"Dog ear" formation after double-stapled low anterior resection as a risk factor for anastomotic disruption.

PURPOSE: The aim of this study was to investigate the possible deleterious effect of the lateral intersecting margins (so-called dog ears) on anastomotic disruption after experimentally performed double-stapled anastomoses. METHODS: Two groups of double-stapled side-to-end anastomoses were performed using pig small intestines. Group A consisted of 35 circular anastomoses and Group B of 32 double-stapled anastomoses with a bilateral dog ear. In both groups bursting pressures were tested using a water-filled, pressure-controlled automatic pumping system (Hamou Endomat), and special attention was paid to the location(s) in the anastomoses were the disruption(s) occurred. RESULTS: In Group A bursting pressures were significantly higher than in Group B (median pressure, 90 vs. 60 mmHg; P < 0.001, Mann-Whitney U test). Remarkably, in Group B in 13 cases (42 percent) the first disruption occurred at the corner of a dog ear. CONCLUSIONS: We conclude that the lateral intersections of double-stapled anastomoses are a structural weak spot and that the currently most often applied double-stapled anastomosis is a less effective type of anastomosis than a complete circular one. Resolving this technical problem might help to reduce the number of anastomotic disruptions after low anterior resections.

Complications and management of Meckel's diverticulum--a review.

OBJECTIVE: To review the anatomy, symptomatology, diagnosis, complications and management of symptomatic and asymptomatic Meckel's diverticula. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 27 consecutive patients who underwent resection of a Meckel's diverticulum during the 16 year period 1 January 1981-31 August 1997. MAIN OUTCOME MEASURES: The symptomatology and histopathological findings. RESULTS: 15 patients had symptoms and 12 did not. Haemorrhage and inflammation were the most common presenting symptoms. All histopathological signs of inflammation were found in those with symptomatic diverticula. Resected asymptomatic Meckel's diverticula were abnormal in only two occasions: one contained an adenocarcinoma and one a faecolith. CONCLUSION: All symptomatic Meckel's diverticula should be resected. The surgical treatment of asymptomatic Meckel's diverticula is still controversial.

Factors related to outcome after pneumonectomy: retrospective study of 62 patients.

OBJECTIVE: To find out which risk factors affect outcome after pneumonectomy. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 62 patients who were treated for bronchial cancer by pneumonectomy between 1984 and 1995. MAIN OUTCOME MEASURE: Hospital mortality and postoperative complications. RESULTS: Hospital mortality increased with age, being 5/51 (10%) in the 40-69 age group and 4/11 (36%) in patients aged 70 or more. In the American Society of Anesthesiologists (ASA) class I group hospital mortality was 8% (2/26), in class II 12% (3/26) and in class III 40% (4/10). Hospital mortality was highest when the FEV1:FVC-ratio was below 55%. Cardiac arrhythmias developed in 8 (13%), early bronchopleural fistulas in 7 (11%), and postpneumonectomy syndrome in 5 (8%). These major complications had a high mortality. CONCLUSION: Respiratory function, ASA class, and age over 70 years are the main prognostic factors for hospital morbidity and mortality after pneumonectomy.

The impact of 5-FU-based bolus chemotherapy on survival in patients with advanced colorectal cancer.

BACKGROUND: An analysis was performed to evaluate whether bolus chemotherapy with 5-fluorouracil (5-FU) and leucovorin (LV) improves survival for patients with advanced colorectal cancer (ACC). PATIENTS AND METHODS: Two groups of patients were selected from a database which included all patients with colorectal cancer treated in our hospital since 1984. The first group consisted of all patients with irresectable metastases diagnosed between January 1984 and December 1989, who had a performance status of 0 or 1, and were younger than 76 years old. The second group consisted of all patients with irresectable metastases--younger than 76 years old and with a performance status of 0 or 1--who were started on chemotherapy between January 1994 and December 1997. In the first period chemotherapy was never given and in the second period chemotherapy was given to all motivated patients. None of the patients had received a previous metastasectomy or isolated liver perfusion. For chemotherapy, age, location of the metastases, type of surgical intervention for the primary tumor, Hemoglobin, Lactate Dehydrogenase and Carcinoembryonic Antigen concentration we evaluated the relationship with survival. Variables which showed a significant relation with survival in the univariant analysis (logrank test, p < 0.05) were entered into a proportional hazards regression analysis. RESULTS: In the univariant analysis chemotherapy and location of metastases showed a significant relation with survival. The median survival was 11 months for patients who had received chemotherapy and 8 months for untreated patients (p = 0.009). Chemotherapy and location of metastases both retained their significance in a proportional hazards regression analysis. CONCLUSION: In our study group chemotherapy added 3 months to the median life expectancy for patients with ACC.

[Medium-long-term good results of vertical gastroplasty in the treatment of morbid obesity]. / Goede resultaten op middellange termijn van verticale maagverdeling ter behandeling van overmatige vetzucht.

To determine the long-term results of the surgical treatment of patients with morbid obesity, a retrospective analysis of the patients in whom a vertical banded gastroplasty according to Mason was performed in the period 1982-1990 was carried out in the department of General Surgery, St. Joseph Hospital, Veldhoven, the Netherlands. In a series of 20 patients (4 men and 16 women) with a mean age of 32 (17-53) years who were eligible for treatment according to international criteria surgery was performed. The preoperative weight averaged 124 (94-207) kg and the mean preoperative excess weight was 60 (37-132) kg. Immediate postoperative complications occurred in 5 and late complications in 7 patients. Revision for technical complications was necessary in 2 patients. Twelve patients were followed up for more than 4 years. The mean weight loss after 4 years was 37 (18-89) kg, which was 28 (18-43) per cent of the mean preoperative weight and 62 (31-89) per cent of the mean preoperative excess weight. The 4-year results were unsatisfactory (less than 50 percent excess weight loss) in 3 of the 12 patients. It is concluded that vertical banded gastroplasty in our hands seems a relatively safe and effective surgical method of achieving sustained weight loss in most patients.

Abdominal pain as a first symptom of iliac vein thrombosis.

Two patients are described with abdominal pain as a first symptom of primary iliac vein thrombosis. This phenomenon can be regarded to be analogous to the calf tenderness when thrombosis arises from the venous sinusoids in the calf muscles which is the usual localisation. When one is aware of this clinical entity, thrombotic occlusion will be recognized as the cause of the complaints, instead of being regarded to be a complication of another, yet unknown disease.