Ileal pouch-anal anastomosis (IPAA) is now the procedure of choice for most patients requiring proctocolectomy for ulcerative colitis. The J-shaped pouch, usually 15–20 cm in length, is easiest to ...construct and has functional outcomes identical to those of the more complex designs. IPAA is a complex procedure, and complications occur frequently. Despite the significant improvements this surgical advance has made on the quality of life in these patients, inflammation of the surgically created ileal pouch or pouchitis remains a major late postoperative complication that can often overshadow the benefits of this otherwise curative operation. Several inflammatory and noninflammatory complications can occur after IPAA. Pouchitis is the most common, occurring in ≈50% of patients. Whereas acute pouchitis can be treated rapidly and successfully in the majority of patients, refractory and chronic pouchitis remain therapeutic challenges to patients and physicians. The problem is believed to be caused by stasis of feces in the pouch with overgrowth of aerobic and anaerobic organisms. The size of the pouch has a significant influence on the incidence of pouchitis: a smaller pouch usually empties better than a larger pouch and so may be less susceptible to pouchitis.
Surgical treatment of anal stenosis Giuseppe Brisinda; Serafino Vanella; Federica Cadeddu ...
世界胃肠病学杂志（英文版）,
2009, Letnik:
15, Številka:
16
Journal Article
R5; Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy.Anal stenosis represents a technical challenge in terms of surgical management. A ...Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment,both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements.Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anaplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms.
Summary Carcinoma of the rectum is a common malignancy, especially in developed countries. The main stay of the therapy for rectal cancer is radical surgery. Total mesorectal excision has emerged as ...the surgical technique that can substantially reduce local recurrences. The laparoscopic approach does not seem to entail any oncologic disadvantages. Radiotherapy (RT) alone is capable of eradicating some localized rectal tumors while its effect on larger tumors is limited by normal tissue tolerance, tumor sensitivity and microscopic spread beyond the primary site. Preoperative chemoradiation has potential advantages. The rationale for combining cytotoxic agents and RT is based on the ability of some drugs to act as an enhancer of RT. Preoperative chemoradiation can potentially downstage tumors to facilitate surgery, reduce the risk of tumor seeding, problems with hypoxia which is increased postoperatively, allowing more optimal tumor cell kill for equivalent doses compared to postoperative radiotherapy. The addition of radiation to surgery has been successfully used in many disease sites. In the intraoperative radiotherapy (IOERT), a high dose to the area of highest risk for tumor cell persistence is delivered while dose-limiting structures such as small bowel, bladder, or ureters can be mechanically excluded. Our preliminary experience shows that laparoscopic rectal resection with IOERT is not only feasible, but associates oncologic radical treatment with important advantages of laparoscopic approach.
Open tension-free techniques of hernia repair using synthetic meshes are a well-accepted practice with an excellent patient comfort and a low recurrence rate. Otherwise, the influence of the ...resulting fibrosis on testicular perfusion is still unclear. In this study, the effect of prosthetic materials on testicular perfusion was evaluated using Duplex ultrasonography.
Twenty-four patients participated in this prospective study. A total of 26 procedures were performed under general anaesthesia. All patients underwent standardized scrotal ultrasound study and Duplex imaging preoperatively, 1, 3 and 9 months after the procedure. Scrotal volume, vein diameters and modifications of arterial blood flow, evaluated by the acceleration index (AI), of the funicular and peritesticular vessels were measured.
No statistically significant differences were found between preoperative and postoperative measurements which included testicular blood flow parameters and testicular volume. Moreover, in some cases, a testicular flow improvement was detected after the operation. Furthermore the side of the hernia and the position of the mesh slit (lateral or upper) to allow the passage of cord structures did not influence the results.
So far there is no evidence for a significant impairment of funicular structures after open hernia repair using tension free techniques.
To compares the efficacy and safety of laparoscopic surgery (LS) and open surgery (OS). To analyze early results of a single institution experience using adjuvant intraoperative radiation therapy ...(IORT) presacral boost in locally advanced cancer.
264 patients with curable colorectal cancer undergoing laparoscopic (97) or open colorectal resection (167). In 41 patients (31 open and 10 laparoscopic resection) with locally advanced rectal cancer we performed IORT. Primary endpoints were the evaluation of postoperative clinical and oncologic results.
Twenty (21%) patients underwent conversion from laparoscopic to open surgery. The overall morbidity rates were 17.5% in the LS group and 20.9% in the OS group (P= 0.5). Average operative time was shorter in the OS than in the LS series (P= 0.01). Use of parenteral narcotics was shorter in LS than in OS group (P <0.001), but there were more stoma creations in LS group than in OS group (P= 0.001). All patients are alive at different followup periods.
Colorectal cancer is the second leading cause of death from malignancy in the industrialized world. The risk of local recurrence after treatment increases with tumor stage. The roles of radiochemotherapy and surgical procedures have been investigated extensively in the last decades, especially in locally advanced rectal cancer.
Laparoscopic techniques can be applied to colorectal malignancies without sacrificing oncologic results. Multimodality treatment with LS and IORT is safe and feasible.
Left-sided IVC in left renal cell carcinoma Brisinda, Giuseppe; Crocco, Anna; Cina, Alessandro ...
Annali italiani di chirurgia,
2013 Jan-Feb, Letnik:
84, Številka:
1
Journal Article
Congenital anomalies of the inferior vena cava (IVC) are very rare and extremely diverse, reflecting the complexity of the embryological development of these structures. The variants must be ...differentiated from pathology, particularly lymphadenopathy, on imaging studies as their presence can affect surgical and interventional procedures in retroperitoneum. We describe two patients with renal cell carcinoma of left kidney and left IVC.
First patient was taken up for left radical nephroureterectomy. During surgery the existence of a transposed left IVC was demonstrated. The second case is a fifty-four-year-old man; abdomen and pelvic CT-scan with coronal maximum intensity projection reconstruction showed a 7 cm heterogeneously enhancing neoformation involving the left kidney with intraparenchymal hematoma and a transposed left IVC.
Preoperative detection of congenital IVC anomalies can prevent morbidity. Once diagnosed, appropriate care must be taken during the operation to expose and define the anatomic anomaly and protect it from injury.
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