Laparoscopic lavage for perforated diverticulitis in the LapLav study: population-based registry study.

BACKGROUND: The standard treatment for Hinchey III perforated diverticulitis with peritonitis was resection with or without a stoma, but recent trials have shown that laparoscopic lavage is a reasonable alternative. This registry-based Swedish study investigated results at a national level to assess safety in real-world scenarios. METHODS: Patients in Sweden who underwent emergency surgery for perforated diverticulitis between 2016 and 2018 were studied. Inverse probability weighting by propensity score was used to adjust for confounding factors. RESULTS: A total of 499 patients were included in this study. Laparoscopic lavage was associated with a significantly lower 90-day Comprehensive Complication Index (20.9 versus 32.0; odds ratio 0.77, 95 per cent compatibility interval (c.i.) 0.61 to 0.97) and overall duration of hospital stay (9 versus 15 days; ratio of means 0.84, 95 per cent c.i. 0.74 to 0.96) compared with resection. Patients had 82 (95 per cent c.i. 39 to 140) per cent more readmissions following lavage than resection (27.2 versus 21.0 per cent), but similar reoperation rates. More co-morbidity was noted among patients who underwent resection than those who had laparoscopic lavage. CONCLUSION: Laparoscopic lavage is safe in routine care beyond trial evaluations.

Diverticulitis comprises inflammation in pouches (diverticula) of the large intestine. In the most severe instances, this inflammation can cause perforation of the bowel with purulent or faecal peritonitis. If this happens, surgery is needed. The traditional method has been resection of the inflamed bowel with a stoma. A new technique has been proposed whereby the abdomen is rinsed with saline laparoscopically and a drain is placed (laparoscopic lavage). This study aimed to compare these two methods in terms of clinical short-term outcomes, with a focus on complications. It was found that laparoscopic lavage had fewer complications than resectional surgery and a shorter hospital stay. The new method was safe when used in Swedish routine care.

Urogenital function 3 years after abdominoperineal excision for rectal cancer.

AIM: The aim of this study was to explore urogenital dysfunction and associated risk factors after treatment of rectal cancer, in a large national cohort of patients 3 years after abdominoperineal excision, and to compare outcomes with a reference population and a cohort of patients operated for prostate cancer. METHOD: Patients treated with abdominoperineal excision in 2007-2009 were identified using the Swedish Colorectal Cancer Registry. All consenting patients received a questionnaire. A sample of the Swedish population was contacted and completed a questionnaire. Patients undergoing radical prostatectomy in a prospective multicentre trial received questionnaires 24 months after surgery. RESULTS: In the abdominoperineal excision, reference and radical prostatectomy populations 72%, 51% and 91% of the questionnaires were returned. Within the abdominoperineal excision group 36% of the men and 57% of the women were incontinent postoperatively. Fifteen per cent and 37% of men and women in the reference group were incontinent. Two years after radical prostatectomy 49% were incontinent. Seventy-four per cent of the men had erectile dysfunction after abdominoperineal excision. Nineteen per cent of the women experienced reduced ability to reach orgasm. Fewer men and women experienced their present sex life as satisfying after abdominoperineal excision for rectal cancer compared with the reference population. CONCLUSION: A large proportion of patients endure persistent urogenital dysfunction after abdominoperineal excision for rectal cancer as do men after radical prostatectomy. Effects on sexual and urinary function should be part of preoperative information and after surgery patients should be asked about function in order to identify those in need of further assistance.

Ostomy function after abdominoperineal resection--a clinical and patient evaluation.

PURPOSE: Abdominoperineal resection (APR) for rectal cancer results in a permanent colostomy. As a consequence of a recent change in operative technique from standard (S-APR) to extralevator resection (E-APR), the perineal part of the procedure is now performed with the patient in a prone jackknife position. The impact of this change on stoma function is unknown. The aim was to determine stoma-related complications and the individual patient experience of a stoma. METHODS: Consecutive patients with rectal cancer operated on with APR in one institution in 2004 to 2009 were included. Recurrent cancer, palliative procedures, pre-existing stoma and patients not alive at the start of the study were excluded. Data were collected from hospital records and the national colorectal cancer registry. A questionnaire was sent out to patients. The median follow-up was 44 months (13-84) after primary surgery. RESULTS: Ninety-six patients were alive in February 2011. Seventy seven agreed to participate. Sixty-nine patients (90 %) returned the questionnaire. Stoma necrosis was more common for E-APR, 34 % vs. 10 %, but bandaging problems and low stoma height were more common for S-APR. There were no differences in the patients' experience of stoma function. In all, 35 % of the patients felt dirty and unclean, but 90 % felt that they had a full life and could engage in leisure activities of their choice. CONCLUSIONS: This exploratory study indicates no difference in stoma function after 1 year between S-APR and E-APR. Over 90 % of the patients accept their stoma, but our study indicates that more information and support for patients are warranted.

Randomized clinical trial of fluid restriction in colorectal surgery.

BACKGROUND: Perioperative fluid therapy can influence postoperative hospital stay and complications after elective colorectal surgery. This trial was designed to examine whether an extremely restricted perioperative fluid protocol would reduce hospital stay beyond the existing fast-track hospital time of 7 days after surgery. METHODS: Patients were randomized to restricted or standard perioperative intravenous fluid regimens in a single-centre trial. Randomization was stratified for colonic, rectal, open and laparoscopic surgery. Patients were all treated within a fast-track protocol (careful preoperative preparation, optimal analgesia, early oral nutrition and early mobilization). The primary endpoint was length of postoperative hospital stay. The secondary endpoint was complications within 30 days. RESULTS: Seventy-nine patients were randomized to restricted and 82 to standard fluid therapy. Patients in the restricted group received a median of 3050 ml fluid on the day of surgery compared with 5775 ml in the standard group (P < 0·001). There was no difference between groups in primary hospital stay (median 6·0 days in both groups; P = 0·194) or stay including readmission (median 6·0 days in both groups; P = 0·158). The proportion of patients with complications was significantly lower in the restricted group (31 of 79 versus 47 of 82; P = 0·027). Vasopressors were more often required in the restricted group (97 versus 80 per cent; P < 0·001). CONCLUSION: Restricted perioperative intravenous fluid administration does not reduce length of stay in a fast-track protocol.

IgE myeloma: a case presentation and a review of the literature.

In the literature, fewer than 40 cases of IgE myeloma have been described. We report the first Norwegian case, an 80-year-old man presenting with progressive weakness, dyspnea and dizziness. With the exception of hypersedimentation, routine chemistry values were within reference limits. Plasma cells were not observed in the peripheral blood. Serum protein electrophoresis showed a monoclonal protein in the gammaglobulin fraction. Immunofixation confirmed the presence of an IgE kappa monoclonal protein. A bone marrow biopsy revealed an interstitial and nodular infiltration of abnormal plasma cells comprising 40% of nucleated cells present. Skeletal roentgenograms of this patient showed osteolytic lesions in the skull and in the left pubic arc. The findings for this patient were compared with the previous reports of IgE myeloma.

Antigen-induced dyspnea in Sprague Dawley rats. Effects of local treatment with anti-asthmatic drugs.

We wanted to study the effect of anti-asthma drugs on antigen-induced dyspnea in conscious Sprague Dawley (S.D.) rats. A line of dyspnea bred rats was produced, where all immunized animals respond with dyspnea when challenged with aerosolized ovalbumin (OA). The animals were immunized intraperitoneally (i.p.) with OA (10 micrograms) together with Al(OH)3 (100 mg) and challenged 2 to 3 weeks later with OA aerosol. We examined the effects of terbutaline (TERB), disodium cromoglycate (DSCG), atropine (ATRO), theophylline (THEO), a 5-HT receptor antagonist methysergide (METH), and two glucocorticosteroids (GCS) budesonide (BUD) and dexamethasone (DEX), on this response. The drugs were given locally either by intratracheal (i.t.) instillation or by aerosol. The rats were placed one by one in an air tight box and the breathing pattern was recorded. Parameters such as time of onset of dyspnea after end of challenge (elapsed time), duration and occurrence of dyspnea, were used to quantify the response. In the vehicle- treated group nearly all animals responded to OA with signs of dyspnea. TERB was the only drug effective when given as an aerosol, whereas when given i.t., also DEX and METH inhibited the dyspnea. Dyspnea is a serious response and can only be alleviated by the most effective anti-asthma drugs.