ABSTRACT
Transstomal stent deployment to maintain the patency of stoma in a challenging patient who developed stoma stenosis, is a minimal invasive, novel technique. This is a new and alternative approach in management of stoma stenosis in a difficult case using a biodegradable stent for end colostomy.
ABSTRACT
BACKGROUND: Controversy exists regarding the role of laparoscopy in the evaluation of patients with penetrating abdominal trauma (PAT). Our objective was to perform a comprehensive review of the literature and conduct a meta-analysis to compare outcomes of laparoscopy and laparotomy in PAT. METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the Cochrane Central Register of Controlled Trials (CENTRAL); the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Missed injury, mortality, and complications were defined as the primary outcome parameters. Procedure time, length of hospital stay, sensitivity and specificity of the procedure were the secondary outcomes. Combined overall effect sizes were calculated using fixed-effect or random-effects models. RESULTS: We identified one randomised controlled trial (RCT) and 8 observational studies comparing outcomes of laparoscopy with laparotomy in PAT. Laparoscopy was associated with a significantly lower risk of wound infection (Odd ratio (OR): 0.55; 95% Confidence interval (CI), 0.37-0.81, P = 0.003) and pneumonia (OR: 0.22; 95% CI, 0.13-0.37, P < 0.00001), and a significantly shorter length of hospital stay (Mean difference (MD): -3.05; 95% CI, -4.68 to -1.42, P = 0.0002) and procedure time (MD: -27.99; 95% CI, -43.17 to -12.80, P = 0.0003) compared with laparotomy. Laparoscopy was 100% sensitive in most of the included studies and avoided non-therapeutic laparotomies in 45.6% of patients. CONCLUSIONS: Our analysis of best available evidence mainly from heterogeneous observational studies has demonstrated that laparoscopic evaluation of haemodynamically stable patients with PAT may be safe and can reduce post-operative complications and length of hospital stay. The most important advantage of laparoscopy is avoidance of non-therapeutic laparotomies which are associated with considerable morbidity. However, no definitive conclusion can be made regarding the therapeutic role of laparoscopy in PAT based on the available evidence and future research is indeed required.
Subject(s)
Abdominal Injuries/surgery , Laparoscopy/methods , Laparotomy/methods , Postoperative Complications/etiology , Wounds, Penetrating/surgery , Humans , Length of Stay , Observational Studies as Topic , Randomized Controlled Trials as TopicABSTRACT
Gastric perforation secondary to metastasis from breast cancer occurs infrequently. We present the case of a 72-year-old postmenopausal female patient with a known history of lobular carcinoma of the breast who presented to a district general hospital with a clinical diagnosis of an acute abdomen. Further contrast-enhanced CT scan demonstrated free gas and fluid in the abdomen. She underwent emergency exploratory laparotomy and onlay Graham's omentopexy patch due to 1×1â cm prepyloric gastric perforation. Final histopathology proved the presence of metastatic malignant cells in the breast origin. We discuss the issues involved in postoperative investigation and management.
