ABSTRACT
BACKGROUND: The control of body waste emptying is a constant research topic in stoma care. The aim of this pilot study was to assess the efficacy and safety of an innovative colostomy appliance. METHODS: An interventional prospective non-comparative pilot study was conducted in seven French centers. The study device is a new type of two-piece appliance including a base plate and a "capsule cap" (CC) composed of a capsule cover and a folded collecting bag. The device gently seals the stoma to provide stoma output control. When the bowel movement pressure increases the patient may control the deployment of the folded bag and collect stools. Patients with left-sided colostomy all using a flat appliance, were enrolled in a 2-week trial. Outcome measures were type of CC removal and peristomal fecal leaks while wearing the device. RESULTS: Of 30 patients (females 66.7%), with left-sided colostomy (permanent 76.7%), 23 (76.7%) completed the 2-week trial. A total of 472 CC changes were analyzed. EFFICACY: of 404 (85.5%) CC changes reported in diaries, 302 (74.8%) were linked with stool and/or gas. In 244 (60.3%) changes, the patient controlled stoma bag deployment and it occurred with bowel emptying 301 (74.5%) times. No leaks around the appliance were observed in 400 (85.3%) changes. SAFETY: no serious adverse event occurred. Peristomal skin was not modified during the trial. CONCLUSIONS: In the short term this new device has provided an increased control over bowel emptying at no risk in half of the trial population suggesting that an alternative approach to bag wearing is achievable.
Subject(s)
Colonic Pouches , Colostomy/instrumentation , Surgical Stomas , Aged , Defecation , Female , France , Humans , Male , Middle Aged , Pilot Projects , Prospective Studies , Treatment OutcomeABSTRACT
Although many options are available for the management of perineal wounds after abdominoperineal resection, ranging from direct closure to flap reconstruction, treatment remains challenging. A better understanding of the aims, drawbacks and progress in perineal wound management after abdominoperineal rectal resection can help the surgeon make better choices for each patient, but it is very difficult to propose a single, optimal, evidence-based procedure for the management of pelvic exenteration. Recent progress provided by the extralevator abdominoperineal resection technique and perforator flap concepts have changed our conception of reconstruction leading to the different technical options highlighted in this review.
Subject(s)
Perineum/surgery , Plastic Surgery Procedures/methods , Surgical Flaps , Wound Closure Techniques , Anal Canal/surgery , Colon, Sigmoid/surgery , Humans , Laparoscopy , Plastic Surgery Procedures/instrumentation , Rectum/surgery , Surgical Mesh , Wound Closure Techniques/instrumentationSubject(s)
Gastrectomy/methods , Laparoscopy/methods , Obesity, Morbid/surgery , Anastomotic Leak/etiology , Avitaminosis/etiology , Body Mass Index , Gastrectomy/adverse effects , Gastrectomy/mortality , Gastric Dilatation/etiology , Gastroesophageal Reflux/etiology , Humans , Laparoscopy/adverse effects , Laparoscopy/mortality , Postoperative Hemorrhage/etiology , Quality of Life , Treatment Outcome , Weight LossABSTRACT
Lower gastrointestinal bleeding from a primary aortoduodenal fistula is unusual and usually fatal. Postoperative aortoduodenal fistula after biliary surgery is a very rare complication. We report hence a 69-year-old female patient who underwent a main bile duct resection with extended paraaortic lymphadenectomy for a cholangiocarcinoma. Acute melena with hemoglobin drop occurred on postoperative day 24. Initial CT-scan showed an aortic pseudoaneurysm with aortoduodenal fistula. An aortic endoprosthesis with endoscopic drainage of periaortic collections allowed successful treatment.
Subject(s)
Aortic Diseases/etiology , Aortic Diseases/therapy , Bile Ducts, Intrahepatic , Blood Vessel Prosthesis , Duodenal Diseases/etiology , Intestinal Fistula/etiology , Lymph Node Excision/adverse effects , Vascular Fistula/etiology , Vascular Fistula/therapy , Aged , Aorta, Abdominal , Bile Duct Neoplasms/surgery , Cholangiocarcinoma/surgery , Female , HumansABSTRACT
Esophageal perforation during nasogastric tube insertion is a very unusual occurrence. In this case report, radiologic images revealed a right-sided aortic arch with a right-sided thoracic aorta. This anatomical anomaly probably contributed to the complication and necessitated a modified approach to the surgical repair.
Subject(s)
Aorta, Thoracic/anatomy & histology , Esophageal Perforation/etiology , Intubation, Gastrointestinal/adverse effects , Aged , Endoscopy , Esophageal Perforation/surgery , Esophagectomy , Female , Humans , Hydropneumothorax/diagnostic imaging , Imaging, Three-Dimensional , Radiography, ThoracicABSTRACT
Esophageal perforation during nasogastric tube insertion is a very unusual occurrence. In this case report, radiologic images revealed a right-sided aortic arch with a right-sided thoracic aorta. This anatomical anomaly probably contributed to the complication and necessitated a modified approach to the surgical repair.
