Doctor insights on:
Av Fistula Surgery Steps
Av fistula, av graft, subclavian or femoral catheter, av shunt permanent or temporary, which is better?
A fistula is an abnormal connection between two places. Most commonly, it originates somewhere in the intestine and communicates to another location in the intestine or in the skin. A fistula can develop after abdominal surgery, with inflammatory bowel disease, cancer, anorectal abscess, and ...Read more
Appx what percentage develop a stricture after surgery 4 colon/bladder fistula & diverticulitis? Is the balloon treatment (dillation?)very successful?
Open or endo: It can be done with tpa (alteplase) (a high-potency medication to dissolve blood clot) and a rotor-rooter device inserted through a needle stick in the access. I tend to make a small incision to remove the clot with a balloon catheter, then do an angioplasty on the area of stenosis (narrowing) which you usually find in the vein or graft. ...Read moreSee 4 more doctor answers
Diagonised with rectal cancer, after ileostomy reversal, frequent bm's, abcess withleakage at the surgery site. alternatives tocolostomy ?bowel trnspl
Insert drain: Ileostomy after rectal cancer is used to protect the rectal resuturing to establish continuity in the bowel. II there is some kind of abscess and leakage it can occur where the ileostomy has been reversed or at the site of the rectal suture line which may not have been ready for closure. Interventional radiology can place a suction drain to the site and left there until everything has healed. ...Read more
Good: If the defect is not overly large, and is located in the center part of the atrial septum (typically an osmium secundum atral septal defect), and there are no associated cardiovascular problems, the short-term and long-term outcomes are very good and catheter based closure is safe in experiences centers. ...Read more
Many possibilities: Many things can cause a leak--poor blood supply, too much tension on the anastomosis, poor nutrition, use of immunosuppresants such as steroids, infection, distal obstruction, etc. A recent large study from Germany showed a leak occurs in around 10% of cases. Sometimes it's treated with bowel rest and drainage of the fluid, sometimes it requires another operation. ...Read more
What causes an anastomotic leak after an ileostomy reversal surgery? Does a surgeon usually perform an Exploratory Laparotomy to correct?
Variety of causes: Anastomotic leaks can occur for a variety of reasons and are a known complication of GI surgery. The primary concern with anatomic leak is the passage of stool into the abdomen with the formation of abscesses and possibly systemic infections. The treatment for this is often to operate, find the leak, and wash out any stool that may have collected in the process. ...Read more
A fib: Risk of emboli going to brain causing stroke. Rapid ventricular response(heart rate to high) may cause angina, dizziness, passing out, heart attacks, other heart irregular rhythms. Let you cardiologist manage case. Is complex to explain here. It is certainly manageable. ...Read moreSee 1 more doctor answer
Options: Depending on the cause of the fistula, additional diagnoses, age and health of the patient your surgeon will discuss the options. Have friends and family with you to help with this discussion. Usually diagnostic tests colonoscopy, ct scan of abdomen and pelvis are done before final surgical planning. ...Read more
Had ileostomy reversal surgery that failed due 2 anastomotic leak/abscess fluid filling up. Y would Dr wait 5days b4 doing 2nd surgery 2 correct?
Ileostomy reversal: He most likely wanted to give the leak an opportunity to close on its own. ...Read more
Rare condition: Ureter runs into the bladder. Ureterovesical fistula has to be between the intrvesical ureter and bladder & is usually a complication following ureteral reimplant surgery. Procedure for repair is a redo ureteral reiplant excising portion of ureter distal to the fistula. This often requires a so called "boari flap", bringing up flap of bladder to shorten length of ureter needed for reimplant. ...Read more
Pediatric Cardiac: A thoracic surgeon with experience in congenital cardiac surgery. Usually in pediatric hospitals. ...Read more
Depends: Typically i recommend combination of general anesthesia with a regional block (inter scalene of supraclaviclar). Blocks do have risks, and these should be discussed with your anesthesiologist. However, there is very good evidence showing use of pre-op block lessens post-op pain. ...Read moreSee 3 more doctor answers
Variable: A small vsd may close spontaneously as a baby grows or the babies system may decompensate under the strain of the extra work & progress to heart failure. Many times this can be managed for a time with meds. If baby is thriving on meds & close observation, they may wait before repairing the defect.This decision is made by the surgeon & pedi-cardiologist based on individual factors. ...Read more
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