Subject(s)
Fecal Incontinence/etiology , Fecal Incontinence/surgery , Perineum/injuries , Perineum/surgery , Rectum/injuries , Rectum/surgery , Humans , Male , Middle AgedABSTRACT
OBJECTIVE: To evaluate short-term outcomes after construction of synchronous colonic anastomoses without fecal diversion. METHOD: Using a prospective procedural database, all adult general surgery patients who underwent two synchronous segmental colon resections and anastomoses without ostomy at our institution from 1992-2007 were identified. Demographics, operative techniques, and 30-day outcomes are reported. Results are number (percent) of patients or median (interquartile range). RESULTS: Over 15 years, 69 patients underwent double colonic anastomoses [40 males, age 63 (45-76) years, BMI 25.3 (22.9-28.7) kg/m(2)]. Multiple colonic anastomoses were performed in one of every 201 colectomies during the study period (0.5%). The operation was an emergency in two (3%) cases; most cases were clean-contaminated 56 (81%). Ten (17%) cases were laparoscopic-assisted with a 44% conversion rate. Length of stay was seven (5-10) days. Overall 30-day morbidity was 36% including nine (13%) surgical site infections, two (2.9%) intra-abdominal abscesses requiring percutaneous drainage, and one (1.4%) wound dehiscence. There were no anastomotic leaks or fistulas, and two patients (2.9%) died within 30 days from pulmonary sepsis and complications from a distal anastomotic hemorrhage, respectively. CONCLUSIONS: Synchronous colon anastomoses without fecal diversion do not appear to be associated with an increased risk of complications and can be safely constructed in selected patients.
Subject(s)
Colectomy/methods , Colonic Neoplasms/surgery , Crohn Disease/surgery , Aged , Anastomosis, Surgical/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Recovery of Function , Retrospective Studies , Treatment OutcomeABSTRACT
A major advantage of laparoscopic colectomy is the limited incision. We describe an innovative technique in which the entire colon is extracted transvaginally to avoid any abdominal extraction incision in a female patient with hereditary nonpolyposis colon cancer who required total colectomy and hysterectomy. This novel technical approach is feasible and safe, eliminates the need for any extraction abdominal incision, and may be considered in patients requiring concurrent abdominal colectomy and hysterectomy.
