and gas pipelines. However, if leaks result from pipeline rupture, clamps are not usually recommended. It is therefore obvious that inspection of the leaking pipeline is very crucial in deciding the strategy for repair. For subsea pipelines where underwater poor visibility is pronounced, this important aspect of the pipeline repair process becomes difficult to implement. The result is a repair-leak-repair cycle. This challenge is commonly found in repairs of old pipelines in unclear water conditions. Old pipelines and their vulnerability to fractures that often lead to ruptures are discussed. In this paper, the challenges and technologies available for visualisation and examination in such unclear water conditions are discussed. There appears to be a gap in the existing pipeline integrity management system with respect to inspection and repair of pipelines in unclear water conditions. This gap needs to be filled in order to minimise spills and pollution. For pipelines installed in unclear water condition, a perspective is suggested to extend the capability of existing remotely operated vehicles to employ the use of clear laminar water system or a related technique to provide integrity engineers and operators with close visual assess to inspect leaking pipelines and effect adequate repairs. This paper suggests that the use of optical eye as the main tool for examination remains valuable in managing the challenges in underwater pipeline repairs in unclear water condition.

关键词： Pipeline leaks Detection Spill Close-Visual Inspection Pipeline Repair Pipeline Inspection

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Pipeline Potential Leak Detection Technologies: Assessment and Perspective in the Nigeria Niger Delta Region

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Journal of Environmental Protection 2011年第8期2卷 1055-1061页

作者： Jasper Agbakwuru 不详

This paper examines the advances in pipeline third party encroachment alert systems and leak control methods in the oil/gas industry. It also highlights the extent of spill/pollution issues in the Niger Delta region due to intended/unin- tended damages and suggests a possible method of control. It is believed that the best option to avoid pollution due to pipeline failure is to ensure that hydrocarbon does not exit from the pipeline. With the different methods considered in this review, acoustic monitoring of change in the operational sound generated from a given pipeline section is suggested to be practicable to identifying sound abnormalities of third party encroachments. One established challenge of the acoustic system for buried pipelines protection is attenuation of acoustic transmission. An attempt to check the performance of an acoustic transmission on steel pipelines submerged in water points to a similar research on plastic water pipelines that attenuation is small compared with pipe buried in soil. Fortunately, Niger Delta of Nigeria is made of wetland, swamps and shallow water and could therefore offer an opportunity to deploy acoustic system for the safety of pipelines against third party attacks in this region. However, the numerous configuration and quantity of oil installation in this region imply that cost of application will be enormous. It is therefore suggested that a combination of impressed alternating cycle current (IACC) which traces encroachment on the pipeline coating and an acoustic system be used to manage intended and unintended pipeline potential damages. The IACC should be used for flow lines and other short distance delivery lines within the oilfield, while the relatively large diameter and long length delivery, trunk and transmission lines should be considered for acoustic protection. It is, however, noted that further efforts are required to reduce cost and improve effectiveness of these systems.

关键词： Pipeline leaks Detection Niger Delta Oil Spill Oil Pollution

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Biliary complications after pediatric liver transplantation: Risk factors, diagnosis and management

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World Journal of Hepatology 2015年第18期7卷 2162-2170页

作者： Flavia H Feier Eduardo A da Fonseca Joao Seda-Neto Paulo Chapchap Hepatology and Liver Transplantation Hospital Sirio Libanes

The expanded indications of partial grafts in pediatric liver transplantation have reduced waiting list mortality. However, a higher morbidity is observed, including an increased rate of biliary complications(BCs). Factors such as the type of graft, the preservation methods applied, the donor characteristics, the type of biliary reconstruction, and the number of bile ducts in the liver graft influences the occurrence of these complications. Bile leaks and strictures comprise the majority of posttransplant BCs. Biliary strictures require a high grade of suspicion, and because most children have a bileoenteric anastomosis, its diagnosis and management rely on percutaneous hepatic cholangiography and percutaneous biliary interventions(PBI). The success rates with PBI range from 70% to 90%. Surgery is reserved for patients who have failed PBI. BCs in children after liver transplantation have a prolonged treatment and are associated with a longer length of stay and higher hospital costs. However, with early diagnosis and aggressive treatment, patient and graft survival are not significantly compromised.

关键词： Outcomes Live-donor Infants Strictures Bile leaks

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