Gianfranco Donatelli1, David Fuks2, Fabrizio Cereatti3, Guillaume Pourcher2, Thierry Perniceni2, Jean-Loup Dumont4, Thierry Tuszynski4, Bertrand Marie Vergeau4, Bruno Meduri4, Brice Gayet2. 1. Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France. donatelligianfranco@gmail.com. 2. Department of Digestive Surgery, Institut Mutualiste Montsouris, 75014, Paris, France. 3. Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy. 4. Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.
Abstract
BACKGROUND: Post-operative collections are a recognized source of morbidity after abdominal surgery. Percutaneous drainage is currently considered the standard treatment but not all collections are accessible using this method. Since the adoption of EUS, endoscopic transmural drainage has become an attractive option in the management of such complications. The present study aimed to assess the efficacy, safety and modalities of endoscopic transmural drainage in the treatment of post-operative collections. METHODS: Data of all patients referred to our dedicated multidisciplinary facility from 2014 to 2017 for endoscopic drainage of symptomatic post-operative collections after failure of percutaneous drainage or when it was deemed impossible, were retrospectively analyzed. RESULTS: Thirty-two patients (17 males and 15 females) with a median age of 53 years old (range 31-74) were included. Collections resulted from pancreatic (n = 10), colorectal (n = 6), bariatric (n = 5), and other type of surgery (n = 11). Collection size was less than 5 cm in diameter in 10 (31%), between 5 and 10 cm in 17 (53%) ,and more than 10 cm in 5 (16%) patients. The median time from surgery to endoscopic drainage was 38 days (range 6-360). Eight (25%) patients underwent endoscopic guided drainage whereas 24 (75%) patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achieved in 30 (93.4%) after a mean follow-up of 13.5 months (1.2-24.8). Overall complication was 12.5% including four patients who bled following trans-gastric drainage treated with conservative therapy. CONCLUSIONS: The present series suggests that endoscopic transmural drainage represents an interesting alternative in the treatment of post-operative collection when percutaneous drainage is not possible or fails.
BACKGROUND: Post-operative collections are a recognized source of morbidity after abdominal surgery. Percutaneous drainage is currently considered the standard treatment but not all collections are accessible using this method. Since the adoption of EUS, endoscopic transmural drainage has become an attractive option in the management of such complications. The present study aimed to assess the efficacy, safety and modalities of endoscopic transmural drainage in the treatment of post-operative collections. METHODS: Data of all patients referred to our dedicated multidisciplinary facility from 2014 to 2017 for endoscopic drainage of symptomatic post-operative collections after failure of percutaneous drainage or when it was deemed impossible, were retrospectively analyzed. RESULTS: Thirty-two patients (17 males and 15 females) with a median age of 53 years old (range 31-74) were included. Collections resulted from pancreatic (n = 10), colorectal (n = 6), bariatric (n = 5), and other type of surgery (n = 11). Collection size was less than 5 cm in diameter in 10 (31%), between 5 and 10 cm in 17 (53%) ,and more than 10 cm in 5 (16%) patients. The median time from surgery to endoscopic drainage was 38 days (range 6-360). Eight (25%) patients underwent endoscopic guided drainage whereas 24 (75%) patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achieved in 30 (93.4%) after a mean follow-up of 13.5 months (1.2-24.8). Overall complication was 12.5% including four patients who bled following trans-gastric drainage treated with conservative therapy. CONCLUSIONS: The present series suggests that endoscopic transmural drainage represents an interesting alternative in the treatment of post-operative collection when percutaneous drainage is not possible or fails.
Entities:
Keywords:
Double pigtail plastic stent; EUS drainage; Fluid collection; Internal drainage; Intra-abdominal collection; Pseudocyst; Surgical complication; Wall off necrosis
Authors: Amy Tilara; Hans Gerdes; Peter Allen; William Jarnagin; Peter Kingham; Yuman Fong; Ronald DeMatteo; Michael D'Angelica; Mark Schattner Journal: J Am Coll Surg Date: 2013-10-05 Impact factor: 6.113
Authors: Franck Billmann; Aylin Pfeiffer; Peter Sauer; Adrian Billeter; Christian Rupp; Ronald Koschny; Felix Nickel; Moritz von Frankenberg; Beat Peter Müller-Stich; Anja Schaible Journal: Obes Surg Date: 2021-11-03 Impact factor: 4.129
Authors: Ali Ramouz; Saeed Shafiei; Sadeq Ali-Hasan-Al-Saegh; Elias Khajeh; Ricardo Rio-Tinto; Sanam Fakour; Andreas Brandl; Gil Goncalves; Christoph Berchtold; Markus W Büchler; Arianeb Mehrabi Journal: Surg Endosc Date: 2022-03-04 Impact factor: 3.453