Postoperative outcomes after Heal pouch anal anastomosis surgery for patients with ulcerative colitis and familial polyposis

The restorative proctocolectomy [RPC] with ileal pouch anal anastomosis [IPAA] has become the procedure of choice for the surgical treatment of patients with ulcerative colitis [UC] and familial adenomatous polyposis [FAP]. Despite its wide acceptance, reports are variable with regard to the outcomes between patients with UC and FAR This study evaluates the differences in the postoperative morbidity. gastrointestinal function and quality of life between a series of UC [n=12] and FAP patients [n=6] after IPAA. With the exception of septic complications and pouchitis, there was no difference in functional status or quality of life between UC and FAP patients. Septic complications and pouchitis were significant findings among patients with UC than the FAP group [P<0.05]. Despite this, both groups of patients had similar numbers of stools per day, and had similarly low rates of incontinence [P>005], FAP patients were less satisfied than the UC patients did, however, this was not statistically significant [P<0.05]. Our data imply that despite differences in occurrence of septic complications and pouchitis, FAP and UC patients enjoy similar bowel function, quality of life and continence status after IPAA

Primary anastomosis versus Hartmann's procedure for complicated diverticular disease of the left colon

The ideal treatment for complicated diverticulitis is still controversial. The Hartmann's procedure has remained the favored option in patients with acute complicated sigmoid diverticular disease but there has been increasing interest in primary resection and anastomosis. This retrospective study was carried out on 27 patients with complicated diverticular disease of the left colon, comparing primary resection and anastomosis with intraoperative colonic lavage, versus primary resection with Hartmann's procedure, Between 1996 and 2002, 27 patients underwent urgent laparotomy for complicated colonic diverticulitis. Primary resection with anastomosis was performed in 17 patients [group I], and Hartmann's procedure performed in 10 patients [group II]. All data were collected on standardized forms, There were no differences between the two groups as regard age, clinical features, severity of disease, post-operative DVT, mean hospital stay, and post-operative mortality. The incidence of postoperative pneumonia and wound infection was significantly higher after Hartmann's operation, P< 0.05. Re-intervention incidence was significantly higher in group II compared to group I, P < 0.001. The severity of the disease was the main determinant of anastomotic complications and mortality as anastomotic leakage and mortality occurred only in Hughe's stage III Primary resection with anastomosis compares favorably with Hartmann's procedure in complicated diverticulitis. It should be an alternative to and even better than the Hartmann's procedure, However. Hartmann's procedure or decompression should be reserved for cases with generalized peritonitis [Hughe's stage III] and for high- risk patients, particularly diabetics

Mortality and morbidity after resection of synchronous liver metastases from colorectal carcinoma

Disease metastasis to the liver is the primary determinant of patient survival in the natural history of colorectal carcinoma. Resection when possible is still the best hope for cure of colorectal metastasis to the liver objective. The present study is a trial to define some factors that affect the outcome and complications after resection of synchronous liver metastasis. Data analysis of 48 patients underwent curative resection of the primary colorectal carcinoma and synchronous liver metastasis was performed between 1993 and 2000. Patients were followed every 3 months for 2 years, and then every 6 months. The 3 years survival rate for the studied group after surgery was 41.6% and the mean survival was 29.3 + 9 months. Multivariate analysis revealed that the number of peri-colonic lymph nodes [p < 0.001] correlated significantly with the mean survival, although it has no effect on occurrence of postoperative complications. Also, there is a positive correlation between age and the occurrence of postoperative complications [p<0.01], but it has no effect on mean survival. There was no peri-operative mortality. Major operative complications occurred in 12.5%, and minor complications in 27% of the studied group. Recurrence occurred in 56.25% of the patients during the follow up. Synchronous resection of hepatic metastasis from a colorectal carcinoma has nearly the same mean survival and morbidity of metachronous resection as defned by the data in this study when compared to other series the survival rats is only bad when there is 6 or more metastatic pericolonic lymph modes and in that state symchronous liver resection may be letter to be delayed

Conservative management of hepatic trauma

In this study, the conservative management of 54 patients [37 males and 17 females with a mean age of 28 + 12.6 years] with liver trauma [40 cases of blunt trauma and 14 cases of penetrating injury] in the last six years was reviewed. Guided by clinical signs and CT scan, 28 patients were successfully managed without operation [22 with blunt injury and six with penetrating injury]. Most of the operatively managed patients after the failure of the conservative treatment were of grade IV and V liver injury. The complication rate was lower in the nonoperatively managed patients. Only two patients died in the operative group, but no mortality occurred in the nonoperative one. When surgery was done, the simplest maneuver to control bleeding was followed to reduce the morbidity and mortality rates. The clinical assessment and radiological monitoring may reduce the number of unnecessary laparotomies

Management of calcular obstructive jaundice by laparoscopic cholecystectomy in conjunction with preoperative ERCP techniques

Today, the management of CBD stones is in a continuous state of evolution. The desire for cosmetically appearing band-aid surgery and the potential cost effectiveness of shorter hospitalization and convalescence have caused most patients to request laparoscopic removal of the gall-bladder with the possible use of non-operative methods for treating CBD stones. In this study fifty patients with highly suspected choledocholithiasis were managed with selective pre-operative ERCP stone extraction followed by laparoscopic cholecystectomy within 36 hours. There were minor complications in "24%" and major complications in "6%" with no mortality and excellent convalescence. This was a trial to find marketability of minimally invasive surgery and whether it could be applied in cases of calcular obstructive jaundice