Risk factors and outcomes of occurrence of anastomotic leakage and reoperations for its management after colorectal surgery

Background: Anastomotic leakage (AL) is still the most annoying postsurgery complication after colorectal resection due to its serious complications up to death. Limited data were available regarding differences in AL incidence, management, and consequences for different types of colorectal resection. The aim of the present work was to evaluate differences in incidence of AL, incidence of postoperative complications, and length of hospital stay in a large number of patients who underwent elective colorectal resection for management of colorectal lesions. In addition to detect when and what type of reoperation for management of AL occur after colorectal resection. Patients: All 250 included patients underwent elective surgeries for colorectal resection with performance of primary anastomosis for management of colorectal neoplastic and non-neoplastic diseases in the period between May 2016 and July 31, 2021. We followed the patients for 90 days; we registered the follow-up findings. Results: the rates of AL occurrence were variable after the different procedures. The lowest rate of AL occurrence was found in patients who underwent right hemicolectomy, then in patients who underwent sigmoidectomy, left hemicolectomy, transversectomy and anterior resection (p= 0.004). A stoma was frequently performed during reoperation (79.5%) which was significantly different between different procedures: 65.5% in right hemicolectomy, 75.0% in transversectomy, 85.7% in left hemicolectomy, and 93.0% in sigmoid resection (p< 0.001). Conclusion Rates, types, time of occurrence and severity of AL vary according to the type of colectomy performed and selective construction of stoma during AL reoperation is currently safely applied with comparable mortality rates for patients who did and who did not have a stoma after reoperation. (AU)

Laparoscopy adjuvant total colorectal resection for the treatment of familial adenomatous polyposis (FAP).

OBJECTIVE: To discuss and evaluate the safety and value of laparoscopy adjuvant total colorectal resection for the treatment of familial adenomatous polyposis (FAP). METHODS: From March 2010 to June 2015, 38 cases were retrospectively analyzed and divided into 2 groups, of which 17 cases used laparoscopy adjuvant total colorectal resection, and 21 cases used conventional laparotomy. Clinical data were obtained, and the safety and prognosis were observed. RESULTS: Seventeen cases using laparoscopy adjuvant total colorectal resection achieved success with no conversion to laparotomy and intraoperative complications. There was no significant difference in operation time between the two groups. There were significant differences in blood loss, the length of incision, postoperative recovery time of intestinal function and postoperative hospital stay between the two groups (P < 0.05). The trauma in laparoscopy group was less, and could recover faster, and there was no significant difference in complications between the two groups. In addition, there were no recurrence, distant metastasis and death in the follow-up period from 6 to 56 months. CONCLUSION: Laparoscopy adjuvant total colorectal resection is more safe and feasible, which has minimal invasion and can recover fast.

External validation of the SF-36 quality-of-life questionnaire in Italian and Brazilian populations to select patients with colorectal endometriosis for surgery.

STUDY OBJECTIVE: To evaluate the external validity of the validated French model of the quality-of-life questionnaire (QOL) SF-36 in predicting improvement after colorectal resection for endometriosis. DESIGN: Italian and Brazilian cohort studies (Canadian Task Force classification II-3). SETTING: Tertiary referral university hospital in Brazil and expert center in endometriosis in Italy. PATIENTS: Patients with colorectal endometriosis from an Italian population (n = 63) and a Brazilian population (n = 151). INTERVENTION: Laparoscopic colorectal resection for treatment of endometriosis. MEASUREMENTS AND MAIN RESULTS: Preoperative and postoperative evaluations of the Physical Component Summary (PCS) and the Mental Component Summary (MCS) of the SF-36 were performed. Substantial improvement in PCS and MCS was observed after colorectal resection in both populations. In the Brazilian population, the receiver operating curve (ROC) (area under the curve [AUC]) was 0.83 (95% confidence interval [CI], 0.77-0.89) for MCS and 0.78 (95% CI, 0.71-0.83) for PCS, demonstrating good discrimination performance. The mean difference between the predicted and calibrated probabilities was 19.6% for MCS and 32.8% for PCS. In the Italian population, the ROC curve (AUC) was 0.65 (95% CI, 0.52-0.78) for PCS and 0.67 (95% CI, 0.55-0.78) for MCS. The model demonstrated poor discrimination and calibration performance for PCS (p < .001) and MCS (p = .003). The mean difference between the predicted and calibrated probabilities was 17.5% for MCS and 21.8% for PCS. CONCLUSION: Despite the use of validated translations of the SF-36, our results underline the limits of this tool in selection of patients for colorectal resection due to underestimation of predicted quality of life, possibly because of variations in epidemiologic characteristics of the populations.

Tratamento laparoscópico de 98 pacientes com endometriose intestinal / Laparoscopic treatment of 98 women with bowel endometriosis

OBJETIVO: Identificar os tipos de tratamento cirúrgico e a morbidade operatória na endometriose intestinal. MÉTODOS: Estudo retrospectivo de pacientes operadas no Biocor Instituto (Belo Horizonte, MG) por uma equipe multidisciplinar para tratamento de endometriose no período de janeiro de 2002 a junho de 2009. RESULTADO: Noventa e oito pacientes foram submetidas aos seguintes procedimentos para tratamento da endometriose intestinal: ressecção segmentar do reto (n 46; 45,5 por cento), ressecção em disco (n 25; 24,7 por cento), "shaving" (n 18; 17,8 por cento), apendicectomia (n 5; 5 por cento), liberação de aderências sem ressecção (n 5; 5 por cento), ressecção segmentar do sigmóide (n 1; 1 por cento) e ressecção segmentar do colo direito (n 1, 1 por cento). A cirurgia concomitante mais freqüente foi a ressecção de endometriomas ovarianos (n 45). A morbidade operatória foi de 9,2 por cento, sendo as complicações maiores uma fístula retovaginal (1 por cento) e uma deiscência de anastomose (1 por cento). Quarenta e duas pacientes tiveram seguimento médio de 14 meses com recidiva clínica em 8 casos (dor pélvica e dispareunia) e 4 recidivas de imagem à ultrassonografia em parede intestinal, assintomáticas. CONCLUSÃO: O tratamento da endometriose por laparoscopia é factível e seguro, com baixos índices de recidiva.

OBJECTIVE: The purpose of this study was to identify the types of surgical procedures performed and the operative morbidity in women with bowel endometriosis. METHODS: Retrospective evaluation of surgical records of women who underwent surgical treatment of endometriosis by a mutidisciplinar team at Biocor Instituto (Belo Horizonte, MG) from January 2002 to June 2009. RESULTS: Ninety-eight women underwent surgical treatment of bowel endometriosis during the study period. The following surgical procedures were performed: segmetnal rectal resection (n 46; 45,5 percent), intestinal disc excision (n 25; 24,7 percent), "shaving" (n 18; 17,8 percent), appendectomy (n 5; 5 percent), adhesiolysis without intestinal resection (n 5; 5 percent), segmental sigmoidectomy (n 1; 1 percent) e segmental right colon resection (n 1, 1 percent). The most frequent concomitant surgery performed was the removal of ovarian endometriomas (n 45). Operative morbity was observed in 9.2 percent and major complications were rectovaginal fistula (1 percent) and anastomosis dehiscence (1 percent). After a mean followup of 14 months that included 42 patients , recurrence of clinical symptoms (pelvic pain and dyspareunia) was observed in 8 cases as well as 4 cases of asymptomatic intestinal wall endometriosis recurrence which was identified by ultrasonography. CONCLUSION: Laparoscopic treatment of bowel endometriosis is feasible, safe and presents a low recurrence rate.