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Borsuk DJ, Studniarek A, Al-Khamis A, Kochar K, Park JJ, Marecik SJ. Robotic excision of a difficult retrorectal cyst - a video vignette. Colorectal Dis 2020; 22:226-227. [PMID: 31553113 DOI: 10.1111/codi.14862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/18/2019] [Indexed: 02/08/2023]
Affiliation(s)
- D J Borsuk
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA.,Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - A Studniarek
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA.,Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - A Al-Khamis
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - K Kochar
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - J J Park
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - S J Marecik
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA.,Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL, USA
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Eftaiha SM, Balachandran B, Marecik SJ, Mellgren A, Nordenstam J, Melich G, Prasad LM, Park JJ. Sacral nerve stimulation can be an effective treatment for low anterior resection syndrome. Colorectal Dis 2017; 19:927-933. [PMID: 28477435 DOI: 10.1111/codi.13701] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/05/2017] [Indexed: 02/08/2023]
Abstract
AIM Sacral nerve stimulation has become a preferred method for the treatment of faecal incontinence in patients who fail conservative (non-operative) therapy. In previous small studies, sacral nerve stimulation has demonstrated improvement of faecal incontinence and quality of life in a majority of patients with low anterior resection syndrome. We evaluated the efficacy of sacral nerve stimulation in the treatment of low anterior resection syndrome using a recently developed and validated low anterior resection syndrome instrument to quantify symptoms. METHOD A retrospective review of consecutive patients undergoing sacral nerve stimulation for the treatment of low anterior resection syndrome was performed. Procedures took place in the Division of Colon and Rectal Surgery at two academic tertiary medical centres. Pre- and post-treatment Cleveland Clinic Incontinence Scores and Low Anterior Resection Syndrome scores were assessed. RESULTS Twelve patients (50% men) suffering from low anterior resection syndrome with a mean age of 67.8 (±10.8) years underwent sacral nerve test stimulation. Ten patients (83%) proceeded to permanent implantation. Median time from anterior resection to stimulator implant was 16 (range 5-108) months. At a median follow-up of 19.5 (range 4-42) months, there were significant improvements in Cleveland Clinic Incontinence Scores and Low Anterior Resection Syndrome scores (P < 0.001). CONCLUSION Sacral nerve stimulation improved symptoms in patients suffering from low anterior resection syndrome and may therefore be a viable treatment option.
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Affiliation(s)
- S M Eftaiha
- Division of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois, USA
| | - B Balachandran
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - S J Marecik
- Division of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois, USA.,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA.,Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - A Mellgren
- Division of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois, USA
| | - J Nordenstam
- Division of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois, USA
| | - G Melich
- Department of General Surgery, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada
| | - L M Prasad
- Division of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois, USA.,Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - J J Park
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA.,Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
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Balachandran B, Melich G, Mustafa T, Marecik SJ, Prasad LM, Gonzalez M, Sulo S, Dabbous F, Park JJ. Prospective analysis of the sealing ability of the ENSEAL ® G2 Articulating Tissue Sealer and transector on human mesenteric vessels in colorectal surgery. Tech Coloproctol 2017; 21:133-138. [PMID: 28144764 DOI: 10.1007/s10151-017-1584-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 12/18/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND The sealing and transection of mesenteric vessels is a crucial step in minimally invasive colorectal surgery. We examined the sealing quality of the ENSEAL® G2 Articulating Tissue Sealer in three different articulations in mesenteric vessels. METHODS This was a prospective experimental study within a tertiary healthcare center, and 30 patients were recruited. Burst pressures for each specimen were measured as the primary outcome. Ten specimens at each of the three articulations were also histologically assessed for the quality of seal. RESULTS We evaluated 54 sets of specimens from 30 patients for bursting pressure, all of which were harvested and sealed in the operating room. No statistical difference was seen in burst pressures from seals recorded at no angulation, half-maximal angulation, or maximal angulation (1604, 1507, 1478 mmHg; p = 0.07). Histological analysis showed no statistical differences in the average vessel diameter (p = 0.57), lateral extent of thermal injury (p = 0.48), degree of vascular sclerosis, or the integrity of seal at the three articulations. No cases of intraoperative or postoperative bleeding were observed in any of the patients. Five (16.7%) of the ENSEAL® devices developed breaks in the black, heat-shrink, polyethylene covering as a result of repeated articulation and disarticulation. Electrical arcing did not appear to have occurred as a result of the break, although this was not formally examined. CONCLUSIONS The maximum sustainable pressure in mesenteric vessels sealed with a bipolar electrothermal device is supraphysiological, and consequently, the device can be safely used at various articulations to seal vessels during colorectal surgery.
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Affiliation(s)
- B Balachandran
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA
| | - G Melich
- Department of Surgery, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada
| | - T Mustafa
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA
| | - S J Marecik
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA
| | - L M Prasad
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA
| | - M Gonzalez
- Division of Pathology, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - S Sulo
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - F Dabbous
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - J J Park
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA.
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Kamal T, Pai A, Velchuru VR, Zawadzki M, Park JJ, Marecik SJ, Abcarian H, Prasad LM. Should anastomotic assessment with flexible sigmoidoscopy be routine following laparoscopic restorative left colorectal resection? Colorectal Dis 2015; 17:160-4. [PMID: 25359528 DOI: 10.1111/codi.12809] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/15/2014] [Indexed: 02/06/2023]
Abstract
AIM The aim of the study was to evaluate the value of routine intra-operative flexible sigmoidoscopy (IOFS) for left-sided anastomotic integrity and to determine the safest step after a positive leak test. METHOD All consecutive patients undergoing left-sided colorectal resections for benign and malignant disease between August 2005 and April 2011 were included. Data regarding procedure, type of anastomosis and outcomes of IOFS were collected. A positive intra-operative leak test resulted in redoing the anastomosis and repeating the leak test. RESULTS A total of 415 consecutive patients underwent hand-assisted laparoscopic colorectal resection with a colorectal/ileoanal anastomosis. All patients underwent IOFS. Seventeen patients had abnormality on IOFS. Fifteen patients had a positive air leak test. One patient had anastomotic bleeding. There was one stapler misfiring. Fourteen anastomoses were redone without diversion. One patient required diversion to protect the ileoanal anastomosis and another had already been diverted. Minor bleeding from the staple line in one patient resolved without intervention; however, he had a postoperative anastomotic leak needing surgical intervention. None of the patients who had a takedown and refashioning of the anastomosis following a positive leak on IOFS had postoperative anastomotic leakage or bleeding. Our overall anastomotic leak rate was 2.1%. CONCLUSIONS Intra-operative flexible sigmoidoscopy for restorative colorectal resection is safe and reliable and should be performed routinely to assess anastomotic integrity and bleeding. Refashioning the anastomosis after formal takedown would obviate the risk of leakage and is our recommended method of managing intra-operative leaks.
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Affiliation(s)
- T Kamal
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - A Pai
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - V R Velchuru
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - M Zawadzki
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - J J Park
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - S J Marecik
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - H Abcarian
- Department of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois, USA
| | - L M Prasad
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.,Department of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois, USA
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