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Background: Biliary leakage is a serious complication of hepato-pancreato-biliary operations, increasing morbidity and mortality, and challenging clinicians., Objective: This study aims to evaluate the incidence of bilioenteric anastomotic leakage, treatment options, and their outcomes at a high-volume tertiary referral center., Methods: A retrospective cohort study was conducted to analyze the outcomes of patients who underwent biliary anastomosis formation between 2016 and 2021. Data from patients with malignant biliary obstruction was analyzed collectively and in two homogenous cohorts: distal malignant (DM) group with distal biliary obstruction undergoing pancreatic head resection, proximal malignant (PM) group with perihilar biliary obstruction undergoing perihilar biliary resection without liver resection., Results: 724 patients were found. After exclusions, 410 remained in the DM and 41 in the PM group. In the DM group the leak rate was 5.6% (23/410). Mortality was 3.9%, in patients with anastomotic failure 26% (6/23) vs no failure 2.6% (10/387) (p‹0.0001). Leak rate in the ASA III and ASA I-II patients were 52.2% (12/23) vs 48.8% (11/23), (p = 0.597). Leak rates were higher in the PM group 14,6% (6/41), mortality was 4.9% (2/41). All leaks in the PM group occurred in ASA III patients (6/6). No statistically significant associations were found between leak rates and factors such as patient age, preoperative serum bilirubin levels, preoperative or intraoperative biliary drainage, cholangitis, blood transfusion, postoperative pancreatic fistula, or bile duct dilation in either group. Bile leaks (n = 29) were treated conservatively (n = 9) with percutaneous transhepatic drainage (n = 3) or reoperation with (n = 16) or without (n = 10) external biliary drainage. Clinical success rates were slightly higher after reoperation with external drainage., Conclusion: This study identified perihilar resection as a risk factor for biliary leakage and trends indicating higher leak rates among patients with advanced comorbidities (ASA III), elevated preoperative bilirubin levels, non-dilated bile ducts, cholangitis or postoperative pancreatic fistula but these associations did not reach statistical significance, likely due to the limited sample size. In the management of anastomotic leakage, conservative and minimally invasive methods are effective; however, most cases required relaparotomy combined with external biliary drainage., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Semmelweis University Regional and Institutional Committee of Science and Research Ethics (SE RKEB #25/2023). The informed consent is waived by the mentioned ethics committee considering the retrospective nature of the study. Consent for publication: Not applicable. The records were fully anonymized during the data analysis, and the ethics committee did not require informed consent. The authors had no access to information that could identify individual participants during or after data collection. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background : This study aims to compare the surgical outcomes of transorbital versus endonasal endoscopic approaches for orbital subperiosteal abscess drainage. Methods : A retrospective review was conducted at a single institution of patients who underwent orbital subperiosteal abscess drainage from November 2009 to April 2023. Results : Of 64 patients, 44 (68.8%) underwent abscess drainage via an orbital approach, while 20 (31.3%) underwent endonasal endoscopic drainage. No significant difference in operative time or visual acuity improvement was found between the two groups. Abscess drainage via orbitotomy was associated with a longer total (average 8.1 days) and postoperative (average 7.3 days) hospitalization time compared to the endoscopic group (average 5.4 days and 4.2 days, respectively), though this difference was not statistically significant ( p = 0.197, 0.136, respectively). For medial orbital abscesses, the average length of total and postoperative hospitalization was greater after orbitotomy ( p = 0.028 and 0.019, respectively). At discharge, patients who underwent orbitotomy more commonly reported periorbital swelling ( p = 0.0003), while postoperative pain was more common in the endoscopic drainage group ( p = 0.009). Reoperation rate was higher after orbitotomy (34.1%) compared to the endoscopic drainage group (15.0%), though this was not statistically significant ( p = 0.115). Conclusions : Transorbital and endoscopic surgical approaches for orbital abscess drainage have similar surgical outcomes, with no statistically significant differences noted in terms of visual acuity change or reoperation rate. Longer hospital stays were found for patients with medial orbital abscesses drained via orbitotomy.

Purpose: The report presents a modified surgical technique wherein the perfluorocarbon liquid (PFCL)-assisted drainage of subretinal fluid (SRF) through the choroid was combined with partial-thickness sclerectomy (PTS) and punch sclerostomy as a treatment for bullous central serous chorioretinopathy (bCSCR) in a nanophthalmic eye., Methods: The developed surgical approach is herein discussed together with a corresponding surgical video. Briefly, two 5 × 4 mm half-thickness sclerectomies and a punch sclerostomy (diameter: 2 mm) to the choroid were performed in the inferior quadrants. Following vitrectomy, SRF was drained through the exposed choroid in the region where the punch sclerostomy was performed, whereafter PFCL was instilled into the vitreous cavity., Results: The complete resolution of SRF accumulation was evident at one-week post-surgery, with no evidence of recurrence over an 18-month follow-up period. No abnormal fluorescent leakage or choroidal vasodilation were evident via fundus fluorescein angiography and indocyanine green angiography examination at the patient's final follow-up visit., Conclusion: PFCL-assisted SRF drainage through the choroid combined with PTS and punch sclerostomy may represent a viable approach to treating patients with bCSCR and nanophthalmic eyes, providing a rapid and long-lasting means of eliminating SRF accumulation., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To investigate the efficacy and safety of pedunculated rectus abdominis combined with bilateral ureteral extravestheter drainage in the treatment of refractory bladder-vaginal stump fistula. Methods: The clinical data of 8 cases of the refractory bladder-vaginal stump fistula were admitted to the Second Hospital of Hebei Medical University and Henan Cancer Hospital and underwent the clinical treatment of bladder-vaginal stump from December 2019 to December 2022 were collected. The reason of refractory bladder-vaginal stump fistula was analyzed, the operation manner of pedunculated rectus abdominis combined with peduncle and bilateral ureter for the treatment of bladder-vaginal stump through extrabladder drainage was explored. The operation time, bleeding volume and clinical effect were record. Results: The median operation time of 8 patients was 150 minutes(120~180 min), and the median blood loss was 400 ml(200~600 ml). During the perioperative period, there were 2 cases of incision infection, delayed healing by debridement and dressing, 2 cases of incision rupture and suture wound healing after reoperation, and 2 cases of urinary tract infection were cured by anti-infection. When followed up for 6 months, 8 cases of vesicovaginal stump fistula were cured. Conclusion: Bilateral ureteral external drainage of the rectus abdominis muscle, has a practical effect in the treatment of refractory bladder-vaginal stump fistula, which can be one of the clinical repairing treatment.

Introduction: Urinary drainage is usually left in place after laparoscopic pyeloplasty to limit the risk of complications, such as urinary leakage. The procedure is sometimes laborious and complications may occur., Purpose: Prospective evaluation of the Kirschner technique for urinary drainage during pediatric laparoscopic pyeloplasty., Study Design: This technique (Upasani et al., J Pediatr Urol 2018) involves introducing a nephrostomy tube (Blue Stent) with a Kirschner wire during laparoscopic transperitoneal pyeloplasty. We evaluated this technique by analyzing 14 consecutive pyeloplasties (53% on female patients, median age 10 years (6-16 years), on the right side in 40%) performed by a single operator between 2018 and 2021. The drain and urinary catheter were clamped and the perirenal drain removed on day 2. The stent was removed during consultation between days 7 and 15., Results: The median duration of surgery was 155 ± 7 min. Urinary drainage was installed within 5 min, without the need for radiological control and with no complications. All drains were correctly placed, with no drain migration or urinoma. Median hospital stay was 2 ± 1 days. One patient developed pyelonephritis (D8). The stent was removed without difficulty or complications. One patient presented an 8-mm lower calyx urinary stone at two months, revealed by macroscopic hematuria, necessitating extracorporeal shock wave lithotripsy., Discussion: The study design was based on a homogeneous series of patients, without comparison with another drainage technique or procedures performed by another operator. A comparison with other techniques might have been informative. Before this study, we tested various types of urinary drainage, to optimize performance. This technique was considered the simplest and least invasive., Conclusion: External drain placement with this technique was rapid, safe, and reproducible in children. It also made it possible to test the tightness of the anastomosis and to avoid the need for anesthesia for drain removal., Competing Interests: Conflicts of interest None., (Copyright © 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Congenital web formations are extremely rare anomalies of the extrahepatic biliary tree. We herein report a case of common bile duct septum combined with multiple intrahepatic bile duct strictures in a 74-year-old female patient who was successfully treated with radiological intervention. The patient initially visited the hospital because of upper abdominal pain. Imaging studies revealed multifocal strictures with dilatation in both intra- and extrahepatic ducts; the final clinical diagnosis was congenital common bile duct web combined with multiple intrahepatic duct strictures. Surgical treatment was not indicated because multiple biliary strictures were untreatable, and the disease was clinically diagnosed as benign. The multiple strictures were extensively dilated twice through bilateral percutaneous transhepatic biliary drainage (PTBD) for 2 months. After 1 month of observation, PTBD catheters were successfully removed. The patient is doing well at 6 months after completion of the radiological intervention, with the maintenance of normal liver function. Congenital web of the bile duct is very rare, and its treatment may vary depending on the patterns of biliary stenosis. In cases where surgical intervention is not indicated for congenital web and its associated disease, radiological intervention with balloon dilatation can be a viable therapeutic option.

Purpose: This work aims to assess the value of intravitreal triamcinolone acetonide (IVTA) as an adjunctive therapy in advanced Coats disease with exudative retinal detachment (ERD)., Methods: A retrospective review was conducted of patients with Coats disease stage 3 or higher who received IVTA to decrease subretinal fluid (SRF), facilitate retinal ablative therapy, and avoid surgical drainage. Primary outcomes were SRF resolution and avoidance of surgical SRF drainage., Results: Seventeen eyes of 17 patients (mean, [SD] age, 3.9 [3.4] years) met the inclusion criteria. ERD configuration was bullous in 7 and shallow in 10 eyes. Following a single IVTA injection, ablative therapy was achieved after a mean (SD) of 2.1 (3.0) weeks. Complete SRF resolution was observed in 13 eyes (76.4%) after a mean of 1.3 IVTA injections and a mean of 2 (SD, 1.27) laser sessions, and none of these eyes required SRF drainage up to last follow-up (mean [SD], 50.5 [26.24] months). In 4 eyes with bullous ERD at presentation, SRF persisted ( P = .015) despite additional measures including surgical drainage. Final visual acuity ranged from 20/100 to no light perception. Cataract developed in 12 of the 17 eyes (70.5%). None developed an increase in intraocular pressure at final follow-up., Conclusions: IVTA injection can be a helpful adjunctive modality to address SRF in advanced Coats disease. It may obviate the need to surgically drain SRF to effectively treat the condition, particularly when the ERD is not highly bullous., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: The extent of surgery required in the management of pediatric non-medial subperiosteal orbital abscess (SPOA) due to medically refractory complicated acute sinusitis is unknown., Objectives: The primary objective is to compare operative outcomes of children treated with combined endoscopic sinus surgery (ESS) and external orbital drainage (EOD) versus those treated with EOD alone., Methods: Retrospective case series from a tertiary children's hospital analyzing outcomes in children requiring surgical management for acute sinusitis complicated by non-medial SPOA between November 2007 and September 2019., Results: Sixteen children with a mean age of 9.4 years (95% CI: 7.3-11.4) met inclusion. Eleven (68.8%) underwent combined EOD and ESS, while five (31.2%) underwent EOD alone. Groups were similar in age, symptom duration, white blood cell count, C-reactive protein level, intraocular pressure, Lund-Mackay score, and abscess volume. There was no significant difference in median length of stay between patients treated with a combined approach versus those treated by EOD alone. Cultures identified non-beta-hemolytic Streptococcus species in 56.3% of patients, with Streptococcus intermedius representing the most common organism in 37.5%. In one case, ESS identified a pathogen not acquired via concomitant EOD, which did influence management. No child required a subsequent surgical procedure and there were no operative complications., Conclusions: The addition of ESS in the management of pediatric non-medial SPOA was not associated with a statistically different duration of hospitalization. Cultures from concomitant ESS rarely aided in diagnosis or antibiotic therapy. Further study should delineate the indications for ESS in these cases.

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.

Introduction: Percutaneous lumbar discectomy (PLD) combined with external drainage (ED) is a new technique for the treatment of intervertebral disc infection with epidural abscess., Aim: To discuss the feasibility, safety and efficacy of PLD and ED for the treatment of intervertebral disc infections with epidural abscess., Material and Methods: We enrolled 12 patients who underwent intervertebral disc infections with epidural abscess. The clinical efficacy was evaluated by visual analog scale (VAS) and standard Macnab's evaluation. Postoperative computed tomography and magnetic resonance imaging were also used to evaluate the clinical efficacy., Results: The technical success rate is 100%. Preoperation mean VAS score was 8.18 ±0.98; 5.36 ±1.50 postoperation 1 month; 3.36 ±2.24 postoperation 6 months; 2.77 ±0.31 postoperation 12 months. The comparison of preoperation and postoperation VAS showed a significant difference (p < 0.05). According to standard Macnab's evaluation, of all 12 cases, postoperation 12 months - excellent 4 cases, good 7 cases, poor 1 case. The efficacy rate was 91.6%. No serious complications were recorded., Conclusions: Percutaneous lumbar discectomy combined with external drainage may be a safe and efficacy method for the treatment of intervertebral disc infections with epidural abscess., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2020 Fundacja Videochirurgii.)

Objective: To examine the effect of pancreaticojejunostomy with pancreatic duct binding external drainage in laparoscopic pancreatoduodenectomy. Methods: The data of 21 patients who underwent laparoscopic pancreaticoduodenectomy in the same treatment group from January 2017 to October 2019 in Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University were analyzed retrospectively.All patients underwent pancreaticojejunostomy with external drainage of pancreatic ducts.There were 12 males and 9 females, aged (63.1±8.1)years old (range: 46 to 77 years old), body mass index (24.8±3.2)kg/m(2)(range: 18.8 to 29.1 kg/m(2)).There were 3 cases of hypertension, 5 cases of diabetes, 3 cases of hypertension and diabetes, 3 cases of liver cirrhosis. Results: Laparoscopic pancreatoduodenectomy was successfully performed in all 21 patients.The operation time was (359.3±71.0)minutes, the pancreaticojejunostomy time was (23.8±7.4)minutes, the diameter of pancreatic duct was(3.3±0.6)mm, the intraoperative blood loss was (247.6±90.1)ml, the postoperative hospital stay was(13.7±4.9)days, the leakage of B-level fistula occurred in 1 case(4.8%), and there was no C-level pancreatic fistula.There were 3 cases of bile leakage, 1 case of incision infection, 2 cases of gastroparesis, 1 case of hydrops abdominis, no death and secondary operation. Conclusion: It is a simple and easy method of pancreatoenterostomy with pancreatic duct binding external drainage, which can reduce the incidence of pancreatic fistula and related complications after laparoscopic pancreatoduodenectomy for patients with high risk pancreatic fistula.

Objective: External ventricular drain (EVD) placement is a common neurosurgical procedure. While this procedure is simple and effective, infection is a major limiting factor. Factors predictive of infection reported in the literature are not conclusive. The aim of this retrospective, single-center large series was to assess the rate and independent predictors of ventriculostomy-associated infection (VAI)., Methods: The authors performed a retrospective chart review of consecutive patients who underwent EVD placement between January 2012 and January 2018., Results: A total of 389 patients were included in the study. The infection rate was 3.1% (n = 12). Variables that were significantly associated with VAI were EVD replacement (OR 10, p = 0.001), bilateral EVDs (OR 9.2, p = 0.009), duration of EVD placement (OR 1.1, p = 0.011), increased CSF output/day (OR 1.0, p = 0.001), CSF leak (OR 12.9, p = 0.001), and increased length of hospital stay (OR 1.1, p = 0.002). Using multivariate logistic regression, independent predictors of VAI were female sex (OR 7.1, 95% CI 1.1-47.4; p = 0.043), EVD replacement (OR 8.5, 95% CI 1.44-50.72; p = 0.027), increased CSF output/day (OR 1.01, 95% CI 1.0-1.02; p = 0.023), and CSF leak (OR 15.1, 95% CI 2.6-87.1; p = 0.003)., Conclusions: The rate of VAI was 3.1%. Routine CSF collection (every other day or every 3 days) and CSF collection when needed were not associated with VAI. The authors recommend CSF collection when clinically needed rather than routinely.

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., (Copyright © 2020 Termedia & Banach.)

Background: Uveal effusion syndrome is a rare entity of idiopathic exudative detachments of uveal tissues and retina. Medical treatments with systemic steroids and antimetabolites have been tried but with variable results. Scleral windows or vortex decompressions are usually performed and surgeons usually perform partial sclerectomy in all the quadrants., Case Presentation: For the first time, we report 2 cases of nanophthalmic uveal effusion syndrome managed with our technique., Conclusion: Quadrantic vortex vein decompression with external drainage for nanophthalmic uveal effusion can provide immediate and stable gain in vision.

Introduction: Despite advances in treating gastric staple line leaks after bariatric surgical procedures, chronic leaks have been reported. Failure of their treatment frequently leads to radical surgery. We aimed to describe a strategy for preventing occurrence of chronic gastric leaks after complicated sleeve gastrectomy in patients necessitating relaparoscopy and external drainage as a first step of gastric leak management., Methods: Data from 14 consecutive patients admitted for gastric leak after laparoscopic sleeve gastrectomy were prospectively collected and retrospectively analyzed. Patients included underwent relaparoscopy and external drainage as first step of management., Results: Median time to gastric leak detection was 4 days. Emergency relaparoscopy allowed peritoneal lavage and external drainage placement next to the leak. Median time between surgery and endoscopic internal drainage (EID) was 4 days. Progressive external drainage mobilization started after 2 days. Control endoscopy was performed every 4 weeks until healing. A median interval of 112 days was necessary before healing in 13 patients. Thirteen patients (92.8%) had no gastric leak recurrence at 1 year. In one patient, EID was considerably delayed and external drainage mobilization prolonged, leading to chronic gastric leak and total gastrectomy after 18 months., Conclusion: This study reports for the first time a well-standardized protocol of early EID after relaparoscopy coupled to rapid external drainage removal for effectively treating complicated cases of sleeve gastrectomy. Bariatric surgeons should be aware of such therapeutic strategies and include them in their arsenal against postoperative gastric staple line leaks in severely obese patients.

Background: Pancreatic injuries are rare, and no treatment plan has yet been established for grade III injuries. In many cases, pancreatic stent placement has resulted in saving patients. However, some cases of perforation of a pancreatic duct during the placement of a stent have been described, and there are also a few cases of delayed perforation by a pancreatic stent., Case Presentation: A 62-year-old man had obstructive jaundice and pancreatitis due to locally advanced pancreatic head cancer. Both biliary and pancreatic stent were placed by endoscopy, after which chemoradiotherapy was performed. Four months later, he visited our hospital with severe abdominal pain. We performed enhanced CT and diagnosed the patient as having a perforation of a pancreatic duct by a pancreatic stent; therefore, we performed an emergency operation. Since we deemed pancreatectomy risky, we inserted pancreatic tubes into both sides of the perforated site and performed percutaneous transgastric drainage. The postoperative course was uneventful. We thereafter cut the tubes and switched to internal drainage., Conclusion: Many cases of pancreatic injuries have reported that pancreatic stent placement results in saving the patient, but there have been few cases in which a pancreatic stent causes perforation of a pancreatic duct. External drainage by pancreatic tubes is very effective in resolving perforation of a pancreatic duct.

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., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: Hypotonic maculopathy secondary to cyclodialysis often persists and causes irreversible visual loss despite a variety of treatments proposed. The purpose of this study is to report two cases with persistent hypotonic maculopathy due to a large cyclodialysis cleft treated with a simple, lens-sparing technique of external drainage, diathermy, and suturing under the placement of an infusion cannula., Observations: Both patients had sustained blunt trauma to one eye, causing persisting hypotonic maculopathy. One eye was phakic. The ciliary body was totally detached with a large cyclodialysis cleft. After half-thickness scleral flaps were made and a 25-gauge infusion cannula was placed at the pars plana, external drainage was performed. Transscleral diathermy and interrupted suturing also were done., Results: In both cases, the ciliary detachment promptly improved and the intraocular pressure normalized after transient elevation for a few days. No adverse events were observed., Conclusions and Importance: We successfully treated two cases with hypotonic maculopathy by a simple technique with an infusion cannula. This procedure is simple, immediately effective, less invasive, and applicable to all cases including phakic eyes.

Objective: Postoperative pancreatic fistula (POPF) remains a common problem and leading cause of morbidity and mortality after central pancreatectomy (CP). The aim of this study was to present a technique of external drainage of monolayer pancreaticojejunostomy for prevention of POPF., Methods: Patients received elective CP with external drainage of monolayer pancreaticojejunostomy between January 2010 and December 2016 were retrospectively analyzed. The occurrence and severity of POPF, overall complications, reoperation rate, in-hospital mortality, and length of postoperative hospital stay were measured. The 2016 updated definition and classification system of the International Study Group of Pancreatic Surgery (ISGPS) was used for POPF. In addition, a matched-pairs comparison with internal drainage of pancreaticojejunostomy was made., Results: 33 consecutive patients underwent CP with external drainage of monolayer pancreaticojejunostomy during this period. 4 (12.1%) cases developed grade B POPF, among which one patient was classified as having Clavien-Dindo classification IIIa complication. None of the patients developed grade C POPF, delayed gastric emptying, or postpancreatectomy hemorrhage. There was no reoperation or in-hospital mortality occurred. Matched-pairs comparison revealed that patients with external drainage of pancreaticojejunostomy had significantly lower incidence of POPF., Conclusion: External drainage of monolayer pancreaticojejunostomy seems effective in prevention of POPF after CP., (Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Infections in the neck layers and spaces are potentially life-threatening diseases causing further complications, like mediastinitis, airway obstruction, or sepsis. Despite of the need for a conservative approach, they still regularly require surgical intervention. Records of 17 patients with severe neck infections that were treated by wide external incision and open wound management were retrospectively analyzed. The aim of the study was to clinically characterize these most serious neck infections. The most common presenting symptoms were neck pain and tense neck mass (94-94%) regularly with fever (65%), always accompanied by a marked elevation of C reactive protein level (average 192 uG/l). These findings were constant and very similar among both the deep neck infection and necrotizing fasciitis cases. More than half of the patients (53%) had at least one systemic co-morbidity. The parapharyngeal space was most commonly affected (83%), but extended disease involving more than two major neck regions was found in 13 cases (76%). Dental (29%) was the most common primary infection, followed by peritonsillar abscess (23%), Microbiological results showed a wide variety of corresponding bacteria. Mediastinitis was developed in three cases (18%), and airway obstruction requiring tracheostomy in two cases (12%). All the patients survived. Severe neck infections are a heterogenous group of diseases regarding to the primary site of infection, microbiology, localisation and host reaction. However, rapidly developed, painful, tense neck mass with a highly elevated CRP level should always alert for an extended or phlegmonous process in the layers or spaces of the neck.