Colocolostomy and coloproctostomy utilizing the circular intraluminal stapling devices

Coloproctostomy or colocolostomy by peranal insertion of a circular stapling device was performed on 265 patients between January 1978, and June 1981. A low anterior resection was performed in 174 patients. Stapler-related technical complications occurred in 52 patients (20 per cent). Complementary transverse colostomies were performed in 11 patients, of which seven were performed on the first 30 patients. Intraoperative complications occurred in 18 patients (7 per cent). Twenty-six major postoperative complications occurred (10 per cent), and clinical anastomotic leaks occurred in eight patients (3 per cent). Four postoperative deaths occurred (1.5 per cent). This study concludes that (1)coloproctostomy or colocolostomy can be safely performed by transanal insertion of a circular stapling device, (2) these instruments allow a sphincter-preserving procedure to be performed for lesions in the low and midrectum (5 to 10 cm from the anal verge) with an acceptable early morbidity and mortality, and (3) the majority of stapler-related technical complications can be managed without protecting colostomy. Read at the meeting of the American Society of Colon and Rectal Surgeons, San Francisco, California, May 2 to 6, 1982.     

Exercise during early pregnancy is associated with greater sleep continuity

Objectives/background: Pregnant women report disturbed sleep beginning in early pregnancy. Among nonpregnant populations, exercise has been associated with improved sleep; however, research in pregnant samples has been equivocal. We examined whether varying degrees of exercise were associated with better nocturnal sleep among pregnant women during early gestation. Participants: 172 pregnant women. Methods: Self-reported sleep and exercise and objective sleep were collected during early gestation: T1 (10–12 weeks), T2 (14–16 weeks), and T3 (18–20 weeks) from 172 pregnant women. Exercise was categorized into three time-varying groups: 0 metabolic equivalent minutes per week (MET-min/week), 1 to < 500 MET-min/week, or ≥ 500 MET-min/week. Linear mixed-effects models were employed to test hypotheses. Results: A significant main effect for Time (F[2,254] = 9.77, p < 0.0001) and Time*Exercise group interaction were observed for actigraphic sleep efficiency (aSE) (F[4,569] = 2.73, p = 0.0285). At T2, women who reported ≥ 500 MET-min/week had higher aSE than those who reported 0 MET-min/week. Significant main effects for Exercise Group and Time were observed for actigraphic wake after sleep onset (aWASO; F[2,694] = 3.04, p = 0.0483 and F[2,260] = 3.21, p = 0.0419). aWASO was lowest for those reporting 1 to < 500 MET-min/week (t[701] = 2.35, adjusted p = .0489) and aWASO decreased from T1 to T3 (t[258] = 2.53, adjusted p value = 0.036). Lastly, there was a main effect for Time for the PSQI (F[2,689] = 52.11, p < 0.0001), indicating that sleep quality improved over time. Conclusions: Some level of exercise among pregnant women appears to be more advantageous than no exercise at all. Moderate exercise, while still unclearly defined, may be a worthwhile adjunct treatment to combat sleep disturbances during pregnancy.     

Preoperative bowel preparation

A survey of 500 clinically active, board-certified colon and rectal surgeons in the United States and Canada was conducted to obtain data regarding current methods of bowel preparation for elective colorectal surgery. A review of recent publications on preoperative bowel preparation was used to compare the current literature recommendations with the actual practice among the group surveyed. Responses were received from 352 of 500 colorectal surgeons to whom questionnaires were sent (70 percent response rate). All respondents used a mechanical preparation and some form of antibiotics. The favorite antibiotic regimen was oral antimicrobials combined with systemic antibiotics (88 percent). Concomitant administration of oral neomycin-erythromycin base and a systemic second generation cephalosporin active against both anaerobic and aerobic colonic bacteria, together with oral polyethelene glycol electrolyte mechanical colonic cleansing, was the most popular method of preoperative bowel preparation (58 percent). The second most frequent method of mechanical bowel cleansing consisted of conventional enemas, dietary restrictions, and cathartic preparations (36 percent). Mannitol solution (5 percent), and whole-gut irrigation per nasogastric tube (1 percent) were the least popular methods of mechanical bowel cleansing. The literature supports the current methods of preoperative bowel preparation used by the vast majority of surgeons surveyed.Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The Effect of a Hyaluronan-Carboxymethylcellulose Membrane vs. Polyglactin 910 Mesh on Intra-Abdominal Tumor Formation in Mice

Purpose

Hyaluronan mediates growth of SW620 colon cancer cells. Because hyaluronan is the active ingredient in Seprafilm®, we hypothesized that Seprafilm® would affect intraperitoneal tumor growth in a mouse model of peritoneal seeding.

Methods

Immunodeficient mice underwent laparotomy and intraperitoneal inoculation of 10⁵ SW620 cells. Seprafilm® (n?=?22), Vicryl mesh (foreign body control; n?=?24), or no material (sham; n?=?19) was placed under the incision. Mice were killed after four weeks and tumors were dissected, counted, and weighed.

Results

Ninety-five percent of mice in the sham group and 96 percent in the Vicryl group developed intraperitoneal tumors. In contrast, only 64 percent of mice in the Seprafilm® group developed tumors (P?=?0.024), and these tumors were smaller than those in the sham group; (Seprafilm®?=?42?±?9 mg vs. sham?=?82?±?17 mg; P?=?0.05). In contrast, tumors in the Vicryl group were dramatically larger (349?±?49 mg; P?vs. sham or Seprafilm®).

Conclusions

Despite previous data that suggested that hyaluronan increases colon cancer cell growth, we found that Seprafilm® decreased tumor formation and tended to decrease size in this model. In contrast, Vicryl mesh increased tumor formation and size. Our results suggest that Seprafilm® does not promote intraperitoneal tumor growth, especially compared with Vicryl mesh.     

Computed tomography-guided percutaneous abscess drainage in intestinal disease

PURPOSE: This study was designed to assess the efficacy of computed tomography-guided percutaneous abscess drainage in intestinal disease. METHODS: Retrospective chart review of patients who underwent percutaneous abscess drainage for complications of intestinal disease with or without surgery between 1990 and 1994. RESULTS: Eighty-two patients with 111 abscesses were identified. Causes of abscess included anastomotic leaks (35 percent), postoperative complications without leak (30 percent), and diverticular disease (23 percent). Complete success (no surgery necessary) was achieved in 53 of 82 patients (65 percent). Nine patients (11 percent) who underwent interval surgery were classified as having partial successes. Twenty-six of 26 (100 percent) well-defined unilocular collections containing pus were successfully drained. Complex abscesses (loculated, poorly defined, multiple, associated with fistula, draining feces) were successfully drained in 35 of 55 patients (63 percent). Success rates varied inversely with the number of complicating factors present. Apache II scores of 15 or higher were associated with decreased success rates. CONCLUSION: Percutaneous abscess drainage is a highly successful technique for treatment of patients with intra-abdominal infection related to intestinal disease. Although several factors are associated with decreased success rates and multiple complicating factors combine to reduce success rates, no identifiable factor or combination of factors preclude the possibility of a successful outcome.Read at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.