RISK FACTOR ANALYSIS OF TYPE COLORECTAL OPERATION AND INTRAABDOMEN CONTAMINATION ON EVENT POST OPERATIVE ADHESION: SYSTEMATIC REVIEW AND METAANALYSIS

BACKGROUND: Colorectal surgery is the highest incidence of adhesion-related problems. The type of surgery might be total coletomy, right hemicolectomy, left hemicolectomy, segmental colectomy, Hartmann procedure, and colostomy. Surgical procedures performed on the colon could be contaminated. The most common contamination is faecal contamination. Various causes of peritoneal irritation result in localized brin production, which results in adhesion to the surfaces in contact. PURPOSE: This study focused on the type of colorectal surgery and intra-abdominal contamination on the incidence of postoperative adhesions. METHOD: Systematic review and meta-analysis. We searched for published journal on types of colorectal surgery and contamination with adhesion events published from 2010-2020 using electronic database : Pubmed, Science Direct and Cochrane. RESULT: Ten journals (8 cohort and 2 case control) were included in the meta-analysis. In the risk factors for colorectal surgery: APR surgery, total colectomy and rectal resection had a signicant risk of postoperative adhesions with a pooled odds ratio of 1.74 (95% CI 1 respectively). ,10-2,78); 2.89 (95% CI 2.44-3.41) and 9.91 (95% CI 8.66-11.35). Intra-abdominal contamination also had a risk of adhesions with a pooled odds ratio of 863.47 (95% CI 177.73-4194.13). CONCLUSION: Types of colorectal surgery : APR, total colectomy, and rectal resection and intra-abdominal contamination had a risk of postoperative adhesions.

P074 PARASTOMAL AND INCISIONAL HERNIAS FOLLOWING EMERGENCY SURGERY FOR HINCHEY III-IV DIVERTICULITIS: A SYSTEMATIC REVIEW

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.

Post-resectional pelvic recurrences of rectal cancer

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).

Effects of Laparoscopic Hartmann Reversal on Short-term Operative Outcomes Among Vietnamese Patients

Background The reestablishment of continuity after Hartmann operation is considered a major surgical procedure with high morbidity and mortality. The optimal interval time between the Hartman procedure and reversal is controversial. Our study aimed to evaluate the effectiveness of laparoscopic Hartmann reversal and to determine the optimal timing of operation. Methods All patients who underwent laparoscopic Hartmann reversal from 2008 to 2019 (11 years) at the University Medical Center (UMC) in Ho Chi Minh City were recruited and divided into 2 groups according to the interval time (≤ 4 or > 4 months). The short-term operative outcomes of these groups were compared. Results There were 66 patients who underwent laparoscopic Hartmann reversal (mean age: 63.2 years old); ∼ 77% of them had colorectal cancer, and 17% had complicated diverticular disease. The mortality rate, anastomotic leakage rate, and overall complication rate were 0%, 1.5%, and 13.2%, respectively. Early operation was performed in 36 patients, and late reversal in 28 patients. There was no difference in mortality, anastomotic leakage, operative complications, and hospital stay between the two groups. Conclusion Laparoscopic Hartmann reversal was effective with acceptable morbidity and mortality at the UMC. There was no observed impact of the interval time between the Hartmann procedure and laparoscopic Hartmann reversal on the short-term operative outcomes.

Reversión operación de Hartmann por vía laparoscópica

Introducción. El procedimiento de Hartmann es una de las cirugías que se realizan con mayor frecuencia frente a una complicación oclusiva o perforativa de colon izquierdo; nos permite resolver el cuadro clínico de la complicación. El porcentaje de restitución del tránsito intestinal es muy bajo, promedialmente inferior al 50%. Ésto se debe a factores propios del paciente, la morbimortalidad de la cirugía, y a dificultades técnicas. El reestablecimiento del tránsito intestinal luego de un Hartmann puede llegar a ser una cirugía muy hostil. Tiene una morbilidadmortalidad propia no despreciable, independientemente de la vía de abordaje utilizada. La reversión por laparoscopía es uno de los procedimientos más complejos a realizar mediante este abordaje. Pero varios estudios han demostrado, que si bien requiere de una curva de aprendizaje más larga y un nivel de destreza técnica alto, tiene mejores resultados que el laparotómico. Descripción. Presentamos el caso clínico de un hombre de 65 años, que consultó por una peritonitis purulenta diverticular un año atrás, al cual se le realizó una procedimiento de Hartmann. Se coordina para reconstrucción del tránsito intestinal por vía laparoscópica. Paciente en decúbito dorsal, Trendelemburg 30º y lateralizado a derecha. Neumoperitoneo hasta 12mmHg por técnica abierta en flanco derecho para un puerto de 12mm, inicialmente para la cámara, y luego para la mano izquierda del cirujano. Otro de 6mm en fosa ilíaca derecha para la mano derecha del cirujano, y uno de 12mm supraumbilical para la cámara. Identificamos el muñón rectal en la pelvis. Liberamos el ostoma circunferencialmente, y confeccionamos una jareta con polipropileno 2-0. Colocacamos el anvil de la sutura mecánica 29mm, y reintroducimos el cabo colónico al abdomen. Se realiza cierre parietal en dos planos, y reinstalamos el neumoperitoneo. Colocacamos la sutura mecánica transrectal, engarzando la misma con el anvil a través de la cara anterior del muñón rectal, confeccionando la anastomosis colo-rectal término-lateral. La prueba hidroneumática fue negativa. El paciente tuvo un postoperatorio sin complicaciones, otorgándole el alta a las 72hs del procedimiento, tolerando vía oral, sin dolor, sin fiebre y habiendo movilizado el intestino. Conclusiones. La cirugía de Hartmann sigue siendo uno de los procedimiento más realizados para tratar las complicaciones perforativas y oclusivas del colon izquierdo y recto. La restitución del tránsito intestinal luego de esta cirugía tiene un altísimo porcentaje de no concretarse por diferentes motivos. La cirugía miniinvasiva requiere de una larga curva de aprendizaje y destreza de alto nivel, pero hay varios trabajos que demuestran que la reversión de un Hartmann tiene mejores resultados por esta vía. Bibliografía Hallam S, Mothe BS, Tirumulaju R. Hartmann's procedure, reversal and rate of stoma-free survival. Ann R Coll Surg Engl. 2018;100(4):301-307. doi:10.1308/rcsann.2018.0006 Horesh N, Lessing Y, Rudnicki Y, et al. Considerations for Hartmann's reversal and Hartmann's reversal outcomes-a multicenter study. Int J Colorectal Dis. 2017;32(11):1577-1582. doi:10.1007/s00384-017-2897-2 Melkonian E, Heine C, Contreras D, et al. Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery. J Minim Access Surg. 2017;13(1):47-50. doi:10.4103/0972-9941.181329 Resio BJ, Jean R, Chiu AS, Pei KY. Association of Timing of Colostomy Reversal With Outcomes Following Hartmann Procedure for Diverticulitis. JAMA Surg. 2019;154(3):218-224. doi:10.1001/jamasurg.2018.4359 Park W, Park WC, Kim KY, Lee SY. Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal. Ann Coloproctol. 2018;34(6):306-311. doi:10.3393/ac.2018.09.07