Short-term outcomes after incontinent conduit for gynecologic cancer: comparison of ileal, sigmoid, and transverse colon.

OBJECTIVE: The aim of this study is to estimate the overall rates of significant incontinent conduit-related complications and compare rates between conduit types. METHODS: This was a retrospective review of 166 patients who underwent incontinent urinary diversion from April 1993 through April 2013. Patients were categorized by conduit type-ileal, sigmoid colon, and transverse colon. Significant conduit-related complications were assessed at 30 and 90days after surgery. Significant conduit-related complication was defined as any of the following: ureteral stricture, conduit leak, conduit obstruction, conduit ischemia, ureteral anastomotic leak, stent obstruction requiring intervention via interventional radiology procedure or reoperation, and renal failure. RESULTS: A total of 166 patients underwent formation of an incontinent urinary conduit, most commonly during exenteration for gynecologic malignancy. There were 129 ileal, 11 transverse colon, and 26 sigmoid conduits. The overall significant conduit-related complication rate within 30days was 15.1%. Complication rates for ileal, transverse and sigmoid conduits were 14.7%, 0%, and 23.1%, respectively (Fisher's exact test, p=0.24). By 90days, the Kaplan-Meier estimated rates of significant complications were 21.8% overall, and 22.3%, 0%, and 28.9%, respectively, by conduit type (log-rank test, p=0.19). The most common significant conduit-related complications were conduit or ureteral anastomotic leaks and conduit obstructions. By 1 and 2years following surgery, the Kaplan-Meier estimated overall rate of significant conduit-related complication increased to 26.5% and 30.1%, respectively. CONCLUSIONS: Our study suggests that there are multiple appropriate tissue sites for use in incontinent conduit formation, and surgical approach should be individualized. Most significant conduit-related complications occur within 90days after surgery.

Motor criteria evaluation of iso-anisoperistaltic graft in oesophageal reconstruction -- an experimental study of isolated colic graft motility pattern in dogs.

In the medical literature there are more than one opinion in favour of the isoperistaltic interposed loop, considering it to render a higher propulsive activity and thus with much better functionality, with less intense symptoms of regurgitation,reflux or aspiration. Technically, however, due to anatomical relationships, anisoperistaltic graft interposition is more convenient. Is this detrimental to functionality? What is the best peristaltic model? At first sight, it seems that due to the local anatomy and surgical technique involved, we compromise at the expense of better functionality. To find the answer to these questions, starting from the typical pattern of colonic motility in the transverse and left colon, we need to identify new motor behaviour of the isolated colic segment. Because motor activity is generated by electric waves discharged from the area control centre, their electromyographic registration would allow finding the contractile pattern of a transplanted loop.

Substernal long segment left colon interposition for oesophageal replacement.

Long segments of colon, transposed on a vascular pedicle, have been used for oesophageal substitution for a long time. However the techniques employed for colonic reconstruction remain debated. We describe our substernal long segment replacement technique and emphasise several key aspects which are important in management of these patients. Optimising nutritional status and pulmonary function remain important aspects. Thymectomy allows room for the colonic segment preventing venous congestion. These patients are best managed in specialist units incorporating a multidisciplinary approach with good intensive care and radiological support.

Gender-Confirmation Surgery Using the Pedicle Transverse Colon Flap for Vaginal Reconstruction: A Clinical Outcome and Sexual Function Evaluation Study.

Vaginal reconstruction and vaginoplasty are indicated in vaginal agenesis, following pelvic tumor resection, trauma, and for gender-confirmation surgery. In this article, the authors present the clinical outcomes and sexual function evaluation when using the pedicle transverse colon flap for gender-confirmation surgery in transgender women. This is a retrospective chart review of all transgender women who underwent gender-confirmation surgery using the pedicle transverse colon flap. Demographics, procedure specifics, and surgical outcomes were recorded and analyzed. Sexual function was measured using the Female Sexual Function Index and the Female Genital Self-Image Scale 1 year after surgery. Fifteen patients underwent gender-confirmation surgery using the aforementioned technique. The average age of the patients was 20 years (range, 18 to 32 years), and the average operating room time was 10.1 hours (range, 8 to 12.5 hours). The average length and width of the flaps were 15 and 2.8 cm, respectively. During a 12-year follow-up, two complications were reported: one patient had pain caused by narrowing at the introitus, which required intervention, and one patient had an excessive amount of secretions in the first month, which subsided 3 months after surgery. The mean Female Sexual Function Index score was 28.6 (range, 24 to 31). All patients achieved normal sexual function as indicated by a Female Sexual Function Index score of 25 or more. For the Female Genital Self-Image Scale, the mean total score was 20.0 ± 4.5 (range, 7 to 28). The pedicle transverse colon flap is another valuable alternative method for vaginoplasty with promising results and minor complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

[Treatment of cicatricial stricture subsequent to esophageal chemical burns with transverse colon replacing esophagus in children].

OBJECTIVE: To study the validity of transplanting transverse colon to replace esophagus in treating cicatricial stricture resulting from severe esophageal chemical burns in children. METHODS: A retrospective study was carried out on the clinical data of 46 patients with severe chemical esophageal burns who were treated from November 1972 to September 2008. The transverse colon with the ascending branch of the left colic artery was brought through a retrosternal tunnel to replace strictured esophagus. Thirty-two patients underwent colon-esophageal anastomosis and 14 patients underwent colon-pharyngeal anastomosis. RESULTS: All patients survived after surgery, but complications occurred in 7 cases, including leakage of anastomosis in cervical region in 4 cases, stenosis of anastomosis in 2 cases, and dyspnea in 1 case, and they were cured after due treatment. Follow-up study (1 - 26 years) in 39 patients revealed that there was no difference in growth, development and diet between the patients and the normal children of the same age. CONCLUSIONS: Esophageal reconstruction with transverse colon together with the ascending branch of the left colic artery through a retrosternal tunnel is a valuable method for treating cicatricial stricture of the esophagus secondary to severe chemical burns of the esophagus in children.

Technique for pure transverse colon continent cutaneous urinary diversion.

We describe a new method for constructing a pure transverse colon reservoir with two short segments of transverse colon fashioned as Monti tubes that are placed in a serous-lined extramural tunnel for construction of the efferent segment and for ureteral reimplantation, respectively.