Comparison of side-to-end with end-to-end Anastomosis technique for colorectal anastomosis

2021 ◽  
Vol 15 (12) ◽  
pp. 3537-3539
Author(s):  
Anila Ahmed ◽  
Rizwan Khan ◽  
Maria Shaikh ◽  
Farah Shah ◽  
Sobia Majeed
Keyword(s):  
Anterior Resection ◽  
Medical Center ◽  
Colorectal Anastomosis ◽  
Group Versus ◽  
P Value ◽  
Sphincter Function ◽  
Anterior Resection Syndrome ◽  
End To End ◽  
Lower Anterior Resection

Objective: To compared the functional and anatomic outcomes of end-to-end anastpmosis (EEA) technique with side-to-end anastomosis (SEA) technique for colorectal anastomosis. Methods: A randomized clinical trail was conducted in Jinnah Postgraduate Medical Center (JPMC), Karachi. We recruited 60 patients who were planned for colorectal surgery from January 2020 to January 2021. Patients having histology proven adenocarcinoma of rectum of sigmoid colon, with normal sphincter function were included. Patients were randomly attributed into two groups in 1:1 ratio. The primary endpoint was to determine immediate post-operative complications, and assessment of intestinal function (using Lower anterior resection syndrome (LARS) score) at one-month follow-up. Results: There was no statistical difference in anatomic and functional outcomes in SEA and EEA groups, mean operative time was 168±43 minutes in SEA group versus 159±38 minutes in EEA group. Anastomosis leakage was diagnosed in 1 (3.3%) patients in SEA group versus in 2 (6.7%) patients in EEA group (p-value 0.55). Redo-procedure was needed in 1 (3.3%) patients in SEA group versus in 2 (6.7%) patients in EEA group (p-value 0.55). At one-month follow-up, major LARS was diagnosed in 03 (10.0%) patients in EEA group, while minor LARS was diagnosed in 5 (16.7%) patients in SEA group versus in 4 (13.3%) patients in EEA group (p-value 0.52). Conclusion: Both side to end anastomosis and end to end anastomosis are comparable in-terms of functional and anatomic outcomes. So the operating surgeons can adopt any of these techniques for colorectal anastomosis. Keywords: side-to-end anastomosis, end-to-end anastomosis, lower anterior resection syndrome, colorectal anastomosis.

Changes in Peritoneal Transport during the First Month of Peritoneal Dialysis

1995 ◽  
Vol 15 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Michael V. Rocco ◽  
Jean R. Jordan ◽  
John M. Burkart
Keyword(s):  
Peritoneal Dialysis ◽  
Medical Center ◽  
Group Versus ◽  
Dialysis Patients ◽  
Dialysis Unit ◽  
Peritoneal Transport ◽  
Time Period ◽  
Initiation Of Dialysis ◽  
Calculated Mass

Objective To determine if peritoneal transport characteristics change during the initial month of peritoneal dialysis. Design Retrospective review of peritoneal equilibration test (PET) results in patients who received their first PET during the first two weeks of peritoneal dialysis (early PET group) versus patients who received their first PET between four and 28 weeks after the initiation of dialysis (late PET group). The initial PET values were compared to subsequent PET results obtained approximately seven months after the initial PET. Setting Peritoneal dialysis unit of a tertiary medical center. Outcome Measures PET results and calculated mass transfer area coefficient (MT AC) values. Patients Thirty-four peritoneal dialysis patients in the early PET group and 17 peritoneal dialysis patients in the late PET group. Results In the early PET group, there was a statistically significant increase from the initial to follow-up values for both dialysate-to-plasma (DIP) creatinine and MTAC creatinine (p < 0.01) as well as a significant decrease for four-hour dialysate to initial dialysate ratios (DID) glucose (p = 0.08) and MTAC glucose (p < 0.05). In the late PET group, there was no significant change in any of these parameters with time. However, in the late PET group, there was a significant decrease in DIP urea values with time (p < 0.01), but not with MTAC urea. In addition, there were no differences over time in either group for serum albumin or hematocrit values. Conclusion During the first two weeks of peritoneal dialysis, there tends to be a change in peritoneal transport characteristics in some patients. PET data obtained during this time period should be interpreted as preliminary.

scholarly journals Low Anterior Resection Syndrome in Adults with Rectal Cancer in China: a Case Series Analysis

2021 ◽  
Author(s):  
Yuan Qiu ◽  
Yu Pu ◽  
Haidi Guan ◽  
Weijie Fan ◽  
Shuai Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Recovery Time ◽  
Colorectal Anastomosis ◽  
Postoperative Recovery ◽  
Low Anterior Resection Syndrome ◽  
Anterior Resection Syndrome ◽  
Lars Score

AbstractLow anterior resection syndrome (LARS) comprises a collection of symptoms affecting patients’ defecation after restorative surgery for rectal cancer. The aim of this work was to study the incidence and risk factors for LARS in China. Rectal cancer patients undergoing total mesorectal excision and colorectal anastomosis between May 2012 and January 2015 were identified from a single center. The patients completed the LARS score questionnaire through telephone. The clinical and pathological factors that may influence the occurrence of LARS were analyzed using univariate and multivariate logistic regression analysis. The influence of postoperative recovery time and pelvic dimensions on the occurrence of LARS was also analyzed. This study included 337 patients, at an average age of 61.03 SD11.32. The mean LARS score of the patients was 14.08 (range 0–41). A total of 126 patients (37.4%) developed LARS after surgery, including 63 (18.7%) severe cases. Compared with the scores within the initial 6 postoperative months, the LARS scores of the patients in 6~18 months after the surgery showed significant reductions (p < 0.01). In multivariate analysis, lower locations of anastomosis, pre-surgery radiotherapy, and shorter postoperative recovery time were significant predisposing factors for LARS. A subgroup analysis revealed that patients suffering from LARS over 18 months after surgery were found to have a significantly shorter interspinous distance than those without LARS (p < 0.05). LARS could improve over time after surgery. Lower anastomotic level and pre-surgery radiotherapy are risk factors for LARS.

Telemedicine visits result in a significantly lower rate of cancellations compared to in-person visits for interventional oncology clinic patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13624-e13624
Author(s):  
Suken Shah ◽  
Stephen Barnett Solomon
Keyword(s):  
Interventional Oncology ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
P Value ◽  
Waiting Room ◽  
Academic Medical ◽  
Physician Time ◽  
Clinic Visits

e13624 Background: Telemedicine allows increased access to specialists, less time in a waiting room and on-demand options with little to no transportation costs. These changes have been accelerated by the COIVD-19 pandemic. The purpose of the study was to test the hypothesis that a virtual telemedicine clinic would significantly decrease no-show rates and cancellations compared to in-person visits for interventional oncology (IO) clinic patients. Methods: Telemedicine visits were performed by a physician or advanced practice provider (PA or NP) at a single institution, academic medical center including 5 regional sites to patients at home in multiple states. Total patients encounters and data from January 2020 to December 2020 were analyzed. Visit types included new visits and follow up visits. Phone only visits were excluded. Primary outcome measures were an analysis of total cancelled visits (both same day and rescheduled visits), completed visits, and total scheduled visits with calculation of the telemedicine and in-person cancellation rates. Results: There was a total of 9,044 IR clinic visits in 2020 from 6,348 unique patients across the MSK Main Campus and Regional Network. Of these clinic visits, 5586 were telemedicine visits and 3458 were in-person visits. There was a significant decrease in no show and cancellation rates for telemedicine patients (6.3%) compared to in-person visits (8.1%) (p-value <0.00001). Conclusions: Telemedicine visits resulted in a significantly lower rate of visit cancellation compared to in-person visits. This reduction in no-show and cancellation rates may yield significant cost savings by eliminating gaps in the interventional oncology clinic schedule to allow for more efficient use of physician time and resources.

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 127. walking to the Virtual Era. Analysis of the Telehealth Experience in the Infectious Diseases Clinic During the COVID Pandemic

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S193-S193
Author(s):  
Karen L Carvajal ◽  
Prishanya Pillai ◽  
Angelina Winbush ◽  
Rupinder mangat ◽  
Ted Louie
Keyword(s):  
New York ◽  
Infectious Diseases ◽  
Medical Center ◽  
Compliance Rate ◽  
Tertiary Care ◽  
Clinic Visit ◽  
P Value ◽  
Hiv Patients ◽  
The Impact

Abstract Background The COVID pandemic has changed and will continue changing the way we practice medicine. We sought to investigate the impact of telehealth (TH) in the delivery of healthcare in the general infectious diseases (GID), and HIV clinic during the COVID pandemic. The University of Rochester Medical Center is a major tertiary care and referral center for ID in upstate New York. From March through May of 2020, the clinics were closed, and nearly all visits were conducted by TH. Methods We surveyed (either by telephone or online) a total of 260 patients who participated in TH visits, with a mean age of 56 years in the HIV group and 59 years in the GID group. With a predominance of 62.8 of males v/s 37.2 of females. We collected information regarding the reason for the TH visits, access to technology, patient satisfaction, and preferences over in-person visits. We obtained the volume and no-show rate from prior years through EPIC. We evaluated compliance between in-person and TH visits using statistical analysis. Results We found 93.4% of GID and 84.3% of HIV patients surveyed, either strongly agreed or somewhat agreed that their TH visit was as satisfactory as a clinic visit. 67.5% of GID and 63% of HIV patients agreed that the option of TH would increase their compliance rate in the future. The no-show rate during the TH period in the HIV group decreased from 23% to 5% compared to the previous year, while the no-show rate in GID decreased from 9% to 4%. These results were statistically significant with a P-value &lt; 0.005 in both groups. Conclusion GID patients were more likely to have TH for hospital follow-up, follow-up of acute problems, and outpatient antibiotic therapy, compared to HIV patients, who more often had TH for chronic problems. GID patients were more likely to have the capability for televideo visits when compared to the HIV group, although this was not statistically significant. TH was statistically significant in improving patient compliance with appointments in both the HIV and ID clinics. Patients were overall highly satisfied with their TH experience and many patients also reported that continued availability of telemedicine would improve their compliance with appointments. Disclosures All Authors: No reported disclosures

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