Preliminary functional results after transanal irrigation in patients undergoing SHiP procedure for low rectal cancer.

The short-stump and high-anastomosis pull-through procedure (SHiP) is a newly introduced technique in the treatment of rectal cancer. This procedure does not involve the creation of a diverting ostomy with great improvement of the patients' quality of life in the post-operative period. However, functional post-operative alterations such as low anterior rectal resection syndrome (LARS) may occur. In this context, trans-anal irrigation (TAI) may represent a viable option in the treatment and management of LARS symptoms. The aim of the present study is to investigate the role of TAI in patients operated on SHiP procedure for low rectal cancer. A prospective database of 17 patients who underwent a SHiP procedure was maintained from April 2019 to December 2021. Anal continence and functional outcomes were assessed through LARS score and Cleveland Clinic Incontinence Score (CCIS), respectively. All patients with a LARS score > 21 underwent TAI in the post-operative period. LARS median value was 36 (IQR = 8) and drastically improved after TAI treatment to 3 (IQR = 3), as the CCIS at a mean follow-up of 9 months (SD ± 5.02). Good functional result was reached in 12 out of 13 patients (92%). Our study confirms that patients with severe post-operative dysfunction could benefit from the use of TAI.

Intraluminal migration of a surgical drain. Report of a very rare complication and literature review.

INTRODUCTION: Gastric or intestinal foreign bodies may cause heterogeneous symptoms ranging from asymptomatic conditions to chronic pain and, in some cases, occlusion and/or perforation. There are sporadic reports of intraluminal migration of medical devices. Most commonly they are sponges, hernia meshes, gastrotomy tubes, while surgical drains are very rarely reported. METHODS: A 79 year-old female who consulted our department in May 2009 for abdominal pain and constipation. Her symptomatology started in 2006 some months after an anterior resection for sigmoid diverticulitis associated to obstructed incisional hernia. The symptoms had begun a few months after the operation and were progressively increased month by month. An abdominal CT- scan showed the presence of an intra-peritoneal foreign body and at laparotomy a drain fragment was found inside a small bowel loop and pulled out through a small enterotomy. RESULTS: Post-operative course was regular and the patient was discharged at 7th day. DISCUSSION: The observation of this case and a literature review led us to analyze the origin and the clinical problems of this very rare complication. Incidence, symptomatology, diagnosis and treatment were analysed. CONCLUSIONS: The intraluminal migration of a surgical drain is very rare. The diagnosis is easy by abdominal plan radiogram or CT-scan, but it is casually achieved, because, as it almost always occurs in case of intra-peritoneal foreign bodies, the clinical suspicion is focused on other conditions that most frequently cause abdominal symptoms. When a foreign body is found in intraluminal position and its endoscopic removal is not feasible, then surgery is mandatory and resolutive.

Laparoscopic retrieval of retained intraperitoneal drain in the immediate postoperative period Report of two cases.

AIM: The purpose of this study is to analyze a "rare" complication on the management of abdominal surgical drains: abdominal drainage's retention. Starting from our experience we reviewed literature on this topic MATERIAL OF STUDY: We report two cases (occurred on 2004 and 2010) of retained intraperitoneal drain occurred in the immediate postoperative period after laparoscopic cholecystectomy. RESULTS: Both patients were successfully treated by early laparoscopic removal. DISCUSSION: We compared our experience with literature. Incidence, ethiology, prevention, diagnosis and treatment of this rare complication are analysed. We also considered the guidelines in the placement of intraperitoneal drains, the different fixation techniques, the causes of fragmentation of the drainage and removal techniques. CONCLUSIONS: Retained intraperitoneal drain secondary to fracture and adhesion in the immediate postoperative period is rare but probably underestimated surgical complication. It is impossible to know its real incidence. The role of laparoscopy is emphasized because this approach is cosmetically acceptable, contributes to early recovery and discharge of the patient, and helps to lessen the friction in worsening doctor-patient relationship. KEY WORDS: Abdominal drainage, Drain-related complications, Laparoscopy, Retained intraperitoneal drain.