Surgery Open Digestive Advance最新文献

Umbilical metastasis, also known as Sister Mary Joseph's nodule, is a rare clinical manifestation of colon cancer. It usually represents late stage with advanced disease. Herein, we report a case of colon cancer presenting with Mary Joseph's nodule. In the literature, the treatment modality is controversial and management is commonly palliative. However, few reports have suggested that surgical treatment might influence the prognosis. We reviewed the published literature on this phenomenon. Statistical analysis confirmed that colectomy did not appear to provide a survival outcome.

Introduction

Sigmoidal diverticulitis is the inflammation or infection of a diverticulum. It may be simple or complicate into an abscess, perforation, stenosis or fistula. These complications are referred to as diverticular disease. Surgical treatment may be required as an emergency measure in the event of serious signs, or at a later stage if disabling symptoms persist. The aim of this study was to assess the 90-day post-operative morbidity and mortality of complicated sigmoidal diverticulitis managed in emergency.

Methods

We retrospectively included all patients (n = 62) with complicated sigmoidal diverticulitis who underwent surgery between 2010 and 2019. 90-day mortality was assessed for each patient. Overall morbidity was assessed using the Dindo-Clavien classification, with major morbidity corresponding to stages ≥III. Factors predictive of overall and major morbidity were analyzed.

Results

Postoperative mortality at 90 days was nil. Overall morbidity at 90 days according to the Dindo-Clavien classification was 80,7 %, with major morbidity at 27,4 %. Multivariate logistic regression analysis retained male gender (OR=6.77[1,40; 32.74], p = 0.02), BMI over 25 (OR=58.82[3.95; 876.95], p = 0.01) and smoking (OR=8.77[0.84; 91.13], p = 0.07) as independent predictors of the occurrence of overall morbidity at 90 days. Likewise, only an ASA score ≥ III was highlighted as an independent predictive factor (OR=5.00[1.51; 16.51], p = 0.01) of major morbidity at 90 days (Dindo-Clavien ≥ III).

Conclusion

In our study, mortality was nil, the overall morbidity rate was 80.7 % and 27.4 % for major morbidity. Nevertheless, the choice of surgical technique remains open to debate, given the absence of any difference in morbidity and mortality from anastomotic resection during emergency surgery, and the less morbid and easier restoration of digestive continuity afterwards in selected patients.

Background

Herein we describe the anatomic consequences of maintaining splenic artery and removing the splenic vein in distal pancreatectomy with spleen preservation.

Patients and Methods

The records of 9 patients who were scheduled for splenic preservation distal pancreatectomy were analyzed.

Results

Three patients underwent vessels preservation, 4 had splenic vein ligation and artery preservation, Warshaw procedure was performed in 1 patient, and another patient required unintended splenectomy. In the long-term follow-up, one patient had submucosal gastric varices and gastrointestinal bleeding 12.7 years after distal pancreatectomy. One patient developed perisplenic varicesand hypertrophic perigastric veins, and 3 patients developed perigastric hypertrophic vessels. None of these patients manifest gastric bleeding.

Discussion

Spleen preservation in distal pancreatectomy can be performed by preserving splenic artery and vein, ligation of the vein, or ligation of vein and artery and preservation of short gastric vessels. It is not unusual the hypertrophic perigastric vessels development after distal pancreatectomy with spleen preservation. Submucosal varices may result in late gastric hemorrhage.

Background

During laparoscopic inguinal hernia repair (LIH) repair, it is common practice to insert a urinary catheter (UC) to mitigate the risk of bladder injury or acute postoperative urinary retention. However, this procedure often leads to potential complications or infections. This study aims to evaluate the implications of the UC placement during LIH repair.

Methods

This retrospective, monocentric study included patients who underwent LIH repair between 01/01/2018 to 31/12/2022. Patients were divided into two groups: UC and no-UC.

Results

212 patients were included: 119 (56 %) in the no-UC group and 93 (44 %) in the UC group. The UC group presented a higher prevalence of bilateral hernias (38.7 % vs. 52.7 %), (p = 0.01) and a greater frequency of intraperitoneal approach (TAPP) (83.9 % vs. 100 %), (p = 0.01). No intraoperative complications were attributable to the absence of the UC. Four patients in the UC group had postoperative acute urinary retention necessitating intermittent catheterization, allowing discharge (p = 0.13). Rates of readmission and reoperation rates were comparable between groups. One month post-surgery, 7.5 % of UC group patients (vs. 0.8 %) developed urinary tract infection (p = 0.01). Subgroup analysis confirmed a higher incidence of urinary tract infections in unilateral hernia and in TAPP procedure.

Conclusion

Routine UC insertion during LIH repair seems unnecessary; rather, it increases the risk of postoperative urinary tract infections and should thus be avoided.

Introduction

External rectal prolapse (ERP) is a complete protrusion of the rectal wall through the anal canal. The precise prevalence of recurrent (R)- ERP is still unknown although some studies have reported 20–30 % after primary surgery. The aim of this study was to assess the anatomic and functional outcomes of R-ERP surgical treatment proposing a decision-making algorithm for this rare and challenging disease.

Material and methods

This is a case series report. Of the 141 patients treated for external rectal prolapsed between January 2014 and December 2020, 19 (3M-16F) developed a recurrence. Anatomical recurrence was assessed and classified as complete or partial and mucosal or full-thickness. Functional outcomes were assessed using Wexner scores for constipation and incontinence. The global satisfaction rate was evaluated using a 5-point scale.

Results

The patients were stratified according to the first line surgery: 5(26 %) Delorme (Group A), 6(32 %) Altemeier (Group B), and 8(42 %) robotic ventral rectopexy (Group C). Five patients had a previous proctologic and pelvic floor surgery; Functional disorders were: 8 (42 %) fecal incontinence and 4(21 %) ODS. The overall recurrence rate was 21.4 %. The overall functional outcomes showed a significant improvement in the Wexner incontinence score (median value 8.7 vs 3.1) and constipation score (10.4 vs 4.6). 78.6 % patients declared to be satisfied.

Conclusion

The treatment of choice for R-ERP needs to be tailored according to personal surgical competence considering the first-line ERP surgery,prolapse characteristics, and patients’ comorbidities.

Background

Gastric cancer is an important cause of morbidity and mortality worldwide. Laparoscopic procedures have been adopted to perform oncologic resection but still required a mini-laparotomy incision for specimen extraction. Natural orifice specimen extraction has proven to be an effective method to minimize trauma, decrease complications, speed recovery, and improve cosmetic result.

Case presentation

This is the case of a 67-year-old obese lady presenting with asymptomatic microcytic anemia wherein investigations revealed her to have subcardial gastric adenocarcinoma stage IIA. She underwent neoadjuvant chemotherapy followed by laparoscopic total gastrectomy with D2 lymphadenectomy. The procedure was complemented by a roux-en-y gastrojejunal anastomosis complemented with transvaginal specimen extraction through a posterior colpotomy. The recovery period post-operatively went smoothly and the patient had no major complaints on follow up.

Conclusion

Extracting a gastric cancer specimen transvaginally after laparoscopic procedures is feasible in females, mostly postmenopausal, who are overweight, even obese, and might pose a way to lessen complications post-operatively.