The Experts below are selected from a list of 4164 Experts worldwide ranked by ideXlab platform
Gottumukkala S Raju - One of the best experts on this subject based on the ideXlab platform.
-
Endoscopic closure of Colon Perforation compared to surgery in a porcine model: a randomized controlled trial (with videos)
Gastrointestinal endoscopy, 2008Co-Authors: Gottumukkala S Raju, Ijaz Ahmed, Annette Fritscher-ravens, Richard I. Rothstein, Paul Swain, Andres Gelrud, Guillermo Gomez, Markus Winny, Thomas Sonnanstine, Maria BergströmAbstract:Background Endoscopic closure of inadvertent or intentional Colon Perforations might be valuable if comparable to surgical closure. Objective The aim of this study was to compare endoscopic closure of a 4-cm Colon Perforation in a porcine model with surgical closure in a multicenter study. Setting University hospitals in the United States and Europe. Design and Interventions After creating a 4-cm linear Colon Perforation, the animals were randomized to either endoscopic or surgical closure. The total procedure time from the beginning of Perforation to the completion of procedure was measured. The animals were euthanized after 2 weeks to evaluate healing, unless there was a complication. Results Fifty-four animals were randomized to either surgical or endoscopic closure of Colon Perforation. Eight animals developed complications, and 7 of these were euthanized before 2 weeks. Twenty-three animals in each group survived for 2 weeks. Surgical closure of the Perforation was successful in all animals in that group, and endoscopic closure was successful in 25 of the 27 animals. The median procedure time was shorter in the surgery group compared to the endoscopy group (35 vs 44 minutes, P = .016). Peritonitis, local adhesions, and leak test results were comparable in both groups. Distant adhesions were less frequent in the endoscopic closure group (26.1% vs 56.5%, P = .03). Five of the 186 T-tags (2.7%) were noted in the adjacent viscera. Limitation This porcine study does not mimic clean Colon Perforation in humans; it mimics dirty Colon Perforation in humans. Conclusions Endoscopic closure of a 4-cm Colon Perforation was comparable to surgery, and this technique can be potentially used for closure of intentional or inadvertent Colon Perforations.
-
endoluminal suturing may overcome the limitations of clip closure of a gaping wide Colon Perforation with videos
Gastrointestinal Endoscopy, 2007Co-Authors: Gottumukkala S Raju, Goro Shibukawa, Ijaz Ahmed, Douglas Brining, Allison Poussard, Shuyuan Xiao, Mike Cropper, Dave Martin, Joanne HullAbstract:Background It is unclear whether large gaping Perforations of the Colon can be closed by the endoluminal route. Objective To evaluate the feasibility and the outcome of closure of large Perforations of Colon with clips and sutures by using through-the-endoscope novel devices. Design Prospective animal study. Setting University hospital. Patients Ten pigs. Interventions Closure of a 4-cm full-thickness Colon Perforation freshly created by an insulated-tip knife with the InScope Multi-Clip Applier (n = 6) and with the tissue approximation device (n = 4). Main Outcome Measurements (a) Technical feasibility of closure, (b) clinical monitoring for 2 weeks, (c) necropsy (day 14), (d) healing by a dye-leak test and histology. Results Endoluminal closure of a 4-cm–long Colon Perforation was successful in 9 of 10 animals. The clips failed to close a gaping wide Colon Perforation in 1 animal. The sutures were successful in the closure of both nongaping and gaping Perforations. Successful closure resulted in a leakproof sealing at 2 weeks and prevented clinical peritonitis in all the animals in the clip-closure group and in 3 of 4 animals in the suture-closure group. Necropsy at 2 weeks revealed mild peritonitis in 2 of the 5 animals in the clip closure group and in 2 of the 4 animals in the suture-closure group; none developed fecal peritonitis. Limitations None. Conclusions Endoluminal closure of a 4-cm Colon Perforation with clips was successful in the majority of cases. Sutures were useful in the closure of gaping Colon Perforations that could not be closed with clips.
-
immediate endoscopic closure of Colon Perforation by using a prototype endoscopic suturing device feasibility and outcome in a porcine model with video
Gastrointestinal Endoscopy, 2006Co-Authors: Binh V Pham, Gottumukkala S Raju, Ijaz Ahmed, Douglas Brining, Sydney Chung, Peter B Cotton, Christopher J Gostout, Robert H Hawes, Anthony N Kalloo, Sergey V KantsevoyAbstract:Background Perforation is an uncommon but potentially devastating complication of Colonoscopy. Surgical closure is the standard of care. Immediate endoluminal closure of a Perforation would avoid the morbidity and mortality associated with general anesthesia, laparotomy, and surgical repair. Objectives To evaluate the feasibility and safety of full-thickness endoscopic closure of Colonic Perforations with a prototype endoscopic suturing device, the Eagle Claw, in a porcine model. Design Endoscopic animal experimental study of closure of Colon Perforation by using a porcine model. Subjects Ten pigs were included in the study. Interventions The Eagle Claw was used to close small Perforations (1.5 to 2 cm) of the Colon created by needle-knife with the animal under general anesthesia by using the endoluminal route. All animals received intravenous antibiotics and were allowed to eat after 24 hours. Main Outcome Measurements The animals were monitored daily for signs of sepsis and peritonitis. On day 7, they were euthanized. The peritoneal cavity was examined for fecal peritonitis, and the Colon Perforation site was checked for wound dehiscence and pericolic abscess formation. Results Endoscopic closure of the Colon Perforation was successful in 7 animals, and they recovered well without any sepsis or peritonitis. Necropsy did not reveal fecal peritonitis or periColonic abscess formation at the site of Perforation, and the Perforation healed well. Closure was successful in 1 animal, but necropsy revealed dehiscence of the Colon Perforation site. Endoscopic closure was unsuccessful in 2 animals, and these were euthanized immediately. Conclusions Closure of acute Perforation of the Colon is feasible with the Eagle Claw endoscopic suturing device in a porcine model.
-
Controlled trial of immediate endoluminal closure of Colon Perforations in a porcine model by use of a novel clip device (with videos)
Gastrointestinal endoscopy, 2006Co-Authors: Gottumukkala S Raju, Goro Shibukawa, Ijaz Ahmed, Douglas Brining, Allison Poussard, Shuyuan Xiao, Orhan Tarcin, Kristin Dawson, Gary Knight, Randall TanguayAbstract:Background Although endoluminal closure of a small Perforation of the Colon is technically feasible, the outcome of such a closure is unclear. Objective Our purpose was to evaluate the feasibility and the outcome of endoluminal closure of a small Perforation of the Colon with a novel clip device, the InScope MultiClip Applier (IMCA), and to assess the number of clips required for successful closure. Design Prospective controlled study. Setting University hospital. Animals 17 pigs. Interventions A 2-cm full-thickness Colon Perforation was randomized to 3 groups: control, no closure (n = 4), 2-clip closure (n = 7), and 4-clip closure (n = 6). Main Outcome Measurements (1) Technical feasibility of closure, (2) closure time, (3) clinical monitoring for 2 weeks, (4) necropsy (day 14), and (5) healing by a dye leak test and histologic examination. Results Endoscopic closure of the Colon Perforation was technically successful in 12 of 13 animals. A wide gaping hole prevented satisfactory closure in 1 animal. The median time for closure with 2 and 4 clips was 2 and 3 minutes, respectively. Clip closure of Perforation prevented clinical sepsis ( P = .008) and diminished the risk for fibrinous peritonitis ( P = .02 for a single test of hypothesis; however, correction for the multiple testing of data removes this significance) and adhesion formation ( P = .008) compared with controls, without any leakage. The outcomes of 2- and 4-clip closure were similar. Conclusions Endoluminal closure of a 2-cm Colon Perforation with clips is successful in preventing peritonitis and adhesions and it can be accomplished quickly with this novel device. Clip closure at 1-cm intervals is sufficient for successful closure of a 2-cm Colon Perforation.
Frederick L. Grover - One of the best experts on this subject based on the ideXlab platform.
-
Colon Perforation After Lung Transplantation
The Annals of thoracic surgery, 1996Co-Authors: Thomas M. Beaver, David A. Fullerton, Martin R. Zamora, David B. Badesch, David Weill, James M. Brown, David N. Campbell, Frederick L. GroverAbstract:Background Colon Perforation has been previously described after solid organ transplantation. Since the inception of the lung transplant program at the University of Colorado 60 isolated lung transplantations have been performed. Four of these patients have suffered spontaneous Colonic Perforation. Methods The case history of each lung transplant patient with a Colon Perforation and the literature were reviewed. Results An increased incidence of Colon Perforation in lung transplant patients was identified. Diverticulitis was found to be the predominant cause, and an association with steroids was noted. The two deaths in this series were in patients receiving high-dose steroids in whom invasive Aspergillus infections developed. Conclusions Careful screening of the gastrointestinal tract before transplantation is advocated. A steroid-sparing immunosuppressive regimen is recommended. All lung transplant patients with abdominal complaints require an aggressive work-up, and surgeons should have a low threshold for laparotomy. Conservative surgical principles, including resection of the perforated segment of Colon and proximal end-colostomy rather than primary anastomosis, are necessary for the optimal outcome.
Ijaz Ahmed - One of the best experts on this subject based on the ideXlab platform.
-
Endoscopic closure of Colon Perforation compared to surgery in a porcine model: a randomized controlled trial (with videos)
Gastrointestinal endoscopy, 2008Co-Authors: Gottumukkala S Raju, Ijaz Ahmed, Annette Fritscher-ravens, Richard I. Rothstein, Paul Swain, Andres Gelrud, Guillermo Gomez, Markus Winny, Thomas Sonnanstine, Maria BergströmAbstract:Background Endoscopic closure of inadvertent or intentional Colon Perforations might be valuable if comparable to surgical closure. Objective The aim of this study was to compare endoscopic closure of a 4-cm Colon Perforation in a porcine model with surgical closure in a multicenter study. Setting University hospitals in the United States and Europe. Design and Interventions After creating a 4-cm linear Colon Perforation, the animals were randomized to either endoscopic or surgical closure. The total procedure time from the beginning of Perforation to the completion of procedure was measured. The animals were euthanized after 2 weeks to evaluate healing, unless there was a complication. Results Fifty-four animals were randomized to either surgical or endoscopic closure of Colon Perforation. Eight animals developed complications, and 7 of these were euthanized before 2 weeks. Twenty-three animals in each group survived for 2 weeks. Surgical closure of the Perforation was successful in all animals in that group, and endoscopic closure was successful in 25 of the 27 animals. The median procedure time was shorter in the surgery group compared to the endoscopy group (35 vs 44 minutes, P = .016). Peritonitis, local adhesions, and leak test results were comparable in both groups. Distant adhesions were less frequent in the endoscopic closure group (26.1% vs 56.5%, P = .03). Five of the 186 T-tags (2.7%) were noted in the adjacent viscera. Limitation This porcine study does not mimic clean Colon Perforation in humans; it mimics dirty Colon Perforation in humans. Conclusions Endoscopic closure of a 4-cm Colon Perforation was comparable to surgery, and this technique can be potentially used for closure of intentional or inadvertent Colon Perforations.
-
endoluminal suturing may overcome the limitations of clip closure of a gaping wide Colon Perforation with videos
Gastrointestinal Endoscopy, 2007Co-Authors: Gottumukkala S Raju, Goro Shibukawa, Ijaz Ahmed, Douglas Brining, Allison Poussard, Shuyuan Xiao, Mike Cropper, Dave Martin, Joanne HullAbstract:Background It is unclear whether large gaping Perforations of the Colon can be closed by the endoluminal route. Objective To evaluate the feasibility and the outcome of closure of large Perforations of Colon with clips and sutures by using through-the-endoscope novel devices. Design Prospective animal study. Setting University hospital. Patients Ten pigs. Interventions Closure of a 4-cm full-thickness Colon Perforation freshly created by an insulated-tip knife with the InScope Multi-Clip Applier (n = 6) and with the tissue approximation device (n = 4). Main Outcome Measurements (a) Technical feasibility of closure, (b) clinical monitoring for 2 weeks, (c) necropsy (day 14), (d) healing by a dye-leak test and histology. Results Endoluminal closure of a 4-cm–long Colon Perforation was successful in 9 of 10 animals. The clips failed to close a gaping wide Colon Perforation in 1 animal. The sutures were successful in the closure of both nongaping and gaping Perforations. Successful closure resulted in a leakproof sealing at 2 weeks and prevented clinical peritonitis in all the animals in the clip-closure group and in 3 of 4 animals in the suture-closure group. Necropsy at 2 weeks revealed mild peritonitis in 2 of the 5 animals in the clip closure group and in 2 of the 4 animals in the suture-closure group; none developed fecal peritonitis. Limitations None. Conclusions Endoluminal closure of a 4-cm Colon Perforation with clips was successful in the majority of cases. Sutures were useful in the closure of gaping Colon Perforations that could not be closed with clips.
-
immediate endoscopic closure of Colon Perforation by using a prototype endoscopic suturing device feasibility and outcome in a porcine model with video
Gastrointestinal Endoscopy, 2006Co-Authors: Binh V Pham, Gottumukkala S Raju, Ijaz Ahmed, Douglas Brining, Sydney Chung, Peter B Cotton, Christopher J Gostout, Robert H Hawes, Anthony N Kalloo, Sergey V KantsevoyAbstract:Background Perforation is an uncommon but potentially devastating complication of Colonoscopy. Surgical closure is the standard of care. Immediate endoluminal closure of a Perforation would avoid the morbidity and mortality associated with general anesthesia, laparotomy, and surgical repair. Objectives To evaluate the feasibility and safety of full-thickness endoscopic closure of Colonic Perforations with a prototype endoscopic suturing device, the Eagle Claw, in a porcine model. Design Endoscopic animal experimental study of closure of Colon Perforation by using a porcine model. Subjects Ten pigs were included in the study. Interventions The Eagle Claw was used to close small Perforations (1.5 to 2 cm) of the Colon created by needle-knife with the animal under general anesthesia by using the endoluminal route. All animals received intravenous antibiotics and were allowed to eat after 24 hours. Main Outcome Measurements The animals were monitored daily for signs of sepsis and peritonitis. On day 7, they were euthanized. The peritoneal cavity was examined for fecal peritonitis, and the Colon Perforation site was checked for wound dehiscence and pericolic abscess formation. Results Endoscopic closure of the Colon Perforation was successful in 7 animals, and they recovered well without any sepsis or peritonitis. Necropsy did not reveal fecal peritonitis or periColonic abscess formation at the site of Perforation, and the Perforation healed well. Closure was successful in 1 animal, but necropsy revealed dehiscence of the Colon Perforation site. Endoscopic closure was unsuccessful in 2 animals, and these were euthanized immediately. Conclusions Closure of acute Perforation of the Colon is feasible with the Eagle Claw endoscopic suturing device in a porcine model.
-
Controlled trial of immediate endoluminal closure of Colon Perforations in a porcine model by use of a novel clip device (with videos)
Gastrointestinal endoscopy, 2006Co-Authors: Gottumukkala S Raju, Goro Shibukawa, Ijaz Ahmed, Douglas Brining, Allison Poussard, Shuyuan Xiao, Orhan Tarcin, Kristin Dawson, Gary Knight, Randall TanguayAbstract:Background Although endoluminal closure of a small Perforation of the Colon is technically feasible, the outcome of such a closure is unclear. Objective Our purpose was to evaluate the feasibility and the outcome of endoluminal closure of a small Perforation of the Colon with a novel clip device, the InScope MultiClip Applier (IMCA), and to assess the number of clips required for successful closure. Design Prospective controlled study. Setting University hospital. Animals 17 pigs. Interventions A 2-cm full-thickness Colon Perforation was randomized to 3 groups: control, no closure (n = 4), 2-clip closure (n = 7), and 4-clip closure (n = 6). Main Outcome Measurements (1) Technical feasibility of closure, (2) closure time, (3) clinical monitoring for 2 weeks, (4) necropsy (day 14), and (5) healing by a dye leak test and histologic examination. Results Endoscopic closure of the Colon Perforation was technically successful in 12 of 13 animals. A wide gaping hole prevented satisfactory closure in 1 animal. The median time for closure with 2 and 4 clips was 2 and 3 minutes, respectively. Clip closure of Perforation prevented clinical sepsis ( P = .008) and diminished the risk for fibrinous peritonitis ( P = .02 for a single test of hypothesis; however, correction for the multiple testing of data removes this significance) and adhesion formation ( P = .008) compared with controls, without any leakage. The outcomes of 2- and 4-clip closure were similar. Conclusions Endoluminal closure of a 2-cm Colon Perforation with clips is successful in preventing peritonitis and adhesions and it can be accomplished quickly with this novel device. Clip closure at 1-cm intervals is sufficient for successful closure of a 2-cm Colon Perforation.
Eduardo E. Montalvo-javé - One of the best experts on this subject based on the ideXlab platform.
-
Evolution of Surgical Treatment of Amebiasis-Associated Colon Perforation
Journal of Gastrointestinal Surgery, 2009Co-Authors: César Athié-gutiérrez, Heriberto Rodea-rosas, Clemente Guízar-bermúdez, Avisaí Alcántara, Eduardo E. Montalvo-javéAbstract:Background Amebiasis is a worldwide health problem that mainly affects developing countries. Invasive amebiasis tends to develop complications, and among these, Perforation of the Colon, although infrequent (1.9–9.1%), is the most lethal. Surgical treatment in these cases should be carried out in a timely fashion prior to the presentation of systemic repercussions or death. In the present study, we analyzed a total of 122 cases of invasive amebiasis-associated Colon Perforation. Methods and Study Design We conducted a clinical, retrospective, and observational study and presented cases of Colonic Perforation observed over the past 30 years at the Medical-Surgical Emergency Service of the Mexico City-based Hospital General de México OD during the 1970–1999 period. Results During this time, a total of 19,916 emergency abdominal surgeries were performed. One hundred twenty-two of these procedures corresponded to cases of Colon Perforation by ameba, which represents 0.6%; 80 patients were men (65.6%) and 42 were women (34.4%), with an average age of 48 years. Multiple Colon Perforation was 74%, with right Colon the most affected (90.5%). Depending on the Perforation’s extension and localization, right hemicolectomy with ileostomy were performed in 53 patients (43.45%), subtotal colectomy with ileostomy in 43 (35.25%), left hemicolectomy with transverse colostomy in 12 (9.83%), exteriorization of perforated left Colon (stoma) in 13 (10.65%), and primary closure with exteriorization in one patient (0.8%). Post-operative complications were present in 48 patients (39.3%), and 20 cases were related with the creation of a stoma. Eighteen of these cases were due to persistent abdominal sepsis and ten due to toxic Colon; the latter correspond solely to patients with initial nonresective treatment. General mortality was 40%, with 32% (17 of 53 cases) of mortality in those submitted to right hemicolestomy, 16.7% (two of 12) of left hemicolestomy, 44.2% (19 of 43) in those in whom a subtotal colectomy was performed, with 76.9% (ten of 13) patients with exteriorization of the perforated right Colon, and with 100% (one of one patient) mortality with primary closure. Conclusions Perforation is the most frequent surgical complication of invasive amebiasis of the Colon, occurring principally in masculine gender and in the fourth decade of life. Resection and stoma creation is the procedure of choice that can resolve the septic focus from the first surgical procedure, depending on the general status of the patient. However, morbidity and mortality are high, and there is a tendency for these to be lower on comparing initial cases with those with recently conducted surgical procedures.
-
Evolution of surgical treatment of amebiasis-associated Colon Perforation.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2009Co-Authors: César Athié-gutiérrez, Heriberto Rodea-rosas, Clemente Guízar-bermúdez, Avisaí Alcántara, Eduardo E. Montalvo-javéAbstract:Background Amebiasis is a worldwide health problem that mainly affects developing countries. Invasive amebiasis tends to develop complications, and among these, Perforation of the Colon, although infrequent (1.9–9.1%), is the most lethal. Surgical treatment in these cases should be carried out in a timely fashion prior to the presentation of systemic repercussions or death. In the present study, we analyzed a total of 122 cases of invasive amebiasis-associated Colon Perforation.
Li Li-tao - One of the best experts on this subject based on the ideXlab platform.
-
Clinical Application of Damage Control Surgery in Treatment of Non-traumatic Colon Perforation with Severe Abdominal Cavity Infection
Journal of Kunming Medical University, 2012Co-Authors: Li Li-taoAbstract:Objective To explore the experience and effect of damage control surgery(DCS)in treatment of non-traumatic Colon Perforation with severe abdominal cavity infection.Methods 24 non-traumatic Colon Perforation with severe abdominal cavity infection patients who admitted in our department of general surgery from Aug.2005 to Aug.2011 were enrolled in this study.A retrospective analysis was done on the clinical data of the patients including preference of DCS methods and perioperative therapies.Results DCS was performed in all 24 patients.Then 21 patients were healed after SICU resuscitation and 14 patients among of them were performed defined reoperations after 2 months.Mortality rate was 12.5% with 3 cases in 7 days postoperation,and the causes were irrespective with DCS.Conclusion For non-traumatic Colon Perforation with severe abdominal cavity infection patients,DCS should be made positively to increase the survival chance of patients,and save the opportunities for them to receive defined operations.