ABSTRACT
The urethrovesical anastomosis during total laparoscopic radical bladder cancer was mostly operated by one-hand. In this study, 10 patients with bladder cancer were legally operated by double-hand, all of which were successfully completed. With the follow-up of 3-15 months, the patient could urinate smoothly, with no anastomotic fistula or stenosis. The effect of the urethrovesical anastomosis was satisfactory.
ABSTRACT
Acute intestinal obstruction is one of the common causes of emergency surgery in patients with colorectal cancer,which is usually with poor prognosis. Surgery is the most important way to relieve obstruction and save the lives. One-stage resection and anastomosis can completely remove the tumor, restore the continuity of the intestine, avoid complications of staged surgery and reduce disease burden,and is supposed to be the most ideal surgery. However,due to certain intraoperative technical difficulties and the risk of anastomotic leakage,it is still controversial whether the one-stage resection and anastomosis surgery can be preferred during emergency exploration.
ABSTRACT
Four consecutive cases of a colonic stricture following a da Vinci robot-assisted ultra-low anterior resection (LAR) with coloanal anastomosis and diverting ileostomy for the treatment of rectal cancer are reported. The colonic strictures developed after early proximal colonic ischemia without anastomotic site leakage or disruption. All patients were treated with preoperative chemoradiation therapy. During the postoperative recovery period, patients developed colonic ischemia, presenting with a high, spiking fever, but without any symptoms of peritonitis. Patients were treated with conservative management (antibiotic therapy) and discharged after two weeks when in good condition. Several months after discharge, all four patients developed a long-segment colonic stricture from the anastomosis site to the distal colon. Management of the colon strictures, including the anastomotic site, involved colonic dilation with a Hegar dilator in an outpatient clinic for several months. The ileostomies in three patients could not be closed.
Subject(s)
Humans , Ambulatory Care Facilities , Colon , Constriction, Pathologic , Fever , Ileostomy , Ischemia , Peritonitis , Rectal NeoplasmsABSTRACT
BACKGROUND: Although considerable efforts have been made to improve the graft patency in coronary artery bypass surgery, the role of biomechanical factors remains underrecognized. The aim of this study is to investigate the influences of geometric configurations of the bypass graft on hemodynamic characteristics in relation to anastomosis. MATERIALS AND METHODS: The Numerical analysis focuses on understanding the flow patterns for different values of inlet and distal diameters and graft angles. The Blood flow field is treated as a two-dimensional incompressible laminar flow. A finite volume method is adopted for discretization of the governing equations. The Carreau model is employed as a constitutive equation for blood. In an attempt to obtain the optimal aorto-coronary bypass conditions, the blood flow characteristics are analyzed using in vitro models of the end-to-side anastomotic angles of 45degrees, 60degrees and 90degrees. To find the optimal graft configurations, the mass flow rates at the outlets of the four models are compared quantitatively. RESULTS: This study finds that Model 3, whose bypass diameter is the same as the inlet diameter of the stenosed coronary artery, delivers the largest amount of blood and the least pressure drop along the arteries. CONCLUSION: Biomechanical factors are speculated to contribute to the graft patency in coronary artery bypass grafting.