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This study aims to propose a novel surgical technique to rehabilitate patients with long term complication of trachea-esophageal puncture and stomal stenosis. Ours is retrospective study. Ten patients with tracheo-esophageal puncture who developed long term complications and who failed conservative management were included in our study. Majority of our patients were males within the age group of 50–70 years of age. Most of our patients had received adjuvant radiotherapy (8/10). All patients had multiple change of prosthesis. Nine patients suffered from multiple complications of TEP. Most common complication was that of progressive thinning of trachea-esophageal wall. All the patients who underwent this procedure healed well without any major complications. Long term trachea-esophageal puncture may undergo significant modification in terms of position and size. This technique gives a satisfactory and viable method of excising the altered anatomy and establishes speech & swallowing in such patients who fail conservative management. [ABSTRACT FROM AUTHOR]

Continent cutaneous urinary diversion can be employed after cystectomy when orthotopic diversion is not appropriate and a continent diversion is desired. It is a technically challenging operation and requires careful pre-operative and intra-operative planning as well as an experienced surgeon and ancillary staff. Overall, continent cutaneous diversion (CCD) carries a high rate of long-term continence and patient satisfaction, and is an important and widely accepted part of the urologist's armamentarium. Many different types of CCD and efferent channels have been described with variable success. Complications are largely related to the stoma and catheterizable channel. These complications can usually be managed outside of the operating room although occasionally re-operation is required. [ABSTRACT FROM AUTHOR]

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To report our experience of synchronous panniculectomy with stomal revision in morbidly obese patients after radical cystectomy (RC) and ileal conduit urinary diversion (UD). Abnormal skin folds with an uneven surface, stomal retraction and stomal stenosis result in a poorly fitting appliance which leads to urinary leakage, need for frequent change of appliances and skin excoriation. PATIENTS AND METHODS In all, 302 RCs with UD were done by one surgical team between 2002 and 2008, with ileal conduit diversion in 182 (60%); 18 had a body mass index (BMI) of >35 kg/m2, and among them four had severe stomal stenosis with retraction. We report the technique we used for managing stomal stenosis in these patients. RESULTS The mean (range) BMI of the patients was 42 (38–46) kg/m2; all were women. The mean (sd) operative duration was 2 (0.5)h. The drain was removed once the drainage was <25 mL in 24 h. The mean (sd) hospital stay was 3 (1) days; there were no significant complications. After a mean follow-up of 3 years there was no recurrent stomal stenosis or retraction. CONCLUSIONS The unique advantage of this procedure is that it avoids laparotomy in a morbidly obese patient, and it provides excellent cosmesis while correcting the stomal complication. [ABSTRACT FROM AUTHOR]

Background: Stomal stenosis after laryngectomy is a common and distressing complication. Once sets in, it is generally progressive, causes problems and needs active intervention. Aim: To evaluate effectiveness of new simple method of stomaplasty in solving troublesome complication of stoma stenosis. Settings and Design: Charts of eight patients who underwent modified stomaplasty and completed 1 year were reviewed. Materials and Methods: A modified anterior advancement flap and lateral splaying of trachea for stoma plasty are described. This involves excision of scar tissue of the anterior two-third of trachea and interposition of the defect with an inferiorly based triangular skin flap. The tracheo-esophageal-prosthesis (TEP) site is left untouched. Statistical Analysis: Outcome were measured in relation with need for further stenting or any other revision procedure required and ability to use TEP for speech production. Results: Eight patients underwent stoma revision surgery. Median preprocedure stoma diameter was 10 mm vertically (range 8-12 mm) and 6 mm horizontally (range 5-10 mm). This could be improved to 25 mm (range 22-30 mm) vertically and 16 mm (range 14-20 mm) horizontally after stoma revision. At 1-year follow-up, the median measurements were 20 mm (range 16-26) vertically and 14 mm (range 12-18) horizontally. Postprocedure, one patient required intermittent stenting at nighttime. All patients could use the TEP effectively. One patient who underwent salvage laryngectomy following chemoradiotherapy developed flap dehiscence. Conclusions: This is a simple and effective technique for stomaplasty. All patients treated with this technique had adequately large stoma for breathing and use of TEP. [ABSTRACT FROM AUTHOR]

Background: In the United States, Roux-en-Y gastric bypass has evolved into the procedure of choice for clinically severe obesity. Stomal stenosis resulting in gastric outlet obstruction is a recognized complication. Endoscopic balloon dilation is often used to treat this condition. To evaluate the safety and efficacy of endoscopic management of stomal stenosis we evaluated our treatment methods and outcomes.Methods: The records of all patients undergoing Roux-en-Y gastric bypass from 1 July 2000 to 30 June 2002 were studied. Stenosis was defined as signs and symptoms of obstruction with inability to cannulate the gastrojejunostomy using an 8.5-mm diagnostic endoscope. Charts were reviewed and demographic data, operative course, symptoms, and outcomes were recorded.Results: A total of 562 patients underwent Roux-en-Y gastric bypass for obesity during the study period. Of these, 38 patients underwent endoscopic balloon dilation for stomal stenosis, for a stenosis rate of 6.8%. The average time from surgery to initial dilation was 7.7 weeks (range 3 to 24). The average number of dilations required was 2.1 (range one to six). The mean initial balloon size was 13 mm and the mean final balloon size was 16 mm. Two patients failed endoscopic dilation and proceeded to surgery, including one patient who developed pneumomediastinum and pneumothorax after dilation. All patients were relieved of their gastric outlet obstruction. The success rate for endoscopic balloon dilation was 95% with a 3% complication rate.Conclusions: In our experience, the rate of gastrojejunostomy stenosis following Roux-en-Y gastric bypass is 6.8%. Endoscopic balloon dilation is a safe and effective therapy for stomal stenosis with a high success rate. It should be considered an appropriate intervention with a low risk for reoperation. [ABSTRACT FROM AUTHOR]

Hypothesis Stenosis of the tracheostome is a frequent complication following total laryngectomy; the problems created by tracheostomal stenosis are the result of reduced airflow and consequent turbulence. Many authors have studied etiological factors for the onset of stomal stenosis, and a number of procedures have been recommended for the surgical correction of such stenosis. Study Design A prospective analysis of 12 patients who underwent surgical correction of stomal stenosis is presented. Methods At the Institute of Clinical Otolaryngology we have recently defined a surgical technique for the correction of stomal stenosis that combines radial incisions, V-shaped flaps, and interposing flaps. This technique enables us to correct all the types of stenosis, and we have treated 12 patients to date. Results To date, the average follow-up has been 17 months (range, 3-36 mo), and the results are encouraging. Early stenosis of the tracheostoma reappeared in one patient, who had successful repeat surgery with the same technique. Conclusions Early results suggest the routine use of this surgical technique in the treatment of stomal stenosis. [ABSTRACT FROM AUTHOR]

As part of the Adelaide Obesity Surgery Study, we have reviewed all patients who have undergone revisional surgery. Of the 310 trial patients, 63 (20%) had revisions 1-69 (median 32) months following their original surgery--30% of all 105 gastrogastrostomy (GG) operations, 22% of 106 gastroplasty (GP) procedures, and 9% of 99 gastric bypasses (GB). Failure was due to stomal dilatation, 11% of all trial patients (71% of GG revisions), stomal stenosis, 6% (52% of GP revisions) and staple dehiscence, 4%. There was no mortality and a low hospital morbidity. Long-term success was only 23% (follow-up at least 3 years) and was achieved at considerable expense (3 reversals, 10 further revisions, 44 endoscopic procedures). Revisional surgery was successful in 45% of patients with stomal dilatation or dehiscence but in only 17% with stenosis. Overall, the most successful operation was revision of, or conversion to, gastric bypass (58% success rate), compared with gastroplasty (24%) and gastrogastrostomy (25%). Our long-term results following revisional surgery were disappointing, particularly for stenosis, and most failures followed revision to GG or GP. Roux-en-Y gastric bypass is the procedure of choice when considering revision. [ABSTRACT FROM AUTHOR]

The main problem with urinary diversion via cutaneous ureterostomy is stomal stenosis. Results with experimental and clinical implants of carbon polymer stoma prostheses (max. clinical observation period: 31 months) for vesicostomies have encouraged us to find out whether implants of this material would be suitable for cutaneous ureterostomies as well. The first step was dilatation of the ureters in 16 mongrel dogs, 4 mini pigs and 4 sheep. This was done by knotting a thread over a splint which had been introduced into the ureter. After 7 days the ureter was ligated prevesically and a carbon polymer stoma was implanted into the ureter. 37 of the 48 stoma implants were well tolerated and provided water tight urinary drainage; slight encrustation occurred but, radiologically, a smooth flow of contrast medium was seen. Ten of these 37 cases had transient urinary leakage. Eleven of the 48 stoma implants were unsuccessful because of insufficient healing, urinary extravasation, parastomal inflammation or severe encrustations. The results of these experiments on animals would seem to justify initial clinical use. It is conceiveable that in this way stomal stenosis of the cutaneous ureterostomy can be avoided. [ABSTRACT FROM AUTHOR]

Background: Stomal stenosis (SS) and marginal ulcer (MU) are reported to occur in 9-20% and 2-13%, respectively, of patients undergoing gastric bypass for morbid obesity. It is hypothesized that decreasing tension on the gastrojejunostomy by performing limited small bowel resection (SBR) would decrease ischemia, thereby decreasing the likelihood of SS and MU. Methods: A retrospective review of 150 consecutive gastric bypass patients operated by one surgeon from 1993 to 1996 was performed. The incidence of SS and MU was compared in patients with and without SBR. Results: The overall rate of SS was 24.0% and that of MU was 9.3%: the incidence of both was 2.0%. The incidence of SS in patients without SBR was 26.9% and with SBR was 19.6%. The incidence of MU in patients without SBR was 8.9% and with SBR was 9.8%. Neither result was statistically significant by Fisher's exact test. Conclusion: There is a trend towards a decrease in the incidence of SS in gastric bypass patients with concomitant SBR although this did not reach clinical significance. [ABSTRACT FROM AUTHOR]

The case is reported of incarcerated intestinal hernia in a hernia sac of reversed ileal conduit wall protruding through the stoma. An 82-year-old woman presented with suspected parastomal intestinal hernia. The patient had undergone total cystectomy with ileal conduit construction 3 years previously, followed by stomal reconstruction surgery for stomal stenosis 2 years later. She had been taking various kinds of purgatives for severe constipation. Initially, this case was diagnosed as parastomal hernia, but emergency surgery demonstrated that incarcerated intestinal hernia in a hernia sac of reversed ileal conduit wall was protruding through the stoma. This case was apparently caused by high abdominal pressure and thinning of the ileal conduit wall. [ABSTRACT FROM AUTHOR]

Indication Amongst late complications of stomas, stenosis can be difficult to treat. Repeated dilatations rarely achieve long-term resolution and re-fashioning is not always successful. Application of an existing plastic surgical technique to treat stomal stenosis is described. Method After marking the skin, a W-plasty is made with a number of consecutive small triangular flaps through the skin. The corresponding mucosal margin is then made to interdigitate with this configuration and fixed using a Gillies corner stich with 5/0 Vycril rapide on a compound curved needle. Results Five patients underwent W-plasty reconstruction for a stenotic stoma. Median follow up was 12.5 months (range 11–15). No patient had stenosis of the stoma on review and the patient satisfaction rate was high. Conclusion The W-plasty technique is a new treatment for stenotic stoma. [ABSTRACT FROM AUTHOR]