Billroth II anastomosis combined with brown anastomosis reduce reflux gastritis in gastric cancer patients

BACKGROUND

The surgeon performing a distal gastrectomy, has an arsenal of reconstruction techniques at his disposal, Billroth II among them. Braun anastomosis performed during a Billroth II procedure has shown evidence of superiority over typical Billroth II, in terms of survival, with no impact on postoperative morbidity and mortality.

AIM

To compare Billroth II vs Billroth II and Braun following distal gastrectomy, regarding their postoperative course.

METHODS

Patients who underwent distal gastrectomy during 2002-2021, were separated into two groups, depending on the surgical technique used (Billroth II: 74 patients and Billroth II and Braun: 28 patients). The daily output of the nasogastric tube (NGT), the postoperative day that NGT was removed and the day the patient started per os feeding were recorded. Postoperative complications were at the same time noted. Data were then statistically analyzed.

RESULTS

There was difference in the mean NGT removal day and the mean start feeding day. Mean total postoperative NGT output was lower in Braun group (399.17 mL vs 1102.78 mL) and it was statistically significant (P < 0.0001). Mean daily postoperative NGT output was also statistically significantly lower in Braun group. According to the postoperative follow up 40 patient experienced bile reflux and alkaline gastritis from the Billroth II group, while 9 patients who underwent Billroth II and Braun anastomosis were presented with the same conditions (P < 0.05).

CONCLUSION

There was evidence of superiority of Billroth II and Braun vs typical Billroth II in terms of bile reflux, alkaline gastritis and NGT output.

The transverse coloplasty pouch is technically easy and safe and improves functional outcomes after low rectal cancer resection-a single center experience with 397 patients

BACKGROUND

Following resection for low rectal cancer, numerous patients suffer from frequent bowel movements, fecal urgency, and incontinence. Although there is good evidence that colonic J-pouch reconstruction, side-to-end anastomosis, or a transverse coloplasty pouch (TCP) improves functional outcome, many surgeons still prefer straight coloanal anastomosis because it is technically easier and lacks the risk of pouch-associated complications. The present single-center study aimed to evaluate the practicability of TCPs in routine clinical practice as well as pouch-related complications.

METHOD

All consecutive patients who underwent low anterior rectal resection with restoration of bowel continuity for cancer during the period September 2008 to June 2018 were included. A TCP in combination with a diverting ileostomy was defined as the hospital standard. The feasibility and safety of TCPs were assessed in a retrospective single-center study.

RESULTS

A total of 397 patients were included in the study. A total of 328/397 patients underwent TCP construction (82.6%). Two pouch-related surgical complications occurred (0.6%); one case of pouch-related stenosis and one case of sutural insufficiency. Overall, leakage of the coloanal anastomosis was reported in 14.1% of patients with a TCP and in 18.8% of patients without a pouch (p=0.252). Diverting ileostomy was applied in 378/397 patients (95.2%). The 30-day mortality was 0.25%.

CONCLUSION

The present study is by far the largest single-center experience with TCP construction for low rectal cancer resection. The study shows that a TCP is technically applicable in the vast majority of cases (82.6%). Pouch-associated surgical complications are sporadic events. In our opinion, the TCP can be considered an alternative to J-pouch construction after low anterior rectal resection.

Long-term effects of elevated CO2 on the population dynamics of the seagrass Cymodocea nodosa: Evidence from volcanic seeps

Population reconstruction techniques was used to assess for the first time the population dynamics of a seagrass, Cymodocea nodosa, exposed to long-term elevated CO₂ near three volcanic seeps and compared them with reference sites away from the seeps. Under high CO₂, the density of shoots and of individuals (apical shoots), and the vertical and horizontal elongation and production rates, were higher than at the reference sites. Nitrogen limitation effects on rhizome elongation and production rates and on biomass were more evident than CO₂ as these were highest at the location where the limitation of nitrogen was highest. At the seep where the availability of CO₂ was highest and nitrogen lowest, density of shoots and individuals were highest, probably due to CO₂ effects on shoot differentiation and induced reproductive output, respectively. At the three seeps, there was higher short- and long-term shoot recruitment than at the reference sites, and growth rates was around zero, indicating that elevated CO₂ increases the turnover of C. nodosa shoots.

Transclival approaches for intradural pathologies: historical overview and present scenario

Recently, endoscopic transsphenoidal transclival approaches have been developed and their role is widely accepted for extradural pathologies. Their application to intradural pathologies is still debated, but is undoubtedly increasing. In the past five decades, different authors have reported various extracranial, anterior transclival approaches for intradural pathologies. The aim of this review is to provide a historical overview of transclival approaches applied to intradural pathologies. PubMed was searched in October 2018 using the terms transcliv*, cliv* intradural, transsphenoidal transcliv*, transoral transcliv*, transcervical transcliv*, transsphenoidal brainstem, and transoral brainstem. Exclusion criteria included not reporting reconstruction technique, anatomical studies, reviews without new data, and transcranial approaches. Ninety-one studies were included in the systematic review. Since 1966, transcervical, transoral, transsphenoidal microsurgical, and, recently, endoscopic routes have been used as a corridor for transclival approaches to treat intradural pathologies. Each approach presents a curve that follows Scott's parabola, with evident phases of enthusiasm that quickly faded, possibly due to high post-operative CSF leak rates and other complications. It is evident that the introduction of the endoscope has led to a significant increase in reports of transclival approaches for intradural pathologies. Various reconstruction techniques and materials have been used, although rates of CSF leak remain relatively high. Transclival approaches for intradural pathologies have a long history. We are now in a new era of interest, but achieving effective dural and skull base reconstruction must still be definitively addressed, possibly with the use of newly available technologies.

[Complex vulvar reconstruction following female genital mutilation/cutting]

BACKGROUND

Female genital mutilation/cutting (FGM/C) is a worldwide problem affecting millions of women and is especially common in Africa and Arabia. Women suffer from serious physical and psychological problems. Anatomic reconstruction, therefore, is an important and life-changing option for many affected women.

OBJECTIVES

This work gives a short overview of specialized techniques invented by the author for functional and aesthetic vulvar reconstruction following FGM/C. This work does not intend to provide anatomic or surgical details.

MATERIALS AND METHODS

The anterior obturator artery perforator flap (aOAP flap), the omega domed flap (OD flap), and a microsurgical procedure called neurotizing and molding of the clitoral stump (NMCS procedure) are described.

RESULTS

The aOAP-flap for vulvar reconstruction, the OD-flap for clitoral prepuce reconstruction, and the NMCS-procedure for reconstruction of the clitoral tip provided natural, reliable, and long-lasting results, all of which normalize the anatomy of the mutilated outer female genitalia.

CONCLUSIONS

The reconstructive options presented contribute to re-establish normal anatomy and, thus, support women's health and relieve the burden forced upon them by FGM/C.

Diagnosis of portal vein tumor thrombus: the combination of enhanced multislice spiral computed tomography and portography

AIM: To evaluate the value of combined enhanced 16-slice spiral CT and portography reconstruction in the diagnosis of portal vein tumor thrombus.

METHODS: Fifty-two patients with portal vein tumor thrombus underwent 16-slice spiral CT examination. A plain scan and triple-phase enhanced scans (arterial phase, portal venous phase, and equilibrium phase) were performed. Scanning parameters were as follows: a slice thickness of 2.5 mm, a reconstruction interval of 0.625 mm, a flow rate of 3.5-4 mL/s, 80-100 mL of contrast agent, and scan time of 25-30 s, 45-60 s, and 120 s, respectively. Image reformation, including volume rendering (VR), multiplanar reformation (MPR) and maximum intensity projection (MIP), was performed by one radiologist. Two radiologists assessed the scope, shape and collateral vessels of the thrombus.

RESULTS: Thirty-five cases (67.3%) of portal vein tumor thrombus showed inhomogeneous enhancement in the arterial phase, and 47 cases (90.4%) had the enlarged portal vein and filling defect. Enhancement of the vessel wall was seen in 19 cases (36.5%), collateral circulation formation in 13 cases (25%), compression of the portal vein in 13 cases (25%), and arterioportal fistula in 6 cases (11.5%). Different portal vein reconstruction techniques showed different number of cases of portal vein tumor thrombus: 52 (100%) by MPR, 43 (82.7%) by MIP, 39 (75%) by VR.

CONCLUSION: The combination of enhanced CT and portography reconstruction can reveal portal vein tumor thrombus completely and has important clinical value.