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1.
Leonie Haverkamp Pieter C. van der Sluis Roy J. J. Verhage Peter D. Siersema Jelle P. Ruurda Richard van Hillegersberg 《Journal of gastrointestinal surgery》2013,17(5):872-876
Background
Leakage and benign strictures occur frequently after esophagectomy. The objective of this study was to analyze the outcome of hand-sewn end-to-end versus end-to-side cervical esophagogastric anastomoses.Methods
A series of 390 consecutive patients who underwent esophagectomy with gastric conduit reconstruction was analyzed.Results
The end-to-end technique was performed in 112 (29 %) patients and the end-to-side in 278 (71 %) patients. Anastomotic leakage occurred in 20 (18 %) patients with an end-to-end anastomosis versus 58 (21 %) patients with an end-to-side anastomosis (p?=?0.50). A higher incidence in anastomotic strictures was seen in end-to-end anastomoses (48 (43 %)) compared with end-to-side anastomoses (89 (32 %); p?=?0.04). Moreover, a median of 11 (7–17) dilations was necessary in patients with a benign anastomotic stricture in the end-to-end group compared with four (2–8) dilations in patients with a benign anastomotic stricture in the end-to-end group (p?<?0.036). After multivariate analysis, the difference in anastomotic leakage rates remained nonsignificant (p?=?0.74), whereas anastomotic stricture rate and number of dilations were higher in the end-to-end group (p?=?0.03 and p?=?0.01, respectively).Conclusion
The technique of anastomosis is not significantly related to anastomotic leakage rate. However, patients with end-to-end anastomoses develop postoperative strictures more frequently, requiring a higher number of dilations compared to end-to-side anastomoses. 相似文献2.
E. J. T. Belt H. B. A. C. Stockmann G. S. A. Abis J. M. de Boer E. S. M. de Lange-de Klerk M. van Egmond G. A. Meijer S. J. Oosterling 《Journal of gastrointestinal surgery》2012,16(12):2260-2266
Background
The presence of an inflammatory response resulting from bowel perforation or anastomotic leakage has been suggested to enhance recurrence rates in colorectal cancer patients. Currently, it is unknown if bowel perforation or anastomotic leakage has prognostic significance in early stage colon cancer patients. In this study, the impact of peri-operative bowel perforation including anastomotic leakage on disease-free survival of stage I/II colon cancer patients was investigated.Methods
Prospective follow up data of 448 patients with stages I/II colon cancer that underwent resection were included. Patients who died within 3?months after initial surgery were excluded.Results
Median follow up was 56.0?months. Patients with peri-operative bowel perforation (n?=?25) had a higher recurrence rate compared to patients without perforation (n?=?423), 36.0?% vs. 16.1?% (p?=?0.01). Disease-free survival was significantly worse for the perforation group compared to patients without perforation (p?=?0.004). Multivariate analysis including T-stage, histological grade, and adjuvant chemotherapy showed peri-operative bowel perforation to be an independent factor significantly associated with disease recurrence (odds ratio, 2.7; 95?% CI, 1.1?C6.7).Conclusion
Peri-operative bowel perforation is associated with increased recurrence rates and impaired disease-free survival in early-stage colon cancer patients. 相似文献3.
Purpose
The aim of this study was to determine the risk factors for anastomotic leakage after laparoscopic rectal surgery.Methods
We conducted a prospective trial involving 395 patients with stage 0/I rectal carcinoma who underwent laparoscopic low anterior resection using a double stapling technique. Data concerning variables related to patient background, tumors and surgical factors were evaluated. The outcomes with respect to anastomotic leakage were recorded, and univariate and multivariate analyses were performed to identify relevant risk factors.Results
The overall anastomotic leakage rate was 8.4%. A univariate analysis showed male gender (P?=?0.006) and preoperative blood sugar level (P?=?0.0034) to be significantly associated with anastomotic leakage. The variables of gender, preoperative blood sugar level, American Society of Anesthesiologists (ASA) classification (P?=?0.15), transanal decompression tube (P?=?0.06) and number of stapler cartridges used for rectal transection (P?=?0.18) were selected for the multivariate analysis because of their P values being <0.2. The multivariate analysis identified male gender (odds ratio 4.12, P?=?0.006) and the absence of a transanal decompression tube (odds ratio 3.11, P?=?0.0484) as independent risk factors predicting anastomotic leakage.Conclusions
Male gender and the absence of a transanal decompression tube appeared to be independent risk factors for anastomotic leakage. Insertion of a transanal decompression tube may help prevent anastomotic leakage after low anterior resection, particularly in male patients.4.
Tetsuo Ikeda Hiroyuki Kawano Yuichi Hisamatsu Koji Ando Hiroshi Saeki Eiji Oki Takefumi Ohga Yoshihiro Kakeji Shunichi Tsujitani Shunji Kohnoe Yoshihiko Maehara 《Surgical endoscopy》2013,27(1):325-332
Background
Billroth I (B-I) gastroduodenostomy is an anastomotic procedure that is widely performed after gastric resection for distal gastric cancer. A circular stapler often is used for B-I gastroduodenostomy in open and laparoscopic-assisted distal gastrectomy. Recently, totally laparoscopic distal gastrectomy (TLDG) has been considered less invasive than laparoscopic-assisted gastrectomy, and many institutions performing laparoscopic-assisted distal gastrectomy are trying to progress to TLDG without markedly changing the anastomosis method. The purpose of this report is to introduce the technical details of new methods of intracorporeal gastroduodenostomy using either a circular or linear stapler and to evaluate their technical feasibility and safety.Methods
Seventeen patients who underwent TLDG with the intracorporeal double-stapling technique using a circular stapler (n = 7) or the book-binding technique (BBT) using a linear stapler (n = 10) between February 2010 and April 2011 were enrolled in the study. Clinicopathological data, surgical data, and postoperative outcomes were analyzed.Results
There were no intraoperative complications or conversions to open surgery in any of the 17 patients. The usual postoperative complications following gastroduodenostomy, such as anastomotic leakage and stenosis, were not observed. Anastomosis took significantly longer to complete with DST (64 ± 24 min) than with BBT (34 ± 7 min), but more stapler cartridges were needed with BBT than with DST.Conclusions
TLDG using a circular or linear stapler is feasible and safe to perform. DST will enable institutions performing laparoscopic-assisted distal gastrectomy with circular staplers to progress to TLDG without problems, and this progression may be more economical because fewer stapler cartridges are used during surgery. However, if an institution has already been performing δ anastomosis in TLDG but has been experiencing certain issues with δ anastomosis, converting from δ anastomosis to BBT should be beneficial. 相似文献5.
Toru Zuiki Yoshinori Hosoya Yuji Kaneda Kentaro Kurashina Shin Saito Takashi Ui Hidenori Haruta Masanobu Hyodo Naohiro Sata Alan T. Lefor Yoshikazu Yasuda 《Surgical endoscopy》2013,27(10):3683-3689
Background
The double-stapling technique (DST) for esophagojejunostomy using the transorally inserted anvil (OrVil; Covidien Japan, Tokyo, Japan) is one of the reconstruction methods used after laparoscopy-assisted total gastrectomy (LATG). This technique has potential advantages in terms of less invasive surgery without the need to create a complicated intraabdominal anastomosis.Methods
From 2008 to 2011, 262 patients with gastric cancer underwent total gastrectomy and reconstruction with a Roux-en-Y anastomosis, and 52 patients underwent LATG with DST. A retrospective analysis then was performed comparing the patients who experienced postoperative stenosis after LATG-DST (positive group) and the patients who did not (negative group). A comparative analysis was performed among patients comparing conventional open total gastrectomy and LATG, and multivariate analysis was performed to evaluate risk factors for the development of anastomotic stenosis.Results
A minor leak was found in 1 patient (1.9 %), and 11 patients experienced anastomotic stenosis (21 %) after LATG with DST. Among the patients with anastomotic stenosis, three (3/4, 75 %) anastomoses were performed with the 21-mm end-to-end anastomosis (EEA) stapler, and eight anastomoses were performed (8/47, 17 %) with the 25-mm EEA stapler. The median interval to the diagnosis of anastomotic stenosis was 43 days after surgery. The patients with stenosis needed endoscopic balloon dilation an average of four times, and the rate of perforation after dilation was 13 %. The clinical and operative characteristics did not differ between the two groups. Anastomotic stenosis after open total gastrectomy occurred in two cases (0.98 %). Multivariate analysis showed that the size of the EEA stapler and the use of DST were risk factors for anastomotic stenosis.Conclusion
Esophagojejunostomy using DST with OrVil is useful in performing a minimally invasive procedure but carries a high risk of anastomotic stenosis. 相似文献6.
Akiyoshi T Ueno M Fukunaga Y Nagayama S Fujimoto Y Konishi T Kuroyanagi H Yamaguchi T 《American journal of surgery》2011,(3):259-264
Background
Laparoscopic rectal cancer surgery involving rectal division with intracorporeal stapling devices is technically difficult. This study aimed to identify risk factors for anastomotic leakage associated with laparoscopic anterior resection for rectal cancer.Methods
We studied 363 patients who underwent laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique (DST) anastomosis for rectal cancer between July 2005 and February 2010. Twenty-two independent clinical variables were examined by univariate and multivariate analyses. The outcome of interest was clinical anastomotic leakage.Results
Anastomotic leakage was identified in 13 (3.6%) patients. Multivariate analysis identified middle/lower rectal cancer (odds ratio, 9.446) and lack of pelvic drain (odds ratio, 3.814) as independent predictive factors for anastomotic leakage. The number of cartridges used for rectal division had no significant impact on anastomotic leakage.Conclusions
Laparoscopic anterior resection involving intracorporeal rectal transection and DST anastomosis is safe if performed using an appropriate technique. 相似文献7.
Saluja SS Ray S Pal S Sanyal S Agrawal N Dash NR Sahni P Chattopadhyay TK 《Journal of gastrointestinal surgery》2012,16(7):1287-1295
Background
Leak from cervical esophagogastric anastomosis (CEGA) following esophagectomy is associated with morbidity and poor functional outcome. To address this issue, we conducted a randomized trial comparing ??hand-sewn?? with ??stapled side-to-side?? CEGA.Methods
Of 174 patients who underwent esophageal resection and CEGA between 2004 and 2010, 87 each were randomized to ??hand-sewn?? and ??stapled side-to-side?? CEGA [www.Clinical Trials.gov: NCT00497549]. The primary outcome measure was anastomotic leak rate. The secondary outcome measures included CEGA construction time and occurrence of anastomotic stricture during follow up.Results
The overall anastomotic leak rate was 17.2?% (major leaks: 8?%). The leak rate was similar among the two groups (hand-sewn: 14/87, stapled: 16/87; p?=?0.33). The stapled anastomotic technique was faster (25?±?6.5?min vs. 27?±?5.5?min; p?=?0.02). The overall operative mortality and morbidity rates were 6.3?% and 40.8?%, respectively. At a median follow up of 12 (6?C42) months, anastomotic stricture occurred in 24 (14.7?%) patients and was significantly more common in the ??hand-sewn?? group (17/82 vs. 7/81; p?=?0.045).Conclusion
There were no differences in the leak rates and postoperative outcome between the two CEGA techniques. At follow up, anastomotic strictures occurred less frequently following stapled CEGA. The ideal CEGA technique remains elusive. 相似文献8.
Bin Li Yu-Min Li Jian-Hua Zhang Yun-Feng Su Cheng Wang Zhi-Qiang Wang Yun-Jiu Gou Tie-Niu Song Jian-Bao Yang 《Journal of gastrointestinal surgery》2013,17(12):2051-2058
Background
The study aims to compare the efficacy in prevention of anastomotic complications using layer-to-layer mucosal valve technique versus circular stapled technique for esophagogastric intrathoracic anastomosis after resection for esophageal and gastric cardiac carcinoma.Methods
From January 2005 to December 2010, 136 patients received layer-to-layer mucosal valve technique (LM group), 219 received circular stapled anastomosis (CS group) after curative intent resection for esophageal and gastric cardiac carcinoma. The technique details were reported and the clinical results were analyzed.Results
The two groups were comparable on clinical baseline characteristics. The average duration of operation was longer with LM technique by 16 min, but without statistical significance (P?=?0.073). There was no anastomotic leakage in the LM group, while in the CS group, leakage occurred in seven patients (3.2 %, P?=?0.047). Both the incidence and grade of postoperative dysphagia were significantly lower in the LM group (P?<?0.05). Significantly fewer patients experienced stricture after LM technique (3.8 %) compared with CS anastomosis (18.2 %, P?<?0.001). CS anastomosis was associated with a significantly higher incidence of persistent stricture requiring more dilatation (P?<?0.001). Symptoms of reflux were better controlled by LM technique; 82.7 % of patients were asymptomatic with respect to reflux compared to 58.9 % in the CS group, P?<?0.001. And there was a significant reduction in the incidence of esophagitis in remnant esophagus in the LM group (P?=?0.001).Conclusions
The layered mucosal valve anastomosis could significantly diminish the incidence of anastomotic complications and could be used as an alternative for esophagogastric anastomosis after resection of esophageal and gastric cardiac carcinoma. 相似文献9.
S. A. Käser U. Nitsche M. Maak C. W. Michalski C. Späth T. C. Müller C. A. Maurer K. P. Janssen J. Kleeff H. Friess F. G. Bader 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2014,399(6):783-788
Purpose
The aim of this study is to define the significance of hyponatremia as a marker of anastomotic leakage after colorectal surgery.Methods
All anastomoses in colorectal surgery performed at a single institution between July 2007 and July 2012 (n?=?1,106) were retrospectively identified. Serum sodium levels and leukocyte values measured when an anastomotic leak was diagnosed by CT scan and/or surgical reintervention (n?=?81) were compared to the values preferably on postoperative day 5 in the absence of an anastomotic leak (n?=?1,025).Results
The leak rate in anastomoses of the rectum was 9.0 %, while the leak rate of the other anastomoses was 5.4 %. Mean serum sodium level was 138.8 mmol/l in the group with an anastomotic leak and 140.5 mmol/l in the group without. Hyponatremia (<136 mmol/l) was present in 23 % of patients in the group with an anastomotic leak and in 15 % in the group without (p?<?0.001). In multivariate analysis, leukocytes and serum sodium level remained as significant markers of an anastomotic leak. As a marker of an anastomotic leak, hyponatremia had a specificity of 93 % and a sensitivity of 23 %, while the presence of either leukocytosis or hyponatremia had a sensitivity of 68 %, a specificity of 75 %, a positive predictive value of 18 %, and a negative predictive value of 97 %.Conclusions
Hyponatremia could be a specific and relevant marker of anastomotic leakage after colorectal surgery. If hyponatremia and leukocytosis are present after colorectal surgery, anastomotic leakage should be suspected and a CT scan with rectal contrast dye is recommended. 相似文献10.
Introduction
Emergency operations for perforations and anastomotic leakage of the upper gastrointestinal tract are associated with a high overall morbidity and mortality rate. An endoscopic vacuum therapy (EVT) has been established successfully for anastomotic leakage after rectal resection but only limited data exist for EVT of the upper GI tract.Methods
We report on a series of nine patients treated with EVT for defects of the upper intestinal tract between March 2011 and May 2012. In four patients, initial endoscopic sponge placement was performed in combination with open surgical revision. Median follow-up was 189 (range, 51?C366) days.Results
In total, 52 vacuum sponges were placed in upper GI defects of nine patients. Indication for EVT were anastomotic leakage after esophageal resection or gastrectomy (n?=?5) and iatrogenic or spontaneous esophageal perforations (n?=?4). The mean number of sponge insertions was six (range, 1?C13) with a mean changing interval of 3.5?days (range, 2?C5). A successful vacuum therapy for upper intestinal defects was achieved in eight of nine patients (89?%).Conclusion
EVT is a promising approach for postoperative, iatrogenic, or spontaneous lesions of the upper GI tract. If necessary the endoscopic procedure can be combined with operative revision for better control of the local septic focus. 相似文献11.
Kenji Kawada Suguru Hasegawa Koya Hida Kenjiro Hirai Kae Okoshi Akinari Nomura Junichiro Kawamura Satoshi Nagayama Yoshiharu Sakai 《Surgical endoscopy》2014,28(10):2988-2995
Background
Laparoscopic rectal surgery involving rectal transection and anastomosis with stapling devices is technically difficult. The aim of this study was to evaluate the risk factors for anastomotic leakage (AL) after laparoscopic low anterior resection (LAR) with double-stapling technique (DST) anastomosis.Methods
This was a retrospective single-institution study of 154 rectal cancer patients who underwent laparoscopic LAR with DST anastomosis between June 2005 and August 2013. Patient-, tumor-, and surgery-related variables were examined by univariate and multivariate analyses. The outcome of interest was clinical AL.Results
The overall AL rate was 12.3 % (19/154). In univariate analysis, tumor size (P = 0.001), operative time (P = 0.049), intraoperative bleeding (P = 0.037), lateral lymph node dissection (P = 0.009), multiple firings of the linear stapler (P = 0.041), and precompression before stapler firings (P = 0.008) were significantly associated with AL. Multivariate analysis identified tumor size (odds ratio [OR] 4.01; 95 % confidence interval [CI] 1.25–12.89; P = 0.02) and precompression before stapler firings (OR 4.58; CI 1.22–17.20; P = 0.024) as independent risk factors for AL. In particular, precompression before stapler firing tended to reduce the AL occurring in early postoperative period.Conclusions
Using appropriate techniques, laparoscopic LAR with DST anastomosis can be performed safely without increasing the risk of AL. Important risk factors for AL were tumor size and precompression before stapler firings. 相似文献12.
Johannes Klose Ignazio Tarantino Armin von Fournier Moritz J. Stowitzki Yakup Kulu Thomas Bruckner Claudia Volz Thomas Schmidt Martin Schneider Markus W. Büchler Alexis Ulrich 《Journal of gastrointestinal surgery》2018,22(9):1619-1630
Background
Anastomotic leakage is the most dreaded complication after rectal resection and total mesorectal excision, leading to increased morbidity and mortality. Formation of a diverting ileostomy is generally performed to protect anastomotic healing. Identification of variables predicting anastomotic leakage might help to select patients who are under increased risk for the development of anastomotic leakage prior to surgery. The objective of this study was to assess the applicability of a nomogram as prognostic model for the occurrence of anastomotic leakage after rectal resection in a cohort of rectal cancer patients.Methods
Nine hundred seventy-two consecutive patients who underwent surgery for rectal cancer were retrospectively analyzed. Univariate and multivariable Cox regression analyses were used to determine independent risk factors associated with anastomotic leakage. Receiver operating characteristics (ROC) curve analysis was performed to calculate the sensitivity, specificity, and overall model correctness of a recently published nomogram and an adopted risk score based on the variables identified in this study as a predictive model.Results
Male sex (p?=?0.042), obesity (p?=?0.017), smoking (p?=?0.012), postoperative bleeding (p?=?0.024), and total protein level?≤?5.6 g/dl (p?=?0.007) were identified as independent risk factors for anastomotic leakage. The investigated nomogram and the adopted risk score failed to reach relevant areas under the ROC curve greater than 0.700 for the prediction of anastomotic leakage.Conclusions
The proposed nomogram and the adopted risk score failed to reliably predict the occurrence of anastomotic leakage after rectal resection. Risk scores as prognostic models for the prediction of anastomotic leakage, independently of the study population, still need to be identified.13.
Hiroya Kuroyanagi Takashi Akiyoshi Masatoshi Oya Yoshiya Fujimoto Masashi Ueno Toshiharu Yamaguchi Tetsuichiro Muto 《Surgical endoscopy》2009,23(10):2197-2202
Background
Laparoscopic surgery for rectal cancer has been considered more demanding than laparoscopic colectomy due to its technical difficulties.Objective
The aim of this study was to show safety and feasibility of laparoscopic low anterior resection for lower rectal cancer reconstructed by double-stapling technique (DST).Methods
The present study reviewed 159 patients with rectal cancer undergoing laparoscopic anterior resection reconstructed by DST. They were subdivided into two groups: 98 patients with upper rectal cancer located between 75 and 150 mm from the anal verge (group A) and 61 with lower rectal cancer located within 75 mm from the anal verge (group B). Short-term results and pathological findings were compared between the two groups.Results
There was no conversion in both groups. Operating time and intraoperative blood loss were similar in the two groups. No mortality occurred in either group. Overall morbidity rate was 10.2% in group A and 11.5% in group B (p = 0.798). Anastomotic leak rate was similar in the two groups (2.0% in group A versus 3.3% in group B; p = 0.638). Pathological examination of resected specimen showed no involvement of distal resection margin or circumferential resection margin in both groups.Conclusions
The present study shows that laparoscopic surgery is safe and feasible for lower rectal cancer in a very select group of patients. 相似文献14.
Audrey H. Choi Amanda Arrington Ann Falor Rebecca A. Nelson Michael Lew Joseph Chao Byrne Lee Joseph Kim 《Journal of gastrointestinal surgery》2016,20(4):688-692
Introduction
Reports on outcomes after double-staple technique (DST) for total and proximal gastrectomy are limited, originating mostly from Asian centers. Our objective was to examine anastomotic leak and stricture with DST for esophagoenteric anastomosis in gastric cancer patients.Methods
A single institution review was performed for patients who underwent total/proximal gastrectomy with DST between 2006 and 2015. DST was performed using transoral anvil delivery (OrVil?) with end-to-end anastomosis. Clinical characteristics and outcomes, including anastomotic leak and stricture, were recorded.Results
Overall, DST was performed in 60 patients [total gastrectomy (81.7 %, n?=?49/60), proximal gastrectomy (10.0 %, n?=?6/60), and completion gastrectomy (8.3 %, n?=?5/60)]. Neoadjuvant chemotherapy was administered to 21 patients (35.0 %), and 6 patients (10.0 %) received external beam radiation therapy prior to completion gastrectomy. Operative approach was open (51.7 %, n?=?31/60), laparoscopic (43.3 %, n?=?26/60), or robotic (5.0 %, n?=?3/60). Anastomotic leak occurred in 6.7 % (n?=?4/60), while stricture independent of leak was identified in 19.0 % (n?=?11/58) of patients. Complications occurred in 38.3 % (n?=?23/60) of patients, of which 52 % were classified as Clavien-Dindo grades III–V complications.Conclusion
In the largest Western series of DST for esophagoenteric anastomoses in gastric cancer surgery, our experience demonstrates that DST is safe and effective with low rates of leak and stricture.15.
Suda K Ishida Y Kawamura Y Inaba K Kanaya S Teramukai S Satoh S Uyama I 《World journal of surgery》2012,36(7):1608-1616
Background
Meticulous mediastinal lymphadenectomy frequently induces recurrent laryngeal nerve palsy (RLNP). Surgical robots with impressive dexterity and precise dissection skills have been developed to help surgeons perform operations. The objective of this study was to determine the impact on short-term outcomes of robot-assisted thoracoscopic radical esophagectomy performed on patients in the prone position for the treatment of esophageal squamous cell carcinoma, including its impact on RLNP.Methods
A single-institution nonrandomized prospective study was performed. The patients (n?=?36) with resectable esophageal squamous cell carcinoma were divided into two groups: patients who agreed to robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy performed in the prone position (n?=?16, robot-assisted group) without insurance reimbursement, and those who agreed to undergo the same operation without robot assistance but with health insurance coverage (n?=?20, control group). These patients were observed for 30?days following surgery to assess short-term surgical outcomes, including the incidence of vocal cord palsy, hoarseness, and aspiration.Results
Robot assistance significantly reduced the incidence of vocal cord palsy (p?=?0.018) and hoarseness (p?=?0.015) and the time on the ventilator (p?=?0.025). There was no in-hospital mortality in either group. There were no significant differences between the two groups with respect to patient background, except for the use of preoperative therapy (robot-assisted groupConclusion
Robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy is feasible and safe. This method shows promise in preventing RLNP. 相似文献16.
Ramanah R Ballester M Chereau E Bui C Rouzier R Daraï E 《International urogynecology journal》2012,23(6):779-783
Introduction and hypothesis
To evaluate changes in anorectal symptoms before and after pelvic organ prolapse (POP) surgery, using laparoscopic sacrocolpoperineopexy.Methods
Preoperative and postoperative anorectal symptoms, colorectal–anal distress inventory (CRADI) and colorectal–anal impact questionnaire (CRAIQ) scores were prospectively compared from 90 consecutive women undergoing laparoscopic sacrocolpoperineopexy.Results
After a median follow-up of 30.7?months, laparoscopic surgery significantly worsened CRADI (p?=?0.02) with no effect on CRAIQ (p?=?0.37) scores. Post-operative and de novo straining (27%) and the need for digital assistance (17%) were the most frequent anorectal symptoms. No correlation was found between laparoscopic surgery and anorectal symptoms after multivariate analysis (OR?=?2.45[95% confidence interval 0.99–6.05], p?=?0.05).Conclusion
Anorectal symptoms are not improved after POP surgery by laparoscopic sacrocolpoperineopexy. 相似文献17.
Introduction
Anastomotic leakage is a serious complication after colorectal resection. Recent studies suggest that nonsteroidal anti-inflammatory drugs may increase the risk of anastomotic leakage. We investigated this association in our enhanced recovery population.Material and Methods
Patients undergoing an elective colon or rectal resection with primary anastomosis because of malignancy and treated within our enhanced recovery program were included. Univariable and multivariable logistic regression analyses were used to study risk factors for anastomotic leakage.Results
Between 2006 and 2013, 856 patients were included. The anastomotic leakage rate was significantly higher in the group that received nonsteroidal anti-inflammatory drugs compared to patients who did not: 9.2 vs. 5.3 %, p?=?0.038. This higher rate was only seen in patients receiving diclofenac: for colonic resections, 11.8 vs. 6.0 %, p?=?0.016; for rectal resections, 13.1 vs. 0 %, p?=?0.017. Only male sex (odds ratio 2.20, p?=?0.005) was also independently associated with anastomotic leakage.Conclusion
The results of this study are in line with other comparable studies in the literature, showing an increased risk for anastomotic leakage with diclofenac. The use of diclofenac in colorectal surgery can no longer be recommended. Alternatives for postoperative analgesia need to be explored within an enhanced recovery program.18.
Smeenk RM Plaisier PW van der Hoeven JA Hesp WL 《Journal of gastrointestinal surgery》2012,16(8):1559-1565
Introduction
According to literature, colonic resection with a primary anastomosis and no defunctioning ileostomy is a safe treatment for colovesical or colovaginal fistula of diverticular origin. This study investigates the outcome of surgery for this patient group in a regional hospital.Methods
Patients were obtained from a prospective database in the period 2004?C2011. Several variables were investigated for their relation with surgical outcome.Results
A colovesical (n?=?35) or colovaginal (n?=?5) fistula was diagnosed in 18 men and 22 women. The mean age was 69?years (range, 45?C90). A rectosigmoid resection with primary anastomosis was performed in 32 patients. Fourteen patients received a defunctioning ileostomy. Eight patients were treated with a Hartmann procedure. Overall 30-day treatment-related morbidity and mortality was 48 and 8?%, respectively. Major morbidity, because of anastomotic leakage, was mainly observed in the primary anastomosis group without a defunctioning ileostomy. Morbidity and mortality were associated with high body mass index, diabetes, use of corticosteroids, and American Society of Anesthesiologists classification, though not significantly.Conclusions
One should be liberal in the use of a defunctioning ileostomy in case of a primary anastomosis after colonic resection for a diverticular fistula, in order to prevent high morbidity rates due to anastomotic leakage. 相似文献19.
Wang G Jiang Z Zhao K Li G Liu F Pan H Li J 《Journal of gastrointestinal surgery》2012,16(7):1379-1388
Objective
It has been demonstrated that colon operation combined with fast-track (FT) surgery and laparoscopic technique can shorten the length of hospital stay, accelerate recovery of intestinal function, and reduce the occurrence of post-operative complications. However, there are no reports regarding the combined effects of FT colon operation and laparoscopic technique on humoral inflammatory cellular immunity.Methods
This was a prospective, controlled study. One hundred sixty-three colon cancer patients underwent the traditional protocol and open operation (traditional open group, n?=?42), the traditional protocol and laparoscopic operation (traditional laparoscopic group, n?=?40), the FT protocol and open operation (FT open group, n?=?41), or the FT protocol and laparoscopic operation (FT laparoscopic group, n?=?40). Blood samples were taken prior to operation as well as on days 1, 3, and 5 after operation. The number of lymphocyte subpopulations was determined by flow cytometry, and serum interleukin-6 and C-reactive protein levels were measured. Post-operative hospital stay, post-operative morbidity, readmission rate, and in-hospital mortality were recorded.Results
Compared with open operation, laparoscopic colon operation effectively inhibited the release of post-operative inflammatory factors and yielded good protection via post-operative cell immunity. FT surgery had a better protective role with respect to the post-operative immune system compared with traditional peri-operative care. Inflammatory reactions, based on interleukin-6 and C-reactive protein levels, were less intense following FT laparoscopic operation compared to FT open operation; however, there were no differences in specific immunity (CD3+ and CD4+ counts, and the CD4+/CD8+ ratio) during these two types of surgical procedures. Post-operative hospital stay in patients randomized to the FT laparoscopic group was significantly shorter than in the other three treatment groups (P?0.01). Post-operative complications in patients who underwent FT laparoscopic treatment were less than in the other three treatment groups (P?0.05). There were no significant differences between the four treatment groups regarding readmission rate and in-hospital mortality.Conclusions
The laparoscopic technique and FT surgery rehabilitation program effectively inhibited release of post-operative inflammatory factors with a reduction in peri-operative trauma and stress, which together played a protective role on the post-operative immune system. Combining two treatment measures during colon operation produced better protective effects via the immune system. The beneficial clinical effects support that the better-preserved post-operative immune system may also contribute to the improvement of post-operative results in FT laparoscopic patients. 相似文献20.
Nino Gull�� Stefano Trastulli Carlo Boselli Roberto Cirocchi Davide Cavaliere Giorgio Maria Verdecchia Umberto Morelli Daniele Gentile Emilio Eugeni Daniela Caracappa Chiara Listorti Francesco Sciannameo Giuseppe Noya 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2011,396(7):997-1007