Aim
For the treatment of complex pelvic organ prolapse, many different surgical procedures are described without any comparative studies available. Laparoscopic ventral mesh rectopexy after D’Hoore ...is one of the methods, which is publicized to treat patients with symptomatic rectocele, enterocele and rectal prolapse.
Method
All patients who received ventral mesh rectopexy since 07/10 for symptomatic rectocele, enterocele and possible rectal prolapse I ° or II ° in terms of a complex pelvic floor disorder were included in this follow-up study. The Wexner score for incontinence was recorded (range 0–20), the constipation score of Herold (r6-30) was evaluated as well as supplementary questions compiled by D’Hoore concerning outlet symptoms (r0-20). In addition, the quality of life (SF-12) was requested.
Results
Thirty-one women were operated in the period, and 27 were eligible to be included in the present study. Median follow-up was 22 months (2–39). The preoperative Wexner score was in median 8 (0–20), going down to 6 (0–20) without significance (
p
= 0.735). The constipation score decreased significantly from median 14 (9–21) to 11 (6–25) (
p
= 0.007). The median score after D’Hoore was preoperatively 8 (4–16) and 4.5 (0–17) postoperatively (
p
= 0.004). The SF-12 values were preoperatively significantly reduced compared to the normal population; postoperatively, they equalized.
Conclusion
Two years after laparoscopic ventral mesh rectopexy, constipation and quality of life improve significantly in patients with complex pelvic organ prolapse. The grade of incontinence remains essentially the same, but was not the dominant clinical problem in the treated patients of our study.
Statement
The improvement in constipation and quality of life after laparoscopic ventral mesh rectopexy for obstructive defecation is encouraging. However, the impact on sexual life differs; some patients improve but a relevant number reports a change for the worse.
Background
If a primary anastomosis is considered too risky after emergency colon resection either a resection enterostomy or an end stoma with closure of the distal bowel (Hartmann’s procedure) is ...possible. This study analyzes the rate of restoration of intestinal continuity and other surgical outcomes after resection enterostomy placement versus Hartmann’s procedure for emergency colon resections.
Methods
All patients who underwent emergency colorectal resections between August 2009 and June 2014 at the University Medical Center Mannheim were reviewed in regard to therapeutic approach, rate of restoration of bowel continuity, and surgical morbidity after the primary operation and after reversal surgery.
Results
Fifty-five patients in whom both studied interventions would have been technically feasible were further analyzed. The rate of revisional surgery was significantly higher in the resection enterostomy cohort after the primary operation. There were no significant differences regarding morbidity, mortality, and the rate of restoration of intestinal continuity. Overall, bowel continuity could be restored in 63% (29/46) of the surviving patients. The median time of surgery of the initial as well as of the reversal surgery was significantly longer in the Hartmann’s group. Five of 13 patients underwent protective ileostomy placement in the Hartmann’s group at the time of the reversal (vs. none in the resection enterostomy group).
Conclusions
The bowel continuity can be restored in the majority of patients after emergency colonic resection. Conclusive evidence which surgical option should be preferred when a primary anastomosis is considered too risky—Hartmann’s procedure or resection enterostomy—is still lacking.
Abstract Background Neoadjuvant chemotherapy improves prognosis of patients with locally advanced gastroesophageal adenocarcinoma. The aim of this study was to identify predictors for postoperative ...survival following neoadjuvant therapy. These could be useful in deciding about postoperative continuation of chemotherapy. Methods This meta-analysis used IPD from RCTs comparing neoadjuvant chemotherapy with surgery alone for gastroesophageal adenocarcinoma. Trials providing IPD on age, sex, performance status, pT/N stage, resection status, overall and recurrence-free survival were included. Survival was calculated in the entire study population and subgroups stratified by supposed predictors and compared using the log-rank test. Multivariable Cox models were used to identify independent survival predictors. Results Four RCTs providing IPD from 553 patients fulfilled the inclusion criteria. (y)pT and (y)pN stage and resection status strongly predicted postoperative survival both after neoadjuvant therapy and surgery alone. Patients with R1 resection after neoadjuvant therapy survived longer than those with R1 resection after surgery alone. Patients with stage pN0 after surgery alone had better prognosis than those with ypN0 after neoadjuvant therapy. Patients with stage ypT3/4 after neoadjuvant therapy survived longer than those with stage pT3/4 after surgery alone. Multivariable regression identified resection status and (y)pN stage as predictors of survival in both groups. (y)pT stage predicted survival only after surgery alone. Conclusion After neoadjuvant therapy for gastroesophageal adenocarcinoma, survival is determined by the same factors as after surgery alone. However, ypT stage is not an independent predictor. These results can facilitate the decision about postoperative continuation of chemotherapy in pretreated patients.
The study of the K¯N system at very low energies plays a key role for the understanding of the strong interaction between hadrons in the strangeness sector. At the DAΦNE electron–positron collider of ...Laboratori Nazionali di Frascati we studied kaonic atoms with Z=1 and Z=2, taking advantage of the low-energy charged kaons from Φ-mesons decaying nearly at rest. The SIDDHARTA experiment used X-ray spectroscopy of the kaonic atoms to determine the transition yields and the strong interaction induced shift and width of the lowest experimentally accessible level (1s for H and D and 2p for He). Shift and width are connected to the real and imaginary part of the scattering length. To disentangle the isospin dependent scattering lengths of the antikaon–nucleon interaction, measurements of K−p and of K−d are needed. We report here on an exploratory deuterium measurement, from which a limit for the yield of the K-series transitions was derived: Y(Ktot)<0.0143 and Y(Kα)<0.0039 (CL 90%). Also, the upcoming SIDDHARTA-2 kaonic deuterium experiment is introduced.
Purpose
Apart from stapling methods, single- or double-layer continuous hand sutures are established techniques for colonic anastomoses. It is unclear which hand suture technique has superior ...anastomotic safety. This randomized trial evaluated the incidence of postoperative complications depending on anastomosis technique.
Methods
This multicentre randomized trial enrolled adult elective patients between February 2004 and June 2012 in four German university hospitals. Primary endpoint was incidence of clinical anastomotic leakage until 3 months postoperatively. Estimated sample size was 768 randomized patients. Main secondary endpoints were duration of anastomotic suture, postoperative morbidity and stool patterns at 3-month follow-up. Patients and postoperative outcome assessors were blinded to the group assignment. This trial is registered (NCT00996554).
Results
Due to slow recruitment, the trial was stopped prematurely. Two hundred fifty-two patients (129 to single-layer suture anastomosis (SLA), 123 to double-layer suture anastomosis (DLA)) were randomized and analysed. Nine patients (3.6 %) were lost during follow-up. Exploratory primary endpoint analysis by intention-to-treat principle showed no significant difference for clinical anastomotic leakage between suturing techniques (SLA, 4 of 129 (3.1 %) vs. DLA, 6 of 123 (4.9 %),
p
= 0.532). Secondary endpoint analysis showed on average a 6-min shorter suture duration for SLA than DLA (18 min (4–49) vs. 24 min (8–50),
p
< 0.001). At 3-month follow-up, subjective well-being and stool patterns were not significantly different between groups.
Conclusions
The present study did not reach sufficient power and cannot confirm whether both techniques might be equally or if one technique might be superior. Exploratory analysis suggests that in elective colonic resections, the single-layer continuous hand suture technique may be equally effective as the double-layer technique regarding incidence of anastomotic leakage, length of hospital stay, overall postoperative complications, subjective short-term well-being and stool patterns. Lessons learned from this trial course are summarized.
Trial Registration
This trial is registered (Trial registration: NCT00996554). Link:
https://clinicaltrials.gov/ct2/show/NCT00996554
.
The kaonic (3)He and (4)He X-rays emitted in the Formula: see text transitions were measured in the SIDDHARTA experiment. The widths of the kaonic (3)He and (4)He 2p states were determined to be ...Formula: see text, and Formula: see text, respectively. Both results are consistent with the theoretical predictions. The width of kaonic (4)He is much smaller than the value of Formula: see text determined by the experiments performed in the 70's and 80's, while the width of kaonic (3)He was determined for the first time.
Purpose
There is ample evidence of the benefits of clinical pathways (CPs), but this study is the first to investigate the potential additional benefits of a CP for rectal resections in a setting ...with an already established policy of enhanced postoperative recovery.
Methods
We compared 36 patients who underwent rectal resections with ileostomy placement and were treated according to a CP (CP group) with 67 patients treated before CP implementation (prepathway group). Indicators of process quality were placement of central venous line and epidural catheter, day of removal of Foley catheter in relation to removal of the epidural catheter, day of first mobilization, day of resumption of regular diet, day of first passage of stool through the stoma, and length of stay. Outcome quality was assessed by morbidity, mortality, reoperation, and readmission rates.
Results
We found that patients in the CP group resumed regular diet significantly sooner (
p
= 0.001). There were no significant differences regarding the day of first mobilization (
p
= 0.69), epidural catheter (
p
= 0.74), central venous line placement (
p
= 0.92), and removal of Foley catheter (
p
= 0.23). The first stool was passed through the stoma earlier (
p
= 0.04) in the prepathway group. Median length of hospital stay was significantly shorter in the CP group (12.5 vs. 15.0 days;
p
= 0.008). There were no significant changes in outcome quality, except for a significantly higher need for revisional surgery in the CP group (13.9 vs. 3 %,
p
= 0.05).
Conclusions
After implementation of a CP for rectal resections, one parameter of process quality improved and length of stay decreased.
Zusammenfassung
Stomaanlagen sind häufig im Rahmen abdomineller Operationen notwendig, sowohl in der Notfallsituation als auch bei Elektiveingriffen. Unterschieden werden temporäre, in der Regel zur ...Diversion angelegte und permanente Stomata. Insgesamt ist bei der Stomakonstruktion auch zu berücksichtigen, inwiefern eine komplette Ausschaltung der Stuhlpassage im nachfolgenden Darmabschnitt notwendig ist. Hier bietet sich ein Verschluss des distalen Schenkels im Sinne eines langen Hartmann-Stumpfes an. Bei entzündlichen Darmerkrankungen besteht häufig die Indikation zur Stomaanlage, entweder als protektives Stoma, um Anastomosen oder tiefe Rekonstruktionen zu schützen, oder auch als permanentes Stoma, um eine bessere Lebensqualität zu erreichen. Beim Rektumkarzinom ist das Deviationsstoma bei der tiefen Resektion mit totaler mesorektaler Exzision (TME) der Standard, wobei hier das Ileostoma gegenüber dem Kolostoma tendenziell mehr Vorteile aufweist. In der Notfallsituation hängt die Indikation zur Stomaanlage von der zugrundeliegenden Erkrankung und der Allgemeinsituation ab. In seltenen Fällen besteht auch bei Patienten mit funktionellen Darmerkrankungen die Indikation zur Stomaanlage. Zu vielen Fragen zur Stomaanlage liegen nur wenig kontrollierte Daten vor, sodass viele Empfehlungen im Wesentlichen erfahrungsbasiert erfolgen.
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