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JSLS : Journal of the Society of... 2020Published comparisons of minimally invasive approaches to colon surgery are limited. The objective of the current study is to compare the effectiveness of... (Comparative Study)
Comparative Study
BACKGROUND AND OBJECTIVES
Published comparisons of minimally invasive approaches to colon surgery are limited. The objective of the current study is to compare the effectiveness of robotic-assisted and laparoscopic sigmoid resection.
METHODS
A multicenter retrospective comparative analysis of perioperative outcomes from consecutive robotic-assisted and laparoscopic sigmoid resections performed between 2010 and 2015 by six general and colorectal surgeons, who are experienced in both robotic-assisted and laparoscopic surgical techniques and who had >50 annual case volumes for each approach. Baseline characteristics and surgical risk factors between the two groups were balanced using a propensity score methodology with inverse probability of treatment weighting. Mean standardized differences were reported, and in all instances, a -value < 0.05 was considered statistically significant.
RESULTS
Three hundred thirty-six cases (robotic-assisted, n = 211; laparoscopic, n = 125) met eligibility criteria and were included in the study. Following weighting, patient demographics and baseline characteristics were comparable between the robotic-assisted (n = 344) and laparoscopic (n = 349) groups. The laparoscopic group was associated with shorter operating room and surgical times. The robotic-assisted group had lower estimated blood loss and shorter time to first flatus compared to the laparoscopic group. Rates of complications post discharge to 30 d tended to be lower for the RA group: 5.1% vs 8.6% [ = 0.0657]. The RA group also had lower rates of readmissions and reoperations: 4% vs 8% [ = 0.029] and 0.5% vs 5.1% [ = 0.0003], respectively.
CONCLUSIONS
Robotic-assisted sigmoid colon resection is clinically effective and provides a minimally invasive alternative to the laparoscopic approach with improved intraoperative and postoperative outcomes for colorectal patients.
Topics: Adult; Aged; Colectomy; Colon, Sigmoid; Female; Humans; Laparoscopy; Male; Middle Aged; Outcome Assessment, Health Care; Retrospective Studies; Robotic Surgical Procedures
PubMed: 32831543
DOI: 10.4293/JSLS.2020.00028 -
Revista Espanola de Enfermedades... Aug 2022Schwannomas tumours are uncommonly developed in the gastrointestinal tract (2-6%), located in 12% of cases in small and large intestines. An 87-year-old woman was...
Schwannomas tumours are uncommonly developed in the gastrointestinal tract (2-6%), located in 12% of cases in small and large intestines. An 87-year-old woman was studied due to epigastric pain and dyspepsia. CT scan and colonoscopy showed a neoplastic process in the sigmoid colon. It was performed an oncologic laparoscopic sigmoidectomy. Histological study described a schwannoma and a positive immunohistochemistry to S-100. The diagnostic challenge is that this is a submucosa lesion, therefore, endoscopy biopsy is realized only in the mucosa. This becomes the differential diagnostic very difficult in order to differentiate from another mesenchymal tumor (GIST or leiomyoma). The immunohistochemistry helps in the diagnostic if it is positive to S- 100 and negative to C-KIT, CD-34, actine and desmine (findings of GIST tumors and leiomyoma). In conclusion, schwannoma diagnostic is tough. Those are asymptomatic tumors with nonspecific radiological findings. Diagnostic confirmation is a S-100 positive immunohistochemistry in the histological study.
Topics: Aged, 80 and over; Colon, Sigmoid; Female; Gastrointestinal Stromal Tumors; Humans; Leiomyoma; Neurilemmoma; Sigmoid Neoplasms
PubMed: 35285666
DOI: 10.17235/reed.2022.8684/2022 -
BMC Pediatrics Jun 2022Despite the relative prevalence of small bowel and proximal colon perforation in the neonatal period, recto-sigmoid perforation is extremely rare. Full-term neonates... (Review)
Review
BACKGROUND
Despite the relative prevalence of small bowel and proximal colon perforation in the neonatal period, recto-sigmoid perforation is extremely rare. Full-term neonates experience intestinal perforation less frequently than premature infants. Here we report a neonate with sigmoid perforation and simultaneous Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection.
CASE PRESENTATION
A 2550 g female neonate born at 38-weeks' gestation from a coronavirus disease-2019 (COVID-19) infected mother by cesarean section. Despite a good Apgar score in the first and fifth minutes, she was admitted to the neonatal intensive care unit with grunting and mild respiratory distress. She underwent antibiotics and oxygen by head box resulting in an Oxygen Saturation rate of 94%. The patients' respiratory distress decreased during the second day, resulting once breastfeeding without tolerance. While she passed meconium in the first 2 days, she developed abdominal distention on day 3. The nasopharyngeal SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) was performed with positive results. Surgical consultation was requested and a thoraco-abdominal X-Ray was performed at this stage, which suspected to be a gastrointestinal perforation. Due to clinical deterioration and persistent abdominal distention, a contrast study was performed with water-soluble contrast, which confirmed intestinal perforation. However, the surgical exploration revealed perforation of the sigmoid colon at the posterior segment. The patient underwent antibiotic therapy, abdominal lavage, and colostomy, immediately. She was discharged in good condition approximately 14-days later.
CONCLUSION
To our knowledge, this is the first report of sigmoid colon perforation in a term neonate following COVID-19.
Topics: COVID-19; Cesarean Section; Colon, Sigmoid; Colonic Diseases; Female; Humans; Infant; Infant, Newborn; Intestinal Perforation; Pregnancy; Respiratory Distress Syndrome; SARS-CoV-2
PubMed: 35659271
DOI: 10.1186/s12887-022-03392-1 -
Diseases of the Colon and Rectum Oct 2019A healthy 65-year-old woman presents to the emergency department with a 12-hour history of sudden-onset severe lower abdominal pain. This is her first episode. She... (Review)
Review
A healthy 65-year-old woman presents to the emergency department with a 12-hour history of sudden-onset severe lower abdominal pain. This is her first episode. She reports nausea, vomiting, and anorexia. Her last colonoscopy was at age 60, and was normal, except for diverticulosis of the sigmoid colon. Physical examination is significant for fever, tachycardia, and generalized abdominal pain with rebound tenderness. Pertinent laboratory findings include a leukocytosis and metabolic acidosis. A CT scan is obtained and is consistent with freely perforated diverticulitis, including a thickened sigmoid colon, free fluid in the pelvis, and free air noted near the diaphragm (). The surgeon completes the patient evaluation, recommends initiation of intravenous fluid resuscitation and antibiotics, and plans to go immediately to the operating room for surgical resection.
Topics: Aged; Anastomosis, Surgical; Colon, Sigmoid; Colostomy; Disease Management; Diverticulitis, Colonic; Female; Humans; Intestinal Perforation; Laparoscopy; Radiography, Abdominal; Tomography, X-Ray Computed; Ultrasonography
PubMed: 31490823
DOI: 10.1097/DCR.0000000000001457 -
BioMed Research International 2018Many techniques have been described for reconstruction of the vaginal canal for oncologic, traumatic, and congenital indications. An increasing role exists for these... (Review)
Review
BACKGROUND
Many techniques have been described for reconstruction of the vaginal canal for oncologic, traumatic, and congenital indications. An increasing role exists for these procedures within the transgender community. Most often, inverted phallus skin is used to create the neovagina in transwomen. However, not all patients have sufficient tissue to achieve satisfactory depth and those that do must endure cumbersome postoperative dilation routines to prevent contracture. In selected patients, the sigmoid colon can be used to harvest ample tissue while avoiding the limitations of penile inversion techniques.
METHODS
Records were retrospectively reviewed for all transwomen undergoing primary sigmoid vaginoplasty with the University of Miami Gender Reassignment service between 2014 and 2017.
RESULTS
Average neovaginal depth was 13.9 +/- 2.0 centimeters in 12 patients. 67% were without complications, and all maintained tissue conducive to sexual activity. No incidences of bowel injury, anastomotic leak, sigmoid necrosis, prolapse, diversion neovaginitis, dyspareunia, or excessive secretions had occurred at last follow-up.
CONCLUSIONS
Sigmoid vaginoplasty is a reliable technique for achieving a satisfactory vaginal depth that is sexually functional. Using a collaborative approach, it is now our standard of care to offer this surgery to transwomen with phallus length less than 11.4 centimeters.
Topics: Adult; Colon, Sigmoid; Female; Humans; Plastic Surgery Procedures; Sex Reassignment Surgery; Transgender Persons; Vagina
PubMed: 29862275
DOI: 10.1155/2018/4907208 -
PloS One 2021Sigmoid colon anatomic dimensions have been studied to have roles in the occurrence of sigmoid volvulus; however, these studies are few in number and failed to control...
INTRODUCTION
Sigmoid colon anatomic dimensions have been studied to have roles in the occurrence of sigmoid volvulus; however, these studies are few in number and failed to control the confounding effect of acute sigmoid obstruction on the anatomic dimensions. The main objective of this study was to assess the role of sigmoid colon anatomic dimensions in the development of sigmoid volvulus controlling the effect of acute sigmoid obstruction on the anatomic dimensions.
MATERIALS AND METHODS
The study was carried out from Dec, 2019 to April, 2021 at Tibebe Ghion Specialized Hospital and Felege Hiwot Comprehensive Specialized Hospital, two referral hospitals in Bahir Dar city, North-Western Ethiopia to compare sigmoid anatomic dimensions among three independent groups of participants: patients with no history of sigmoid volvulus (I), those for whom elective surgery was done after non-surgical detorsion of sigmoid volvulus (II), and patients for whom emergency surgery was done for sigmoid volvulus (III). The anatomic dimensions were compared using fixed effects one-way ANOVA or Kruskal-Wallis H test at p-value ≤ .05 (two-sided) and Tukey method or Dunn-Bonferroni's test was used for post-hoc comparisons.
RESULTS
A total of 66 consecutive eligible patients (22 for each of the three groups) were included and analyzed in the study. The means of anatomic dimensions (in cm) for groups (I, II, III) were: sigmoid colon length-SCL (35.91, 71.07, 80.86), meso-sigmoid height-MSH (17.11, 26.52, 28.86), meso-sigmoid maximal width-MSMW (9.70, 14.89,16.80), and meso-sigmoid root width-MSRW (8.34, 7.48, 8.11). SCL, MSH, MSMW, MSH/MSRW, and MSMW/MSRW were found to be statistically significantly different in patients with sigmoid volvulus. MSRW and MSH/MSMW were not different between the study groups.
CONCLUSION
A long sigmoid colon with long and wide mesentery, but with a constant base is highly likely to predispose individuals to sigmoid volvulus.
Topics: Adult; Aged; Body Height; Body Weight; Colon, Sigmoid; Elective Surgical Procedures; Ethiopia; Female; Hospitalization; Humans; Intestinal Volvulus; Male; Middle Aged; Sigmoid Diseases
PubMed: 34851992
DOI: 10.1371/journal.pone.0260708 -
Journal of Visceral Surgery Feb 2016The Hartmann procedure is used in the case of left-sided colonic disease, especially in the setting of emergency where intraoperative conditions contraindicate... (Review)
Review
The Hartmann procedure is used in the case of left-sided colonic disease, especially in the setting of emergency where intraoperative conditions contraindicate completion of an anastomosis. This procedure has been initially described for the management of colorectal cancer and is based on a sigmoïdectomy without restoration of intestinal continuity, including a left-sided iliac terminal stoma and closure of the rectal stump. Both procedure and underlying risk factors explain high rates of mortality and morbidity, around 15 and 50% respectively, and a low overall rate of subsequent restoration of internal continuity, less than 50%. The purpose of this review was to evaluate the value of the Hartmann procedure and its equivalents in colonic surgery, according to its indications: colorectal cancer, peritonitis from diverticular disease, anastomotic complications, ischemic colitis, left-sided colonic volvulus and abdominal trauma.
Topics: Colectomy; Colon, Sigmoid; Colonic Diseases; Humans; Ileostomy; Postoperative Complications; Rectum
PubMed: 26868514
DOI: 10.1016/j.jviscsurg.2016.01.002 -
World Journal of Surgical Oncology Jul 2023The diagnostic criteria and effect of persistent descending mesocolon (PDM) on sigmoid and rectal cancers (SRCs) remain controversial. This study aims to clarify PDM...
BACKGROUND
The diagnostic criteria and effect of persistent descending mesocolon (PDM) on sigmoid and rectal cancers (SRCs) remain controversial. This study aims to clarify PDM patients' radiological features and short-term surgical results.
METHOD
From January 2020 to December 2021, radiological imaging data from 845 consecutive patients were retrospectively analyzed using multiplanar reconstruction (MRP) and maximum intensity projection (MIP). PDM is defined as the condition wherein the right margin of the descending colon is located medially to the left renal hilum. Propensity score matching (PSM) was used to minimize database bias. The anatomical features and surgical results of PDM patients were compared with those of non-PDM patients.
RESULTS
Thirty-two patients with PDM and 813 patients with non-PDM were enrolled into the study who underwent laparoscopic resection. After 1:4 matching, patients were stratified into PDM (n = 27) and non-PDM (n = 105) groups. The lengths from the inferior mesenteric artery (IMA) to the inferior mesenteric vein (1.6 cm vs. 2.5 cm, p = 0.001), IMA to marginal artery arch (2.7 cm vs. 8.4 cm, p = 0.001), and IMA to the colon (3.3 cm vs. 10.2 cm, p = 0.001) were significantly shorter in the PDM group than those in the non-PDM group. The conversion to open surgery (11.1% vs. 0.9%, p = 0.008), operative time (210 min vs. 163 min, p = 0.001), intraoperative blood loss (50 ml vs. 30 ml, p = 0.002), marginal arch injury (14.8% vs. 0.9%, p = 0.006), splenic flexure free (22.2% vs. 3.8%, p = 0.005), Hartmann procedure (18.5% vs. 0.0%, p < 0.001) and anastomosis failure (18.5% vs. 0.9%, p = 0.001) were significantly higher in the PDM group. Moreover, PDM was an independent risk factor for prolonged operative time (OR = 3.205, p = 0.004) and anastomotic failure (OR = 7.601, p = 0.003).
CONCLUSION
PDM was an independent risk factor for prolonged operative time and anastomotic failure in SRCs surgery. Preoperative radiological evaluation using MRP and MIP can help surgeons better handle this rare congenital variant.
Topics: Humans; Colon, Sigmoid; Mesocolon; Operative Time; Retrospective Studies; Rectal Neoplasms; Anastomosis, Surgical; Sigmoid Neoplasms; Laparoscopy; Risk Factors; Mesenteric Artery, Inferior
PubMed: 37420246
DOI: 10.1186/s12957-023-03091-w -
Journal of Visceral Surgery Nov 2015Giant colonic diverticulum is defined by a diverticulum whose diameter is greater than 4 cm. This is a rare entity, arising mainly in the sigmoid colon. The diagnosis is...
Giant colonic diverticulum is defined by a diverticulum whose diameter is greater than 4 cm. This is a rare entity, arising mainly in the sigmoid colon. The diagnosis is based on abdominal computed tomography that shows a gas-filled structure communicating with the adjacent colon, with a smooth, thin diverticular wall that does not enhance after injection of contrast. Surgical treatment is recommended even in asymptomatic diverticula, due to the high prevalence and severity of complications. The gold standard treatment is segmental colectomy. Some authors propose a diverticulectomy when the giant diverticulum is unique.
Topics: Aged; Colectomy; Colon, Sigmoid; Diverticulum, Colon; Humans; Male; Tomography, X-Ray Computed
PubMed: 26190163
DOI: 10.1016/j.jviscsurg.2015.06.002 -
World Journal of Surgical Oncology Apr 2016Curative resection of sigmoid colon and rectal cancer includes "high tie" of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the...
BACKGROUND
Curative resection of sigmoid colon and rectal cancer includes "high tie" of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the leakage rate, and it is unclear whether this confers a survival advantage. Accordingly, the IMA may be ligated at a point just below the origin of the left colic artery (LCA) "low tie" combined with lymph node dissection (LND) around the origin of the IMA (low tie with LND). However, no study has investigated the detailed prognostic results between "high tie" and "low tie with LND." The aim of this study was to assess the utility of "low tie with LND" on survival in patients with sigmoid colon or rectal cancer.
METHODS
A total of 189 sigmoid colon or rectal cancer patients who underwent curative operation from 1997 to 2007 were enrolled in this study. The patient's medical records were reviewed to obtain clinicopathological information. Overall survival (OS) and relapse-free survival (RFS) rates were calculated using the Kaplan-Meier method, with differences assessed using log-rank test.
RESULTS
Forty-two and 147 patients were ligated at the origin of the IMA (high tie) and just below the origin of the LCA combined with LND around the origin of the IMA (low tie with LND), respectively. No significant differences were observed in the complication rate and OS and RFS rates in the two groups. Further, no significant difference was observed in the OS and RFS rates in the lymph node-positive cases in the two groups.
CONCLUSIONS
"Low tie with LND" is anatomically less invasive and is not inferior to "high tie" with prognostic point of view.
Topics: Aged; Colon, Sigmoid; Female; Follow-Up Studies; Humans; Ligation; Lymph Node Excision; Male; Mesenteric Artery, Inferior; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Postoperative Complications; Prognosis; Rectal Neoplasms; Retrospective Studies; Sigmoid Neoplasms; Survival Rate; Vascular Surgical Procedures
PubMed: 27036117
DOI: 10.1186/s12957-016-0819-3