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Anastomotic Stenosis (anastomotic + stenosis)
Selected AbstractsEvaluation of the hepatic artery anastomosis by intraoperative sonography with high-frequency transducer in right-lobe graft living donor liver transplantationJOURNAL OF CLINICAL ULTRASOUND, Issue 1 2010Han Song Mun MD Abstract Objective To describe the usefulness of intraoperative ultrasonography (IOUS) with high-frequency transducer in living donor liver transplantation (LDLT) using right-lobe graft (RLG). Method This retrospective study was approved by our institutional review board. We performed IOUS in 22 patients (17 men and 5 women, aged 51 ± 9.0 years) during LDLT with RLG using a Sequoia 512 scanner with an 8,12-MHz linear transducer. Hepatic artery (HA) anastomosis was identified on gray-scale US, and the diameter and percentage of stenosis of the anastomosis were measured. The HA was evaluated to detect thrombus or dissection in the region of anastomosis. Doppler study of the graft HA was also performed. Patients were divided into those with and without abnormalities, including thrombosis, dissection, and abnormal Doppler parameters (peak systolic velocity < 30 cm/s or > 2 m/s, resistance index < 0.5, and systolic acceleration time > 80 msec). Result On gray-scale and Doppler IOUS study, abnormalities were found in 10 of 22 patients. Diagnoses were anastomotic stenosis (n = 2), celiac stenosis (n = 1), compromise of HA inflow due to systemic hypotension (n = 1), HA thrombosis (n = 2), and HA dissection (n = 4). Re-anastomoses were done in 3 case (2 stenoses and 1 thrombosis). Uneventful postoperative recovery occurred in the other 7 patients without re-anastomosis. Conclusion IOUS with high-frequency transducer is a useful method to make an early diagnosis of HA complications of LDLT with RLG. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010 [source] Management of recurrent anastomotic stenosis following radical prostatectomy using holmium laser and steroid injectionBJU INTERNATIONAL, Issue 7 2008Ehab Eltahawy OBJECTIVE To present our experience with the management of recurrent and resistant anastomotic stenosis following radical prostatectomy (RP) using transurethral laser incision of the stenotic area and injection of steroids. PATIENTS AND METHODS Between January 1999 and April 2006, we evaluated 24 patients with anastomotic stenosis that would not allow the passage of the flexible cystoscope (17 F). Using the paediatric 7.5 F Olympus scope and a 550-µm fibre holmium laser, deep incisions were cut at the 3 and 9 o'clock positions at the bladder neck, and then triamcinolone was injected at the incision sites. Another session was then scheduled for office cystoscopy 6 weeks later, and if that showed evidence of annularity, another incision was made, as described above. RESULTS All 24 patients had RP for localized disease, 21 were retropubic and two were perineal, and one laparoscopic. Five patients had adjuvant radiotherapy. The mean patient age was 64 years. Nineteen (79%) patients had previous attempts to open the bladder neck: eight patients had dilatation, eight patients had internal urethrotomy, five patients underwent transurethral resection of the bladder neck, and six patients had open surgical intervention. The procedure was done once in 17 patients, and twice in seven patients. After a mean (range) follow up of 24 (6,72) months, 19 patients (83%) had a well-healed and widely patent bladder neck. Of the 24 patients, 17 had urinary incontinence (UI) associated with the bladder neck contracture. An artificial urinary sphincter was implanted in 11 patients, three of which had to be explanted for malfunction in two, and erosion in one. CONCLUSION Holmium laser bladder neck incision and steroid injection for anastomotic stenosis after RP had a success rate of 83% in this small series. It can be used safely as a primary treatment, or in some cases, for resistant and recurrent stenosis. It appears that insertion of an artificial sphincter can be done in patients with UI when the bladder neck remains patent for at least 8 weeks. [source] | ||||||||||