BACKGROUND Single port laparoscopic surgery allows total colectomy and end ileostomy for medically uncontrolled ulcerative colitis solely via the stoma site incision.While intuitively appealing,there is sparse evidenc...BACKGROUND Single port laparoscopic surgery allows total colectomy and end ileostomy for medically uncontrolled ulcerative colitis solely via the stoma site incision.While intuitively appealing,there is sparse evidence for its use beyond feasibility.AIM To examine the usefulness of single access laparoscopy(SAL)in a general series experience of patients sick with ulcerative colitis.METHODS All patients presenting electively,urgently or emergently over a three-year period under a colorectal specialist team were studied.SAL was performed via the stoma site on a near-consecutive basis by one surgical team using a“surgical glove port”allowing group-comparative and case-control analysis with a contemporary cohort undergoing conventional multiport surgery.Standard,straight rigid laparoscopic instrumentation were used without additional resource.RESULTS Of 46 consecutive patients requiring surgery,39(85%)had their procedure begun laparoscopically.27(69%)of these were commenced by single port access with an 89%completion rate thereafter(three were concluded by multi-trocar laparoscopy).SAL proved effective in comparison to multiport access regardless of disease severity providing significantly reduced operative access costs(>100€case)and postoperative hospital stay(median 5 d vs 7.5 d,P=0.045)without increasing operative time.It proved especially efficient in those with preoperative albumin>30 g/dL(n=20).Its comparative advantages were further confirmed in ten pairs case-matched for gender,body mass index and preoperative albumin.SAL outcomes proved durable in the intermediate term(median follow-up=20 mo).CONCLUSION Single port total colectomy proved useful in planned and acute settings for patients with medically refractory colitis.Assumptions regarding duration and cost should not be barriers to its implementation.展开更多
A patent foramen ovale(PFO)is a clinical condition linked to ischemic stroke,aura migraine,and other pathologies.Current medical consensus posits that PFO closure may mitigate the risk of recurrent strokes.This case r...A patent foramen ovale(PFO)is a clinical condition linked to ischemic stroke,aura migraine,and other pathologies.Current medical consensus posits that PFO closure may mitigate the risk of recurrent strokes.This case report details the management of a 61-year-old female diagnosed with colon cancer for one month.Preoperative transthoracic echocardiography indicated a potential left-to-right shunt through the foramen ovale and mild regurgitation of both the mitral and aortic valves.The patient’s history revealed previous left-sided migraines,and a review of her medical records disclosed multifocal cerebral infarctions identified by a head CT.A pulmonary artery computed tomography angiography suggested embolization in the anterior branch of the right upper pulmonary artery and several branches of the right lower lung’s posterior and lateral basilar artery,along with thickening of the trunk canals of the pulmonary arteries.After a thorough assessment and extensive consultation with the surgical team,the procedure was transitioned from a laparoscopic radical resection to an open total colectomy.Anesthesia induction required careful avoidance of hypoxia,breath-holding,and coughing.Vigilant management of respiratory and circulatory functions was crucial during periods prone to intraoperative embolism formation.Postoperatively,attention was given to the stabilization of respiratory and circulatory functions during extubation,ensuring adequate sputum suction to prevent choking and close monitoring of breathing to avert airway obstruction post-extubation.Additionally,the patient was closely monitored for postoperative nausea and vomiting,a high-risk condition for this patient cohort.Strategies were implemented to minimize the risk of right-to-left shunting,ensuring the patient’s vital signs remained stable throughout the perioperative period.The patient was discharged safely after a 10-day recovery.For patients with cancer and PFO,comprehensive risk assessment and meticulous safety management are paramount.This case confirms the patient’s history of patent foramen ovale through the association between some atypical symptoms such as migraine,pulmonary embolism and cerebral infarction,which provides guidance for the management of anesthesia in the perioperative period,offering significant clinical implications.展开更多
AIM:To determine long-term outcomes of surgical treatments for patients with constipation and features of colonic pseudo-obstruction.METHODS:Consecutive 42 patients who underwent surgery for chronic constipation withi...AIM:To determine long-term outcomes of surgical treatments for patients with constipation and features of colonic pseudo-obstruction.METHODS:Consecutive 42 patients who underwent surgery for chronic constipation within the last 13 years were prospectively collected.We identified a subgroup with colonic pseudo-obstruction(CPO) features,with dilatation of the colon proximal to the narrowed transitional zone,in contrast to typical slowtransit constipation(STC),without any dilated colonic segments.The outcomes of surgical treatments for chronic constipation with features of CPO were analyzed and compared with outcomes for STC.RESULTS:Of the 42 patients who underwent surgery for constipation,33 patients had CPO with dilatation of the colon proximal to the narrowed transitional zone.There were 16 males and 17 females with a mean age of 51.2 ± 16.1 years.All had symptoms of chronic intestinal obstruction,including abdominal distension,pain,nausea,or vomiting,and the mean duration of symptoms was 67 mo(range:6-252 mo).Preoperative defecation frequency was 1.5 ± 0.6 times/wk(range:1-2 times/wk).Thirty-two patients underwent total colectomy,and one patient underwent diverting transverse colostomy.There was no surgery-related mortality.Postoperative histologic examination showed hypoganglionosis or agangliosis in 23 patients and hypoganglionosis combined with visceral neuropathy or myopathy in 10 patients.In contrast,histology of STC group revealed intestinal neuronal dysplasia type B(n = 6) and visceral myopathy(n = 3).Early postoperative complications developed in six patients with CPO;wound infection(n = 3),paralytic ileus(n = 2),and intraabdominal abscess(n = 1).Defecation frequencies 3 mo after surgery improved to 4.2 ± 3.2 times/d(range:1-15 times/d).Long-term follow-up(median:39.7 mo) was available in 32 patients;all patients had improvements in constipation symptoms,but two patients needed intermittent medication for management of diarrhea.All 32 patients had distinct improvements in constipation symptoms(with a mean bowel frequency of 3.3 ± 1.3 times/d),social activities,and body mass index(20.5 kg/m 2 to 22.1 kg/m 2) and were satisfied with the results of their surgical treatment.In comparison with nine patients who underwent colectomy for STC without colon dilatation,those in the CPO group had a lower incidence of small bowel obstructions(0% vs 55.6%,P < 0.01) and less difficulty with long-distance travel(6.7% vs 66.7%,P = 0.007) on long-term follow-up.CONCLUSION:Chronic constipation patients with features of CPO caused by narrowed transitional zone in the left colon had favorable outcomes after total colectomy.展开更多
The most common localization for intestinal Crohn’s disease(CD)is the terminal ileum and ileocecal area.It is estimated that patients with CD have one in four chance of undergoing surgery during their life.As surgery...The most common localization for intestinal Crohn’s disease(CD)is the terminal ileum and ileocecal area.It is estimated that patients with CD have one in four chance of undergoing surgery during their life.As surgery in ulcerative colitis ultimately cures the disease,in CD,regardless of the extent of bowel removed,the risk of disease recurrence is as high as 40%.In elective surgery,management of isolated Crohn’s colitis continues to evolve.Depending on the type of surgery performed,colonic CD patients often require further medical or surgical therapy to prevent or treat recurrence.The elective surgical treatment of colonic CD is strictly dependent on the localization of disease,and the choice of the procedure is dependent of the extent of colonic involvement and previous resection.The most common surgical options in colonic CD are total proctocolectomy(TPC)with permanent ileostomy,segmental bowel resection,subtotal colectomy.TPC completely removes all colonic and rectal disease and avoids the use of a potentially diseased anus.We will review current options for the elective surgical treatment of colonic CD,based on the current literature and our own personal experience.展开更多
Intestinal pseudo-obstruction (IPO) either acute or chronic is a condition including features of intestinal ileus in absence of mechanical obstruction. Our paper presents such a rare case of idiopathic IPO in a 53-yea...Intestinal pseudo-obstruction (IPO) either acute or chronic is a condition including features of intestinal ileus in absence of mechanical obstruction. Our paper presents such a rare case of idiopathic IPO in a 53-year-old male patient with recurrent episodes of pseudo-obstruction, which were successfully resolved by anticholinesterase agents, motilin agonists or colonic decompression. However, the patient finally underwent total colectomy. Huge colonic dilatation was identified intraoperatorily, while histology showed a neuropathic variant of chronic intestinal pseudo-obstruction. Etiologic mechanisms and current therapeutic methods are reviewed in this paper, which concludes that IPO is a condition in which conservative treatment usually fails. Total colectomy with ileoanal pouch may be the only solution in these situations.展开更多
Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conv...Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease.The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven.Furthermore,these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications.Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients.Surgery is traditionally recommended as salvage therapy when medical management fails,and,despite advances in medical therapy,colectomy rates remain unchanged between 20% and 30%.To overcome the reported increase in postoperative complications in patients on biologic therapies,several surgical strategies have been developed to maintain long-term pouch failure rate around 10%,as previously reported.Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.展开更多
文摘BACKGROUND Single port laparoscopic surgery allows total colectomy and end ileostomy for medically uncontrolled ulcerative colitis solely via the stoma site incision.While intuitively appealing,there is sparse evidence for its use beyond feasibility.AIM To examine the usefulness of single access laparoscopy(SAL)in a general series experience of patients sick with ulcerative colitis.METHODS All patients presenting electively,urgently or emergently over a three-year period under a colorectal specialist team were studied.SAL was performed via the stoma site on a near-consecutive basis by one surgical team using a“surgical glove port”allowing group-comparative and case-control analysis with a contemporary cohort undergoing conventional multiport surgery.Standard,straight rigid laparoscopic instrumentation were used without additional resource.RESULTS Of 46 consecutive patients requiring surgery,39(85%)had their procedure begun laparoscopically.27(69%)of these were commenced by single port access with an 89%completion rate thereafter(three were concluded by multi-trocar laparoscopy).SAL proved effective in comparison to multiport access regardless of disease severity providing significantly reduced operative access costs(>100€case)and postoperative hospital stay(median 5 d vs 7.5 d,P=0.045)without increasing operative time.It proved especially efficient in those with preoperative albumin>30 g/dL(n=20).Its comparative advantages were further confirmed in ten pairs case-matched for gender,body mass index and preoperative albumin.SAL outcomes proved durable in the intermediate term(median follow-up=20 mo).CONCLUSION Single port total colectomy proved useful in planned and acute settings for patients with medically refractory colitis.Assumptions regarding duration and cost should not be barriers to its implementation.
基金supported by grants from the Anhui Provincial Natural Science Foundation(Grant No.2208085Y32 to Chaoliang Tang)the Chen Xiao-Ping Foundation for the Development of Science and Technology of Hubei Province(Grant No.CXPJJH12000005-07-115 to Chaoliang Tang).
文摘A patent foramen ovale(PFO)is a clinical condition linked to ischemic stroke,aura migraine,and other pathologies.Current medical consensus posits that PFO closure may mitigate the risk of recurrent strokes.This case report details the management of a 61-year-old female diagnosed with colon cancer for one month.Preoperative transthoracic echocardiography indicated a potential left-to-right shunt through the foramen ovale and mild regurgitation of both the mitral and aortic valves.The patient’s history revealed previous left-sided migraines,and a review of her medical records disclosed multifocal cerebral infarctions identified by a head CT.A pulmonary artery computed tomography angiography suggested embolization in the anterior branch of the right upper pulmonary artery and several branches of the right lower lung’s posterior and lateral basilar artery,along with thickening of the trunk canals of the pulmonary arteries.After a thorough assessment and extensive consultation with the surgical team,the procedure was transitioned from a laparoscopic radical resection to an open total colectomy.Anesthesia induction required careful avoidance of hypoxia,breath-holding,and coughing.Vigilant management of respiratory and circulatory functions was crucial during periods prone to intraoperative embolism formation.Postoperatively,attention was given to the stabilization of respiratory and circulatory functions during extubation,ensuring adequate sputum suction to prevent choking and close monitoring of breathing to avert airway obstruction post-extubation.Additionally,the patient was closely monitored for postoperative nausea and vomiting,a high-risk condition for this patient cohort.Strategies were implemented to minimize the risk of right-to-left shunting,ensuring the patient’s vital signs remained stable throughout the perioperative period.The patient was discharged safely after a 10-day recovery.For patients with cancer and PFO,comprehensive risk assessment and meticulous safety management are paramount.This case confirms the patient’s history of patent foramen ovale through the association between some atypical symptoms such as migraine,pulmonary embolism and cerebral infarction,which provides guidance for the management of anesthesia in the perioperative period,offering significant clinical implications.
文摘AIM:To determine long-term outcomes of surgical treatments for patients with constipation and features of colonic pseudo-obstruction.METHODS:Consecutive 42 patients who underwent surgery for chronic constipation within the last 13 years were prospectively collected.We identified a subgroup with colonic pseudo-obstruction(CPO) features,with dilatation of the colon proximal to the narrowed transitional zone,in contrast to typical slowtransit constipation(STC),without any dilated colonic segments.The outcomes of surgical treatments for chronic constipation with features of CPO were analyzed and compared with outcomes for STC.RESULTS:Of the 42 patients who underwent surgery for constipation,33 patients had CPO with dilatation of the colon proximal to the narrowed transitional zone.There were 16 males and 17 females with a mean age of 51.2 ± 16.1 years.All had symptoms of chronic intestinal obstruction,including abdominal distension,pain,nausea,or vomiting,and the mean duration of symptoms was 67 mo(range:6-252 mo).Preoperative defecation frequency was 1.5 ± 0.6 times/wk(range:1-2 times/wk).Thirty-two patients underwent total colectomy,and one patient underwent diverting transverse colostomy.There was no surgery-related mortality.Postoperative histologic examination showed hypoganglionosis or agangliosis in 23 patients and hypoganglionosis combined with visceral neuropathy or myopathy in 10 patients.In contrast,histology of STC group revealed intestinal neuronal dysplasia type B(n = 6) and visceral myopathy(n = 3).Early postoperative complications developed in six patients with CPO;wound infection(n = 3),paralytic ileus(n = 2),and intraabdominal abscess(n = 1).Defecation frequencies 3 mo after surgery improved to 4.2 ± 3.2 times/d(range:1-15 times/d).Long-term follow-up(median:39.7 mo) was available in 32 patients;all patients had improvements in constipation symptoms,but two patients needed intermittent medication for management of diarrhea.All 32 patients had distinct improvements in constipation symptoms(with a mean bowel frequency of 3.3 ± 1.3 times/d),social activities,and body mass index(20.5 kg/m 2 to 22.1 kg/m 2) and were satisfied with the results of their surgical treatment.In comparison with nine patients who underwent colectomy for STC without colon dilatation,those in the CPO group had a lower incidence of small bowel obstructions(0% vs 55.6%,P < 0.01) and less difficulty with long-distance travel(6.7% vs 66.7%,P = 0.007) on long-term follow-up.CONCLUSION:Chronic constipation patients with features of CPO caused by narrowed transitional zone in the left colon had favorable outcomes after total colectomy.
文摘The most common localization for intestinal Crohn’s disease(CD)is the terminal ileum and ileocecal area.It is estimated that patients with CD have one in four chance of undergoing surgery during their life.As surgery in ulcerative colitis ultimately cures the disease,in CD,regardless of the extent of bowel removed,the risk of disease recurrence is as high as 40%.In elective surgery,management of isolated Crohn’s colitis continues to evolve.Depending on the type of surgery performed,colonic CD patients often require further medical or surgical therapy to prevent or treat recurrence.The elective surgical treatment of colonic CD is strictly dependent on the localization of disease,and the choice of the procedure is dependent of the extent of colonic involvement and previous resection.The most common surgical options in colonic CD are total proctocolectomy(TPC)with permanent ileostomy,segmental bowel resection,subtotal colectomy.TPC completely removes all colonic and rectal disease and avoids the use of a potentially diseased anus.We will review current options for the elective surgical treatment of colonic CD,based on the current literature and our own personal experience.
文摘Intestinal pseudo-obstruction (IPO) either acute or chronic is a condition including features of intestinal ileus in absence of mechanical obstruction. Our paper presents such a rare case of idiopathic IPO in a 53-year-old male patient with recurrent episodes of pseudo-obstruction, which were successfully resolved by anticholinesterase agents, motilin agonists or colonic decompression. However, the patient finally underwent total colectomy. Huge colonic dilatation was identified intraoperatorily, while histology showed a neuropathic variant of chronic intestinal pseudo-obstruction. Etiologic mechanisms and current therapeutic methods are reviewed in this paper, which concludes that IPO is a condition in which conservative treatment usually fails. Total colectomy with ileoanal pouch may be the only solution in these situations.
文摘Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease.The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven.Furthermore,these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications.Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients.Surgery is traditionally recommended as salvage therapy when medical management fails,and,despite advances in medical therapy,colectomy rates remain unchanged between 20% and 30%.To overcome the reported increase in postoperative complications in patients on biologic therapies,several surgical strategies have been developed to maintain long-term pouch failure rate around 10%,as previously reported.Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.
