Endoscopic ultrasonography (EUS) has progressed beyond diagnostic imaging to include EUS-guided tissue acquisition and EUS-directed therapies. This review provides an update on EUS-guided drainage and anastomotic procedures, and other therapeutic procedures. Today, EUS-guided drainage of symptomatic walled-off pancreatic fluid collections is the norm, with endoscopic necrosectomy as an adjunct. For high-risk surgical patients unsuitable for cholecystectomy, EUS-guided gallbladder drainage of acute cholecystitis is an option. Additionally, EUS-guided drainage of obstructed biliary and pancreatic ductal system can be performed as salvage procedures after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Bariatric procedures such as Roux-en-Y gastric bypass alter the gastric anatomy, hindering access to the major papilla. This can be overcome by creating a conduit through the excluded stomach using EUS-directed transgastric ERCP. Gastric outlet obstruction and afferent loop syndrome can be treated using EUS-guided gastrojejunostomy. These therapeutic interventions are a major advancement in the field of interventional EUS, achieving significant clinical impact.
Humans ; Endosonography/methods* ; Drainage/methods* ; Cholangiopancreatography, Endoscopic Retrograde/methods* ; Ultrasonography, Interventional/methods* ; Anastomosis, Surgical/methods*

Insertion of external ventricular drainage (EVD) is an effective neurosurgical treatment approach. The accuracy of EVD insertion is related to potential complications, and the precise placement of the catheter tip can reduce the incidence of complications. With the progress of medical technology, the research and application of EVD catheterization technology are developing rapidly. This paper reviews the traditional blind catheterization, computed tomography, ultrasound guidance, mixed reality navigation system, laser positioning neural navigation, mobile device neural navigation, stereotactic system, and the visualization technology of the whole process of neuroendoscope assisted ventricle puncture to guide EVD catheterization to provide references for clinical decision-making by medical staff.
Humans ; Drainage/methods* ; Catheterization/methods* ; Cerebral Ventricles/surgery*

Objective:To discuss the clinical efficacy of low-temperature radiofrequency ablation assisted by endoscopy combined with resection and drainage of cervical abscess for the treatment of congenital pyriform sinus fistula （CPSF） in the acute inflammatory period of children. Methods:Clinical data of 30 patients with CPSF in the acute inflammatory period who received low-temperature radiofrequency ablation assisted by endoscopy under laryngoscope, combined with resection and drainage of cervical abscess, from January 2018 to December 2023 were reviewed. After the operation, patients were followed up closely at different stages. All patients underwent color Doppler ultrasound and electronic laryngoscopy, and the results were analyzed. Results:All 30 children successfully completed the surgery without pharyngeal fistula, dysphagia, perifistula, or distal fistula infection, and the incision in the neck healed well. The follow-up survey ranged from 6 months to 2 years, and no recurrences were observed. Conclusion:Low-temperature radiofrequency ablation assisted by endoscopy combined with resection and drainage of cervical abscess is a promising method for treating CPSF in the acute inflammatory period. It is less traumatic, simple, safe, has a significant curative effect, and a low recurrence rate. This approach can be used as a supplementary operation for CPSF in children and provides a new way for clinical treatment.
Humans ; Pyriform Sinus/abnormalities* ; Abscess/surgery* ; Drainage ; Fistula/congenital* ; Female ; Male ; Child ; Radiofrequency Ablation ; Treatment Outcome ; Postoperative Period ; Endoscopy ; Laryngoscopy ; Inflammation ; Child, Preschool

Ventriculostomy drainage is one of the commonly used surgical techniques in neurocritical care, which can relieve intracranial hypertension and facilitate postoperative cerebrospinal fluid and intracranial pressure monitoring. By placing a drainage tube in the ventricle, blood and fluid accumulation within the ventricle are drained out of the brain, reducing intracranial pressure and preventing brain tissue damage. Clinically, the speed of ventriculostomy drainage is often controlled by measuring the height difference between the drainage opening and the plane of the ventricle, ensuring the safe and effective reduction of intracranial pressure, facilitating the implementation of clinical management plans, and preventing complications. However, how to easily, safely, and effectively measure the height difference between the drainage opening and the ventricular plane remains a challenge in nursing management. Currently, clinical practice often uses a tape measure to measure the height of the ventriculostomy drainage, a process that is cumbersome and time-consuming and susceptible to human error, leading to inaccurate measurements. However, the challenge of easily, safely, and effectively detecting the height difference between the drainage opening and the ventricular plane remains a difficult problem in nursing management. To address this issue, the medical and nursing staff of the intensive care unit (ICU) at Zhongda Hospital, Southeast University, jointly designed a novel ventriculostomy drainage height measurement device, which has been granted a national utility model patent (patent number: ZL 2022 2 1400920.9). This device can be easily and securely fixed to an infusion stand. Using a level within the horizontal measuring part and a rotational structure, the vertical measuring part of the device is adjusted to be perpendicular to the ground. After opening the limit clip, the horizontal part is manually guided down to the appropriate height. The front end of the horizontal measuring part is then extended towards the patient's head, and after confirming the position, the limit clip is closed. At this point, the horizontal height difference between the drainage opening and the ventricular plane can be accurately measured. When temporarily finishing the height measurement of the drainage tube, the device can be folded and stored by retracting the horizontal measuring part and rotating components. This measuring device has a simple operation process, which can improve the accuracy and reliability of the drainage height measurement, enhance treatment outcomes and patient safety, reduce the workload of nursing staff, and has certain clinical promotion and practical value.
Humans ; Ventriculostomy/methods* ; Drainage/instrumentation* ; Equipment Design ; Cerebral Ventricles

INTRODUCTION

Hysteroscopy is the gold standard procedure for the evaluation and diagnosis of intrauterine pathologies. The optimal time to do hysteroscopy is during the proliferative phase. However, for women with irregular bleeding, the optimal time is unpredictable. Besides pharmacological means, mechanical endometrial preparation could be done.

The objective of this study was to determine the effect of suction curettage on visualization, operative time, fluid deficit, and histopathologic diagnosis among perimenopausal women with abnormal uterine bleeding (AUB) and unprepared endometrium prior to operative hysteroscopy.

Thirty-four (34) perimenopausal women admitted for AUB with unprepared endometrium for operative hysteroscopy who consented to participate were recruited and randomly divided into two groups: 18 women had suction curettage done prior to operative hysteroscopy and 16 women had operative hysteroscopy done alone. The following data were obtained for each group: (1) improvement in clarity (i.e., visualization of fundus and both tubal ostia), (2) operative time from entry to withdrawal of the resectoscope (measured in minutes), (3) fluid deficit, and (4) final histopathological diagnosis. P 

Women who underwent suction curettage prior to operative hysteroscopy had improved visualization (72.2%, P < 0.001), shorter operative time (29.06 ± 7.06 min vs. 35.5 ± 7.2 min, P = 0.013), no difference in fluid deficit (P = 0.276), and the histopathologic diagnosis (P = 0.470).

Suction curettage prior to operative hysteroscopy among perimenopausal women with AUB and unprepared endometrium improved visualization and shortened operative time without affecting fluid deficit and histopathologic diagnosis.

OBJECTIVE: To explore the effect of intravenous tranexamic acid on postoperative drainage and elbow joint function after traumatic elbow stiffness release. METHODS: The clinical data of 44 patients with elbow joint stiffness who were treated with release surgery between March 2022 and December 2023 and met the selection criteria were retrospectively analyzed. Among them, 20 patients were given intravenous infusion of 100 mL (1 g/100 mL, once a day) of tranexamic acid solution for 3 consecutive days after surgery (group A), and 24 patients were not treated with tranexamic acid after surgery (group B). There was no significant difference in baseline data such as gender, age, side, body mass index, initial injury, and preoperative hemoglobin, visual analogue scale (VAS) score, and Mayo elbow function score (MEPS), elbow flexion and extension activity between the two groups ( P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, postoperative hospital stay, VAS score before operation and at 1, 2, and 3 days after operation, MEPS score before operation, at 3 months after operation, and at last follow-up, and elbow flexion and extension activity before operation and at last follow-up were recorded and compared between the two groups. RESULTS: Both groups of patients successfully completed the operation, and there was no significant difference in operation time ( P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, and postoperative hospital stay in group A were significantly less than those in group B ( P<0.05). Both groups of patients were followed up 6-12 months, with an average of 8.6 months. No complications such as wound infection, elbow joint varus and varus instability or dislocation, and pulmonary embolism or other thromboembolic events occurred in either group. The VAS scores of both groups were significantly higher at 1 day and 2 days after operation than before operation ( P<0.05); the VAS score of group A was significantly lower than that of group B ( P<0.05). The VAS scores of both groups decreased to the preoperative level at 3 months after operation, and there was no significant difference between the two groups ( P>0.05). At 3 months after operation and at last follow-up, the MEPS scores of both groups significantly improved when compared with those before operation ( P<0.05); there was no significant difference between the two groups ( P>0.05). At last follow-up, the postoperative elbow flexion and extension activity of the two groups significantly increased when compared with that before operation ( P<0.05); there was no significant difference in change of elbow flexion and extension activity between the two groups ( P>0.05). CONCLUSION Intravenous tranexamic acid for 3 consecutive days after release of traumatic elbow stiffness can significantly reduce postoperative drainage volume, shorten drainage tube indwelling time and hospital stay, and relieve early postoperative pain, but it has no effect on the risk of thrombotic and embolic events and postoperative elbow function.
Humans ; Tranexamic Acid/administration & dosage* ; Elbow Joint ; Drainage ; Range of Motion, Articular ; Elbow Injuries ; Antifibrinolytic Agents/administration & dosage* ; Postoperative Period ; Female ; Male ; Retrospective Studies ; Adult

OBJECTIVE: To investigate correlation of the effect factors on surgical efficacythe of whether postoperative drainage through the multifidus interspace approach in the treatment of thoracolumbar fractures. METHODS: A total of 66 patients with thoracolumbar fractures admitted from January 2017 to December 2021 were retrospectively analyzed. According to whether postoperative drainage, 36 patients were in drainage group and 30 patients were in no drainage group. In the drainage group, there were 17 males and 19 females with an average age of (55.4±9.5) years old ranging from 23 to 68 years old;in the no drainage group, there were 16 males and 14 females with an average age of (53.9±8.3) years ranging from 30 to 69 years old. A multifidus interspace approach was used in both groups. Then factores of age, gender, fracture site, injured segment, operation time, intraoperative blood loss, preoperative Cobb angle, preoperative vertebral anterior height ratio, preoperative Japanese 0rthopaedic Association(J0A) score, preoperative visual ana1ogue scale(VAS), preoperative Oswestry Disability Index(ODI) score may affect the postoperative drainage, using univariate and multivariate Logistic regression analysis to study their influence on the prognosis. The postoperative Cobb angle, anterior vertebral height ratio, JOA score, VAS and ODI were compared between the two groups. RESULTS: Univariate analysis showed that whether postoperative drainage may be related to patient age, whether injury to multiple segments, operation time, and intraoperative blood loss(P<0.05). The multivariate analysis showed that age, operation time were the main factors affecting postoperative drainage(P<0.05). There was no significant difference in Cobb angle, anterior vertebral height loss rate, JOA score, VAS score and ODI score between the two groups at the postoperative follow-up(P>0.05). In terms of complications, the total incidence of postoperative low back pain in the no drainage group was lower than that in the drainage group(P<0.05). There was no significant difference in postoperative infection and postoperative nerve loss between the two groups(P>0.05). CONCLUSION Age and operation time are the main factors affecting the postoperative drainage through multifidus interspace approach for thoracolumbar fractures. And no drainage does not affect the long-term effect of the operation, on the contrary, no drainage can reduce the method of low back pain and obtain more benefits.
Humans ; Male ; Female ; Middle Aged ; Thoracic Vertebrae/injuries* ; Lumbar Vertebrae/injuries* ; Adult ; Spinal Fractures/surgery* ; Aged ; Drainage/methods* ; Retrospective Studies ; Young Adult ; Treatment Outcome

OBJECTIVE: To compare the effects of normal-pressure drainage (norPD) and negative-pressure drainage (negPD) after laparoscopic radical prostatectomy (LRP) in the treatment of PCa. METHODS: We retrospectively analyzed the clinical and follow-up data on 87 cases of PCa treated by LRP from October 2019 to October 2022, 46 receiving norPD and the other 41 negPD postoperatively. We indwelt an F20 pelvic drainage tube for each of the patients, which were connected to an anti-reflux drainage bag for those in the norPD group and a 200 ml negative pressure ball for those in the negPD group, and removed the tubes at the drainage volume ≤30 ml/d. We compared the operation time, intraoperative blood loss, drainage volume on the first day after surgery, total postoperative drainage volume, drainage tube-indwelling duration, drainage tube-related nursing time, urinary catheter removal time, wound healing time, and incidence of postoperative complications between the two groups of patients. RESULTS: No statistically significant differences were observed between the two groups in terms of operation time, intraoperative blood loss, wound healing time, and postoperative complications (P>0.05). The drainage volume on the first postoperative day and the total postoperative drainage volume were significantly lower, and the drainage tube-indwelling duration and drainage tube-related nursing time markedly shorter in the norPD than in the negPD group (all P<0.05). CONCLUSION Normal-pressure drainage is a safe and effective drainage method after laparoscopic radical prostatectomy, which can significantly reduce the postoperative drainage volume, drainage tube-indwelling duration and drainage tube-related nursing time.
Humans ; Male ; Prostatectomy/methods* ; Laparoscopy ; Prostatic Neoplasms/surgery* ; Drainage/methods* ; Retrospective Studies ; Postoperative Complications ; Middle Aged ; Operative Time

Open abdomen therapy is an effective treatment to deal with severe abdominal infections, abdominal hypertension and other critical abdominal diseases. However, this therapy is difficult to implement and has many uncertainties in the timing, manners, and follow-up treatment, which leads to the fact that open abdomen therapy is not very accessible and standardized in medical systems of China. This consensus aims to provide guiding principles for indications and implementation of open abdomen, classification methods of open abdomen wounds, technologies for abdominal closure, and management of enteroatmospheric fistula, so as to improve the accessibility and success rate of open abdomen in China.
Humans ; Abdomen/surgery* ; Consensus ; Intestinal Fistula/therapy* ; Negative-Pressure Wound Therapy ; Open Abdomen Techniques

OBJECTIVE: To discuss the development of a multifunctional and multipoint fixed support drainage device for the digestive tract, as well as the effect of its application on animal experimental models and patients. METHODS: The digestive tract multifunctional and multipoint fixed support drainage device is designed according to the requirements of the various gastrointestinal surgery and interventional procedures. It has metal flaps and airbags to achieve multi point fixation. The cuffs and shears are used to achieve endoscopic removal. And through different tube diameters and lengths, surgeons can achieve different surgical purposes. RESULTS: A multifunctional and multipoint fixed support drainage device for the digestive tract was successfully designed and developed. The application experiment of the winged pancreatico-intestinal supporting drainage tube on animal models and patients, showed lower drainage fluid amylase level, faster amylase recovery speed, and better perioperative safety. CONCLUSIONS The support drainage device has the characteristics of simple operation, firm fixation, and good controllability of removal. It is an ideal choice among support drainage tubes in gastrointestinal surgery and interventional operations.
Drainage ; Gastrointestinal Tract ; Endoscopy