共查询到20条相似文献，搜索用时 31 毫秒
1.
M. G. Pramateftakis D. Raptis I. Mantzoros D. Kanellos S. Angelopoulos S. Psomas Th. Tsachalis 《Techniques in coloproctology》2011,15(1):29-31
Aim
The aim of this study is to present our experience with the laparoscopic treatment approach for colonic carcinoma.Patients and methods
Between 2005 and 2010, laparoscopic colectomy was performed in 13 patients; 9 patients underwent laparoscopic right hemicolectomy, 3 sigmoidectomy and 1 patient underwent laparoscopic caecectomy.Results
With regards to the right hemicolectomies, the average operative time was 168 min and the average hospital stay 5.3 days. In patients who underwent laparoscopic sigmoidectomy, the average operative time was 176 min, while the average hospital stay was 10.2 days. Finally, the laparoscopic caecectomy was performed in 85 min. There was one conversion (7.7%) to an open procedure, as well as one case (7.7%) of anastomotic leakage, which was treated with re-laparotomy and a Hartmann’s procedure. Up to today, all patients remain healthy with no signs of tumor recurrence.Conclusion
Laparoscopic colectomy for cancer, in the hands of an experienced laparoscopic surgeon, is a safe and efficient procedure.2.
M. R. Freund Y. Edden P. Reissman A. Dagan 《International journal of colorectal disease》2016,31(9):1649-1651
Purpose
The purpose of this review is to highlight the perils and pitfalls associated with high vascular ligation during right colectomies for adenocarcinoma and to identify the various mechanisms of injury to the superior mesenteric vein (SMV) and its tributaries.Methods
This is a retrospective chart review of 304 right colectomies (159 open and 145 laparoscopic) performed over a period of 10 years (1 June 2006–31 May 2016) for right-sided colonic adenocarcinoma in an academic medical center.Results
During a 10-year study period, we encountered five cases in which significant damage to the SMV and its tributaries occurred. This accounts for a total of 1.6 % of all right colectomies performed for colonic adenocarcinoma.Conclusions
Iatrogenic superior mesenteric vein injury is a rare, severe, and underreported complication of both open and laparoscopic right colectomy for colonic adenocarcinoma. We identified several mechanisms of injury such as anatomic misperception, excessive traction and pulling on the venous system, extensive tumor involvement of the mesentery, and uncontrolled suturing attempts at hemostasis. We believe that increased awareness of this complication with profound understanding of vascular anatomy and the different mechanisms of injury will allow surgeons to avoid this often devastating complication.3.
Background
Complete mesocolic excision (CME) with central vascular ligation (CVL) should be employed for the treatment of colon cancer patients because of its superior oncological outcomes. However, this technique is technically challenging in laparoscopic right hemicolectomy because of the anatomical complexity of the transverse mesocolon.Methods
We focused on the embryology and anatomy of the transverse mesocolon to overcome the difficulty of this surgery. The validity and efficacy of a cranial approach in achieving CME with CVL in laparoscopic right hemicolectomy was elucidated from the embryological point of view.Results
In total, 28 consecutive patients with right-sided colon cancer were treated by laparoscopic right hemicolectomy using a cranial approach. There were no conversion to open surgery or switching to another approach. Using this approach, torsion and fusion of the transverse mesocolon, which occurred during embryological development, could be reversed and the complex anatomy of the transverse mesocolon could be simplified before performing CVL of colonic vessels.Conclusions
A cranial approach is considered valid and useful for CME with CVL in laparoscopic right hemicolectomy from the embryological point of view.4.
Introduction
Colonic laterally spreading lesions (LSL) are increasingly managed using endoscopic methods that comprise two main techniques: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).Purpose of Review
In this review, we aimed to review the most recent literature on selection of the best endoscopic technique in the management of colonic LSL.Recent Findings
EMR and ESD are complimentary techniques in the management of patients with colonic LSL.Summary
EMR is safe and effective in most patients with LSL, except for cancers with submucosal invasion in whom R0 resection is favored.5.
Introduction
Laparoscopy is widely used in colorectal practice, but recent trial results have questioned its use in rectal cancer resections. Patient outcomes are directly linked to the quality of total mesorectal excision (TME) specimen. Objective assessment of intraoperative performance could help ensure competence and delivery of optimal outcomes. Objective tools may also contribute to TME intervention trials, but their nature, structure and utilisation is unknown.Aim
To systemically review the available literature to report on the available tools for the objective assessment of minimally invasive TME operative performance and their use within multicentre laparoscopic TME randomised controlled trials.Methods
A systematic search of the PubMed and Cochrane databases was performed to identify tools used in the objective intraoperative assessment of minimally invasive TME performance in accordance with the PRISMA guidelines, independently by two authors. The identified tools were then evaluated within reported TME RCTs.Results
A total of 8642 abstracts were screened of which 12 papers met the inclusion criteria; ten prospective observational studies, one randomised trial and one educational consensus. Eight assessment methods were described, which include formative and summative tools. The tools were mostly adaptations of colonic surgery tools based on either operative video review or post-operative trainer rating. All studies reported objective assessment of intraoperative performance was feasible, but only 126 (7%) of the 1762 included laparoscopic cases were TME. No multicentre laparoscopic TME trial reported using any objective surgical performance assessment tool.Conclusion
Objective intraoperative laparoscopic TME performance assessment is feasible, but most of the current tools are adaptation of colonic surgery. There is a need to develop dedicated assessment tools for minimal access rectal surgery. No multicentre minimally invasive TME RCT reported using any objective assessment tool.6.
Background
To provide a standardised ‘medial to lateral’ approach to laparoscopic colorectal surgery.Methods
Both right- and left- sided laparoscopic colorectal procedures were simplified into three well-defined steps and a join. An instructional video and procedural guide provides the important pearls and pitfalls in performing laparoscopic colorectal surgery.Results
During a 10-year period (2006–2016) at a single institution, 20 senior colorectal trainee surgeons and 20 general surgery registrars were trained in the ‘three steps and a join’ technique. Five hundred and sixty-eight laparoscopic anterior resections using this technique were performed. There were 5 (0.9%) leaks. Five hundred and forty-three laparoscopic right-sided resections were performed. There were 3 (0.6%) anastomotic leaks requiring reoperation and loop ileostomy.Conclusions
This step-by-step instructional video and procedural guide provides a simple and standardised approach which may be incorporated into a training pathway for laparoscopic right- and left-sided colorectal surgery.7.
Background
Three-dimensional (3D) vision technology has recently been validated for the improvement of surgical skills in a simulated setting. Clinical studies on specific operations have been published in the field of general, urologic, and gynecologic laparoscopic surgery. We hypothesized that 3D vision laparoscopic right colectomy has better intra and short-term postoperative outcomes than two-dimensional (2D) vision.Aim
The outcomes of this review and meta-analysis were to compare the 3D vision and the 2D vision laparoscopic right colectomy.Methods
A systematic search of the literature was performed on Pubmed, WOS, Google Scholar, and Scopus databases (Prospero reg. nr. 42016047704) for comparative studies between 2D and 3D laparoscopic right colectomy. Primary endpoints were safety issues and secondarily patients’ related and surgeons’ comfort outcomes. Meta-analyses, when possible, were conducted with a random-effects model.Results
Two retrospective comparative studies (for a total of 56 patients in the 2D arm and 52 patients for the 3D arm) were selected out of 680 screened records. Methodological quality was fair. Three-dimensional laparoscopic right colectomy has similar safety and secondary outcomes when compared to 2D, with not statistically significant shorter operating times (mean difference 11.81 min). The results are comparable also for anastomosis leakage. The results for other outcomes were not aggregated for heterogeneity.Conclusions
3D laparoscopic right colectomy shows equivalent patients’ outcomes compared to 2D operation, but the scarce clinical data and the potential amelioration of surgeons’ skills, especially on difficult intracorporeal tasks like suturing, suggest the publication of further trials.8.
G. Christodoulidis M. Spyridakis D. Symeonidis K. Kapatou A. Manolakis K. Tepetes 《Techniques in coloproctology》2010,14(1):45-47
Aim
This study is to analyze the clinicopathological differences between right- and left-sided colonic tumors and to evaluate the impact upon the patient’s survival.Methods
In a period of 5 years (2004–2009), 453 patients were diagnosed with colorectal cancer.Results
From a total of 453 patients diagnosed with colon cancer, 56.5% of them were men, while 43.5% of them were women. Right-sided colonic tumors were diagnosed in 54.53% of the patients compared to the 45.47% of patients with left-sided colonic tumors. The size of colonic tumors is statistically significant greater in right-sided colonic tumors compared to left ones (P < 0.001). Left-sided colon cancer patients identified to have a statistically significant better overall 5-year survival rate compared to right-sided ones (P < 0.001).Conclusion
Based upon our results, there is a different biological profile between right- and left-sided colonic tumors.9.
Background
It is believed that loosing ileocecal valve is well tolerated in patients who do not have short bowel syndrome or Crohn disease. From the hypothesis of colonic peristalsis and transit is regulated by that ileocecal valvular mechanism, we try to find out if the creation of a new pseudo-valvular mechanism as antiperistaltic anastomosis could be considered after right hemicolectomy can cause any short- or long-term changes in gastrointestinal habits.Purpose
The purpose of the study at primary endpoint is to compare early (occurring within 30 days of surgery) and late (occurring during the follow-up) postoperative complications between both groupsThe purpose of the study at secondary endpoint is to compare intraoperative and postoperative events between experimental and control groups in terms of operating time, first oral tolerance day, first flatus and faeces, length of hospital stay and orocecal transit; comparing rates of gastrointestinal life quality and comparing mortality rates between both groups.Methods
The ISOVANTI trial is a randomized controlled single-centre trial comparing isoperistaltic versus antiperistaltic side-to-side anastomosis after right laparoscopic hemicolectomy. It is designed as a parallel group superiority trial.Conclusions
It is unknown if a pseudo-valvular mechanism as antiperistaltic anastomosis can be considered has short- or long-term consequences in gastrointestinal habit. Considering the impact that ileocolic anastomosis configuration could have on the restitution of bowel transit after right hemicolectomy, we think it is indicated and necessary a randomized trial comparing iso- and antiperistaltic modalities.Trial registration
NCT0230993110.
Constantinos?Chatzicostas Ioannis?E?Koutroubakis Maria?Tzardi Maria?Roussomoustakaki Panagiotis?Prassopoulos Elias?A?Kouroumalis
Background
Intestinal tuberculosis is a rare disease in western countries, affecting mainly immigrants and immunocompromised patients. Intestinal tuberculosis is a diagnostic challenge, especially when active pulmonary infection is absent. It may mimic many other abdominal diseases.Case presentation
Here, we report a case of isolated colonic tuberculosis where the initial diagnostic workup was suggestive of Crohn's disease. Computed tomography findings however, raised the possibility of colonic tuberculosis and the detection of acid-fast bacilli in biopsy specimens confirmed the diagnosis.Conclusions
In conclusion, this case highlights the need for awareness of intestinal tuberculosis in the differential diagnosis of chronic intestinal disease11.
Background
The middle colic artery (MCA) is of crucial importance in abdominal surgery, for laparoscopic or open right and transverse colectomies. Against this background, a high number of reports concerning anatomical variations of the MCA have been published intended to contribute to the improvement of operative techniques for the treatment of colon cancer. Despite this extensive literature, briefly reviewed in the present paper, a course of the MCA posterior to the superior mesenteric vein, called a retromesenteric trajectory, has been related to only once, to the best of our knowledge.Methods
A total series of 507 patients included in two prospective trials concerning laparoscopic or open right colectomy for cancer between 2011 and 2017 are reported. The investigation included preoperative or postoperative multidetector-computed tomography angiography.Results
We found four (0.79%) cases of retromesenteric MCA. They all underwent meticulous image analysis with mesenteric vessels’ road mapping, detailed morphometry, and surgical validation which revealed that, apart from their course, those cases did not differ significantly from the rest of the series.Conclusion
This paper therefore documents the worth-knowing behavior causing considerable confusion for the operating surgeon unaware of the abnormality and shows its concrete impact on patient-tailored surgical practice, in particular for laparoscopic D3 colectomy (including the “uncinated process first” approach).12.
Purpose
The cytotoxic and immunosuppressive effects of azathioprine, which mitigate the disease activity in inflammatory bowel disease, may compromise the healing of intestinal anastomoses leading to an increased risk of anastomotic leakage. The effect of azathioprine treatment on intestinal healing was tested.Methods
In an experimental study, rats were randomly given one oral dose of azathioprine (5 mg or 20 mg/kg body weight per day) or placebo. After 28 days of treatment, a left colonic anastomosis was performed. After three days of healing, the breaking strengths of the anastomoses were tested, along with measurements of azathioprine major metabolite concentrations: 6-thioguanine and 6-methyl-mercaptopurine.Results
There were no significant differences in the anastomotic breaking strength between the three groups.Conclusions
Daily treatment for four weeks with high or low azathioprine doses has no inhibitory effect on colonic healing in rats.13.
M. G. Pramateftakis P. Hatzigianni D. Kanellos G. Vrakas Th. Tsachalis I. Mantzoros I. Kanellos C. Lazaridis 《Techniques in coloproctology》2010,14(1):63-64
Aim
In this study, we present our patients with metachronous colorectal cancer.Patients and methods
In the period between 1990 and 2009, 670 patients with colorectal cancer were treated.Results
Metachronous cancer was developed in 4 (0.6%) patients. The time interval between index and metachronous cancer was 28 months to 22 years (mean 146 months).Conclusion
Metachronous colorectal cancer is a potential risk that proves the necessity of postoperative colonoscopic control of all patients with colorectal cancer.14.
Introduction
In acromegaly the long-term exposure to high growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels may result in specific complications in different human organs, including the thyroid gland and the colon.Materials and Methods
We will review here the evidence available regarding the characteristic thyroid and colon complications in acromegaly.Results
This review summarizes the published data observing noncancerous structural abnormalities (thyroid nodules, colonic polyps) and thyroid and colon cancer in patients diagnosed with acromegaly.Conclusion
Thyroid micro-carcinomas are probably over-diagnosed among acromegalic patients. In regard to colon cancer, there is no sufficient data to suggest that colon cancer risk is higher in acromegaly compared to the general population.15.
I. Mantzoros D. Raptis M. G. Pramateftakis D. Kanellos S. Psomas A. Makrantonakis T. Tsachalis S. Angelopoulos 《Techniques in coloproctology》2011,15(1):71-73
Aim
The aim of this study is to present our experience in colonic lipomas.Patients and methods
We present 4 patients (1 male, 3 females) of mean age 65.5 years (range, 61–72 years) treated for single colonic lipomas. The diameters of the lesions were 4.5, 4, 3.5 and 2.5 cm, respectively. In 3 cases, colonic lipomas were located within the cecum, while in one patient within the descending colon, proximally to the splenic flexure.Results
Lipomas of diameter greater than 3 cm caused nonspecific symptoms. Lipomas of higher diameter were removed laparoscopically with colotomy; in two cases, the patients underwent open hemicolectomy, because of the suspicion of malignancy, while the smallest lesion was resected endoscopically, using a bipolar snare. All patients recovered without complications and remain healthy with no signs of recurrence.Conclusion
In cases of ulcerated lipomas, greater than 3 cm of diameter, surgical resection is recommended.16.
Takashi Murakami Chikara Kunisaki Shinichi Hasegawa Jun Kimura Ryo Takagawa Takashi Kosaka Hidetaka A. Ono Hirochika Makino Hirotoshi Akiyama Itaru Endo 《Esophagus》2016,13(4):343-350
Background
Few reports have reported the long-term outcome of esophageal cancer patients suffering from postoperative infectious complications. Here, we investigated the impact of postoperative infectious complications in patients who had undergone curative resection for esophageal cancer.Methods
The study population comprised 97 patients who underwent radical resection for esophageal cancer with curative intent between 2001 and 2008. Postoperative infectious complications were defined as surgical site infections and pneumonia. We compared clinical features, tumor histology, recurrence, and overall survival between patients with postoperative infections and those who did not.Results
Of the 97 patients studied, 37 had postoperative infectious complications. The disease-free and overall survival rates of the entire cohort did not significantly differ between patients with and without postoperative infectious complications. Univariate analysis revealed that among patients with stage III esophageal cancer, those with postoperative infectious complications demonstrated significantly shorter disease-free survival than those without. Multivariate analysis demonstrated that postoperative infectious complications were independent prognostic indicators for disease-free survival of stage III esophageal cancer patients.Conclusions
Our findings suggest that postoperative infectious complications in stage III esophageal cancer patients have a negative impact on disease-free survival.17.
Background
In order to improve the surgical treatment of rectal cancer, robot-assisted laparoscopy has been introduced. The robot has gained widespread use; however, the scientific basis for treatment of rectal cancer is still unclear. The aim of this study was to investigate whether robot-assisted laparoscopic rectal resection cause less perioperative pain than standard laparoscopic resection measured by the numerical rating scale (NRS score) as well as morphine consumption.Methods
Fifty-one patients were randomized to either laparoscopic or robot-assisted rectal resection at the Department of Surgery at Aarhus University Hospital in Denmark. The intra-operative analgetic consumption was recorded prospectively and registered in patient records. Likewise all postoperative medicine administration including analgesia was recorded prospectively at the hospital medical charts. All morphine analogues were converted into equivalent oral morphine by a converter. Postoperative pain where measured by numeric rating scale (NRS) every hour at the postoperative care unit and three times a day at the ward.Results
Opioid consumption during operation was significantly lower during robotic-assisted surgery than during laparoscopic surgery (p=0.0001). However, there were no differences in opioid consumption or NRS in the period of recovery. We found no differences in length of surgery between the two groups; however, ten patients from the laparoscopic group underwent conversion to open surgery compared to one from the robotic group (p=0.005). No significant difference between groups with respect to complications where found.Conclusions
In the present study, we found that patients who underwent rectal cancer resection by robotic technique needed less analgetics during surgery than patients operated laparoscopically. We did, however, not find any difference in postoperative pain score or morphine consumption postoperatively between the robotic and laparoscopic group.18.
Upender Shava Surender Kumar Yachha Anshu Srivastava Ujjal Poddar Moinak Sen Sarma 《Indian journal of gastroenterology》2018,37(5):410-415
Introduction
Indian adults have higher stool frequency and shorter colonic transit time compared to the Western population. Colonic transit time has not been studied well in Indian children. We aimed to compare colonic transit time in normal and constipated children.Methods
In this prospective study, stool characteristics and colonic transit time by radio-opaque markers were studied in healthy children (group A, n?=?39) and functional constipation patients (group B, n?=?61). Twenty radio-opaque markers were ingested per orally at 0, 12, and 24 h followed by a single abdominal X-ray at 36 h. Total and segmental colonic transit times were calculated using the standard formula.Results
Stool frequency per week and consistency were significantly different between group A (9 [2.5–17] years) vs. group B (4.5 [2–14] years), 7 (7–14) vs.1 (1–2), and Bristol type 4 (3–5) vs. type 2 (1–3). Total colonic transit time of groups A and B was 16.2 (0.6–36) vs. 22.8 (1.8–35.4) hours; p?=?0.003. Ninety-fifth percentile (upper limit of normal) cutoff derived from group A was 31.8 h. Ninety-two percent of group B had colonic transit <?95th percentile of normal healthy children. Despite 8% with colonic transit >?95th percentile, all group B patients responded well to standard therapy with laxatives.Conclusion
Indian children have significantly higher stool frequency and shorter colonic transit time, which are different compared to the reported figures from the West. Most of the Indian children with functional constipation had normal colonic transit time.19.
Gunjan S. Desai Rajvilas Narkhede Prasad Pande Bhushan Bhole Paresh Varty Hitesh Mehta 《Indian journal of gastroenterology》2018,37(5):430-438
Background
All operative procedures for simple or complicated diverticulitis, including primary resection and anastomosis (PRA) with or without a diverting stoma, Hartmann procedure (HP), or stoma reversal, whether done in an elective setting or as an emergency, can be performed laparoscopically. However, owing to low incidence of the disease and complexity of the procedure, there are very few studies on outcomes of laparoscopic surgery for sigmoid diverticulitis from India.Aim
The present study was undertaken to evaluate outcomes of laparoscopically treated patients of sigmoid diverticulitis.Methods
Prospective observational study enrolled 37 patients with sigmoid diverticulitis managed laparoscopically from March 2015 to March 2017. Demographic, clinical, operative, postoperative, and complication data were entered into a patient proforma and analyzed.Results
Eleven simple and 26 complicated diverticulitis patients were operated laparoscopically, 22 in emergency setting and 15 in elective setting. Only three patients required conversion to open surgery—two due to dense adhesions and one due to chronic obstructive pulmonary disease (COPD). No patients had ureteric or bowel injury. Eighteen patients underwent laparoscopic PRA without stoma, 11 patients had PRA with stoma, 6 had HP, and 2 had laparoscopic lavage. Results showed lesser blood loss, shorter hospital stay, and fewer complications in the elective group and simple diverticulitis patients. None of the patients had anastomosis-related complications. Two patients had stoma-related complications.Conclusion
Laparoscopic management of diverticulitis is feasible, safe, provides the benefits of less wound-related complications, and shorter hospital stay and should be the surgical procedure of choice in elective or emergency setting for simple/complicated diverticulitis.20.