Objective: to analyze short-term outcomes and complications for our first fifty patients with fecal incontinence undergoing sacral root stimulation.Patients: fifty patients with fecal incontinence receiving sacral neuromodulation in 4 hospitals are reviewed. Discussed variables include: age, sex, incontinence duration, incontinence cause, prior surgery for incontinence, Wexner scale score, anorectal manometry parameters, and endoanal ultrasonographic findings. Following the procedure Wexner scale score, anorectal manometry parameters, and associated complications are reviewed.Results: mean age of patients is 59.9 years, with females predominating. Most common causes of incontinence include obstetric procedures, idiopathic origin, and prior anal surgery. Mean followup is 17.02 months. Follow-up revealed a statistically significant reduction in Wexner scale score and increase in voluntary anal pressure. Technique-derived minor complications included: 2 surgical wound infections that led to stimulator withdrawal; 2 patients with pain who were managed conservatively; 1 case of externalization in a gluteal stimulator; and 1 broken tetrapolar electrode.Conclusions: sacral nerve stimulation is a simple technique that improves Wexner scores in a statistically significant manner with a low complications rate.Key words: Fecal incontinence. Anal sphincter. Anorectal manometry. INTRODUCTIONSacral nerve stimulation in the management of fecal incontinence has led to a change in the diagnostic and therapeutic algorithm for this disease in recent years (1-5). This treatment modality so far removed from the common practice of general surgeons has forced coloproctology specialists to undergo specific education on the technique's theoretical and practical aspects in order to treat their patients.The procedure's absolute indication in fecal incontinence was initially focused on incontinent patients showing integrity of the sphincteric apparatus because of no previous lesions (idiopathic incontinence) or because of a prior sphincteroplaty procedure losing efficacy over time (incontinence most often resulting from obstetric trauma or prior surgery). Its indication has been gradually extended to patients with sphincteric defects (6-10), hence there is an ever increasing number of incontinent patients that are eligible for this procedure, also including stimulators indicated for constipation (11) and pain (12). As with all surgical skills, neuromodulation also displays a learning curve that may be shortened with workshops on stimulators and cadaveric training but cannot be obviated. The goal of this study was to analyze the first fifty cases by three general surgeon teams who used sacral root stimulations for the management of fecal incontinence, and to review the procedure's difficulties and short-term outcomes and complications. MATERIAL AND METHODSThe first fifty patients with fecal incontinence treated with sacral nerve stimulation in four Madrid sites from 2004 to 2009 are retrospectively reviewed. All patients are adults (older t...
Over the last years the oil and gas Mexican operator's exploration and development programs are becoming more challenging due to the complex conditions where hydrocarbons are found today. One of the areas that have seen a decline on production over the years is the offshore. As an alternative to find new sources of oil that overcome the current production decline in the area, the operator is drilling new wells where the operational capabilities of the equipment are put out of their limits. These new wells are drilled at depths beyond the conventional 5,000-m (16,400-ft) with bottom hole pressures as high as 15,000-psi and temperature over 180ºC requiring that the equipment providing the services over their producing life reach their own limitations and in some cases re-engineering of the design and process has to be done.In some cases, minimum changes to the equipment or processes are enough; however, a service of such complexity as the use of Coiled Tubing (CT) requires a major review of all the components of the operation to be completed in order to reach the new targets without jeopardizing the safety of the operations and/or compromising the production of the well. This paper details the CT string design criteria to reach the deeper vertical depths with high wellbore mechanical friction coefficients while withstanding high pressures; equipment selection, to allow greater CT length capacity on reel and higher pulling capacity on injector head; platform and crane specifications to withstand over dimensioned equipment, as well as, a case study to analyze equipment and CT string performance for interventions on these types of wells.
Over the last 10 years, matrix stimulation of multilateral wells has been one of the most fascinating and technology-driven interventions in the oil and gas industry due to the several challenges involved in this kind of operation. Overcoming these challenges, which include lateral identification and accessibility, reservoir assessment, and accurate placement of stimulation fluids, has encouraged operators and manufacturing and service companies to develop innovative techniques and novel technologies. In Saudi Arabia, coiled tubing (CT) equipped with real-time downhole measurements and a multilateral identification tool (LIT) has been one of the most valuable technologies to enhance the interventions in multilateral wells. Initially, the ability to monitor real-time data enabled a more efficient operation of the LIT, as well as optimizing and properly placing the stimulation treatment fluids by avoiding the identified high-intake zones across each lateral. Most recently, the incorporation of gamma ray tool into the real-time downhole measurements package allowed a faster identification of each lateral and accurate depth correlation for pinpoint acid stimulation; nevertheless, when this technology was deployed, pumping rates were significantly limited to a maximum of 2.0 bbl/min due to limitations on downhole tools and optical fiber installed inside the 2 3/8-in. CT. In some cases, this barrier also represented a drawback for optimum fluid penetration and efficient diversion across the zone of interest during the stimulation treatment. This paper documents the first worldwide applications of the enhanced version of a real-time downhole measurements package deployed on 2 3/8-in. CT for the successful matrix stimulation of a multilateral power injector well in Saudi Arabia, where the barrier of 2.0 bbl/min was far exceeded while maintaining intact all downhole readings. The operation represented a significant increase in operational efficiency and set a new record for this technology. A total of 4,585 bbl of stimulation fluids were injected across the open hole laterals (7,685-ft combined on both wells) at maximum rate achieved of 4.6 bbl/min, which were successfully accessed with the use of the LIT in a single run without the need to pull out the CT to surface. The use of enhanced the real-time downhole measurements package reduced the operational time by almost 50%, enabled more effective formation damage removal by injecting stimulation fluids at a higher rate, provided real-time depth correlation, verified access via gamma ray to each lateral without the need to tag total depth, and resulted in a tangible cost reduction.
Coiled tubing (CT) operated from a floating anchored vessel (FAV) was developed for well intervention in offshore locations where crane limitations and deck loading constrains imposes various limitations on the ability to perform workover operations. This tailor-made solution involves the operation of a CT unit with the tubing reel located on a FAV and the injector head positioned on the offshore platform. Today, CT operations supported by a FAV are routinely performed in several countries, including Malaysia, Gabon, Tunisia, Brunei, Angola and the North Sea. The first CT operation supported with a vessel in the Gulf of Mexico was successfully performed in a non-producing well which had been shut-in for nine months due to compatibility issues with the structure for temporary installing service equipment and and the limited availability of jack-up platforms to provide a deck area for positioning CT equipment. As result of this successful operation, a new perspective of CT rigless interventions was adopted in offshore Mexico, thus allowing the operator to improve equipment utilization for both CT units and workover rigs, in order to maximize oil production. This paper details the analysis, execution and evaluation of the first CT operation from a FAV in offshore Mexico, which includes equipment selection, sea condition and weather-related studies, contingency planning, personnel competency and training requirements, and logistical considerations, among other technical factors that were critical in the implementation of such project. As well, the benefits that were realized by the operator regarding production enhancement and operational cost reduction are covered.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.