ABSTRACT
Aim: The aim of this study is to evaluate the results of laparoscopic reversal of Hartmann’s procedure assisted by transanal circular stapler as a primary treatment modality. Materials and methods: About 32 patients presenting with an end colostomy due to various elective and emergency surgical, gynecological, and obstetric indications were selected for this study, from April 2010 to March 2016. All the patients were subjected to ultrasonography of the abdomen and pelvis, a colostogram and contrast enema, and colonoscopy. Patients selected for the study were subjected to all routine workup. Pre-anesthetic evaluation was done. Parameters such as operative time, conversion rates, intraoperative blood loss, postoperative complications, return of bowel movements, starting on oral feed, anastomotic leak, port-site infection, and hospital stay were studied. Results: About 32 patients, including both male (12) and female (20), were included in the study. The age ranged between 30 years and 65 years (mean 47.5 years). The mean operative time was 150.6 ± 20.4 minutes. Four cases were converted to open. Oral feeds were started on 2 ± 1 postoperative day. Patients tolerated solid soft diet 96 hours after surgery. Postoperative hospital stay was 7 days (range 6–8 days). No patients had anastomotic leak or required revision surgery. Three patients had port-site infections. Conclusion: We conclude that transanal stapler-assisted laparoscopic Hartmann reversal can be considered as a primary modality of treatment in the hands of an experienced surgeon though having a steeper learning curve and a higher difficulty score compared with other laparoscopic colorectal surgeries with benefits of lesser intraoperative time, early return of bowel movements, faster initiation of oral solid feeds, decreased incidence of anastomosis leak, and lesser hospital stay. © The Author(s). 2022.
ABSTRACT
OBJECTIVE: To determine the outcomes in children with MIS-C receiving different immunomodulatory treatment. METHODS: In this multicentric, retrospective cohort study, data regarding treatment and outcomes of children meeting the WHO case definition for MIS-C, were collected. The primary composite outcome was the requirement of vasoactive/inotropic support on day 2 or beyond or need of mechanical ventilation on day 2 or beyond after initiation of immunomodulatory treatment or death during hospitalization in the treatment groups. Logistic regression and propensity score matching analyses were used to compare the outcomes in different treatment arms based on the initial immunomodulation, i.e., IVIG alone, IVIG plus steroids, and steroids alone. RESULTS: The data of 368 children (diagnosed between April 2020 and June 2021) meeting the WHO case definition for MIS-C, were analyzed. Of the 368 subjects, 28 received IVIG alone, 82 received steroids alone, 237 received IVIG and steroids, and 21 did not receive any immunomodulation. One hundred fifty-six (42.39%) children had the primary outcome. On logistic regression analysis, the treatment group was not associated with the primary outcome; only the children with shock at diagnosis had higher odds for the occurrence of the outcome [OR (95% CI): 11.4 (5.19-25.0), p < 0.001]. On propensity score matching analysis, the primary outcome was comparable in steroid (n = 45), and IVIG plus steroid (n = 84) groups (p = 0.515). CONCLUSION: While no significant difference was observed in the frequency of occurrence of the primary outcome in different treatment groups, data from adequately powered RCTs are required for definitive recommendations.