Journal of Visceral Surgery最新文献

Background: High output enterostomy leads to malnutrition and fluid/electrolyte loss which may be challenging to manage despite dietary modification, anti-motility, anti-secretory drugs, and parenteral nutrition. Distal infusion stomal enteroclysis (DISE) is an alternative to restore nutritional deficit and replace parenteral nutrition in resource-limited settings where treatment cost and availability of trained nurses are limiting factors.

Objective: To assess the effectiveness and feasibility of DISE in managing postoperative enterostomal output.

Methods: Consecutive patients who met the inclusion criteria and underwent enterostomy in one year were included. Postoperatively, DISE was started after the return of bowel movement. Stomal effluent was collected, filtered, and reinfused through the distal limb using a Foley catheter. The patients and caregivers were trained to perform under supervision. At discharge, they were encouraged to maintain regular contact and advised to report back when necessary.

Results: Twenty-five patients received DISE, of which 22 were discharged and successfully continued to manage at home, while 3 expired. The median age was 36 years, the median BMI at admission and discharge was 19 and 17.8kg/m² respectively (the difference was statistically significant), and the male: female ratio was 2.5: 1. Thirty-day readmission was done for 2 patients to manage minor complications. The average stomal output was 820mL/day initially and 478mL/day at discharge. The median duration of DISE was 12 days. Thirteen patients (52%) needed parenteral nutritional support due to inadequate oral intake.

Conclusion: DISE is a feasible and effective technique for managing high output enterostomies. It can be easily taught and performed with minimal resources at home.

Purpose: Approximately 7% of patients with rectal cancer experience local recurrence within 5 years of curative surgery. A positive circumferential resection margin (CRM) is among the most significant risk factors. Other reported risk factors include histopathologic type, anastomotic leakage, positive distal margins, and more recently, the anterior localization of the tumor. In this retrospective cohort study, we aimed to assess risk factors for local recurrence in our institution, with a focus on tumor localization as an independent negative predictive factor.

Patients and methods: From 2007 to 2018, all patients with stage II or III rectal cancer were included in this study. Patients underwent neoadjuvant chemoradiotherapy followed by surgical resection with total mesorectal excision. The tumor's anterior or posterior localization was assessed by preoperative endosonography or magnetic resonance imaging. Risk factors for local recurrence were assessed using univariate and multivariate regression analyses.

Results: A total of 128 patients were included. The 3-year and 5-year local recurrence rates were 4.7% and 7%, respectively. In univariate and multivariate analyses, the histologic type of a poorly differentiated tumor (P=0.001) and a positive CRM (P=0.001) were correlated with local recurrence. Tumor localization (anterior or posterior) was not identified as a statistically significant factor associated with local recurrence.

Conclusion: Positive CRM and a poorly differentiated tumor histological subtype were found to be independent risk factors for local recurrence. In contrast to previous findings, anterior localization was not identified as an independent risk factor for local recurrence in our patient cohort.