Ileosigmoid knotting: A review of 923 cases

Objectives: Ileosigmoid knotting (ISK) is a rare intestinal obstruction form worldwide. The aim of this study was to investigate changing trends in ISK. Methods: The Web of Science and PubMed databases were electronically searched to find all publications to evaluate all epidemiological, etiological, clinical, laboratory, radiological, therapeutic, and prognostic factors in ISK. Results: Most of the cases were reported from Asian and African countries. Mean age was 43.9 years with a 79.9%/20.1% of male/female ratio. Main symptom period was 48.1 hours, while the most common clinical features were abdominal pain/tenderness (99.1%), distention (88.3%), and obstipation/constipation (58.8%). Abdominal X-ray radiography, computerized tomography (CT), and magnetic resonance imaging (MRI) were diagnostic in 8.2%, 96.2%, and 100.0%, respectively, while the total diagnostic accuracy rate was 20.8%. Bowels were gangrenous in 85.6% of the patients. Ileum resection was applied in 14.0% of the cases, while sigmoid colon resection in 7.6%, and both segment resection in 67.1%. The mortality rate was 22.7%, while the morbidity rate was also 22.7%. Conclusion: ISK is a rare disease, but it is still catastrophic despite its two-century recognised past. As an exception, diagnostic convenience arising from CT or MRI looks like the most important change over the last half-century. doi: https://doi.org/10.12669/pjms.38.3.5320 How to cite this:Atamanalp SS, Disci E, Peksoz R, Atamanalp RS, Tatar Atamanalp C. Ileosigmoid knotting: A review of 923 cases. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5320 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Preoperative intravenous iron treatment reduces postoperative complications and postoperative anemia in preoperatively anemic patients with colon carcinoma

Purpose Anemia is common among patients with colorectal cancer and is associated with an increased risk of complications and poorer survival rate. The main objective of our study was to determine the effect of preoperative intravenous iron supplementation therapy on the need for red blood cell transfusions, other postoperative complications, and length of hospital stay in colon cancer patients undergoing colon resection. Methods In this retrospective cohort study, data were collected from medical records of all 549 colon carcinoma patients who underwent a colon resection in Helsinki University Hospital during the years 2017 and 2018. The patients were divided into two cohorts: one with anemic patients treated with preoperative intravenous iron supplementation therapy (180 patients) and one with anemic patients without preoperative intravenous iron supplementation therapy (138 patients). Non-anemic patients and patients requiring emergency surgery were excluded (231 patients). Results Patients treated with intravenous iron had less postoperative complications (33.9% vs. 45.9%, p = 0.045) and a lower prevalence of anemia at 1 month after surgery (38.7% vs. 65.3%, p < 0.01) when compared with patients without preoperative iv iron treatment. No difference was found in the amount of red blood cell transfusions, length of stay, or mortality between the groups. Conclusion This is the first study demonstrating a significant decrease in postoperative complications in anemic colon cancer patients receiving preoperative intravenous iron supplementation therapy. This treatment also diminishes the rate of postoperative anemia, which is often associated with a facilitated recovery.

ON THE ISSUE OF SURGICAL TREATMENT OF DOLICHOSIGMA

До настоящего времени результаты лечения больных долихосигмой с длительными запорами остаются неудовлетворительными. Так при консервативном лечении долихосигмы неудовлетворительные результаты наблюдаются у 20-30% больных, а прихирургическом лечении доходит до 35-45%. Целью настоящего исследования является изучение результатов хиркргического лечения долихосигмы с длительностью запоров 7 и более дней. Материалом данного исследования являются результаты обследования и хирургического лечения 98 больных долихосигмой с длительными запорами, находившихся в отделении проктологии Национального Госпиталя при Министерстве здравоохранения Кыргызской Республики с 2001 года по 2020 год. Для уточнения диагноза кроме общеклинических методов исследования применены: пальцевое исследование прямой кишки, ректороманоскопия, сфинктерометрия, колоноскапия, ирригоскапия, пассаж бариевой взвеси по толстой кишке. Результаты хирургического лечения больных долихосигмой с длительными запорами в зависимости от вида оперативного вмешательства изучены в сравнительном аспекте. Из 98 больных 50 (51%) пациентам произведена резекция сигмовидной кишки, а 48 (49%) пациентам левосторонняя гемиколэктомия. Изучены отдаленные результаты хирургического лечения долихосигмы с длительными запорами у 79 больных. Так из 79 больных у 38 (48%) пациентов ранее была произведена левосторонняя гемиколэктомия, а у 41 (52%) - резекция сигмовидной кишки. У всех 38 больных перенесших левосторонную гемоколэктомию результаты хирургического лечения были хорошими. У этих пациентов отмечалось самостоятельный стул 1 раз в два дня, исчезли боли в левой половине живота и метиоризм. Из 41 пациента, перенесших резекцию сигмовидной кишки, у 29 (70,7%) больных результаты хирургического лечения оценены кака удовлетворительные. У этих больных улучшилось общее состояние, периодически наблюдался самостоятельный стул. А у 12(29,3%) больных, так же перенесших резекцию сигмовидной кишки, в последующем вновь отмечалось отсутствие самостоятельного стула, возникли боли в левой половине живота и метиоризм. У этих 12 больных результаты хирургического расценены как неудовлетворительные. Таким образом, сравнительный анализ результатов хирургического лечения долихосигмы с длительностью запора 7 и более дней показал преимущества левосторонней гемоколэктомии при этой патологии. Until now, the results of treatment of patients with dolichosigma with prolonged constipation remain unsatisfactory. So with the conservative treatment of dolichosigma, unsatisfactory results are observed in 20-30% of patients, and with surgical treatment it reaches 35-45%. The aim of this research is to study the results of surgical treatment of dolichosigma with constipation duration of 7 or more days. The material of this research is the results of examination and surgical treatment of 98 patients with dolichosigma with prolonged constipation, who were in the proctology department of the National Hospital under the Ministry of Health of the Kyrgyz Republic since 2001 till 2020. To clarify the diagnosis, in addition to general clinical research methods applied: digital examination of the rectum, sigmoidoscopy, sphincterometry, colonoscopy, irrigoscapia, passage of barium suspension through the colon. The results of surgical treatment of patients with dolichosigma with prolonged constipation, depending on the type of surgical intervention, were studied in a comparative aspect. From 98 patients, 50 (51%) patients underwent resection of the sigmoid colon, and 48 (49%) patients underwent left-sided hemicolectomy. The long-term results of surgical treatment of dolichosigma with prolonged constipation were studied in 79 patients. Thus, out of 79 patients, 38 (48%) patients had previously undergone left-sided hemicolectomy, and of 41 (52%) had sigmoid colon resection. In all 38 patients who underwent left-sided hemocolectomy, the results of surgical treatment were good. These patients had independent bowel movements once every two days, pain in the left abdomen and methiorism disappeared. From 41 patients who underwent resection of the sigmoid colon, in 29 (70.7%) patients, the results of surgical treatment were assessed as satisfactory. These patients have improved their general condition, periodically there was an independent bowel movements. And in 12 (29.3%) patients who also underwent resection of the sigmoid colon, subsequently, there was again a lack of independent bowel movements, and pain in the left side of abdomen and methiorism. In these 12 patients, the results of the surgical procedure were assessed as unsatisfactory. Therefore, a comparative analysis of surgical treatment results of dolichosigma with constipation duration of 7 or more days showed the advantages of left-sided hemocolectomy in this pathology.

ROBOTIC LIVER RESECTION. REPORT OF THE FIRST 50 CASES

ABSTRACT BACKGROUND: Robotic surgery has gained growing acceptance in recent years, expanding to liver resection. OBJECTIVE: The aim of this paper is to report the experience with our first fifty robotic liver resections. METHODS: This was a single-cohort, retrospective study. From May 2018 to December 2020, 50 consecutive patients underwent robotic liver resection in a single center. All patients with indication for minimally invasive liver resection underwent robotic hepatectomy. The indication for the use of minimally invasive technique followed practical guidelines based on the second international laparoscopic liver consensus conference. RESULTS: The proportion of robotic liver resection was 58.8% of all liver resections. Thirty women and 20 men with median age of 61 years underwent robotic liver resection. Forty-two patients were operated on for malignant diseases. Major liver resection was performed in 16 (32%) patients. Intrahepatic Glissonian approach was used in 28 patients for anatomical resection. In sixteen patients, the robotic liver resection was a redo hepatectomy. In 10 patients, previous liver resection was an open resection and in six it was minimally invasive resection. Simultaneous colon resection was done in three patients. One patient was converted to open resection. Two patients received blood transfusion. Four (8%) patients presented postoperative complications. No 90-day mortality was observed. CONCLUSION: The use of the robot for liver surgery allowed to perform increasingly difficult procedures with similar outcomes of less difficult liver resections.

EP.FRI.9Meta-analysis of mortality risk in octogenarians undergoing emergency General Surgery operations

Aims To quantify the risk of perioperative mortality in octogenarians undergoing emergency general surgical operations and to compare such risk between octogenarians and non-octogenarians. Methods A systematic review was performed in accordance with the PRISMA statement standards to identify studies reporting the mortality risk in patients aged over 80 years undergoing emergency general surgery operations. The certainty of evidence was assessed using the GRADE system. Random-effects models were applied to calculate pooled outcome data. Results Analysis of 66701 octogenarians from 22 studies showed that the risk of 30-day mortality was 26% (95% CI 18-34%) for all operations;29% (95% CI 25-33%) for emergency laparotomy,9% (95% CI 1-23%) for non-laparotomy emergency operations;21% (95% CI 13-30%) for colon resection;17% (95% CI 11-25%) for small bowel resection;9% (95% CI 7-11%) for adhesiolysis;6% (95% CI 5.9-6.8%) for perforated ulcer repair;3% (95% CI 2.6-4%) for appendicectomy;3% (95% CI 2.8-3.3%) for cholecystectomy;5% (95% CI 0.2-14%) for hernia repair. When stratified based on ASA status, the risk was 11% (95% CI 4-20%) for ASA 2, 22% (95% CI 10-36%) for ASA 3, 39% (95% CI 29-48%) for ASA 4, and 94% (95% CI 77-100%) for ASA 5. The risk was higher in octogenarians compared with non-octogenarians (OR:4.07,95% CI 2.40-6.89), patients aged 70-79 (OR:1.21,95% CI 1.13-1.31), and patients aged 50-79 (OR:2.03,95% CI 1.68-2.45). Conclusions The risk of perioperative death in octogenarians undergoing emergency general surgical operations is higher than the risk in younger patients. Laparotomy, bowel resection, and ASA status above 3 carry the highest risk.

Delayed Anastomotic Failure After Chemoradiation: A Delay in Diagnosis or Late Presentation? - A Case Series

Anastomotic leak after colorectal surgery can result in serious morbidity for certain patients. The rate of clinically significant anastomotic leak after colon resection ranges from 1.8% to 11.9%. Risk factors include male sex, steroids, smoking, perioperative blood transfusion, malnutrition, and a low anastomosis. However, the effect of pre-operative chemoradiation therapy (CRT) on rates of anastomotic leak is controversial. Specifically, late leaks, which are defined as those that occur greater than 30 days after surgery, are sparsely described in current literature. Recent evidence suggests that CRT may contribute to the presentation of late anastomotic leaks. In this case series, we report our experience with three patients who received CRT and developed varying presentations of a late anastomotic leak. Therefore, our experience supports the consideration of late anastomotic leaks as a separate entity in colorectal surgery. While pre-operative CRT may increase risk for postoperative anastomotic leak overall, further exploration into the relationship between preoperative CRT and late anastomotic leaks is warranted.