scholarly journals Treatment of a Total Obstructive Anastomosis Stricture Using a Transanal Laparoscopic Approach and Intraoperative Colonoscopic Balloon Dilatation

2020 ◽  
Vol 36 (5) ◽  
pp. 353-356
Author(s):  
Jae Young Kwak ◽  
Kwan Mo Yang ◽  
Hyun Il Seo
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Balloon Dilatation ◽  
Single Port ◽  
Treatment Options ◽  
Laparoscopic Approach ◽  
Diverting Ileostomy ◽  
Transanal Approach ◽  
Alternative Approach ◽  
Lower Anterior Resection

An anastomosis stricture with a total obstruction is rare and treatment options are variable. We describe our experience with a combination of a single port transanal laparoscopic approach and intraoperative colonoscopic balloon dilatation. The patient was a 48-year-old man with rectal cancer. A laparoscopic single port lower anterior resection and diverting ileostomy were performed followed by a colon study and ileostomy takedown. The colon study and sigmoidoscopy revealed total obstruction of the rectum at the anastomosis level. We employed a transanal approach using a single port to correct this. We located the anastomosis stricture site and generated a lumen using a dissector and electocautery method to insert the balloon device. Colonoscopic balloon dilatation was subsequently successful. The patient was discharged with no postoperative complications. A laparoscopic single port transanal approach with an intraoperative colonoscopic balloon dilatation is a viable alternative approach to treating an anastomosis stricture of the rectum.

scholarly journals Low anterior resection syndrome score among Nepalese population undergoing lower anterior resection for rectal carcinoma

2018 ◽  
Vol 7 (2) ◽  
pp. 59-63
Author(s):  
Dhiresh Kumar Maharjan ◽  
SC Acharya ◽  
PB Thapa
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Functional Results ◽  
Diverting Ileostomy ◽  
Low Anterior Resection Syndrome ◽  
Anterior Resection Syndrome ◽  
Medical College ◽  
Ultralow Anterior Resection ◽  
Lower Anterior Resection

Background: With more sphincters preserving surgery being performed for distal rectal cancer, these have been associated with clusters of symptoms experienced by the patient after reversal of diverting ileostomy collectively known as low anterior resection syndrome.Objective: Our objective is to know incidence of Lower Anterior Resection (LAR) syndrome in different phase of time in our context using low anterior resection symptom score translate in Nepali language.Methodology: This is an observational descriptive study conducted at Department of Surgery, Kathmandu Medical College and Department of Clinical Oncology, Bir Hospital, Kathmandu from Jan 2015 till Jan 2017. All patients who had undergone low and ultra low anterior resection for middle and low rectal cancer respectively after a long course of neo adjuvant concurrent chemo radiotherapy, having undergone a reversal of diverting ileostomy after 6 weeks of primary surgery were included. A Nepalese version of low anterior resection score was developed after translation from English and scoring was done on 30th day, at the end of 6 months and 1 year postoperative following reversal of ileostomy.Results: Out of 43 consecutive patient 100 % of patients had features of major low anterior resection syndrome during 30 days of ileostomy reversal. However, 46.5% patient showed major low anterior resection syndrome during 6 months of follow up and that decreased to 34.9% showed major LAR syndrome upon one year of follow up.Conclusions: The Low anterior resection syndrome score converted in Nepali language is feasible to use and helps in comparing the functional results of reconstruction after low or ultralow anterior resection and our study have shown improvement in score with time. Journal of Kathmandu Medical College,Vol. 7, No. 2, Issue 24, Apr.-Jun., 2018, page: 59-63 

scholarly journals Age and comorbidities do not affect short-term outcomes after laparoscopic rectal cancer resection in elderly patients. A multi-institutional cohort study in 287 patients

2021 ◽  
Author(s):  
Roberto Peltrini ◽  
Nicola Imperatore ◽  
Filippo Carannante ◽  
Diego Cuccurullo ◽  
Gabriella Teresa Capolupo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Rectal Resection ◽  
Laparoscopic Approach ◽  
Postoperative Outcomes ◽  
Rectal Cancer Surgery ◽  
Short Term ◽  
Number Of Patients ◽  
Laparoscopic Rectal Resection

AbstractPostoperative complications and mortality rates after rectal cancer surgery are higher in elderly than in non-elderly patients. The aim of this study is to evaluate whether, like in open surgery, age and comorbidities affect postoperative outcomes limiting the benefits of a laparoscopic approach. Between April 2011 and July 2020, data of 287 patients with rectal cancer submitted to laparoscopic rectal resection from different institutions were collected in an electronic database and were categorized into two groups: < 75 years and ≥ 75 years of age. Perioperative data and short-term outcomes were compared between these groups. Risk factors for postoperative complications were determined on multivariate analysis, including age groups and previous comorbidities as variables. Seventy-seven elderly patients had both higher ASA scores (p < 0.001) and cardiovascular disease rates (p = 0.02) compared with 210 non-elderly patients. There were no significative differences between groups in terms of overall postoperative complications (p = 0.3), number of patients with complications (p = 0.2), length of stay (p = 0.2) and death during hospitalization (p = 0.9). The only independent variables correlated with postoperative morbidity were male gender (OR 2.56; 95% CI 1.53–3.68, p < 0.01) and low-medium localization of the tumor (OR 2.12; 75% CI 1.43–4.21, p < 0.01). Although older people are more frail patients, short-term postoperative outcomes in patients ≥ 75 years of age were similar to those of younger patients after laparoscopic surgery for rectal cancer. Elderly patients benefit from laparoscopic rectal resection as well as non-elderly patient, despite advanced age and comorbidities.

scholarly journals Single Incision Laparoscopic Cholecystectomy by Using a 2 mm Atraumatic Grasper without Trocar

HPB Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Kamil Gulpinar ◽  
Suleyman Ozdemir ◽  
S. Erpulat Ozis ◽  
Turgut Aydin ◽  
Atila Korkmaz
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Abdominal Wall ◽  
Single Incision ◽  
Single Port ◽  
Operation Time ◽  
Scar Formation ◽  
Single Incision Laparoscopic Cholecystectomy ◽  
Skin Scar

Purpose. We present our experience in single incision laparoscopic cholecystectomy by using a grasper directly without using a trocar in five patients. Methods and Results. The technique involves the use of Karl Storz 27290F grasper in order to perform gallbladder retraction in single port cholecystectomy. The grasper was introduced directly into the skin through abdominal wall without using any trocar and used to mobilize gallbladder whenever needed during surgery without causing any perforation or leakage of the gallbladder. There were no intraoperative and postoperative complications in 5 patients with the advantages of shorter operation time and almost invisible postoperative skin scar formation. Conclusion. We claim that the use of this instrument in SILS surgery might be advantageous than the conventional placement of sutures for the gallbladder mobilization.

scholarly journals Impact of the preoperative prognostic nutritional index as a predictor for postoperative complications after resection of locally recurrent rectal cancer

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masakatsu Paku ◽  
Mamoru Uemura ◽  
Masatoshi Kitakaze ◽  
Shiki Fujino ◽  
Takayuki Ogino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Receiver Operating Characteristic ◽  
Odds Ratio ◽  
Inflammatory Markers ◽  
Operating Characteristic ◽  
Recurrent Rectal Cancer ◽  
Prognostic Nutrition Index

Abstract Background Local recurrence is common after curative resections for rectal cancer. Surgical intervention is among the best treatment choices. However, achieving a negative resection margin often requires extensive pelvic organ resections; thus, the postoperative complication rate is quite high. Recent studies have reported that the inflammatory index could predict postoperative complications. This study aimed to validate the correlation between clinical factors, including inflammatory markers, and severe complications after surgery for local recurrent rectal cancer. Methods This retrospective study included 99 patients that underwent radical resections for local recurrences of rectal cancer. Postoperative complications were graded according to the Clavien-Dindo classification. Grades ≥3 were defined as severe complications. Risk factors for severe complications were identified with univariate and multivariate logistic regression models and assessed with receiver-operating characteristic curves. Results Severe postoperative complications occurred in 38 patients (38.4%). Analyses of correlations between inflammatory markers and severe postoperative complications revealed that the strongest correlation was found between the prognostic nutrition index and severe postoperative complications. The receiver-operating characteristic analysis showed that the optimal prognostic nutrition index cut-off value was 42.2 (sensitivity: 0.790, specificity: 0.508). In univariate and multivariate analyses, a prognostic nutrition index ≤44.2 (Odds ratio: 3.007, 95%CI:1.171–8.255, p = 0.02) and a blood loss ≥2850 mL (Odds ratio: 2.545, 95%CI: 1.044–6.367, p = 0.04) were associated with a significantly higher incidence of severe postoperative complications. Conclusions We found that a low preoperative prognostic nutrition index and excessive intraoperative blood loss were risk factors for severe complications after surgery for local recurrent rectal cancer.

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