Primary Anastomosis
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2021 ◽  
Vol 10 ◽  
pp. 46
Muhammad Shamil Suhaimi ◽  
Mohd Yusran Othman ◽  
Khalilah Alhuda Kamilen

Background: Colonic atresia (CA) is a rare cause of congenital intestinal obstruction. The management of CA is challenging because of its rarity. Case Presentation: We present a case of right-sided CA in a term male baby weighing 3006 gm, without any other comorbidity. Type 1 atresia was seen at ascending colon and upon decompression, a reasonable caliber was achieved for a primary anastomosis following distal Cheatle slit and proximal tapering. Postoperative recovery was uneventful. Conclusion: Primary anastomosis is a feasible option in right-sided CA when no major comorbidity is present and a normal distal colon with reasonable caliber is certain.

2021 ◽  
pp. 000313482110474
Arthur D. Grimes ◽  
Kenneth E. Stewart ◽  
Katherine T. Morris ◽  
Gary D. Dunn ◽  
Kristina K. Booth ◽  

With the increasing prevalence of obesity, there has been a parallel increase in the incidence of rectal cancer. The association of body mass index (BMI) and end-colostomy creation versus primary anastomosis in patients undergoing proctectomy for rectal cancer has not been described. This is a retrospective study of patients with rectal cancer from 2012 to 2018 using data from the National Surgical Quality Improvement Project. 16,446 (92.1%) underwent primary anastomosis and 1,418 (7.9%) underwent creation of an end-colostomy. Patients with a BMI of 25-29.9 (overweight) comprised the most frequent group to have a proctectomy (reference group), but the least likely to have an end-colostomy. Patients with severe obesity (BMI 50+) had an adjusted odds ratio for end-colostomy of 2.7 (95% CI 1.5-4.7) compared to the reference group. Patients who have severe obesity should be counseled regarding the likelihood of an end-colostomy and may benefit from medical weight management or weight-loss surgery.

JW Li ◽  
JCY Ngu ◽  
KR Lim ◽  
SW Tay ◽  
B Jiang ◽  

Introduction: Acute malignant large bowel obstruction (MBO) occurs in 8-15% of colorectal cancer patients. Self-expandable metal stents (SEMS) have progressed from a palliative modality to use as bridge-to-surgery (BTS). We aimed to conduct a clinical audit on safety and efficacy of SEMS for MBO in our institution. Methods: Data from a prospectively maintained electronic database in a tertiary referral centre in Singapore was reviewed for all consecutive patients undergoing SEMS insertion for MBO. Technical success defined as successful SEMS deployment across tumour without complications. Clinical success defined as colonic decompression without requiring further surgical intervention. Rates of complications, median time to surgery, types of surgery and rates of recurrence were studied. Results: 79 patients underwent emergent SEMS placement from September 2013 to February 2020. Mean age 68.8±13.8 years, male 43/79 (54%). Mean tumour length 4.2cm±2.2cm; 89.9% (71/79) distal to splenic flexure. Technical and clinical success was 94.9% (75/79) and 98.7% (74/75), respectively. Perforation occurred in 5.1% (4/79), with no cases of stent migration or bleeding. 50/79(63.3%) of SEMS inserted as BTS. Median time to surgery was 20 days (range 6-57). Majority (41/50;82%) underwent minimally invasive surgery (robotic-assisted 7/50,14%; laparoscopic 34/50,68%). Primary anastomosis rate was 98% (49/50). 39 patients had follow-up beyond 1-year post-treatment (median 34 months). Local recurrence and distant metastasis were observed in 4/39(10.3%) and 5/39(12.8%), respectively. Conclusion: SEMS acute MBO has high technical and clinical success rates with a good safety profile. Majority of patients in our audit underwent minimally invasive surgery and primary anastomosis after successful BTS.

2021 ◽  
Vol 11 (1) ◽  
Ozkan Cesur ◽  
Tugba Endogan Tanir ◽  
Pinar Celepli ◽  
Fatma Ozarslan ◽  
Sema Hucumenoglu ◽  

AbstractWe aimed to prepare a bioactive and biodegradable bilayer mesh formed by fibroblast growth factor (FGF) loaded gelatin film layer, and poly ε-caprolactone (PCL) film layer, and to investigate its treatment efficacy on esophageal anastomosis. It is envisaged that the bioactive mesh in in vivo model would improve tissue healing in rats. The full thickness semicircular defects of 0.5 × 0.5 cm2 were created in anterior walls of abdominal esophagus. The control group had abdominal esophagus isolated with distal esophageal blunt dissection, and sham group had primary anastomosis. In the test groups, the defects were covered with bilayer polymeric meshes containing FGF (5 μg/2 cm2), or not. All rats were sacrificed for histopathology investigation after 7 or 28 days of operation. The groups are coded as FGF(−)-7th day, FGF(+)-7th day, and FGF(+)-28th day, based on their content and operation day. Highest burst pressures were obtained for FGF(+)-7th day, and FGF(+)-28th day groups (p < 0.005) and decreased inflammation grades were observed. Submucosal and muscular collagen deposition scores were markedly increased in these groups compared to sham and FGF(−)-7th day groups having no FGF (p = 0.002, p = 0.001, respectively). It was proved that FGF loaded bioactive bilayer mesh provided effective repair, reinforcement and tissue healing of esophageal defects.

Khalilah Alhuda Binti Kamilen ◽  
Mohd Yusran Othman

Intussusception is a well-known cause of intestinal obstruction in children. Its occurrence in fetus as an intrauterine incidence is extremely rare and poses a diagnostic difficulty. Intrauterine intussusception may result in intestinal atresia once the gangrenous segment resorbed. However, a very late occurrence of intussusception just prior to delivery may present as meconium peritonitis. We are reporting a case of premature baby who was born at 35 weeks gestation via emergency caesarean for breech in labour. Routine scan 4 days prior to the delivery showed evidence of fetal ascites. She was born with good Apgar Score and weighed 2.5kg. Subsequently she developed respiratory distress syndrome requiring mechanical ventilation. She passed minimal meconium once after birth then developed progressive abdominal distension and vomiting. Abdominal radiograph on day 4 of life revealed gross pneumoperitoneum and bedside percutaneous drain was inserted to ease the ventilation. Upon exploratory laparotomy, a single ileal perforation was seen 20cm from ileocecal junction with an intussusceptum was seen in the distal bowel. Gross meconium contamination and bowel edema did not favour the option of primary anastomosis, thus stoma was created. Reversal of stoma was performed a month later and she recovered well. Fetus with a complicated intrauterine intussusception may present with fetal ascites and their postnatal clinical and radiological findings need to be carefully assessed for evidence of meconium peritonitis; in which a timely surgical intervention is required to prevent the sequelae of prolonged intraabdominal sepsis in this premature baby.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S18

2021 ◽  
Vol 108 (Supplement_6) ◽  
A. Mukhtar A Mukhtar ◽  
B.A. Abdalaziz Alshareif ◽  
M. Gareeballah Yousif Hijazi ◽  
M Y Ibrahim

Abstract Usually, the Jejunal diverticula appeared multiple and vary in size. These false diverticula lack the muscular coat of the normal intestinal walls, and most patients presented with it were asymptomatic. Although 10% of all patients develop complications such as perforation, obstruction, or bleeding, which then requires surgical intervention, but bleeding is relatively rare among these complications. A case of 74 years old lady was referred to our hospital because of persistent hematemesis and fresh melena. Her previous and recent upper gastrointestinal endoscopy both revealed only gastric erosions without any active bleeding. Also, previous, and recent colonoscopy was done but not completed due to the presents of fresh blood and blood clots along the colon, which led to improper visualization. Her selective mesenteric angiography was done together with upper and lower endoscopy, but none of them revealed the source of bleeding. Emergency exploratory laparotomy was undertaken, and a prominent single jejunal diverticulum with a prominent vessel entering it was noted, and no bleeding from other sites detected. Enterotomy was performed, and enteroscopy confirmed ulceration at the jejunal diverticulum site. Resection of the portion containing the diverticulum and primary anastomosis was done, and this cured the patient. The histopathological examination of the specimen showed an ulcerative lesion with an exposed vessel suggestive of the source of bleeding. Although jejunal diverticula incidence is rare, it is important to look for such lesions in patients with intestinal bleeding. Keywords: jejunal diverticulum, small intestine, intestinal bleeding.

Ayman Moussa Atwa ◽  
Ayman Ahmed Hassan ◽  
Samir Shabaan Orabi ◽  
Samir Abdelhakim Elgamal ◽  
Osama Mostafa Elgamal

Background: The study aimed to evaluate the outcomes of transecting bulbar urethroplasty techniques used for management of bulbar urethral stricture as regards the success rate and sexual dysfunction.Methods: Our study was a prospective study and it was carried out at urology department Tanta university, Egypt. The study was approved our ethical committee and an informed consent was obtained from all participants. Thirty patients underwent transecting urethroplasty either excision and primary anastomosis (EPA) or augmented anastomotic urethroplasty. Assessment of the sexual function by sexual health inventory for men (SHIM) questionnaire and postoperatively. Retrograde urethrogram (RGU) and micturating cystourethrogram (MCUG) were performed by an experienced urological surgeon.Results: The age of studied patients ranged from 15-72 years with a mean of  41±13.87. The length of stricture ranged from 2-3 cm with a mean of 2.57±0.38. The stricture was non obliterative in 13 patients (43.3%), obliterative in 4 patients (13.3%) and near obliterative in 13 patients (43.3%). Anastomotic urethroplasty was carried out in 20 out of 30 patients (66.7%) and augmented anastomotic urethroplasty was carried out in 10 out of 30 patients (33.3%). The success rate was 90%. As regard erectile dysfunction, 5 patients reported erectile dysfunction (16.7%).Conclusions: Anastomotic urethroplasty of short segment bulbar strictures continues to have excellent success rates and durability, but some patients who undergo anastomotic urethroplasty experience de novo sexual dysfunction.

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