Diverticular disease and posture during defecation : a prospective comparative study

BACKGROUND AND STUDY AIMS

Although several factors are thought to be responsible for the development of colonic diverticulosis (CD), the underlying pathogenesis is still obscure and needs clarification. The aim of this study was to determine the prevalence, location and clinical features of CD and especially to detect whether there is an association between CD and postures during defecation.

PATIENTS AND METHODS

This prospective study enrolled 757 patients. The subjects were divided into two groups as a diverticulosis group (D group, n:95) and non-diverticulosis group (non-D group, n:662).

RESULTS

The median patient age was 54.9±13.2 years. CD frequency was 12.5% (n:95). The most commonly involved part of the colon was the sigmoid colon (56.8%). Diverticula location was on the left in 45.3% (n:43), on the right in 24.2% (n:23) and on both sides of the colon in 30.5% (n:29). Patients in the D group were older (p<0.001) and were predominantly female (p:0.04). The frequency of sitting during defecation (Western type toilet) was higher in the D group compared to the non-D group (72.2% vs 53.5%; p:0.007). The use-time of a Western-type toilet was longer in the D group compared to the non-D group (p:0.04). In multivariable logistic regression analysis, age and toilet type were independent risk factors for the development of diverticulosis.

CONCLUSION

Sitting during defecation seems to increase the risk of CD.

Evaluation of three instruments for laparoscopic cholecystectomy: harmonic scalpel, bipolar vessel sealer, and conventional technique

AIM

Laparoscopy is the gold standard procedure in the surgery of gall bladder. Harmonic scalpel and bipolar vessel sealer are the other instruments for laparoscopic cholecystectomy. The aim of this study is to compare the effectiveness and safety of the three instruments for laparoscopic cholecystectomy.

METHODS

A total of 60 patients were included into the study. Patients were divided into three groups. In Group A, cystic duct and artery were sealed using laparoscopic clips and gall bladder was dissected from the hepatic bed using electrocautery. In Group B, cystic duct and artery were sealed using Harmonic scalpel and gall bladder was dissected from the hepatic bed using Harmonic scalpel. In Group C, cystic duct and artery were sealed using Bipolar vessel sealer and gall bladder was dissected from the hepatic bed using Bipolar vessel sealer. Groups were compared for the following parameters: duration of surgery, amount of drainage, cystic duct opening pressure and cost.

RESULTS

The duration of surgery was 31.5 ± 11.1 minutes in Group B, 33.1 ± 10 minutes in Group A, and 36.5 ± 9.9 in Group C; and the difference between Group B and Group C was statistically significant (P<0.04). Cystic duct opening pressure was highest in Group A which was 324.0 ± 23.4 mmHg. For all of these 3 groups total cost was found to be 900$, 2900$, 1800$ for groups A, B, and C; respectively.

CONCLUSION

In laparoscopic cholecystectomy different energy source instruments may be safe to use with a cautious dissection and sealing of the cystic duct.