Introduction
The aim of this prospective human trial was to evaluate the clinical performance of a novel THUNDERBEAT (TB) energy device in laparoscopic colon surgery. This study reports the first ...human trial in USA with this combined energy device in colon surgery.
Methods and procedures
This is a prospective pilot study with 30 subjects undergoing left or right laparoscopic colon resection for neoplasm in a single institution. All soft tissue dissections and all vessel ligations were performed using TB. No other energy device was used within the abdomen. Recorded end-points were dissection time (from the start of colon mobilization to specimen removal), surgical procedure time, the number of times TB taken out of the abdominal cavity, intraoperative complications (bleeding at the time of mesenteric dissection or vessel ligation, thermal injury during surgery, injury of other organs), technical device problems, postoperative complications (bleeding, delayed thermal injuries, other complications within 30 days), length of hospital stay, and mortality.
Results
Thirty subjects (15 males) were enrolled in the study with median age and range 68.5 (21–86) and BMI kg/m
2
25.5 (20–35). Twelve subjects underwent right and 18 left laparoscopic hemicolectomy. The mean surgical procedure time was 163 ± 86 min and for dissection using TB device 80.6 ± 35 min. Major vessel ligation was successful in all subjects. The median number of TB applications to seal inferior mesenteric artery was 3 (2–8). TB was taken out of the abdominal cavity during dissection for tip cleaning a medium number of two times/per case. No intraoperative or postoperative complications (bleeding, thermal injuries, etc.) related to use of TB were noted.
Conclusions
The TB device demonstrated efficient and successful performance at tissue dissection and vessel ligation in left and right colectomies. TB technology can be employed in complex abdominal surgery and may save time through faster dissection but comparative studies with other energy devices are needed to confirm this.
Aim
The natural history and appropriate management of anastomotic sinus has not been clearly defined. The aim of this study was to evaluate the incidence, management and outcomes of anastomotic ...sinus.
Method
The medical records of all patients who underwent a low anterior resection (LAR) or an ileal pouch–anal anastomosis (IPAA) with a diverting loop ileostomy (LI) and with contrast enema performed before planned stoma closure between 2001 and 2011 were retrospectively reviewed. The radiological features of the sinus tract, treatment and outcome of anastomotic sinus were studied.
Results
Twenty patients (8.2%) were found to have anastomotic sinuses out of the total of 244 patients who had undergone LAR (n = 146) or IPAA (n = 98) with LI. Of these, 13 (65%) had prior symptomatic leaks, while seven did not. Twelve patients (60%) were found to have simple sinus tracts, while eight had complex sinuses (associated with either pelvic cavities or severe strictures). Five patients with simple tracts were treated with observation alone. Fifteen patients underwent surgical interventions. Overall, with a median follow‐up of 28 (6–73) months, 16 patients (80%) had resolution of their sinuses. All of 12 patients (100%) with simple sinus tracts and four of eight patients (50%) with complex sinuses underwent successful stoma reversals after 8 (3.5–24) months following the initial surgery (P = 0.01).
Conclusion
Patients with simple tracts are significantly more likely to have complete resolution of sinuses than patients with complex sinuses. Persistent sinus associated with either a pelvic cavity or severe stricture despite surgical intervention is likely to lead to a permanent stoma.
Objective There are a limited number of studies describing the role of minimally invasive colectomy for urgent or emergent conditions of the large bowel. We hypothesize that laparoscopic colectomy ...in urgent and emergent setting can be performed safely in select settings.
Method A cohort of patients treated at a single institution from 2001 to 2006 was identified from a prospective database. Patients who underwent open or minimally invasive surgery (MIS), including laparoscopic (LAP) or hand‐assisted laparoscopic surgery (HALS) colectomy for urgent and emergent conditions were included.
Results A total of 68 open 32, MIS 36 HALS 22, LAP 14) patients underwent urgent or emergent colectomy on our colorectal service during the 5‐year time period. Patients with toxic colitis were more often selected for MIS. Patients with colon perforation or large bowel obstruction were more often selected for open surgery. The MIS group had a lower body mass index (BMI), lower American Society of Anesthesiologists fitness grade and was more likely to have been immunosuppressed. There was no difference in patient morbidity between the open and MIS groups. The MIS group had a longer median operative time and fewer cases of prolonged hospitalization.
Conclusion We conclude that minimally invasive colectomy by experienced surgeons appears to be safe and effective for appropriately selected patients with emergent and urgent conditions of the large bowel.
Abstract
Background
A novel anastomosis (Kono-S) was described in 2003 in Crohn’s disease. Subsequent observations have suggested that this anastomosis is associated with lower endoscopic and ...surgical recurrence rates. The purpose of this study was to compare the endoscopic recurrence between the Kono-S and the side-to-side functional end anastomosis at 3-6 months after resection of Crohn’s terminal ileitis.
Methods
This was a prospective multi-center randomized trial conducted at eight international centers. Patients with Crohn’s terminal ileitis requiring elective ileocecal resection were randomized to a Kono-S (Group1) or a side-to-side functional end (Group2) anastomosis (Image1). Patients were discharged on no biologicals. Exclusion criteria included age (<18), pregnancy, recurrent or multisite Crohn’s disease, and need of postoperative treatment with biologicals. Data were collected prior to and during surgery, daily after surgery until discharge, at 30 days post-op, and at 3-6 months colonoscopy. Participating surgeons were instructed in the Kono-S technique through videos. Disease clinical activity was measured by Harvey Bradshaw Index (HBI). Endoscopic remission/recurrence was graded with the modified Rutgeerts score: endoscopic remission was defined as a Rutgeerts score of 0, 1, or 2a, and a Rutgeerts score of 2b or higher was considered a recurrence. All study sites had Institutional Review Board approval, ClinicalTrial.gov # NCT03256240.
Results
We enrolled 288 Crohn’s patients (50.7% female) with a median age of 34 (18-81). 154 patients were randomized to Group 1 (Kono-S) and 134 to Group 2 (Side-to-Side). 30 days follow-up was completed on 278 (96.9%) patients. The Kono-S group had a higher percentage of past smokers (57 vs.30, p = 0.007) and current smokers (33 vs.12, p = 0.004). The mean operative time was 22 minutes longer in the Kono-S group (154 vs.132 minutes; p = 0.386). There was no mortality. 233 (81%) patients underwent a colonoscopy at 3-6 months. There was no significant difference between the two groups in terms of endoscopic recurrence (p = 0.883) and HBI (p = 0.109) or in recurrence-free survival (Log Rank Mantel-Cox test p = 0.256) (Table 1). On multivariable analysis, current smokers had significantly higher odds for endoscopic recurrence at 3-6 months (OR= 2.80, 95% CI =1.10 - 6.92, p = 0.029).
Conclusion
Kono-S and Side-to-side anastomoses have similar endoscopic recurrence rates at 3-6 months. Independently of surgical techniques, smokers had a significantly higher rate of endoscopic recurrence at 3-6 months after surgery.
Introduction: We compared outcomes of elderly patients (>70 years) who underwent the Altemeier procedure versus laparoscopic rectopexy for full‐thickness rectal prolapse.
Materials and Methods: We ...reviewed our data from a prospective database and the medical records of patients treated at a single institution from 2002 to 2008. Patients who underwent surgery for full‐thickness rectal prolapse were evaluated.
Results: Sixteen patients underwent laparoscopic rectopexy (median age 82 years; ASA 2.6), and 16 patients underwent the Altemeier procedure (median age 85 years; ASA 2.8). The Altemeier procedure patients had a significantly higher recurrence rate when compared to laparoscopic rectopexy patients (P<0.045). The mean length of follow‐up was longer for the Altemeier group (20 months) compared to the laparoscopic rectopexy group (28.5 months; most recurrence (5/6) occurred <1 year. The median length of specimen removed in the Altmeier group was 9.5 cm (6.5–18.5 cm). The majority of patients in both groups had preoperative fecal incontinence. Significantly more Altemeier patients reported worsening perioperative fecal incontinence at 1–3 months (p<0.046). All laparoscopic rectopexy patients underwent general anesthesia while 44% of the Altemeier patients underwent regional anesthesia (p<0.003). One laparoscopic rectopexy patient required reoperation for an incarcerated trocar site hernia. No other major complications occurred in either group. There was no difference in rates of minor complications.
Discussion: Compared to the Altemeier procedure, laparoscopic rectopexy for elderly patients with rectal prolapse resulted in a significantly smaller recurrence rate, better perioperative fecal incontinence and an equivalent morbidity rate.
Investigations on the microflora of the Brazilian cockroach Blaberus giganteus L. were done in order to estimate its role as a vector of pathogenic agents. The isolated microorganisms refer mainly to ...the following groups: the family Enterobacteriaceae Salmonella entericа, Enterobacter aerogenes, Serratia liquefaciens, Hafnia alvei and the genera Pseudomonas Р. solanacearum, P. aeruginosa, Staphylococcus S. xylosus, S. haemolyticus, S. hominis, Enterococcus, Bacillus, Clostridium and Listeria. The established fungi are from the genera Fusarium, Aspergillus и Candida С. albicans. The results of the investigations show that the cockroaches from this species might be a reservoir and spreader of causal agents of infections not only among the animals and humans, but among the plants too.
Annotated list of pest insects associated with stored plant and animal products in Bulgaria is presented. The list compiles data published during the period 1891 – 2012. The valid names of insects ...according to Fauna Europea data base, their synonyms used in Bulgarian literature, and bibliography of papers concerning their bio ecology and distribution in Bulgaria are presented. The total number of 149 insect species is reported as direct and indirect pests on stored products in Bulgaria. Most numerous are insects from order Coleoptera – 76.5%, followed by Lepidoptera 15.4%. Non-indigenous for Bulgaria are 80 species, from which 39 species have cryptogenic origin.
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