BACKGROUND Complications associated with stomas—including parastomal hernia(PSH),pro-lapse,mucocutaneous separation,and stoma retraction—provide considerable postoperative challenges for colostomy patients.Selecting...BACKGROUND Complications associated with stomas—including parastomal hernia(PSH),pro-lapse,mucocutaneous separation,and stoma retraction—provide considerable postoperative challenges for colostomy patients.Selecting between extraperi-toneal colostomy(EPC)and transperitoneal colostomy(TPC)pathways is there-fore essential for mitigating these complications.AIM To analyze the existing data regarding the efficacy of EPC compared to TPC in reducing stoma-related complications post-colostomy.METHODS PubMed,Google Scholar,EMBASE,MEDLINE,and the Cochrane Library were adopted to uncover pertinent papers in which EPC and TPC approaches were compared.We then conducted a meta-analysis using RevMan 5.4.1.RESULTS Both laparoscopic(Lap)and open approaches showed a reduced incidence of PSH in EPC relative to TPC(P<0.00001 and P=0.02 respectively).In addition,Lap EPC depicted a lesser incidence of prolapse,mucocutaneous separation,and stoma retraction(P=0.007,P=0.03,and P=0.01,respectively)compared to Lap TPC.However,EPC and TPC did not differ with respect to operation time,blood loss,edema,ischemia,necrosis,or infection after the LAP approach.CONCLUSION The extraperitoneal approach may provide benefits in minimizing some stoma-related problems such as PSH,pro-lapse,mucocutaneous separation,and stoma retraction after colostomy surgery.展开更多
BACKGROUND Elderly patients with refractory ulcerative colitis(UC)have a poor prognosis,and timely surgical intervention should not be delayed.However,with the advent of biologics,therapy has become more complex,and t...BACKGROUND Elderly patients with refractory ulcerative colitis(UC)have a poor prognosis,and timely surgical intervention should not be delayed.However,with the advent of biologics,therapy has become more complex,and there are no clear criteria for the timing of surgical conversion.AIM To investigate the risk factors for postoperative complications in elderly patients with UC.METHODS Elderly patients(≥60 years old)with refractory UC who underwent colectomy at Hyogo Medical University between April 2012 and March 2024 were included in this study.Fatal complications included life-threatening complications requiring intensive care unit management and death.The primary outcome was defined by possible risk factors for fatal complications in older patients with refractory UC.RESULTS A total of 191 elderly patients with UC were analyzed in this series.The rate of fatal complications was 18/191(9.4%),and the most common complication was pneumonia due to disuse syndrome.Body mass index(BMI)<17 kg/m^(2)[odds ratio(OR)=4.08,95%confidence interval(95%CI):1.19-13.97,P=0.02]and Eastern Cooperative Oncology Group performance status(ECOG-PS)≥3(OR=14.5,95%CI:3.43-61.64,P<0.01)were identified as independent risk factors for fatal complications.CONCLUSION Among the elderly patients with refractory UC,the risk factors for fatal complications were low BMI and ECOG-PS score.Prompt surgical intervention is recommended before the patient loses weight or has difficulty walking.These factors may allow for early surgical decision-making before patients become debilitated.展开更多
BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in d...BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment.There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.CASE SUMMARY Here,we report a 16-year-old female patient with intestinal obstruction due to AC.She was treated with abdominal surgery three times.First,she underwent a laparotomy for peritonitis after trauma from a traffic accident.During the pro-cedure,pelvic empyema,severe intestinal adhesions,and damage to the serous layer of the rectum were found,but no significant intestinal rupture and perfo-ration were found.As a precaution,she underwent a prophylactic ileostomy after a flush in her abdomen.The second and third surgeries were for treatment of recurrent stoma obstruction.The patient’s condition was complicated for a long period,but after comprehensive treatment by our department,the patient was successfully discharged from the hospital and is currently recovering well.CONCLUSION Currently,abdominal contrast-enhanced computed tomography is the best imaging modality for pre-operative evaluation of AC,but most patients are diagnosed only after intrao-perative exploration.For the treatment of typical or severe ACs,the primary me-thod of removal and healing of ACs is complete removal of the abdominal fibrous membrane.Finding a breakthrough in the anatomy is the key to the success of the surgery.展开更多
文摘BACKGROUND Complications associated with stomas—including parastomal hernia(PSH),pro-lapse,mucocutaneous separation,and stoma retraction—provide considerable postoperative challenges for colostomy patients.Selecting between extraperi-toneal colostomy(EPC)and transperitoneal colostomy(TPC)pathways is there-fore essential for mitigating these complications.AIM To analyze the existing data regarding the efficacy of EPC compared to TPC in reducing stoma-related complications post-colostomy.METHODS PubMed,Google Scholar,EMBASE,MEDLINE,and the Cochrane Library were adopted to uncover pertinent papers in which EPC and TPC approaches were compared.We then conducted a meta-analysis using RevMan 5.4.1.RESULTS Both laparoscopic(Lap)and open approaches showed a reduced incidence of PSH in EPC relative to TPC(P<0.00001 and P=0.02 respectively).In addition,Lap EPC depicted a lesser incidence of prolapse,mucocutaneous separation,and stoma retraction(P=0.007,P=0.03,and P=0.01,respectively)compared to Lap TPC.However,EPC and TPC did not differ with respect to operation time,blood loss,edema,ischemia,necrosis,or infection after the LAP approach.CONCLUSION The extraperitoneal approach may provide benefits in minimizing some stoma-related problems such as PSH,pro-lapse,mucocutaneous separation,and stoma retraction after colostomy surgery.
文摘BACKGROUND Elderly patients with refractory ulcerative colitis(UC)have a poor prognosis,and timely surgical intervention should not be delayed.However,with the advent of biologics,therapy has become more complex,and there are no clear criteria for the timing of surgical conversion.AIM To investigate the risk factors for postoperative complications in elderly patients with UC.METHODS Elderly patients(≥60 years old)with refractory UC who underwent colectomy at Hyogo Medical University between April 2012 and March 2024 were included in this study.Fatal complications included life-threatening complications requiring intensive care unit management and death.The primary outcome was defined by possible risk factors for fatal complications in older patients with refractory UC.RESULTS A total of 191 elderly patients with UC were analyzed in this series.The rate of fatal complications was 18/191(9.4%),and the most common complication was pneumonia due to disuse syndrome.Body mass index(BMI)<17 kg/m^(2)[odds ratio(OR)=4.08,95%confidence interval(95%CI):1.19-13.97,P=0.02]and Eastern Cooperative Oncology Group performance status(ECOG-PS)≥3(OR=14.5,95%CI:3.43-61.64,P<0.01)were identified as independent risk factors for fatal complications.CONCLUSION Among the elderly patients with refractory UC,the risk factors for fatal complications were low BMI and ECOG-PS score.Prompt surgical intervention is recommended before the patient loses weight or has difficulty walking.These factors may allow for early surgical decision-making before patients become debilitated.
基金Supported by Suqian Science and Technology Project Contract,No.S201910。
文摘BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment.There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.CASE SUMMARY Here,we report a 16-year-old female patient with intestinal obstruction due to AC.She was treated with abdominal surgery three times.First,she underwent a laparotomy for peritonitis after trauma from a traffic accident.During the pro-cedure,pelvic empyema,severe intestinal adhesions,and damage to the serous layer of the rectum were found,but no significant intestinal rupture and perfo-ration were found.As a precaution,she underwent a prophylactic ileostomy after a flush in her abdomen.The second and third surgeries were for treatment of recurrent stoma obstruction.The patient’s condition was complicated for a long period,but after comprehensive treatment by our department,the patient was successfully discharged from the hospital and is currently recovering well.CONCLUSION Currently,abdominal contrast-enhanced computed tomography is the best imaging modality for pre-operative evaluation of AC,but most patients are diagnosed only after intrao-perative exploration.For the treatment of typical or severe ACs,the primary me-thod of removal and healing of ACs is complete removal of the abdominal fibrous membrane.Finding a breakthrough in the anatomy is the key to the success of the surgery.
