Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection

PURPOSE: We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL). METHODS: Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL. RESULTS: Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20–35 kg/m2). The median tumor distance from the anal verge was 8 cm (range, 4–12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation. CONCLUSION: These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.

Rubber band ligation for 550 patients of symptomatic haemorrhoids out of 2200 patients retrospective study

This retrospective study was conducted to elucidate the results of the treatment for symptomatic haemorrhoids using rubber band ligation [RBL] method. Method: a retrospective study for 550 patients who came to the colorectal unit from June 1998 to June 2006, data was retrieved from archived files. Forty four patients with haemorrhoid had liver cirrhosis.RBL was performed using the Mc Gown applicator on an outpatients basis. The patients were asked to return to out-patient clinic for follow up at 2 week, 1, 6, months and through telephone call every 6 month for 2 years]. After RBL 496 patients [90.18%] were cured with no difference in outcome for first, second or third degree haemorrhoids [P value = 0.31]. symptomatic recurrence was detected in 16.03% after 2 years then repeated RBL or surgery were done for them. A total of 88 patients [16%] had 155 complications from RBL which required no hospitalization. Complications were registered; pain in 10.37%, rectal bleeding in 8.36% and vaso-vagal symptoms in 7.81%. RBL is a safe and successful method for treating symptomatic haemorrhoids, even in cirrhotic patients

Comparative study between biofeedback retraining and botulinum neurotoxin in treatment of anismus patients

Anismus is a significant cause of chronic constipation. This study came to revive the results of biofeedback BFB retraining and botulinum toxin A BTX- A injection in treatment of anismus patients. Forty eight patients with history of constipation underwent anorectal manometry, balloon expulsion, defecography, and electromyography. All patients had a non relaxing puoborectalis muscle. The patients were randomized into 2 groups. Group I patients receive biofeedback, two times per week for one month. Group II patients were injected with BTX- A. Follow up was conducted weekly in the first month then monthly for one year. In BFB training group 3 patients quite before the end of sessions with no improvement, initial improvement was recorded in 12 patients [50%] while long term success was recorded in 6 patients [25%]. In BTX-A group, initial improvement recorded in 17 patients [70.83%] with long term improvement in 8 patients [33.3%] There is a significant difference between BTX-A group and BFB group as regarding the initial success, but this significant difference disappeared at the end of follow up. Biofeedback retraining has therapeutic effect on patients suffering from anismus also, BTX-A injection is successful for temporary treatment of anismus and need repeated injection. Initial improvement is better after BTX-A injection

Emergent thoracotomy in congenital malformations of the lung experience in 32 cases

Background: congenital anomalies of the lung are rare disorders that can present by life threatening emergency which may need emergent thoracotomy

Aim: to evaluate our methods of investigations and emergent management of these life threatening problems

Patients and Methods: this study represents the experience of Cardio Thoracic Surgery Department in collaboration with General Surgery Department, Mansoura University Hospital, Mansoura, Egypt on 32 cases who needed emergent thoracotomy for different congenital lung anomalies. Thirty two Consecutive patients had emergent operations from January 1996 until December 2001

Results: eighteen patients had tension lung cysts, 11 patients had congenital lobar over inflation, 2 patients had sequestrated segment, and one patient had congenital arteriovenous malformation. There were 14 males and 18 females, the age ranged from 3 days up to 16 years [mean age4+/-4.2y]. Patients less than 2 years presented with dyspnea, tachypnea, cyanosis, and respiratory distress, while the older patients presented with chest pain, hemoptysis. Plain X-ray chest was sufficient for the diagnosis in 26 patients [81.25%], while CT chest was done in 23 patients [71.8%], bronchoscopy was also done in 6 patients [18.75 %] for exclusion of foreign body inhalation. Curative surgery was achieved by 28 lobectomies, 3 bilobectomies, and in one case by cyst enucleation. The complications were in the form of postoperative pneumonia, atelectasis, air leak and empyema in 14.5% of cases which managed easily. Infants and children tolerate lobectomy extremely well, with compensatory lung growth, so that total lung volume and gas exchange capacity returns to normal during somatic maturation

Conclusion : it is concluded from this study that these congenital lung malformations may cause respiratory distress and hemoptysis and need emergent thoracotomy which is curative. X-ray chest and CT scan are sufficient for accurate diagnosis. Emergent surgery is safe and curative in those patients as infants and children tolerate lung resection very well with compensatory lung growth during somatic maturation

role of CA15.3 in cancer breast and its correlation with some other tumour markers

The aim of this study was to evaluate serum tumor markers [CA15-3, CEA and TNF] and ER receptors in serum and urine. It was done on 20 patients with breast cancer, 20 patients with benign breast lesions and 20 normal controls. A significant high level of the mean serum value of CA15-3 in cancer patients compared with benign and control groups. The mean preoperative levels returned nearly to normal in completely cured cases, while it was in a high level if there was metastasis or recurrence. In conclusion, serum CA15-3 and CEA levels could be valuable as a prognostic parameter and may have a role in monitoring patients with breast cancer. Other tested tumor markers, especially TNF may be complementary in this regard, while receptor patterns were important for determining the modality and response of treatment