ABSTRACT
Bleeding of parastomal varices is an unusual complication of portal hypertension. We report a case with recurrent parastomal variceal bleeding who had chronic liver disease secondary to autoimmune hepatitis and who had undergone abdominoperineal resection for rectal cancer. She presented four episodes of parastomal variceal bleeding in one month and was successfully treated with combined polidocanol and cyanoacrylate glue.
Subject(s)
Colostomy/adverse effects , Rectal Neoplasms/surgery , Varicose Veins/etiology , Varicose Veins/therapy , Cyanoacrylates/therapeutic use , End Stage Liver Disease/virology , Female , Hepatitis, Autoimmune/complications , Humans , Polidocanol , Polyethylene Glycols/therapeutic use , Recurrence , Tissue Adhesives/therapeutic useABSTRACT
BACKGROUND: Various techniques have been used for the division of mesoappendix, such as endoloops, endoscopic linear cutting staplers, an electrothermal vessel-sealing system (LigaSure), the Harmonic Scalpel, clips, and bipolar coagulation. In the present study, LigaSure and an endoclip were compared in laparoscopic appendectomy (LA). MATERIALS AND METHODS: This study included patients who underwent LA for acute appendicitis at Istanbul University, Cerrahpasa Medical Faculty, Emergency Unit (Istanbul, Turkey) between May 2003 and April 2007. The patients were assigned to two groups according to the mesoappendix dissection device: LigaSure and endoclip groups. The main outcome measures (e.g., operating time, conversion rate, hospital stay, postoperative complications, etc.) were then compared. RESULTS: LA was performed in 280 patients with acute appendicitis. LigaSure and endoclips were used in 127 and 153 patients, respectively. The mean operative times were 41 and 54 minutes in the LigaSure and endoclip groups, respectively. Conversions to open rates were found to be 9.4% (12 patients) in the LigaSure and 11.1% (17 patients) in endoclip groups. No statistically significant differences regarding hospital stay or complications were found, whereas significant differences were observed in surgical time and conversion rate. CONCLUSION: The use of LigaSure facilitates the dissection of mesoappendix and shortens the operation time in LA. We believe that LigaSure is a safe, useful tool for mesoappendix dissection.
