188 Right Hemicolectomy with End-To-Side Circular Stapled Ileo-Colic Anastomosis: Evaluation of Outcomes in A Series Of 55 Consecutive Patients

Background Stapled ileo-colic anastomosis is a well-established alternative to hand-sewn anastomosis after right hemicolectomy. A side-to-side configuration (SSA) is the option commonly practiced. This study describes our experience using a less well described technique, using an end-to-side circular stapled ileo-colic anastomosis (ESSA). Method Consecutive adult patients undergoing a right or extended- right hemicolectomy with ESSA for colonic cancer between July 2013 and March 2020 were included. Perioperative outcomes including anastomotic leak and anastomotic bleeding were extracted from a prospectively maintained institutional database. The Clavien-Dindo classification was used to stratify post-operative complications. Data are presented in medians and IQR. Results Right hemicolectomy with circular stapled ESSA ileo-colic anastomosis was performed in 55 consecutive patients (M:F 26:29) by a single surgeon at a tertiary referral centre. Over half of patients (54.5%, 30/55) were in the 8th and 9th decades of age with a median BMI of 26.5 (IQR:24-30.7). Median postoperative length of stay was 6 days (IQR:4-8) and the overall morbidity rate was 34.5% (19/55). Anastomotic leak and anastomotic bleeding were seen in 5.45% (3/55) and 3.64% (2/55), respectively. None of the patients with leak or bleeding needed a re-operation. Conclusions In comparison to the widely used SSA type of ileo-colic anastomosis, the ESSA configuration using a circular stapling device is a viable option for restoring bowel continuity after right colonic resections with comparable results. Potential advantages of this approach include avoidance of cross stapling and improved ileo-colic anatomical fidelity.

Delayed Bleeding at Different Anastomotic Sites After Operation for Synchronous Colon and Rectal Carcinoma: A Rare Case Report

Background: Delayed postoperative anastomotic bleeding is a life-threatening complication of gastrointestinal reconstruction surgery, but rarely been reported in the literature. Case presentation: A 64-year-old man was admitted to our hospital with bleeding stool for 10 days, he had a long history of uncontrolled type 2 diabetes mellitus. He was then diagnosed with synchronous adenocarcinoma of the ascending colon and the rectum. Laparoscopic right hemicolectomy combined with low anterior resection of rectal cancer was conducted later. Delayed bleeding occured at ileocolonic anastomotic orifice and colorectal anastomotic orifice at different periods, by multi-means of hemostasis therapy, he fianlly gained a good recovery.Conclusion: Enhanced postoperative monitoring, early detection of bleeding and combined with multiple hemostasis methods are the keys to successful management of delayed postoperative anastomotic bleeding in colorectal cancer. Type 2 diabetes mellitus may be one of the risk factors of delayed postoperative anastomotic bleeding, and preventive ostomy may be beneficial to avoid the occurrence of delayed postoperative anastomotic bleeding, both of which needs to be confirmed by further studies.

Autoimmune Haemolysis After Operation of Gastric Cancer Complicated With Drug-refractory Idiopathic Thrombocytopenic Purpura: a Case Report and Review of the Literature

Background: To the best of our knowledge, few reports are available at home and abroad on autoimmune haemolysis occurring after operation of gastric cancer complicated with drug-refractory idiopathic thrombocytopenic purpura (ITP)(Table 1). The treatment process in this case is usually risky, and multidisciplinary collaboration is often required. Therefore, the case report aims to improve the awareness of the perioperative management of this type of patients.Case presentation: A 69-year-old male admitted to the hospital for "anaemia" was diagnosed with gastric adenocarcinoma after gastroscopy and biopsy. This diagnosis was confirmed to be an early stage by abdominal CT imaging. However, the patient had an extremely low platelet level and a history of hormone therapy. Moreover, administration of thrombopoietin and immunoglobulin was ineffective for treatment. After transfusion of aphaeretic platelets, laparoscopic total gastrectomy with D2 lymphadenectomy and splenectomy were performed. Anastomotic bleeding and autoimmune haemolysis occurred after the operation. Haemolytic symptoms were spontaneously relieved after a period of hospitalisation.Conclusion: This case involved many disciplines, and revealed the interaction and mutual promotion of gastric cancer, ITP and autoimmune haemolysis, but further relationships need to be further investigated.

Clinical study of use of large C suture in procedure for prolapse and hemorrhoids for treatment of mixed hemorrhoids

Objective To investigate the clinical use of a large C suture in the procedure for prolapse and hemorrhoids (PPH) for treatment of mixed hemorrhoids. Methods Patients with mixed hemorrhoids (grade III or IV) who underwent treatment with a large C suture during PPH in the Affiliated Hospital (Group) of Putian University from 1 April 2018 to 31 March 2019 were enrolled in this retrospective study. The incidences of anastomotic stenosis and anastomotic hemorrhage after the operation were observed. Results The study population comprised 126 patients (46 men and 80 women) ranging in age from 30 to 78 years (mean, 46.1 ± 2.5 years). Of these patients, 60 had circular mixed hemorrhoids, 36 had grade III circular internal hemorrhoids, and 30 had grade IV circular internal hemorrhoids. The onset time among all patients ranged from 0.5 to 25 years. All patients underwent 6 months of postoperative follow-up. None of the patients with mixed hemorrhoids developed anastomotic stenosis, although two patients developed secondary anastomotic bleeding. Conclusion Placement of a large C suture during PPH is a reliable technique for treatment of mixed hemorrhoids. It is simple, effective, and applicable and can be helpful for a large number of patients in primary hospitals.

Retrospective Analysis of the Influence of Closure of Mesenteric Defects on Complications During Laparoscopic Radical Resection of Right Colon Cancer

Background: The influence of closure of mesenteric defects during laparoscopic radical resection of right colon cancer is still controversial.Methods: A total of 66 patients who were received laparoscopic radical resection of right colon cancer in our hospital were enrolled. The statistics of complications, included Postoperative Length of Stay, Exhaust time after surgery, Defecation time after surgery, Intraoperative blood loss, Length of incision, Length of operation, Lung infection, Abdominal infection, Anastomotic bleeding and Anastomotic leakage were examined.Results: The mesenteric defects were closed in 35 patients in Clousure group and not closed in 31 patients in Nonclosure group.The difference between two group included Total complication, Postoperative length of stay, Exhaust time after surgery, Defecation time after surgery, Length of operation, Lung infection, Abdominal infection, Anastomotic bleeding and Anastomotic leakage are not significant (p>0.05).Conclusion: Whether to close the mesenteric defects during laparoscopic radical resection of right colon cancer does not affect the rate of comlications.