761 research outputs found
Use of a novel magnetic sphincter augmentation device for the treatment of GERD: a European experience
No full textEXPERIMENTAL STUDY WITH THREE-DIMENSIONAL MANOMETRIC TECHNIQUE OF THE EFFECTS OF HELLER MYOTOMY
No full textPredictors for anastomotic leak, postoperative complications, and mortality after right colectomy for cancer: Results from an international snapshot audit
No full textBACKGROUND: A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking. OBJECTIVE: This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy. DESIGN: This was a snapshot observational prospective study. SETTING: The study was conducted as a multicenter international study. PATIENTS: The 2015 European Society of Coloproctology snapshot study was a prospective multicenter international series that included all patients undergoing elective or emergency right hemicolectomy or ileocecal resection over a 2-month period in early 2015. This is a subanalysis of the colon cancer cohort of patients. MAIN OUTCOME MEASURES: Predictors for anastomotic leak and 30-day postoperative morbidity and mortality were assessed using multivariable mixed-effect logistic regression models after variables selection with the Lasso method. RESULTS: Of the 2515 included patients, an anastomosis was performed in 97.2% (n = 2444), handsewn in 38.5% (n = 940) and stapled in 61.5% (n = 1504) cases. The overall anastomotic leak rate was 7.4% (180/2444), 30-day morbidity was 38.0% (n = 956), and mortality was 2.6% (n = 66). Patients with anastomotic leak had a significantly increased mortality rate (10.6% vs 1.6% no-leak patients; p > 0.001). At multivariable analysis the following variables were associated with anastomotic leak: longer duration of surgery (OR = 1.007 per min; p = 0.0037), open approach (OR = 1.9; p = 0.0037), and stapled anastomosis (OR = 1.5; p = 0.041). LIMITATIONS: This is an observational study, and therefore selection bias could be present. For this reason, a multivariable logistic regression model was performed, trying to correct possible confounding factors. CONCLUSIONS: Anastomotic leak after oncologic right hemicolectomy is a frequent complication, and it is associated with increased mortality. The key contributing surgical factors for anastomotic leak were anastomotic technique, surgical approach, and duration of surgery
Early experience with laparoscopic lavage for perforated diverticulitis
No full textBACKGROUND: Laparoscopic lavage has recently emerged as a
promising alternative to sigmoid resection in the treatment of
perforated diverticulitis. This study examined an early
experience with this technique. METHODS: The files of all
patients with complicated diverticulitis were searched in 34
teaching hospitals of the Netherlands. Patients with perforated
diverticulitis treated with laparoscopic lavage between 1
January 2008 and 31 December 2010 were included. RESULTS:
Treatment with laparoscopic lavage was performed in only 38
patients in ten hospitals. Lavage was successful in controlling
sepsis in 31 of the 38 included patients, with 32 per cent
morbidity (10 of 31 patients) and fast recovery. Overall, 17 of
38 patients developed complications, of whom two had a missed
overt sigmoid perforation. Two patients died from multiple organ
failure and one from aspiration pneumonia; one other patient
died after palliative management of inoperable lung carcinoma.
Three patients in whom lavage was successful underwent
subsequent sigmoid resection for recurrent diverticulitis.
Patients in whom lavage was unsuccessful tended to have more
co-morbidities, a higher preoperative C-reactive protein
concentration and a higher Mannheim Peritonitis Index.
CONCLUSION: Laparoscopic lavage for perforated diverticulitis
was feasible in the majority of patients, but identification of
an overt sigmoid perforation and patient selection are of
critical importance
Vacuum assisted closure in coloproctology
No full textVacuum-assisted closure has earned its indications in coloproctology. It has been described with variable results in the treatment of large perineal defects after abdominoperineal excision, in the treatment of stoma dehiscence and perirectal abscesses. The most promising indication for vacuum-assisted closure is probably the treatment of para-anastomotic presacral abscesses following anastomotic leakage after total mesorectal excision. Early initiation of vacuum-assisted closure has the potential to prevent debilitating persistent presacral sinuses precluding stoma closure and bad function of the neorectum. Prompt initiation of endosponge treatment is advised after the anastomotic leakage with the purulent cavity is diagnosed. The endosponge is inserted transanally and connected with a low vacuum bottle. With the gradual reduction in the cavity, the endosponge is reduced in size every 3-4 days when the endosponge is exchanged. It takes 3-6 weeks to close the cavity. Future studies should focus on the stoma closure rate and function to assess whether this intensive postoperative treatment of anastomotic leakages is justifie
STUDIO SPERIMENTALE DEGLI EFFETTI DELLA CARDIASMIOTOMIA SEC. HELLER MEDIANTE MANOMETRIA INTRAOPERATORIA (IEM) TRIDIMENSIONALE: VALUTAZIONE DEL VOLUME VETTORE (VV)
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