Enterocutaneous fistula: a single‐centre experience

Background: Enterocutaneous fistulae (ECFs) present a difficult management problem and can cause significant morbidity. The aim of the study was to assess the outcome of these patients. Methods: A retrospective chart review of all patients with ECF managed at a tertiary centre between 1996 and 2006 was performed. Demographic, management and outcome data including ECF closure, morbidity and mortality were recorded. Results: A total of 33 patients (17 male) were identified with ECF (median age: 63 years, range: 27–84). The primary aetiology was Crohn's (30%), anastomotic leak (24%), iatrogenic (18%), mesh (6%), neoplasia (6%) and other (16%). Definitive surgery was undertaken in 21 (64%) at a median of 6.4 months (0.4–72 range) following presentation. Twenty percent of patients required emergency surgical intervention and 5 patients required preoperative total parenteral nutrition (TPN). Surgical management was formal resection and reanastomosis in all patients, with a mean operative time of 4.75 h (standard deviation = 1.8). The median hospital stay for the operative group was 19 days (7–85). Four patients required post‐operative TPN with one patient requiring home TPN. Fistula closure rate was 97% (operative group: 21 out of 21; non‐operative group: 11 out of 12). Mean follow‐up was 37.3 months (0.5–217). Six (19%) operative patients developed fistula recurrence. There were two deaths at 2 and 5 months (fistula aetiology malignant colonic fistula and radiation enteritis, respectively). Conclusion: Patients with ECF can be treated with low morbidity and low recurrence rate in a multidisciplinary setting. We believe that patients with ECF should be referred to specialist units for management.     

Whole‐body vibration for functional constipation: a single‐centre,single‐blinded,randomized controlled trial

Aim The aim of this trial was to determine whether whole‐body vibration (WBV) induced via a noninvasive oscillation platform could improve symptoms and health‐related quality of life (HRQOL) in patients with chronic functional constipation. Method A single‐blinded, randomized controlled trial was performed in a single hospital in Taiwan. Patients diagnosed with chronic functional constipation, as per the Rome III diagnostic criteria, were included and randomized to either the WBV treatment or no treatment (control) group. The treatment group received six 15‐min sessions of WBV therapy over a 2‐week period. Patients received vibrations of 2 mm in amplitude at a frequency of 12 Hz. The primary outcome was whether constipation symptoms improved, assessed by the constipation severity instrument (CSI) and the secondary outcome measure was whether there was an improvement in HRQOL. Results Whole‐body vibration therapy over a 2‐week period in patients with chronic functional constipation (n = 14) significantly reduced the total CSI and obstructive defaecation subscale scores compared with control (n = 13). However, WBV did not improve the pain and chronic inertia subscale scores of the CSI or HRQOL. Conclusion These findings suggest that low‐intensity WBV induced via a noninvasive oscillation platform may be an effective therapy for reducing symptom severity in patients with chronic functional constipation.     

Papillary breast cancer: A retrospective single‐centre clinical study

Papillary carcinoma (PC) of the breast is a rare malignancy that accounts for 0.5%‐1% of breast cancers. PC remains an understudied cancer, and we still require further information on its behaviour, staging and management. In particular, a significant proportion of PC cases still undergo sentinel lymph node biopsy without clear empirical justification. In the present study, we provide a valuable cohort of 44 PC patients and examine the clinicopathological features and outcome of loco‐regional staging. Our results provide important insights into the behaviour of PC and suggest SLNB may be spared in this condition. Crucially, we show only one histologically confirmed PC case had evidence of nodal metastasis. In addition, up to 5 years postsurgery, no patient in our cohort died from their cancer. Together, our results support further work in the utility of SLNB in PC and highlight the favourable prognosis of this tumour. We propose SLNB should not be routinely indicated for patients with PC treated with breast conservation, and future studies should aim to incorporate prospective data to help inform optimal management of PC.     

Single‐port,single‐operator‐light endoscopic robot‐assisted laparoscopic urology: pilot study in a pig model

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVES

To present our initial operative experience in which single‐port‐light endoscopic robot‐assisted reconstructive and extirpative urological surgery was performed by one surgeon, using a pig model.

MATERIALS AND METHODS

This pilot study was conducted in male farm pigs to determine the feasibility and safety of single‐port, single‐surgeon urological surgery. All pigs had a general anaesthetic and were placed in the flank position. A 2‐cm umbilical incision was made, through which a single port was placed and pneumoperitoneum obtained. An operative laparoscope was introduced and securely held using a novel low‐profile robot under foot and/or voice control. Using articulating instruments, each pig had bilateral reconstructive and extirpative renal surgery. Salient intraoperative and postmortem data were recorded. Results were analysed statistically to determine if outcomes improved with surgeon experience.

RESULTS

Five male farm pigs underwent bilateral partial nephrectomy and bilateral pyeloplasty before a completion bilateral radical nephrectomy. There were no intraoperative complications and there was no need for additional ports to be placed. The mean (range) operative duration for partial nephrectomy, pyeloplasty, and nephrectomy were 120 (100–150), 110 (95–130) and 20 (15–30) min, respectively. The mean (range) estimated blood loss for all procedures was 240 (200–280) mL. The preparation time decreased with increasing number of cases (P = 0.002).

CONCLUSIONS

The combination of a single‐port, a robotic endoscope holder and articulated instruments operated by one surgeon is feasible. With a single‐port access, the robot allows more room to the surgeon than an assistant.     

Outcome analysis of robotic pyeloplasty: a large single‐centre experience

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To present our experience and outcomes of robot‐assisted laparoscopic pyeloplasty (RALP) for pelvi‐ureteric junction obstruction (PUJO).

PATIENTS AND METHODS

This was a prospective study of 85 consecutive patients who had RALP for PUJO at our institute from July 2006 to December 2008. The preoperative evaluation included intravenous urography (IVU) and diuretic renography. The type of pyeloplasty was decided based on the size of the pelves, presence of crossing vessel, level of ureteric insertion and the length of obstruction. All surgery was done through a transperitoneal approach using four or five ports. The follow‐up comprised IVU and renal dynamic scintigraphy. Relevant data were collected and analysed for perioperative morbidity, complications and long‐term functional outcomes.

RESULTS

In all, 86 RALPs were performed, including one bilateral, 41 right‐sided and 43 left‐sided cases. The mean operative time was 121 min, including an anastomosis time of 47 min. The mean estimated blood loss was 45 mL. The drain was removed within 48 h. The mean hospital stay was 2.5 days. Three patients had stents that migrated upwards, and prolonged drainage. The success rate was 97% (82/85) with a mean follow‐up of 13.6 months.

CONCLUSIONS

RALP is highly effective for managing PUJO, with low morbidity, quick recovery and a durable success rate.