Study of late complications of restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis operated at a tertiary care center and factors affecting to that.

Background and Objective: Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) is usually preferred surgical treatment for ulcerative colitis (UC). Although treated primarily medically, some refractory and complicated cases of UC may require surgical intervention. It eliminates chronic UC and the risk of colonic cancer. This research aims to study the risk factors associated with the development of postoperative complications. Methodology: For this cohort study, we included all the patients who underwent RPC-IPAA in the Department of Gastroenterology, Sheth Vadilal Sarabhai General Hospital, Ahmedabad, over 6 years. Data of the patients were obtained retrospectively from the medical records. We collected the data and analyzed using appropriate statistical tests to look for preoperative patient variables associated with late complications. Late complications were defined as those developed after 1 month. Results: Out of 32 patients, 19 were male and 13 were female, with an average age of 32.3 years at the time of operation. Thirteen patients developed complications such as pouchitis (n = 6), incisional hernia (n = 3), bowel obstruction (n = 2), pouch leakage (n = 1), and erectile dysfunction (n = 1). We found serum albumin <3 mg/dl and pancolitis associated with more postoperative late complications with P = 0.007 and 0.04, respectively, which is statistically significant. Conclusion: This study demonstrates that low preoperative albumin level and pancolitis are risk factors for late complications of IPAA. Preoperative nutritional support, especially albumin, could reduce late complications.

Résumé L'IPAA (iléopouch-anal anastomose) est une procédure chirurgicale complexe qui, lorsqu'elle est réalisée par un chirurgien expérimenté, peut donner d'excellents résultats. De plus, il est important de comprendre les complications et leur prise en charge. Nos résultats mettent en lumière les facteurs associés aux complications chez les patients ayant subi une IPAA (iléopouch-anal anastomose) pour la CU (colite ulcéreuse). Dans notre population d'échantillon, une concentration sérique d'albumine préopératoire inférieure à 3 mg/dl et une pancolite ont été associées à des complications postopératoires. Cette étude démontre que des taux d'albumine préopératoires bas et la pancolite sont des facteurs de risque de complications tardives de l'IPAA. Un soutien nutritionnel préopératoire, en particulier l'albumine, pourrait réduire les complications tardive. Mots-clés: Iléite de reflux, Hypoalbuminemia, pancolite, colite ulcéreuse, pouchite.

Chylous ascites in a case of henoch-schonlein purpura - A case report and literature review.

Chylous ascites is a rare form of ascites characterized by the accumulation of lymph fluid in the peritoneal cavity. Henoch-Schonlein purpura (HSP) is a form of vasculitis usually seen in children affecting small vessels. Gastrointestinal (GI) manifestations of HSP are coming to the forefront as a presenting symptom. The presence of a rash usually succeeds the GI manifestations, making diagnosis difficult and leading to unnecessary surgical interventions. Our case shows a 38-year-old female who presented with an acute abdomen followed by an erythematous rash noticed later on, with radiological investigations suggestive of acute appendicitis. Chylous ascites was found as an incidental finding on diagnostic laparoscopy with a healthy appendix.

Résumé L'ascite chyleuse est une forme rare d'ascite caractérisée par l'accumulation de liquide lymphatique dans la cavité péritonéale. Henoch-Schonlein le purpura (HSP) est une forme de vascularite généralement observée chez les enfants et affectant les petits vaisseaux. Les manifestations gastro-intestinales (GI) de la HSP arrivent au premier plan comme symptôme révélateur. La présence d'une éruption cutanée succède généralement aux manifestations gastro-intestinales, rendant le diagnostic difficile et conduisant à des interventions chirurgicales inutiles. Notre cas montre une femme de 38 ans qui s'est présentée avec un abdomen aigu suivi d'un érythémateux éruption cutanée constatée ultérieurement, avec des investigations radiologiques évocatrices d'une appendicite aiguë. Une ascite chyleuse a été découverte de manière fortuite sur laparoscopie diagnostique avec un appendice sain. Mots-clés: Abdomen aigu, ascite chyleuse, purpura Henoch-Schonlein.

Comparison of Conventional Bipolar Electrocautery and Ultrasonic Harmonic Scalpel in Colorectal Cancer Surgeries.

Background and objective Colorectal cancer (CRC) is the third most common malignancy and the second most deadly cancer worldwide. Powered equipment has transformed modern surgery, revolutionizing the delicacy, precision, and accuracy of many surgeries. The safety and efficacy of tissue dissection and artery sealing in colorectal surgery remain highly debatable. With the increased use of minimally invasive procedures in colon and rectal surgery, energy devices for tissue dissection and vascular sealing have become widely used. In light of this, we aimed at comparing the use of bipolar electrocautery and harmonic scalpel in CRC surgeries. Methods Our study was a hospital-based comparative study conducted at our tertiary care hospital. Fifty patients were divided equally into two groups by block randomization, and bipolar electrocautery was used in one group, and harmonic scalpel was used in the second group during surgery. The mean operative time, blood loss, and hospital stay were calculated in both groups. The comparison between bipolar electrocautery and harmonic scalpel was evaluated using independent t-tests. Results The mean operative time, blood loss, and hospital stay were significantly lower in the harmonic scalpel group than in the electrocautery group. The results were statistically significant (p < 0.001). Conclusion Based on our findings, the harmonic scalpel is a better energy source when compared to bipolar electrocautery in CRC surgeries.