Abdominoperineal resection for rectal cancer: is the pelvic drain externalization site an independent risk factor for perineal wound healing?

Aim. The aim of this paper is to investigate if the insertion of the pelvic drainage tube via the perineal wound could be considered as an independent risk factor for perineal healing disorders, after abdominoperineal resection for rectal malignancy. Patients and Methods. The last two decades, 75 patients underwent elective abdominoperineal resection for malignancy. In 42 patients (56%), the pelvic drain catheter was inserted through the perineal wound (PW group), while in the remaining 33 (44%) through a puncture skin wound of the perineum (SW group). Patients' data with respect to age (P = 0.136), stage (P > 0.05), sex (P = 0.188) and comorbidity (P = 0.128) were similar in both groups. 25 patients (PW versus SW: 8 versus 17, P = 0.0026) underwent neoadjuvant radio/chemotherapy. Results. The overall morbidity rate was 36%, but a significant increase was revealed in PW group (52.4% versus 9%, P = 0.0007). In 33.3% of the patients in the PW group, perineal healing was delayed, while in the SW group, no delay was noted. Perineal healing disorders were revealed as the main source of increased morbidity in this group. Conclusion. The insertion of the pelvic drain tube through the perineal wound should be considered as an independent risk factor predisposing to perineal healing disorders.

Selective embolization for massive upper gastrointestinal bleeding deriving from gastric angiodysplasia.

Transcatheter arterial embolization is a valuable, minimally invasive method, used as treatment for upper gastrointestinal bleeding, after failed primary endoscopic approach. It is a safe and effective procedure, but it's use is limited because of relatively high rates of rebleeding and mortality. The aim of this paper is to present a case of severe, massive upper gastrointestinal bleeding deriving from gastric angiodysplasia, which was treated successfully with superselective embolization. The patient recovered from the haemorrhagic shock and avoided emergency surgical intervention.

Intraperitoneally administered irinotecan with 5-fluorouracil impair wound healing of colonic anastomoses in a rat model: an experimental study.

AIM: The aim of this experimental study is the assessment of the effects of the immediate post-operative intraperitoneal administration of 5-fluorouracil and irinotecan on the healing process of large bowel anastomoses in rats. MATERIALS AND METHODS: Sixty male Wistar rats were divided into 4 groups of 15 rats each. The rats underwent large bowel resection and anastomosis, followed by the intraperitoneal administration of normal saline (group 1), 5-fluorouracil (group 2), irinotecan (group 3) or the combination of 5-fluorouracil and irinotecan (group 4). All animals were killed on the eighth post-operative day. During post-mortem examination, the anastomoses were assessed macroscopically for a possible anastomotic leak and the extent of adhesion formation. Subsequently, the anastomotic bursting pressure was measured, and the anastomoses were assessed histologically. RESULTS: No anastomotic dehiscence was observed in the rats of group 1. In groups 2 and 3, we observed 3 anastomotic leaks in each group, and in group 4, we observed 5 leaks (P = 0.111). The mean bursting pressure of the anastomoses in group 1 was significantly higher compared to groups 2, 3 and 4 (P < 0.001). The least inflammatory cell infiltration score was observed in group 1 (P < 0.001). The lowest neoangiogenesis score was observed in group 2 and the highest in group 4. The collagen formation in group 1 was significantly higher compared to the other 3 groups (P < 0.001). Similar results were observed for the fibroblast activity, where group 1 revealed significantly higher fibroblast scores compared to groups 2, 3 and 4 (P < 0.001). Finally, groups 2, 3 and 4 showed significantly lower hydroxyproline levels compared to the control group (P < 0.001). CONCLUSION: The immediate, post-operative intraperitoneal administration of 5-fluorouracil or irinotecan had a negative effect on the healing process of the large bowel anastomoses in rats. The negative effects of the combination of 5-fluorouracil and irinotecan were statistically more significant compared to the single use of 5-fluorouracil or irinotecan.

Laparoscopic colectomy for colonic carcinoma.

AIM: The aim of this study is to present our experience with the laparoscopic treatment approach for colonic carcinoma. PATIENTS AND METHODS: Between 2005 and 2010, laparoscopic colectomy was performed in 13 patients; 9 patients underwent laparoscopic right hemicolectomy, 3 sigmoidectomy and 1 patient underwent laparoscopic caecectomy. RESULTS: With regards to the right hemicolectomies, the average operative time was 168 min and the average hospital stay 5.3 days. In patients who underwent laparoscopic sigmoidectomy, the average operative time was 176 min, while the average hospital stay was 10.2 days. Finally, the laparoscopic caecectomy was performed in 85 min. There was one conversion (7.7%) to an open procedure, as well as one case (7.7%) of anastomotic leakage, which was treated with re-laparotomy and a Hartmann's procedure. Up to today, all patients remain healthy with no signs of tumor recurrence. CONCLUSION: Laparoscopic colectomy for cancer, in the hands of an experienced laparoscopic surgeon, is a safe and efficient procedure.

Colonic lipomas: our experience in diagnosis and treatment.

AIM: The aim of this study is to present our experience in colonic lipomas. PATIENTS AND METHODS: We present 4 patients (1 male, 3 females) of mean age 65.5 years (range, 61-72 years) treated for single colonic lipomas. The diameters of the lesions were 4.5, 4, 3.5 and 2.5 cm, respectively. In 3 cases, colonic lipomas were located within the cecum, while in one patient within the descending colon, proximally to the splenic flexure. RESULTS: Lipomas of diameter greater than 3 cm caused nonspecific symptoms. Lipomas of higher diameter were removed laparoscopically with colotomy; in two cases, the patients underwent open hemicolectomy, because of the suspicion of malignancy, while the smallest lesion was resected endoscopically, using a bipolar snare. All patients recovered without complications and remain healthy with no signs of recurrence. CONCLUSION: In cases of ulcerated lipomas, greater than 3 cm of diameter, surgical resection is recommended.

The effects of the intraperitoneal administration of oxaliplatin and 5-FU on the healing of colonic anastomoses: an experimental study.

BACKGROUND: The purpose of this experimental study was to assess the effects of the immediate postoperative intraperitoneal administration of oxaliplatin and 5-FU on the healing of colonic anastomoses in rats. METHODS: Sixty rats were randomized into 4 groups of 15 rats each and were subjected to colonic anastomoses. To the 1st group, saline solution was administered immediately postoperatively, intraperitoneally. To the 2nd group, 5-FU was administered, to the 3rd group oxaliplatin and to the 4th group 5-FU and oxaliplatin were administered immediately postoperatively, intraperitoneally. After killing the rats on the 8th postoperative day, the anastomoses were examined macroscopically and the anastomotic bursting pressures were measured. The anastomoses were also examined histologically and the hydroxyproline contents were determined. RESULTS: Rupture of the anastomosis was observed in no rats of the 1st group, in 3 rats of the 2nd group, in 4 rats of the 3rd group and in 7 rats of the 4th group (P = 0.016). The bursting pressure (P < 0.001), the hydroxyproline content (P < 0.001) and the concentration of collagen (P < 0.001) and fibroblasts (P < 0.001) were significantly lower in the 2nd, 3rd and 4th group in comparison with the 1st group. The formation of adhesions and the leukocytosis on the anastomoses were significantly higher in the 2nd, 3rd and 4th group than in the 1st group (P < 0.001). CONCLUSIONS: The immediate postoperative, intraperitoneal administration of oxaliplatin, 5-FU or the combination of 5-FU and oxaliplatin impairs the healing of colonic anastomoses in rats.

The effects of iloprost on colonic anastomotic healing in rats.

PURPOSE: The purpose of this experimental study is to investigate the effects of iloprost on colonic anastomotic healing in rats, after intraperitoneal administration. METHODS: Forty male Albino-Wistar rats were randomized into two groups of twenty animals each. They all underwent colonic resection followed by an inverted anastomosis. The rats of Group A (control) received 3 ml of NaCl intraperitoneally, while those of Group B (iloprost) received iloprost (2 µg/kg body weight), immediately postoperatively and daily until killed. Each group was further divided into two equal subgroups, depending on the day of killing. The animals of subgroups 1 were killed on the fourth postoperative day, while those of subgroups 2 on the eighth. Macroscopical and histological assessments were performed. Besides, anastomotic bursting pressures and the tissue concentrations in hydroxyproline and collagenase I were also evaluated. RESULTS: No anastomotic dehiscence was noted. The mean bursting pressure was higher in the iloprost group compared with the control group, but a significant difference was revealed only on the fourth postoperative day. Furthermore, iloprost significantly increased the new vessel formation on the fourth, as well as on the eighth postoperative day. CONCLUSION: Iloprost enhances the early phase of colonic anastomotic healing in rats.

[Hiatoplasty reinforcement by means of a lightweight titanized polypropylene mesh fixed with fibrin glue]. / Verstärkung der Hiatoplastik durch ein leichtgewichtiges titanisiertes Polypropylennetz mit Fixierung durch Fibrinklebung.

INTRODUCTION: Suture-based hiatoplasty is associated with a high recurrence rate. Using meshes of different shapes and materials to reinforce these sutures reduces the risk of recurrences. On the other hand morbidity attributable to the suture and tack fixation of these meshes has been observed during the development phase of these techniques. Moreover, there are some experimental and clinical data about mesh migration into the oesophageus. For this reason we analysed the outcome of our patients who underwent a mesh-reinforced hiatoplasty with a lightweight titanised polypropylene mesh fixed by fibrin glue. PATIENTS AND METHODS: All the patients who under-went a mesh-reinforcement between 3 / 2006 and 12 / 2007 were collected retrospectively. The hiatoplasty was reinforced by means of a lightweight titanised polypropylene mesh that had been designed especially for that purpose (TiSure®, GfE). Mesh fixation was performed with 2  mL of fibrin glue (Tissucol®, Baxter). Postoperative data were elucidated for all patients via their general practitioner or by interviewing the patients by telephone using a dedicated questionnaire. RESULTS: 26  patients with a median age of 58  years and a median BMI of 27.5 kg / m² underwent laparoscopic mesh-reinforced hiatoplasty. There were 15  axial and 11  paraoesophageal hernias, in 5  cases with upside-down stomach and in 4  cases recurrent hernias. 15  patients underwent an additional dorsal 270°-fundoplication, the remaining 11 patients had a fundophrenicopexy, with conversion taking place in 2  cases. The median follow-up was 34.3  months. 3  patients suffered from dysphagia, 1  of them had to be re-operated and has been free of symptoms since then. 2  patients suffered from mild gastrooesophageal reflux which was treated conservatively. So far no mesh migration and no recurrences have been seen. CONCLUSIONS: Despite the short observation time, this study indicates the patients are not exposed to any danger by the lightweight titanised polypropylene mesh. Moreover, the mesh appears to enhance hiatorrhaphy safety even in the presence of extensive hiatal hernias as well as in the case of an upside-down stomach.

Laparoscopic sigmoidectomy for colon cancer.

The aim of this study is to report our experience with laparoscopic sigmoidectomy due to cancer. Between 2007 and 2009, laparoscopic sigmoidectomy for cancer was performed in 3 patients. The average operative time was 176 min. The average hospital stay was 10.2 days. There was one anastomotic leak. The patient was subjected to laparotomy and a Hartmann's procedure and drainage of the peritoneal cavity was performed. In conclusion, laparoscopic sigmoidectomy for cancer is a safe and efficient procedure.

Anastomotic leakage following low anterior resection for rectal cancer.

AIM: Aim of this study is to present the incidence of anastomotic leakage after anterior resection for rectal cancer and to demonstrate the therapeutic approach for the treatment of this complication. PATIENTS AND METHODS: Between 1990 and 2009, 170 patients underwent low anterior resection with total mesorectal excision (TME). RESULTS: A total of 14 (8.2%) anastomotic leaks were confirmed. Reoperation was carried out in six patients with major leaks. Eight patients with minor leaks were treated conservatively by nutritional support and antibiotic therapy. CONCLUSION: The incidence of anastomotic leakage after anterior resection of the rectum for rectal cancer is relatively low.

Progress in rectal cancer staging and treatment.

Colorectal cancer poses a worldwide major health issue. Rectal cancer has somewhat distanced itself from colonic cancer as a different oncologic entity, due to differences in diagnosis and treatment. Several developments over the last years have improved screening, diagnostics, pre-operative therapy, surgical techniques and postoperative patient care. The multidisciplinary approach to rectal cancer, mainly through the co-operation of surgeons, oncologists and radiologists, seems to be one of the most important steps in the management of that disease.

Defunctioning ileostomy closure following low anterior resection by chemotherapy.

AIM: The aim of this study is to review the time between formation and closure of loop ileostomies following total mesorectal excision in patients with rectal cancer. PATIENTS AND METHODS: A retrospective study of 170 patients who underwent low anterior resection for rectal cancer, between 1990 and 2009. Loop ileostomies were created in 8 patients. RESULTS: Of the 8 patients with defunctioning loop ileostomies, 4 received adjuvant chemo-radiotherapy, 3 received neo-adjuvant chemo-radiotherapy and 1 did not receive anything. There was 12.5% morbidity. The time from formation to closure for the patient with no adjuvant therapy was 3 months and for those with adjuvant therapy was 7 months. This was a significant delay. CONCLUSION: Time between formation and closure of loop ileostomy following anterior resection of rectum is significantly delayed by adjuvant chemotherapy.

Brain metastases in colorectal cancer.

AIM: The aim of this study is the presentation of brain secondaries associated with colorectal cancer. PATIENTS AND METHODS: In the period between 1990 and 2009, 670 patients with colorectal cancer were treated. RESULTS: From 670 patients, 5 patients were identified with brain metastases. The incidence was 0.73%. The median interval between the colorectal cancer and the development of the brain secondaries was 7.5 months. Median survival after the diagnosis of brain metastases was 4.3 months. CONCLUSION: Brain metastases associated with colorectal cancer are relatively rare, but also a frequent cause of death.

Large bowel obstruction due to endometriosis.

We report on three cases of premenopausal female patients with large bowel endometriosis causing intermittent obstruction.

Circumferential stapled procedure for bleeding ano-rectal varices.

AIM: Aim of this study is to demonstrate that the circumferential stapled procedure for rectal varices is a feasible and suitable method of controlling bleeding varices. PATIENTS: Between 2004 and December 2007, four patients underwent the procedure as an emergency, with the intention of controlling haemorrhage. RESULTS: Four patients underwent this procedure, with successful control of bleeding achieved in all. No further rebleeding was observed in the follow-up period. CONCLUSION: The stapled disruption of bleeding rectal varices in patients with portal hypertension seems a very useful and effective procedure.

Metachronous colorectal cancer.

AIM: In this study, we present our patients with metachronous colorectal cancer. PATIENTS AND METHODS: In the period between 1990 and 2009, 670 patients with colorectal cancer were treated. RESULTS: Metachronous cancer was developed in 4 (0.6%) patients. The time interval between index and metachronous cancer was 28 months to 22 years (mean 146 months). CONCLUSION: Metachronous colorectal cancer is a potential risk that proves the necessity of postoperative colonoscopic control of all patients with colorectal cancer.

Anastomotic leakage after colonic resection.

The aim of this study is to present the diagnosis and management of anastomotic leakage after colon resection. Early diagnosis and urgent therapeutic intervention are required in order to avert life-threatening conditions that may be caused by anastomotic leakage. Minor leaks can be managed conservatively with successful outcomes. Major leaks should be managed operatively. In conclusion, leakage of colonic anastomosis remains the most serious complication after colon resection.

Laparoscopic right hemicolectomy due to colon cancer.

AIM: The aim of this study is to present our patients with laparoscopic right hemicolectomy due to cancer. PATIENTS AND METHODS: Between 2005 and 2009, laparoscopic right hemicolectomy for cancer was performed in 9 patients. RESULTS: The average operative time was 168 min. The average hospital stay was 5.3 days. There was one conversion (11.1%) to an open procedure. There were no postoperative complications. All the patients remain so far with no signs of tumor recurrence. CONCLUSION: Laparoscopic right hemicolectomy for cancer in the hands of an experienced laparoscopic surgeon is a safe and efficient procedure.