Surgery for Intestinal Crohn's Disease: Results of a multidisciplinary approach.

OBJECTIVES: Crohn's disease is a chronic inflammatory bowel disease that requires lifelong multidisciplinary management. Seventy percent of patients affected by Crohn's disease will require at least one surgical procedure over their lifetime. The aim of this retrospective study was to present our series of patients suffering from Crohn's disease who were scheduled for surgery by a multidisciplinary team. MATERIAL AND METHODS: The data were retrieved from a review of 950 patients with Crohn's disease treated at our institution between March 2000 and March 2016. Only patients with intestinal Crohn's disease were included into the study. A multidisciplinary team assessed the decision to perform surgery. RESULTS: There were 203 patients who underwent surgery included in this study. One hundred and sixty-six were intestinal and 37 were perianal Crohn's disease. The mean age was 36±11.5 (range, 12-75) years. Ninety-two were stricturing, 45 were fistulizing, and 12 were inflammatory. The most commonly affected site was the ileocecal region (n=109, 65.7%), and the most common surgical procedure was the ileocecal resection (n=109, 65.6%). Laparoscopic approach was the procedure of choice in 56 (33.7%) patients. Of the patients enrolled, the most common early (<30 days) complications observed were the wound infection as the first (n=11) and anastomotic leak as the second (n=10). The mortality rate was 2.4% (n=4). CONCLUSION: Multidisciplinary approach to Crohn's disease may decrease the surgical complications and recurrence rates leading to a better treatment.

Role of robotic approach for management of complicated jejunoileal diverticulosis - video vignette.

Jejunoileal diverticulosis (JID) is a rare condition with a reported incidence lower than 0.1% (1-3). Surgery is the definitive treatment for JID and can be considered to improve the patient's quality of life and to prevent further occurrence of severe symptoms (3, 4, 5). Minimally invasive approach facilitates postoperative recovery, lowers risks and improves outcomes in JID treatment (6). This article is protected by copyright. All rights reserved.

Covered self-expandable metallic stents could be used successfully in the palliation of malignant cervical esophageal strictures: preliminary report.

PURPOSE: To present the authors' preliminary experience with covered self-expandable metallic stents in the palliation of malignant cervical esophageal strictures. METHODS: Covered self-expandable metallic stents were placed into the cervical esophagus of 6 patients with malignant cervical esophageal strictures under fluoroscopic guidance. RESULTS: Stent placement was technically successful in all patients, and the mean dysphagia score decreased from 3.3 to 0.5 according to the Ogilvie Dysphagia Scoring. Two patients complained of chest pain, which lasted for 24 to 48 hours. Foreign body sensation disappeared spontaneously within a week in all patients, but one. Migration, dysphagia, or obstruction was not observed in any of the patients during the follow-up period (47 d to 8 mo). CONCLUSIONS: According to our limited number of cases, placement of covered self-expandable metallic stents into the cervical esophagus can be performed safely, and significant improvement of dysphagia scores and life quality of patients can be obtained instantly after the procedure.

Evaluation of diverting ileostomy in laparoscopic low anterior resection for rectal cancer.

BACKGROUND: Diverting ileostomy is believed to mitigate the effects of anastomotic complications in low anterior resections (LAR) for rectal cancer. However, there are no data about the effects of diverting ileostomy on the outcomes of laparoscopic LAR METHODS: We retrospectively reviewed the medical records of 77 consecutive rectal cancer patients who had undergone laparoscopic LAR with (n = 23) or without (n = 54) diverting ileostomy. The patients' data were recorded and supplemented on short-term follow-up visits and included standard demographics, operative procedure, location of the cancer, and final pathologic diagnosis. We noted length of hospitalisation, complications, and time interval from ileostomy creation to closure. Morbidity and mortality were also included. RESULTS: Surgical intervention requiring anastomotic leakage occurred in three patients who underwent laparoscopic LAR without diverting ileostomy. The anastomosis level of patients who underwent laparoscopic LAR with diverting ileostomy was significantly lower than that of patients who underwent laparoscopic LAR without diverting ileostomy (p < 0.05). CONCLUSION: Anastomosis level and total mesorectal excision are the main factors for creation of diverting ileostomy in laparoscopic LAR Laparoscopic LAR without diverting ileostomy could be selectively performed. Our study provides a basis for further prospective randomised studies on the role of diverting ileostomy in LAR.

Comparison of classical surgery and sutureless repair with DuraSeal or fibrin glue for duodenal perforation in rats.

BACKGROUND: The purpose of the study was to compare classical primary suture repair and sutureless repair with fibrin glue or DuraSeal adhesion barrier for the closure of duodenal perforation in rats. METHODS: Forty adult female Wistar Albino rats weighing between 250-300 g were randomly divided into four equal groups. Primary repair, primary repair and omentoplasty, or application of fibrin glue or DuraSeal adhesion barrier was performed in each of the four groups, respectively. The bursting pressure, tissue hydroxyproline levels and histopathology were evaluated. RESULTS: Bursting pressure values of the primary repair and primary repair and omentoplasty groups were significantly higher than in the fibrin glue and DuraSeal groups (p < 0.001). There were no significant differences between the experimental groups regarding hydroxyproline levels and histological parameters. CONCLUSION: The sutureless methods (Fibrin glue, DuraSeal) have no superior effects when compared with the conventional repair techniques. We observed similar results between the sutureless repair groups; thus, DuraSeal can be considered an alternative to fibrin glue for this purpose. This suggestion must be supported with new studies, however, which would be planned with other wound healing markers and different designs.