ABSTRACT
Aim: this study aimed to compare the results of palliative stenting with the results of emergency surgery for patients with obstructing left-sided colorectal cancer
Methods: patients with inoperable obstructing left-sided colorectal cancer with self-expanding metallic stent [SEMS] placement [group A] or emergency surgery [group B] from June 2003 to June 2005 were included. Data on the mortality, morbidity, necessity of intensive care and hospital stay for the two groups were compared
Results: insertion of metallic stent was successful in 14 of 16 patients [87.5%]. Hospital death occurred in two patients in group A and in 6 patients in group B. The mean hospital stay was significantly shorter in [Group A]/3.3 +/- .3days versus [Group B] [15.7 +/- 0.7, p=0.0001 Table 1. The incidence of colostomy was significantly lower in [Group A] [4 patients] versus [13 patients] in [Group B], p=0.003. Twelve patients [70%] required intensive care admission after surgery, compared with only two patients [12.5%] following SEMS insertion [p=0.0001]
Conclusion: SEMS are effective in the palliation of obstructing left-sided colorectal cancer. SEMS is associated with a shorter hospital stay, less likelihood of intensive care admission and lower incidence of stoma creation, when compared with emergency surgery
ABSTRACT
Laparoscopic Nissen fundoplication is positioned to become the standard of surgical treatment for patients with gastroesophageal reflux disease [GERD]. The present study aimed to evaluate in a prospective manner the technique and the clinical results of laparoscopic Nissen fundoplications. Between Ianuary 1998 and January 2001, 28 patients [17 male and 11 female with a mean age 42 +/- 6.7 years] who had undergone a laparoscopic approach for a Nissen fundoplication in El-Minia University Hospital were studied. All patients had undergone medical treatment for at least 3 months and then were referred to surgery due to unsatisfactory symptom control in 19 patients [67.8%] or to avoid lifelong medications in 9 patients [32.2%]. Laparoscopic Nissen fundoplication was done with or without division of short gastric vessels. It was successful in 24 of 28 patients [85.7%]. The mean operative time was 126 +/- 12.4 minutes. The mean post operative hospital stay was 3.1 + 0.2 days. Conversion from laparoscopic to open fundoplication was needed in 4 cases [14.3%]. There was no operative mortality with low serious morbidity. The mean heartburn score was 2.68 +/- 1.26 before operation versus 0.35 +/- 0.79 after operation by one year, with significant improvement [P<0.01]. The mean preoperative dysphagia score was 1.1 +/- 0.9 versus 0.32 +/- 0.21 by one year postoperatively [P<0.01]. Troublesome dysphagia was reported in 10 patients [35.7%], one was reoperated upon and 9 cases responded to dilatation or diet management
Conclusion: Laparoscopic Nissen fundoplication is a promising technique because it is safe with low morbidity rate and short hospital stay. The short term functional results shows the effectiveness of the technique in controlling the gastroesophageal reflux disease. Long term results should be studied
ABSTRACT
Postoperative adhesions are the most common cause of recurrent small bowel obstruction [SBO]. Laparotomy has classically been used in its treatment. The aim of this prospective study was to assess the feasibility, safety and clinical outcome of laparoscopic adhesiolysis in patients with recurrent 530 with the use of the ultrasonically activated shears. Between January 1998 and January 2001, elective laparoscopic adhesiolysis was attempted in 23 patients [13 men and 10 women, mean age 49.6 +/- 6.3 years, range 16-63 years] with post operative recurrent 530. All patients were subjected for complete clinical assessment, laboratory investigations, serial abdominal radiographs, abdominal ultrasound and CT. Patients in whom the bowel obstruction resolved within one day and who fulfilled the following criteria were treated laparoscopically: at least 2 prior episodes of small obstruction, confirmed improvement in physical signs of peritoneal inflammation, a decrease in white blood cell count to normal level and disappearance of air and fluid levels on plain abdominal radiographs . The technique of open laparoscopy was used for initial access to the peritoneum. The adhesions were lysed with the ultrasonically activated shears [Harmonic Scalpel]. Follow up evaluation was performed by clinical examination every 6 months for 3 years [range 1-4]. Laparoscopic adhesiolysis was successful in 18 patients [78.26%]. Conversion to laparotomy was required in 5 cases [21.74], because of intestinal peforation in one patient [4.5%], and convoluted masses in 4 patients [17.9%]. T here was no mortality and low morbidity in the form of serosal injuries in 4 patients [17.9%] and intestinal perforation in one patient [4.5%]. The mean time of operation, return of intestinal motility, and postoperative hospital stay were significantly shorter in the laparoscopically successful adhesiolysis group versus the group of patients who were converted to laparotomy. [[115 +/- 9.1 vs 130 +/- 6.7] P<0.001, [1.9 +/- 0.3 vs 3.8 +/- 1.2] P<0.01, [5.5 +/- 2.2 vs 8.3 +/- 3.4] P<0.001, respectively]. Recurrent SBO developed in 2 patients [12.5%] over a mean period of follow up [3 years]
Conclusion: Laparoscopic adhesiolysis is a feasible procedure for recurrent SBO with the use of the ultrasonically activated shears. It is safe [low morbidity and no mortality] and effective [low rate of recurrence of intestinal obstruction]. Conversion to laparotomy should be considered only in patients with intestinal perforation or convoluted masses