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PubMed2006

[Endoscopic ligation of maxillary and sphenopalatine artery for intractable epistaxis].

We report the endoscopic ligation of the maxillary and sphenopalatine arteries for the treatment of intractable epistaxis. From March 2003 to February 2005, 17 patients (12 men, 5 women) with epistaxis were hospitalized in our department. Patient age ranged from 25 to 83 years, with an average age of 62 years. 8 patients were successfully treated using the conventional packing method, 2 patients were treated using electrocauterization, and 1 patient with macroglobulinemia was treated using plasma exchange therapy. 6 patients underwent endoscopic ligation of the maxillary and sphenopalatine arteries while under general anesthesia. The post operative courses were uneventful, and no recurrent bleeding has been noted. Endscopic ligation of the maxillary and sphenopalatine arteries is safer than intraarterial embolization and less invasive than conventional surgical approach for the ligation of maxillary artery. This technique appears to be a safe and effective surgical treatment for patients with intractable epistaxis.

Adult↗
PubMedDate not supplied

A comparison of the Ameroid constrictor versus ligation in the surgical management of single extrahepatic portosystemic shunts.

Twenty-two dogs were managed surgically for a single extrahepatic portosystemic shunt; 12 with surgical ligation and 10 with an Ameroid constrictor. Utilization of the Ameroid constrictor significantly decreased surgery time to approximately half that of the ligation technique. A decreased intraoperative and postoperative complication rate was noted with the Ameroid constrictor group. Follow-up evaluation demonstrated comparable efficacy when comparing surgical techniques. The Ameroid constrictor offered a surgical occlusion technique for management of a single extra-hepatic portosystemic shunt that was equally effective to ligation while shortening surgical time and minimizing the risks that are commonly associated with ligation of the shunting vessel.

Animals↗
PubMed1992

[Results of deep dorsal vein ligation for venogenic impotence].

We treated seventy venogenic impotence with ligation of the deep dorsal vein of the penis. Their corporal veno-occlusive function was evaluated by dynamic infusion cavernosometry and cavernosography (DICC). Under local anesthesia, we made a longitudinal skin incision at the base of the penis. The deep dorsal vein was ligated and also a portion of this vein of 1.5 cm long was resected together with branches surrounding the vein. After the operation, the infusion rate determined by DICC was confirmed to be decreased in almost all patients. Thirty nine out of seventy cases had their erectile capability restored and reported that they could achieve sexual intercourse. Sixty one of the seventy cases showed full erection together with an intracavernous papaverine injection. However fifty percent of the sixty one patients who became capable of obtaining erection with the treatment had lost their erectile capability again within one year of the operation, however the other fifty percent were shown to maintain their erectile capability for up to three years. As four years after the treatment only thirty percent of those who had achieved the initial erectile capability still remained potent. This operation is easy to perform without any major complications, and its outcome is as good as that achieved by other more invasive venous ligation in the treatment of patients with venogenic impotence. We therefore conclude that penile deep dorsal vein ligation and partial resection of the vein one of the most useful treatments currently available for venogenic impotence and should be the treatment of choice.

Adult↗
PubMed1999

[Prospective study of gastroesophageal reflux after esophageal variceal band ligation].

UNLABELLED: In recent years, variceal ligation has been introduced as an alternative treatment to endoscopic sclerotherapy. AIM: To evaluate the occurrence of excess gastroesophageal reflux in cirrhotic patients with esophageal varices eradicated by band ligation. PATIENTS AND METHODS: Twenty-six cirrhotic patients with esophageal varices underwent band ligation until variceal eradication. pH monitoring was carried out in all patients before inclusion in the eradication program and again at the end. The results were evaluated according to De Meester's criteria. RESULTS: Five patients presented excess gastroesophageal reflux before the beginning of treatment. A further six patients developed excess gastroesophageal reflux after endoscopic treatment. The only factor implicated in the development of excess gastroesophageal reflux was the use of sclerosant at the end of treatment to ensure complete eradication: five of the eight who needed sclerosant developed excess gastrophageal reflux, while only two of the 16 treated without sclerosant did so (p < 0.01). CONCLUSION: Esophageal variceal band ligation does not significantly provoke excess gastroesophageal reflux if sclerosant is not used in the endoscopic technique.

Adult↗
PubMed2000

[Long-term portal hypertension in the rat by means of triple stenotic ligation of the portal vein].

OBJECTIVE: To improve the technique of stenosing ligation of the portal vein, frequently used to obtain a prehepatic portal hypertension model in the rat, by increase the initial resistance to the blood flow. METHODS: In this experimental work portal stenosis by three equidistant stenosing ligatures which are fixed in a plastic guide is proposed as an alternative technique. RESULTS: Triple stenosing ligation of the portal vein does not produce mortality and causes splenomegaly as well as a larger degree of collateral venous circulation, particularly of splenorenal type, in relation to rats with a simple stenosing ligation. CONCLUSION: Increase of the stenosed tract length of the portal vein in the rats with triple ligation increases the initial resistance to the portal flow and then the posterior evolution would be impaired and this mechanism could be involved in a larger degree of collateral venous circulation.

Analysis of Variance↗
PubMedDate not supplied

Laparoscopic versus open high ligation of the testicular veins for the treatment of varicocele.

The purpose of this study is to determine the relative advantages of laparoscopic varicocelectomy compared to the conventional open high ligation of Palomo. We studied 193 patients who presented with varicocele. While 65 patients were treated by open high ligation of the testicular veins, 128 patients had laparoscopic varicocelectomy. In addition to varicocele ligation, 14 patients (11%) had laparoscopy-assisted right orchidopexy, and 5 patients (4%) had laparoscopic repair of concomitant right inguinal hernia. The mean hospital stay was 3.5 days and 1.3 days, respectively, and the recurrence rates were 10.8% and 3.9%, respectively. Return to normal activity was significantly earlier in Group II (mean 4.5 days) compared to Group I (mean 8.9 days). There was no incidence of testicular atrophy in any case in the study, regardless of whether the testicular artery was ligated or preserved during surgery. We conclude that laparoscopic varicocelectomy is safe, effective and minimally invasive. In addition to its better cosmetic results and advantage in case of bilateral disease, it allows excellent exposure and control of the affected vessels. Furthermore, the shorter hospital stay and the earlier return to normal activities are very important advantages in recommending this technique as an efficient alternative to the open surgical method.

Adolescent↗
PubMedDate not supplied

Thoracoscopic ligation of the thoracic duct.

OBJECTIVE: When nonoperative treatment of chylothorax fails, thoracic duct ligation is usually performed through a thoracotomy. We describe two cases of persistent chylothorax, in a child and an adult, successfully treated with thoracoscopic ligation of the thoracic duct. METHODS: A 4-year-old girl developed a right chylothorax following a Fontan procedure. Aggressive nonoperative management failed to eliminate the persistent chyle loss. A 72-year-old insulin-dependent diabetic man was involved in a motor vehicle accident, in which he sustained multiple fractured ribs, a right hemopneumothorax, a right femoral shaft fracture, and a T-11 thoracic vertebral fracture. Subsequently, he developed a right chylothorax, which did not respond to nonoperative management. Both patients were successfully treated with thoracoscopic ligation of the thoracic duct. RESULTS: The child had significant decrease of chyle drainage following surgery. Increased drainage that appeared after the introduction of full feedings five days postoperatively was controlled with the somatostatin analog octreotide. The chest tube was removed two weeks after surgery. After two years' follow-up, she has had no recurrence of chylothorax. The adult had no chyle drainage following surgery. He was maintained on a medium-chain triglyceride diet postoperatively for two weeks. The chest tube was removed four days after surgery. After six months' follow-up, he has had no recurrence of chylothorax. CONCLUSIONS: Thoracoscopic ligation of the thoracic duct provides a safe and effective treatment of chylothorax and may avoid thoracotomy and its associated morbidity.

Aged↗
PubMed2000

[Treatment of esophageal varices with banding ligation].

BACKGROUND: Randomised trials have shown that banding ligation is superior to sclerotherapy, requiring fewer treatment sessions to achieve variceal eradication, and giving lower rebleeding and complication rates. MATERIAL AND METHODS: From November 1997 through December 1999, we have treated 22 patients with bleeding oesophageal varices with endoscopic banding ligation to obliterate the varices and prevent recurrent bleeding. RESULTS: A total of 72 banding procedures have been performed using rubber bands. The varices have been obliterated in 14 patients requiring a median of 3.5 (range 2-8) procedures, which is in good agreement with other published data. Twelve of these patients have been observed for a median of six (range 1-19) months without signs of recurrent bleeding. One patient had a bleeding four months after the last ligation procedure; the varices were obliterated six weeks before. One patient had a recurrent bleeding between the first and second banding procedure. One patient bled from an oesophageal ulcer caused by a rubber band two weeks after the procedure. Otherwise no serious complications occurred. INTERPRETATION: On the basis of our own experiences and published studies, we propose that endoscopic banding ligation should be the method of choice for elective treatment of bleeding varices.

Adult↗
PubMed2001

[In contrast to captopril and enalapril, losartan does not increase mortality of gerbils after carotid ligation].

OBJECTIVE: To check wether the deleterious effect of enalaprilat administered before unilateral caroid ligation in the gerbil reported by Fernandez et al. (J Cardiovasc Pharmacol 1994; 24: 937) is not a molecule specific effect but an angiotensin converting enzyme inhibitor class effect. DESIGN AND METHOD: Survival rate of gerbils (an animal with incomplete Willis hexagona) was measured after unilateral carotid ligation with preadministration (2 hours before by gavage) of saline (0.75 ml) (n = 37); losartan (20 mg/kg) (n = 37), enalaparil (10 mg/kg) (n = 37); a combination of losartan and enalapril at the same dose (n = 37); and of captopril (75 mg/kg) (n = 35). RESULTS: The survival rate of the gerbils 72 hours after carotid ligation was 65% in control, 62% in losartan, 30% in enalapril, 32% in enalapril + losartan, and 32% in captopril groups. Statistical analysis (log rank test) of the Kaplan-Meier survival curves over 72 hours showed no difference between losartan and controls nor between the various groups treated with ACEI. However survival was significantly lower in the ACEI groups than in the group treated by losartan alone (p < 0.02) or controls (p < 0.02). Intraaortic mean arterial pressure was measured in 6 controls, 6 animals treated with losartan and 6 other treated with enalapril. It was comparable in the losartan and enalapril treated animals (65 +/- 2 mm Hg vs 64 +/- 2) but significantly lower than in the controls (77 +/- 2 mmHg) (p < 0.02). CONCLUSIONS: In contrast to oral preadministration of enalapril and captopril that of losartan does not increase the mortality of the gerbil after unilateral carotid ligation in spite of the same decrease in systemic blood pressure. Although a lower mortality than in controls was not observed with losartan as in the princeps study of Fernandez, these data are consistent with the demonstration by this author that angiotensin II plays a critical protective role in acute ischemia probably by promoting collateral circulation recruitment through non-AT1 receptors stimulation.

Administration, Oral↗
PubMed1979

Prolactin and colibacillus-induced fluid transport in ligated intestinal segments.

Two experiments, using the ligated intestinal segment technique, were conducted to determine whether the pituitary hormone prolactin (PRL) could reduce Escherichia coli-induced fluid loss into the small intestine of 2- to 3-week-old pigs. Inoculation of 10(6) to 10(8) enteropathogenic E coli organisms into ligated jejunal segments caused a significant accumulation of luminal fluid within 12 hours. In the first experiment, intraluminal inoculation with 0.5 mg of ovine PRL along with the bacteria did not have any effect on fluid accumulation. Systemic IV treatment of the animals with 1.0 mg of ovine PRL at 3-hour intervals, beginning either immediately after or 9 to 10 hours before intestinal ligation, did not significantly (P less than 0.05) reduce fluid accumulation as compared with control animals. In the second experiment, IM administration of 100 microgram of thyrotropin-releasing hormone (TRH) at 3-hour intervals, beginning 6 hours before intestinal ligation, significantly (P less than 0.05) increased circulating PRL concentrations, as measured by radioimmunoassay. However, TRH treatment did not reduce the accumulation of luminal fluid in E coli-inoculated segments.

Animals↗
PubMed2001

Endoscopic mucosal resection of the esophagus: band ligation technique.

Endoscopic mucosal resection (EMR) is a minimally invasive endoscopic technique used in treating superficial cancers of premalignant lesions in the gastrointestinal tract. An attraction of this technique is that it can be curative with low morbidity, often providing the entire lesion for pathologic evaluation. The band ligation technique of EMR uses the existing technology of variceal band ligation to endoscopically place a band on flat mucosal lesions of the gastrointestinal tract to create a "pseudopolyp" before resection with an electrocautery snare. The band ligating technique and two variant band ligating devices are described.

Esophageal Neoplasms↗
PubMed2001

[Endoscopic ligation plus sclerotherapy in esophageal varices treatment. Experience in active bleeding and in the elective treatment].

BACKGROUND: Endoscopic ligation is the treatment of choice for bleeding esophageal varices. The usefulness of additional sclerotherapy is not clear. AIM: To assess the effectiveness of ligation followed by sclerotherapy in the treatment of variceal bleeding. PATIENTS AND METHODS: Forty eight patients with variceal bleeding admitted for emergency treatment and 73 patients admitted for elective treatment were studied. Varices were ligated until a significant reduction in size was achieved. Eradication was completed with the injection of 1% polidocanol. RESULTS: In 34 of 48 patients admitted for emergency treatment, the site of variceal rupture was identified. In all these subjects, and in 13 of 14 patients in whom the rupture site was not identified, hemorrhage was stopped with the procedure. Varices were eradicated in 108 of the 121 patients. Hemorrhage recidivated in 12.5% of patients admitted for emergency treatment, in a period of 14 months of follow up and in 9.6% of those admitted for elective treatment, in a period of 16 months follow up. Mortality was 14, 18 and 57% among patients classified as Child Pugh A, B or C, respectively. CONCLUSIONS: Endoscopic ligation is effective in the treatment of variceal bleeding. Adding sclerotherapy, variceal eradication is achieved in a high percentage of patients. Survival depends on hepatic function.

Adolescent↗
PubMed1975

Evaluation of the ligation of the hepatic artery and regional arterial chemotherapy in the treatment of primary and secondary cancer of the liver.

Ligation of the hepatic artery was carried out in 23 patients with primary and secondary cancer of the liver. The survival time correlated well with the amount of tumor tissue in the liver. Ligation of the hepatic artery prolonged the survival time of the operated patients when compared with the untreated group, and, in addition, yielded good palliation. In appropriate cases, the most promising result in the treatment of hepatic malignancies was achieved by liver resection two to four months after the initial ligation of the hepatic artery, whereas from our experiences the final value of regional arterial chemotherapy is still unsettled. Very promising results were achieved by ligation in the treatment of liver metastases from lymphosarcoma of the stomach, which responded especially well to this kind of therapy.

Adolescent↗
PubMed2002

Massive life-threatening lower gastrointestinal hemorrhage following hemorrhoidal rubber band ligation.

Hemorrhoids are common, and a significant proportion of patients who have hemorrhoids experience symptoms such as bleeding, pain and itching. Endoscopic hemorrhoidal ligation is a safe and effective technique indicated for the treatment of grade 1 to 3 hemorrhoids, with a high success and low complication rate. Complications, when they occur, are minor and may include painful thrombosed prolapsed hemorrhoids, slippage of bands, minor rectal bleeding and chronic longitudinal ulcer. Rare, potentially life-threatening complications are massive hemorrhage and pelvic sepsis. A case of massive, life-threatening lower gastrointestinal hemorrhage following endoscopic hemorrhoidal rubber-band ligation is presented. Our patient ingested aspirin intermittently following the procedure. In a study documenting complications after hemorrhoidal band ligation, two of three individuals requiring transfusion for massive hemorrhage were taking aspirin on a regular basis. The risk of massive hemorrhage after hemorrhoidal rubber band ligation is probably increased by ingestion of nonsteroidal anti-inflammatory drugs. It may be wise to withhold such drugs soon after the procedure, if feasible.

Digestive System Surgical Procedures↗
PubMedDate not supplied

The influence of endoscopic variceal ligation on the portal pressure gradient in cirrhotics.

BACKGROUND/AIMS: After variceal eradication by endoscopic ligation, fundal varices and worsening of portal hypertensive gastropathy can occur. The aim of this study is to verify the impact of the eradication of esophageal varices by endoscopic ligation on the portal pressure gradient, worsening of portal hypertensive gastropathy and development of fundal varices. METHODOLOGY: Twenty-two (15M/7F, mean age: 54.5 years) cirrhotics with previous variceal bleeding were submitted to measurement of hepatic venous pressure gradient before and after variceal eradication by endoscopic ligation. RESULTS: The mean hepatic venous pressure gradient in the first measurement was 14.1 mmHg and after eradication, 13.5 mmHg (p = 0.403). After eradication, 12 patients experienced a reduction in portal pressure and 10, an elevation. Three patients developed fundal varices. Their mean gradient before treatment was 22 mmHg and 18.8 mmHg after therapy (p = 0.368). The gastropathy worsened in 9 patients (mean gradient before therapy of 15.2 mmHg; and 16.1 mmHg after treatment) (p = 0.303). The initial pressure gradient of these patients was not different from the other 13 cases (p = 0.463). CONCLUSIONS: The esophageal variceal eradication by endoscopic band ligation does not alter the hepatic venous pressure gradient. There is no significant variation in the portal pressure of patients in whom there was a worsening of portal hypertensive gastropathy or fundal varices development.

Adult↗
PubMedDate not supplied

Arterial ligation for pediatric epistaxis: developmental anatomy.

BACKGROUND: Anatomic studies of adult skulls have aided in the design of operations for the surgical ligation of nasal feeding vessels in the treatment of severe epistaxis. Lack of appropriate specimens has prevented similar studies in children. We performed an anthropometric study of archeological specimens to learn the effects of growth on key anatomic relationships. METHODS: We studied the skulls of children who died between 200 and 8000 years ago, recovered from archeological digs around the world. Measurements of the distances from the posterior lacrimal crest to the foramina of anterior and posterior ethmoidal arteries and optic canal and the pyriform aperture to the foramen of the sphenopalatine artery were made and compared with postnatal age, estimated from facial growth and dental eruption patterns. RESULTS: There is rapid growth in the orbit and midface during the first 6 years of life and gradual growth between 7 years and adulthood. The length of the medial wall of the orbit doubles during development with disproportionate enlargement of its anterior half. CONCLUSION: Arterial ligation is sometimes required for intractable pediatric epistaxis, especially after trauma. The changing relationships of critical structures in the orbital must be understood to allow safe ethmoidal artery ligation. The transantral approach to the maxillary artery is greatly limited by lack of midfacial development and maxillary pneumatization. We describe the necessary parameters for endoscopic, transnasal sphenopalatine artery ligation in growing children.

Africa↗
PubMed2003

Effectiveness of rubber band ligation in haemorrhoids and factors related to relapse.

PURPOSE: to assess the effectiveness of ambulatory rubber band ligation (RBL) in the treatment of symptomatic internal haemorrhoids and to identify factors related to relapse. PATIENTS AND METHODS: prospective study of 232 patients treated with rubber band ligation for symptomatic haemorrhoids (grade I-III or grade IV with severe contraindication for surgery) from November 1996 to November 2000 at the outpatient clinic. Ligation was performed with a Stille AB (Comedic) ligator and suction pump, placing 1-3 bands per session and with up to three sessions per patient. Effectiveness of treatment was defined as the absence of symptoms and was confirmed by anoscopy by checking the residual scar after the cushions' detachment. Categorical variables were compared using the shi-squared test, whereas Student's t-test was used for continuous variables. Logistic regression was employed to identify clinical factors related to relapse. RESULTS: a total of 331 bands were placed during 235 sessions in the 163 patients who completed follow-up (70%). Mean age was 45.6 years, with males accounting for 64.4%. Most patients (86.5%) had grade II or grade III haemorrhoids. Overall morbidity was 6%. The most frequent complications were rectal tenesmus (11%), slight or mild anal pain (7.4%), dysuria (4.3%) and transient anal bleeding (3.7%). The treatment was effective in 86% of patients after a mean follow-up of 32 months. Efficacy was high for grades I and II (100% and 97.4% ) but decreased for grade III (69.8%; p<0.001) and grade IV (0%; p<0.001). Most relapses occurred within the first 24 months (87%) and were not significantly related to age, gender, duration of symptoms, itching, bleeding, pain, tenesmus or bowel habit, but were significantly related to the presence of prolapse and its grade (p<0.001), and to the involvement of left posterior, right lateral and anterior pedicles (p<0.05). CONCLUSIONS: ambulatory RBL is a safe and effective treatment for grade I, II and III symptomatic haemorrhoids, and is associated with low morbidity. Recurrence is uncommon and occurs mainly within the first 24 months, being related to the presence and grade of prolapse as well as to its location, but bears little relation to the rest of factors analysed.

Adolescent↗
PubMedDate not supplied

Thoracoscopic pericardial window creation and thoracic duct ligation in neonates.

OBJECTIVE: We describe 2 newborn infants with persistent pericardial effusion treated with thoracoscopic pericardial window and thoracic duct ligation. METHODS: Patient 1 was a premature female newborn who presented with severe cardiac anomalies, including dextrocardia. She was treated with pulmonary artery handing and pacemaker placement for complete cardiac block. Postoperatively, she developed pericarditis with persistent symptomatic pericardial effusion. She did not improve despite pericardial drain placement. She was treated with a thoracoscopic pericardial window. Patient 2 was a newborn male who presented with cardiac tamponade secondary to congenital chylopericardium. He did not respond to pericardial drain placement or medical management with fasting, total parenteral nutrition, and octreotide. He was treated with thoracoscopic pericardial window and thoracic duct ligation. RESULTS: Patient 1 improved rapidly. The pericardial effusion disappeared. The chest tube was removed 5 days following surgery. She died 6 weeks later of a cardiac arrhythmia secondary to pacemaker failure. The pericardial effusion had resolved. Patient 2 responded to the pericardial window and thoracic duct ligation. He was discharged 10 days following the procedure. CONCLUSIONS: Thoracoscopy provides an excellent approach to the pericardium. Pericardial windows and biopsy can be safely performed with this approach. The thoracic duct can be easily identified and ligated even in small babies. Recovery can be fast with minimal postoperative discomfort. Cosmetic results are excellent and length of hospitalization is minimized.

Fatal Outcome↗