BackgroundIn this preliminary study we used a goat model to quantify pressure at an interbody bone graft interface. Although the study was designed to assess fusion status, the concept behind the technology could lead to early detection of implant failure and potential hazardous complications related to motion-preservation devices. The purpose of this study was to investigate the feasibility of in vivo pressure monitoring as a strategy to determine fusion status.MethodsTelemetric pressure transducers were implanted, and pressure at the bone graft interfaces of cervical interbody fusion autografts placed into living goats (Groups A and B) was evaluated. Group A constituted the 4-month survival group and Group B the 6-month survival group. One goat served as the study control (Group C) and was not implanted with a pressure transducer. An additional six cadaveric goat cervical spines (Group D) were obtained from a local slaughterhouse and implanted with bone grafts and ventral plates and used for in vitro biomechanical comparison to the specimens from Groups A and B.ResultsAll goats demonstrated an increase in interface pressure within the first 10 days postoperatively, with the largest relative change in pressure occurring between the sixth and ninth days. The goats from Groups A and B had a 200% to 400% increase in relative pressure.ConclusionsAlthough this was a pilot study to assess pressure as an indicator for a fusion or pseudarthrosis, the preliminary data suggest that early bone healing is detectable by an increase in pressure. Thus, pressure may serve as an indicator of fusion status by detecting altered biomechanical parameters.
BackgroundIn this preliminary study we used a goat model to quantify pressure at an interbody bone graft interface. Although the study was designed to assess fusion status, the concept behind the technology could lead to early detection of implant failure and potential hazardous complications related to motion-preservation devices. Th e purpose of this study was to investigate the feasibility of in vivo pressure monitoring as a strategy to determine fusion status. MethodsTelemetric pressure transducers were implanted, and pressure at the bone graft interfaces of cervical interbody fusion autografts placed into living goats (Groups A and B) was evaluated. Group A constituted the 4-month survival group and Group B the 6-month survival group. One goat served as the study control (Group C) and was not implanted with a pressure transducer. An additional six cadaveric goat cervical spines (Group D) were obtained from a local slaughterhouse and implanted with bone grafts and ventral plates and used for in vitro biomechanical comparison to the specimens from Groups A and B. ResultsAll goats demonstrated an increase in interface pressure within the fi rst 10 days postoperatively, with the largest relative change in pressure occurring between the sixth and ninth days. Th e goats from Groups A and B had a 200% to 400% increase in relative pressure. ConclusionsAlthough this was a pilot study to assess pressure as an indicator for a fusion or pseudarthrosis, the preliminary data suggest that early bone healing is detectable by an increase in pressure. Th us, pressure may serve as an indicator of fusion status by detecting altered biomechanical parameters.
Background Small bowel fibrostenotic strictures are common in patients with Crohn’s disease (CD). No global consensus recommendations on definitions, diagnosis and clinical management are available. Methods Several systematic reviews followed by a RAND/University of California Los Angeles appropriateness study on the definitions, diagnosis and clinical management of fibrostenosing CD in clinical practice were performed. A panel of 28 global experts and a patient representative were convened. They assessed a total of 152 candidate items. The items were subsequently evaluated for appropriateness. Results No accurate predictive biomarkers are available for naïve or anastomotic fibrostenosing strictures. Accurate diagnosis of fibrostenosing CD requires cross-sectional imaging which should evaluate bowel wall thickness, luminal narrowing and prestenotic dilatation. A potential inflammatory component should be assessed. Abdominal cross-sectional imaging was considered necessary prior to any treatment decision. The panel proposed an approach to medical, endoscopic, and surgical therapies (Figure 1 and Table 1). Technical characteristics for endoscopic balloon dilation and follow up strategies after successful dilation therapy were identified. Appropriateness, types and performance of different surgical approaches in various settings were evaluated. Conclusion This global consensus provides clinical guidance for the diagnostic and therapeutic management of patients with fibrostenotic CD.
Background Ileal pouch-anal anastomosis (IPAA) is a technically demanding procedure. Intraoperatively, great care must be taken to assure a straight superior mesenteric axis. Rarely, twisted pouches are inadvertently constructed, resulting in deviations of expected pouch function. Herein we describe our quaternary pouch referral center experience with twisted pouch syndrome (TPS). Methods We performed a retrospective review of our prospectively maintained pouch registry from 1995 – 2020. Patients were identified using free-text search of redo IPAA operative reports for variations of the term “twist”. We defined twisted pouch syndrome as intraoperative findings of twisting of the pouch around its mesenteric axis which could not be reduced without disconnection from the anus. Data represent frequency (proportion) or median (range). Results Over 25-years, we identified 31 patients with confirmed TPS who underwent a redo pouch procedure by 11 surgeons: 67% were female, median BMI 21.2 (16.9 – 29.5) kg/m2. The duration from the index IPAA to redo procedure was 5 (0.5 – 21) years; all (100%) were referral cases constructed elsewhere. Original diagnoses included: ulcerative colitis 28 (90%), FAP 2 (6.5%). All patients presented with symptoms of pouch dysfunction including erratic bowel habits 28 (93%) with urgency and frequency, abdominal/pelvic/rectal pain 26 (87%), and obstructive symptoms 28 (93%) i.e. obstructed defecation and incomplete evacuation. Most had (75%) been treated for chronic pouchitis with medical therapy, and 48% had undergone previous surgery. Prior to redo IPAA procedure patients underwent a thorough workup: 100% pouchoscopy, 94% pouchogram, 87% underwent EUA, 87% MRI/CT, 71% manometry, and 39% defecography. TPS was diagnosed in 16% by pouchoscopy, in 13% by imaging, and in 71% was diagnosed intra-operatively at re-diversion (20%) or revision/redo IPAA (51%). In terms of surgical intervention, 81% were initially re-diverted. A total of 18 (60%) underwent pouch revision, and 12 (40%) required neo-IPAA. Short-term outcomes: LOS 8 (3 – 32) days, any complication 48%, readmission 11%, reoperation 3.4%, zero mortalities. After a median follow-up 52.5 (1 – 206) months, there were 4 failures: 2 never had loop ileostomy closure, 1 pouch excision, 1 Kock pouch, yielding an overall pouch survival rate of 87%. Conclusion Twisted pouch syndrome presents with pouch dysfunction manifest by the triad of erratic bowel habits, unexplained pain, and obstructive (defecation) symptoms. This syndrome may also mimic chronic pouchitis. Despite a thorough workup suggesting a mechanical problem, many patient are not diagnosed until time of redo pouch surgery. Redo surgery for twisted pouch syndrome results in long-term pouch survival for the majority.
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