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Introduction: A higher rate of anastomotic leakage (AL) is reported after ileosigmoid anastomosis (ISA) or ileorectal anastomosis (IRA) in total or subtotal colectomy (TSC) compared with colonic or colorectal anastomosis. Themain aimof the present studywas to assess potential risk factors for AL after ISA or IRA and to investigate determinants of morbidity. Methods: We identified 180 consecutive patients in a prospective referral, single center database, in which 83 of the patients underwent TSC with ISA or IRA. Data regarding the clinical characteristics, surgical treatment, and outcome were assessed to determine their association with the cumulative incidence of AL and surgical morbidity. Results: Ileosigmoid anastomosis was performed in 51 of the patients (61.5%) and IRA in 32 patients (38.6%). The cumulative incidence of ALwas 15.6% (13 of 83 patients). A higher AL rate was found in patients under 50 years-old (p=0.038), in the electivelaparoscopic approach subgroup (p=0.049), and patients in the inflammatory bowel disease (IBD) subgroup (p=0.009). Furthermore, 14 patients (16.9%) had morbidity classified as Clavien-Dindo ≥ IIIA. Discussion: A relatively high incidence of AL after TSC was observed in a relatively safe surgical procedure. Our findings suggest that the risk of AL may be higher in IBD patients. According to our results, identifying risk factors prior to surgerymay improve short-term outcomes. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Anastomosis, Surgical , Colectomy/adverse effects , Anastomotic Leak/epidemiology , Postoperative Complications , Rectum/surgery , Risk Factors , Morbidity , Ileum/surgeryABSTRACT
PURPOSE: Whether subtotal or total colectomy with primary anastomosis (PA) is safer than Hartmann procedure (HP) for left-sided colon cancer obstruction or perforation remains controversial. The purpose of this study was to compare postoperative morbidity, mortality, and defecation frequency between PA and HP for left-sided colon cancer obstruction or perforation.METHODS: This retrospective study enrolled 54 patients from January 2014 to February 2018 who underwent emergency surgery due to left-sided colon cancer obstruction or perforation.RESULTS: PA was carried out in 20 patients while HP was performed for 34 patients. Thirty-day mortality did not show significant difference between the two groups (15.0% vs. 14.7%, P=1.000). No anastomotic leakage occurred in PA group while three (8.8%) cases of stump leakage occurred in HP group. Stoma repair was performed for 13 cases (44.8%) and stoma reformation was performed for one case in HP group (7.7%). Stoma related complications occurred in five cases (17.24%). For patients after stoma repair, defecation frequency at 3 months after operation was 2.91±2.88 times per day in PA group and 2.86±2.63 times per day in HP group. At 1 year after operation, defecation frequency was changed to 1.40±1.12 times per day in PA group and 1.17±0.39 times per day in HP group.CONCLUSION: Primary ileosigmoid or ileorectal anastomosis for left-sided colon cancer obstruction or perforation is safe, and shows similar outcome of defecation frequency compared to HP.
Subject(s)
Humans , Anastomotic Leak , Colectomy , Colon , Colonic Neoplasms , Defecation , Emergencies , Mortality , Retrospective StudiesABSTRACT
Objective To investigate the length of preserved ileocecum in surgical treatment of slow transit constipation ( STC) by sub-total colectomy with antiperistaltic cecorectal anastomosis .Methods A total of 82 patients with STC were divided into two groups according to the random number table method ,with 41 cases in each group ,all the patients of the two groups underwent subtotal colectomy ,intraopera-tive ileocecum was preserved length of group A was 10~15 cm,group B was 2~3 cm.The operation time,intraoperative bleeding volume, postoperative exhaust time and length of hospital stay were compared .Wexner constipation score and gastrointestinal quality of life index ,ab-dominal pain ,frequency score and emptying time of ileocecus before and after 6 months and 12 months between the two groups were com-pared.Results There was no statistically significant difference in the operation time ,intraoperative bleeding volume ,postoperative exhaust time and hospitalization time of two groups (P>0.05).Wexner constipation score,abdominal pain,frequency score of the two groups after 6 months and 12 months decreased significantly (P<0.05,P<0.01),of which the group B was lower than that of the group A (P<0.05,P<0.01). The gastrointestinal quality of life index after operation significantly increased (P<0.01),of which the group B was higher than that of the group A (P<0.01).Ileocecal emptying time of the group B 12 months after operation was shorter than that of the group A (P<0.01),the differences were statistically significant .Conclusion Subtotal colectomy with antiperistaltic cecorectal anastomosis is an effective method to treat STC,which can reduce the length of preserved ileocecum and improve the prognosis of patients .
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Introducción: la colectomía subtotal con anastomosis cecorrectal o cecoproctoplastia, es una alternativa a la colectomía total con anastomosis ileorrectal; permite conservar el íleon distal, válvula ileocecal y el ciego preservando las importantes funciones de absorción. El objetivo del trabajo es observar los resultados clínicos y funcionales post operatorios de la cecoproctoplastia. Materiales y Métodos: los pacientes seleccionados con promedio de 57 años de edad, fueron 3 (tres) casos de diverticulosis colónica complicada, 2 (dos) casos con hemorragia y 1 (uno) con diverticulitis, 1 (uno) caso de angiodisplasias múltiples y 1 (uno) caso de cáncer de colon sigmoides, adenocarcinoma bien diferenciado T2 N0 M0, todos fueron sometidos a colonoscopia y en cuatro de ellos se efectuó enema opaco y todos presentaban válvula ileocecal continente. La técnica, sigue la propuesta de Zinzidohoue. Resultados: no se registraron mortalidad ni complicaciones mayores. Los resultados funcionales en relación a la cantidad y característica de las deposiciones diarias al año del postoperatorio, todos los pacientes presentaron 2 a 3 deposiciones diarias. Discusión: en 1998, Zinzidohoue propuso una modificación a la técnica de Deloyers en la colectomía subtotal con conservación de la unión ileocecal, que preserva la continuidad anastomosando el ciego al muñón rectal. Esta técnica, representa actualmente una alternativa a la colectomía total con anastomosis ileorrectal considerado a menudo como insatisfactorio debido a la alta frecuencia de diarrea y alto índice obstrucción del intestino delgado. Conclusión: nuestra experiencia preliminar, nos permite afirmar que la cecoproctoplastia es una técnica aconsejable en seleccionados casos, representa una alternativa a la ileoproctoanastomosis por sus resultados clínicos y funcionales satisfactorio.
Background: subtotal colectomy with cecorrectal anastomosis or cecoproctoplasty is an alternative to total colectomy with ileorectal anastomosis. It allows keeping the distal ileon, the ileocaecal valve and the cecum, preserving important absorption functions. This work is aimed to evaluate the postoperative clinical and functional outcomes from cecoproctoplasty technique. Materials and methods: five patients with a mean age of 57 years old were selected. Three of them were suffering from complicated colonic diverticulitis, 2 with hemorrhage and 1 with diverticulitis; 1 case of multiple angiodysplasia and 1 with sigmoid colon cancer, well-differentiated adenocarcinoma T2N0M0. All of them undergone colonoscopy, in 4 of them were performed x ray with barium enema. All patients presented good continence of the ileocaecal valve. The technique is based on the proposal of Zinzidohoue. Results: there was no mortality and no postoperative complication. Functional outcomes regarding the number and characteristics of mean daily stool frequency over a year was 2-3. Discussion: by 1998, Zinzidohoue proposed a Deloyers technique modification in subtotal colectomy with ileocaecal junction conservation, which keeps the continuity, joining the cecum to the rectal stump. This technique represents an alternative to total colectomy with ileorectal anastomosis. It is often considered as unsatisfactory because of the high rate of diarrhea and small intestine obstruction. Conclusion: our preliminary experience allows us to state that cecoproctoplasty is a recommended technique in selected cases. It represents an alternative to ileorectal anastomosis because of its satisfactory clinical and functional results.
Subject(s)
Humans , Adult , Middle Aged , Anal Canal/physiology , Colectomy/methods , Quality of Life , Postoperative Care , Gastrointestinal Diseases/surgery , Follow-Up StudiesABSTRACT
Objective To explore the feasibility of laparoscopic-assisted partial and subtotal colectomy and per anum intrarectal pull-through procedures for Hirschsprung's disease-allied disorder(HAD).Methods From October 1999 to May 2006,38 infants and children with HAD or Hirschsprung's disease(HD) associated with HAD,to whom conservative treatments proved ineffective or relapse occurred,were treated by laparoscopic-assisted partial or subtotal colectomy and per anum intrarectal pull-through procedures.Four 5 mm trocars were inserted at the edge of umbilicus,right upper,right lower and left center quadarant of abdomen when subtotal colectomy was carried out.Two trocars were placed in the left side,lied in left upper and mid lower quadarant of abdomen respectively.Colon descendens,colon transversum,colon ascendens and ileocecal junction lateral peritoneum were mobilized under laparoscope.The operation on anus was referred to modified Soave procedures.Results 38 patients underwent the operations successfully.Left hemicolon resection were performed in 9 cases,with operation time being 110-180 min(mean,135 min).Subtotal colectomy were performed in 29 cases and colon ascendens were rotated reversal clockwise 270? and pulled down using Deloyers procedures,lengths of remaining colon ascendens being 7-13 cm(mean,11.5 cm),operation time being 140-220 min(mean,175 min),intraoperative blood loss being 15-70 ml(mean,35 ml).Postoperative pathological diagnosis showed 10 cases of intestine neuron developmental anormaly(IND),3 cases of hypoganglionosis(HG),4 cases of immature gangliocyte(IGC),9 cases were not classified,6 cases of HD complicated with IND,2 cases of HD complicated with HG,4 cases of HD complicated with ICG.38 cases were followed up for a mean of 3 years and 5 months(range,6 months to 7 years).9 cases of left hemicolon resection had 1-2 stools per day at 6 months postoperatively without stoma stenosis and constipation recurrence.Conclusions Laparoscopic-assisted partial or subtotal colectomy and radical per anum pull-through procedures for HAD are safe,effect,feasible,with minimal invasion,but some laparoscopic procedure experiences are required.
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PURPOSE: The results of a subtotal colectomy in colonic inertia, even those reported in the most recent literature, vary dramatically. The purpose of this study was to assess the effect of a colonic transit study on the results of a subtotal colectomy in colonic inertia. METHODS: Between 1992 and 1997, 30 patients underwent a subtotal colectomy with ileorectal anastomosis due to colonic inertia. Twenty-one of them underwent a colonic transit study only one time preoperatively, and 9 patients underwent such a study two times. The success rate was calculated using traditional definition with two sets of criteria. We modi fied the criteria of success by including new symptoms, such as abdominal, pelvic, or rectal pain, difficult evacuation, and loose stool or diarrhea. The success rate was recalculated using our more stringent cri teria, and compared between group 1 and group 2. RESULTS: By the traditional definition, the functional success rate was 100% for patients undergoing a colonic transit study two times preoperatively and 90% for patients undergoing only one study (p=0.34). By our more stringent criteria, the success rate was 100% for patients undergoing studies two times and 62% for those undergoing only one study (p=0.03). CONCLUSIONS: The success rate of a colectomy for colonic inertia was significantly higher for patients who underwent a repeat transit study than for those who underwent a single study. Patients who have two or more transit studies to confirm the diagnosis of inertia have a significantly higher probability of postoperative improvement of both bowel frequency and associated symptoms, such as pain and difficult evacuation. The mechanism for this discriminatory effect of repeated colonic transit studies requires elucidation by further study.
Subject(s)
Humans , Colectomy , Colon , Constipation , Diagnosis , DiarrheaABSTRACT
PURPOSE: The aim of this study was to assess the outcome of subtotal colectomy on patients with a diagnosis of chronic constipation. METHODS: A retrospective review of 11 consecutive patients who underwent subtotal colectomy between January 1990 and July 1999 was undertaken. Preoperative testings included complete history and physical examination, anorectal manometry, videodefecography, and colonic transit studies. RESULTS: The 11 patients consisted of 5 men and 6 women, with a mean age of 44 (range, 25~62) years. The most common symptom was inability to defecation and mean duration of this symptom was 13.6 (range, 0.75~45) years. Ten patients had slow colon transit and one patient had normal colon transit with anismus. All patients were followed up for mean duration of 33 (range, 5~120) months. Mean bowel frequency was 4 times per day after colectomy. Nine patients were satisfied with the results of surgery and showed improvement in quality of life. One patient was less satisfied due to diarrhea even with several times bowel movement per day. One patient felt that the operation was not so effective due to incontinence for liquid stool and 7 bowel movement per day. Three patients frequently used antidiarrheal medication after surgery. Three patients had postoperative small bowel obstruction and were treated without surgery. CONCLUSION: Subtotal colectomy with ileorectal anastomosis produces a satisfactory functional outcome in the majority of patients with proven slow transit constipation.
Subject(s)
Female , Humans , Male , Colectomy , Colon , Constipation , Defecation , Diagnosis , Diarrhea , Manometry , Physical Examination , Quality of Life , Retrospective StudiesABSTRACT
0.05) Conclusion Subtotal colectomy and intraoperative colonic irrigation are effective methods for management of obstructing carcinoma in the left colon To select an effective technique depends on the analysis of the practical situations and evaluation of the idiographic complexions.