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Basahai I, Alzeer MA, Almuhanna BS. Successful treatment of gastric bleeding caused by left phrenic artery pseudoaneurysm post-surgery with endovascular embolization: A case report. Radiol Case Rep 2024; 19:2351-2356. [PMID: 38532908 PMCID: PMC10963892 DOI: 10.1016/j.radcr.2024.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/18/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
Pseudoaneurysms are rare but potentially life-threatening complications that may occur after surgical procedures. This report presents the case of a 28-year-old woman who developed a pseudoaneurysm in the Left Inferior Phrenic Artery (LIPA) following a Laparoscopic Sleeve Gastrectomy (LSG). The complication manifested as severe gastrointestinal bleeding. Upper GI Endoscopy and multislice CT scan, repeated twice, failed to localize the bleeding source to treat it. Successful endovascular embolization using a Glue/Lipidol mixture was achieved despite difficulties in localizing the pseudoaneurysm, resulting in immediate symptomatic relief and avoiding surgical intervention. This case shows the importance of prompt identification and management of LIPA pseudoaneurysms following LSG, highlighting the importance of early diagnosis to prevent further hemodynamic deterioration and other adverse outcomes.
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Affiliation(s)
- Izzat Basahai
- Consultant Interventional Radiologist, King Khalid University Hospital, Department of Radiology, King Saud University, Riyadh, Saudi Arabia
| | - Meshari A. Alzeer
- MBBS, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Li KK, Wang YJ, Zhang TM, Zhang L, Zhao SL, Chen L, Bao T, Zhao XL, Xie XF, Guo W. Right gastroepiploic artery length determined anastomotic leakage after minimally invasive esophagectomy for esophageal cancer: a prospective cohort study. Int J Surg 2024; 110:2757-2764. [PMID: 38349216 DOI: 10.1097/js9.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/29/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND This prospective cohort study, conducted at a high-volume esophageal cancer center from July 2019 to July 2022, aimed to investigate the link between the right gastroepiploic artery (RGEA) length and anastomotic leakage (AL) rates following minimally invasive esophagectomy (MIE). Real-world data on stomach blood supply in the Chinese population were examined. MATERIALS AND METHODS A total of 516 cases were enrolled, categorized into two groups based on the Youden index-determined optimal cut-off value for the relative length of RGEA (length of RGEA/length of gastric conduit, 64.69%) through ROC analysis: Group SR (short RGEA) and Group LR (long RGEA). The primary observation parameter was the relationship between AL incidence and the ratio of direct blood supply from RGEA. Secondary parameters included the mean length of the right gastroepiploic artery, greater curvature, and the connection type between right and left gastroepiploic vessels. Patient data were prospectively recorded in electronic case report forms. RESULTS The study revealed median lengths of 43.60 cm for greater curvature, 43.16 cm for the gastric conduit, and 26.75 cm for RGEA. AL, the most common postoperative complication, showed a significant difference between groups (16.88 vs. 8.84%, P =0.01). Multivariable binary logistic regression identified Group SR and LR (odds ratio: 2.651, 95% CI: 1.124-6.250, P =0.03) and Neoadjuvant therapy (odds ratio: 2.479, 95% CI: 1.374-4.473, P =0.00) as independent predictors of AL. CONCLUSIONS The study emphasizes the crucial role of RGEA length in determining AL incidence in MIE for esophageal cancer. Preserving RGEA and fostering capillary arches between RGEA and LGEA are recommended strategies to mitigate AL risk.
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Affiliation(s)
- Kun-Kun Li
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, People's Republic of China
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Intraoperative Patterns of Gastric Microperfusion During Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2022; 32:4047-4056. [PMID: 36243899 DOI: 10.1007/s11695-022-06318-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/01/2022] [Accepted: 10/11/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Visible light spectroscopy (VLS) represents a sensitive, non-invasive method to quantify tissue oxygen levels and detect hypoxemia. The aim of this study was to assess the microperfusion patterns of the gastric pouch during laparoscopic Roux-en-Y gastric bypass (LRYGB) using the VLS technique. METHODS Twenty patients were enrolled. Tissue oxygenation (StO2%) measurements were performed at three different localizations of the gastric wall, prior and after the creation of the gastric pouch, and after the creation of the gastro-jejunostomy. RESULTS Prior to the creation of the gastric pouch, the lowest StO2% levels were observed at the level of the distal esophagus with a median StO2% of 43 (IQR 40.8-49.5). After the creation of the gastric pouch and after the creation of the gastro-jejunostomy, the lowest StO2% levels were recorded at the level of the His angle with median values of 29% (IQR 20-38.5) and 34.5% (IQR 19-39), respectively. The highest mean StO2 reduction was recorded at the level of the His angle after the creation of the gastric pouch, and it was 18.3% (SD ± 18.1%, p < 0.001). A reduction of StO2% was recorded at all localizations after the formation of the gastro-jejunostomy compared to the beginning of the operation, but the mean differences of the StO2% levels were statistically significant only at the resection line of the pouch and at the His angle (p = 0.044 and p < 0.001, respectively). CONCLUSION Gastric pouch demonstrates reduction of StO2% during LRYGB. VLS is a useful technique to assess microperfusion patterns of the stomach during LRYGB.
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Jia L, Cheng H, Hou M. The "Hand as Foot" teaching method in perigastric arteries. Asian J Surg 2022; 45:1141-1142. [PMID: 35221182 DOI: 10.1016/j.asjsur.2022.01.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/07/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Longlong Jia
- Inner Mongolia Medical University, Department of Gastrointestinal Surgery, Affiliated Hospital of Inner Mongolia Medical University, Huhhot North Street, Inner Mongolia, 010050, China
| | - Haidong Cheng
- Inner Mongolia Medical University, Department of Gastrointestinal Surgery, Affiliated Hospital of Inner Mongolia Medical University, Huhhot North Street, Inner Mongolia, 010050, China.
| | - Mingxing Hou
- Inner Mongolia Medical University, Department of Gastrointestinal Surgery, Affiliated Hospital of Inner Mongolia Medical University, Huhhot North Street, Inner Mongolia, 010050, China
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Angeles MA, Martínez-Gómez C, Del M, Migliorelli F, Daix M, Provendier A, Picard M, Ruiz J, Chantalat E, Leray H, Martinez A, Gladieff L, Ferron G. Risk factors for gastric perforation after cytoreductive surgery in patients with peritoneal carcinomatosis: Splenectomy and increased body mass index. PLoS One 2021; 16:e0248205. [PMID: 33661999 PMCID: PMC7932550 DOI: 10.1371/journal.pone.0248205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Gastric perforation after cytoreductive surgery (CRS) is an infrequent complication. There is lack of evidence regarding the risk factors for this postoperative complication. The aim of this study was to assess the prevalence of postoperative gastric perforation in patients undergoing CRS for peritoneal carcinomatosis (PC) and to evaluate risk factors predisposing to this complication. Methods We designed a unicentric retrospective study to identify all patients who underwent an open upfront or interval CRS after a primary diagnosis of PC of different origins between March 2007 and December 2018 at a French Comprehensive Cancer Center. The main outcome was the occurrence of postoperative gastric perforation. Results Five hundred thirty-three patients underwent a CRS for PC during the study period and 13 (2.4%) presented a postoperative gastric perforation with a mortality rate of 23% (3/13). Neoadjuvant chemotherapy was administered in 283 (53.1%) patients and 99 (18.6%) received hyperthermic intraperitoneal chemotherapy (HIPEC). In the univariate analysis, body mass index (BMI), peritoneal cancer index, splenectomy, distal pancreatectomy, and histology were significantly associated with postoperative gastric perforation. After multivariate analysis, BMI (OR [95%CI] = 1.13 [1.05–1.22], p = 0.002) and splenectomy (OR [95%CI] = 26.65 [1.39–509.67], p = 0.029) remained significantly related to the primary outcome. Conclusions Gastric perforation after CRS is a rare event with a high rate of mortality. While splenectomy and increased BMI are risk factors associated with this complication, HIPEC does not seem to be related. Gastric perforation is probably an ischemic complication due to a multifactorial process. Preventive measures such as preservation of the gastroepiploic arcade and prophylactic suture of the greater gastric curvature require further assessment.
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Affiliation(s)
- Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Carlos Martínez-Gómez
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
- INSERM CRCT Team 1, Tumor Immunology and Immunotherapy, Toulouse, France
| | - Mathilde Del
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Federico Migliorelli
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal des Vallées de l’Ariège, St Jean de Verges, France
| | - Manon Daix
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Anaïs Provendier
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Muriel Picard
- Intensive Care Unit, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Jean Ruiz
- Intensive Care Unit, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Elodie Chantalat
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Hélène Leray
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
- INSERM CRCT Team 1, Tumor Immunology and Immunotherapy, Toulouse, France
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Gwénaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
- INSERM CRCT Team 19, ONCOSARC – Oncogenesis of sarcomas, Toulouse, France
- * E-mail:
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Komanduri SK, Hormuzdi D, Desai SS, Patil DB, Khivasara JS, Kulkarni SGS, Desai SS. Free Gastric Flap for Oral Reconstruction-a Feasibility Study in Oral Defects. Indian J Surg Oncol 2021; 12:172-176. [PMID: 33814849 DOI: 10.1007/s13193-020-01276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Abstract
Background Free flap transfer is a standard practice in reconstruction of oral defects. Fasciocutaneous flaps are commonly used for reconstruction of soft tissue defects. Replacement of oral mucosa with skin often causes discomfort, foreign body sensation, dysgeusia, problems with skin hair and morbidity at the donor site. Morbidity at the donor site may interfere with physical activity among manual labourers. Materials and methods We prospectively analysed nine cases of oral cavity defects reconstructed with free gastro-omental flap over 4 months from March to July 2019. A free gastric flap based on right and left gastric artery and vascular arcade was harvested from the body of stomach. Feasibility, technical aspects, advantages and disadvantages of the flap are reviewed. Results Flap survival was 100%. No re-exploration for salvage was required. Flap was monitored for viability by colour change and capillary refill. All the nine cases healed well. One patient required readmission for bleeding from the raw area exposed at the margins of the flap. Patient satisfaction and quality of life was satisfactory. Long pedicle length, rich submucosal vascular network, dual pedicles available for anastomosis, like to like mucosal tissue replacement and low donor site morbidity make it a reliable option in the armamentarium of oral reconstruction. Conclusion Free gastro-omental flap is a feasible and reliable tissue available for reconstruction of oral soft tissue defects.
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Affiliation(s)
| | - Dinshaw Hormuzdi
- Department of Head And Neck Surgery Unit, Mahatma Gandhi Cancer Hospital, Miraj, India
| | | | - Dipti Babasaheb Patil
- Department of Head And Neck Surgery Unit, Mahatma Gandhi Cancer Hospital, Miraj, India
| | | | - Sanika G S Kulkarni
- Department of Head And Neck Surgery Unit, Mahatma Gandhi Cancer Hospital, Miraj, India
| | - Shivani Sharad Desai
- Department of Head And Neck Surgery Unit, Mahatma Gandhi Cancer Hospital, Miraj, India
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Relationship of early acute complications and insertion site in push method percutaneous endoscopic gastrostomy. Sci Rep 2020; 10:20551. [PMID: 33239745 PMCID: PMC7689522 DOI: 10.1038/s41598-020-77553-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/10/2020] [Indexed: 12/31/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG), which is frequently used for nutrition management in patients having difficulty with oral intake, is considered a safe procedure. However, serious complications may occur depending on site of the puncture. This study aimed to clarify whether push method PEG construction at the posterior wall (PW) of the greater curvature (GC) had a higher risk of complications. We retrospectively investigated the relationship between puncture site at the PW of the GC and early acute complications in 540 patients receiving PEG. Early acute complications were defined as bleeding or perforation within 30 days after the PEG procedure. PEG-related complications were observed in 80 patients in total, with early acute complications detected in 42 patients. PEG construction at the PW of the GC in 12 cases exhibited a significantly higher occurrence of early acute complications versus PEG at other sites (41.7% vs. 7.0%, p = 0.001). Further, multivariate analysis revealed PW at the GC to be independently associated with early acute complications (OR 9.59, 95% CI 2.82-32.61; p = 0.0003). It may be desirable to avoid PEG at the PW of the GC. If performed, clinicians should pay careful attention to early acute complications.
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Intra-mural distribution of the blood vessels in the stomach demonstrated by contrast medium injection: a cadaver study. Surg Radiol Anat 2020; 43:389-396. [PMID: 33164135 DOI: 10.1007/s00276-020-02613-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE With advances in diagnostic imaging techniques of gastric cancer screening with X-ray fluoroscopy, it has been suggested that mucosal projections induced by the vessels distributed in the submucosal layer of the stomach may be mistaken for abnormal mucosal folds. In this study, we aimed to describe the distribution of blood vessels in the submucosal layer of the stomach to improve the diagnostic accuracy of screening of gastric cancer. METHODS Twenty-four stomachs from Japanese cadavers were used in this study. Uncolored or colored contrast agents were injected into arteries and/or veins for macroscopic analyses, X-ray imaging, and methyl salicylate clearing. In addition, histological analysis was performed to examine blood vessels distributed inside the stomach wall. RESULTS Following contrast agent injection, thick blood vessels were distributed perpendicular to both curvature sides, and branches parallel to both curvature sides flowed from these thick blood vessels, and a vascular network was formed throughout the stomach wall. This vascular network had intra-mural anastomoses connecting both curvature sides. Moreover, in histological analyses, blood vessels depicted by injection were mainly distributed in the submucosal layer. CONCLUSION This study strongly suggests that the mucosal projections induced by arteries and veins in the submucosal layer could be mistaken for abnormal mucosal folds. Therefore, a better understanding of the vascular distribution in the submucosal layer is important to improve diagnostic accuracy from imaging studies of the stomach. The information provided by this research may facilitate better accuracy in diagnosis and reduce the number of unnecessary invasive procedures.
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Gao Y, Hu J, Zhang X, Zhang M, Wang D, Zheng X, Liu S, Lu Y. Use of Hisense Computer-Assisted Surgery System Enhances Infrapyloric Lymph Node Dissection for Gastric Cancer. J Surg Res 2019; 242:31-39. [DOI: 10.1016/j.jss.2019.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/19/2019] [Accepted: 04/04/2019] [Indexed: 12/20/2022]
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Thamtorawat S, Nadarajan C, Rojwatcharapibarn S. Essential vascular anatomy and choice of embolic materials in gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Somrach Thamtorawat
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chandran Nadarajan
- Department of Radiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Satit Rojwatcharapibarn
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Neovascularization after ischemic conditioning of the stomach and the influence of follow-up neoadjuvant chemotherapy thereon. Wideochir Inne Tech Maloinwazyjne 2018; 13:299-305. [PMID: 30302142 PMCID: PMC6174163 DOI: 10.5114/wiitm.2018.75907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/26/2018] [Indexed: 01/22/2023] Open
Abstract
Introduction Esophagectomy and reconstruction remain the optimal treatment for patients with resectable esophageal cancer. Neovascularization after ischemic conditioning of the stomach before esophagectomy is a laparoscopic procedure which may potentially reduce gastric conduit ischemia. Aim To investigate the influence of ischemic conditioning on neovascularization along the greater curvature of the stomach and to explore the effect of neoadjuvant chemotherapy on neovascularization after ischemic conditioning. Material and methods Staging laparoscopy was performed before the main resection procedure; during this procedure ischemic conditioning was performed. Samples taken from the human stomach were divided into 3 groups: group A – patients after ischemic conditioning with a delay of 30–45 days after left gastric artery (LGA) ligation (n = 4); group B – patients who were undergoing neoadjuvant chemotherapy with a delay of 90–140 days after left gastric artery ligation (n = 4); and control group C – patients without ischemic conditioning (n = 7). Results After ischemic conditioning with a delay of 30–45 days, the count of neovessels along the greater curvature of the stomach increased from 5.4 ±0.7 in the control group to 17.5 ±0.9 in a low-power field of view (LPF) in group A and increased still further on average to 19.8 ±10.4 in group B. Conclusions Left gastric artery ligation only is a sufficient procedure for ischemic conditioning of the stomach. Neovascularization along the greater curvature is a continuous process that depends on delay time. Neoadjuvant therapy has no influence on the effect of neovascularization.
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