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1.
Colorectal Dis ; 23(10): 2501-2514, 2021 10.
Article in English | MEDLINE | ID: covidwho-1455531

ABSTRACT

AIM: The objective of this systematic review was to investigate the outcomes of ileorectal anastomosis (IRA) in Crohn's disease and to clarify whether there are any time-related trends in outcome measures. The primary outcomes are risk of anastomotic leakage, death, clinical recurrence and subsequent diverting or permanent stoma and/or proctectomy. Secondary end-points are quality of life and functional outcome. METHODS: Systematic searches were conducted using the Cochrane Library, Embase and MEDLINE. The complete search strategy is uploaded online at http://www.crd.york.ac.uk/prospero/. Human studies in English with over five subjects were included and no limit was set regarding the date of publication. All relevant studies were screened by two reviewers. The web-based software platform www.covidence.org was used for primary screening of the title, abstract, full-text review and data extraction. RESULTS: The search identified 2231 unique articles. After the screening process, 37 remained. Key results were an overall anastomotic leak rate of 6.4%; cumulative rates of clinical recurrence of 43% and 67% at 5 and 10 years, respectively; an overall rate of proctectomy of 18.9%; and subsequent ileostomy required in 18.8%. Only one study presented useful data on quality of life. Recurrence rates remained stable over time. A small decline in the anastomotic leak rate was found. CONCLUSIONS: Only minor improvements in the outcomes of IRA in patients with Crohn´s disease have occurred during the past 50 years regarding anastomotic leakage and recurrence, except for a slight increase in the rate of a functioning IRA. These results call for implementation guidelines in patient selection for IRA and postoperative medical treatment and follow-up.


Subject(s)
Crohn Disease , Anastomosis, Surgical/adverse effects , Colectomy , Crohn Disease/surgery , Humans , Ileum/surgery , Neoplasm Recurrence, Local , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Quality of Life , Rectum/surgery , Retrospective Studies
2.
J Minim Invasive Gynecol ; 27(5): 1014-1016, 2020.
Article in English | MEDLINE | ID: covidwho-1454309

ABSTRACT

OBJECTIVE: To demonstrate our application of the ghost ileostomy in the setting of laparoscopic segmental bowel resection for symptomatic bowel endometriosis nodule. DESIGN: Technical step-by-step surgical video description (educative video) SETTING: University Tertiary Hospital. Institutional Review Board ruled that approval was not required for this study. Endometriosis affects the bowel in 3% to 37% of all cases, and in 90% of these cases, the rectum or sigmoid colon is also involved. Infiltration up to the rectal mucosa and invasion of >50% of the circumference have been suggested as an indication for bowel resection [1]. Apart from general risks (bleeding, infection, direct organ injuries) and bowel and bladder dysfunctions, anastomotic leakage is one of the most severe complications. In women with bowel and vaginal mucosa endometriosis involvement, there is a risk of rectovaginal fistula after concomitant rectum and vagina resections. Hence, for lower colorectal anastomosis, the use of temporary protective ileostomy is usually recommended to prevent these complications but carries on stoma-related risks, such as hernia, retraction, dehydration, prolapse, and necrosis. Ghost ileostomy is a specific technique, first described in 2010, that gives an easy and safe option to prevent anastomotic leakage with maximum preservation of the patient's quality of life [2]. In case of anastomotic leakage, the ghost (or virtual) ileostomy is converted, under local anesthesia, into a loop (real) ileostomy by extracting the isolated loop through an adequate abdominal wall opening. In principle, avoiding readmission for performing the closure of the ileostomy, with all the costs related, means a considerable saving for the hospital management. Also, applying a protective rectal tube in intestinal anastomosis may have a beneficial effect [3]. These options are performed by general surgeons in oncological scenarios, but their use in endometriosis has never been described. INTERVENTIONS: In a 32-year-old woman with intense dysmenorrhea, deep dyspareunia, dyschesia, and cyclic rectal bleeding, a complete laparoscopic approach was performed using blunt and sharp dissection with cold scissors, bipolar dissector and a 5-mm LigaSure Advance (Covidien, Valley lab, Norwalk, Connecticut). An extensive adhesiolysis restoring the pelvic anatomy and endometriosis excision was done. Afterward, the segmental bowel resection was performed using linear and circular endo-anal stapler technique with immediate end-to-end bowel anastomosis and transit reconstitution. Once anastomosis was done, the terminal ileal loop was identified, and a window was made in the adjacent mesentery. Then, an elastic tape (vessel loop) was passed around the ileal loop, brought out of the abdomen through the right iliac fossa 5-mm port site incision and, fixed to the abdominal wall using nonabsorbable stitches. Finally, a trans-anal tube was placed for 5 days. The patient was discharged on the fifth day postoperatively without any complications. The tape was removed 10 days after surgery, and the loop dropped back. Two months after the intervention, the patient remains asymptomatic. CONCLUSION: Ghost ileostomy is a simple, safe, and feasible technique available in the setting of lower colorectal anastomosis following bowel endometriosis resection.


Subject(s)
Endometriosis/surgery , Ileostomy/methods , Intestinal Diseases/surgery , Laparoscopy/methods , Abdominal Wall/pathology , Abdominal Wall/surgery , Adult , Anal Canal/surgery , Anastomosis, Surgical/methods , Anastomotic Leak , Colon, Sigmoid/surgery , Dysmenorrhea/etiology , Dysmenorrhea/surgery , Endometriosis/complications , Endometriosis/pathology , Female , Humans , Intestinal Diseases/complications , Intestinal Diseases/pathology , Pelvis/pathology , Pelvis/surgery , Rectum/pathology , Rectum/surgery
5.
BMJ Case Rep ; 13(12)2020 Dec 22.
Article in English | MEDLINE | ID: covidwho-1186238

ABSTRACT

Cholecystocolonic fistula with associated idiopathic megabowel (megacolon and megarectum) is a rare presentation as acute large bowel obstruction. Frequently presenting with chronic constipation, acute bowel obstruction is rarely encountered in the presence of concomitant cholecystocolonic fistula. This presents diagnostic and management difficulties with no consensus on appropriate surgical approach. This case highlights the outcomes following emergency total colectomy and subtotal cholecystectomy as a single-stage procedure for a 68-year-old man presenting with cholecystocolonic fistula secondary to idiopathic megabowel as acute large bowel obstruction.


Subject(s)
Biliary Fistula/etiology , Gallbladder Diseases/etiology , Intestinal Fistula/etiology , Intestinal Obstruction/etiology , Megacolon/complications , Rectal Diseases/complications , Aged , Biliary Fistula/diagnosis , Biliary Fistula/surgery , Cholecystectomy , Colectomy , Colon/diagnostic imaging , Colon/surgery , Gallbladder/diagnostic imaging , Gallbladder/surgery , Gallbladder Diseases/diagnosis , Gallbladder Diseases/surgery , Humans , Intestinal Fistula/diagnosis , Intestinal Fistula/surgery , Intestinal Obstruction/diagnosis , Intestinal Obstruction/surgery , Male , Megacolon/diagnosis , Megacolon/surgery , Rectal Diseases/diagnosis , Rectal Diseases/surgery , Rectum/diagnostic imaging , Rectum/surgery , Tomography, X-Ray Computed , Treatment Outcome
6.
J Gastrointest Cancer ; 51(3): 800-804, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-640099

ABSTRACT

PURPOSE: Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era. METHODS: In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran. RESULTS: We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19. CONCLUSION: Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Medical Oncology/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic/standards , Rectal Neoplasms/therapy , Age Factors , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/standards , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Betacoronavirus/isolation & purification , COVID-19 , Chemotherapy, Adjuvant/standards , Clinical Decision-Making , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Humans , Infection Control/standards , Iran/epidemiology , Medical Oncology/methods , Neoadjuvant Therapy/standards , Neoplasm Staging , Palliative Care/methods , Palliative Care/standards , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Proctectomy/standards , Rectal Neoplasms/pathology , Rectum/pathology , Rectum/surgery , SARS-CoV-2
7.
Updates Surg ; 72(2): 249-257, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-324541

ABSTRACT

BACKGROUND: The COVID19 pandemic had a deep impact on healthcare facilities in Italy, with profound reorganization of surgical activities. The Italian ColoRectal Anastomotic Leakage (iCral) study group collecting 43 Italian surgical centers experienced in colorectal surgery from multiple regions performed a quick survey to make a snapshot of the current situation. METHODS: A 25-items questionnaire was sent to the 43 principal investigators of the iCral study group, with questions regarding qualitative and quantitative aspects of the surgical activity before and after the COVID19 outbreak. RESULTS: Two-thirds of the centers were involved in the treatment of COVID19 cases. Intensive care units (ICU) beds were partially or totally reallocated for the treatment of COVID19 cases in 72% of the hospitals. Elective colorectal surgery for malignancy was stopped or delayed in nearly 30% of the centers, with less than 20% of them still scheduling elective colorectal resections for frail and comorbid patients needing postoperative ICU care. A significant reduction of the number of colorectal resections during the time span from January to March 2020 was recorded, with significant delay in treatment in more than 50% of the centers. DISCUSSION: Our survey confirms that COVID19 outbreak is severely affecting the activity of colorectal surgery centers participating to iCral study group. This could impact the activity of surgical centers for many months after the end of the emergency.


Subject(s)
Colon/surgery , Coronavirus Infections/epidemiology , Digestive System Surgical Procedures/statistics & numerical data , Disease Outbreaks , Elective Surgical Procedures/statistics & numerical data , Pneumonia, Viral/epidemiology , Rectum/surgery , COVID-19 , Humans , Italy/epidemiology , Pandemics , Surveys and Questionnaires , Time Factors
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