scholarly journals Revising Our Concepts about Stoma Covering a Low Rectal Anastomosis

2021 ◽  
Author(s):  
Wael E. Lotfy ◽  
Ahmed Raafat Abdel Fattah ◽  
Osama A. Eltih ◽  
Peter H. Wasef ◽  
Hassan R. Ashour
Keyword(s):  
Colorectal Anastomosis ◽  
Conclusive Evidence ◽  
Transverse Colostomy ◽  
Nutritional Deficiencies ◽  
Rectal Anastomosis ◽  
Frequent Change ◽  
Defunctioning Stoma ◽  
Low Rectal Anastomosis ◽  
Group I ◽  
Before And After

Abstract Introduction There has been conclusive evidence that defunctioning stoma with either transverse colostomy or ileostomy mitigates the serious consequences of anastomotic leakage. However, whether transverse colostomy or ileostomy is preferred for defunctioning a rectal anastomosis remains controversial. The present study was designed to identify the best defunctioning stoma for colorectal anastomosis. Objective To improve the quality of life in patients with rectal resection and anastomosis and reduce the morbidity before and after closure of the stoma. Patients and Methods The present study included 48 patients with elective colorectal resection who were randomly arranged into 2 equal groups, with 24 patients each. Group I consisted of patients who underwent ileostomy, and group II consisted of patients who underwent colostomy as a defunctioning stoma for a low rectal anastomosis. All surviving patients were readmitted to have their stoma closed and were followed-up for 6 months after closure of their stomas. All data regarding local and general complications of construction and closure of the stoma of the two groups were recorded and blotted against each other to clarify the most safe and tolerable procedure. Results We found that all nutritional deficiencies, dehydration, electrolytes imbalance, peristomal dermatitis, and frequent change of appliances are statistically more common in the ileostomy group, while stomal retraction and wound infection after closure of the stoma were statistically more common in the colostomy group. There were no statistically significant differences regarding the total hospital stay and mortality between the two groups. Conclusion and Recommendation Ileostomy has much higher morbidities than colostomy and it also has a potential risk of mortality; therefore, we recommend colostomy as the ideal method for defunctioning a distal colorectal anastomosis.

scholarly journals The “impossible” rectal anastomosis: a novel use for endoluminal vacuum-assisted therapy

2020 ◽  
Author(s):  
Nadja C. Lehwald-Tywuschik ◽  
Andrea Alexander ◽  
Nour Alkhanji ◽  
Georg Flügen ◽  
Stephen Fung ◽  
...  
Keyword(s):  
High Risk ◽  
Colorectal Anastomosis ◽  
Rectal Stump ◽  
Patient Characteristics ◽  
Underlying Disease ◽  
Sigmoid Diverticulitis ◽  
Rectal Anastomosis ◽  
Low Rectal Anastomosis ◽  
Polyurethane Sponge ◽  
Diverting Ostomy

Abstract Purpose Low rectal anastomoses can safely be performed, usually secured by a diverting ostomy. However, in cases of inflammation, extensive scarring, after extensive radiation, or after severe stapler dysfunction the risk for an anastomotic leak may become prohibitively high. We present a novel use for endoluminal vacuum-assisted therapy (EVAT) for otherwise “impossible” low rectal anastomoses. Methods Our initial series consisted of 14 consecutive patients who underwent prophylactic EVAT treatment due to unsafe low colorectal anastomosis. The vacuum sponge was placed intraoperatively in cases otherwise calling for a Hartmann’s procedure. An open-pored polyurethane sponge was placed prophylactically transanally for a mean duration of 11 days. Patient characteristics, complications, and risk factors were prospectively collected from medical records and analyzed. Results Between March 2017 and September 2019, we performed this novel technique in 14 patients enabling us to perform an anastomosis. Our collective consisted of 4 female (29%) and 10 male (71%) patients with a medium age of 59 years. Underlying disease was colorectal cancer in 10 patients, ovarian cancer, perforated sigmoid diverticulitis, ischemic colitis and sarcoma in one patient each. Dominant factors putting the anastomosis at extremely high risk were acute inflammation (n = 2), frozen pelvis (n = 2), intraoperative local chemotherapy (n = 2), stapler dysfunction (n = 2), non-closable rectal stump (n = 2), empty pelvis (n = 1) and ultra-low anastomosis (n = 3). Prophylactic EVAT was successful in 92% and gastrointestinal continuity was preserved in all patients. Conclusion This is the first description of prophylactic EVAT treatment. It seems to be a simple and safe method to enforce the high-risk low rectal anastomosis.

Is Circular Fibrin Sealing of Low Rectal Anastomosis Able to Prevent Leakage in 21-Day Follow-up? Randomized Experimental Trial in Pigs

2019 ◽  
Vol 26 (4) ◽  
pp. 408-419
Author(s):  
Frank Axel Wenger ◽  
Eduard Szucsik ◽  
Bogdan Florin Hoinoiu ◽  
Anca M. Cimpean ◽  
John P. Matonick ◽  
...  
Keyword(s):  
Fibrin Sealant ◽  
Therapy Group ◽  
Anal Verge ◽  
Colorectal Anastomosis ◽  
Clinical Signs ◽  
Stapled Anastomosis ◽  
Control Group ◽  
Defunctioning Stoma ◽  
Low Rectal Anastomosis ◽  
Anterior Rectal Resection

Purpose. Clinically apparent anastomotic leakage (AL) after low anterior rectal resection (LAR; <7 cm from anal verge) using circular double-stapled anastomosis without defunctioning stoma is up to 37.5%. However, it is unclear whether there is reduction of LAR after 21 postoperative days without defunctioning stoma but with extraluminal anastomotic application of fibrin sealant. Methods. Forty-eight-week-old pigs underwent LAR and circular double-stapled anastomosis in end-to-end technique (descendo-rectostomy). Animals were randomized into therapy and control group (cg). Therapy group (n = 20) received additional extraluminal circular anastomotic application of fibrin sealant. Objective was to assess incidence of clinically apparent and nonclinically apparent leakage through the 21st postoperative day. Remaining animals were sacrificed on the 21st day, and anastomotic region was analyzed. In case of earlier diagnosed AL, animals were sacrificed. Results. In cg, we observed clinically and nonclinically AL in 20% (n = 4). No animal was identified with a nonclinical-apparent leakage in this group, and all 4 animals with leakages presented clinical signs. In the therapy group, no animal (0/20) developed clinically apparent leakage signs. There were no leakages in this group, but 3 animals had ulcerative lesions without leak and without clinical signs. These lesions were observed intraluminally at crossing of staple lines after 21 days. In one of these animals, incomplete leakage was observed, blocked by fibrin sealant. Conclusion. In circular stapled colorectal anastomosis, circular fibrin glue sealant successfully protected anastomotic intraluminal wall defects at crossing of staple lines, reducing leakage rate from 20% to 0% (cg vs therapy group) after 21 postoperative days.

scholarly journals Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

2008 ◽  
Vol 23 (3) ◽  
pp. 294-303 ◽  
Author(s):  
Katia Ferreira Güenaga ◽  
Suzana Angélica Silva Lustosa ◽  
Sarhan Sydney Saad ◽  
Humberto Saconato ◽  
Delcio Matos
Keyword(s):  
Large Scale ◽  
Loop Ileostomy ◽  
Skin Irritation ◽  
Colorectal Anastomosis ◽  
Length Of Hospital Stay ◽  
Transverse Colostomy ◽  
Time Interval ◽  
Stoma Formation ◽  
Statistical Heterogeneity ◽  
Stoma Prolapse

PURPOSE: The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review. METHODS: Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction. RESULTS: Stoma prolapse was statistically significant (p = 0.00001), but with statistical heterogeneity; the sensitive analysis was applied, excluding the trials that included emergency surgery, and this showed: p = 0.02, with I² = 0% for the heterogeneity test. CONCLUSIONS: The outcomes reported were not statistically or clinically significant except for stoma prolapse. Better evidence for making the choice between loop ileostomy or loop colostomy requires large-scale randomized controlled trials.

Endothelin effects in isolated, perfused lamb lungs: role of cyclooxygenase inhibition and vasomotor tone

1991 ◽  
Vol 261 (2) ◽  
pp. H443-H450 ◽  
Author(s):  
H. Toga ◽  
J. Usha Raj ◽  
R. Hillyard ◽  
B. Ku ◽  
J. Anderson
Keyword(s):  
Vasomotor Tone ◽  
Cyclooxygenase Inhibition ◽  
Group Iii ◽  
Group I ◽  
Before And After ◽  
Pulmonary Arterial ◽  
Group Ii ◽  
Sites Of Action ◽  
Arteries And Veins

We have determined the sites of action of endothelin-1 (ET) in the lamb pulmonary circulation. The influence of cyclooxygenase inhibition and baseline vasomotor tone on ET effects was also studied. Lungs of 14 lambs (6-9 wk of age, 12.1 +/- 0.6 kg body wt) were isolated and perfused with blood. Group I lungs (n = 5) were untreated, group II lungs (n = 5) were treated with indomethacin to inhibit cyclooxygenase, and group III lungs (n = 4) were treated with indomethacin and a thromboxane A2 analogue, U-46619, to elevate vasomotor tone. All lungs were perfused with constant flow in zone 3, with left atrial and airway pressures being 8 and 6 cmH2O, respectively. We measured pulmonary arterial pressure and, by the micropuncture servo-null method, pressures in 20- to 50-microns diameter subpleural venules, both before and after each dose of ET was infused (50, 100, 250, and 500 ng/kg). Group I lungs, with high baseline vasomotor tone, exhibited a biphasic response to ET; 50-100 ng/kg of ET dilated both arteries and veins, whereas 500 ng/kg of ET constricted both arteries and veins. In group II lungs with low vasomotor tone, all doses of ET caused constriction of arteries only. In group III lungs (indomethacin treated with elevated vasomotor tone), 50-100 ng/kg of ET caused dilation of arteries and veins, whereas 500 ng/kg of ET induced constriction, this time only in arteries. We conclude that ET has both dilator and constrictor effects in arteries and veins of isolated, perfused lamb lungs. ET-induced arterial and venous dilation is dependent on initial vasomotor tone but not on cyclooxygenase metabolites.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Effect of Virtual Reality‐Based Rehabilitation on Physical Fitness in Patients with Chronic Obstructive Pulmonary Disease

2019 ◽  
Vol 69 (1) ◽  
pp. 149-157 ◽  
Author(s):  
Sebastian Rutkowski ◽  
Anna Rutkowska ◽  
Dariusz Jastrzębski ◽  
Henryk Racheniuk ◽  
Witold Pawełczyk ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Virtual Reality ◽  
Physical Fitness ◽  
Pulmonary Disease ◽  
Training Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Group I ◽  
Before And After ◽  
Group Ii

Abstract The aim of the study was to evaluate the effects of rehabilitation in patients with chronic obstructive pulmonary disease (COPD) using the Kinect system during stationary rehabilitation. The study included 68 patients with COPD (35 men, 33 women, mean age 61.3 ± 3.7). The subjects were randomly assigned to one of the two experimental groups described below. Group I included 34 patients – non‐participants in Kinect training. Group II included 34 patients – participants in Kinect training. In all patients before and after rehabilitation physical fitness was assessed using the Senior Fitness Test (SFT). The Xbox 360 and Kinect motion sensor were used to carry out virtual reality training. In group I, statistically significant improvements in SFT performance were observed. Patients in group II also showed statistically significant improvement in physical fitness in all attempts of the SFT. Virtual rehabilitation training in patients with COPD seems to be a practical and beneficial intervention capable of enhancing mobility and physical fitness.

scholarly journals Binocular responses and vertical strabismus

2007 ◽  
Vol 64 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Dusica Risovic ◽  
Lidija Petrovic ◽  
Natalija Kosanovic-Jakovic ◽  
Katarina Misailovic ◽  
Branislav Stankovic ◽  
...  
Keyword(s):  
Binocular Vision ◽  
Oblique Muscle ◽  
Common Pattern ◽  
Inferior Oblique Muscle ◽  
Group I ◽  
Significant Difference ◽  
Before And After ◽  
Group Ii ◽  
Sensory Tests ◽  
Dissociated Vertical Deviation

Background/Aim. Elevation in adduction is the most common pattern of vertical strabismus, and it is mostly treated with surgery. The results of weaking of inferior oblique muscle are very changeable. The aim of this study was to evaluate binocular vision using sensory tests before and one and six months after the surgery. Methods. A total of 79 children were divided in two groups: the first, with inferior oblique muscle of overaction (n = 52), and the second with dissociated vertical deviation (DVD), and primary inferior oblique muscle overaction (n = 27). We tested them by polaroid mirror test (PMT), Worth test at distance and near, fusion amplitudes on sinoptofore, Lang I stereo test and Wirt-Titmus stereo test. We examined our patients before and two times after the surgery for vertical strabismus. Results. Foveal suppression in the group I was found in 60.5% of the patients before, and in 56.4% after the surgery. In group II Foveal suppression was detected in 64.7% of the patients before, but in 55.6% 6 months after the surgery with PMT. Worth test revealed suppression in 23.5% of the patients before, and in 40.7% after the vertical muscle surgery. Parafoveal fussion persisted in about 1/3 of the patients before the surgery, and their amplitudes were a little larger after the surgery in the group I patients. Lang I stereo test was negative in 53.9% before and 51.9% after the surgery in the group I, and in 48.2% of the patients before and after the surgery in the group II patients. Wirt-Titmus stereo test was negative in 74.5% of the patients before and in 72.9% after the surgery in the group I, but in the group II it was negative in 70.8% before and in 68.0% of the patients 6 months after the surgery. Conclusion. Binocular responses were found after surgery in 65.7% of the patients the group I and in 55.6% patients the group II. There was no significant difference between these two groups, but binocular responses were more often in the patients of the group I.

scholarly journals EFFECT OF SKY YOGA AND PRANAYAMA ON EMOTION AMONG COLLEGE GIRLS

2019 ◽  
pp. 1-2
Author(s):  
S. Neelavathy ◽  
R. P. Balasubramania
Keyword(s):  
The State ◽  
Psychological Effects ◽  
Control Group ◽  
Not Given ◽  
Psychological Change ◽  
Group I ◽  
State Of Mind ◽  
Before And After ◽  
Post Test ◽  
Experimental Group

Emotion is the ability of a person to express the state of mind which he is, but when a person is mentally, physically, emotionally, and spiritually unstable results in a psychological change and helpless on situations. The purpose of the study was to nd out Effect of SKY yoga and pranayama on emotion among college girls .To achieve the purpose of the study 45 College girls were selected randomly from Coimbatore as the subjects. The subject's age ranged from 18 to 21 years. . The selected subjects were divided into 3 groups. Experimental Group I under went on sky yoga only & Experimental Group II went on pranayama only for 50 minutes per day, six days a week for 12 weeks. The control group was not given any practice. The pre-test and post-test were conducted before and after the training for all three groups. The data collected from the groups before and after the training period were statistically analysed by using Analysis of Co-Variance (ANACOVA) to determine the signicant difference and tested at 0.05 level of signicance. The result of the study showed that there was signicant improvement in the emotion of the Experimental Groups I, II subjects than the Controlled group. Through the SKY yoga and Pranayama Emotion got controlled. The conclusion was that SKY yoga controlled emotions and got reduced the psychological effects depression and stress etc. among college girls.

scholarly journals FLUORIDE ABSORBED ON EXTRACTED TEETH AFTER IMMERSING IN FLUORIDE TABLET, FLUOCOL SOLUTION AND FLUORIDE DENTRIFICE (IN VITRO TEST)

2016 ◽  
Vol 3 (1) ◽  
pp. 42
Author(s):  
Diyah Fatmasari ◽  
Lanny Sunarjo
Keyword(s):  
Research Result ◽  
Fluoride Concentration ◽  
Group Iv ◽  
In Vitro Test ◽  
Significance Level ◽  
Group Iii ◽  
Group I ◽  
Before And After ◽  
Vitro Test

Background: The role of fluoride in preventing tooth decay both for children and adult has been acknowledged internationally. There are several types of fluoride modalities either topically or systemic way. In Indonesia the modalities used to apply are fluoride tablet, fluocol solution and fluoride containing toothpaste. The purpose of this research is to find the effectiveness of fluoride modalities.Method: The study design was quasy experimental with 40 extracted teeth (Premolar teeth). The teeth divided into four groups D group I soaked on tablet fluor, Group II ; soaked on fluocol solution, Group III soaked on fluoride tooth paste and group IV soaked on Mill J (Aquadest/ Control solution). Fluoride concentration before and after soaking was determined using Spectrophotometer UV-Vis. Fluoride absorption was determined by the reduction of fluoride concentration after soaking.Result: Research result shown that the highest fluoride absorption was on soaking in fluoride tablet, followed by soaking on fluocol and tooth paste (mean fluoride absorption was 0,32; 0,08 and 0,04 ppm). Anova test shown significance level was 0,000.Conclusion: there were a significance of fluoride absorption on soaking in tablet fluoride, fluocol solution and toothpaste. The mechanism of fluoride regimens shown different fluoride absorption.

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