scholarly journals A technique for constructing diverting loop ileostomy to prevent outlet obstruction after rectal resection and total colectomy: a retrospective single-center study

Surgery Today ◽  
2021 ◽  
Author(s):  
Yusuke Takehara ◽  
Mihoko Nakagawa ◽  
Hiroaki Kobayashi ◽  
Kensuke Kakisako ◽  
Yojiro Takano ◽  
...  
Keyword(s):  
Small Intestine ◽  
Total Colectomy ◽  
Clinical Stage ◽  
Loop Ileostomy ◽  
Outlet Obstruction ◽  
Diverting Stoma ◽  
Single Center Study ◽  
History Of ◽  
Group A ◽  
Diverting Loop Ileostomy

Abstract Purpose Preventing outlet obstruction associated with a diverting stoma is important. Previously, we constructed a diverting loop ileostomy with the proximal limb of the small intestine on the caudal side, namely the oral inferior (OI) method. However, to address the issue of twisting and stenosis of the small intestine, we recently constructed a diverting loop ileostomy with the proximal limb on the cranial side, namely the oral superior (OS) method. We compared the incidence of outlet obstruction between the two methods. Methods The subjects of this retrospective study were 133 patients who underwent colorectal resection or total colectomy, with D2 or more lymph node dissection and diverting loop ileostomy construction, between April, 2001 and December, 2018, at our hospital. The OI method was performed in 54 patients and the OS method was performed in 79 patients. Results In the OS group, a history of laparotomy, neoadjuvant therapy, clinical stage III, and the use of anti-adhesion materials were more common, whereas blood loss and the incidence of outlet obstruction were significantly lower. Multivariate analysis identified only OS placement as a significant factor for reducing the incidence of outlet obstruction. Conclusion When constructing a diverting loop ileostomy, placing the proximal limb on the cranial side is important.

scholarly journals Diverting Ostomy: For Whom, When, What, Where, and Why

2019 ◽  
Vol 32 (03) ◽  
pp. 171-175 ◽  
Author(s):  
Alexis Plasencia ◽  
Heidi Bahna
Keyword(s):  
Recent Literature ◽  
Coloanal Anastomosis ◽  
Primary Anastomosis ◽  
Loop Ileostomy ◽  
Diverting Ileostomy ◽  
Clinical Scenarios ◽  
Diverting Stoma ◽  
Diverting Loop Ileostomy ◽  
Inflammatory Bowel ◽  
Diverting Ostomy

AbstractFecal diversion is an important tool in the surgical armamentarium. There is much controversy regarding which clinical scenarios warrant diversion. Throughout this article, we have analyzed the most recent literature and discussed the most common applications for the use of a diverting stoma. These include construction of diverting ileostomy or colostomy, ostomy for low colorectal/coloanal anastomosis, inflammatory bowel disease, diverticular disease, and obstructing colorectal cancer. We conclude the following: diverting loop ileostomy is preferred to loop colostomy, an ostomy should be used for a pelvic anastomosis < 5 to 6 cm including coloanal anastomosis and ileo-anal-pouch anastomosis, severe perianal Crohn's disease frequently requires diversion, a primary anastomosis with diverting ileostomy in the setting of diverticular perforation is safe, and a diverting stoma can be used as a bridge to primary resection in the setting of an obstructing malignancy.

scholarly journals Metachronous volvulus of the splenic flexure: a rarer entity

2018 ◽  
Vol 5 (2) ◽  
pp. 728
Author(s):  
Suchin Dhamnaskar ◽  
Prashant C. Sawarkar ◽  
Sumit Mandal ◽  
Preeti Vijaykumaran
Keyword(s):  
Intestinal Obstruction ◽  
Splenic Flexure ◽  
Loop Ileostomy ◽  
Rare Condition ◽  
Postoperative Recovery ◽  
Surgical History ◽  
History Of ◽  
Diverting Loop Ileostomy ◽  
Abdominal Operations ◽  
Flatus Tube

Intestinal obstruction due to volvulus is a well-known entity in India, one of the ‘volvulus belt’ countries; but volvulus of the splenic flexure is a rare condition, even more so when metachronous. Only about half a century of citations has been mentioned in the surgical history since its first mention in literature. Our patient, a young man with a history of previous two abdominal operations presented with signs of intestinal obstruction which were confirmed by radiological findings to be volvulus of splenic flexure. Following failed attempted derotation by flatus tube, he underwent laparotomy, intraoperative derotation of the volvulus followed by resection of the involved segment and colo-colic anastomosis with diverting loop ileostomy. Apart from surgical site infection, his postoperative recovery was uneventful.

scholarly journals Stapled Hemorrhoidopexy: “Mucosectomy or Not Only Mucosectomy, This Is the Problem”

2021 ◽  
Vol 8 ◽  
Author(s):  
Chiara Eberspacher ◽  
Fabio M. Magliocca ◽  
Stefano Pontone ◽  
Pietro Mascagni ◽  
Lisa Fralleone ◽  
...  
Keyword(s):  
Rectal Wall ◽  
Muscularis Propria ◽  
Stapled Hemorrhoidopexy ◽  
Single Center Study ◽  
Significant Difference ◽  
History Of ◽  
Group A ◽  
Rectal Mucosectomy ◽  
Group B ◽  
Almost All

Introduction: Stapled hemorrhoidopexy was originally defined as a rectal mucosectomy. The aims of our retrospective, single-center study were to demonstrate if the excised specimen comprises only the mucosa or more wall rectal layers and if the latter excision should be considered a technical mistake with an increase in complications.Materials and Methods: We histopathologically analyzed surgical samples from patients who underwent stapled hemorrhoidopexy performed between 2014 and 2019. Patients were divided into three groups, according to the stapler used: Group A (single PPH®), Group B (double PPH®), and Group C (CPH34 HV™). We evaluated the actual wall layers included in the stapled rectal ring. For every specimen, we reconstructed the history of the corresponding patient and the incidence of complications.Results: Of the 137 histological slides available, 13 were only mucosectomies (9.5%), and 124 presented also the submucosa and muscularis propria (90.5%)−50/58 patients in Group A, 28/28 in Group B, and 46/51 in Group C. No statistically significant difference in the rate of complications was found when stratifying patients according to the thickness of the resection [mucosectomy (M) or “full thickness” (FT)].Discussion: Stapled hemorrhoidopexy is not a simple mucosectomy but a resection of the rectal wall with almost all its layers. This concept defines the entity of the surgical procedure and excludes a direct correlation with an increased rate of complications.

Hormonal stimulation and some risk factors studied to improve bovine pregnancy rate at the Coastal areas of Barisal district of Bangladesh

2018 ◽  
Vol 52 (1-4) ◽  
pp. 22-30
Author(s):  
A K Paul ◽  
S M T Rahman
Keyword(s):  
Pregnancy Rate ◽  
Coastal Region ◽  
Hormonal Treatment ◽  
Coastal Areas ◽  
Pregnancy Rates ◽  
Hormonal Stimulation ◽  
Crossbred Cows ◽  
Treatment Groups ◽  
History Of ◽  
Group A

Hormonal treatment of cows at the coastal region of Barisal district of Bangladesh was performed to assess the improvement of pregnancy rate. A total of 100 cows and heifers with irregular history of cyclicity were selected randomly and divided into five treatment groups. The groups were A (treated with anthelmintic), B (treated with anthelmintic, vitamin ADE and multivitamin powder), C (treated with PGF2α), D (treated with GnRH) and E (treated with GnRH and PGF2α). Each group comprised of 20 animals. The age, breed and parity of experimental cows were considered during treatment. In the study, the cows treated with both GnRH and PGF2α (group E) showed significantly (p<0.05) higher estrus (80%) and pregnancy rate (60%) than that of group A, B, C and D. The overall estrus rates of local and crossbred cows were 64% and 70%, respectively and the pregnancy rates were 40 and 52%, respectively. The crossbred cows responded significantly (p<0.05) to hormonal treatment than that of local cows. Parity-2 cows showed higher estrus sign than that of other parities. However, the pregnancy rates were higher significantly (p<0.05) in parity-2 and parity ≥4 cows than that of parity-0, parity-1 and parity-3 cows. The pregnancy rate was also found higher in case of 4 to <5 years old cows than that of 2 to <3, 3 to <4, 5 to <6, and ≥6 years old. It may conclude that the hormonal regimen increases the pregnancy rate as well as decreases the undesired waiting of estrus and conception. Further study with more sample size will reveal the more effective treatment for cows at the coastal areas of Bangladesh.

Hormonal stimulation and some risk factors studied to improve bovine pregnancy rate at the Coastal areas of Barisal district of Bangladesh

2018 ◽  
Vol 52 (1-4) ◽  
pp. 22-30
Author(s):  
A K Paul ◽  
S M T Rahman
Keyword(s):  
Pregnancy Rate ◽  
Coastal Region ◽  
Hormonal Treatment ◽  
Coastal Areas ◽  
Pregnancy Rates ◽  
Hormonal Stimulation ◽  
Crossbred Cows ◽  
Treatment Groups ◽  
History Of ◽  
Group A

Hormonal treatment of cows at the coastal region of Barisal district of Bangladesh was performed to assess the improvement of pregnancy rate. A total of 100 cows and heifers with irregular history of cyclicity were selected randomly and divided into five treatment groups. The groups were A (treated with anthelmintic), B (treated with anthelmintic, vitamin ADE and multivitamin powder), C (treated with PGF2α), D (treated with GnRH) and E (treated with GnRH and PGF2α). Each group comprised of 20 animals. The age, breed and parity of experimental cows were considered during treatment. In the study, the cows treated with both GnRH and PGF2α (group E) showed significantly (p<0.05) higher estrus (80%) and pregnancy rate (60%) than that of group A, B, C and D. The overall estrus rates of local and crossbred cows were 64% and 70%, respectively and the pregnancy rates were 40 and 52%, respectively. The crossbred cows responded significantly (p<0.05) to hormonal treatment than that of local cows. Parity-2 cows showed higher estrus sign than that of other parities. However, the pregnancy rates were higher significantly (p<0.05) in parity-2 and parity ≥4 cows than that of parity-0, parity-1 and parity-3 cows. The pregnancy rate was also found higher in case of 4 to <5 years old cows than that of 2 to <3, 3 to <4, 5 to <6, and ≥6 years old. It may conclude that the hormonal regimen increases the pregnancy rate as well as decreases the undesired waiting of estrus and conception. Further study with more sample size will reveal the more effective treatment for cows at the coastal areas of Bangladesh.

Appreciation of the importance of pregravid preparation and reproductive attitudes of women of childbearing age in the city of Omsk

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 48-52
Author(s):  
E N Kravchenko ◽  
R A Morgunov
Keyword(s):  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Pregnancy And Childbirth ◽  
Perinatal Center ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Complicated Pregnancy ◽  
The Relationship ◽  
The City

The aim of the study. Assess the importance of pregravid preparation and outcomes of pregnancy and childbirth, depending on the reproductive attitudes of women in the city of Omsk. Materials and methods. The study included 92 women who were divided into groups: group A (n=43) - women whose pregnancy was planned; group B (n=49) - women whose pregnancy occurred accidentally. Each group was divided into subgroups depending on age: from 18 to 30 and from 31 to 49 years. For each patient included in the study, a specially designed map was filled out. These patients were interviewed at the City Clinical Perinatal Center. Results. Comparative analysis revealed the relationship between the reproductive settings of women of childbearing age and the peculiarity of the course of pregnancy and childbirth in these patients. Summary. The majority of women of fertile age are married: in subgroup AA - 25 (96.2%), AB - 13 (76.5%), BA - 25 (92.6%), BB - 20 (91.0%). The predominant number of women of fertile age have one or more abortions: in subgroup AA - 12 (46.2%), AB - 6 (35.3%), in subgroups of comparison BA - 8 (29.6%), BB - 6 (27.3%). More than half of the women of fertile age surveyed have a history of untreated cervical pathology (from 40.8% to 64.7%). The course of pregnancy in women planning pregnancy in most cases proceeded without complications: in subgroup AA - 13 (50.0%), AB - 11 (64.7%). The most common cause of complicated pregnancy in women whose pregnancy occurred accidentally is the threat of spontaneous miscarriage: in subgroup BA - 15 (55.6%), BB - 16 (72.7%). The uncomplicated course of labor more often [subgroup AA - 19 (73.0%), AB - 12 (70.6%)] was observed in women whose pregnancy was planned and they were motivated to give birth to a healthy child.

STEREOTACTIC HYPO-FRACTIONAL RADIOTHERAPY OF PATIENTS WITH LUNG CANCER I-IIA CLINICAL STAGE: THE ROLE OF SUVMAX ASSESSMENT IN 18F-FDG PET/CT FOR MONITORING TREATMENT OUTCOMES

2017 ◽  
Vol 63 (4) ◽  
pp. 632-638
Author(s):  
Tatyana Borisova ◽  
Arif Allakhverdiev ◽  
Yuriy Gerasimov ◽  
Nadezhda Meshcheryakova ◽  
Mikhail Dolgushin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Treatment Effectiveness ◽  
Clinical Stage ◽  
First Year ◽  
Pet Ct ◽  
History Of ◽  
Single Factor Analysis ◽  
Fdg Pet Ct ◽  
Second Tumor ◽  
Monitoring Treatment

Material and methods: Since 2014, 33 patients with lung cancer of clinical stage I-IIa (cT1N0M0 - 12 patients, with T2N0M0 - 21 patients) have undergone SRT. Verification of tumor process was obtained in 30 patients. A third of patients (n = 10) had a history of metachronic primary-multiple tumors and 31 patients had peripheral lung cancer. The used variants of SRT fractionation were as followed: 10Gr x 5 fractions (n = 22) and 7Gr x 8 fractions (n = 11) - BED 100Gy. Results: With a median follow-up of 21 months (range 3-37 months), 4 patients (12 %) within the first year had a loco-regional and distant progression, of which two died. During the year one patient died from complications of treatment, one - from the progression of the second tumor. One- and two-year local control was 94 %. Overall and disease-free 2-year survival was 84 % (95 % CI, 70 - 99) and 83.2 % (95 % CI, 70.5 - 99), respectively. Single-factor analysis revealed a significant effect on the overall survival of the fractionation regimen (p = 0.04). The effect of the baseline SUVmax tended to be reliable (p = 0.07). Conclusions: In order to implement the principles of risk-adaptive radiation therapy it is necessary to consider the initial SUVmax of tumor as one of potential predictive and predicative markers of treatment effectiveness.

scholarly journals Unusual Tissue – Unusual Issue: Pancreatic Heterotopia Presenting as Gastric Outlet Obstruction

2021 ◽  
pp. 338-343
Author(s):  
Thu L. Nguyen ◽  
Shivani Kapur ◽  
Stephen C. Schlack-Haerer ◽  
Grzegorz T. Gurda ◽  
Milan E. Folkers
Keyword(s):  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Needle Aspiration ◽  
Pancreatic Tissue ◽  
Cystic Mass ◽  
Pancreatic Heterotopia ◽  
History Of

Pancreatic heterotopia (PH) is a common, but typically small (<1 cm), incidental and asymptomatic finding; however, PH should be considered even for large and symptomatic upper gastrointestinal masses. A 27-year-old white woman presented with a 3-week history of burning epigastric pain, nausea, early satiety, and constipation. Physical examination revealed epigastric and right upper quadrant tenderness with normal laboratory workup, but imaging revealed a 5-cm, partly cystic mass arising from the gastric antrum with resulting pyloric stenosis and partial gastric outlet obstruction. Endoscopic ultrasound-guided fine needle aspiration revealed PH – an anomalous pancreatic tissue lying in a nonphysiological site. The patient ultimately underwent a resection and recovered uneventfully, with a complete pathologic examination revealing normal exocrine pancreatic tissue (PH type 2) without malignant transformation. We report a case of heterotopic pancreas manifesting as severe gastric outlet obstruction, in addition to a thorough diagnostic workup and surgical follow-up, in a young adult. Differential diagnoses and features that speak to benignity of a large, symptomatic mass lesion (PH in particular) are discussed.

Anterior approach levator plication for congenital ptosis, absorpable versus non absorpable sutures

2021 ◽  
pp. 112067212110053
Author(s):  
Moustafa Salamah ◽  
Ashraf Mahrous Eid ◽  
Hani Albialy ◽  
Sherif Sharaf EL Deen
Keyword(s):  
Randomized Study ◽  
Early Postoperative Period ◽  
Polyglactin 910 ◽  
Exclusion Criteria ◽  
Congenital Ptosis ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Over Time

Purpose: To compare the efficacy of two different suture types in levator plication for correction of congenital ptosis. Subjects and methods: Prospective comparative interventional randomized study involving 42 eyes of 42 patients aged more than 6 years with congenital ptosis and good levator action. The exclusion criteria were as follows: bilateral ptosis, history of previous surgery, fair or poor levator action, and associated other ocular diseases. Patients were randomized into group A, in which double-armed 5/0 polyester Ethibond were used, and group B, in which double-armed 5/0 Coated Vicryl® (polyglactin 910) suture material we used. Outcomes including eyelid height and stability of eyelid height over time were compared with follow-up data. The MRD was 4.05 ± 0.36 mm and 3.95 ± 0.34 after 1 week for both groups A and B, respectively. At the end of study follow up period (24 weeks), the MRD was 3.60 ± 0.42 mm in group A, and 2.52 ± 0.85 mm in group B. Conclusion: No difference in eyelid height between two groups in early postoperative period, but the postoperative eyelid height was more stable over time in the 5/0 polyester Ethibond group (group A) than in the 5/0 Coated Vicryl® (polyglactin 910) group (group B).

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