bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.076: LAPAROSCOPIC REMOVAL OF A SLIPPED ANGELCHIK ANTIREFLUX PROSTHESIS
Authors: Masuda Takahiro , Mittal Sumeet 
Published: September 2018

Abstract

Background
The Angelchik prosthesis is c-shaped silicone ring designed to prevent acid reflux. The device, which is fitted around the gastroesophageal junction, was popular in 1980s and over 25,000 devices were placed in patients worldwide. However, follow-up showed a high frequency of undesirable results, including device migration and esophageal erosion. The use of this device was therefore abandoned in the early 1990s.

Methods
A 70-year-old man with a body mass index of 36 kg/m2 presented to us with persistent dysphagia and progressively increasing heartburn. He had undergone placement of an Angelchik prosthesis 37 years earlier. He said that he had experienced dysphagia since it was implanted, but had accepted it. His past medical history included hypertension, hyperlipidemia, sleep apnea, atrial fibrillation, cerebrovascular accident, and benign prostatic hypertrophy. Upper gastrointestinal endoscopy, contrast esophagram, and high-resolution manometry showed a slipped Angelchik device on the stomach with moderately impaired esophageal body motility.

Results
The patient underwent laparoscopic removal of the Angelchik prosthesis, followed by a Roux-en-Y gastric bypass for antireflux. After laparoscopic access, adhesions from previous laparotomy were taken down and standard laparoscopic foregut surgery ports were placed. A fibrous calcified capsule encircling the Angelchik prosthesis was noted around the proximal stomach. The anterior wall of the capsule was peeled off using a Harmonic scalpel, and the Angelchik prosthesis was removed in one piece. Given the patient's esophageal dysmotility and scarring around the fundus, we proceeded with Roux-en-Y gastric bypass. The alimentary and biliary limbs were tailored to 80 cm and 30 cm in length, respectively. Using linear staplers, the gastric pouch was created by dividing the proximal stomach just below the level of the scarred tissue created by the Angelchik device. The distal stomach was left in situ. The operation lasted 160 minutes, and the intraoperative blood loss was 150 mL. Barium swallow on postoperative day 1 showed no leakage, and a liquid diet was initiated. The patient was discharged on postoperative day 2. The patient now reports resolved dysphagia and reflux.

Conclusion
Laparoscopic removal of the Angelchik prosthesis and Roux-en-Y gastric bypass was performed safely with good outcomes.

Disclosure
All authors have declared no conflicts of interest.
PS01.077: GASTRIC NECROSIS WITH PERFORATION AS LATE COMPLICATION OF NISSEN FUNDUPLICATION
Authors: De Vega Marta , Miliani Carlos , Antonio Martinez-Piñeiro Juan , Acin Debora , Pereira Fernando 
Published: September 2018

Abstract

Background
Gastric necrosis and perforation after Nissen funduplication is a rare and life-treatening complication. Prompt diagnosis of acute gastric dilatation is mandatory to avoid gastric necrosis. A tight funduplication can cause a gastric dilatation because of the inability to vomit. Other causes of gastric dlatation include trauma, volvulus, anorexia and bulimia diabetes, polyphagia, acute infections and others.

Methods
A 56-year-old man was admited to emergency room with acute-onset epigastric pain and persistent nausea for the past 4 hours. Nine years ago he underwent a laparosocpic Nissen-Rossetti funduplication for a reflux disease.The examination showed abdominal distension and defense. Computed tomography of the abdomen (TAC) show a important pneumoperitoneum distributed diffusely throughout the abdomen, marked gastric distension with abundant content inside. Free intraperitoneal fluid and postsurgical changes in relation to Nissen fundoplication. An emergentcy laparotomy was indicated.

Results
Emergency laparotomy showed free peritoneal fluid with gastric dilatation and two areas of necrosis and perforation (localized in fundus and gastric body). We performed a total gastrectomy with esophagojejunal anastomosis. The patient sufferd a pulmonary embolism 8 days after laparotomy Pathological examination reported gastric dilatation and two areas of ischemia and trasnmural necrosis with perforation and peritonitis.

Conclusion
If the intragastric pressure excede gastric venous pressure can result in ischaemia and infarctation.Increased intragastric pressure is usually the result of a closed loop, secondary to mechanical compresion of the cardio-esophageaal and pyloroduodenal junctions, as can occur in patients with a Nissen procedure. CONCLUSION: Early diagnosis of gastric dilatation in these patients is mandatory to avoid major complications.

Disclosure
All authors have declared no conflicts of interest.
PS01.083: NEGATIVE INTRALUMINAL PRESSURE FOR COMPLEX ESOPHAGEAL PERFORATIONS OR ANASTOMOTIC LEAKS
Authors: Flood Mike , Boland Patrick , Arumugasamy Mayilone , Walsh Thomas 
Published: September 2018

Abstract

Background
Dehiscence of esophago-gastric or esophago-jejunal anastomosis and spontaneous esophageal perforation are life threatening conditions due to the likelihood of breakdown following repair and the sequelae of sepsis. No unit has a large experience in the management of these problems and many approaches are described. Negative intraluminal pressure therapy (NIPT) is a method of minimally invasive operative management described by Berrisford and colleagues (Eur J Cardio-Thoracic Surg 33;2008;742–744). Despite its success, few institutions have reported on its use.

Methods
We reviewed our experience with the management of complex esophageal and anastomotic leaks and identified those that failed stenting, or where the diagnosis of major clinical anastomotic leaks was delayed. In this unit NIPT is the treatment of choice for these at risk patients. NIPT involves the open or endoscopic placement of an intra-luminal drainage tube with multiple side-holes, which is placed across the esophageal defect and brought through the stomach or jejunum and through the upper abdominal wall. A 10cm negative pressure of H20 is applied and the patency of the tube is maintained by the patient orally ingesting sterile water continuously. Nutrition may be provided parenterally or jejunally.

Results
Eleven patients were identified who were treated with NIPT for either esophageal perforation or delayed anastomotic failure over a 7 year period. Four patients had anastomotic leaks, 4 had iatrogenic perforations (2 failed stenting and 1 delayed diagnosis) and 3 had Boerhaave's syndrome. Of the 11 patients, 8 were male. Age ranged from 19–71 years. The median duration of drain application was 19 days. For 5 of the 11 patients, NIPT was combined with some degree of formal operative intervention. Operative video footage was taken and archived where possible. Complete restoration of the GI tract continuity was achieved in all patients. There was no significant procedural morbidity and there were no mortalities.

Conclusion
NIPT is a minimally invasive treatment option for complex esophageal/anastomotic leaks and we advocate its use, alone or as an adjunct to surgical intervention, in the above patient cohort. We have increasingly inserted the tube successfully under sedation alone, reducing the perioperative complications of general anaesthesia.

Disclosure
All authors have declared no conflicts of interest.
PS01.085: TREATMENT STRATEGY FOR AORTO-ESOPHAGEAL FISTULA
Authors: Takahashi Kozue , Taniyama Yusuke , Sakurai Tadashi , Heishi Takahiro , Sato Chiaki , Takaya Kai , Okamoto Hiroshi , Maruyama Shota , Unno Michiaki , Kamei Takashi 
Published: September 2018

Abstract

Background
Aorto-esophageal fistula (AEF) is relatively rare, but life-threatening condition. AEF is usually caused in the patients with thoracic aortic diseases, such as aneurysms, or after thoracic aortic surgery. We present our surgical strategy for AEF.

Methods
From May 2004 to November 2017, 12 patients with AEF were treated at our hospital. The age ranges from 44 to 83 years, and the number of male/female was 9/3. Five patients had previous thoracic endovascular aortic repair (TEVER) in the descending aorta, four patients had descending or total arch replacement. Two patients caused by rupture of thoracic aortic aneurysm, and one patient had penetration of esophagus caused by aspiration of Press Through Package. As the first procedures for surgical treatment, we perform TEVAR in order to prevent the fatal hemorrhage from aortic pseudoaneurysm. At the same day, removal of esophagus with debridement of adjacent infected tissues is performed by open thoracic procedure. After a few days, excision of the infected graft or the aorta followed by new graft replacement with omental flap installation is performed. Four patients used homograft and four patients used rifampicin-soaked graft. After the patient's general condition improve, we plan to perform open surgery for reconstruction of esophagus.

Results
A 3-year survival rate was 50%, and perioperative mortality was 25%. Hospital mortality was noted in 3 patients due to sepsis, brainstem infarction and pulmonary hemorrhage (6–117 days after the first surgery). Late death occurred in 4 patients (n = 2: ileus, n = 1: carcinoma, n = 1: pneumonia). Eight patients could undergo esophagus reconstruction, by colon graft in 4 patients, a pedicled jejunum and a gastric tube in 2 patients, respectively. The duration from esophageal resection to reconstruction was 1–11 months.

Conclusion
Because AEF usually accompanied with hemodynamic instability, immediate surgical intervention is regarded as the only effective treatment. Corporation between gastrointestinal surgeons and cardiovascular surgeons is necessary to achieve this treatment. We share our experiences of AEF treatment and discuss surgical strategy.

Disclosure
All authors have declared no conflicts of interest.
PS01.087: SINGLE STEP TREATMENT OF ESOPHAGEL PERFORATION CAUSED BY HUGE FOREIGN BODY
Authors: Choi Soohwan , Kil Park Jae , Yoon Seungkeun 
Published: September 2018

Abstract

Background
If a clinician encounters a foreign body in thoracic esophagus, flexible endoscopy is the first treatment modality that comes up in mind. But if the foreign body is too huge to pass the upper esophageal sphincter or stuck in esophageal wall, removal is not easy and could result in iatrogenic injury. Furthermore, esophageal perforation is clinically fatal situation and mandates prompt surgical intervention. Here, we report our successful single step treatment of esophageal perforation caused by huge foreign body. The procedure proceeded in operating room with endoscopic assistance.

Methods
Medical chart review.

Results
69 years old male patient admitted to emergency department complaining of neck pain. About 4 days ago, he had ingested a crab. Since then, foreign body sensation and neck pain had been persisted. Computed Tomography (CT) and endoscopy revealed perforation of cervical esophagus. We performed a surgical exploration. With left cervical collar incision, we were able to exposure the injured esophagus. Simultaneously, a gastroenterologist performed an endoscopic inspection. Foreign bodies had migrated to the thoracic esophagus. With endoscopic forceps, most of foreign bodies were removed through the patient's mouth (including the longest one, about 4centimeter; cm). But, 2.8cm sized foreign body was not able to pass the upper esophageal sphincter. Thus, the gastroenterologist pulled the foreign body to level of perforated esophagus and we removed it without difficulty. Finally, the gastroenterologist checked the total length of esophagus. There was no other perforation. Then, we did primary repair of esophagus. The patient discharged at post operation day 11 without complication.

Conclusion
In our case, some of foreign body was situated perpendicularly in thoracic esophagus. Therefore, it couldn’t pass the upper esophageal sphincter, which the longer one could. With endoscopic assistance in operating room, single step treatment (foreign body removal and perforation repair) was possible. In addition, full inspection of total length of esophagus was possible, simultaneously. We think this single step approach is feasible in terms of avoiding unnecessary thoracic approach and multistep procedures (endoscopy followed by surgery).

Disclosure
All authors have declared no conflicts of interest.
PS01.088: CERVICOSTERNOTOMY COMBINED WITH LAPAROSCOPY FOR RESECTION OF UPPER THORACIC ESOPHAGUS: AN INSTITUTIONAL EXPERIENCE
Authors: Hua Rong , Guo Xufeng , Gu Haiyong , Li Bin , Yang Yu , Ye Bo , Li Zhigang , Mao Teng 
Published: September 2018

Abstract

Background
Access to the cervicothoracic junction, whether by lower anterior cervical or transthoracic approach, is particularly difficult. It has been found that the cervicosternotomy allows exposure of the upper thoracic esophagus to the level of the carina. Our goal in this study is to summarize the experience in resection of the upper segment of the esophagus through cervicosternal splitting approach combined with laparoscopy and to discuss the choice of surgical approach, the clearance of lymph node and the treatment of postoperative complications.

Methods
From January 2016 to February 2018, 7 patients with esophageal disease underwent cervicosternotomy as part of a larger procedure. The lesion of the upper esophagus was resected by the direct anterior approach and the lower segmeat of the thoracic esophagus was freed by laparoscopic transesophageal hiatus. The stomach was taken up to the neck through the bed of esophagus and anastomoted between the stomach and esophagus. We analyzed these patients to determine the utility of this means, the ability to achieve complete resection and the outcomes.

Results
Of the 7 patients, 4 patients underwent radical resection for esophageal squamous cell carcinoma, 2 for esophagectomy and laryngectomy, 1 for benign stricture of the esophagus, 6 for cervical and mediastinal node dissection.The lesion of esophagus was resected in all cases. Recurrent laryngeal nerve injury in one patient with carcinoma, the only major postoperative complication in this group. There was no operative death.

Conclusion
The cervicosternal splitting approach can offer good exposure, high rate of resectability and low incidence of postoperative complications for the pathology of the upper segment of esophagus. Careful evaluation of the patient, focusing on the type, extent, and location of the abnormality relative to the level of the carina, often indicates that cervicosternotomy combined with laparoscopy is a safe and effective method of upper thoracic esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS01.089: A DIFFERENT FIXATION METHOD TO PREVENT STENT MIGRATION IN ESOPHAGEAL FISTULAS AND PERFORATIONS
Authors: Eroglu Atila , Aydin Yener , Ulas Ali , Yilmaz Omer 
Published: September 2018

Abstract

Background
Esophageal perforation is an emergency condition characterized by high morbidity and mortality. The removable esophageal stent is an effective method of treatment in cases with esophageal perforation as they allow minimal invasive and rapid nutrition. Stent migration is an important problem in perforations and fistulas where there is no obstruction in the esophageal lumen. Several methods are used to prevent stent migration, including different stent types and endoscopic suture technique. In this study, we aimed to present a method that we use in our clinic to prevent stent migration.

Methods
We retrospectively evaluated 12 consecutive patients who underwent stent placement and were fixed for migration prevention for esophageal fistula or perforation between January 2013 and February 2018 in our clinic. All of the cases were self-expandable metallic stents. The stent was removed from the delivery catheter without insertion and the suture material was passed through the head and reattached to the catheter. The stent was placed using flexible endoscopy. The suture material placed on the upper part of the stent was taken out of the mouth of the patient. After the stent is inserted and the delivery catheter is removed, the nasal catheter (aspiration catheter) was inserted and removed from the mouth. The suture material in the mouth was connected to the tip of the aspiration catheter. The aspiration catheter was withdrawn. The suture material removed from the patient's nose was fixed like a nasogastric catheter. After 3 or 4 days from the procedure, the suture was cut. Migration of the stent was followed by direct radiography.

Results
Seven cases were female and five cases were male. The mean age was 51.1 ± 12.7 years (range 20–72 years). No migrations were observed in any of the cases. After a mean of 19.5 days (range 11–23 days), the stent was removed endoscopically. In all cases, perforation and fistula improved.

Conclusion
We think that the esophageal stent fixation method is a simple and effective method to prevent migration.

Disclosure
All authors have declared no conflicts of interest.
PS01.092: FOKER GROWTH INDUCTION FOR LONG GAP ESOPHAGEAL ATRESIA: WHAT WE HAVE LEARNED
Authors: Jo Svetanoff Wendy , Bairdain Sigrid , Zurakowski David , Hamilton Thomas , Clark Susannah , Ngo Peter , Manfredi Michael , Jennings Russell , Gallagher Dorothy , Smithers C 
Published: September 2018

Abstract

Background
The Foker process is used in patients with long-gap esophageal atresia (LGEA) to maintain the native esophagus; however, chemical paralysis, used to ‘protect’ the esophagus, is associated with complications and longer hospital stays. The purpose of this study was to identify changes in practice patterns with increased Foker experience, and to review the relationship of paralysis time with the incidence of esophageal leaks and need for stricture resections.

Methods
A retrospective review of LGEA patients from January 2006 to December 2016 was performed. Patients were excluded if they had previous attempts elsewhere. Patients were initially divided into two groups: early group (surgery before 2013) and late group (2013–2016) to assess outcomes. All patients, irrespective of surgery date, were then divided into three subgroups based on esophageal anastomotic tension. Logistic regression with odds ratio (OR) and 95% confidence interval (CI) was used to assess risk of leaks and need for stricture resection.

Results
Fifty-eight patients met criteria, and demographics were similar between groups. The late group required significantly fewer surgeries between Foker I and Foker II and had shorter ICU length of stay (LOS). Variables that trended towards statistical significance included total length of paralysis, time between Foker I and Foker II, and total hospital LOS. Overall, 18 patients developed a leak, and 13 required stricture resections. There was no correlation between paralysis time or anastomotic tension with incidence of leak or stricture resection. Multivariable analysis indicated that the occurrence of a leak (OR 5.7, 95% CI: 1.4–27.3, P = 0.025) and need for > 8 dilations (OR 11.0, 95% CI: 2.3–53.4, P = 0.002) were significant predictors of need for stricture resection.

Conclusion
As our experience has grown, the need for multiple procedures between Foker I and Foker II has decreased, leading to less paralytic exposure, shorter ICU LOS, and trending toward decreased hospital LOS. By verifying that specified paralysis times are not required, we can continue to mitigate complications associated with lengthy paralysis times and longer hospital admissions without risking esophageal health.

Disclosure
All authors have declared no conflicts of interest.
PS01.093: REPEAT ESOPHAGEAL STRICTURE RESECTION: WHAT FACTORS ARE MOST INFLUENTIAL?
Authors: Jo Svetanoff Wendy , Bairdain Sigrid , Zurakowski David , Hamilton Thomas , Smithers C , Jennings Russell 
Published: September 2018

Abstract

Background
The objective of this study was to identify whether paralysis time following stricture resection and tension applied at the anastomosis influenced leak rate, need for repeat stricture resection (SR), or need for an interposition graft.

Methods
A retrospective chart review was performed of patients undergoing esophageal stricture resection and anastomosis from October 2007 to July 2017 (IRB# P00004344). Patients who required an interposition as their primary surgery were excluded. Leak rates following stricture resection and the need for further esophageal surgery was identified. Tension groups were also delineated into mild, moderate, and high anastomotic tension. Anastomotic tension and paralysis times were analyzed by multivariable logistic regression and area under the curve (AUC) to determine factors associated with development of leaks and an increased risk of repeat SR.

Results
Ninety-four patients were identified; 45 were males and mean gestational age was 35 weeks. Fifty-one patients were categorized with mild tension, 35 with moderate, and 8 with high tension. Four of the 51 patients (8%) with low tension and 15/43 (35%) with moderate or high tension developed leaks (P = 0.002). Seventeen patients overall required repeat SR (18%), including 3/51 with low tension (6%) versus 14/43 (33%) with moderate or high tension (P < 0.001). Additionally, 12/17 (71%) patients requiring repeat operations initially had a Foker process for their esophageal atresia. Multivariable analysis indicated that moderate/high tension (P = 0.006) and longer paralysis time (p 0.04) were predictive of a leak after initial SR (AUC = 0.720). Paralysis time of 7 + days (P = 0.05), moderate/high tension (P = 0.05) and occurrence of a leak (P = 0.002) were independent risk factors for the need for repeat SR (AUC = 0.861, 95% CI: 0.772–0.949). Of the 17 patients with repeat SR, 10 (59%) underwent a jejunal interposition.

Conclusion
Tension, paralysis time, and presence of a leak are independent risk factors for repeat SR. Low tension anastomoses had a significantly small incidence of repeat surgery. Esophageal replacement shoudl be considered earlier among patients who originally undergo a Foker procedure for esophageal continuity and for those whose stricture repair is placed under moderate or high tension.

Disclosure
All authors have declared no conflicts of interest.
PS01.094: PREDICTING FACTOR OF FAILURE OF CONSERVATIVE TREATMENT AND OUTCOME IN PATIENTS WITH ACUTE CAUSTIC FOREGUT INJURY
Authors: Athigakunagorn Jadsada , Sukpan Panupong , Jiravongbunrod Teerasak 
Published: September 2018

Abstract

Background
Most of the patients with caustic injury can be successfully manage with conservative treatment. However, some patients with high severity required surgery. In this study, we assess failure rate, outcome and predictors of failure of conservative treatment in patients with acute caustic foregut injuries.

Methods
We retrospectively reviewed clinical records of patients with acute caustic foregut injuries who were hospitalized and treated at the Bhumibol Adulyadej Hospital from January2008 – December 2015. Analysis the data included the clinical factor, laboratory result, failure rate and outcome of management.

Results
Out of the 190 patients with caustic foregut injuries, 7.4%(14 patients) were failed to treat with conservative treatment and underwent to emergency surgery. 2 deaths were found in this study. Factors that associated with failure of conservative treatment were epigastrium tenderness (OR 22.2, 2.8–173.6 95% CI), Heart rate > 100 (OR 7, 2.2- 22.6 95% CI), WBC count > 10,000 (OR 4.9, 1.3–18.3 95% CI), Band form positive (OR 9.2, 2.6–32.7 95% CI), Blood PH < 7.2 (OR 16, 3.6–70.9 95% CI).

Conclusion
We consider epigastrium tenderness, Heart rate > 100 bpm, WBC count > 10,000 cell/ul, positive band form and blood pH < 7.2 to be the significant factor associating with failure of conservative management in patients with acute caustic foregut injuries. Intensive evaluation and early surgery should be considered in this group of patients.

Disclosure
All authors have declared no conflicts of interest.