Risk factors for postoperative ileus after colorectal cancer surgery.

AIM: To assess the rate and independent risk factors of postoperative ileus (POI) after colorectal cancer surgery. METHODS: Three hundred consecutive patients underwent colorectal surgery for cancer at the State Scientific Centre of coloproctology, Moscow, Russia, between November 2015 and August 2016. POI was diagnosed as an absence of intestinal function for 72 hours or more after operation and confirmed by plain radiography. Uni- and multivariate logistic regression of the tumour-, patient- and treatment-related factors was performed. All patients had epidural catheters with multimodal analgesia. RESULTS: Thirty-nine patients (13%) had postoperative ileus. The variables associated with this condition in univariate analysis were age < 64 y.o. (p = 0.02), male gender (p = 0.02), BMI ≥ 25 kg/m2 (p = 0.02), moderate drinking (p = 0.02), heavier drinking (p < 0.0001), opioids (p = 0.02), history of abdominal operation (p = 0.003), firm, extensive adhesions as a result of previous surgery (p = 0.005), multivisceral resection (p = 0.009), blood loss ≥ 150 mL (p = 0.006), haemotransfusion (p = 0.01) and open approach (p = 0.006). In the multivariate logistic regression, BMI ≥ 26 kg/m2 (p = 0.008), opioids (p = 0.04) history of abdominal operation (p = 0.04) and adhesions (p = 0.03) were identified as independent risk factors. CONCLUSION: Postoperative ileus is a common complication in colorectal surgery. The results of our study suggest at least two surgeon-dependent risk factors, i.e., open approach and opioids in the postoperative period. This article is protected by copyright. All rights reserved.

[Rectosacropexy in rectal prolapse management].

AIM: To compare results of rectosacropexy and posterior-loop rectopexy in rectal prolapse management. MATERIAL AND METHODS: Study included 122 patients operated for rectal prolapse for the period January 2007 to August 2014. Patients' age ranged from 19 to 85 years (mean 47.3±16.1). Main group consisted of 60 (49.2%) patients who underwent rectosacropexy (D'Hoore's procedure). Control group included 62 (50.8%) patients in whom posterior-loop rectopexy was applied (Wells's procedure). RESULTS: Long-term results were followed-up in 94 (77.0%) patients including 48 and 46 from main and control group respectively. Recurrent prolaple incidence after rectosacropexy and posterior-loop rectopexy was 2% and 8.7% respectively. Multivariant analysis statistically confirmed that postoperative impaired colon motility was independent risk factor of recurrence. Recurrent disease is observed 5.7 times more often in this case. Rectosacropexy does not significantly impair colon motility because of ileus occurs in 8.3% of operated patients. Impovement of anal continence does not depend on rectopexy method and occurs in all patients with degree 1-2 of anal sphincter failure. CONCLUSION: Rectosacropexy may be preferred in rectal prolapse. However, further highly significant studies are necessary to optimize rectal prolapse management.

[Colovesical fistula as a complication of diverticular disease].

The results of research on the clinical picture, features of manifestation, diagnosis, and treatment of patients with diverticular disease complicated by sigmovesical fistula are presented. The study included 31 patients (19 [61.3%] men, 12 [38.7%] women), aged 32-83 (55.6 +/- 7.1) years. Diagnostic program included physical examination, laboratory blood and urine tests, endoscopic, radiological, ultrasound examinations. All patients underwent different interventions according to the severity and extent of the inflammatory process, the involvement of other organs of the abdominal cavity and the extent of diverticular lesions of the colon. Long-term results were assessed in all patients in a period of 5 months to 12 years, with a median follow-up 4.7 years. It is shown that the clinical manifestations of intestinovesical fistula did not match the severity of complications, and were subclinical. Timing for referral the patient to coloproctologist was 5 months after the occurrence of first clinical signs. In any case, conservative treatment has not led to spontaneous colovesical fistula closure. Average size of parafistulous infiltration on the wall of the bladder and perivesical tissue was 6.5 +/- 2.4 cm. All the patients underwent different types of colon resection. Postoperative complications did not requiring recurrent surgery were detected in 5 (16.1%) patients. None of these has experienced recurrence complications of diverticular disease. For the optimization the treatment strategy, physicians should follow multidisciplinary approach immediately after revealing the patient with persistent bacteriuria, pneumaturia and fecaluria. The surgery is the method of choice in the treatment of colovesical fistula as a complication of diverticular disease.

[Use of modified irrigoradioscopy in the diagnosis of external and internal rectal prolapse]. / Primenenie modifitsirovannoi irrigoskopii v diagnostike naruzhnogo i vnutrennego vypadeniia priamoi kishki..

The paper gives colonic X-ray findings in 39 patients with rectal prolapse. Of them, 20 and 19 patients were found to have internal and external rectal prolapse, respectively. Studies were conducted by the modified irrigoscopy developed by the State Coloproctology Research Center, Ministry of Health of the Russian Federation, to explore the anatomic and functional status of the rectum and the fundus of the pelvis in patients with impaired defecation. The X-ray sign of circular invagination that had been detected by the authors allowed them to make the diagnosis of internal rectal prolapse with the greatest assurance. The modified irrigoscopy in combination with oral enterography for external rectal prolapse could show associated changes, including enterocele and sigmocele.

[Use of an x-ray method in the assessment of changes in the intestinal wall in colonic diverticulosis]. / Ispol'zovanie rentgenologicheskogo metoda dlia otsenki izmenenii kishechnoi stenki pri divertikuleze tolstoi kishki.

The authors analyze x-ray findings in 194 patients with colonic diverticulosis and its inflammatory complications. Findings of preoperative irrigoscopy were correlated with dates of morphological investigations. Roentgenomorphological and functional changes were assessed in different clinical types of colonic diverticulosis. Correlation was received between this changes and clinical sings of disease. Authors determined risk-groups of inflammatory complications of colonic diverticulosis.

[Radiologic diagnosis of inflammatory complications of colonic diverticulosis]. / Vozmozhnosti rentgenologicheskoi diagnostiki vospalitelnykh oslozhnenii divertikuleza tolstoi kishki.

The authors analyze x-ray findings in 194 patients with colonic diverticulosis and its inflammatory complications. Clinical, x-ray, and morphologic studies helped the authors to specify the x-ray semeiotics of diverticulitis, paraintestinal infiltrates, intestinal fistulas. An optimal complex of radiological methods to detect each of these complications has been developed. The authors claim that irrigoscopy supplemented, if necessary, with simultaneous fistulography, or oral enterography is the priority and basic method for the diagnosis of inflammatory complications of colonic diverticulosis.

[Pathomorphology of colonic diverticulosis]. / Patomorfologiia divertikuleza tolstoi kishki.

Two clinico-morphological forms of colon diverticulosis are distinguished on the basis of post-mortem and surgical material (89 observations) studied histologically, neurohistologically and electron-microscopically. The first form is characterized by the disturbance of colon peristalsis, inflammation, segmentation of the colon wall and the presence of staged changes in the colon wall muscles. Disturbances of the vegetative innervation and regional hemodynamic disturbances play a role in the patho- and morphogenesis. The second form develops in aged persons and is characterized by weakness of the colon wall with thinning of the muscle layer. In both forms atrophy of the circular muscle layer develops with dilation of perivascular spaces and formation of "weak sites" in the colonic wall.