ABSTRACT
BACKGROUND: Double barrelled uro-colostomy (DBUC) is an alternative to traditional ileal conduit (IC) and separate colostomy in patients requiring simultaneous urinary and faecal diversion for reconstruction in pelvic exenteration surgery (PES). METHODS: This cohort study evaluated short- and long-term morbidity and mortality associated with DBUC formation in 20 consecutive adult patients undergoing PES in an Australian Complex Pelvic Surgical Unit. Data were obtained from a prospective database. RESULTS: Mean age 59 years (range 27-76 years). PES was performed for malignant disease in 18 patients (curative intent in 17). Mean operative duration 11.8 h (range 7-17 h). Mean follow-up duration 29.1 months (range 2.6-90.1 months). Early DBUC-related complications occurred in four patients (20.0%): urinary tract infection (UTI)/urosepsis (n = 4) and early ureteric stenosis requiring intervention (n = 1). Late DBUC-related complications occurred in five patients (25.0%): recurrent UTI/urosepsis (n = 4), chronic kidney disease (n = 4), ureteric stenosis (n = 2) and parastomal hernia (n = 4). No mortality occurred secondary to a DBUC complication. CONCLUSION: DBUC is a safe reconstructive option with acceptable morbidity profile in patients requiring simultaneous urinary and faecal diversion.
Subject(s)
Colostomy , Pelvic Exenteration , Postoperative Complications , Urinary Diversion , Humans , Pelvic Exenteration/methods , Pelvic Exenteration/adverse effects , Middle Aged , Aged , Male , Female , Adult , Urinary Diversion/methods , Colostomy/methods , Colostomy/adverse effects , Postoperative Complications/epidemiology , Cohort Studies , Treatment Outcome , Australia/epidemiology , Follow-Up StudiesSubject(s)
Cysts , Hamartoma , Rectal Diseases , Humans , Rectal Diseases/diagnosis , Rectal Diseases/surgery , Cysts/diagnostic imaging , Cysts/surgeryABSTRACT
The surgical treatment of occlusive acute mesenteric ischemia (AMI) without revascularization is associated with an 80% overall mortality. Early diagnosis is crucial, and revascularization may reduce overall mortality in AMI by up to 50%. A diagnosis of AMI requires a high index of clinical suspicion and the collaborative effort of emergency department physicians, general and vascular surgeons, and radiologists. This article provides an overview of the etiology, physiology, evaluation, and management of acute mesenteric ischemia.
Subject(s)
Diverticulitis, Colonic , Diverticulitis , Intestinal Perforation , Sigmoid Diseases , Abscess/diagnostic imaging , Abscess/etiology , Colon, Sigmoid/surgery , Diverticulitis/complications , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/surgery , Humans , Intestinal Perforation/diagnosis , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Leg , Retroperitoneal Space , Sigmoid Diseases/diagnosis , Sigmoid Diseases/etiology , Sigmoid Diseases/surgeryABSTRACT
BACKGROUND: Despite advantages associated with laparoscopic colorectal surgery, there is significant morbidity associated with incisions required for specimen extraction and restoration of bowel continuity. In laparoscopic colorectal surgery, the length of the longest incision depends upon that required to facilitate extra-corporeal steps. The purpose of this study was to analyse obese patients (body mass index >30 kg/m2 ) who have undergone laparoscopic small bowel or right-sided colonic resection with intracorporeal anastomosis (ICA) and natural orifice surgery extraction (NOSE)/minimal extraction site (MES) surgery. METHODS: A retrospective review of 11 obese patients who have undergone laparoscopic small bowel and right-sided colonic resection with ICA and NOSE/MES was conducted. RESULTS: Mean body mass index was 40.4 kg/m2 (range 32.7-56 kg/m2 ) in 11 patients. Procedures performed were laparoscopic right hemicolectomy (7) - one with high anterior resection, pelvic peritonectomy, bilateral salpingo-oophorectomy and greater omentectomy, small bowel resection (2), transverse colotomy (1) and segmental transverse colectomy (1). All colonic specimens were extracted via NOSE (vaginal colpotomy or transcolonic), except two requiring a miniaturized extraction wound. Small bowel specimens were extracted via a 12-mm port hole, without extension. Mean operating time was 240 min (range 100-510 min). Mean time to discharge was 4 days (range 4-6 days). Complications included a superficial wound infection in a patient presenting with an obstructed tumour and a second patient developed a seroma following small bowel resection for an incarcerated hernia. CONCLUSION: Obese patients can undergo laparoscopic small bowel and right-sided colonic resection with ICA and NOSE/MES surgery and benefit from short length of stay and low morbidity.
