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Arab Journal of Gastroenterology : the... Mar 2015Complete surgical removal of the involved bowel segment in colorectal cancer is the most effective primary treatment. The main prognostic factors for colorectal cancer...
BACKGROUND AND STUDY AIMS
Complete surgical removal of the involved bowel segment in colorectal cancer is the most effective primary treatment. The main prognostic factors for colorectal cancer are penetration of the tumour into different layers of the bowel wall and regional lymph node involvement. Positive lavage cytology has been used to predict peritoneal recurrence, but its effectiveness remains controversial. This study was conducted to assess the prevalence of positive peritoneal lavage cytology in correlation with the tumour stage in patients with colorectal cancer.
PATIENTS AND METHODS
This prospective cross-sectional study was performed on 20 patients with different cases of colorectal cancer attending the colorectal unit and emergency department of the Kasr Al Ainy Hospital, Cairo University Hospitals, from March 2012 to March 2013.
RESULTS
The patients' gender did not influence the peritoneal lavage cytology results (p = 0.062); there is no significant correlation between the TNM staging system and cytology in patients with colorectal cancer (p = 0.253).
CONCLUSION
Although there is a positive linear correlation between the tumour stage and positive peritoneal lavage cytology, it did not reach a statistically significant level. In addition, the greater the depth of invasion, the higher the lavage cytology rate. However, this trend was not statistically significant.
Topics: Age Factors; Aged; Biopsy, Needle; Colorectal Neoplasms; Cross-Sectional Studies; Cytodiagnosis; Egypt; Female; Humans; Immunohistochemistry; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Peritoneal Cavity; Peritoneal Lavage; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Sensitivity and Specificity; Sex Factors
PubMed: 25817827
DOI: 10.1016/j.ajg.2015.02.002 -
The Veterinary Record May 2017A prospective, randomised, non-blinded, clinical study to assess the effect of peritoneal lavage using warmed fluid on body temperature in anesthetised cats and dogs of... (Randomized Controlled Trial)
Randomized Controlled Trial
A prospective, randomised, non-blinded, clinical study to assess the effect of peritoneal lavage using warmed fluid on body temperature in anesthetised cats and dogs of less than 10 kg body mass undergoing coeliotomy. A standardised anaesthetic protocol was used. Oesophageal and rectal temperatures were measured at various time points. At the end of surgery, group 1 patients (n=10) were lavaged with 200 ml/kg sterile isotonic saline at 34±1°C and group 2 (n=10) at 40±1°C. Groups were similar with respect to age, mass, body condition and surgical incision length. Duration of anaesthesia, surgical procedures and peritoneal lavage was similar between groups. Linear regression showed no significant change in oesophageal temperature during the lavage period for group 1 (P=0.64), but a significant increase for group 2 patients (P<0.0001), with mean temperature changes of -0.5°C (from (36.3°C to 35.9°C) and +0.9°C (from 35.4°C to 36.3°C), respectively. Similar results were found for rectal temperature, with mean changes of -0.5°C and +0.8°C (P=0.922 and 0.045), respectively. The use of isotonic crystalloid solution for peritoneal lavage at a temperature of 40±1°C significantly warms small animal patients, when applied in a clinical setting, compared with lavage solution at 34±1°C.
Topics: Anesthesia; Animals; Body Temperature; Cats; Dogs; Peritoneal Lavage; Prospective Studies; Solutions; Temperature; Treatment Outcome
PubMed: 28283668
DOI: 10.1136/vr.103894 -
Surgical Laparoscopy, Endoscopy &... Apr 2017Diverticular disease is a first-class health care problem and one of the most common gastrointestinal disorders in western industrialized countries, causing significant... (Review)
Review
BACKGROUND/AIM
Diverticular disease is a first-class health care problem and one of the most common gastrointestinal disorders in western industrialized countries, causing significant morbidity and mortality. In this review of the literature, we aim to assess the feasibility and effectiveness of the laparoscopic approach in both elective and emergency setting of diverticular disease.
MATERIALS AND METHODS
A bibliographic search of articles was performed using the electronic database Medline from PubMed. Of 341 articles identified, 279 were excluded, resulting in 62 full-text articles for review. Our final review included 16 articles.
RESULTS
The 16 articles included in the final review consisted of 6 retrospective studies, 5 prospective studies, 2 randomized controlled trials, 1 systematic review and meta-analysis, and 2 systematic reviews. Seven articles considered elective laparoscopic sigmoid resection, 7 articles evaluated laparoscopic peritoneal lavage, and 2 articles considered emergency laparoscopic sigmoid resection for perforated diverticulitis. The elective laparoscopic approach is feasible and safe. Laparoscopic peritoneal lavage has emerged as a safe and effective minimally invasive procedure for the treatment of perforated diverticulitis. Furthermore, in selected patients, emergency laparoscopic sigmoidectomy could also be feasible for perforated diverticulitis with generalized peritonitis.
CONCLUSIONS
Laparoscopic approach can be a safe and effective option in both elective and emergency setting of diverticular disease. Large, prospective, randomized studies should be conducted to confirm these findings.
Topics: Adult; Aged; Aged, 80 and over; Diverticulitis, Colonic; Elective Surgical Procedures; Emergency Treatment; Epidemiologic Methods; Humans; Laparoscopy; Middle Aged; Young Adult
PubMed: 28212260
DOI: 10.1097/SLE.0000000000000386 -
Journal of Visceral Surgery Apr 2019
Review
If you must operate on a patient presenting with purulent peritonitis secondary to sigmoid diverticular perforation…do not throw the baby out with the bathwater, not yet….
Topics: Anastomosis, Surgical; Clinical Competence; Conservative Treatment; Contraindications, Procedure; Drainage; Humans; Intestinal Perforation; Laparoscopy; Patient Selection; Peritoneal Lavage; Peritonitis; Practice Guidelines as Topic; Sigmoid Diseases; Suppuration
PubMed: 30241908
DOI: 10.1016/j.jviscsurg.2018.08.008 -
Updates in Surgery Feb 2022This study aims to synthesize the benefits of surgery plus extensive intraoperative peritoneal lavage (EIPL) for patients with gastric cancer compared with surgery... (Meta-Analysis)
Meta-Analysis Review
The benefits of surgery plus extensive intraoperative peritoneal lavage (EIPL) for patients with gastric cancer compared with surgery alone: a systematic review and meta-analysis.
This study aims to synthesize the benefits of surgery plus extensive intraoperative peritoneal lavage (EIPL) for patients with gastric cancer compared with surgery alone. We searched Pubmed, Embase, Web of Science, Cochrane library, ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (ICTRP) for randomized controlled trials from 2000 to 2021 according to the inclusion and exclusion criteria. The reference lists of studies meeting the criteria were also screened for additional studies. The quality of these studies was assessed by the Cochrane Collaboration Risk of Bias Tool. An inverse-variance random-effects model of DerSimonian and Laird was used to synthesize the HRs and corresponding 95% CIs of short-term outcomes: hospital mortality and postoperative complications. For long-term outcomes (peritoneal recurrence and 3-year or 5-year overall survival rate), narrative synthesis was used. 4 of 43 studies were included for quantitative analysis. For short-term outcomes, the pooled HRs of hospital mortality and postoperative complications are 0.422 (95%CI: 0.037, 4.790) and 0.774 (95%CI: 0.376, 1.592). For long-term outcomes, despite the inconsistent results, patients receiving EPIL did not have reduced peritoneal recurrence and 3-year or 5-year overall survival rate. Compared with surgery alone, surgery plus EIPL does not have more benefits for patients with gastric cancer.
Topics: Humans; Peritoneal Lavage; Postoperative Complications; Stomach Neoplasms; Survival Rate
PubMed: 34170498
DOI: 10.1007/s13304-021-01120-5 -
Gastric Cancer : Official Journal of... Mar 2020The long-term outcomes of type 4 and large type 3 gastric cancer patients with positive peritoneal lavage cytology (CY1) remain unsatisfying. We evaluated our treatment...
Conversion therapy for peritoneal lavage cytology-positive type 4 and large type 3 gastric cancer patients selected as candidates for R0 resection by diagnostic staging laparoscopy.
BACKGROUND
The long-term outcomes of type 4 and large type 3 gastric cancer patients with positive peritoneal lavage cytology (CY1) remain unsatisfying. We evaluated our treatment strategy of conversion therapy for CY1 patients without peritoneal dissemination (P0).
METHODS
Diagnostic staging laparoscopy (DSL) was performed before treatment. Chemotherapy was applied for DSL-diagnosed P0CY1. The re-evaluation of peritoneal metastasis by staging laparoscopy (re-SL) was performed when a response to chemotherapy was identified by gastroscopy and/or CT. Gastrectomy with radical lymphadenectomy was applied as conversion therapy when peritoneal lavage cytology-negative (CY0) and P0 were diagnosed with re-SL, with the aim of achieving R0 resection. Chemotherapy was continued as palliative treatment in patients for whom re-SL was not applicable or when re-SL did not confirm P0CY0. The long-term outcomes were retrospectively evaluated.
RESULTS
Between 2009 and 2015, 214 patients with type 4 and large type 3 gastric cancer underwent DSL in the Cancer Institute Hospital. Thirty-nine patients were initially diagnosed with P0CY1. Seven patients received palliative gastrectomy first due to outlet obstruction or other reasons. Thirty-two patients received chemotherapy first. Among them, 13 patients underwent gastrectomy as conversion therapy and 19 were treated with palliative chemotherapy. The 3-year survival rate of patients who underwent conversion therapy, palliative chemotherapy and palliative gastrectomy was 76.9% [95% confidence interval (CI) 47.8-92.4%], 10.5% (95% CI 1.9-42.3%), and 0%, respectively.
CONCLUSION
Conversion therapy might be a promising treatment for P0CY1 type 4 and large type 3 gastric cancer patients. Re-SL was useful for selecting candidates for R0 resection.
Topics: Adult; Aged; Aged, 80 and over; Cytodiagnosis; Female; Follow-Up Studies; Gastrectomy; Humans; Laparoscopy; Lymph Node Excision; Male; Middle Aged; Neoplasm Staging; Peritoneal Lavage; Peritoneal Neoplasms; Retrospective Studies; Stomach Neoplasms; Survival Rate; Young Adult
PubMed: 31350702
DOI: 10.1007/s10120-019-00994-0 -
Inflammopharmacology Apr 2023Intraperitoneal adhesion formation is a significant problem following surgeries, resulting in substantial clinical and economic consequences. Glycyrrhiza glabra has...
BACKGROUND
Intraperitoneal adhesion formation is a significant problem following surgeries, resulting in substantial clinical and economic consequences. Glycyrrhiza glabra has several pharmacological properties consisting of anti-inflammatory, anti-microbial, anti-oxidant, anti-cancer, and immunomodulatory activities.
AIM
Therefore, we aimed to investigate the impacts of G. glabra on the development of post-operative abdominal adhesion in a rat model.
METHODS
Male Wistar rats weighing 200-250 g were divided into six groups (n = 8): Group 1: normal group (non-surgical), and the surgical groups including Group 2: control group received the vehicle, Group 3: G. glabra 0.5% w/v, Group 4: G. glabra 1% w/v, Group 5: G. glabra 2% w/v, and Group 6: dexamethasone, 0.4% w/v. The intra-abdominal adhesion was performed utilizing soft sterilized sandpaper on one side of the cecum, and the peritoneum was slightly washed with 2 ml of the extract or vehicle. In addition, macroscopic examination of adhesion scoring and the levels of inflammatory mediators [interferon (IFN)-γ, prostaglandin E (PGE)], fibrosis markers [interleukin (IL)-4, transforming growth factor (TGF)-ꞵ], and oxidative factors [malondialdehyde (MDA), nitric oxide metabolites (NO), and reduced glutathione (GSH)] were evaluated. In vitro toxicities were also done on mouse fibroblast L929 and NIH/3T3 cell lines.
RESULTS
We found higher levels of adhesion (P < 0.001), IFN-γ(P < 0.001), PGE(P < 0.001), IL-4(P < 0.001), TGF-β(P < 0.001), MDA(P < 0.001), and NO(P < 0.001), and lower levels of GSH(P < 0.001) in the control group. In contrast, G. glabra concentration dependent and dexamethasone alleviated the levels of adhesion (P < 0.05), inflammatory mediators (P < 0.001-0.05), fibrosis (P < 0.001-0.05), and oxidative (P < 0.001-0.05) factors, while propagating the anti-oxidant marker (P < 0.001-0.05) in comparison to the control group. Results also showed that the extract did not significantly reduce cell viability up to 300 µg/ml (P > 0.05).
CONCLUSION
G. glabra could concentration-dependently mitigate peritoneal adhesion formation through its anti-inflammatory, anti-fibrosis, and anti-oxidant properties. However, further clinical investigations are required to approve that G. glabra may be a promising candidate against post-surgical adhesive complications.
Topics: Mice; Rats; Male; Animals; Rats, Wistar; Peritoneal Lavage; Antioxidants; Plant Extracts; Glycyrrhiza; Inflammation Mediators; Dexamethasone
PubMed: 36862226
DOI: 10.1007/s10787-023-01139-7 -
African Journal of Paediatric Surgery :... 2022Appendicitis is one of the most common paediatric surgical pathologies seen by paediatric surgeons worldwide. Laparoscopic appendectomy is undertaken for all cases of...
AIM
Appendicitis is one of the most common paediatric surgical pathologies seen by paediatric surgeons worldwide. Laparoscopic appendectomy is undertaken for all cases of appendicitis in our institute. Intraperitoneal lavage following appendectomy is the conventional way of managing complicated appendicitis; however, some surgeons debate the efficacy of this practice. The aim of this study was to compare outcomes of intraperitoneal lavage versus suction only in children with complicated appendicitis.
METHODS
Data were collected retrospectively between January 2018 and January 2019. All patients undergoing laparoscopic appendectomy for complex appendicitis were included and divided into two groups, patients who had suction only and those who had lavage and suction. Outcome parameters studied were the length of stay (LOS), number of temperature spikes > 37.7 (TS), operative times (OT) and readmission for intra-abdominal collections. Comparison between the two groups was performed using two sample t-test with unequal variance, significance was set at P < 0.05.
RESULTS
A total of 115 patients were included (lavage n = 52, Suction n = 63). The LOS (P = 0.0054), TS (0.0109), OT (P < 0.0001) were significantly higher in the lavage group compared to the suction-only group. Overall rates of readmission were similar between groups, however, readmission for the confirmed intra-abdominal collection was more common in the lavage group.
CONCLUSION
Based on our study, it appears that there is no advantage in performing an intraperitoneal lavage for complex appendicitis. It resulted in a prolonged stay, more post-operative TS and longer operative duration. The likelihood of being readmitted with an intra-abdominal collection following a lavage was higher compared to suction only.
Topics: Appendectomy; Appendicitis; Child; Humans; Laparoscopy; Length of Stay; Morbidity; Peritoneal Lavage; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 36018206
DOI: 10.4103/ajps.ajps_146_21 -
Journal of Gastrointestinal Surgery :... Sep 2017Perforated diverticulitis carries the risk of significant comorbidity and mortality. Although colon resection provides adequate source control, the procedure itself... (Comparative Study)
Comparative Study Meta-Analysis Review
IMPORTANCE
Perforated diverticulitis carries the risk of significant comorbidity and mortality. Although colon resection provides adequate source control, the procedure itself carries morbidity, as well as later stoma reversal procedures. The effectiveness of laparoscopic lavage to treat perforated diverticulitis remains unclear.
OBJECTIVE
We aimed to conduct a meta-analysis to evaluate current studies comparing laparoscopic lavage with colon resection in cases of perforated diverticulitis for the effectiveness in source control, without the need for subsequent interventions, stoma formation, and death.
DATA SOURCES
Electronic database searches were conducted using EMBASE, Pubmed, CINAHL, Cochrane databases, and clinicaltrials.gov following PRISMA guidelines.
STUDY SELECTION
Randomized controlled trials (RCTs) were included that compared laparoscopic lavage against colon resection for perforated diverticulitis.
DATA EXTRACTION AND SYNTHESIS
Risk of bias in RCT's was assessed the Cochrane Assessment of Bias risk tool and Jadad scale. A meta-analysis was performed using random-effects risk ratios (RR) and 95% confidence intervals (CI).
MAIN OUTCOME
Outcome measures included the total rate of reoperation, rate of reoperation for infection, need for subsequent percutaneous drainage, stoma formation, and mortality rate within 90 days.
RESULTS
Three eligible randomized controlled studies were identified, with a combined total of 372 patients. Laparoscopic lavage carried an increased rate of total reoperations (RR 2.07; CI 1.12-3.84; p = 0.021) and an increased rate of reoperation for infection (RR 5.56; CI 1.97-15.69; p = 0.001) compared with colon resection. In addition, laparoscopic lavage increased the rate of subsequent percutaneous drainage (RR 6.54; CI 1.77-24.16; p = 0.005) compared with colon resection, but a lesser risk of stoma formation within 90 days (RR 0.18; CI 0.12-0.27; p < 0.001). No difference in mortality rate was observed between treatments (RR 1.03; CI 0.45-2.34; p = 0.950).
CONCLUSION
Despite decreased rates of stoma formation and equivalent mortality rates as compared with colon resection, laparoscopic lavage for Hinchey III diverticulitis fails to completely control the source of infection. Our data show that laparoscopic lavage is associated with increased rates of total reoperations, increased rates of reoperation for infections, and need for subsequent percutaneous drainage.
Topics: Colectomy; Diverticulitis, Colonic; Drainage; Humans; Intestinal Perforation; Laparoscopy; Peritoneal Lavage; Peritonitis; Randomized Controlled Trials as Topic; Reoperation; Surgical Stomas
PubMed: 28608041
DOI: 10.1007/s11605-017-3462-6 -
International Journal of Molecular... Nov 2023The omentum is the predominant site of ovarian cancer metastasis, but it is difficult to remove the omentum in its entirety. There is a critical need for effective... (Review)
Review
The omentum is the predominant site of ovarian cancer metastasis, but it is difficult to remove the omentum in its entirety. There is a critical need for effective approaches that minimize the risk of colonization of preserved omental tissues by occult cancer cells. Normal saline (0.9% sodium chloride) is commonly used to wash the peritoneal cavity during ovarian cancer surgery. The omentum has a prodigious ability to absorb fluid in the peritoneal cavity, but the impact of normal saline on the omentum is poorly understood. In this review article, we discuss why normal saline is not a biocompatible solution, drawing insights from clinical investigations of normal saline in fluid resuscitation and from the cytopathologic evaluation of peritoneal washings. We integrate these insights with the unique biology of the omentum and omental metastasis, highlighting the importance of considering the absorptive ability of the omentum when administering agents into the peritoneal cavity. Furthermore, we describe insights from preclinical studies regarding the mechanisms by which normal saline might render the omentum conducive for colonization by cancer cells. Importantly, we discuss the possibility that the risk of colonization of preserved omental tissues might be minimized by using balanced crystalloid solutions for peritoneal washing.
Topics: Humans; Female; Saline Solution; Peritoneal Cavity; Peritoneal Neoplasms; Peritoneal Lavage; Ovarian Neoplasms
PubMed: 38003636
DOI: 10.3390/ijms242216449