ABSTRACT
Aim of Study:Laparoscopiccolorectal surgery has gained popularity around the Globe. Laparoscopiccolectomy significantly improves the short term and long term outcomes of patients. The bowel anastomosis after laparoscopic resection of the tumour can be done in two ways -extracorporeal anastomosis and Intracorporeal anastomosis. Our study observed and evaluated the data of the patients who underwent these two techniques.Materials and Methods:A prospective observational study was conducted in the department of General Surgery, SMHS hospital of Government Medical College, Srinagar. A total of 32 patients were studied out of which 20 patients had undergone intracorporeal anastomosis and 12 patients had undergone extracorporeal anastomosis. The aims of the study were to assess the operative time, post-operative ileus, length of hospital stay, anastomoticleak and other anastomotic complications,wound infections and extraction site hernias.Results:The patients in our study were in the range of 30-85 years with a mean age of 59.18 ± 14.92. and 59.4% of patients were males and the rest 40.6% were females, with male/female ratio of 1.46:1. There was no significant difference in mean operative time between the intracorporeal group and extracorporeal group (188±9.78 minutes’ vs.180.3±13.8 minutes). The patients in the intracorporeal group had earlier return of bowel function than extracorporeal group as reflected by earlier appreciation of flatus and tolerance to orals. This had led to the shorter hospital stay of the intracorporeal group than the extracorporeal group of patients (median of 5 days vs. 6.5 days) The wound infection rate was 6.3 percent in our study, 5.0% in the intracorporeal group and 8.3% in the extracorporeal group. Only 1 out of the total 32 patients developed mesenteric twist to the extracorporeal group (1 out of 12 patients). We observedno leak or incisional hernia in either groups.Conclusion:Intracorporeal anastomosis in laparoscopic colorectal surgeries leads to earlier return of bowel function, earlier resumption of orals and shorter hospital stay than the extracorporeal anastomosis. There does not exist a significant difference between the two modes of anastomosis in terms of anastomotic and wound related complications
ABSTRACT
Primary linitis plastica of the colon, rectum and ileum is very uncommon, especially when it mimicks the colonic Crohn's disease. We observed this uncommon disease in a 26-year-old male. Barium enema showed characteristics of multiple consentric lesions in the entire colon, and some irregularity in mesenteric border of the terminal ileum. Colonofiberscopic finding showed multiple cobble stone appearance of the colon with a skipped area. The result of the biopsy illustrated that there was a poorly differentiated adenocarcinoma 5 cm from the anal verge. A longitudinal duodenal ulcer was discovered using the gastroscopic method. Upper gastrointestinal and small bowel series showed a suspicious gastric and duodenal Crohn's disease, and also showed ileum involvement. Operative finding showed a lead pipe appearance of the total colon, and the rectum was very fixed to the bladder and pelvic floor. The mesentery of the colon was thickened, and some portion of mesenteric creeping of the ileum was found to be mimicking Crohn's disease. The duodenal wall was also thickened. The biopsy result showed that there was a total involvement of the colon, rectum and ileum with signet-ring cell type adenocarcinoma with intact mucosa with the exception of a little portion of the rectum. This disease is very uncommon, and it is difficult to diagnose preoperatively, especially in Oriental countries.