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Abstract Background As a common disease in orthopedic clinics, popliteal cysts often coexist with intra-articular lesions. Compared with traditional open surgery, arthroscopic treatment of popliteal cysts is less traumatic, and intra-articular lesions can be treated. The ‘one-way valve’ mechanism of the popliteal cyst can be removed by expanding the communication between the articular cavity and the cyst to avoid cyst recurrence. In terms of arthroscopic techniques, the comparison of clinical effects between the double posteromedial portal (DPP) and single posteromedial portal (SPP) has rarely been studied. The purpose of this retrospective study was to compare the clinical effects of DPP and SPP. Methods A total of 46 consecutive patients with symptomatic popliteal cysts who underwent arthroscopic treatment were included in this study and followed for approximately 1 year. All patients were divided into two groups according to the arthroscopic portals (DPP group and SPP group). The cyst size, Lysholm score and Rauschening–Lindgren (R–L) grade were evaluated before the operation for all patients, and the intra-articular lesions, operative time and complications were recorded after operation. At the last follow-up, the Lysholm score and R–L grade were recorded, and magnetic resonance imaging was used to evaluate the outcome of the cyst. The clinical data of the two groups was statistically compared and analyzed. Results There were no significant differences in preoperative cyst size, Lysholm score or R–L grade between the two groups (P > 0.05). The operation time of the DPP group (67.52 ± 18.23 min) was longer than that of the SPP group (55.95 ± 16.40 min) (P = 0.030), but the recurrence rate of cysts in the DPP group (0%) was obviously lower than that in the SPP group (19.0%) (P = 0.046). There were no significant differences in the Lysholm score, R–L grade or complication rate between the two groups at the last follow-up (P > 0.05). Conclusion Arthroscopic treatment of popliteal cysts using double posteromedial portals was a safe and effective surgical method. Trial registration: ChiCTR, ChiCTR2200060115. Registered 19 May 2022, https://www.chictr.org.cn/showproj.html?proj=133199

Background: As a common disease in orthopedic clinics, popliteal cysts often coexist with intra-articular lesions. Compared with traditional open surgery, arthroscopic treatment of popliteal cysts is less traumatic, and intra-articular lesions can be treated. The 'one-way valve' mechanism of the popliteal cyst can be removed by expanding the communication between the articular cavity and the cyst to avoid cyst recurrence. In terms of arthroscopic techniques, the comparison of clinical effects between the double posteromedial portal (DPP) and single posteromedial portal (SPP) has rarely been studied. The purpose of this retrospective study was to compare the clinical effects of DPP and SPP. Methods: A total of 46 consecutive patients with symptomatic popliteal cysts who underwent arthroscopic treatment were included in this study and followed for approximately 1 year. All patients were divided into two groups according to the arthroscopic portals (DPP group and SPP group). The cyst size, Lysholm score and Rauschening–Lindgren (R–L) grade were evaluated before the operation for all patients, and the intra-articular lesions, operative time and complications were recorded after operation. At the last follow-up, the Lysholm score and R–L grade were recorded, and magnetic resonance imaging was used to evaluate the outcome of the cyst. The clinical data of the two groups was statistically compared and analyzed. Results: There were no significant differences in preoperative cyst size, Lysholm score or R–L grade between the two groups (P > 0.05). The operation time of the DPP group (67.52 ± 18.23 min) was longer than that of the SPP group (55.95 ± 16.40 min) (P = 0.030), but the recurrence rate of cysts in the DPP group (0%) was obviously lower than that in the SPP group (19.0%) (P = 0.046). There were no significant differences in the Lysholm score, R–L grade or complication rate between the two groups at the last follow-up (P > 0.05). Conclusion: Arthroscopic treatment of popliteal cysts using double posteromedial portals was a safe and effective surgical method. Trial registration: ChiCTR, ChiCTR2200060115. Registered 19 May 2022, https://www.chictr.org.cn/showproj.html?proj=133199 [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of this study was to introduce the arthroscopic internal drainage with anterior-anteromedial approach for the treatment of popliteal cysts in children. To compare its clinical efficacy with open surgery. Methods This was a retrospective case–control study of 102 patients diagnosed with popliteal cysts from January 2018 to February 2020 who received surgery. The study included 27 cases with minimally invasive group (MI group) and 75 cases with open surgery group (OS group). The MI group included 21 males and 6 females, age 6.71 ± 2.16 years who received arthroscopic internal drainage of the cysts to adequately widen the valve opening between the cyst and the articular cavity, excised the fibrous diaphragm without complete excision of the cyst wall. The OS group included 57 males and 18 females, age 6.21 ± 1.67 years who received open excision. The clinical parameters regarding the preoperative characteristics and surgical results were compared. Ultrasound or MRI was used to identify the recurrence of the popliteal cysts. Rauschning-Lindgren grade was recorded to evaluate the clinical outcome. Results All patients were followed up for at least 24 months. There were no significant differences between the two groups in age, gender, left and right sides, disease time, cyst size, length of hospitalization, preoperative Rauschning-Lindgren grade (p > 0.05). At the last follow-up, the preoperative and postoperative Rauschning-Lindgren grade was improved in both groups. Compared with the OS group, operation time was significantly shortened in the MI group (28.89 ± 4.51 min vs 52.96 ± 29.72 min, p

Background: Following pancreatic resection, postoperative pancreatic fistula (POPF) is still the leading cause of significant morbidity and death. As pancreaticoduodenectomy (PD) is one of the greatest challenges in gastrointestinal surgery, the current study aimed to evaluate either internal or external drainage is the best technique for preventing pancreatic fistula (PF) following pancreaticoduodenectomy (PD). Patients and methods: After the exclusion of 12 patients, 48 patients were included and subdivided into two groups; the internal drainage group: the pancreatic duct was drained into the intestinal lumen, and the external drainage group: the pancreatic duct was drained through the anterior abdominal wall. Results: Following up the patients for one month after the surgery revealed no significant difference between the two studied groups regarding the liver parameters. Postoperative drain amylase was less in the internal group than the external group. Operative time and hospital stay were slightly increased in the external group while the postoperative pancreatic fistula (POPF) was slightly increased in the internal group. Conclusion: there were no significant differences in the risks of postoperative complications between the internal and external drainage groups. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to introduce the arthroscopic internal drainage with anterior-anteromedial approach for the treatment of popliteal cysts in children. To compare its clinical efficacy with open surgery.Methods: This was a retrospective case-control study of 102 patients diagnosed with popliteal cysts from January 2018 to February 2020 who received surgery. The study included 27 cases with minimally invasive group (MI group) and 75 cases with open surgery group (OS group). The MI group included 21 males and 6 females, age 6.71 ± 2.16 years who received arthroscopic internal drainage of the cysts to adequately widen the valve opening between the cyst and the articular cavity, excised the fibrous diaphragm without complete excision of the cyst wall. The OS group included 57 males and 18 females, age 6.21 ± 1.67 years who received open excision. The clinical parameters regarding the preoperative characteristics and surgical results were compared. Ultrasound or MRI was used to identify the recurrence of the popliteal cysts. Rauschning-Lindgren grade was recorded to evaluate the clinical outcome.Results: All patients were followed up for at least 24 months. There were no significant differences between the two groups in age, gender, left and right sides, disease time, cyst size, length of hospitalization, preoperative Rauschning-Lindgren grade (p > 0.05). At the last follow-up, the preoperative and postoperative Rauschning-Lindgren grade was improved in both groups. Compared with the OS group, operation time was significantly shortened in the MI group (28.89 ± 4.51 min vs 52.96 ± 29.72 min, p < 0.05). The MI group was superior to the OS group in terms of blood loss and plaster fixation, with statistical significance (p < 0.05). There was obvious difference in recurrence rate between the two groups (0% vs 17.33%, p = 0.018). No postoperative complications occurred during the follow-up period.Conclusions: Compared with open excision, the treatment of popliteal cyst in children by arthroscopic internal drainage to expand the articular cavity and eliminate the "one-way valve" mechanism between the cyst and the articular cavity exhibits better clinical outcomes and significantly reduces the recurrence rate, which is worthy of further clinical promotion. [ABSTRACT FROM AUTHOR]

Abstract Background Persistent pancreatic leakage (PL) due to disconnected pancreatic duct syndrome (DPDS) is associated with severe morbidity and mortality and it usually treated with internal drainage. However, in cases without localized fistula formation, internal drainage is challenging to perform. We report an original one-stage surgical approach for nonlocalized persistent PL, namely, the “intentional internal drainage tube method”. Case presentation A 49-year-old woman whose main pancreatic duct was penetrated during endoscopic retrograde cholangiopancreatography experienced severe PL. Peritoneal lavage and a second operation involving central pancreatectomy failed to relieve the symptoms, and nonlocalized PL persisted due to DPDS. Although we attempted a radical resection of the pancreatic remnants as a third strategy, the highly inflamed tissue and massive bleeding prevented the completion of the procedure. We sutured the pancreatic head margin and performed a pancreaticojejunostomy to the distal margin. Because these two cut margins could possibly be the source of the persistent PL, we created a hole at the Roux-en-Y jejunal limb, and a silicone drainage tube was inserted into the peritoneal space via this hole. Postoperatively, we continuously suctioned the intentional internal drainage tube, and the residual PL cavity gradually diminished. Even after removal of the tube, the residual PL drained internally into the jejunum through this hole. Conclusions We present this intentional internal drainage tube method as a novel alternative approach for the management of nonlocalized PL consequential of DPDS. Due to the simplicity and minimally invasive nature of this method, we propose this technique may also be used to treat various types of nonlocalized persistent PL or be used prophylactically for central pancreatectomy.

Global warming-induced changes in the pattern and amount of precipitation are important from the viewpoint of long-term stability of geo-structures. In this paper, the effectiveness of in-plane drainage provided by permeable geosynthetic reinforcement was evaluated as a means to relieve the rainfall infiltration effect on GRS walls backfilled with marginal soil. A series of laboratory tests were performed using a reduced-scale model geosynthetic reinforced soil (GRS) wall (constructed with due consideration of the similitude law) with different rainfall characteristics and backfill soils. Layers of nonwoven geotextiles were used as reinforcement as well as in-plane drainage media. The results showed that the inclusion of internal drainage facilitated the dissipation of pore water pressure, thereby reducing the wall facing displacement. The discharge water volume and volumetric water content data measured in the reinforced soil zone supported the observation. The degree to which the internal drainage improves the deformation behavior of the GRS wall during rainfall was found to depend on the rainfall characteristics and the backfill soil type. Practical implications of the findings are discussed in detail. [ABSTRACT FROM AUTHOR]

Much of the interior of the Tibetan Plateau is characterized by internal drainage, low relief topography, and high altitude. How and when this landscape formed is controversial. In this study, we use new zircon U‐Pb data and low‐temperature thermochronological data (apatite and zircon [U‐Th/He], apatite fission track [AFT]) from the Late Cretaceous to Cenozoic Nima Basin sedimentary rocks and Xiabie granite in the adjacent Muggar Thrust hanging wall (part of the regional Shiquanhe‐Gaize‐Amdo thrust system), to determine the paleodrainage and timing of exhumation in the region. Individual AHe and ZHe cooling ages range from 9 to 60 Ma and 58 to 118 Ma, and the AFT ages range from 30 to 90 Ma. The thermal history derived from the Northern Nima Basin sediments and Xiabie granite require a period of exhumation between 70 and 40 Ma in the thrust fault hanging wall, and 40 and 30 Ma in the Nima Basin. Across the region, this event was followed by low rates of exhumation and the deposition of locally sourced sediment, lacustrine, and evaporitic deposits that are indicative of an internal drainage system. We suggest that the exhumation event is associated with development of thrust‐elevated relief that may have disrupted the drainage network favoring the development of an endorheic system. This system, sediment accumulation, and/or post‐30 Ma tectonic quiescence led to the generation of low relief topography. Plain Language Summary: The Tibetan Plateau is the highest altitude low topographic relief region on Earth. There is no consensus on how the flat topography formed. Low‐temperature thermochronology is widely used to establish the time of exhumation of rocks to the Earth's surface. In this study, we found that the rocks in the Nima area of the central Tibetan Plateau experienced moderate exhumation from Late Cretaceous to early Oligocene (70‐30 Ma), after which time the exhumation rate slowed. Such low rates imply slowing of local tectonic activity. The sedimentology and stratigraphy of the basin indicate that an internal drainage system developed in the Nima area since 30 Ma. Given the arid climate conditions, we therefore propose that the fault activity (70‐30 Ma) represented by rapid exhumation resulted in a change to topography that triggered the change of water systems. The low relief topography subsequently developed in the arid and tectonically quiescent environments in this area. Key Points: Low‐temperature thermochronology records moderate exhumation of the Nima area from 70 to 30 Ma, after which time exhumation slowedGeneration of local thrust‐related relief over the period of 70‐30 Ma may have played a role in the development of internal drainage by 30 MaThe transition to tectonic quiescence and/or the establishment of internal drainage may have led to the development of low relief topography [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Internal drainage of subretinal fluid is a useful surgical technique to supplement chandelier-assisted scleral buckling procedures. This article reports the technique and discusses the advantages, subtleties, and disadvantages of this procedure. Purpose: To describe the surgical technique of internal drainage of subretinal fluid as an adjunct to chandelier-assisted scleral buckling for the repair of rhegmatogenous retinal detachment. Methods: The technique of internal drainage with a sharp needle or cannula through a trocar is described and shown in a Supplemental Digital Content 1 (see Video, http://links.lww.com/ICB/A87). Results: Three patients (3 eyes) underwent scleral buckling for rhegmatogenous retinal detachment repair. Subretinal fluid was drained using the internal drainage approach in all cases. All three patients had successful reattachment of retina with improvement in visual function. No complications were reported related to vitreous loss, retinal incarceration, or redetachment following primary surgery. Conclusion: Internal drainage of subretinal fluid during chandelier-assisted scleral buckling is a useful technique that can be considered for repairing rhegmatogenous retinal detachment. [ABSTRACT FROM AUTHOR]

Abstract The timing of formation of the low‐gradient, internally drained landscape of the Tibetan Plateau is fundamental to understanding the evolution of the plateau as a whole. Well‐dated sedimentary records of internal drainage of rivers into lakes are used to reveal the timing of this evolution. Here we redate the youngest continental sedimentary successions of central Tibet in the Lunpola Basin and propose a new age range of ca. 35 to 9 Ma, significantly younger than previously thought. We demonstrate long‐standing internal drainage in central Tibet since the late Eocene and stable sedimentary environments, source regions, and low topographic relief since at least the early Miocene. We suggest that sediment aggradation of internal drainage and reduction of hillslope gradients by erosion dominate the formation of low‐relief landscapes and that the late Cenozoic drainage basins in central Tibet developed in response to flow in the lower crust and/or mantle lithosphere.

Background: Most anastomotic leaks after surgical resection for esophageal or esophagogastric junction malignancies are treated endoscopically with esophageal stents. Internal drainage by double pigtail stents has been used for the endoscopic management of leaks following bariatric surgery, and recently introduced for anastomotic leaks after resections for malignancies. Our aim was to assess the overall efficacy of the endoscopic treatment for anastomotic leaks after esophageal or gastric resection for malignancies. Methods: We conducted a multicenter retrospective study in four digestive endoscopy tertiary referral centers in France. We included consecutive patients managed endoscopically for anastomotic leak following esophagectomy or gastrectomy for malignancies between January 2016 and December 2018. The primary outcome was the efficacy of the endoscopic management on leak closure. Results: Sixty-eight patients were included, among which 46 men and 22 women, with a mean ± SD age of 61 ± 11 years. Forty-four percent had an Ivor Lewis procedure, 16% a tri-incisional esophagectomy, and 40% a total gastrectomy. The median time between surgery and the diagnosis of leak was 9 (6–13) days. Endoscopic treatment was successful in 90% of the patients. The efficacy of internal drainage and esophageal stents was 95% and 77%, respectively (p = 0.06). The mortality rate was 3%. The only predictive factor of successful endoscopic treatment was the initial use of internal drainage (p = 0.002). Conclusion: Endoscopic management of early postoperative leak is successful in 90% of patients, preventing highly morbid surgical revisions. Internal endoscopic drainage should be considered as the first-line endoscopic treatment of anastomotic fistulas whenever technically feasible. [ABSTRACT FROM AUTHOR]

Background: Persistent pancreatic leakage (PL) due to disconnected pancreatic duct syndrome (DPDS) is associated with severe morbidity and mortality and it usually treated with internal drainage. However, in cases without localized fistula formation, internal drainage is challenging to perform. We report an original one-stage surgical approach for nonlocalized persistent PL, namely, the "intentional internal drainage tube method".Case Presentation: A 49-year-old woman whose main pancreatic duct was penetrated during endoscopic retrograde cholangiopancreatography experienced severe PL. Peritoneal lavage and a second operation involving central pancreatectomy failed to relieve the symptoms, and nonlocalized PL persisted due to DPDS. Although we attempted a radical resection of the pancreatic remnants as a third strategy, the highly inflamed tissue and massive bleeding prevented the completion of the procedure. We sutured the pancreatic head margin and performed a pancreaticojejunostomy to the distal margin. Because these two cut margins could possibly be the source of the persistent PL, we created a hole at the Roux-en-Y jejunal limb, and a silicone drainage tube was inserted into the peritoneal space via this hole. Postoperatively, we continuously suctioned the intentional internal drainage tube, and the residual PL cavity gradually diminished. Even after removal of the tube, the residual PL drained internally into the jejunum through this hole.Conclusions: We present this intentional internal drainage tube method as a novel alternative approach for the management of nonlocalized PL consequential of DPDS. Due to the simplicity and minimally invasive nature of this method, we propose this technique may also be used to treat various types of nonlocalized persistent PL or be used prophylactically for central pancreatectomy. [ABSTRACT FROM AUTHOR]

Introduction: Preoperative biliary drainage has been widely used to treat patients with malignant biliary obstruction. However, it is still unclear which method is more effective: internal drainage or external drainage. Thus, we carried out a meta-analysis to compare the safety and efficacy of the two drainage methods in treatment of malignant biliary obstruction in terms of preoperative and postoperative complications.Material and Methods: We conducted a literature search of Medline, EMBASE, PubMed, Ovid journals and the Cochrane Library, and compared internal drainage and external drainage in malignant biliary obstruction patients. The pre- and postoperative complications, stent dysfunction rate and mortality were analyzed.Results: Ten published studies (n = 1464 patients) were included in this meta-analysis. We found that patients with malignant biliary obstruction who received external drainage showed reductions in the preoperative cholangitis rate (OR = 0.33, 95% CI: 0.24-0.44, p < 0.00001), the incidence of stent dysfunction (OR = 0.41, 95% CI: 0.30-0.57, p < 0.00001), and total morbidity (OR = 0.34, 95% CI: 0.23-0.50, p < 0.00001) compared with patients who received internal drainage.Conclusions: The current meta-analysis indicates that external drainage is better than internal drainage for malignant biliary obstruction in terms of the preoperative cholangitis rate, the incidence of stent dysfunction and total morbidity, etc. However, the findings need to be confirmed by randomized controlled trials. [ABSTRACT FROM AUTHOR]

Abstract Background A popliteal cyst is a benign swelling with synovial fluid located behind the knee joint. Popliteal cysts are often asymptomatic; however, symptomatic cysts may cause pain and may need surgery interventions. Here, we performed a perspective study to compare the clinical efficacy of different surgical approaches, including traditional open excision and advanced arthroscopic treatment. Methods A total of 76 patients with popliteal cysts were assigned into three groups by a randomized complete block design. Group A included 32 patients (15 males and 17 females, age 55.3 ± 9.8 years) who received arthroscopic internal drainage of the cysts. Group B included 19 patients (9 males and 10 females, age 55.4 ± 7.6 years) who received open excision after arthroscopic treatment. Group C included 25 patients (11 males and 14 females, age 54.2 ± 8.5 years) who received open excision. All patients were followed up for an average of 13.7 ± 2.4 months. The following parameters were compared: the time of surgery, during surgery, the length of incision, the incision healing rate, the visual analog scale (VAS) for pain, the hospitalization time, the rate of recovery to level 0–1 cysts, the recurrence rate, and the Lysholm score. Results Group A exhibited significant better outcomes compared to groups B and C in the length of incision (1.6 ± 0.1 cm), the incision healing rate (100%), the postoperative VAS score (2.7 ± 1.2), the hospitalization time (7.8 ± 2.8 days), and the Lysholm score at the last follow-up (85.8 ± 5.2). The recurrence rate is significantly lower in groups A (3.1%) and B (5.2%) than group C (40%) (P

The timing of formation of the low‐gradient, internally drained landscape of the Tibetan Plateau is fundamental to understanding the evolution of the plateau as a whole. Well‐dated sedimentary records of internal drainage of rivers into lakes are used to reveal the timing of this evolution. Here we redate the youngest continental sedimentary successions of central Tibet in the Lunpola Basin and propose a new age range of ca. 35 to 9 Ma, significantly younger than previously thought. We demonstrate long‐standing internal drainage in central Tibet since the late Eocene and stable sedimentary environments, source regions, and low topographic relief since at least the early Miocene. We suggest that sediment aggradation of internal drainage and reduction of hillslope gradients by erosion dominate the formation of low‐relief landscapes and that the late Cenozoic drainage basins in central Tibet developed in response to flow in the lower crust and/or mantle lithosphere. Plain Language Summary: Internal drainage of rivers into lakes is a characteristic of the high plateaus of the world and, most notably, the Tibetan Plateau. Internal drainage generates local perched base levels for Tibetan rivers, enabling geomorphic isolation from the rapidly incising rivers of the Himalaya and surrounding regions. However, the question of when the low‐relief plateau topography was initiated has been largely ignored, and its formation mechanism is controversial. Here we report a detailed investigation in the Lunpola Basin of central Tibet and propose a new depositional age range of ca. 35–9 Ma. We demonstrate that the internal drainage kept eroding the mountain ranges and filling the surrounding lowlands since at least the late Eocene. By no later than the early Miocene, a gentle landscape formed in central Tibet. The late Cenozoic basins in central Tibet developed in response to deep crustal or mantle flow and associated upper crustal deformation. Key Points: Robust age constraints of the youngest continental stratigraphic unit from the Lunpola Basin in central Tibet are reportedAggradation and erosion of internal drainage dominated the formation of low‐relief topography in central Tibet by the early Miocene timesLate Cenozoic drainage basins in central Tibet developed in response to flow in the lower crust and/or mantle lithosphere [ABSTRACT FROM AUTHOR]

Gastric leak remains the main complication after sleeve gastrectomy, but there are no standardized guidelines for its treatment. Good results have been reported using endoscopic double-pigtail stent. To estimate its effectiveness, we carried out this systematic review. Eleven eligible articles were identified by searching PubMed, Embase, and Cochrane Library databases. A total of 385 patients met the inclusion criteria. The pooled proportion of successful leak closures by using double pigtail drainage was 83.41%. The proportion of successful leak closures by using double pigtail drainage by experienced operators as first-line treatment was 84.71%. Our review suggested that double-pigtail stent could be a valid approach to manage the postbariatric gastric leak, with low rate of complications and a good tolerance by patients. More high-quality studies with large samples sizes should be undertaken to better evaluate and compare the variety of techniques available. Gastric leak remains the main complication after sleeve gastrectomy, but there are no standardized guidelines for its treatment. To date, many studies have investigated the safety and efficacy of DPS, but their results remain inconsistent and only a limited number of them report a significant sample size. To our best knowledge, there's no previous review evaluating the effects of this endoscopic management. The aim of our work is to carry out a comprehensive literature review on the efficacy of the DPS endoscopically positioned to treat leak post-sleeve gastric resection. The results showed that DPS had high rate of successful leak closures (84.42% in total and 85.92% as first line treatment). [ABSTRACT FROM AUTHOR]

Introduction: Necrosectomy and external drainage has been the traditional surgical treatment for infected pancreatic necrosis (IPN) following acute pancreatitis. It is a highly invasive and high risk procedure in an already compromised individual and demands multiple trips to the operating room for subsequent debridement. Recent evidence suggests that minimally invasive procedures, including surgical video-assisted retroperitoneal debridement and percutaneous catheter drainage (PCD) can often "take the heat out of the fire" and thereby delay or even avoid surgery, but these procedures sometimes fail and surgical intervention needs to be undertaken. In order to avoid multiple surgical procedures we decided to drain the IPN internally into the stomach. Aims and Objectives: To ascertain the efficacy and safety of open necrosectomy and internal drainage into the stomach as a feasible alternative in patients with IPN. Materials and Methods: We conducted a prospective study of the results of open surgical necrosectomy and internal drainage performed on patients with IPN from March 2012 to February 2019. This was a record based qualitative study. The patients were initially managed in the intensive care unit (ICU) with goal-directed therapy and organ support where indicated. All patients with IPN requiring PCD or surgical intervention were included in this study. Results: A total of 44 patients with acute necrotizing pancreatitis who underwent either PCD or surgical drainage were included in the study. Of the 44 patients, 16 (36.4%) were treated with open transgastric debridement and internal drainage into the stomach for IPN. The mean age of this subgroup of patients was 51.3 ± 11.1 years, the most common etiology of the pancreatitis was alcoholic, the mean acute physiology and chronic health (APACHE II) score of these patients was 15.9 ± 4.72, and the mean bedside index of severity in acute pancreatitis (BISAP) score was 4.92 ± 0.11. On contrast enhanced computed tomography (CECT) scan of the abdomen, 93.8% of the patients had >50% necrosis, with a mean CT severity index (CTSI) of 9.3 ± 0.7. The mean operating time was 137 ± 42.4 minutes, with a mean blood loss of 225.4 ± 50.5 ml. Two patients required reoperation because of persistence of necrosum and signs of collection on repeat CT, and there were two mortalities. None of the patients had any late complications related to the surgery and the procedure was successful in 91%. Conclusion: Internal drainage into the stomach in IPN is a feasible and relatively safe procedure when indicated. It is more effective in avoiding repeated surgical procedures when compared to external drainage. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this study was to determine whether internal or external drainage with a pancreatic duct stent is the optimal pancreaticojejunostomy method to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD) for subgroups of patients at high risk for PF. Materials and methods A total of 495 patients who underwent PD were reviewed. Univariate and multivariate analyses were used to identify risk factors for PF after PD. We further compared the incidence of PF and outcomes between the internal and external drainage groups for subgroups of patients at high risk for PF. Results There was no difference in the incidence of complications according to the Clavien-Dindo classification or the rate of PF after PD in both groups (P = 0.961 and P = 0.505, respectively). The incidence of mortality was 3.8% in the internal drainage group and 3.9% in the external drainage group (P = 0.980). Univariate and multivariate analyses identified male gender (odds ratio [OR] = 2.93; 95% confidence interval [CI], 1.78-4.83; P = 0.000), pancreatic duct diameter (<3 mm) (OR = 2.58; 95% CI, 1.57-4.23; P = 0.000), and soft pancreatic texture (OR = 2.92; 95% CI, 1.71-4.98; P = 0.000) as independent risk factors for PF after PD. No differences in the incidence of PF for the subgroups of patients with one, two, or three risk factors were observed between the internal and external drainage groups (P = 0.334, P = 1.000, and P = 0.936, respectively). No differences in total complications, delayed gastric emptying, postpancreatectomy hemorrhage, biliary fistula, infection complications, reoperation, perioperative mortality, or postoperative hospital stay were noted. In addition, liquid loss and tube-related complications occurred in the external drainage group. Conclusions Internal drainage is the optimal method to prevent PF after PD for subgroups of patients at high risk for PF because the surgical procedure is simple and prevents liquid loss and tube-related complications associated with external drainage. However, no differences in the incidence of PF and other complications after PD were observed between the two approaches. [ABSTRACT FROM AUTHOR]

Purpose of Review: Gastrointestinal transmural defects are defined as total rupture of the gastrointestinal wall and can be divided into three main categories: perforations, leaks, and fistulas. Due to an increase in the number of therapeutic endoscopic procedures including full-thickness resections and the increase incidence of complications related to bariatric surgeries, there has been an increase in the number of transmural defects seen in clinical practice and the number of non-invasive endoscopic treatment procedures used to treat these defects.Recent Findings: The variety of endoscopic approaches and devices, including closure techniques using clips, endoloop, and endoscopic sutures; covering techniques such as the cardiac septal occluder device, luminal stents, and tissue sealants; and drainage techniques including endoscopic vacuum therapy, pigtail, and septotomy with balloon dilation are transforming endoscopy as the first-line approach for therapy of these conditions.Summary: In this review, we describe the various transmural defects and the endoscopic techniques and devices used in their closure. [ABSTRACT FROM AUTHOR]

The development of internal drainage is intimately tied to the tectonic and climatic history of an area, but research into the exact causes and processes of internal drainage is constrained by the ability to accurately delineate both internally and externally draining watersheds. Until recently, existing global catalogs of internally drained regions were either hand-drawn or based upon digital elevation models whose resolution is much lower than those currently available. Here, the World Wildlife Fund’s HydroBASINS dataset is analyzed in a GIS program to identify points of former connectivity between endorheic and exorheic basins, to identify possible palaeolakes and palaeo-distributary channels, and to quantify on a global basis the extent of area lost to internal drainage for 101 large watersheds. The results have been made available in Google Earth© KMZ files, and a sample workflow is presented which uses the data to approximate the relative importance of tectonic vs climatic factors in initiating endorheism. As an example of how the dataset and workflow can be used, the drainage history is modeled for endorheic watersheds within two very different tectonic regimes, the Afar region of northeastern Africa and the Northern Territory of Australia. The methodology is readily adaptable to other endorheic basins and offers the ability to create drainage history models which can help in research areas such as climate change investigations and groundwater and economic mineral prospecting. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background The treatment of pancreatic pseudocysts has evolved during the past two decades. Endoscopic treatment (ET) has gradually become used as a first-line management even though it showed no significant superiority to surgical internal drainages (SIDs) in a recent randomized trial. The objective of the present work was to analyze the effect of ET failure on the results of SID in the global management of pancreatic pseudocysts. Methods A multicenter retrospective study (Clichy, Bordeaux, Nantes, and Rennes) was conducted between January 2000 and December 2012. The main criteria were as follows: (i) major postoperative complications (MPCs) (Clavien ≥ 3) and (ii) treatment failure in the first 12 mo. All factors that may affect these two parameters were tested in univariate and multivariate analyses, when necessary. Results One hundred nineteen patients, with a median age of 52 y (22-83) underwent SID, including 45 procedures (37.8%) performed after ET failure. Mortality and overall morbidity rates were 1.7% and 30.2%, respectively. Eighteen patients (15.1%) presented an MPC. Multivariate analysis revealed that failure of ET (odds ratio 3.04, confidence interval [1.04 to 9.5], P = 0.046) and BMI ≤20 (odds ratio 4.5, confidence interval [1.50; 15.5], P = 0.010) were independent risk factors of MPCs. The success of SID was 92.5% in the first year. In univariate analysis, the occurrence of an MPC was the only factor linked to the failure of SID ( P = 0.029). Conclusions Performing an SID after ET failure is associated with an increased risk of MPC. Close postoperative monitoring is recommended for these patients. [ABSTRACT FROM AUTHOR]

Taking into account the nature of the hydrological processes involved in in situ measurement of Field Capacity (FC), this study proposes a variation of the definition of FC aiming not only at minimizing the inadequacies of its determination, but also at maintaining its original, practical meaning. Analysis of FC data for 22 Brazilian soils and additional FC data from the literature, all measured according to the proposed definition, which is based on a 48-h drainage time after infiltration by shallow ponding, indicates a weak dependency on the amount of infiltrated water, antecedent moisture level, soil morphology, and the level of the groundwater table, but a strong dependency on basic soil properties. The dependence on basic soil properties allowed determination of FC of the 22 soil profiles by pedotransfer functions (PTFs) using the input variables usually adopted in prediction of soil water retention. Among the input variables, soil moisture content θ (6 kPa) had the greatest impact. Indeed, a linear PTF based only on it resulted in an FC with a root mean squared residue less than 0.04 m³ m-3 for most soils individually. Such a PTF proved to be a better FC predictor than the traditional method of using moisture content at an arbitrary suction. Our FC data were compatible with an equivalent and broader USA database found in the literature, mainly for medium-texture soil samples. One reason for differences between FCs of the two data sets of fine-textured soils is due to their different drainage times. Thus, a standardized procedure for in situ determination of FC is recommended.

Field capacity (FC) is a parameter widely used in applied soil science. However, its in situ method of determination may be difficult to apply, generally because of the need of large supplies of water at the test sites. Ottoni Filho et al. (2014) proposed a standardized procedure for field determination of FC and showed that such in situ FC can be estimated by a linear pedotransfer function (PTF) based on volumetric soil water content at the matric potential of -6 kPa [θ(6)] for the same soils used in the present study. The objective of this study was to use soil moisture data below a double ring infiltrometer measured 48 h after the end of the infiltration test in order to develop PTFs for standard in situ FC. We found that such ring FC data were an average of 0.03 m³ m- 3 greater than standard FC values. The linear PTF that was developed for the ring FC data based only on θ(6) was nearly as accurate as the equivalent PTF reported by Ottoni Filho et al. (2014), which was developed for the standard FC data. The root mean squared residues of FC determined from both PTFs were about 0.02 m³ m- 3. The proposed method has the advantage of estimating the soil in situ FC using the water applied in the infiltration test.

Introduction: Pancreatic pseudocysts are frequent complications after acute and chronic pancreatitis. They are diagnosed in 6–18% of patients with the history of acute pancreatitis and in 20–40% cases with chronic pancreatitis. The aim of the study was to analyse early results of surgical treatment of pancreatic acute and chronic pseudocysts based on our experience. Material and methods: The retrospective analysis was based on early results of surgical treatment of 46 patients aged between 20 and 78 (33 males and 13 females) who underwent treatment of acute (n = 26) and chronic (n = 20) pancreatic pseudocysts from November 2005 to July 2011 at the Second Department of General and Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract in Lublin. Results: The choice of a surgical method of treatment depended on the size, localisation, thickness of pseudocystic wall and changes in the main pancreatic duct. We used the following surgical methods: cystogastrostomy (Jurasz procedure) was conducted in 22 patients (47.8%), Roux-en-Y cystojejunostomy was performed in 19 cases (41.3%), complete excision of the pseudocyst was possible in two patients (4.3%) and cystoduodenostomy – in one case (2.1%). Also, in single cases external drainage (2.1%) and cystopancreaticojejunostomy of Puestow (2.1%) were applied. Forty-four patients (95.6%) were cured. Early postoperative complications were observed in 2 patients (4.4%). Two reoperations (4.4%) were required. Early postoperative mortality was 0%. Conclusions: Classic internal drainage procedures, known since the 19th century, are still effective methods of treatment in acute and chronic pancreatic pseudocysts.

Background Pancreatic pseudocysts (PPC) are collections of fluid encapsulated within a well-defined inflammatory wall that develop during pancreatic inflammation. Internal drainage represents the standard of care in lesions that persist and lead to symptoms and complications. Only limited data are available on long-term results and recurrence of PPC after drainage procedures. Thus, the aim of the present study was to analyse the long-term outcome after endoscopic drainage of PPC. Material and methods Patient data were retrospectively collected by review of clinical records of the University Medical Center Mannheim. We assessed the clinical short-term outcome (results in the first 30 days after initial drainage procedure), medium-term outcome (results 6 months after initial drainage procedure) and long-term outcome (results after stent removal). We performed statistical analysis to identify possible risk factors for recurrence of PPC. Results We identified 51 patients with initially successful endoscopic drainage of the PPC (n = 51/53, 96%). Among this cohort, 43 patients were available for assessment of medium-term results. In 82.9% of these 43 patients the drainage could be removed after successful treatment of the PPC. Thirty patients were available for long term follow-up with a mean observation period of 42.2 months (SD 32.8 months). Among these patients, seven (n = 7/30, 23.3%) had recurrent PPC. Approximately half of the recurrent cysts arose in different anatomical regions and most patients with recurrence had chronic pancreatitis. Conclusion Endoscopic drainage represents an effective treatment for PPC. Approximately one quarter of the patients developed recurrent PPC. Half of recurrent PPC developed in different pancreatic regions than the initial PPC. [ABSTRACT FROM AUTHOR]

Determining the intensity of the water balance components in the control volume of a soil, and consequently defining the most likely periods of occurrence of a water deficit in a crop, is an exercise that requires knowledge about soil, climate and plant factors. This research aimed to evaluate soil water balance components at phenological stages of corn (Zea mays L.) under no-till system, when fertilized with 60, 120, and 180 kg ha-1 of nitrogen. The field experiment was carried out in Piracicaba, State of São Paulo, Brazil, on a Typic Hapludox. Evaluations were made in the 2004/2005 and 2005/2006 corn cropping seasons, divided over three stages according to the plant's phenology. Runoff was not taken into account. Measurements were made for precipitation (P), internal drainage (D) (or capillary rise) at a 0.8 m depth, and water storage variation (Δh) in the soil layer from 0.0-0.80 m; actual evapotranspiration (ET) was considered the unknown quantity of the equation. Corn grain yield was evaluated as well. In general, the soil water balance components were modified by N doses, because the soil had been relatively smaller Δh in treatments involving N application than in the treatment without N, resulting in smaller D values in those treatments, which resulted in greater absorption by the plants and greater ET. As expected, the plant developmental stage II had a higher ET value.Determinar a intensidade dos componentes do balanço de água no solo num certo volume de controle de solo e, por conseguinte, a definição dos períodos mais prováveis de déficit hídrico para a cultura, está relacionada ao conhecimento de fatores do solo, do clima e da planta. Avaliaram-se componentes da equação do balanço de água no solo para fases fenológicas do milho (Zea mays L.), sob sistema de plantio direto, adubado com 60, 120 e 180 kg ha-1 de nitrogênio. O experimento foi conduzido em Piracicaba, SP, num Latossolo Vermelho-Amarelo. A avaliação foi feita nas safras 2004/2005 e 2005/2006 de milho dividindo-as em três fases de acordo com a fenologia da planta. O deflúvio superficial foi desconsiderado, e foram medidas a precipitação pluvial (P), a drenagem interna (D) (ou ascensão capilar) na profundidade de 0,8 m, a variação da armazenagem (Δh) na camada de solo de 0,0-0,80 m, e a evapotranspiração real (ET) foi considerada como incógnita da equação. Também, avaliou-se o rendimento de grãos de milho. De forma geral, os componentes da equação do balanço foram alterados pelas doses de N, uma vez que nos tratamentos com aplicação de N, o solo mostrou uma Δh relativamente menor que o tratamento sem N, refletindo em menor valor de D nesses tratamentos, sendo traduzido em maior absorção pelas plantas bem como maior ET. A fase II de desenvolvimento das plantas apresentou maior ET como esperado.

O estudo do balanço de água no solo com cana-de-açúcar, cultivada em larga escala no Brasil, é essencial para o manejo agrícola, visando ao aumento de produtividade e à redução de riscos de poluição. Este estudo objetivou avaliar os componentes da equação do balanço de água em dois Latossolos cultivados com cana-de-açúcar (cana-planta), localizados nos Municípios de Jaboticabal e Pirassununga (São Paulo). Na área experimental de Jaboticabal, o estudo foi realizado entre os dias 30 de setembro de 2005 e 12 de julho de 2006, e constou de dois tratamentos: T1 (sem adubação nitrogenada) e T2 (120 kg ha-1 de N). Em Pirassununga, o estudo foi feito entre os dias 28 de setembro de 2005 e 08 de junho de 2006, mas apenas o tratamento T2. O delineamento experimental foi o de blocos aleatórios, com quatro repetições. O volume de controle utilizado para o balanço de água teve como limite superior a superfície do solo e como limite inferior outra paralela à primeira, localizada em profundidade de 0,90 m. As variações de armazenagem, as entradas (precipitação pluvial e ascensão capilar) e as saídas de água (evapotranspiração real e drenagem interna) nesse volume de solo, nas áreas experimentais de Jaboticabal e Pirassununga, foram determinadas em 13 e 10 períodos, respectivamente. Ambas as áreas estudadas eram planas e não irrigadas. Na área de Jaboticabal, em todo o período, tanto a perda de água por drenagem interna quanto o ganho por ascensão capilar foram maiores no tratamento T2 (-191,69 mm/5,33 mm e -238,37 mm/24,60 mm para T1 e T2, respectivamente); não houve diferença significativa de produtividade (145 e 146 t ha-1 para T1 e T2, respectivamente), nem de evapotranspiração real (1.058 mm para T1 e 1.028 mm para o T2) entre os tratamentos nesse ciclo de cana-planta, fazendo com que as plantas não adubadas apresentassem a mesma eficiência do uso da água (14 kg m-3) que as adubadas. Na área de Pirassununga, a drenagem interna e a ascensão capilar foram de -110,9 e 0,67 mm, respectivamente, e a eficiência de uso da água 13 kg m-3. Portanto, pode-se concluir que (a) nos períodos de alta pluviosidade, a drenagem interna foi significativa, alertando para possíveis problemas no manejo em relação a uma potencial de contaminação do lençol freático, e (b) tanto a evapotranspiração real quanto à eficiência do uso da água foram da mesma ordem de grandeza, independentemente da adubação nitrogenada, e a armazenagem de água no solo foi praticamente a mesma no início e no fim do ciclo estudado.The water balance study in soils with sugarcane, cropped in large areas in Brazil, is essential for the agricultural management to increase the crop productivity and to reduce pollution risks. The objective of this research was to evaluate soil water balance equation components of two Oxisols under sugar-cane (first crop), in the counties of Jaboticabal and Pirassununga, State of São Paulo, Brazil. The study was carried out in an experimental area in Pirassununga (21 º 55 ' 54 '' S, 47 º 10 ' 54 '' W, 650 m), for only one level (120 kg ha-1) of nitrogen, in four replications. In Jaboticabal (21 º 19 ' 98 '' S, 48 º 19 ' 03 '' W, 600 m), two nitrogen levels were used: 0 kg ha-1 (treatment 1-T1) and 120 kg ha-1 (treatment 2-T2). In Pirassununga, the experiments were evaluated between September 28, 2005 and June 08, 2006 and, in Jaboticabal, between September 30, 2005 and July 12, 2006. The upper limit of the control volume used for the water balance was the soil surface and the lower limit a surface at a soil depth of 0.90 m, parallel to the soil surface. Soil water storage variations, soil water inputs (rain and capillary rise) and soil water outputs (internal drainage and actual evapotranspiration) were determined in 13 and 10 monitoring periods, in Jaboticabal and Pirassununga, respectively. Both studied areas were plane and non irrigated. In the area in Jaboticabal, both internal drainage and capillary rise were greater in treatment T2 (-191.69 mm/5.33 mm and -238.37 mm/24.60 mm for T1 and T2, respectively) for the entire period; there was no significant difference in yield (145 and 146 t ha-1 for T1 and T2, respectively) and also in actual evapotranspiration (1058 mm for T1 and 1028 mm for T2) between the treatments in this sugar-cane cycle, so that the water use efficiency of plants without nitrogen fertilization was the same (14 kg m-3) as of those with nitrogen fertilization. In Pirassununga, internal drainage and capillary rise were -110.9 and 0.67 mm, respectively and the water use efficiency 13 kg m-3. It can therefore be concluded that (a) internal drainage was relevant in the high rainfall periods, which warns for possible problems in soil management due to the risk of groundwater contamination, and (b) the actual evapotranspiration and the water use efficiency were in the same order of magnitude, independently of nitrogen fertilization; and soil water storage was practically the same from the beginning to the end of the studied cycle.

A software for the calculation of unsaturated soil hydraulic conductivity K(theta) is presented for commonly used methods found in the literature, based on field experiments in which a soil profile is submitted to water infiltration followed by internal drainage. The software is available at: dourado@esalq.usp.br.É apresentado neste trabalho um programa para cálculo da condutividade hidráulica do solo não saturado K(teta) para métodos da literatura mais utilizados, baseados em experimentos de campo nos quais o perfil de solo é submetido à infiltração de água, seguida da drenagem interna. O programa é disponibilizado por: dourado@esalq.usp.br

The westernmost Tibetan plateau, despite being internally drained, has a high topographic relief. Here, using apatite (U–Th–Sm)/He and 4 He/ 3 He thermochronometry, we reconstruct the exhumation history of the Rutog batholith during the Neogene. Thermal modeling in 1D using the QTQt program indicates that relatively slow cooling occurred from 30 Ma to 19 Ma, which we interpret as an exhumation rate of ∼10 m/Ma. This was followed by two pulses of moderate cooling from 19 to 17 Ma and ∼11 to 9 Ma that correspond to a total exhumation of about 1500 m. Cooling since 9 Ma has been negligible. This differs from exhumation patterns in central Tibet but reveals timing similarities with externally drained portions of southern Tibet. We interpret our cooling constraints as recording two different transitions in western Tibet from an externally to an internally drained system since the Oligocene. External drainage allowed this part of the Tibetan plateau, unlike internally drained portions of central Tibet, to record regional-scale processes. The first cooling event, at about 20 Ma, was likely related to a major geodynamic event such as slab breakoff that induced contemporaneous potassic and ultrapotassic magmatism. The second rapid cooling pulse from ∼11 Ma to 9 Ma and subsequent negligible cooling was most likely controlled by a local factor such as Indus and Shyok river network reorganization caused by dextral motion of the Karakorum fault. We discuss these interpretations and their limitations in this contribution. [ABSTRACT FROM AUTHOR]

Background Progressive familial intrahepatic cholestasis (PFIC) is a cholestatic liver disease of childhood. Pruritus resulting from increased bile salts in serum might not respond to medical treatment, and internal or external biliary drainage methods have been described. In this study, we aimed to evaluate different internal drainage techniques in patients with PFIC. Patients and methods Between 2009 and 2014, seven children (4 male, 3 female, 3 months–5 years old), (median 2 years of age) with PFIC were evaluated. The patients were reviewed according to age, gender, complaints, surgical technique, laboratory findings and outcome. In each two patients, cholecystoileocolonic anastomosis, cholecystojejunocolonic anastomosis and cholecystocolostomy were performed. Cholecysto-appendico-colonic anastomosis was the technique used in one patient. Results Jaundice and excessive pruritus were the main complaints. One of the patients with cholecystoileocolonic anastomosis died of comorbid pathologies (cirrhosis, adhesive obstruction and severe sepsis). Temporary rectal bleeding was observed in all the patients postoperatively. Regardless of the surgical technique, pruritus was dramatically decreased in all the patients in the postoperative period. Conclusion Regardless of the technique, internal biliary diversion methods are beneficial for the relief of pruritus in PFIC patients. Selection of the surgical method might vary depending on the surgeon's preference and the surgical anatomy of the gastrointestinal system of the patient. [ABSTRACT FROM AUTHOR]

Highlights • The most frequent and severe complication after laparoscopic sleeve gastrectomy is gastric leak. • The endoscopic placement of a double-pigtail drain across the leak has been proven to be effective and minimally invasive. • Drain's migration into the abdominal cavity is not common and its intrasplenic displacement is even more rare. • Pigtail drain migration involving the spleen may expose the patient to the risk of parenchymal abscess or haemorrhage. Abstract Introduction The most frequent and severe complication after laparoscopic sleeve gastrectomy is gastric leak. Nowadays, there is no specific standard recommendation for its management, but the endoscopic placement of a double-pigtail drain across the leak has been proven to be effective and minimally invasive. Stent displacement into the abdominal cavity is not common and intrasplenic migration is even more rare. Case presentation We report a case of a 49-year-old woman with intrasplenic displacement of an endoscopic double-pigtail stent as a treatment for laparoscopic sleeve gastrectomy leak. Discussion Pigtail drain migration involving the spleen is rare but may potentially expose the patient to the risk of parenchymal abscess or haemorrhage. Often the clinic does not indicate early this complication. Conclusion We underline the need for a close radiologic follow-up, regardless of clinical conditions, in all patients treated with double-pigtail drain and its early removal in case of migration. [ABSTRACT FROM AUTHOR]

Lightweight expanded polystyrene (EPS) geofoam (geofoam block) is used in slope remediation works as a soil substitute fill to reduce driving forces that can lead to global instability. On the other hand, the presence of seepage flow requires special attention because geofoam block slope systems are vulnerable to seepage-induced lateral forces. In this study, the effect of an internal drainage system on the alleviation of piezometric pressures within the back-slope of a geofoam block slope system was investigated. For this purpose, laboratory experiments were conducted using a small-scale lysimeter with dimensions of 60 cm height, 20 cm width, and 200 cm length. The slope was compacted with sand to obtain an overall dry unit weight of 14 kN/m3. The constant piezometric head boundary conditions of 25, 38 and 50 cm generated the necessary hydraulic energy gradient for the seepage flow directed from the water reservoir of the lysimeter to the 45° angle slope face. The slopes were remediated by using geofoam blocks assembled in an embankment-type configuration at the toe of the slope. The internal drainage system consisted of grooved geofoam blocks that formed the 10, 15 and 22.5 cm high embankments. Deep-seated failures of the non-remediated slope were prevented except for the experiments with 10 and 15 cm high embankments under 50 cm pressure head boundary conditions. In general, the internal drainage system alleviated the piezometric pressure conditions within the back-slope by lowering the phreatic surface using the active drainage channels observed during laboratory experiments. These drainage channels provided a convenient passageway for seepage flow. The coupled numerical variably saturated flow modelling and slope stability modelling predicted the factor of safety for global stability which confirmed the observed physical conditions in the laboratory. The use of the internal drainage system increased the factor of safety of the geofoam block slope system under seepage conditions. [ABSTRACT FROM AUTHOR]

Background: Gastric fistula after bariatric surgery has high morbi-mortality, and treatment is a challenge due to persistent abscess and/or distal stenosis. The present study evaluated the efficacy and safety of stricturotomy/internal drainage, a novel endoscopic procedure that can avoid re-operation and allow early oral feeding. Methods: This prospective, non-randomized study, with no control or sham group, included 27 patients (74.07 % were female), approved by the local IRB, who underwent the following bariatric surgeries: Roux-en-Y gastric bypass (RYGB; n = 14, 51.85 %), laparoscopic sleeve gastrectomy (LSG; n = 9, 33.33 %) and duodenal switch (DS; n = 4, 14.81 %). The patients presented with gastric fistulas which were treated by internal drainage/stricturotomy. The mean patient age was 42.67 years, and the mean pre-operative BMI was 40.69 kg/m. Balloon dilation was performed if distal stenosis and/or axis deviation was present. The first endoscopic procedure was applied on the 15th day after RYGB and the 30th day after LSG and DS. Results: All patients presented with His angle fistula. Eight patients (57.1 %) had stenosis of the anastomosis after RYGB and were treated with balloon dilatation (20 mm). The patients submitted to LSG and DS had stenosis at the angularis incisure and were treated with achalasia balloon dilation (30 mm). The number of endoscopic sessions for stricturotomy ranged from 1 to 6. Two patients experienced bleeding after dilation, and one had perforation. The mean time to achieve fistula closure was 18.11 days (range, 1-72 days) without mortality. All the fistulas closed. Conclusions: This novel endoscopic procedure is safe, feasible, and effective, avoiding re-operation, allowing early oral feeding and discharge. [ABSTRACT FROM AUTHOR]