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Colorectal Disease : the Official... Apr 2024
PubMed: 38590008
DOI: 10.1111/codi.16980 -
Frontiers in Surgery 2024
PubMed: 38586240
DOI: 10.3389/fsurg.2024.1400636 -
International Journal of Surgery Case... May 2024Ilea caecum Intussusception protruding to the level of anus is a rare manifestation and potentially serious condition in infants.
INTRODUCTION AND IMPORTANCE
Ilea caecum Intussusception protruding to the level of anus is a rare manifestation and potentially serious condition in infants.
CASE PRESENTATION
A four-month-old infant presented with a one-day history of non-projectile vomiting, three episodes, food contents, worsened by feeding, accompanied by intermittent low-grade fever, and one instance of passing black tarry stool. After outpatient treatment, the infant showed improvement for three days, but later the mother noticed a protruding, self-reducing anal mass, hence the suspected rectal prolapse, which was then Referred for further management.
CLINICAL DISCUSSION
Intussusception, the most frequent surgical emergency in infants and young children aged 3 to 6 months, is primarily idiopathic, with the ileocecal region being the most commonly affected (90 % of cases). However, when the intussusceptum advances to the anus, it's rare, often leading to misdiagnosis and mismanagement.
CONCLUSION
Intussusception of the colon should be added to the differential diagnosis of symptoms and the clinical picture of rectal prolapse.
PubMed: 38579601
DOI: 10.1016/j.ijscr.2024.109572 -
Journal of Robotic Surgery Apr 2024Currently, there is no consensus on the position and method for temporary ileostomy in robotic-assisted low anterior resection for rectal cancer. Herein, this study... (Comparative Study)
Comparative Study
Currently, there is no consensus on the position and method for temporary ileostomy in robotic-assisted low anterior resection for rectal cancer. Herein, this study introduced the B-type sutured ileostomy, a new temporary ileostomy technique, and compared it to the traditional one to assess its efficacy and safety. Between September 2020 and December 2022 in our centre, B-type sutured ileostomy was performed on 124 patients undergoing robotic-assisted low anterior resection for rectal cancer. A retrospective review of a prospectively collected database identified patients who underwent robotic-assisted low anterior resection for rectal cancer with a temporary ileostomy between January 2018 and December 2022. Patients who underwent B-type sutured ileostomy (B group) were matched in a 1:1 ratio with patients who underwent traditional ileostomy (Control group) using a propensity score based on age, sex, BMI, Comorbidity, American Society of Anesthesiologists (ASA) score, and Prior abdominal surgery history. Surgical and postoperative outcomes, health status, and stoma closure data were analyzed for both groups. ClinicalTrials.gov Identifier:NCT05915052. The B group (n = 118) shows advantages compared to the Control group (n = 118) regarding total operation time (155.98 ± 21.63 min vs 168.92 ± 21.49 min, p = 0.001), postoperative body pain (81.92 ± 4.12 vs 78.41 ± 3.02, p = 0.001) and operation time of stoma closure (46.19 ± 11.30 min vs 57.88 ± 11.08 min, p = 0.025). The two groups had no other notable differences. The B-type sutured ileostomy is a safe and feasible option in robotic-assisted low anterior resection for rectal cancer. The B-type sutured ileostomy may offer advantages such as shorter overall surgical duration, lighter postoperative pain, and shorter second-stage ostomy incorporation surgery. However, attention should be directed towards the occurrence of stoma prolapse.
Topics: Humans; Ileostomy; Pain, Postoperative; Postoperative Complications; Proctectomy; Propensity Score; Rectal Neoplasms; Retrospective Studies; Robotic Surgical Procedures
PubMed: 38578352
DOI: 10.1007/s11701-024-01924-8 -
Journal of Surgical Case Reports Jan 2024A defunctioning stoma is used to alleviate the consequences of anastomotic leakage after low anterior resection for rectal cancer. A loop ileostomy is often preferred...
A defunctioning stoma is used to alleviate the consequences of anastomotic leakage after low anterior resection for rectal cancer. A loop ileostomy is often preferred but may lead to dehydration and kidney injury. Here, we present a case series for an alternative: the left-sided loop colostomy. A convenience sample of four patients underwent robotic low anterior resection for rectal cancer. A complete splenic flexure mobilization and a total mesorectal excision were performed. To defunction the anastomosis, the redundant left colon was brought up to a stoma site in the left iliac fossa and matured as a loop colostomy. Two patients experienced minor stoma leaks and one also had a small prolapse, while all patients had their colostomies reversed on average 7 months after surgery without complications. There were no dehydration episodes and creatinine levels remained within baseline levels at end of follow-up (on average 18 months).
PubMed: 38576543
DOI: 10.1093/jscr/rjad709 -
International Journal of Molecular... Mar 2024High-grade hemorrhoids are usually recommended to receive operational treatments. However, these traditional surgeries are associated with severe postoperative pain. A...
High-grade hemorrhoids are usually recommended to receive operational treatments. However, these traditional surgeries are associated with severe postoperative pain. A procedure for prolapse and hemorrhoids (PPH), a circular staple device, has been developed to improve short-term outcomes, including reducing the severity of postoperative pain. PPH, compared to conventional surgery, has been associated with the incidence of anatomical anal stenosis. The causes of stenosis after PPH are not yet clear. We first analyzed the complications of our patients with PPH, and then developed a rat model to verify the tension force of PPH using Hematoxylin-eosin, Masson's trichrome, immunohistochemistry, and immunofluorescence staining. Our clinical data showed that PPH significantly improved postoperative pain, but that it resulted in higher incidences of complications, including anal stenosis, than hemorrhoidectomy. We simulated the status of PPH and developed a rat model to verify PPH's tension force, including the scarring area and the deposition of proinflammatory factors, angiogenic factors, and fibrotic factors. The tension wound histological data showed more extensive granulation tissue and inflammatory cell infiltration and a thicker epidermis than the control group on day 12 post-operation and tension treatment. In addition to IL-1β and IL-10 cytokines on day 3 and IL-1β, IL-6, and IL-10 cytokines on day 12 post-operation in the tension group, two angiogenic factors, CD31 and VEGF-A, were found to have a more significant expression on day 7 post-operation in the tension group. The mean scar area was larger and the distribution of fibrotic proteins (collagen 1, α-SMA, CTGF, and MMP2) in the tension group was significantly broader than in the control on day 12 post-operation and tension treatment. Based on the findings of our animal model, the development of a lesser tensile force for PPH to decrease the deposition of proinflammatory factors, angiogenic factors, and fibrotic factors is urgently required.
Topics: Humans; Animals; Rats; Hemorrhoids; Retrospective Studies; Interleukin-10; Constriction, Pathologic; Prolapse; Pain, Postoperative; Treatment Outcome
PubMed: 38542515
DOI: 10.3390/ijms25063543 -
Children (Basel, Switzerland) Mar 2024We aimed to compare among patients with high-type anorectal malformations (ARM): (i) short- and long-term outcomes of laparoscopic-assisted anorectoplasty (LAARP)... (Review)
Review
Short and Long-Term Outcomes of PSARP versus LAARP and Single versus Staged Repair for Infants with High-Type Anorectal Malformations: A Systematic Review and Meta-Analysis.
BACKGROUND
We aimed to compare among patients with high-type anorectal malformations (ARM): (i) short- and long-term outcomes of laparoscopic-assisted anorectoplasty (LAARP) compared to classic posterior sagittal anorectoplasty (PSARP) and (ii) the results of single-stage versus staged PSARP.
METHODS
Using a defined search strategy, two independent investigators systematically reviewed the English literature. PRISMA guidelines were followed, and meta-analysis was performed using RevMan5.3.
RESULTS
Of 567 abstracts screened, 7 papers have been included (254 pts; 121 PSARP, 133 LAARP) in the first systematic review and meta-analysis. The length of hospitalization was shortened in LAARP versus PSARP (10.9 versus 14.4 days; < 0.0001). PSARP and LAARP were comparable in terms of early postoperative complications (28.9% versus 24.7%; = ns) and rectal prolapse (21.6% versus 17.5%; = ns). At long-term follow-up, the presence of voluntary bowel movements (74.0% versus 83.5%; = ns) and the incidence of soiling (45.5% versus 47.6%; = ns) were similar in both PSARP and LAARP. Six papers (297 pts) were included in the second systematic review, with three comparative studies included in the meta-analysis (247 pts; 117 one-stage, 130 staged procedures). No significant difference in terms of presence of voluntary bowel movements after single-stage versus staged procedures (72.6% versus 67.3%; = ns) has been detected.
CONCLUSIONS
LAARP seems to be a safe and effective procedure, showing short- and long-term outcomes similar to PSARP. One-stage PSARP could be a safe alternative to the classic three-stage procedure, even for those infants with high-type ARM. Further and larger comparative studies would be needed to corroborate these partial existing data.
PubMed: 38539411
DOI: 10.3390/children11030376 -
Journal of Laparoendoscopic & Advanced... Mar 2024Indications for combined colon surgery together with other procedures include oncologic multivisceral resections and abdominal trauma. It is unclear if combining...
Indications for combined colon surgery together with other procedures include oncologic multivisceral resections and abdominal trauma. It is unclear if combining minimally invasive (MI) colon surgery with unrelated other procedures increases the risk for complications. The surgical database from two institutions during a 10-year period was queried for combined colon surgeries together with other interventions. All open cases, combined cases performed for one pathology and MI colectomies together with a minor procedure, were excluded. Median age of the 6 men and 7 women was 64.4 (range 42.7-75.4) years. Colon surgeries included right (5), sigmoid (4) transverse (1) colectomies, rectum resection (1), rectopexy (1), and colostomy reversal (1) with indications of colorectal cancer (5), diverticulitis (3), benign ileocecal mass (1), colonic volvulus (3) and rectal prolapse (1). Second procedures included two splenectomies (sarcoidosis, ITP), paraesophageal hernia repairs (4), right diaphragmatic repairs [eventration (2) and Morgagni type hernia]; cholecystectomies (2), appendectomy (acute appendicitis), duodenal wedge resection (carcinoid), reversal of a gastric bypass (Roux limb stricture) one each. Cases were done laparoscopically (7) and robotic assisted (6). In most cases only 4 trocars were used. Median OR time was 4.3 (range 2.5 to 6.6) hours. No anastomotic breakdown was observed. Combining MI colectomy and other major abdominal surgeries can be safely done and in this series did not increase morbidity or mortality but avoids a second operation. Patient selection seems important and port placement may need to be altered to achieve good exposure for both procedures.
PubMed: 38531046
DOI: 10.1089/lap.2024.0072 -
Frontiers in Surgery 2024Diastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba, which is common in the female population during pregnancy and in...
PURPOSE
Diastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba, which is common in the female population during pregnancy and in the postpartum period. The present study aimed at investigating DRA severity, risk factors and associated disorders.
METHODS
In the present cross-sectional study, a web-based questionnaire was addressed to the 23,000 members of the Women's Diastasis Association. The questionnaire comprised three parts, dedicated respectively to diastasis characteristics, possible risk factors, and related disorders. Faecal and urinary incontinences were assessed using the Wexner and ICIQ-SF score, respectively. Risk factors for diastasis severity (<3, 3-5, >5 cm) were evaluated by a multinomial regression model.
RESULTS
Four thousand six hundred twenty-nine women with a mean age (SD) of 39.8 (6.5) years and a median BMI of 23.7 kg/m (range 16.0-40.0) responded to the questionnaire. Proportion of DRA >5 cm increased from 22.8% in norm weight women to 44.0% in severely obese women, and from 10.0% in nulliparous women to 39.3% in women with >3 pregnancies. These associations were confirmed in multivariable analysis. DRA severity was associated with the risk of abdominal hernia and pelvic prolapse, whose prevalence more than doubled from women with DRA <3 cm (31.6% and 9.7%, respectively) to women with DRA >5 cm (68.2% and 20.2%). In addition, most patients reported postural pain and urinary incontinence, whose frequency increased with DRA severity.
CONCLUSION
The present study confirmed that DRA severity increases with increasing BMI and number of pregnancies. Larger separation between rectal muscles was associated with increased risk of pain/discomfort, urinary incontinence, abdominal hernia and pelvic prolapse. Prospective studies are needed to better evaluate risk factors.
PubMed: 38529469
DOI: 10.3389/fsurg.2024.1360207 -
Diseases of the Colon and Rectum Jul 2024Surgical treatment of recurrent rectal prolapse is associated with unique technical challenges, partially determined by the surgical approach used for the index...
BACKGROUND
Surgical treatment of recurrent rectal prolapse is associated with unique technical challenges, partially determined by the surgical approach used for the index operation. Success rates are variable, and data to determine the best approach in patients with recurring prolapse are lacking.
OBJECTIVE
The study aimed to assess current surgical approaches to patients with prior rectal prolapse repairs and to compare short-term outcomes of de novo and redo procedures, including recurrence of rectal prolapse.
DESIGN
Retrospective analysis of a prospective database.
SETTINGS
The Multicenter Pelvic Floor Disorders Consortium Prospective Quality Improvement database. De-identified surgeons at more than 25 sites (81% high volume) self-reported patient demographics, prior repairs, symptoms of incontinence and obstructed defecation, and operative details, including history of concomitant repairs and prior prolapse repairs.
PATIENTS
Patients who were offered surgery for full thickness rectal prolapse.
INTERVENTIONS
Incidence and type of repair used for prior rectal prolapse surgery were recorded. Primary and secondary outcomes of index and redo operations were calculated. Patients undergoing rectal prolapse re-repair (redo) were compared with patients undergoing first (de novo) rectal prolapse repair. The incidence of rectal prolapse recurrence in de novo and redo operations was quantified.
OUTCOMES
The primary outcome of rectal prolapse recurrence in de novo and redo settings.
RESULTS
Eighty-nine (19.3%) of 461 patients underwent redo rectal prolapse repair. On short-term follow-up, redo patients had prolapse recurrence rates similar to those undergoing de novo repair. However, patients undergoing redo procedures rarely had the same operation as their index procedure.
LIMITATIONS
Self-reported, de-identified data.
CONCLUSION
Our results suggest that recurrent rectal prolapse surgery is feasible and can offer adequate rates of rectal prolapse durability in the short term but may argue for a change in surgical approach for redo procedures when clinically feasible. See Video Abstract .
LOS ENFOQUES DURADEROS PARA LA REPARACIN DEL PROLAPSO RECTAL RECURRENTE PUEDEN REQUERIR EVITAR EL PROCEDIMIENTO NDICE
ANTECEDENTES:El tratamiento quirúrgico del prolapso rectal recurrente se asocia con desafíos técnicos únicos, determinados en parte por el abordaje quirúrgico utilizado para la operación inicial. Las tasas de éxito son variables y faltan datos para determinar el mejor abordaje en pacientes con prolapso recurrente.OBJETIVO:Evaluar los enfoques quirúrgicos actuales para pacientes con reparaciones previas de prolapso rectal y comparar los resultados a corto plazo de los procedimientos de novo y rehacer, incluida la recurrencia del prolapso rectal.DISEÑO:Análisis retrospectivo de una base de datos prospectiva.AJUSTE:Base de datos de mejora prospectiva de la calidad del Consorcio multicéntrico de trastornos del suelo pélvico. Cirujanos no identificados en más de 25 sitios (81% de alto volumen) informaron datos demográficos de los pacientes, reparaciones previas, síntomas de incontinencia y defecación obstruida y detalles operativos, incluido el historial de reparaciones concomitantes y reparaciones previas de prolapso.INTERVENCIONES:Se registro la incidencia y el tipo de reparación utilizada para la cirugía de prolapso rectal previa. Se calcularon los resultados primarios y secundarios de las operaciones de índice y reoperacion. Se compararon los pacientes sometidos a una nueva reparación (reoperacion) de prolapso rectal con pacientes sometidos a una primera reparación (de novo) de prolapso rectal. Se cuantificó la incidencia de recurrencia del prolapso rectal en operaciones de novo y rehacer.RESULTADOS:El resultado primario de recurrencia del prolapso rectal en entornos de novo y redo. Ochenta y nueve (19,3%) de 461 pacientes se sometieron a una nueva reparación del prolapso rectal. En el seguimiento a corto plazo, los pacientes reoperados tuvieron tasas de recurrencia de prolapso similares a los de los sometidos a reparación de novo. Sin embargo, los pacientes sometidos a procedimientos de rehacer rara vez tuvieron la misma operación que su procedimiento índice.LIMITACIONES:Datos no identificados y autoinformados.CONCLUSIONES/DISCUSIÓN:Nuestros resultados sugieren que la cirugía de prolapso rectal recurrente es factible y puede ofrecer tasas adecuadas de durabilidad del prolapso rectal en el corto plazo, pero puede abogar por un cambio en el enfoque quirúrgico para rehacer los procedimientos cuando sea clínicamente factible. (Traducción-Dr. Mauricio Santamaria ).
Topics: Humans; Rectal Prolapse; Female; Recurrence; Male; Reoperation; Retrospective Studies; Middle Aged; Aged; Treatment Outcome; Digestive System Surgical Procedures
PubMed: 38479014
DOI: 10.1097/DCR.0000000000003212