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Frontiers in Pediatrics 2024During the second stage surgery for anorectal malformations (ARM), patients whose distal intestine of the colostomy is particularly short underwent laparoscopic-assisted...
PURPOSE
During the second stage surgery for anorectal malformations (ARM), patients whose distal intestine of the colostomy is particularly short underwent laparoscopic-assisted distal colon excision and proximal colon pull-through anorectoplasty (PCPARP). This study aimed to discuss the outcomes of PCPARP after colostomy in patients with ARM.
METHODS
This is a single-center propensity score-matched (PSM) study which was retrospectively initiated patients with intermediate- or high-type ARM who underwent laparoscopic surgery from June 2007 to December 2018. These patients were divided into PCPARP group and conventional laparoscopic-assisted anorectoplasty (LAARP) group according to specific surgical methods. The general data, surgical data, postoperative complications, and functional results were evaluated.
RESULTS
In total, 216 patients were included in this study: 190 (88.0%) undergoing LAARP approach and 26 (12.0%) undergoing PCPARP approach. After PSM, two well-balanced groups of 26 patients were analyzed and showed the postoperative complications ( = 0.126) and bowel function ( = 0.809) were similiar between the two groups.
CONCLUSIONS
The curative effect of PCPARP after colostomy is similar to that of classic LAARP surgery, which can be used for ARM patients with a very short and abnormal distal intestine of the stoma.
PubMed: 38798309
DOI: 10.3389/fped.2024.1402666 -
Medicine May 2024To determine the distal resection margin in sphincter-sparing surgery in patients with low rectal cancer based on imaging of large pathological sections.
OBJECTIVE
To determine the distal resection margin in sphincter-sparing surgery in patients with low rectal cancer based on imaging of large pathological sections.
METHODS
Patients who underwent sphincter-sparing surgery for ultralow rectal cancer at Guangxi Medical University Cancer Hospital within the period from January 2016 to March 2022 were tracked and observed. The clinical and pathological data of the patients were collected and analyzed. The EVOS fluorescence automatic cell imaging system was used for imaging large pathological sections. Follow-up patient data were acquired mainly by sending the patients letters and contacting them via phone calls, and during outpatient visits.
RESULTS
A total of 46 patients (25 males, 21 females) aged 27 to 86 years participated in the present study. Regarding clinical staging, there were 9, 10, 16, and 10 cases with stages I, II, III, and IV low rectal cancer, respectively. The surgical time was 273.82 ± 111.51 minutes, the blood loss was 123.78 ± 150.91 mL, the postoperative exhaust time was 3.67 ± 1.85 days, and the postoperative discharge time was 10.36 ± 5.41 days. There were 8 patients with complications, including 3 cases of pulmonary infection, 2 cases of intestinal obstruction, one case of pleural effusion, and one case of stoma necrosis. The longest and shortest distal resection margins (distances between the cutting edges and the tumor edges) were 3 cm and 1 cm, respectively. The minimum length of the extension areas of the tumor lesions in the 46 images of large pathological sections was 0.1 mm, and the maximum length was 15 mm. Among the tumor lesions, 91.30% (42/46) had an extension area length of ≤5 mm, and 97.83% (45/46) had an extension area length of ≤10 mm. The length of the extension zone was not related to clinical pathological parameters (P > .05).
CONCLUSION
In the vast majority of cases, the distal resection margin was at least 1 cm; thus, "No Evidence of Disease" could have been achieved. Additional high-powered randomized trials are needed to confirm the results of the present study.
Topics: Humans; Rectal Neoplasms; Male; Middle Aged; Female; Margins of Excision; Aged; Adult; Aged, 80 and over; Neoplasm Staging; Organ Sparing Treatments; Postoperative Complications; Operative Time
PubMed: 38787988
DOI: 10.1097/MD.0000000000038083 -
Ethiopian Journal of Health Sciences Nov 2023Gangrenous sigmoid volvulus has a significant impact on morbidity and mortality. This study was conducted to compare sigmoid resection and primary anastomosis (RPA) with... (Meta-Analysis)
Meta-Analysis Comparative Study Review
BACKGROUND
Gangrenous sigmoid volvulus has a significant impact on morbidity and mortality. This study was conducted to compare sigmoid resection and primary anastomosis (RPA) with sigmoid resection and end colostomy (Hartmann's procedure) for gangrenous sigmoid volvulus.
METHODS
A systematic review and meta-analysis study design was employed to summarize retrospective cohort, prospective cohort, and randomised control trial studies published from inception to march 31, 2023. Searching was performed on Medline, CINAHAL, Web of Science, Google Scholar, the Cochrane Library, and ClinicalTrials.gov to locate eligible articles. Data searching, selection and screening, quality assessment of the included articles, and data extraction were done by two separate reviewers. RevMan 5.4 software with a fixed-effect Mantel-Haenszel model and Stata version 14 were used to analyze the data. The protocol registered on PROSPERO registration website (CRD42023413367).
RESULTS
Ten cohort studies and one randomised control trial with 724 patients were found; all of them were rated as being of moderate quality. The overall mortality after RPA was 15% (95%CI: 11-19%), and after Hartmann's procedure it was 19% (95%CI: 15-23%). Resection and primary anastomosis (RPA) for gangrenous sigmoid volvulus had slightly lower mortality rate than stoma (OR=0.98(95%CI: 0.68-1.42), p=0.07, I=43%), which had no statistically significant difference. Resection and primary anastomosis (RPA) had a slightly higher morbidity rate than Hartmann's procedure (OR=1.01(95%CI: 0.66-1.55), p=0.30, I=18%), which had no statistically significant difference.
CONCLUSION
Sigmoid resection and primary anastomosis (RPA) and Hartmann's procedure had no significant differences in mortality and morbidity for the treatment of gangrenous sigmoid volvulus. Choice of the intervention for gangrenous sigmoid volvulus should be individualized with consideration of different detrimental factors.
Topics: Humans; Intestinal Volvulus; Anastomosis, Surgical; Colostomy; Gangrene; Colon, Sigmoid; Sigmoid Diseases
PubMed: 38784481
DOI: 10.4314/ejhs.v33i6.19 -
Cureus Apr 2024Foreign bodies are encountered relatively often within the practice of general surgery. We present a unique case of a rubber, self-retaining, radiopaque "mushroom-tip"...
Foreign bodies are encountered relatively often within the practice of general surgery. We present a unique case of a rubber, self-retaining, radiopaque "mushroom-tip" Malecot tube placed for fistula drainage control due to an enterocutaneous fistula (ECF) that became a gastrointestinal foreign body. A 24-year-old male presented in shock with gunshot wounds to his right chest and right upper abdomen to a Level I trauma center. He required a prolonged hospital stay with additional urological and thoracic procedures and an interventional radiology procedure for hepatic pseudoaneurysm and subsequently developed an ECF. The patient was discharged to a rehabilitation facility with a wound management system (WMS) for ECF drainage but returned to the clinic with chemical burns and skin excoriation due to poorly controlled output and suboptimal WMS fit. A better fitting WMS was employed and a 20-French Malecot catheter was placed to assist with drainage control. The patient later returned with abdominal pain reporting the Malecot advanced forward spontaneously and was not externally visible. CT scan revealed the Malecot across the prior ileocolic anastomosis. After considering potential treatment options, we initially proceeded with aggressive bowel stimulation, and saline enemas hoping the tube would pass through his colostomy. He was discharged and the catheter passed at home a few days later via the stoma. Gastroenterological literature recommends invasive management for sharp, corrosive, or elongated foreign bodies exceeding 6cm in length. This unusual case demonstrates a 30-centimeter (cm) blunt object passing through the small bowel and colon in the absence of an ileocecal valve.
PubMed: 38770488
DOI: 10.7759/cureus.58630 -
Gastroenterology Report 2024Strictures are a common complication after ileal pouch surgery with the most common locations being at the anastomosis, pouch inlet, and stoma closure site. No previous...
BACKGROUND
Strictures are a common complication after ileal pouch surgery with the most common locations being at the anastomosis, pouch inlet, and stoma closure site. No previous literature has described endoscopic therapy of stoma site stricture. This study aimed to assess the safety and efficacy of endoscopic therapy in the treatment of stoma closure site strictures.
METHOD
Patients diagnosed with stoma closure site strictures following ileal pouch surgery who underwent endoscopic treatment at the Center for Colorectal Diseases, Inflammatory Bowel Disease (IBD), and Ileal Pouch between 2018 and 2022 were analysed. Primary outcomes (technical success and surgery-free survival) were compared between endoscopic balloon dilation (EBD) and stricturotomy and/or strictureplasty.
RESULTS
A total of 30 consecutive eligible patients were analysed. Most patients were female (66.7%) and most patients were diagnosed with IBD (93.3%). Twenty patients (66.7%) had end-to-end anastomosis. A total of 52 procedures were performed, with EBD in 16 (30.8%) and stricturotomy and/or strictureplasty in 36 (69.2%). The mean stricture length was 1.7 ± 1.0 cm. Immediate technical success was achieved in 47 of 52 interventions (90.4%). During a mean follow-up of 12.7 ± 9.9 months, none of the patients underwent surgical intervention for the stricture. Fourteen (46.7%) required endoscopic re-intervention for their strictures with an interval between index and re-interventional pouchoscopy of 8.8 ± 6.3 months. Post-procedural complications were reported in 2 (6.7%) with bleeding and none with perforation. Upon follow-up, 20 (66.7%) patients reported improvement in their symptoms.
CONCLUSION
EBD and endoscopic stricturotomy and/or strictureplasty are safe and effective in treating stoma closure site strictures in patients with ileal pouches, providing symptomatic relief in most patients as well as avoiding surgery.
PubMed: 38766493
DOI: 10.1093/gastro/goae038 -
Cureus Apr 2024Background Hartmann's procedure (HP) is performed for colorectal perforation to avoid the risk of anastomotic leakage. Few reports have compared the safety between...
Background Hartmann's procedure (HP) is performed for colorectal perforation to avoid the risk of anastomotic leakage. Few reports have compared the safety between primary anastomosis without diverting stoma (PAWODS) and HP for colorectal perforation, and whether PAWODS or HP should be performed has remained controversial. We aimed to investigate the feasibility and safety of performing PAWODS in comparison to HP for colorectal perforation. Methods The data of 97 consecutive patients with colorectal perforation who underwent surgery from April 2010 to December 2020 were collected retrospectively. PAWODS and HP were performed in 51 and 46 patients, respectively. Univariate and multivariate analyses were performed to compare the clinical characteristics and postoperative outcomes of patients treated with PAWODS with those treated with HP. Results In the multivariate analysis, low serum albumin (hazard ratio (HR)=3.49; 95%CI=1.247-9.757; P=0.017) and left-sided colon and rectum perforation (HR=16.8; 95%CI=1.792-157.599; P=0.014) were significantly associated with the decision to perform HP. There was a significant difference in the mortality of the two groups (PAWODS vs. HP: 0% vs. 8.7%; P=0.047). The severe morbidity rate (Clavien-Dindo III-V) was significantly higher in the HP group (PAWODS vs. HP: 10% vs. 30%; P=0.020). In the PAWODS group, anastomotic leakage occurred in five of 51 patients (9.8%), four (8.7%) of whom required re-operation. Conclusions In appropriately selected patients, PAWODS could be safely performed with an acceptable rate of anastomotic leakage. The serum albumin level and site of perforation may be simple and useful factors for guiding decision-making on the surgical procedure.
PubMed: 38756300
DOI: 10.7759/cureus.58402 -
Health Science Reports May 2024Enterocutaneous fistula is a severe complication of an open abdomen, which poses devastating challenges for critical care nurses. The study aimed to explore and describe...
BACKGROUND AND AIMS
Enterocutaneous fistula is a severe complication of an open abdomen, which poses devastating challenges for critical care nurses. The study aimed to explore and describe the challenges faced by critical care nurses caring for patients with enterocutaneous fistulas in a tertiary public hospital in Gauteng, South Africa.
METHODS
A qualitative, exploratory, descriptive, and contextual design was conducted to understand the challenges experienced by the critical care nurses caring for patients with enterocutaneous fistulas. The standards for reporting qualitative research checklists are utilized. The study conducted four semistructured focus group interviews with six members in each group.
RESULTS
Critical care nurses revealed two overarching themes: the challenges regarding difficult nursing care and the lack of resources to provide quality patient care. Care of patients with ECF highlighted that nurses were not coping with the care of such patients.
CONCLUSION
Collaboration of a multidisciplinary team involving dieticians, surgeons, and enterostomal therapy nurses could improve the management of ECF without surgical intervention, increase the knowledge and skills of nurses, alleviate their challenges, and yield safe patient outcomes. Standardized and updated protocols will ensure the best practices toward quality patient care that facilitate healing, closure, and reducing mortality and morbidity rates. The key principles for caring for patients with open abdomen, presenting with enterocutaneous fistulas, are based on correcting fluids and electrolytes, nutritional optimization and support, control of abdominal sepsis, wound care management, pain control, and emotional support to critical care nurses and ward nurses.
PubMed: 38742090
DOI: 10.1002/hsr2.2051 -
BMC Surgery May 2024The optimal approach for ensuring both complete resection and preservation of anal function in rectal gastrointestinal stromal tumor (GIST) remains unknown. The aim of...
BACKGROUND
The optimal approach for ensuring both complete resection and preservation of anal function in rectal gastrointestinal stromal tumor (GIST) remains unknown. The aim of this study was to clarify short-term and long-term outcomes after robotic radical surgery for rectal GIST.
METHODS
A total of 13 patients who underwent robotic radical surgery for rectal GIST between December 2011 and April 2022 were included. All robotic procedures were performed using a systematic approach. A supplemental video of robotic radical surgery for rectal GIST is attached. The short-term outcome was the incidence of postoperative complications during the first 30 days after surgery. Surgical outcomes were retrieved from a prospective database. Long-term outcomes, including overall survival and recurrence-free survival, were determined in all patients.
RESULTS
Median distance from the tumor to the anal verge was 4.0 cm. Surgical margins were negative in all patients. Two patients underwent neoadjuvant imatinib therapy. All patients underwent sphincter-preserving surgery. None underwent conversion to open or laparoscopic surgery. The incidence of postoperative Clavien-Dindo grade II and grade ≥ III complications was 7.7% and 0%, respectively. The median postoperative hospital stay was 7 days. Twelve patients (92.3%) underwent stoma closure within 5 months of the initial surgery. Median follow-up time was 76 months. The 5-year overall survival and recurrence-free survival rates were both 100%. None of the patients had recurrence.
CONCLUSION
Short-term and long-term outcomes after radical robotic surgery for rectal GIST were favorable. Robotic surgery might be a useful surgical approach for rectal GIST.
Topics: Humans; Gastrointestinal Stromal Tumors; Robotic Surgical Procedures; Male; Female; Middle Aged; Rectal Neoplasms; Aged; Treatment Outcome; Postoperative Complications; Adult; Retrospective Studies; Time Factors; Follow-Up Studies
PubMed: 38720315
DOI: 10.1186/s12893-024-02434-y -
International Journal of Surgery Case... Apr 2024In several cases, a person can have an abnormal mass in the outer mandible or under the tongue and is usually accompanied with the decrease of saliva. Early and accurate...
BACKGROUND
In several cases, a person can have an abnormal mass in the outer mandible or under the tongue and is usually accompanied with the decrease of saliva. Early and accurate examination is needed to diagnose this case. In this case report, we present two cases of salivary glands defect. The aim of this article is to submit two cases to review the etiology, risk factors, clinical manifestation, and examination methods of sialadenitis using a modified contrast injector to the duct of salivary gland. CASE 1: A 17-year-old man came with a complaint of a lump under the right jaw. Sialography examination using a modified syringe with abbocath 24G showed an occlusion of the right and left Warton duct stoma. Right and left Bartholin's duct stoma occlusion post excision and marsupialization of the ranula. The complaint felt shrink after sialography. Three months follow-up, the patient said the lump was no longer felt and there were no complaints. CASE 2: A 19-year-old man came with a complaint of clear fluid coming out when eating on the surgical scar under the right side of the jaw. From the plain photo, it appears that there is a missing amputatum of the right mandibular symphysis, body, angle, ramus processus condylaris et coronoideus of the left mandible. Sialography examination using a modified syringe with abbocath 24G showed suggest a sialocutaneous fistula (cut of the right mandibular ramus region to Stensen's duct and submandibular). Then the patient underwent fistula excision. A month follow-up after the excision patient had no feeling of lump but sometimes 3-4 drops still came out.
CLINICAL DISCUSSION
Salivary tract injury is a quite rare case. Most frequent etiologies are iatrogenic. Sialography is a simple but effective method to identify obstruction of the salivary tract, including salivary tract injury. According to several studies, sialography identifies sialolithiasis with high sensitivity and specificity.
CONCLUSION
Sialography is a simple but effective method that is beneficial for the treatment and examination with high specificity and sensitivity to assess the possibility of obstruction of the salivary ducts.
PubMed: 38718490
DOI: 10.1016/j.ijscr.2024.109626 -
World Journal of Surgical Oncology May 2024The primary treatment for non-metastatic rectal cancer is curative resection. However, sphincter-preserving surgery may lead to complications. This study aims to develop...
BACKGROUND
The primary treatment for non-metastatic rectal cancer is curative resection. However, sphincter-preserving surgery may lead to complications. This study aims to develop a predictive model for stoma non-closure in rectal cancer patients who underwent curative-intent low anterior resection.
METHODS
Consecutive patients diagnosed with non-metastatic rectal cancer between January 2005 and December 2017, who underwent low anterior resection, were retrospectively included in the Chang Gung Memorial Foundation Institutional Review Board. A comprehensive evaluation and analysis of potential risk factors linked to stoma non-closure were performed.
RESULTS
Out of 956 patients with temporary stomas, 10.3% (n = 103) experienced non-closure primarily due to cancer recurrence and anastomosis-related issues. Through multivariate analysis, several preoperative risk factors significantly associated with stoma non-closure were identified, including advanced age, anastomotic leakage, positive nodal status, high preoperative CEA levels, lower rectal cancer presence, margin involvement, and an eGFR below 30 mL/min/1.73m2. A risk assessment model achieved an AUC of 0.724, with a cutoff of 2.5, 84.5% sensitivity, and 51.4% specificity. Importantly, the non-closure rate could rise to 16.6% when more than two risk factors were present, starkly contrasting the 3.7% non-closure rate observed in cases with a risk score of 2 or below (p < 0.001).
CONCLUSION
Prognostic risk factors associated with the non-closure of a temporary stoma include advanced age, symptomatic anastomotic leakage, nodal status, high CEA levels, margin involvement, and an eGFR below 30 mL/min/1.73m2. Hence, it is crucial for surgeons to evaluate these factors and provide patients with a comprehensive prognosis before undergoing surgical intervention.
Topics: Humans; Rectal Neoplasms; Retrospective Studies; Female; Male; Middle Aged; Surgical Stomas; Aged; Prognosis; Risk Factors; Follow-Up Studies; Anastomotic Leak; Neoplasm Recurrence, Local; Postoperative Complications; Adult; Proctectomy; Aged, 80 and over
PubMed: 38715036
DOI: 10.1186/s12957-024-03403-8