A new spray-type adhesion barrier (AdSpray) improves condition for surgical treatment in the reversal of Hartmann procedure

Abstract Aim The aim of this systematic review was to report the risk of parastomal and incisional hernias after emergency surgery for Hinchey III–IV diverticulitis. Material and Methods The Cochrane Library, Embase, PubMed (MEDLINE), Web of Science and Scopus databases were systematically searched. All randomized controlled trials (RCTs) and cohort studies comparing HP with other surgical treatment options for perforated diverticulitis classified as purulent or faecal (Hinchey III–IV) were considered for inclusion. Exclusion criteria were case series and reports, letters, editorials, reviews and conference abstracts. The primary endpoint was parastomal hernia incidence. The secondary endpoint was incisional hernia incidence. Seven studies (six randomized controlled trials and one retrospective cohort) with a total of 831 patients were eligible for inclusion. Results The parastomal hernia incidence was 15.2–46.0% for Hartmann procedure, 0–85.2% for primary anastomosis, 4.3% for resection and 1.6 % for laparoscopic lavage. The incisional hernia incidences were 7.8–38.1% for Hartmann procedure, 4.5–27.2% for primary anastomosis, 3.2–25.5% for primary resection, 2.7–11.1% for laparoscopic lavage and 16.1–45.8% for secondary resection. Due to heterogeneity of follow-up methods, follow-up time and lack of both parastomal and incisional hernia as outcome, no meta-analysis was conducted. Conclusions The hernia incidences reported after surgical treatment for complicated diverticulitis may be biased and underestimated. For future RCTs, researchers are encouraged to pay attention to hernia diagnosis, symptoms and prevention.

Download Full-text

The effectiveness of anti-adhesive barrier based on carboxymethylcellulose 5 mg and sodium hyaluronate 2.5 mg in various methods of surgical treatment of ectopic tubal pregnancy

GYNECOLOGY ◽

10.26442/20795696.2019.2.190360 ◽

2019 ◽

Vol 21 (2) ◽

pp. 71-75

Author(s):

Larisa E Fitisheva ◽

Vadim G Mozes ◽

Igor S Zaharov ◽

Kira B Mozes

Keyword(s):

Surgical Treatment ◽

Fallopian Tube ◽

Laparoscopic Resection ◽

Randomized Study ◽

Sodium Hyaluronate ◽

Tubal Pregnancy ◽

Postoperative Adhesions ◽

Adhesion Barrier ◽

Significant Difference

Aim. To evaluate the effectiveness of the anti-adhesive barrier in the form of a gel based on carboxymethylcellulose 5 mg and sodium hyaluronate 2.5 mg with various techniques of surgical treatment of ectopic tubal pregnancy. Materials and methods. A randomized study was conducted on 98 women who underwent laparoscopic resection of the ampulla of the fallopian tube, together with a embryo, followed by neostomatoplasty or salpingostomy with or without an anti-adhesive barrier. The primary outcome of the study was the incidence of uterine pregnancy and its outcomes at 18 months of follow-up; secondary outcomes were the frequency of adhesions in the pelvis, the frequency of patency of the operated fallopian tube according to second look laparoscopy with chromohydrotubation by 3 months of follow-up. Results. At 3 months of follow-up, the use of an anti-adhesion barrier reduced the incidence of postoperative adhesions in the area of the operated fallopian tube and the degree of adhesions in the pelvis; increased the frequency of patency of the operated fallopian tube when performing laparoscopic resection of a portion of the ampulla of the fallopian tube, followed by neostomatoplasty. By the 18th month of observation, no statistically significant difference in the incidence of spontaneous pregnancy and its outcomes in the studied women was detected. Conclusion. Use of 5 mg carboxymethylcellulose and 2.5 mg sodium hyaluronate anti-adhesive barrier with various organ-preserving methods of surgical treatment of ectopic tubal pregnancy reduces the frequency and extent of postoperative adhesions in the area of the operated fallopian tube, in the small pelvis, but does not increase fertility in the postoperative period.

Download Full-text

Surgical Treatment of Diverticulitis

DeckerMed Surgery ◽

10.2310/surg.2393 ◽

2019 ◽

Author(s):

Tiffany K Weidner ◽

John T Kidwell ◽

David A Etzioni

Keyword(s):

Surgical Treatment ◽

Diverticular Disease ◽

Primary Anastomosis ◽

Acute Diverticulitis ◽

Sigmoid Resection ◽

Hartmann Procedure ◽

Laparoscopic Lavage ◽

Uncomplicated Diverticulitis ◽

Recurrent Diverticulitis ◽

Purulent Peritonitis

Surgical evaluation and treatment is commonly required for the treatment of diverticulitis in both the acute and elective situations. This chapter discusses the surgical treatment of the clinically important manifestations of diverticular disease. Different options for surgical treatment are described for patients in both the urgent and elective settings, including technical aspects of these options. Current controversies are reviewed, including resection versus laparoscopic lavage for the treatment of purulent peritonitis, the use of gastrointestinal diversion in the surgical treatment of acute diverticulitis, and timing of operation for recurrent diverticulitis. This review contains 8 figures, 4 tables, and 67 references. Key Words: acute diverticulitis, complicated diverticulitis, diverticular disease, diverticulitis, diverticulosis, Hartmann procedure, laparoscopic lavage, sigmoid resection with primary anastomosis, uncomplicated diverticulitis

Download Full-text

Post-resectional pelvic recurrences of rectal cancer

Romanian Journal of Medical Practice ◽

10.37897/rjmp.2021.2.17 ◽

2021 ◽

Vol 16 (2) ◽

pp. 202-206

Author(s):

Adnan Al ALOUL ◽

◽

Dan Florin UNGUREANU ◽

Nicolae BACALBASA ◽

◽

...

Keyword(s):

Rectal Cancer ◽

Surgical Treatment ◽

Recurrence Rate ◽

Abdominoperineal Resection ◽

Anterior Resection ◽

Locally Advanced ◽

Colorectal Anastomosis ◽

Rare Event ◽

Pelvic Recurrence ◽

Hartmann Procedure

Introduction. Pelvic recurrence is not a rare event after resection with curative intent for rectal cancer originating from different segments of the rectum (lower, intermediary and superior part). Material and methods. This retrospective observational study included 106 patients; among these cases there were 79 patients who accepted surgical treatment of rectal cancer (treated in a governmental hospital between 2014 and 2017) and who were submitted to anterior resection with Hartmann’s procedure (6.5% of patients), anterior resection of rectosigmoid with colorectal anastomosis (78% of cases) and abdominoperineal resection (15% of cases). Results. After a 2 year follow-up, pelvic recurrence was reported in 11patients ~ 14% of cases: 33% rate of recurrence after Hartmann procedure, 9% rate of recurrence after abdominoperineal resection, and 10% rate of recurrence after anterior resection of rectosigmoid with colorectal anastomosis. 39 patients (49% of cases) had been submitted to preoperative radiotherapy: the pelvic recurrence rate among these cases was of 11% (9 patients). The rate of recurrence (RR) was also significantly influenced by the stage at diagnostic: stage III had RR = 52% of cases, stage II had RR = 41% of cases and stage I had RR = 0% of cases). The survival rate among surgically treated patients after 1 one year was 86%, and 80% in the first 2 years after treatment. Conclusions. Rectal cancer diagnosed in advanced stages has a high recurrence rate. A low recurrence rate indicates successful curative surgical treatment. The highest recurrence rate was reported after Hartmann procedure (which was usually performed as an emergency operation for locally advanced lesions).

Download Full-text

The using of adhesion barrier interceed in functional uterine surgery

Journal of obstetrics and women s diseases ◽

10.17816/jowd87234 ◽

2005 ◽

Vol 54 (5S) ◽

pp. 35-35

Author(s):

Vitaly F. Bezhenar ◽

N. N. Volkov ◽

R. D. Ivanova ◽

Е. N. Popov ◽

R. P. Volkanov

Keyword(s):

Surgical Treatment ◽

Abdominal Cavity ◽

Preventive Effect ◽

Adhesion Barrier ◽

Uterine Surgery ◽

Liquid Phases ◽

Special Means ◽

Postoperative Time

Introduction.Soldering disease of abdominal cavity is an often complication for organ preservated surgical treatment of fibroids. The most perspective and modem principle, providing the high preventive effect, is using of special means, dividing the wound surfaces in postoperative time. There are two kinds of antisoldering barriers, which can be used in operative gynecology: self-dissolving membranes and liquid phases.

Download Full-text

Human Stapes Crura: Normal Ultrastructure. Scanning Electron Microscopic Findings

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100116267 ◽

1975 ◽

Vol 33 ◽

pp. 528-529

Author(s):

M.D. Graham

Keyword(s):

Electron Microscope ◽

Surgical Treatment ◽

Scanning Electron Microscope ◽

Osmic Acid ◽

Human Cadaver ◽

Electron Microscopic ◽

Scanning Electron Microscopic ◽

Normal Human ◽

Microscopic Findings ◽

Scanning Electron

The recent development of the scanning electron microscope has added great impetus to the study of ultrastructural details of normal human ossicles. A thorough description of the ultrastructure of the human ossicles is required in order to determine changes associated with disease processes following medical or surgical treatment.Human stapes crura were obtained at the time of surgery for clinical otosclerosis and from human cadaver material. The specimens to be examined by the scanning electron microscope were fixed immediately in the operating room in a cold phosphate buffered 2% gluteraldehyde solution, washed with Ringers, post fixed in cold 1% osmic acid and dehydrated in graded alcohol. Specimens were transferred from alcohol to a series of increasing concentrations of ethyl alcohol and amyl acetate. The tissue was then critical point dried, secured to aluminum stubs and coated with gold, approximately 150A thick on a rotating stage in a vacuum evaporator. The specimens were then studied with the Kent-Cambridge S4-10 Scanning Electron Microscope at an accelerating voltage of 20KV.

Download Full-text