Search Results (73)

Background/Objectives: Benign choledochojejunal anastomotic stricture (CJS) is a major late adverse event (AE) after choledochojejunostomy. An endoscopic method using balloon-assisted enteroscopy endoscopic retrograde cholangiopancreatography (BAE-ERCP) was recently developed for CJS. Methods: We retrospectively reviewed 45 patients (98 cases) who underwent BAE-ERCP for benign CJS. The primary endpoint was the success rate of ERCP. The secondary endpoints were AEs and the recurrence rate of benign CJS. Results: ERCP was successful in 36 patients (80%). Balloon dilation of the anastomosis was performed in all 36 patients in whom ERCP was successful, and temporary plastic stent (PS) placement was performed in 20 of these patients (55.6%). Three cases of PS migration and one case of portal vein thrombosis occurred as mild AEs. However, one case of intestinal perforation required emergency surgery for repair. In univariate analysis, proficiency in ERCP procedures (p = 0.019) and surgery at our hospital (p = 0.010) emerged as major factors affecting the procedural success. In univariate analysis, only the early onset of CJS within 400 days after choledochojejunostomy was extracted as a significant factor for the early recurrence of CJS after ERCP (p = 0.036). Conclusions: To ensure successful BAE-ERCP for CJS, it is essential to have proficiency in the ERCP and collect as much detailed information about prior surgery as possible before the procedure. Additionally, the risk of CJS recurrence might be high in patients in whom CJS develops early after surgery. Full article

Background and Objectives. Umbilical hernia is particularly common among patients with liver cirrhosis, affecting about 20% of this group, compared to 3–8.5% in healthy individuals. This increased prevalence is mainly due to weakened abdominal fascia, elevated intra-abdominal pressure, and malnutrition. The rapid progression of umbilical hernias often leads to complications such as skin necrosis, perforation, and strangulation. Historically, patients with liver cirrhosis and complicated umbilical hernia have faced high morbidity and mortality rates. However, recent advancements in perioperative management, especially in controlling ascites, have improved outcomes in elective treatments. Despite these advancements, managing patients with decompensated liver cirrhosis and complicated umbilical hernia in emergency settings remain a significant surgical challenge. Materials and Methods: We conducted a retrospective review of patients treated for complicated umbilical hernia at the University Medical Centre Ljubljana from 2015 to 2024, using prospectively collected data. This analysis involved implementing hernioplasty combined with incisional negative pressure wound therapy (iNPWT) as part of the surgical protocol. The primary endpoint of our study was the rate of local complications, while the secondary endpoints included the rate of systemic complications and 90-day mortality. Results: We treated 28 consecutive patients with complicated umbilical hernia and liver cirrhosis. Local wound complications were observed in three (10.7%) patients. Systemic complications developed in 10 patients (35.7%). The median duration of hospitalization was 8 days (range: 5–29), and no readmissions were recorded within the 30-day period. Two (7.1%) patients died within 90 days. Conclusions: Our experience indicates that iNPWT, when combined with surgical repair, can be safely utilized, yielding outcomes comparable to elective hernia repairs, even in emergency contexts. Further randomized controlled trials are necessary to validate these findings and optimize treatment protocols. Full article

Introduction and Objectives: Bladder injuries are broadly classified based on anatomical location into two main categories: extraperitoneal and intraperitoneal. Traditionally, clinicians manage most extraperitoneal bladder ruptures conservatively with catheter drainage, while intraperitoneal ruptures are surgically repaired. This study aims to evaluate the feasibility of conservative management of intraperitoneal bladder rupture in the largest series to date. Methods: A retrospective review was performed of patients treated for intraperitoneal bladder perforations at two large tertiary care centers from 2015 to 2023. The charts of 290 patients with intraperitoneal perforations were reviewed to compile a list of those who underwent initial conservative management of their rupture via Foley catheter, of which there were 16. Demographic data was collected as well as variables related to patient characteristics, computed tomography (CT) measured size of perforation, management, complications, and follow-up. Data were analyzed using descriptive statistics, and comparative analyses (t-test and Fisher’s exact test) were performed. Results: Our final analysis identified 16 patients with intraperitoneal bladder rupture treated with initial conservative management. Of these patients, 15 (94%) were successfully managed with Foley catheter placement. Four patients (25%) experienced complications after conservative management, which included long-term urinary incontinence/retention, urinary tract infection (UTI), and pelvic abscess. For patients successfully managed conservatively, the median duration of catheterization was 18 days (IQR 21.75). Conclusions: For patients with small intraperitoneal bladder ruptures, conservative management with prolonged Foley catheterization is a suitable and successful strategy. Future studies evaluating outcomes in larger cohorts of patients will help determine whether this strategy should be considered more frequently in select patient populations. Full article

Background: The combination of polynucleotides and hyaluronic acid with bovine bone grafts in maxillary sinus lift procedures appears to be a promising strategy to enhance bone regeneration. This study aimed to analyze implant osseointegration, bone repair and sinus mucosa integrity using Bio-Oss^® and Hyaluronic Acid-Polynucleotide Gel (Regenfast^®) in maxillary sinus augmentation in rabbits. Methods: Sinus floor elevation was performed in 12 rabbits, with one implant placed per sinus simultaneously. In the control group, sinuses were grafted with deproteinized bovine bone mineral (Bio-Oss^®) alone; in the test group, Bio-Oss^® was combined with Regenfast^®. Two histological slides were obtained per sinus after 2 weeks (six animals) and 10 weeks (six animals): one from the grafted area alone (non-implant sites), and one from the implant site. Primary outcome variables included the percentage of newly formed bone, the extent of implant osseointegration, and the number of sinus mucosa perforations caused by contact with graft granules. Results: After 10 weeks of healing, the test group showed a significantly higher percentage of new bone formation (37.2 ± 6.7%) compared to the control group (26.8 ± 10.0%; p = 0.031); osseointegration extended to the implant apex in both groups; fewer sinus mucosa perforations were observed in the test group (n = 5) than in the control group (n = 14). Conclusions: The addition of Regenfast^® to Bio-Oss^® granules promoted enhanced bone regeneration within the elevated sinus area and was associated with a lower incidence of sinus membrane perforations compared to the use of Bio-Oss^® alone. Full article

Background: Laparoscopic antireflux surgery (LARS) is widely used to treat gastroesophageal reflux disease (GERD). Iatrogenic gastroesophageal injuries, when recognized intraoperatively, can be managed without major consequences, whereas undetected injuries presenting as postoperative leaks are associated with high morbidity and mortality. Despite their complexity, research on post-LARS leaks is scant. We aim to describe the diagnosis and management of such injuries at a tertiary referral center. Methods: We describe a single-center case series of patients referred for gastroesophageal perforations after LARS. Patients were identified through the personal records of surgeons at our institution. A narrative literature review was conducted to summarize publications on the topic. Results: Five patients (four female [80%]; median age, 73 years [IQR, 67–74]) were included. The median time between LARS and clinical presentation was 2 (IQR, 1–8) days (range 1–15 days). The most frequent symptoms were shortness of breath (all five patients) and pain (three [60%] patients). All patients presented with hypoxia, and four (80%) patients presented with sepsis. Two (40%) patients underwent primary repair, and three (60%) required limited esophagogastrectomy without immediate reconstruction. All patients required both thoracic and abdominal exploration, and all of them experienced significant postoperative complications (Clavien–Dindo ≥ 3). The median hospital stay was 58 days (IQR, 34–59). At a median follow-up of 14 months (IQR, 6–28), all patients were alive. Conclusions: Although infrequent, gastroesophageal perforation after LARS often requires complex surgical interventions and prolonged hospital stays. Additional efforts should focus on prevention and early recognition. Full article

Background: Oesophageal perforation (OP) is a life-threatening condition requiring prompt diagnosis and treatment. Mortality is influenced by several factors, such as aetiology, defect location, comorbidities, age, and delays in treatment. This study reviews patients with OP undergoing surgery, analysing mortality risks and the impact of timing on surgical outcomes. Methods: Medical records of 45 patients surgically treated for OP across three tertiary centers were analysed. Results: Of the 45 patients, 31 were male (68.88%) and 14 were female (31.11%), with a mean age of 66.00 ± 17.75 years. Pre-operative CT was performed in all patients, and 18 (40%) underwent oesophagogastroduodenoscopy. As many as 25 patients (55.55%) presented within 24 h, 10 (22.22%) within 24–72 h, and 10 (22.22%) after 72 h. Symptoms included pain, vomiting, fever, dysphagia, and subcutaneous emphysema. Foreign body ingestion and Boerhaave’s syndrome were the leading causes (33.33% each), followed by caustic ingestion (17.77%) and iatrogenic and traumatic cases. Treatments included primary repair, debridement, oesophagectomy, and oesophagogastrectomy. Primary repair was performed in 22 cases (48.88%), and muscle flaps reinforced 11 of these. Direct repair showed the highest success rate when performed within 24 h. Thirty patients (66.66%) experienced complications, including respiratory failure, oesophagopleural fistula, and sub-stenosis. The hospital stay average was 36.34 ± 35.03 days. Nine patients underwent same-session/two-stage gastroplasty or retrosternal coloplasty for reconstruction, with complications including stenosis and leaks. Six patients (13.33%) died within the first 24 h after surgery, primarily due to severe comorbidities (three (50%) were octogenarians). Conclusions: OP is a life-threatening condition with high mortality. Primary repair is the preferred treatment. Oesophagectomy and gastrectomy are reserved for extensive lesions. Muscle flaps can reinforce sutures in cervical and thoracic perforations. Mortality is mainly influenced by the severity of the patient’s clinical picture and comorbidities, rather than by time and type of treatment. Full article

Background: Among patients with congenital heart disease, particularly those with a history of undergoing the Fontan operation, pregnancy presents a significant maternal–fetal risk, especially when complicated by severe valvular dysfunction. Lung reperfusion syndrome (LRS) is a rare but life-threatening complication occurring following valve intervention. Multidisciplinary management, including by Cardio-Obstetrics teams, is essential for optimizing outcomes in such high-risk cases. Methods: We present the case of a 37-year-old pregnant patient with previously repaired tetralogy of Fallot (via the Fontan procedure) who presented at 24 weeks gestation with worsening severe pulmonary stenosis and right-ventricular dysfunction. The patient had been lost to cardiac follow-up for over a decade. She experienced recurrent arrhythmias, including supraventricular and non-sustained ventricular tachycardia, prompting hospital admission. A multidisciplinary team recommended transcatheter pulmonic valve replacement (TPVR), performed at 28 weeks’ gestation. Results: Post-TPVR, the patient developed acute hypoxia and hypotension, consistent with Lung Reperfusion Syndrome, necessitating intensive cardiopulmonary support. Despite initial stabilization, progressive maternal respiratory failure and fetal compromise led to an emergent cesarean delivery. The neonate’s neonatal intensive care unit (NICU) course was complicated by spontaneous intestinal perforation, while the mother required intensive care unit (ICU)-level care and a bronchoscopy due to new pulmonary findings. She was extubated and discharged in stable condition on postoperative day five. Conclusions: This case underscores the complexity of managing severe congenital heart disease and valve pathology during pregnancy. Lung reperfusion syndrome should be recognized as a potential complication following TPVR, particularly in pregnant patients with Fontan physiology. Early involvement of a multidisciplinary Cardio-Obstetrics team and structured peripartum planning are critical to improving both maternal and neonatal outcomes. Full article

Background and Objectives: Gender affirmation surgery significantly improves the quality of life and psychological well-being of transgender women. Among various techniques, sigmoid vaginoplasty is widely performed due to its ability to provide adequate vaginal depth and intrinsic lubrication. However, it carries risks, with neovaginal perforation being a serious yet underreported complication. Materials and Methods: This review examines the etiology, clinical manifestations, diagnosis, and management of neovaginal perforation. A literature review was conducted to analyze reported cases and treatment strategies. Additionally, we present a case from our institution to highlight diagnostic and therapeutic challenges. Results: Neovaginal perforation arises from mechanical trauma, ischemia, infection, or structural weaknesses in the sigmoid segment. Common risk factors include improper dilation, introital stenosis, and vascular compromise. Symptoms range from mild pelvic discomfort to peritonitis and sepsis. Computed tomography (CT) is the gold standard for diagnosis. Conservative management is effective in mild cases, whereas severe cases require surgical repair. Conclusions: Neovaginal perforation is rare but potentially life-threatening. Future research should refine surgical techniques, dilation protocols, and tissue engineering solutions. Standardized guidelines and patient education are essential for prevention and improved outcomes. Full article

Bioceramic materials for endodontic treatments have gradually transformed over the years into materials with enhanced biocompatibility and chemical and mechanical properties compared to earlier generations. In endodontics procedures, these materials are used as restorative material in applications such as root-end fillings, pulp capping, perforations repair, and apexification repair procedures. However, they have far from ideal mechanical and handling properties, biocompatibility issues, aesthetic concerns due to tooth discolouration, limited antibacterial activity, and affordability, which are amongst several key limitations. Notably, bioceramic materials are popular due to their biocompatibility, sealing ability, and durability, consequently surpassing traditional materials such as gutta-percha and zinc oxide–eugenol sealers. A lack of recent advancements in the field, combined with nanomaterials, has improved the formulations of these materials to overcome these limitations. The existing literature emphasises the benefits of bioceramics while underreporting their poor mechanical properties, handling difficulties, cost, and various other drawbacks. The key gaps identified in the literature are the insufficient coverage of emerging materials, narrow scope, limited insights into future developments, and underreporting of failures and complications of the existing materials. Consequently, this review aims to highlight the key limitations of various endodontic materials, primarily focusing on calcium silicate, calcium phosphate, and bioactive glass-based materials, which are the most abundantly used materials in dentistry. Based on the literature, bioceramic materials in endodontics have significantly improved over recent years, with different combinations of materials and technology compared to earlier generations while preserving many of their original properties, with some having affordable costs. This review also identified key innovations that could shape the future of endodontic materials, highlighting the ongoing evolution and advancements in endodontic treatments. Full article

Background/Objectives: The endoscopic repair of the tympanic membrane is an established method for addressing perforations in the tympanic membrane. However, there are limited studies in the literature examining the success rate of this procedure in the pediatric population. Methods: This study retrospectively analyzed data from the tertiary referral center at the University Hospital of Verona, Italy. This medical record contains data from 84 type 1 transcanal endoscopic tympanoplasties performed in pediatric patients between November 2014 and February 2022. Seventy-seven pediatric patients aged 4 to 16 years who underwent type 1 transcanal endoscopic tympanoplasty (seven of whom underwent bilateral surgery at different time points) were included in the study. Our study did not include more extensive procedures than type 1 endoscopic tympanoplasty. Only patients with tympanic membrane perforation due to simple chronic otitis media, trauma or when no apparent cause was found were included. Chronic otitis with cholesteatoma and other pathologies of the external or middle ear were exclusion criteria. Patients with a follow-up of less than 12 months were excluded from this study. The technique was based on the endoscopic placement of an underlay graft of temporal fascia or tragal cartilage to repair a tympanic membrane perforation. Demographic, clinical, audiologic, and surgical data were collected from each patient. In the study, we considered the reduction of the air-bone gap (ABG) as a functional outcome and the integrity of the reconstruction as an anatomic outcome of success. Results: The primary surgery had a closure rate of 92.9% (78 of 84). All patients underwent audiological evaluation 4–6 months post-surgery, with 84 ears tested. The mean preoperative ABG was 17.13 dB HL, reduced to 9.16 dB HL postoperatively, showing a mean reduction of 7.97 dB HL. No significant complications occurred. Conclusions: Transcanal endoscopic type 1 tympanoplasty should be considered a safe procedure with a high success rate for the repair of tympanic membrane perforations, even in pediatric patients. Full article

This in vitro study evaluated short-fiber-reinforced composite materials and fiber-reinforced restorations of endodontically treated molars with furcal perforation. The endodontic treatment and mesio-occlusal–distal cavity preparation of 126 two-rooted mandibular third molars were performed. Eighteen non-perforated teeth were restored with resin composite as the control group. Furcal perforations and repair were performed on 108 teeth that were divided into six experimental groups: resin composite (RC), everX Flow (EXF), everX Posterior (EXP), Bioblock (BB), modified transfixed (MT), and horizontal glass-fiber (HGF) groups (n = 18). Fracture resistance tests were performed at an angle of 30◦ using a universal testing machine under static loading, and fracture patterns were classified. Welch’s analysis of variance, Pearson chi-square, and Tamhane post hoc tests (p = 0.05) were used to analyze the data (p = 0.05). The highest fracture resistance values were seen with the HGF (596.305 N), followed by MT (540.365 N), BB (477.906 N), EXP (476.647 N), EXF (414.462 N), control (413.811 N), and RC (335.325 N) groups (p < 0.001). There was no significant difference between the BB and EXP groups or between the EXF and control groups (p > 0.05). In terms of the dominant fracture pattern, the HGF and MT groups were repairable and possibly repairable, whereas the control, RC, and EXP groups were unrepairable. The EXF and BB groups were almost equally divided between possibly repairable and unrepairable. Restorations using horizontal fiber techniques and short-fiber-reinforced materials increased the fracture resistance of endodontically treated teeth with furcal perforation. Full article

The effectiveness of biocements applied in specialistic endodontic procedures can be influenced by multiple factors, including the postplacement chemical action of the irrigating solution. This in vitro study aimed to assess the impact of 2% chlorhexidine digluconate on the surface structure and chemical composition of Biodentine as a perforation repair cement. A total of 54 Biodentine specimens were prepared with strict adherence to the manufacturer’s instructions and irrigated with 2% chlorhexidine with or without ultrasonic activation. The material specimens were divided into three setting-time-based groups: group A—rinsed after 12 min of setting, group B—after 45 min, and group C—after 24 h. The control group was not subjected to any irrigation protocol. The evaluation of the microappearance of biocement surface was performed with the aid of a scanning electron microscope (SEM). The chemical composition of Biodentine was analyzed with the energy dispersive spectroscopy (EDS) method. The SEM images of the specimens in group B and C revealed a heterogeneous and layered surface morphology. The EDS results are comparable between pairs of cement specimens in both groups: after 5 min and 20 min CHX irrigation as well as after 5 min and 20 min ultrasonically activated CHX irrigation. To conclude, the 12 min Biodentine setting time is not recommended when used in perforation closure. Irrigation protocol involving 2% chlorhexidine visibly affected the tested material surface. The EDS results did not confirm any significant changes in Biodentine chemical composition. Further research is required to analyze the influence of the observed changes on the outcome of the endodontic treatment. Full article

Bioceramic endodontic cements, known for their antibacterial properties, calcium ion release, and alkaline pH, may come into contact with various irrigants after furcal perforation repair. This study aimed to evaluate the effect of different irrigating solutions and setting times on the shear bond strength (SBS) of Biodentine^® (Septodont, Saint-Maur-des-Fosses Cedex, France) to a self-adhering flowable composite. Sixty Biodentine^® (Septodont, Saint-Maur-des-Fosses Cedex, France) blocks were prepared and divided into two groups based on the setting time: 72 h and 7 days. These were further subdivided into five subgroups based on the irrigation solution applied: distilled water, sodium hypochlorite, ethylenediaminetetraacetic acid, chlorhexidine, and phosphoric acid. They were then restored with Dyad Flow^TM (Kerr^TM, Orange, CA, USA). SBS and failure modes were assessed at 24 h and 6 months. A two-way analysis of variance (ANOVA) test was performed to analyze the effect of the different irrigating solutions and setting times on the SBS of Biodentine^® (Septodont, Saint-Maur-des-Fosses Cedex, France) and Dyad Flow^TM (Kerr^TM, Orange, CA, USA). The level of significance was set at a ≤0.05. At 24 h, SBS was significantly influenced by both the irrigant solution (p = 0.029) and setting time (p = 0.018); at 6 months, SBS was influenced only by the irrigating solutions (p < 0.001). The predominant mode of bond failure was adhesive across all groups. In conclusion, while the setting time did not affect the bond strength, certain irrigating solutions reduced it. Thus, careful consideration of surface treatments applied to Biodentine^® is crucial for successful endodontic and restorative outcomes. Full article

Thermoplastic composite organosheets (OSs) are increasingly recognized as a viable solution for automotive and aerospace structures, offering a range of benefits including cost-effectiveness through high-rate production, lightweight design, impact resistance, formability, and recyclability. This study examines the impact response, post-impact strength evaluation, and hot-pressing repair effectiveness of woven glass fiber nylon composite OSs across varying impact energy levels. Experimental investigations involved subjecting composite specimens to impact at varying energy levels using a drop-tower test rig, followed by compression-after-impact (CAI) tests. The results underscore the exceptional damage tolerance and improved residual compressive strength of the OSs compared to traditional thermoset composites. This enhancement was primarily attributed to the matrix’s ductility, which mitigated transverse crack propagation and significantly increased the amount of absorbed energy. To mitigate impact-induced damage, a localized hot-pressing repair approach was developed. This allowed to restore the post-impact strength of the OSs to pristine levels for impact energies below 40 J and by 83.6% for higher impact energies, when OS perforation was observed. The measured levels of post-repair strength demonstrate a successful restoration of OS strength over a wide range of impact energies, and despite limitations in achieving complete strength recovery above 40 J, hot-pressing repair emerges as a promising strategy for ensuring the longevity of thermoplastic composites through repairability. Full article

This study investigated the marginal adaptation of three recently introduced bioceramic root repair materials, EdgeBioCeramic RetroFill, Endocem MTA, and One-Fil PT, using VP-SEM analysis. Extracted single-rooted lower incisors were used to simulate retrograde fillings. The results showed no statistically significant differences in the marginal gap between the materials and the dentin walls. All three materials exhibited good dimensional stability, with gap sizes comparable to previously published research on similar materials. The mean GAP was 3.91 ± 2.56 for EdgeBioCeramic RetroFill, 4.32 ± 2.69 for Endocem MTA, and 4.50 ± 2.54 for One-Fil PT. This study employed VP-SEM, a valuable tool for analyzing bioceramic materials without altering their properties. The findings suggest the possibility of daily clinical use of these bioceramics by endodontists and general practitioners that could find applications in retrograde fillings and perforation repairs. However, further in vivo studies are needed to confirm long-term stability and assess the influence of sample preparation methods. Full article