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Petropoulou T, Evangelou K, Polydorou A. Sigmoid Colon Intraluminal Obstruction by a Detached Recurrent Ascending Colon Liposarcoma. Cureus 2024; 16:e58065. [PMID: 38738041 PMCID: PMC11088451 DOI: 10.7759/cureus.58065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/14/2024] Open
Abstract
Primary liposarcoma of the colon is extremely rare in the literature. We present a case of a 51-year-old male patient with recurrent ascending colon liposarcoma, which caused obstructive ileus, just a few days prior to his scheduled elective operation and led us to expedite his surgery. The procedure was scheduled to be a robotic right colectomy. After finishing the operation and extracting the specimen, the tumour could not be detected; hence, an exploratory laparotomy was performed. Findings were a large tumour in the sigmoid colon, causing complete obstruction. Sigmoidectomy was performed, in order to remove the tumour. To our knowledge, this is the first case published in the literature, reporting a colonic tumour detachment, displacement and causing distal bowel occlusion. This event highlights the importance of careful intraoperative inspection in patients with known intraluminal bowel malignancies that present with signs and symptoms of obstruction and emphasises the need for further research on the risk factors for tumour detachment and subsequent bowel occlusion.
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Affiliation(s)
- Thalia Petropoulou
- Robotic Colorectal Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens, Athens, GRC
- Colon and Rectal Surgery, Euroclinic Athens, Athens, GRC
| | - Kyriacos Evangelou
- Faculty of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Andreas Polydorou
- Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Colon and Rectal Surgery, Euroclinic Athens, Athens, GRC
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2
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Sahay SC, Mangla V, Kesarwani P, Goel A. Robotic-Assisted Colovesical Fistula Repair: A Case Report. Cureus 2024; 16:e54404. [PMID: 38505449 PMCID: PMC10950097 DOI: 10.7759/cureus.54404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/21/2024] Open
Abstract
Colovesical fistulas present a diagnostic and therapeutic challenge, commonly arising from complications of diverticular disease. In our case, a 71-year-old male with colovesical fistula symptoms underwent robotic-assisted surgery for complicated sigmoid diverticulitis. Intraoperatively, meticulous adhesiolysis and fistula repair were performed. Histopathology confirmed diverticular disease. Postoperatively, the patient recovered well. Colovesical fistulas may indicate underlying malignancy in diverticulitis. With a lack of standardized protocols, our case suggests that robotic-assisted surgery offers improved outcomes, better vision, and ergonomics. To conclude, robotic-assisted colovesical fistula repair and sigmoidectomy demonstrated excellent outcomes, suggesting a promising approach for enhanced postoperative recovery.
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Affiliation(s)
- Shailesh C Sahay
- Urology, Max Super Speciality Hospital, Patparganj, New Delhi, IND
| | - Vivek Mangla
- Gastrointestinal Surgery, Max Super Speciality Hospital, Patparganj, New Delhi, IND
| | - Pawan Kesarwani
- Urology, Max Super Speciality Hospital, Patparganj, New Delhi, IND
| | - Abhigyan Goel
- Urology, Max Super Speciality Hospital, Patparganj, New Delhi, IND
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3
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Paasch C, De Santo G, Berndt N, Strik MW, Lefering R, Siegel R. Feasibility of laparoscopic resection for perforated diverticulitis: a retrospective observational study of 77 consecutive patients. Acta Chir Belg 2023; 123:632-639. [PMID: 36062887 DOI: 10.1080/00015458.2022.2122006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/02/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Perforated colonic diverticulitis with purulent or fecal contamination (PCD) is a surgical emergency with high morbidity and mortality. Traditionally, open surgery as a Hartmann procedure (HP) has been performed. Feasibility of the laparoscopic approach (LA) either with primary anastomosis (PA) or as an HP has been shown, but evidence and implementation into daily routine remain low. We analysed all patients with PCD and emergency surgery at our institution to compare post-operative outcomes between LA and open surgery. Our results should add more evidence about the potential benefit of LA in treating PCD. METHODS This retrospective analysis conducted at a tertiary care centre in Germany included all patients with PCD undergoing emergency surgery between June 2007 and February 2019. Mortality and postoperative morbidity according to Clavien-Dindo-Classification are the primary endpoints. Secondary endpoints were stoma-free survival and length of hospital stay. RESULTS Seventy-seven patients were identified (41 female/36 male; median age 67.9 years). Sixty patients underwent a LA (conversion in 9 of 60, 15%). PA has been performed in 25 of 77 patients (22 LA, 3 with open surgery). Severe complications and death (Clavien-Dindo-Classification grade IIIb-V) were lower in patients with LA (17/60, 28%) compared to open surgery (9/17, 53%; p = 0.082) as well as the length of hospital stay (LOS; LA 9 days vs. open surgery 17 days; p = 0.016). CONCLUSION The LA is feasible in the majority of patients with PCD and may be warranted as a routine in emergency surgery. Although limited by a selection bias of this retrospective study, the LA seems to reduce morbidity and LOS.
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Affiliation(s)
- Christoph Paasch
- Clinic for General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Brandenburg an der Havel, Germany
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Gianluca De Santo
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Nadja Berndt
- Medical School, Charité - University Medicine Berlin, Berlin, Germany
| | - Martin W Strik
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany
| | - Robert Siegel
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
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4
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Salim N, Daidone C, Smith L, Raza A. Robotic Sigmoidectomy With Natural Orifice Specimen Extraction: A Single-Center Experience. Cureus 2023; 15:e49902. [PMID: 38174165 PMCID: PMC10763519 DOI: 10.7759/cureus.49902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Background Natural orifice specimen extraction (NOSE) involves the removal of specimens through a naturally occurring orifice, such as the anus, rather than trans-abdominal extraction. NOSE procedures have been shown to significantly reduce postoperative complications and improve healing. Objective The purpose of this case series is to report the outcomes of 27 patients undergoing sigmoidectomies through natural orifice specimen extraction. Materials and methods We carefully recorded demographic data on age and BMI, as well as operative data on surgical indication, and length of stay. We also collected data on postoperative complications, including infection, hernia, wound dehiscence, urinary tract infections (UTIs), or anastomotic leaks. Results Our patients were majority female (n = 21, 77.8%) with a median age of 53.5 (range: 25-79) and median BMI of 33.2 kg/m2 (range: 16.7 - 48.3 kg/m2). Thirteen patients (48.1%) were obese (BMI > 30.0 kg/m2). The majority of these patients underwent sigmoidectomies for benign conditions such as recurrent diverticulitis (n = 9, 33.3%), rectal prolapse (n = 8, 29.6%), perforated diverticulitis (n = 3, 11.1%), colovesical fistula (n = 3, 11.1%), and abdominal abscess (n = 3, 11.1%) (Table 1). One patient was receiving treatment for sigmoid cancer. The average estimated blood loss was 63.26 mL. The average hospital stay was 3.61 days. Three patients (11.1%) developed a fever postoperatively (temperature >= 100.4 F), which resolved the day after. One patient completed a post-operative hospital stay of 19 days for dialysis and rehab placement. No patients (0.0%) experienced any postoperative complications, including wound infection, hernia, dehiscence, UTIs, or anastomotic leakages. There was no postoperative mortality. Conclusions Our study demonstrates the practicality and safety of NOSE procedures for sigmoidectomies as an alternative to transabdominal approaches to treat benign colon diseases.
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Affiliation(s)
- Naved Salim
- Department of Research, Edward Via College of Osteopathic Medicine, Monroe, USA
| | - Camryn Daidone
- Department of Research, Edward Via College of Osteopathic Medicine, Monroe, USA
| | - Leslie Smith
- Department of General Surgery, Rapides Regional Medical Center, Alexandria, USA
| | - Ahsan Raza
- Department of General Surgery, Rapides Regional Medical Center, Alexandria, USA
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5
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Ward GH, Sireci A, Wilder W, Soto A, Sanchez R, Dash A, Shemesh E. Robotic Sigmoidectomy of a Rare Instance of Sigmoid Colon Duplication in an Elderly Patient: A Case Report. Cureus 2023; 15:e44208. [PMID: 37767241 PMCID: PMC10521940 DOI: 10.7759/cureus.44208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Duplication of the alimentary tract is a rare malformation that can occur in any portion of the gastrointestinal tract. Rarely diagnosed in adulthood, it is usually an incidental finding due to non-specific gastrointestinal symptoms. Approximately 80% of cases are diagnosed in infants less than two years old. The most common location is the ileum, and the least common location is the rectum. Embryological theories discussing the etiology of alimentary tract duplications include failure of internal vacuolization during the sixth week of fetal development and/or the yolk-sac dorsal protrusion may adhere to the ectoderm during somite development. Environmental factors such as trauma or hypoxia affecting various intestinal fragments receiving blood supply can evolve into duplication. Excision with consideration to the common blood supply to protect the native bowel is the preferred treatment approach. We present the case of an elderly 70-year-old male with a bowel obstruction complicated by sigmoid duplication. After preoperative assessments, the patient underwent a robotic sigmoidectomy. This case report highlights colonic duplication as a differential diagnosis in the bowel obstruction of an elderly patient.
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Affiliation(s)
- Gavin H Ward
- School of Medicine, St. George's University, True Blue, GRD
- General Surgery, Delray Medical Center, Delray, USA
| | - Alexis Sireci
- School of Medicine, St. George's University, True Blue, GRD
- General Surgery, Delray Medical Center, Delray, USA
| | - William Wilder
- School of Medicine, St. George's University, True Blue, GRD
- General Surgery, Delray Medical Center, Delray, USA
| | - Alain Soto
- General Surgery, Larkin Community Hospital, Miami, USA
- General Surgery, Delray Medical Center, Delray, USA
| | - Roynny Sanchez
- General Surgery, Larkin Community Hospital, Miami, USA
- General Surgery, Delray Medical Center, Delray, USA
| | - Aruna Dash
- Pathology, Delray Medical Center, Delray, USA
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6
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Muacevic A, Adler JR, Yglesias B, Phillips JK. Acute Large Bowel Obstruction Caused by Endometriosis Requiring Sigmoidectomy. Cureus 2022; 14:e32430. [PMID: 36644032 PMCID: PMC9833863 DOI: 10.7759/cureus.32430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
Large bowel obstruction (LBO) accounts for nearly 25% of all bowel occlusions. LBO is managed as a surgical emergency due to its increased risk of bowel perforation. Nearly, 2% to 4% of all surgical admissions are a result of LBO. The most common pathological development of LBO remains colonic malignancy, representing approximately 60% of cases. Other etiology includes abdominal adhesions, diverticulosis, hernia, inflammatory bowel disease (IBD), and in rare cases endometriosis. In this report, the patient is a 36-year-old female with an LBO, originally thought to be a complication of diverticulitis. However, it was confirmed that the obstruction was a result of endometriosis tissue adherence to the colonic wall narrowing the intestinal lumen. The patient presented to the emergency department (ED) with nausea, vomiting, and abdominal pain that started six weeks prior. In this case report, we will discuss the rare complication of endometriosis causing LBO, clinical presentation, diagnosis, and management.
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7
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Gray PJ, Goldwag JL, Eid MA, Trooboff SW, Wilson MZ, Ivatury SJ. What Are the Long-Term Changes to Bowel Function Patient-reported Outcomes After Elective Sigmoidectomy for Diverticular Disease?: Observational Study of Patients Undergoing Elective Sigmoidectomy for Diverticular Disease. Ann Surg Open 2021; 2:e110. [PMID: 37637876 PMCID: PMC10455065 DOI: 10.1097/as9.0000000000000110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate long-term changes to bowel function after elective sigmoidectomy for diverticular disease. Background For patients with diverticular disease, choosing surgery is often based on the presumption of improvement in preoperative symptoms. Our group previously reported bowel function does not change in the early perioperative period; however, studies of long-term outcomes are limited. Methods This is an observational study of patients that underwent elective sigmoidectomy for diverticular disease and completed the Colorectal Functional Outcome (COREFO) questionnaire before surgery. Patients were stratified into two groups based on presence or absence of a preoperative symptomatic score (i.e., total COREFO ≥ 15). Long-term bowel function (>1 year from surgery) was assessed using the COREFO questionnaire via telephone or subsequent clinic visit. Paired t-tests compared mean preoperative scores to mean long-term scores. Results Fifty-one patients met inclusion criteria (21 symptomatic, 30 asymptomatic). All symptomatic patients had uncomplicated disease, whereas 90% of asymptomatic patients had complicated disease. Median time from operation to questionnaire completion was 23 months (IQR = 13-34). Asymptomatic patients demonstrated impaired bowel function, predominantly driven by changes in the social impact domain. Symptomatic patients demonstrated improved bowel function, driven by changes in the incontinence, social impact, stool-related aspects, and need for medication domains. Conclusions In the long-term after elective sigmoidectomy for diverticular disease, patients with symptomatic bowel function preoperatively improve substantially, while those with asymptomatic preoperative scores demonstrate statistically significant impairment. Patients determined to be symptomatic with patient-reported outcomes likely benefit long-term from sigmoid resection.Mini-Abstract: In this manuscript, long-term changes to patient-reported bowel function were assessed using a validated questionnaire after sigmoidectomy for diverticular disease. We found that in patients with symptomatic preoperative bowel function, long-term bowel function improved after elective resection. Alternatively, patients with asymptomatic preoperative bowel function demonstrated long-term impairment in bowel function.
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Affiliation(s)
| | | | - Mark A. Eid
- From the Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Matthew Z. Wilson
- From the Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geisel School of Medicine, Hanover, NH
| | - Srinivas J. Ivatury
- Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, TX
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8
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Kudsi OY, Gokcal F, Bou-Ayash N, Chudner A. Robotic sigmoidectomy for diverticulitis - Natural orifice extraction with stapleless hand-sewn intracorporeal anastomosis. Colorectal Dis 2021; 23:1919-1923. [PMID: 33709504 DOI: 10.1111/codi.15624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/24/2021] [Revised: 02/16/2021] [Accepted: 03/03/2021] [Indexed: 02/08/2023]
Abstract
AIM A sigmoidectomy is the most definitive surgical treatment for recurrent diverticulitis. While it is usually accomplished via transabdominal specimen extraction and stapled anastomosis, the robotic platform can facilitate novel approaches and techniques. This is the first report of the initial experience using robotic sigmoidectomy with natural orifice specimen extraction and hand-sewn anastomosis (NOSHA). METHOD A prospectively maintained database of NOSHA procedures performed between 2018 and 2020 was retrospectively examined. The technique was described and variables across preoperative, intra-operative and postoperative timeframes were presented. The Clavien-Dindo classification system was used to describe postoperative complications. RESULTS Sixteen patients with recurrent diverticulitis treated with NOSHA were included in this study. Transanal specimen extraction and an intracorporeal hand-sewn anastomosis were achieved in all patients. However, two (12.8%) patients required specimen debulking prior to extraction. The mean operating time was 171.7 min, and patients had a return of bowel function within an average period of 35.2 h. The mean hospital length of stay was 2.9 days. In total, two (12.8%) complications were seen: one postoperative ileus managed conservatively and one readmission for abdominal pain which resolved without intervention. No anastomotic leaks or reoperations were observed. CONCLUSION Robotic NOSHA appears to be a viable technique for the surgical management of diverticulitis. Further studies are needed to establish its utility for various diseases and its reproducibility across clinical practices.
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Affiliation(s)
- Omar Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts, USA
| | - Fahri Gokcal
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts, USA
| | - Naseem Bou-Ayash
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts, USA
| | - Alexandra Chudner
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts, USA
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9
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Johnson BH, Rai P, Jang SR, Johnston SS, Chen BPH. Real-World Outcomes of Patients Undergoing Open Colorectal Surgery with Wound Closure Incorporating Triclosan-Coated Barbed Sutures: A Multi-Institution, Retrospective Database Study. Med Devices (Auckl) 2021; 14:65-75. [PMID: 33658869 PMCID: PMC7917355 DOI: 10.2147/mder.s297671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Open colorectal surgery is associated with a high rate of postoperative wound complications. This is a single-arm study of real-world outcomes of triclosan-coated barbed suture (Ethicon's STRATAFIXTM Symmetric PDSTM Plus Knotless Tissue Control Device [SSPP]) used in open colorectal surgery. Methods Retrospective cohort study using the Premier Healthcare Database. The study included patients who underwent an inpatient open colorectal surgery with wound closure using SSPP (size 0 or 1 to increase the likelihood the suture was used in fascia) between October 2015-September 2019 (N=593). Wound complications, hospital length of stay, total hospital costs (2019 US$), and all-cause readmissions post-discharge were measured. Post-hoc multivariable analyses compared wound complications between non-elective admissions and elective. Results The overall incidence of wound complications within 30-days post-procedure was 7.1%, with the majority of those being surgical site infections (SSI) (6.0%). Mean operation time was 190 (standard deviation [SD]=64.4) mins, postoperative length of stay was 8.1 (SD=11.9) days, 30-day readmission rate was 11.8%, and total hospital costs were $31,693 (SD=$40,076). As compared with published literature on the rate of SSI in colorectal surgery, the 30-day rate of SSI in the present study (6.0%) fell within the range of 5.4% to 18.2% for open colorectal surgery and from 4.3% to 21.5% for combined open and minimally invasive procedures. Multivariable-adjusted incidence proportions of wound complications were slightly lower for non-elective admissions and did not differ significantly from those of elective admissions. Conclusion The rate of wound complications observed in the present study falls within the range of rates previously reported in the literature, suggesting a safe and effective role for SSPP in open colorectal surgery. In post hoc analyses, the adjusted rate of wound complications was similar between non-elective and elective admissions. Head-to-head studies are required to determine comparative advantages or disadvantages for SSPP versus other sutures.
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Affiliation(s)
- Barbara H Johnson
- Real World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Pragya Rai
- Real World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Se Ryeong Jang
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephen S Johnston
- Real World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Brian Po-Han Chen
- Health Economics and Market Access, Ethicon Inc., Somerville, NJ, USA
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10
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Abstract
BACKGROUND This study will assess the effect of sigmoidectomy in treating sigmoid colon cancer (SCC). METHODS This study will search the following databases from inception to the present: MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, Scopus, OpenGrey, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All electronic databases will be searched with no restrictions of language. Two researchers will independently handle all study selection, data extraction, and risk of bias, respectively. Any disparities between 2 researchers will be figured out by a third researcher through discussion. RevMan 5.3 software will be used for statistical analysis in this study. RESULTS This study will provide a high-quality synthesis of targeted outcomes to evaluate the efficacy and complications of sigmoidectomy in treating SCC. CONCLUSION The results of this study will provide evidence to judge whether sigmoidectomy can benefit patients with SCC. STUDY REGISTRATION ON OSF osf.io/dpxkg.
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Affiliation(s)
- Hua-ping Hou
- Department of General Surgery, The First Hospital of Yulin, Yulin
| | - Pu-guo Gui
- Department of General Surgery, Yangling Demonstration District Hospital, Xianyang, Shaanxi, China
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11
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Ait Ali H, Zeriouh B, Jabi R, Bouziane M. Sigmoid Colon Tuberculosis Revealed by a Perforation and Peritonitis. Cureus 2020; 12:e12272. [PMID: 33520488 PMCID: PMC7834544 DOI: 10.7759/cureus.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Intestinal tuberculosis is a frequent disease in developing countries, causing considerable morbidity and mortality. However, tuberculosis of the colon is rarer, and it also appears to be more common in immunosuppressed patients. We report the case of a 71-year-old immunocompetent man who was admitted to the emergency department with an acute abdomen and features of perforation peritonitis. A sigmoid perforation on cancer was suspected on computed tomography (CT) scan and surgical exploration. A standard sigmoidectomy with end colostomy (Hartmann's procedure) and peritoneal toileting was done. The pathological assessment of the surgical specimen revealed the sigmoid colon tuberculosis, complicated by perforation and peritonitis. Thus, the unexpected diagnosis of sigmoid colon tuberculosis was only made after the histopathological examination. Then, he received anti-tuberculosis treatment for six months. Therefore, a complete colonoscopy was performed at the end of the treatment, which returned to be normal. Thereafter, the restoration of intestinal continuity was performed. Colon tuberculosis is a rare disease and even rarer in people without immunodeficiency or on immunosuppressive therapy. If diverticulitis is the most common cause of sigmoid perforation, sigmoid perforation because of tuberculosis is extremely rare. However, an isolated primary sigmoid perforation of tubercular origin is not reported. We report this exceptional case of sigmoid colon tuberculosis complicated by perforation and generalized peritonitis to sensitize the medical team to its rare occurrence, which will be of paramount importance due to the increasing incidence of tuberculosis worldwide.
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Affiliation(s)
- Hassane Ait Ali
- General Surgery, Mohammed VI University Hospital Center, Oujda, MAR
| | - Brahim Zeriouh
- Oncology Surgery, Mohammed VI University Hospital Center, Oujda, MAR
| | - Rachid Jabi
- Visceral Surgery, Mohammed VI University Hospital Center, Oujda, MAR
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12
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Patel M, Shenoy C, Nagarajan G, Chandiramani V. Mesh migration into the sigmoid colon after total extraperitoneal hernioplasty - Report of a case and review of the literature. J Minim Access Surg 2020; 16:411-414. [PMID: 32978354 PMCID: PMC7597895 DOI: 10.4103/jmas.jmas_122_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Over the past three decades, the practice laparoscopic inguinal hernioplasty has gained momentum. Mesh migration after laparoscopic inguinal hernia repair is an uncommon mesh-related delayed complication which is more common after transabdominal preperitoneal repair as compared to total extraperitoneal (TEP) repair. We report the first case of mesh migration into the sigmoid colon after TEP presenting 10 years after surgery. A 72-year-old male presented with left iliac fossa pain and diffuse lump. His computed tomogram scan showed sigmoid colon adherent to internal oblique at the site of hernia repair with a collection containing air specks and calcification. A colonoscopy revealed mesh within the sigmoid colon. He had to undergo a sigmoidectomy with Hartmann's surgery for the same. Here, we discuss the implicated pathophysiology, management and prevention of mesh migration after laparoscopic inguinal hernioplasty with literature review.
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Affiliation(s)
- Maitreyi Patel
- Department of Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Chetan Shenoy
- Department of Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Ganesh Nagarajan
- Department of Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Vinod Chandiramani
- Department of Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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13
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De Nardi P, Gazzetta P. Does inferior mesenteric artery ligation affect outcome in elective colonic resection for diverticular disease? ANZ J Surg 2018; 88:E778-E781. [PMID: 30062801 DOI: 10.1111/ans.14724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of our study was to analyse the role of inferior mesenteric artery (IMA) ligation during elective colonic resection for diverticular disease (DD) with respect to surgical outcome. METHODS All patients who underwent elective laparoscopic or open colonic resection for DD from January 2006 to December 2012 were studied. The patients were divided into two groups based on IMA ligation or preservation. The primary end point was to compare anastomotic leakage in the two groups. The secondary end points were operative time, stoma formation, overall post-operative complications, restoration of bowel function and length of post-operative hospital stay. RESULTS During the study period, 219 elective colonic resections with primary anastomosis for DD were performed. A laparoscopic technique was employed in 132 (60.3%) cases. IMA ligation was performed in 66 patients (30.1%). Overall anastomotic leakage rate was 4.1%, 4.5% in IMA ligation and 3.9% in IMA preservation group, respectively (P = ns). Mean operative time was 225 ± 43.4 and 191 ± 41.7 min in IMA ligation and preservation group, respectively (P = 0.002). No differences were observed in the rate of overall complications, stoma formation, restoration of bowel function and post-operative length of hospital stay. CONCLUSIONS No differences were observed in surgical outcome in IMA ligation and preservation groups, particularly preservation or ligation of the IMA did not affect leakage rate.
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Affiliation(s)
- Paola De Nardi
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Gazzetta
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy
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Xia ZN, Hou R, Zhu W, Yao R, Lu Z, Qiu HZ, Lin GL. Laparoscopic-Assisted Resection for Advanced Colorectal Cancer in Solid Organ Transplant Recipients. J INVEST SURG 2017; 31:483-490. [PMID: 28925783 DOI: 10.1080/08941939.2017.1359707] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIM To evaluate the feasibility, short- and long-term outcomes, and safety of laparoscopic resection for advanced colorectal cancer (CRC) in solid organ transplant recipients. METHODS Between September 2001 and April 2016, five patients who underwent laparoscopic-assisted resection for CRC after solid organ transplantation were included in this study. Their clinical data were retrospectively analyzed with regard to patient demographics, immunosuppressive therapy, tumor characteristics, surgical outcomes, and follow-up data. RESULTS Four kidney and one heart transplant recipients were included. Laparoscopic-assisted low anterior resection was performed in four patients with rectal or rectosigmoid junction cancer, and sigmoidectomy was done in one with sigmoid colon cancer. One kidney transplant patient received a protective loop transverse colostomy. All resections achieved complete tumor removal with tumor-free margins and total mesorectal excision, with an average number of 14 lymph nodes harvested. Most tumors were in stage III (n = 3), one was in stage II, and one in stage IV. The mean duration of surgery, intraoperative blood loss, and postoperative hospital stay were 144 min, 105 mL, and 8.8 days, respectively. No major complications occurred and graft function stayed well. During a mean follow-up period of 62 months, two patients developed metastasis and died eventually. CONCLUSION Laparoscopic resection for advanced CRC in organ transplant recipients is technically feasible and therapeutically safe, and seems to have the advantages of few postoperative complications, short recovery time, and acceptable oncological outcomes.
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Affiliation(s)
- Ze-Nan Xia
- a Department of Surgery , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing , China
| | - Rui Hou
- a Department of Surgery , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing , China
| | - Wei Zhu
- b Peking Union Medical College Hospital , Chinese Academy of Medical Sciences , Beijing , China
| | - Ru Yao
- a Department of Surgery , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing , China
| | - Zhao Lu
- a Department of Surgery , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing , China
| | - Hui-Zhong Qiu
- c Department of General Surgery , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing , China
| | - Guo-Le Lin
- c Department of General Surgery , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing , China
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Silva GLR, de Moura EGH, Bernardo WM, Leite de Castro V, Morais C, Baba ER, Safatle-Ribeiro AV. Endoscopic versus surgical resection for early colorectal cancer-a systematic review and meta-analysis. J Gastrointest Oncol 2016; 7:326-35. [PMID: 27284463 PMCID: PMC4880782 DOI: 10.21037/jgo.2015.10.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 08/22/2015] [Accepted: 09/08/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To investigate the available data on the treatment of early colorectal cancer (CRC), either endoscopically or surgically. METHODS Two independent reviewers searched MEDLINE, EMBASE, CENTRAL COCHRANE, LILACS and EBSCO for articles published up to August 2015. No language or dates filters were applied. Inclusion criteria were studies with published data about patients with early colonic or rectal cancer undergoing either endoscopic resection (i.e., mucosectomy or submucosal dissection) or surgical resection (i.e., open or laparoscopic). Extracted data items undergoing meta-analysis were en bloc resection rate, curative resection rate, and complications. A complementary analysis was performed on procedure time. The risk of bias among studies was evaluated with funnel-plot expressions, and sensitivity analyses were carried out whenever a high heterogeneity was found. The risk of bias within studies was assessed with the Newcastle score. RESULTS A total of 12,819 articles were identified in the preliminary search. After applying inclusion and exclusion criteria, three cohort studies with a total of 768 patients undergoing endoscopic resection and 552 patients undergoing surgical resection were included. The en bloc resection rate risk difference was -11% [-13%, -8% confidence interval (CI)], demonstrating worse outcome results for the endoscopic resection group as compared to the surgical resection group [number need to harm (NNH) =10]. The curative resection rate risk difference was -9% [(-12%, 6% CI)] after a sensitivity analysis was performed, which also demonstrated worse outcomes in the intervention group (NNH =12). The complications rate exhibited a -7% risk difference [(-11%, -4% CI)], denoting a lesser number of complications in the endoscopic group [Number Need to Treat (NNT =15). A complementary analysis of procedure time with two of the selected studies demonstrated a mean difference of -118.32 min [(-127.77, -108.87 CI)], in favor of endoscopic resection, even though such data lacks homogeneity across studies, and could be heavily influenced by local expertise. Long-term results were found in only one study and therefore were not included in the final analysis. CONCLUSIONS According to the current available data, the treatment of early CRC by surgical resection is associated with higher curative resection rates and higher en bloc resection rates, despite of higher complications rates, as compared to endoscopic resection. Shorter procedure times are associated with the endoscopic methods of treatment, however high heterogeneity levels limit this conclusion.
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Affiliation(s)
| | | | | | | | - Cintia Morais
- Hospital das Clinicas, University of Sao Paulo Medical School, Brazil
| | - Elisa Ryoka Baba
- Hospital das Clinicas, University of Sao Paulo Medical School, Brazil
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Woeste G, Juratli MA, Habbe N, Hannes S, El Youzouri H, Bechstein WO, Trombetta F, Moscato R, Ciamporcero T, Ghiglione F, Morino M, Tahir S, Baldjiev T, Goshev G, Pachoov N, Eftimov E, Kovachevski S, Smirnoff A, Roth JS, Wennergren J, Plymale MA, Zachem A, Davenport DL, Mangiante G, Passeri V, deManzoni G, Kaufmann R, Jairam AP, Mulder IM, Wu Z, Verhelst J, Vennix S, Giessen LJX, Jeekel J, Lange JF, Di Cerbo F, Ikhlawi K, Baladov M, Agha A, Iesalnieks I, Franklin M, Hernandez M, Glass J, Glover M, Gruber-Blum S, Fortelny R, May C, Glaser K, Redl H, Petter-Puchner A, Grossi J, Cavazzola LT, Tezza SLT, Nery LA, Zortea J, Roll S, Gorganchian F, Santa Maria V, Zuvela M, Galun D, Petrovic J, Micev M, Palibrk I, Bidzic N, Colozzi S, Clementi M, Cianca G, Giuliani A, Carlei F, Schietroma M, Amicucci G, Chung M, Cerasani N, Meyer J, Bulian DR, Heiss MM, Kocaay AF, Eker T, Celik SU, Akyol C, Cakmak A. Topic: Abdominal Wall Hernia - Abdominal wall closure. Hernia 2015; 19 Suppl 1:S198-205. [PMID: 26518800 DOI: 10.1007/bf03355349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Woeste
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - M A Juratli
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - N Habbe
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - S Hannes
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - H El Youzouri
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - W O Bechstein
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - F Trombetta
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - R Moscato
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - T Ciamporcero
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - F Ghiglione
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - M Morino
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - S Tahir
- University Surgical Clinic St. Naum Ohridski, Skopje, R. of Macedonia, European Union
| | - T Baldjiev
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - G Goshev
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - N Pachoov
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - E Eftimov
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - S Kovachevski
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | | | - J S Roth
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - J Wennergren
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - M A Plymale
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - A Zachem
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - D L Davenport
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - G Mangiante
- Upper Digestive Surgery, University of Verona, Verona, Italy
| | | | | | - R Kaufmann
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - A P Jairam
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - I M Mulder
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Z Wu
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J Verhelst
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - S Vennix
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - L J X Giessen
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - K Ikhlawi
- Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - M Baladov
- Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - A Agha
- Klinikum Bogenhausen, Munich, Germany
| | | | - M Franklin
- Texas endosurgery Institute, San Antonio, USA
| | - M Hernandez
- Texas endosurgery Institute, San Antonio, USA
| | - J Glass
- Texas endosurgery Institute, San Antonio, USA
| | - M Glover
- Texas endosurgery Institute, San Antonio, USA
| | - S Gruber-Blum
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - R Fortelny
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - C May
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - K Glaser
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - H Redl
- Cluster of Tissue engeneering, Ludwig Boltzmann Institute of Traumatology, Vienna, Austria
| | - A Petter-Puchner
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - J Grossi
- Brazilian lutern hospital, Canoas, Brazil
| | | | | | | | | | | | - F Gorganchian
- Departamento de Cirugia, Instituto de Investigaciones Medicas A. Lanari, Caba, Argentina
| | - V Santa Maria
- Departamento de Cirugia, Instituto de Investigaciones Medicas A. Lanari, Caba, Argentina
| | - M Zuvela
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - D Galun
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - J Petrovic
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
| | - M Micev
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - I Palibrk
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - N Bidzic
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
| | - S Colozzi
- Ospedale Civile San Salvatore, L'Aquila, Italy
| | | | | | | | | | | | | | - M Chung
- Gil Medical Center, Gachon University, Incheon, South Korea
| | - N Cerasani
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - J Meyer
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - D R Bulian
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - M M Heiss
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - A F Kocaay
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - T Eker
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - S U Celik
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - C Akyol
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - A Cakmak
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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Śmigielski JA, Piskorz Ł, Koptas W. Comparison of treatment costs of laparoscopic and open surgery. Wideochir Inne Tech Maloinwazyjne 2015; 10:437-41. [PMID: 26649092 DOI: 10.5114/wiitm.2015.54055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/15/2015] [Accepted: 06/19/2015] [Indexed: 12/18/2022] Open
Abstract
Introduction Laparoscopy has been a standard procedure in most medical centres providing surgical services for many years. Both the range and number of laparoscopic procedures performed are constantly increasing. Over the last decade, laparoscopic procedures have been successfully applied both in emergency and oncological surgery. However, treatment costs have become a more important factor in choosing between open or laparoscopic procedures. Aim To present the total real costs of open and laparoscopic cholecystectomy, appendectomy and sigmoidectomy. Material and methods Between 1 May 2010 and 30 March 2015 in the Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, and in the Department of General Surgery of the Saint John of God Hospital, Lodz, doctors performed 1404 cholecystectomies, 392 appendectomies and 88 sigmoidectomies. A total of 97% of the cholecystectomy procedures were laparoscopic and 3% were open. Similarly, 22% of total appendectomies were laparoscopic and 78% were open, while 9% of sigmoidectomies were laparoscopic and 91% open. Results The requirement for single-use equipment in laparoscopic procedures increases the expense. However, after adding up all other costs, surprisingly, differences between the costs of laparoscopic and open procedures ranged from 451 PLN/€ 114 for laparoscopic operations to 611 PLN/€ 153 for open operations. Conclusions Laparoscopic cholecystectomy, considered the standard surgery for treating gallbladder diseases, is cheaper than open cholecystectomy. Laparoscopic appendectomy and sigmoidectomy are safe methods of minimally invasive surgery, slightly more expensive than open operations. Of all the analyzed procedures, one-day laparoscopic cholecystectomy is the most profitable. The costs of both laparoscopic and open sigmoidectomy are greatly underestimated in Poland.
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Abstract
PURPOSE We aimed to investigate the relationship between the number of prior episodes of diverticulitis and outcomes of sigmoid colectomy. METHODS After institutional review board approval, a retrospective review was undertaken based on records of patients who underwent sigmoid resection with anastomosis for diverticulitis between 4 May 2007 and 29 February 2012. Patients were divided into two groups: 0-3 attacks (group 1) and ≥4 attacks (group 2). Statistical analyses were performed to determine whether the groups differed on demographic, intra-operative and postoperative variables. RESULTS We identified 247 patients who underwent sigmoid colectomy for diverticulitis (45 open, 202 laparoscopic). The two groups did not differ significantly in age, gender, American Society of Anesthesiologists score, past surgical history, body mass index, length of stay, use of a stoma or number of prior hospitalizations for diverticulitis. Group 1 had a higher rate of abscesses (30.6 vs 6.8%, P < 0.001) and fistulas (19.4 vs 0.9%, P < 0.001); a longer operative time (190.1 vs 166.3 min, P = 0.0024); and higher rates of postoperative complications (45.8 vs 23.3%, P < 0.001) and conversion (17.1 vs 4.4%, P = 0.0091). The most common surgical complications in groups 1 and 2 were wound infection (35 vs 10) and ileus (20 vs 8). Based on multivariate regression analysis, ≥4 attacks were independently correlated with a lower complication rate (odds ratio = 0.512, 95% confidence interval = 0.266-0.987, P = 0.046). CONCLUSIONS Patients who had ≥4 previous attacks of diverticulitis had fewer postoperative complications.
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Affiliation(s)
- Shota Takano
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Simoglou C, Gymnopoulou E, Simoglou L, Gymnopoulou M, Nikolaou K, Gymnopoulos D. Surgery for colorectal cancer in the small town of Komotini. J Multidiscip Healthc 2012; 5:273-6. [PMID: 23152685 PMCID: PMC3496519 DOI: 10.2147/jmdh.s30554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Here we report our experience in treating colon cancer in the 5 years from 200 to 2011. Our surgical clinic treated 49 patients with colorectal cancer, of whom 28 (57.14%) were men of mean age 62 years and 21 (42.86%) were women of mean age 66 years. Methods In 15 cases, the cancer was related to the rectum (30.61%) and the remaining 34 cases (69.39%) were related to the colon. We found synchronous cancer in two patients. One was found in the blank and the upper right while the second was found in the transverse and sigmoid colon. Six of our patients suffered from coexisting biliary lithiasis and underwent simultaneous cholecystectomy, and simultaneous bile duct exploration for common bile duct lithiasis was performed in one of these patients. Results Twenty-eight of the patients with colon cancer were treated surgically on an emergency basis. There were two postoperative deaths due to septic shock and multiple organ failure. In total, we noted seven complications, all of which involved patients who had undergone emergency surgery. The length of hospital stay was 8–14 days. Four patients with stage IV disease died 2 years after surgery, and the remainder are still alive. Conclusion We conclude that colon cancer still occurs after the sixth decade, with a male predominance, and is mainly located in the rectum and sigmoid colon. The high rate of ileus in our region indicates inadequate diagnostic access for the residents of our region. However, mortality remains low.
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Abstract
Laparoscopy surgery has achieved wide acceptance for the treatment of benign disease of the colon. A review of the literature regarding the indications, surgical technique, and outcomes of laparoscopic surgery for diverticular disease is presented.
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Affiliation(s)
- Sergio Larach
- Department of Surgery, Colon and Rectal Disease Center, University of Florida, Orlando, FL 32804, USA.
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Sanchez JE, Rasheid SH, Krieger BR, Frattini JC, Marcet JE. Laparoscopic-assisted transvaginal approach for sigmoidectomy and rectocolpopexy. JSLS 2009; 13:217-20. [PMID: 19660219 PMCID: PMC3015929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Laparoscopic-assisted colonic resection has been well described for multiple surgical indications. This typically requires an abdominal incision for specimen removal that is associated with the majority of postoperative pain. We describe the first laparoscopic-assisted transvaginal approach for sigmoidectomy and rectocolpopexy for the treatment of rectal prolapse. METHODS Mobilization of the sigmoid colon was performed laparoscopically using a 12-mm vaginal port and 3 additional 5-mm abdominal ports. A laparoscopic stapler was used through the vaginal port to transect the distal sigmoid colon. The specimen was subsequently externalized through the colpotomy to complete the resection and prepare the remaining bowel for intracorporeal, end-to-end, stapled anastomosis. The colpotomy was then repaired, and the colorectal anastomosis and rectocolpopexy were completed laparoscopically. RESULTS Sigmoidectomy and rectocolpopexy were successfully performed laparoscopically by using a transvaginal approach without the need for an abdominal incision for specimen removal. The patient had an uncomplicated postoperative course, complained of minimal pain, and was discharged home on postoperative day 3. CONCLUSIONS Laparoscopic-assisted transvaginal sigmoidectomy and rectocolpopexy is a feasible option that appears to be associated with little incisional pain and rapid recovery.
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