Can physiological stimulation prior to ileostomy closure reduce postoperative ileus? A prospective multicenter pilot study.

BACKGROUND: The aim of this study was to assess the impact of ileostomy closure following preoperative physiological stimulation (PPS) on postoperative ileus (POI) in patients with loop ileostomy after low anterior resection for rectal cancer. METHODS: Patients who underwent ileostomy closure between January 2017 and February 2020 in two tertiary referral centers were prospectively included. PPS stimulation was compared to standard treatment. Stimulation was carried out daily during the 15 days prior to ileostomy closure by the patient's self-instillation of 200 ml of fecal contents from the ileostomy bag via the efferent loop, using a rectal catheter. Standard treatment (ST) consisted of observation. Outcomes measures were POI, morbidity, stimulation feasibility, and predictors to ileus. RESULTS: A total of 58 patients were included [42 males and 16 females, median age 67 (43-85) years]. PPS was used in 24 patients, who completed the entire stimulation process, and ST in 34 patients. No differences in preoperative factors were found between the two groups. POI was significantly lower in the PPS group (4.2%) vs the ST group (32.4%); p < 0.01, OR: 0.05 (CI 95% 0.01-0.65). The PPS group had a shorter time to restoration of bowel function (1 day vs 3 days) p = 0.02 and a shorter time to tolerance of liquids (1 day vs 2 days), p = 0.04. Age (p = 0.01), open approach at index surgery, p = 0.03, adjuvant capecitabine (p = 0.01). and previous abdominal surgeries (p = 0.02) were associated with POI in the multivariate analysis. C-reactive-protein values on the 3rd (p = 0.02) and 5th (p < 0.01) postoperative day were also associated with POI. CONCLUSIONS: PPS for patients who underwent ileostomy closure after low anterior resection for rectal cancer is feasible and might reduce POI.

Risk factors for anastomotic leakage following total or subtotal colectomy

Introduction: A higher rate of anastomotic leakage (AL) is reported after ileosigmoid anastomosis (ISA) or ileorectal anastomosis (IRA) in total or subtotal colectomy (TSC) compared with colonic or colorectal anastomosis. Themain aimof the present studywas to assess potential risk factors for AL after ISA or IRA and to investigate determinants of morbidity. Methods: We identified 180 consecutive patients in a prospective referral, single center database, in which 83 of the patients underwent TSC with ISA or IRA. Data regarding the clinical characteristics, surgical treatment, and outcome were assessed to determine their association with the cumulative incidence of AL and surgical morbidity. Results: Ileosigmoid anastomosis was performed in 51 of the patients (61.5%) and IRA in 32 patients (38.6%). The cumulative incidence of ALwas 15.6% (13 of 83 patients). A higher AL rate was found in patients under 50 years-old (p=0.038), in the electivelaparoscopic approach subgroup (p=0.049), and patients in the inflammatory bowel disease (IBD) subgroup (p=0.009). Furthermore, 14 patients (16.9%) had morbidity classified as Clavien-Dindo ≥ IIIA. Discussion: A relatively high incidence of AL after TSC was observed in a relatively safe surgical procedure. Our findings suggest that the risk of AL may be higher in IBD patients. According to our results, identifying risk factors prior to surgerymay improve short-term outcomes. (AU)

Laparoscopic approach of persistant retroperitoneal adrenal ganclioneuroma

We report on 26-year-old woman with a right adrenal tumour 10cm in diameter who was treated by laparoscopic resection. The patient was asymptomatic and she has passed medical history of a suprarenal tumour and she was operated in her country 6 years before and six months later there was evidence of recurrence. Any medical treatment was given at this time. We don't have any medical report of this event. A subsequent computed tomography (CT) of the abdomen confirmed a 10x8cm homogenous mass in the suprarenal right spaceLaparoscopic complete excision of the mass was performed. The postoperative period was uneventful, and the patient was discharged on the third postoperative day. Histology was consistent with an adrenal ganglioneuroma. Three years later, there is not evidence of recurrence on abdominal CT scan

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¿Podría englobarse la fibromatosis agresiva dentro del espectro de los tumores del estroma gastrointestinal? / Could aggressive fibromatosis be considered whitin the spectrum of gstrointestinal stromal tumors?

Los tumores desmoides aparecen como resultado de la proliferación fibroblástica, sin signos histológicos de malignidad pero localmente muy agresivos. Se han descrito casos de fibromatosis tras extirpación de GIST. Presentamos el caso de un GIST gástrico operado, que a los 18 meses se realiza laparotomía exploradora por sospecha de recurrencia y tras hallazgos histológicos definitivos, se diagnostica de fibromatosis intra-abdominal agresiva. Se discute la valoración clínico-oncológica de la fibromatosis como forma de recurrencia local del GIST

Desmoid tumors appear as a result of fibroblastic proliferation without histological signs of malignancy but locally aggressive. Fibromatosis have been described after removing a gastrointestinal stromal tumor (GIST). We present a case of a resected gastric GIST and eigthteen months after surgery, a exploratory laparotomy was performed suspecting recurrence and after definitive histological findings, the diagnosis was aggressive intra-abdominal fibromatosis. Clinical-oncological assessment of fibromatosis is discussed as a form of GIST local recurrence

The effect of dentine-bonding agents on substance P release in human dental pulp.

AIM: To quantify the effect of dentine-bonding agents on Substance P (SP) release in healthy human dental pulp tissue. METHODOLOGY: Forty pulp samples were obtained from healthy pre-molars where extraction was indicated for orthodontic reasons. In thirty of these pre-molars, a standardized Class V cavity preparation was performed, and teeth were divided equally into three groups: (i) Unetched-cavity control group: Class V cavities only; (ii) Experimental Group I: 'One-step' self-etch bonding agent was placed in the cavity; and (iii) Experimental Group II: 'Two-step' total-etch bonding agent was placed in the cavity. The remaining ten healthy pre-molars where extracted without treatment and served as an intact-teeth control group. SP was measured by radioimmunoassay. RESULTS: Greater SP release was found in the 'one-step' bonding agent group, followed by the 'two-step' bonding agent group and the unetched-cavity control group. The lower SP values were for the intact-teeth control group. anova showed statistically significant differences between groups (P = 0.0001). Tukey HSD post hoc tests showed statistically significant differences in SP release between the intact-teeth control group and the three other groups (P < 0.01) and between the unetched-cavity control group and the 'one-step' bonding agent group (P < 0.05). No significant difference was found between the 'two-step' bonding agent and the unetched-cavity control group. CONCLUSION: Dentine-bonding agents placed over Class V cavity preparations increased SP release. One-step dentine-bonding agents increased SP release most.