Subject(s)
Rectal Neoplasms/pathology , Rectal Neoplasms/therapy , Accreditation/organization & administration , Digestive System Surgical Procedures/methods , Humans , Magnetic Resonance Imaging , Minimally Invasive Surgical Procedures/methods , Neoadjuvant Therapy , Neoplasm Staging , Quality Improvement/organization & administration , Rectal Neoplasms/diagnostic imagingABSTRACT
Patients presenting with near-obstructing colon lesions requiring segmental colectomy may benefit from intraoperative colonoscopy (IOC) after primary anastomosis for a more timely and accurate diagnosis of synchronous lesions. The aim of this study is to demonstrate the feasibility and safety of this technique. A retrospective cohort study of patients undergoing single-stage segmental colectomy and anastomosis at a single tertiary care institution from 2011 to 2013 was performed. One Hundred and sixty-eight consecutive patients underwent segmental colectomy and primary anastomosis of which 78 (46%) were unable to receive preoperative colonoscopy (POC) because of near-obstructing lesions and received IOC after the anastomosis. IOC detected synchronous adenomatous polyps in 24.4 per cent, diverticular disease in 19 per cent, and colitis/proctitis in 2.5 per cent. The IOC group was not significantly different from the POC group with regard to overall morbidity (31% vs 39% P = 0.45), anastomotic leakage (1.3% vs 0%, P = 0.46), or wound infection (5.1% vs 1.1%, P = 0.18). Operation time was 19 minutes longer in the intraoperative group, but overall length of hospital stay was not significantly different (6.4 ± 2.9 days vs 7.3 ± 4.6 days). In patients unable to receive POC because of partial obstruction, IOC after primary anastomosis is both feasible and safe for detecting proximal synchronous lesions.
Subject(s)
Colectomy , Colonoscopy , Intraoperative Care , Laparoscopy , Adenomatous Polyps/complications , Adenomatous Polyps/surgery , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical/methods , Colectomy/methods , Colitis/surgery , Colonic Neoplasms/surgery , Colonoscopy/methods , Colorectal Neoplasms/surgery , Feasibility Studies , Female , Hospitals, University , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intraoperative Care/methods , Length of Stay , Male , Middle Aged , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment OutcomeSubject(s)
Biomedical Enhancement , General Surgery , Humans , Imaging, Three-Dimensional , United StatesABSTRACT
A 57-year-old woman presented with a 1-week history of left lower quadrant pain and nausea and vomiting. Computed tomography without contrast demonstrated a left 2.3-cm calculus at the ureteropelvic junction and a 6-mm lower pole calculus. The kidneys were in the pelvis and oriented "back-to-back," with the lateral portions of the kidneys fused in the midline. To our knowledge, this is the first description of this renal fusion anomaly. The patient underwent robotic pyelolithotomy of the ureteropelvic junction calculus and subsequent flexible ureteroscopic laser lithotripsy of the lower pole calculus and ureteral stent placement through the assistant working port.
