Colectomy Followed by J-Pouch Reconstruction to Correct Total Colonic Aganglionosis

Background: Patients suffering from complete colonic aganglionosis (TCA) require the best surgical care possible. Only a few studies reported J-Pouch repair as the primary reconstructive surgery in TCA patients. This study adds to the current literature a thorough clinical and functional outcomes group. Methods: Between 2011 and 2021, medical records of Hirschsprung disease (HD) patients who underwent J-Pouch reconstruction during infancy (n = 12) were reviewed. In close follow-up, bowel function and satisfaction with operation results were evaluated. The median age at the time of J-Pouch reconstruction was 16 months, and covering ileostomies were closed four months later. There were no postoperative problems. After the final repair, Pouch-related problems (PRP) occurred in 27% of the children and were treated conservatively. There was no histological evidence of pouchitis in any of the individuals. The median 24-h stooling frequency was 4–5 at the latest follow-up 51 months following enterostomy closure. Conclusions: The current study’s findings support the existing literature and advocate for J-pouch repair in TCA patients. However, more research will be needed to determine the best time to undergo pouch surgery and ileostomy closure in TCA patients.

Effects of Reversal Technique for Neuromuscular Paralysis on Time to Recovery of Bowel Function after Craniotomy

Background Non-depolarizing neuromuscular blockade can be reversed with neostigmine/glycopyrrolate or sugammadex. We test the hypothesis that sugammadex is associated with earlier postoperative recovery of bowel function (first bowel movement, BM). Methods In adult patients undergoing craniotomy from 2016 to 2019, we identified time of first postoperative BM after receiving neostigmine/glycopyrrolate or sugammadex to reverse neuromuscular blockade. Logistic and proportional hazard regression, with and without inverse probability of treatment weighting (IPTW), were used to assess whether sugammadex is associated with earlier recovery of bowel function. Results Seven hundred and thirty-one patients underwent craniotomy, 323 (44.2%) received neostigmine/glycopyrrolate, and 408 (55.8%) sugammadex. From logistic regression analysis, the proportion of patients having a BM within the first 24 and 48 hours was higher in sugammadex group (unadjusted OR [95% CI]) 1.79 [1.16 to 2.77] P = .009; and 1.45 [1.08 to 1.94] P = .014; IPTW adjusted OR [95% CI]) 1.58 [.95, 2.61] P = .078; and 1.38 [.95 to 2.02] P = .095 for 24 and 48 h, respectively). From proportional hazards regression, sugammadex was associated with improved bowel function recovery (unadjusted hazard ratio (HR) [95% CI] 1.35 [1.08, 1.68], P = .008; IPTW adjusted HR 1.29 [.97 to 1.71], P = .076). Conclusion Patients undergoing craniotomy who had neuromuscular blockade reversed with sugammadex may have earlier recovered bowel function compared to patients reversed with neostigmine/glycopyrrolate.

Efficacy of Complete Laparoscopic Ileal Augmentation Cystoplasty for the Treatment of Low Bladder Capacity and Compliance: a Case Series

Objectives: To investigate the safety and efficacy of complete laparoscopic ileal augmentation cystoplasty for the treatment of low bladder capacity and compliance.Methods: The clinical data of 13 patients with low bladder capacity and compliance were retrospectively analyzed. Therapeutic efficacy was evaluated at follow-up. The Clavien system was used to evaluate the severity of postoperative complications.Results: All 13 operations were successfully completed laparoscopically. The operation duration was 140-248 min (average: 189.9 ± 29.6 min), the time to postoperative recovery of bowel function was 1-10 days (average: 2.9 ± 2.3 days). There were 4 cases of grade I complications and 1 case of grade II complications (i.e., paralytic ileus caused by urinary leakage from the anastomosis of the augmented bladder). Cystography showed that the morphology of the bladder was close to normal, and the maximum safe capacity and compliance of the bladder were significantly increased [103.8 ± 16.6 mL and 332.3 ± 20.5 mL, p < 0.01; 7.0 ± 1.3 mL/cm H2O and 32.4 ± 2.1 mL/cm H2O, p < 0.01]. All patients were able to urinate spontaneously after catheter removal.Conclusions: Complete laparoscopic ileal augmentation cystoplasty is a safe and feasible treatment for low bladder capacity and compliance, and has the advantages of less trauma, less bleeding, faster recovery of intestinal function, and fewer postoperative complications. This treatment effectively increases bladder capacity, protects upper urinary tract function, and improves patient quality of life, and thus warrants clinical application.

Intracorporeal versus Extracorporeal Anastomosis for Laparoscopic Right Hemicolectomy: Short-Term Outcomes

Laparoscopic right hemicolectomy represents an effective therapeutic approach for right colon cancer (RCC). The primary aim of this study was to evaluate bowel function recovery, length of hospital stay, operative time, and the number of general and anastomosis-related postoperative complications from intracorporeal anastomosis (ICA) vs. extracorporeal anastomosis (ECA); the secondary outcome was the number of lymph nodes retrieved. This observational study was conducted on 108 patients who underwent right hemicolectomy for RCC; after surgical resection, 64 patients underwent ICA and 44 underwent ECA. The operative time was slightly longer in the ICA group than in the ECA group, even though the difference was not significant (199.31 ± 48.90 min vs. 183.64 ± 35.80 min; p = 0.109). The length of hospital stay (7.53 ± 1.91 days vs. 8.77 ± 3.66 days; p = 0.036) and bowel function recovery (2.21 ± 1.01 days vs. 3.45 ± 1.82 days; p < 0.0001) were significantly lower in the ICA group. There were no significant differences in postoperative complications (12% in ICA group vs. 9% in ECA group), wound infection (6% in ICA group vs. 7% in ECA group), or anastomotic leakage (6% in ICA group vs. 9% in ECA group). We did not observe a significant difference between the two groups in the number of lymph nodes collected (19.46 ± 7.06 in ICA group vs. 22.68 ± 8.79 in ECA group; p = 0.086). ICA following laparoscopic right hemicolectomy, compared to ECA, could lead to a significant improvement in bowel function recovery and a reduction in the length of hospital stay in RCC patients.

The Effects of Chewing Gum on Nausea, Vomiting, and Intestinal Functions of Surgical Patients

Background: It is important to resume regular functions of the digestive system as soon as possible after surgery. It has been reported that chewing gum can be used in this regard. Objectives: This study aimed to evaluate the effect of chewing gum on nausea-vomiting and bowel function in surgical patients. Methods: A total of 60 patients with cholecystectomy and herniotomy (30 controls [non-chewing gum] and 30 interventions [chewing gum]) were enrolled in this controlled experimental study. The intervention group was provided to chew gum 3 times for 15 - 30 minutes with a 2-hour interval. Both control and intervention groups were evaluated 6 and 24 hours after being taken to the surgical service using the nausea-vomiting, intestinal functions monitoring form. Results: A statistically significant difference was found between the control and intervention groups 0 - 6 hours after surgery (χ2 = 4.320, P < 0.05). The intervention group was found to be discharged earlier than the control group (χ² = 4.286, P < 0.05; Z = -2.053, P < 0.05), and the difference was significant. It was found that the intervention group suffered 5.09 times less vomiting compared to the control group 0 - 6 hours after surgery. Conclusions: The positive effects of chewing gum on nausea, vomiting, intestinal function, and early discharge were found. It is recommended that chewing gum be included in nursing interventions for patients after surgery.

Genetic Counseling and Diagnostics in Anorectal Malformation

Anorectal malformation (ARM) is a relatively frequently occurring congenital anomaly of hindgut development with a prevalence of 1 in 3,000 live births. ARM may present as an isolated anomaly, but it can also be associated with other anomalies, sometimes as part of a recognizable syndrome. After birth, much medical attention is given to the treatment and restoring of bowel function in children with ARM. Effort should also be given to studying the etiology of the ARM in these patients. This information is important to both the medical community and the family, because it can help guide treatment and provides information on the long-term prognosis of the patient and recurrence risk in the family.In this article, we will review the current knowledge on the (genetic) etiology of (syndromic) ARM and provide guidelines for (family) history taking and clinical and genetic studies of ARM patients and their families, which is needed to study the causal factors in an ARM patient and for genetic counseling of the families.

Laparoscopic-Assisted Anorectoplasty for Rectovestibular Fistula: A Comparison Study with Anterior Sagittal Anorectoplasty

Background Posterior or anterior sagittal anorectoplasty (ASARP) is the mainstream for correcting rectovestibular fistula (RVF). However, the intermediate RVF has the potential risk of wound complications when applying ASARP due to its high rectal pouch, long fistula tract, and difficulty separating the rectum and vagina. We developed laparoscopic-assisted anorectoplasty (LAARP) for surgical correction of RVF, which has acceptable preliminary outcomes. The purpose of this study is to evaluate the safety and efficacy of LAARP in comparison with ASARP for patients with RVF. Materials and Methods Twenty-five patients with RVF who underwent LAARP between October 2017 and December 2020 were retrospectively reviewed. The outcomes were compared with 43 patients who underwent ASARP between April 2015 and August 2018. The age, weight at operation, sacral ratio, operative time, and postoperative hospital stay were evaluated. The results were assessed for complications, perineum appearance, and bowel function. Results The two groups were comparable in terms of demographics. The median operative time of the LAARP group was significantly longer than that of the ASARP group (113 vs. 95 minutes; p = 0.015). The mean length of the resected rectum in the LAARP group was also longer than that in the ASARP group (6.75 ± 5.07 vs. 3.31 ± 3.06 cm; p = 0.001). Compared with the LAARP group, complications in the ASARP group were more frequent (4.0 vs. 27.9%, p = 0.036). No intraoperative or postoperative wound-related complications occurred in the LAARP group. However, in the ASARP group, one patient had an intraoperative vaginal injury and four had postoperative anastomosis-related complications. The incidence of redo operation in the ASARP group was significantly higher than that in the LAARP group (p = 0.000). Cosmetic satisfaction was higher in the LAARP group (96.0 vs. 76.7%; p < 0.05). In terms of voluntary bowel movement, soiling, and constipation, the LAARP group had similar results compare with the ASARP group. Conclusion The LAARP technique has shown several unique strengths in treating intermediate type RVF, including lower risks of complications, and minimal muscular injury, with a comparable bowel function.

The Relationships among Social Support, Bowel Function Symptoms and Uncertainty in Rectal Cancer Patients

Purpose: This study examined the mediating effect of bowel function symptoms in the relationship between social support and uncertainty in rectal cancer patients.Methods: In total, 132 rectal cancer patients were recruited online. Data were collected from October 1, 2020 to October 31, 2020 using on-line questionnaires and were analyzed using the t-test, analysis of variance, Pearson correlation coefficients and bootstrapping for mediation.Results: Social support had a significant and positive effect on bowel function symptoms and a negative effect on uncertainty. Bowel function symptoms had a significant negative effect on uncertainty; and showed a statistically significant mediating effect in the relationship between social support and uncertainty. In other words, social support had direct and indirect effects on uncertainty.Conclusion: In rectal cancer patients, social support attenuated bowel function symptoms and showed direct and indirect effects on uncertainty. Therefore, to increase the social support of rectal cancer patients, the patients’ family, friends, and meaningful others should be involved in providing nursing. In order to reduce bowel function symptoms, which have a mediating effect, rectal cancer patients need to be well aware of the symptoms of bowel function that change after surgery. Systematic pre- and post- operative education would be help reduce uncertainty.

Study to Determine the Short-Term Outcomes of Laparoscopic Colonic Surgery

Introduction: The article presents early Outcomes in laparoscopic colorectal surgery according to tumour size, duration of surgery, duration of postoperative analgesic requirements, recovery of bowel function, postoperative complications, and mortality. Aim: The aim of the analysis is to describe the short-term outcomes of our patients who endured laparoscopic colonic surgery because of various colon pathologies. Study Design: A Retrospective Case Review cohort study. Methods: The surgical and clinical records of all laparoscopic assisted colon procedures were reviewed and selected for the study held in the Surgical department of Social Security Landhi Hospital Karachi for two years duration from June 2019 to June 2021. All patients underwent surgery under general anaesthesia. Results: During this period, 62 total laparoscopic assisted colon (LAC) procedures were achieved. 41were male and 21 females. 54 patients underwent cancer surgery out of which 51 patient had adenocarcinoma of colon, 2 patient had carcinoids of bowel , and 1 patient had Hodgkin’s lymphoma. Ileocecal tuberculosis was noted in 5 patients and submucosal polyps in one patient. Of these 54 procedures for colonic cancer , 12 were left hemicolectomy, 34 right hemicolectomy, 2 segmental splenic flexure resections, 3 segmental resection with transverse colostomy and 3 sigmoid colectomy The average time of LAC surgery was 140 minutes (range 60 to 250). The average duration of analgesic drugs was 3 days (range 3–6). The median time to the first movement in the bowel was 2.5 days (range 2–4) and the hospital stay was 6 days (range 5–10). Conclusions: Laparoscopically assisted colon procedures are associated with early return of bowel function, less analgesic consumption, short hospital stays, and a lower rate of post operative complication. Laparoscopic colorectal surgery is achievable with optimum operative time and is a logical advantage for good operative outcomes with advanced laparoscopic skills. Keywords: Laparoscopically assisted colon surgery, laparoscopy and Colon cancer.