Early closure of defunctioning stoma increases complications related to stoma closure after concurrent chemoradiotherapy and low anterior resection in patients with rectal cancer.

BACKGROUND: After a low anterior resection, creating a defunctioning stoma is vital for securing the anastomosis in low-lying rectal cancer patients receiving concurrent chemoradiotherapy. Although it decreases the complication and reoperation rates associated with anastomotic leakage, the complications that arise before and after stoma closure should be carefully evaluated and managed. METHODS: This study enrolled 95 rectal cancer patients who received neoadjuvant concurrent chemoradiotherapy and low anterior resection with anastomosis of the bowel between July 2010 and November 2012. A defunctioning stoma was created in 63 patients during low anterior resection and in another three patients after anastomotic leakage. RESULTS: The total complication rate from stoma creation to closure was 36.4%. Ileostomy led to greater renal insufficiency than colostomy did and significantly increased the readmission rate (all p < 0.05). The complication rate related to stoma closure was 36.0%. Patients with ileostomy had an increased risk of developing complications (p = 0.017), and early closure of the defunctioning stoma yielded a higher incidence of morbidity (p = 0.006). Multivariate analysis revealed that a time to closure of ≤109 days was an independent risk factor for developing complications (p = 0.007). CONCLUSIONS: The optimal timing of stoma reversal is at least 109 days after stoma construction in rectal cancer patients receiving concurrent chemoradiotherapy and low anterior resection.

Effective minimally invasive strategy for mixed-type gynecomastia using vacuum-assisted mastectomy and power-assisted liposuction.

INTRODUCTION: Mixed-type gynecomastia is a benign male breast condition characterized by the proliferation of glandular and adipose tissues. Conventional open surgery has been the main approach for treating gynecomastia. However, this method has been associated with complications, including breast deformity, noticeable scar, nipple necrosis, and hypoesthesia. In contrast, vacuum-assisted biopsy systems and liposuction have demonstrated significant advantages in minimally invasive breast surgery. AIMS: Our study aimed to investigate the effectiveness of combining vacuum-assisted mastectomy with power-assisted liposuction (VAM+PAL) for patients with mixed-type gynecomastia compared to conventional open surgery. METHODS: Sixty patients with mixed-type gynecomastia, treated between January 2019 and June 2023, were included in this study. VAM+PAL was performed on 30 patients (59 breasts), and open excision with periareolar approach was performed on 30 patients (59 breasts). The efficacy, complications, outcomes, scar cosmesis, and patient satisfaction were assessed. RESULTS: Compared to open excision group for gynecomastia, the VAM+PAL group demonstrated a substantial reduction in incision size (4.47 ± 1.21 cm vs. 0.97 ± 0.74 cm, p < 0.001) and lower scores of Vancouver scar scale (3.23 ± 2.27 vs. 1.10 ± 1.47, p < 0.001). No drainage tubes were required for postoperative hematoma/seroma prevention. The patients in the VAM+PAL group had significantly lower complication rates (18.64% vs. 3.39%, p = 0.008), particularly in bruise and hypoesthesia. All VAM+PAL patients reported superior satisfaction with the outcomes in breasts and nipples. CONCLUSION: The combination of vacuum-assisted mastectomy and power-assisted liposuction can be used as an efficient minimally invasive method to treat mixed-type gynecomastia with acceptable complications, superior scar cosmesis, and satisfying outcomes.

A rare complication of Meckel's diverticulum: a fistula between Meckel's diverticulum and the appendix.

Meckel diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2%-4% of the population. Meckel diverticulum results from incomplete closure of the omphalomesenteric duct. The presentation of symptomatic Meckel diverticulum includes gastrointestinal hemorrhage, intestinal obstruction, volvulus, intussusception, diverticulitis, and neoplasms. The development of fistula is an extremely rare complication. Previous literature has even shown an enterocolonic fistula, a vesicodiverticular fistula, ileorectal fistula, and fistula-in-ano. To the best of our knowledge, we present the first case of the fistula complicated between Meckel diverticulum and the appendix in a review of the English literature.