SEMS vs cSEMS in duodenal and small bowel obstruction:High risk of migration in the covered stent group

AIM:To compare clinical success and complications of uncovered self-expanding metal stents(SEMS)vs covered SEMS(cSEMS)in obstruction of the small bowel.METHODS:Technical success,complications and outcome of endoscopic SEMS or cSEMS placement in tumor related obstruction of the duodenum or jejunum were retrospectively assessed.The primary end points were rates of stent migration and overgrowth.Secondary end points were the effect of concomitant biliary drainage on migration rate and overall survival.The data was analyzed according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.RESULTS:Thirty-two SEMS were implanted in 20 patients.In all patients,endoscopic stent implantation was successful.Stent migration was observed in 9 of16 cSEMS(56%)in comparison to 0/16 SEMS(0%)implantations(P=0.002).Stent overgrowth did not significantly differ between the two stent types(SEMS:3/16,19%;cSEMS:2/16,13%).One cSEMS dislodged and had to be recovered from the jejunum by way of laparotomy.Time until migration between SEMS and cSEMS in patients with and without concomitant biliary stents did not significantly differ(HR=1.530,95%CI0.731-6.306;P=0.556).The mean follow-up was 57±71 d(range:1-275 d).CONCLUSION:SEMS and cSEMS placement is safe in small bowel tumor obstruction.However,cSEMS is accompanied with a high rate of migration in comparison to uncovered SEMS.

Lymph Fistulas after Inguinal Lymph Node Dissection—Assessment of Risk Factors and Future Treatment Strategies

Background: Inguinal lymph node dissections (ILND) have been commonly associated with postoperative complications such as lymphedema, lymph fistula and wound infections. The reported complication rates after ILND range from 14% - 77%, and a rationale for these large differences is the use of a variety of different definitions of complications. Patients and Methods: Files of patients that underwent inguinal lymph node dissection for lymph node metastases at the Department of General and Visceral Surgery of the University Hospital Frankfurt between February 2005 and March 2012 were retrospectively reviewed. Results: 47 patients (65%) developed a lymphatic fistula in the course of the operation, of which 6 patients (8%) underwent reoperations. Surgical side infections (SSI) were seen in 15 patients (21%), all of them harbouring fistulas. Patients presenting with a BMI ≥ 30 kg/m2 did not develop more fistulas than those with a BMI 2 (p = 0.30). Patients who suffered from a lymph fistula had significantly more visits in the outpatient clinic (p =< 0.0001). There was no difference in the complication rate if the procedure was performed by a resident under supervision or a senior surgeon (p = 0.79). Conclusion: In this study, we demonstrated that lymph fistulas are to date a common complication after ILND and lead to reoperations and significantly more outpatient visits. The number of lymph nodes affected and resected, and prior sentinel lymph node dissection, was not associated with a higher complication rate.