Feasibility and Safety of Intraoperative Colonoscopy after Segmental Colectomy and Primary Anastomosis.

Patients presenting with near-obstructing colon lesions requiring segmental colectomy may benefit from intraoperative colonoscopy (IOC) after primary anastomosis for a more timely and accurate diagnosis of synchronous lesions. The aim of this study is to demonstrate the feasibility and safety of this technique. A retrospective cohort study of patients undergoing single-stage segmental colectomy and anastomosis at a single tertiary care institution from 2011 to 2013 was performed. One Hundred and sixty-eight consecutive patients underwent segmental colectomy and primary anastomosis of which 78 (46%) were unable to receive preoperative colonoscopy (POC) because of near-obstructing lesions and received IOC after the anastomosis. IOC detected synchronous adenomatous polyps in 24.4 per cent, diverticular disease in 19 per cent, and colitis/proctitis in 2.5 per cent. The IOC group was not significantly different from the POC group with regard to overall morbidity (31% vs 39% P = 0.45), anastomotic leakage (1.3% vs 0%, P = 0.46), or wound infection (5.1% vs 1.1%, P = 0.18). Operation time was 19 minutes longer in the intraoperative group, but overall length of hospital stay was not significantly different (6.4 ± 2.9 days vs 7.3 ± 4.6 days). In patients unable to receive POC because of partial obstruction, IOC after primary anastomosis is both feasible and safe for detecting proximal synchronous lesions.

Patch repair of ileoanal pouch-vaginal fistula with Permacol collagen implant.

Though uncommon, ileoanal pouch-vaginal fistulas after restorative proctocolectomy present quite a challenge. Multiple salvage procedures, including endoanal, transabdominal, and trans-vaginal, have been used. Because of high recurrence rates, multiple operations are not uncommon, and ultimate pouch failure rates have been reported as high as 45 per cent. The Permacol Collagen Implant is a surgical implant that has been used successfully in a variety of operations ranging from urological to maxillofacial. Its properties allow fibroblast infiltration and revascularization so that it gradually becomes permanently incorporated into the surrounding tissue, providing strength and inhibiting scarring and contraction. We report the first documented case of Permacol use in repair of ileoanal pouch-vaginal fistula and we feel that it warrants further investigation as an option in the treatment of these fistulas.

Muscle fragment welding for control of massive presacral bleeding during rectal mobilization: a review of eight cases.

INTRODUCTION: Although massive presacral bleeding during rectal mobilization is uncommon, it can rapidly destabilize a patient. Traditional attempts at control include tamponade with pelvic packing and application of sacral thumbtacks. The aim of this review is to describe the anatomic basis of injury and summarize our experience with this challenging problem, with emphasis on the simple, readily available, effective technique of rectus abdominis muscle fragment welding. METHODS: A retrospective review of eight patients who underwent muscle fragment welding for presacral bleeding incurred during rectal mobilization was undertaken. This technique involves harvesting a small piece of rectus abdominis muscle, which is held in place with a forceps to occlude the bleeding site. Electrocautery adjusted to the highest setting is then applied to the forceps to "weld" closed the bleeding point. RESULTS: Control of presacral bleeding was achieved in all eight patients (3 males) with this technique without complications attributable to this method. Previous attempts at pelvic packing failed in all eight patients. CONCLUSION: Muscle fragment welding is a safe, readily available, and highly effective method of controlling massive presacral bleeding.