ABSTRACT
BACKGROUND: Theoretical advantages of Turnbull-Cutait pull-through delayed coloanal anastomosis (DCAA) are a reduced risk of anastomotic leak and therefore avoidance of stoma. Gradually abandoned in favor of immediate coloanal anastomosis (ICAA) with diverting stoma, DCAA has regained popularity in recent years in reconstructive surgery for low RC, especially when combined with minimally invasive surgery (MIS). The aim of this study was to perform the first meta-analysis, exploring the safety and outcomes of DCAA compared to ICAA with protective stoma. METHODS: A systematic search of MEDLINE, EMBASE, and CENTRAL and Google Scholar databases was performed for studies published from January 2000 until December 2020. The systematic review and meta-analysis were performed according to the Cochrane Handbook for Systematic Review on Interventions recommendations and Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. RESULTS: Out of 2626 studies screened, 9 were included in the systematic review and 4 studies in the meta-analysis. Outcomes included were postoperative complications, pelvic sepsis and risk of definitive stoma. Considering postoperative complications classified as Clavien-Dindo III, no significant difference existed in the rate of postoperative morbidity between DCAA and ICAA (13% versus 21%; OR 1.17; 95% CI 0.38-3.62; p = 0.78; I2 = 20%). Patients in the DCAA group experienced a lower rate of postoperative pelvic sepsis compared with patients undergoing ICAA with diverting stoma (7% versus 14%; OR 0.37; 95% CI 0.16-0.85; p = 0.02; I2 = 0%). The risk of definitive stoma was comparable between the two groups (2% versus 2% OR 0.77; 95% CI 0.15-3.85; p = 0.75; I2 = 0%). CONCLUSIONS: According to the limited current evidence, DCAA is associated with a significant decrease in pelvic sepsis. Further prospective trials focusing on oncologic and functional outcomes are needed.
Subject(s)
Rectal Neoplasms , Sepsis , Anal Canal/surgery , Anastomosis, Surgical/adverse effects , Anastomotic Leak/etiology , Anastomotic Leak/surgery , Colon/surgery , Humans , Postoperative Complications/etiology , Postoperative Complications/surgery , Rectal Neoplasms/complications , Rectal Neoplasms/surgery , Retrospective Studies , Sepsis/etiology , Treatment OutcomeABSTRACT
INTRODUCTION: Eating and swallowing disorders in children are common and reflected in several symptoms, yet they are not well known. PATIENTS: Three patients are presented to demonstrate the spectrum of the problems, the diagnosis and the multidisciplinary team approach to treatment. DISCUSSION: To enable safe eating and thriving, swallowing and eating disorders need to be recognized and treated, according to the child's development. This can be done by a multidisciplinary team, such as the one at The Edith Wolfson Medical Center.
Subject(s)
Deglutition Disorders/diagnosis , Feeding and Eating Disorders/diagnosis , Child , Deglutition Disorders/therapy , Feeding and Eating Disorders/therapy , Female , Humans , Infant , Male , Patient Care TeamABSTRACT
The present case study describes the successful reduction of aggressive behavior of an adolescent by combining cognitive intervention with operant techniques in order to restore effective family functioning.
