Endoscopic transgastric fenestration versus percutaneous drainage for management of(peri)pancreatic fluid collections adjacent to gastric wall(with video)

BACKGROUND Percutaneous drainage(PCD)and endoscopic approaches have largely replaced surgical drainage as the initial approach for(peri)pancreatic fluid collections(PFC)s,while complications associated with endoscopic stent implantation are common.AIM To introduce a novel endoscopic therapy named endoscopic transgastric fenestration(ETGF),which involves resection of tissue by endoscopic accessory between gastric and PFCs without stent implantation,and to evaluate its efficacy and safety compared with PCD for the management of PFCs adjacent to the gastric wall.METHODS Patients diagnosed with PFCs adjacent to the gastric wall and who subsequently received ETGF or PCD were restrospectively enrolled.Indications for intervention were consistent with related guidelines.We analyzed patients baseline characteristics,technical and clinical success rate,recurrence and reintervention rate,procedure-related complications and adverse events.RESULTS Seventy-two eligible patients were retrospectively identified(ETGF=34,PCD=38)from October 2017 to May 2021.Patients in the ETGF group had a significantly higher clinical success rate than those in the PCD group(97.1 vs 76.3%,P=0.01).There were no statistically significant differences regarding recurrence,reintervention and incidence of complication between the two groups.While long-term catheter drainage was very common in the PCD group.CONCLUSION Compared with PCD,ETGF has a higher clinical success rate in the management of PFCs adjacent to the gastric wall.ETGF is an alternative effective strategy for the treatment of PFCs adjacent to the gastric wall.

Long-term results of laparoscopic fenestration for patients with congenital liver cysts

BACKGROUND: The feasibility and immediate outcome of laparoscopic fenestration for patients with congenital liver cysts have been generally recognized. The aim of the present study was to assess the long-term results after laparoscopic fenestration. METHODS: A retrospective study was performed on 44 patients with congenital liver cysts who had undergone laparoscopic fenestration between June 1998 and December 2004. Among them, 30 were women and 14 men, aged 57 years on average (range 18-76 years). While 14 patients had solitary cysts, 20 had multiple cysts, and 10 had polycystic liver disease. The results of laparoscopic fenestration, including mortality, morbidity, mean postoperative hospital stay, and recurrences of cysts were evaluated. RESULTS: There was no perioperative death and the morbidity rate was 11% (5/44). All complications were treated conservatively. The mean postoperative hospital stay was 4 days. A mean follow-up of 57 months showed that the rates of cyst recurrence and symptom recurrence were 9% and 4.5%, respectively. CONCLUSION: Laparoscopic fenestration as a feasible and safe treatment procedure for patients with congenital liver cysts can yield very good long-term results.

Laparoscopic fenestration vs open fenestration in patients with congenital hepatic cysts: A meta-analysis

AIM: To determine whether the outcomes of laparoscopic fenestration (LF) were superior to open fenestration (OF) for congenital liver cysts.METHODS: Comparative studies published between January 1991 and May 2010 on Medline (Ovid),Emsco,PubMed,Science Direct;Cochrane Reviews;CNKI;Chinese Biomedical Database,VIP and other electronic databases were searched.Randomized controlled trials (RCTs) and retrospective case-control studies on the management of congenital hepatic cysts were collected according to the pre-determined eligibility criteria to establish a literature database.Retrieval was ended in May 2010.Meta-analysis was performed using RevMan 5.0 software (Cochrane library).RESULTS: Nine retrospective case-control studies involving 657 patients,comparing LF with OF were included for the final pooled analysis.The meta-analysis results showed less operative time [mean difference (MD): -28.76,95% CI: -31.03 to 26.49,P < 0.00001];shorter hospital stay (MD: -3.35,95% CI: -4.46 to -2.24,P < 0.00001);less intraoperative blood loss (MD: -40.18,95% CI: -52.54 to -27.82,P < 0.00001);earlier return to regular diet (MD: -29.19,95% CI: -30.65 to -27.72,P < 0.00001) and activities after operation (MD: -21.85,95% CI: -31.18 to -12.51,P < 0.0001) in LF group;there was no significant difference between the two groups in postoperative complications (odds ratio: 0.99,95% CI: 0.41 to 2.38,P = 0.98) and cysts recurrence rates.CONCLUSION: The short-term outcomes of LF for patients with congenital hepatic cysts were superior to open approach,but its long-term outcomes should be verified by further RCTs and extended follow-up.

Endoscopic gastric fenestration of debriding pancreatic walled-off necrosis: A pilot study

BACKGROUND Endoscopic drainage of walled-off necrosis(WON) is still a challenge due to stentassociated problems. We explored endoscopic gastric fenestration(EGF) as an innovative alternative intervention.AIM To assess the feasibility, efficacy and safety of EGF for WON.METHODS Between March 2019 and March 2020, five patients with symptomatic WON in close contact with the stomach wall were treated by EGF. Endoscopic ultrasound(EUS) was used to select appropriate sites for gastric fenestration, which then proceeded layer by layer as in endoscopic submucosal dissection. Both the stomach muscularis propria and pseudocyst capsule were penetrated. Fenestrations were expanded up to 1.5-3 cm for drainage or subsequent necrosectomy.RESULTS EGF failed in Case 1 due to nonadherence of WON to the gastric wall. EGF was successfully implemented in the other four cases by further refinement of fenestration site selection according to computed tomography, endoscopy and EUS features. The average procedure time for EGF was 124 min(EUS assessment, 32.3 min;initial fenestration, 28.8 min;expanded fenestration, 33 min), and tended to decrease as experience gradually increased. The diameter of the fenestration site was 1.5-3 cm, beyond the caliber of a lumen-apposing metal stent(LAMS), to ensure effective drainage or subsequent necrosectomy. Fenestration sites showed surprising capacity for postoperative self-healing within 1-3 wk. No EGF-related complications were seen. WON disappeared within 3 wk after EGF. In Case 3, another separate WON, treated by endoscopic LAMS drainage, recurred within 4 d after LAMS removal due to stent-related hemorrhage, and resolved slowly over almost 3 mo. No recurrences were observed in the five patients.CONCLUSION EGF is an innovative and promising alternative intervention for WON adherent to the gastric wall. The challenge resides in the gauging of actual adherence and in selecting appropriate fenestration sites.

Treatment of polycystic liver disease with resection-fenestration and a new classification

AIM: To evaluate outcomes in patients with autosomal dominant polycyst liver disease (APLD) treated by combined hepatic resection and fenestration. A new classification was recommended to presume postoperative complications and long outcome of patients. METHODS: Twenty-one patients with APLD were treated by a combined hepatic resection and fenestration technique. All patients were reviewed retrospectively, and clinical symptoms, performance status and morbidity were recorded. A new classifi cation of APLD is recommended here. RESULTS: All patients were discharged when free of symptoms. The mean follow-up time was 55.7 mo and three patients had a recurrence of symptoms at 81, 68 and 43 mo after operation, respectively. The overall morbidity rate was 76.2%. Two patients with Type B-Ⅱ and Type B-Ⅰ developed biliary leakage. Four patients had severe ascites, including three with Type B-Ⅲ and one with Type B-Ⅱ, Nine patients had pleural effusion, including one with Type A-Ⅰ; one with Type B-Ⅰ; fi ve with Type B-Ⅱ; one with Type A-Ⅲ and one with Type B-Ⅲ. Three patients with Type B had recurrence of symptoms, while none with Type A had severe complications. CONCLUSION: Combined hepatic resection and fenestration is an acceptable procedure for treatment of APLD. According to our classifi cation, postoperative complications and long outcome can be predicted before surgery.

Laparoscopic fenestration of multiple giant biliary mucinous cystadenomas of the liver

Biliary cystadenomas of the liver are rare, cystic neoplasms of the biliary ductal system usually occur in middle aged women. We report a case of synchronous multiple huge biliary mucinous cystadenomas with unique features. This is, according to our knowledge, the first report in the literature about three synchronously occurring hepatobiliary cystadenomas. Cystadenomas have a strong tendency to recur, particularly following incomplete excision, and a potential of malignant transformation. A therapeutic re-evaluation may be necessary when the diagnosis of hepatobiliary cystadenoma is made after the operation and an open liver resection should be considered.

Endoscopic Assisted Microscopic Fenestration of Inner Membrane in Cases of Chronic Subdural Hematoma

Introduction: Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhages and carries a significant morbidity;there is no clear optimal treatment. Recurrence, pneumocephaly and seizures are common complications. We will evaluate outcome after inner membrane fenestration in comparison to burr-hole evacuation only in cases of CSDH. Patients and Methods: Our work was conducted on 20 patients with CSDH from February 2017 to July 2017. Endoscopic-assisted microscopic fenestration technique was used to do inner membrane fenestration in ten patients and the other 10 patients operated upon by traditional burr-hole evacuation. Regular follow up was done up to one month. Results: Clinical outcome was nearly the same in the two groups. Recurrence rate was only noted in the non-fenestration group (20%). Midline shift was better in the membrane fenestration group after one month and we experienced no intraoperative surgical complications related to the fenestration technique. Postoperative complications, such as Pneumocephalus and seizures, were seen in both study groups. Conclusion: Endoscopic assisted microscopic technique decreases surgical risks to do inner membrane fenestration although there is no major difference between doing fenestration or not in clinical outcome, but it may decrease recurrence, but larger studies are needed.

Open Reduction by Fenestration to the Ilium for Central Acetabular Depression Fractures: A Case Report and Operative Technique

Aim: The aim was to report a fenestration technique for gap reduction of acetabular depression fractures. Case presentation: A 76-year-old man suffered from severe left leg pain. The computed tomography scanning showed a displaced acetabular depression fracture, including a third fracture fragment in the center of the acetabular weight-bearing area. We performed a fenestration technique to fenestrate the outer plate of ilium to push down the dislocated fragment of the fracture. The patient was pain-free with good functional outcome of the hip joint at three years after operation. Conclusion: The fenestration technique is useful for displaced acetabular depression fractures. We performed open reduction in this particular case, but the technique may be done less invasively with the use of hip arthroscopy.

Endoscopic fenestration in the diagnosis and treatment of delayed anastomotic submucosal abscess:A case report and review of literature

BACKGROUND Abscess formation is one of the complications after radical resection of rectal cancer;cases with delayed postoperative anastomotic abscess are rare.Here,we report a rare case of postoperative anastomotic abscess with a submucosal neoplasm appearing after rectal surgery.Ultimately,the patient was diagnosed and treated by endoscopic fenestration.In addition,we review the literature on the appearance of an abscess as a complication after rectal cancer surgery.CASE SUMMARY A 57-year-old man with a history of rectal malignancy resection complained of a smooth protuberance near the anastomotic stoma.Endoscopic ultrasonography revealed a hypoechoic structure originating from the muscularis propria,and a submucosal tumor was suspected.The patient was subsequently referred to our hospital and underwent pelvic contrast-enhanced computed tomography,which revealed no thickening or strengthening of the anastomotic wall.In order to clarify the origin of the lesion and obtain the pathology,endoscopic fenestration was performed.After endoscopic procedure,a definitive diagnosis of delayed anastomotic submucosal abscess was established.The patient achieved good recovery and prognosis after the complete clearance of abscess.CONCLUSION Endoscopic fenestration may be safe and effective for the diagnosis/treatment of delayed intestinal smooth protuberance after rectal cancer surgery.

Antegrade in situ laser fenestration of aortic stent graft during endovascular aortic repair:A case report

BACKGROUND The endovascular repair of juxtarenal abdominal aortic aneurysms(JAAA)usually requires combination treatment with various stent graft modifications to preserve side branch patency.As a feasible technique,according to the situation,antegrade in situ laser fenestration still needs to be improved.CASE SUMMARY This report describes a case that was successfully treated with endovascular repair facilitated by antegrade in situ laser fenestration while maintaining renal arterial flow.Laser fenestration was performed using a steerable sheath positioned in the stent graft lumen in front of the renal artery ostium.With the bare stent region unreleased,renal artery perfusion could be maintained and accurate positioning could be achieved by angiography in real time.CONCLUSION This study suggests the feasibility and short-term safety of this novel antegrade in situ laser fenestration technique for select JAAA patients.

Laparoscopic fenestration of pancreatic serous cystadenoma:Minimally invasive approach for symptomatic benign disease

Serous cystadenoma(SC) is a benign pancreatic cystic tumor. Surgical resection is recommended for symptomatic forms, but laparoscopic fenestration of large symptomatic macrocystic SC was not yet described in the literature. In this study, 3 female patients underwent laparoscopic fenestration for macrocystic SC(12-14 cm). Diagnosis was established via magnetic resonance imaging and endoscopic ultrasound, with intra-cystic dosage of tumors markers(ACE and CA19-9) in 2 patients. All patients were symptomatic and operated on 15-60 mo after diagnosis.Radiological evaluation showed constant cyst growth.Patients were informed about this new surgical modality that can avoid pancreatic resection. The mean operative time was 103 min(70-150 min) with one conversion.The post-operative course was marked by a grade A pancreatic fistula in one patient and was uneventful in the other two. The hospital stay was 3, 10, and 18 d, respectively. The diagnosis of macrocystic SC was histologically-confirmed in all cases. At the last followup(13-26 mo), all patients were symptom-free, and radiological evaluation showed complete disappearance of the cyst. Laparoscopic fenestration, as opposed to resection, should be considered for large symptomatic macrocystic SC, thereby avoiding pancreatic resection morbidity and mortality.

Shunting,optic nerve sheath fenestration and dural venous stenting for medically refractory idiopathic intracranial hypertension:systematic review and meta-analysis

Background:Cerebrospinal fluid(CSF)-diversion procedures have traditionally been the standard of treatment for patients with medically refractive idiopathic intracranial hypertension(IIH).However,dural venous sinus stent(VSS)placement has been described as a safe and effective procedure for the management of medically refractive IIH.We performed a meta-analysis comparing outcomes and complications of CSF-diversion procedures,VSS and optic nerve sheath fenestration(ONSF)for the treatment of medically refractive IIH.Methods:Electronic searches were performed using six databases from 1988 to January 2017.Data was extracted and meta-analysed from the identified studies.Results:From 55 pooled studies,there were 538 CSF-diversion cases,224 dural venous stent placements,and 872 ONSF procedures.Similar improvements were found in terms of postoperative headaches(CSF vs.VSS vs.ONSF:84%vs.78%vs.62%,P=0.223),papilledema(CSF vs.VSS vs.ONSF:71%vs.86%vs.77%,P=0.192),whilst visual acuity changes favored venous stenting(CSF vs.VSS vs.ONSF:55%vs.69%vs.44%,P=0.037).There was a significantly lower rate of subsequent procedures with venous stent placement(CSF vs.VSS vs.ONSF:37%vs.13%vs.18%,P<0.001),but other complication rates were similar(CSF vs.VSS vs.ONSF:13%vs.8%vs.14%,P=0.28).Subgroup analysis of lumbar-peritoneal vs.ventriculoperitoneal shunts found no differences in symptom improvements,complications and subsequent procedure rates.Conclusions:Our findings suggest that dural venous sinus stenting may be a viable alternative to traditional surgical interventions in patients who are refractory to medical treatment.

中国(北京)国际门窗幕墙博览会Fenestration China 2007

1)新展馆新契机为满足Fenestration展会规模和商业贸易需求的迅猛增长,2007 Fenestration将首度移师上海光大会展中心举行。规模更大：移至上海光大会展中心后展会的整体规模将扩大,展出面积增至25000平方米,届时可容纳更多展位以满足海内外的企业的参展需求。空间更高：新展馆的层高将普遍提高。

Custom Made Fenestrated Stent Graft Collapse after Thoracic Endovascular Aortic Repair: A Case Report

We present a case of stent graft collapse after performing thoracic endovascular aortic repair with a custom-made fenestrated stent graft. The patient was a 70-year-old woman with an asymptomatic aneurysm of the distal aortic arch, and thoracic endovascular aortic repair was performed. The patient showed a blood pressure difference between the left arm and the right arm on postoperative day (POD) 17 prompting the performance of a chest computed tomography scan which revealed stent graft collapse. She then underwent staged debranching of thoracic endovascular aortic repair. Stent graft collapse is a rare but well-described complication of thoracic endovascular repair. Therefore, patients who undergo such a procedure should be carefully monitored for signs and symptoms, which suggest the possibility of stent collapse.

微通道技术在颈椎管肿瘤微创切除术中的应用

目的:探讨微通道技术在颈椎管肿瘤微创切除手术中的应用。方法:选择2017年2月至2020年3月于北京大学第三医院神经外科因颈椎管肿物行微创切除手术的51例患者的病例资料进行回顾性分析,其中5例患者肿物位于硬膜外,6例位于硬膜内外,40例位于髓外硬膜下(6例位于脊髓腹侧)。肿物最大径0.5~3.0 cm。患者临床表现包括颈肩部或上肢疼痛43例,感觉障碍(麻木)22例,肢体无力8例。所有患者均采用微通道锁孔技术进行肿瘤显露,显微镜下进行肿瘤切除手术。结果:35例切除半侧椎板,12例采用半侧椎板间开窗,2例在半椎板切除或半侧椎板间开窗基础上切除内侧1/4小关节,经解剖间隙(未切除骨质)2例。肿瘤切除程度包括50例全部切除和1例次全切除。肿瘤性质包括36例神经鞘瘤,12例脊膜瘤,2例肠源性囊肿和1例皮样囊肿。术后无感染、脑脊液漏。7例患者出现肢体麻木。平均随访时间15个月(3~36个月),未发现颈椎不稳或后突等畸形,肿瘤均无复发。结论:颈椎管较为宽大,不超过三个节段的颈椎管肿瘤可借助微通道技术进行充分显露,除髓内或恶性肿瘤外,可显微外科切除。患者术后更多颈椎正常结构和肌肉附着得到保留,有利于颈椎保持正常功能,神经电生理监测的辅助有助于避免脊髓或神经损伤。

腹腔镜下输卵管开窗取胚术配合甲氨蝶呤对输卵管妊娠患者宫内妊娠率的影响

目的探讨腹腔镜下输卵管开窗取胚术配合甲氨蝶呤治疗输卵管妊娠的效果。方法120例输卵管妊娠患者分为两组,对照组给予甲氨蝶呤治疗,实验组给予腹腔镜下输卵管开窗取胚术配合甲氨蝶呤治疗,比较两组的治疗效果。结果治疗后,实验组的总有效率高于对照组,月经恢复时间、包块消失时间、腹痛消失时间及住院时间均短于对照组,宫内妊娠率高于对照组(P<0.05)。结论腹腔镜下输卵管开窗取胚术配合甲氨蝶呤治疗输卵管妊娠患者可以提高宫内妊娠率,安全性高。

腹腔镜开窗引流术与CT引导下穿刺硬化术治疗肝囊肿的对照研究

目的:分析腹腔镜开窗引流术与CT引导下穿刺硬化术治疗肝囊肿的效果。方法:选择2019年1月—2023年6月张家港市第一人民医院接收的100例肝囊肿患者作为研究对象,按照入院顺序编号,利用最新统计学软件生成随机序列并分为对照组、观察组,各50例。对照组采用CT引导下穿刺硬化术,观察组予以腹腔镜开窗引流术。比较两组临床疗效、围手术期指标、不良事件发生情况及生活质量。结果:对照组手术时间、术后下床时间、住院时间短于观察组,且出血量少于观察组,差异有统计学意义(P<0.05)。观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。观察组不良事件总发生率高于对照组,差异有统计学意义(P<0.05)。治疗前后,两组欧洲五维生存质量量表(EQ-5D)各项评分比较,差异无统计学意义(P>0.05)。结论:在肝囊肿患者的治疗中,腹腔镜开窗引流术的治疗效果优于CT引导下穿刺硬化术,而CT引导下穿刺硬化术治疗后康复进展更快,安全性更高。两种方式均存在不同优势,临床上应根据肝囊肿患者的实际情况选择手术方式。

超声引导下穿刺介入治疗与腹腔镜下开窗引流术在肝囊肿患者中的应用效果分析

目的分析在肝囊肿患者中实施超声引导下穿刺介入治疗与腹腔镜下开窗引流术的效果。方法简单随机选取2022年1月—2023年9月烟台市烟台山医院收治的40例肝囊肿患者为研究对象,以随机数表法将其分为对照组、研究组,各20例。对照组行腹腔镜下开窗引流术,研究组行超声引导下穿刺介入治疗。比较两组患者胃肠道功能指标、肝功能指标和并发症发生率。结果研究组各项术后恢复时间均短于对照组,差异有统计学意义(P均<0.05)。手术后,研究组患者肝功能均优于对照组,差异有统计学意义(P<0.05)。研究组并发症发生率为10.00%,低于对照组的35.00%,差异有统计学意义(χ^(2)=5.291,P<0.05)。结论超声引导下穿刺介入治疗肝囊肿,患者胃肠道功能指标、肝功能指标更优,并发症发生率更低。

骨性Ⅲ类患者正畸-正颌治疗后牙槽骨结构改建的锥形束CT测量

背景:正畸-正颌联合治疗骨性Ⅲ类错颌的大多数研究主要关注患者侧貌的改善和后期的恢复情况,而观察患者下前牙牙槽骨改建这一类微观的研究较少。目的:应用口腔X射线侧位片和口腔锥形束CT评价骨性Ⅲ类错颌畸形患者正畸-正颌联合治疗前后的下前牙去代偿疗效及牙槽骨结构改建情况。方法:选择2015年1月至2023年5月在康复大学青岛医院/青岛市市立医院口腔正畸科进行正畸-正颌联合治疗的骨性Ⅲ类错颌畸形患者15例,治疗前后拍摄头颅X射线侧位片测量下前牙在牙槽骨中的角度及线距等指标,锥形束CT测量和分析下前牙唇/舌侧骨开裂长度(d-La/d-Li)以及骨开裂/骨开窗发生情况。结果与结论:①从X射线侧位片来看,与治疗前相比,下前牙去代偿后相应牙槽骨改建量变化明显,牙根明显向牙槽骨中心移动,但较正常个体仍有部分差距;②锥形束CT测量发现几乎所有牙齿治疗后牙槽骨骨开裂/骨开窗的长度和宽度都得到很大的改善,有的牙槽骨改建甚至已经达到了健康人水平;③治疗前大部分患者往往因为牙齿代偿生长而造成下切牙唇/舌侧的骨开窗/骨开裂,而在术前正畸阶段通过去代偿使牙槽骨改建,牙齿角度发生明显变化,术前正畸使上前牙内收,下前牙唇倾控根,但是术前去代偿量往往不足;在正颌手术阶段,颌骨位置通过定位导板切除,上颌骨前移,下颌骨后退;术后正畸过程中精调效果更好,虽然牙齿与颌骨位置均有一定程度的复发趋势,但术后正畸更接近正常值。