Based on the results, we conclude that phenol injection is as effective as the excision with open healing technique.

Iatrogenic cardiac tamponade (ICT) is a dreadful complication of peri-hiatal surgery and vast majority occur during a hernia repair. Strikingly, against all warnings, the incidents and related deaths seem to be increasing. The aim of this review is to provide insight on how to prevent and challenge ICT. PubMed search identified 30 distinct ICTs with 10 deaths (33.3%) due to peri-hiatal procedures. Twenty-nine operations were mechanical repairs and laparoscopic anti-reflux surgery was the primary cause (n:18). Graft fixation (n:23) and helical tacks (n:13) were the main offenders. Initial symptom was hypotension affecting 92%. Seven ICTs were only identified at autopsy. All treated patients except one underwent a drainage. Almost all ICTs were caused by injury to the diaphragmatic dome, anterior to hiatus. In conclusion, peri-hiatal surgery-related ICT is extremely fatal. ICT mainly occurs during the repair of a hernia, a benign condition and therefore must be prevented. Graft fixation, around the ante-hiatal diaphragmatic dome must be abandoned. If mesh-augmentation is absolutely necessary, meticulous stitching must be preferred instead of fixators. Persistent hypotension during or following a peri-hiatal operation is an alarming sign of ICT. Increased awareness is mandatory for prevention and survival.

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Background: Entrapment of an orally introduced tube by stapling/stitching is an intra-operative complication of bariatric surgery with grave consequences. Incidence is unknown. No prevention/management strategy is available. A systematic review was performed to assess the absolute reported observed risk and incidence. Additionally, data on 3 cases during our entire sleeve gastrectomy (SG) experience is evaluated. Methods: Literature is reviewed using PubMed/Web of science data-bases. Data was recorded prospectively. Videos of orally introduced tube staplings were re-watched, presentation/recognition/management were re-evaluated. A protocol ensuring the removal of the small caliber orogastric tube (OGT) by the surgeons direct inspection was introduced after the 3rd entrapment. Results: Review revealed OGT as the most commonly entrapped tube following temperature probe and bougie. SG/stapling were the most common causative operation/reason, respectively. Leak rates over 20%, conversion, early-late re-operations and mortality were reported. During our 948 consecutive SGs, 3 OGT entrapments (0.32%), third one with double stapling, occurred. All were recognized/managed intraoperatively by freeing the entrapped-end of the OGT from the sleeve part of the staple-line. In doubly stapled case, second transected end could only be recognized when routine reinforcement suturing come in proximity. Defects were continuously stitched with barbed suture. No morbidity occurred. One-year excess-weight-loss was 82%. A pre-protocol incidence of 0.56% (n: 3/534) dropped to nil in the remaining 414. Conclusion: Iatrogenic stapling of the OGT during SG is rare, but morbid. It must be avoided by a strict protocol. Upon occurrence/recognition, stapling must immediately stop until the “entirety” of the tube, including the “specimen-part”, is retrieved, to avoid double entrapment.