Is suturing of the bladder defect in benign Enterovesical fistula necessary?

BACKGROUND: Enterovesical fistula (EVF) is a abnormal connection between the intestine and the bladder. The aim of the study was to analyze whether closure of the defect in the bladder wall during surgery is always necessary. METHODS: Fifty-nine patients with benign EVF undergoing surgical treatment were enrolled. A one-stage surgical procedure was performed in all patients. After the separation of the diseased bowel segment, methylene blue was introduced. Through a catheter into the bladder. Only patients with urinary bladder leakage were sutured. RESULTS: The most common intestinal fistula involving the urinary bladder was colovesical fistula, observed in 53% of cases. Two-thirds of patients had diverticular disease as the underlying pathology. There was no relationship between suturing of the bladder and perioperative complications. Recurrent EVF was observed in one patient with bladder suturing and in two patients without suture. CONCLUSIONS: These findings suggest that closure of the bladder defect is not necessary in cases where a leak is not demonstrated from the bladder intraoperatively. This study is limited by its retrospective design and small numbers and a randomized controlled trial is recommended to answer this question definitively.

Expression of vascular endothelial growth factor and its correlation with clinical symptoms and endoscopic findings in patients with chronic radiation proctitis.

AIM: The aim of this study was to assess the expression of vascular endothelial growth factor (VEGF) as a key proangiogenic factor and determine whether there is any correlation between its expression and clinical symptoms or endoscopic changes in patients with chronic radiation proctitis (ChRP). METHOD: Fifty patients who had all undergone radiotherapy for prostate, cervical or uterine cancer were included in the study (37 women, 13 men). There was a control group of 20 patients (9 women, 11 men). The Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) scoring system was used for grading the severity of the proctitis. Endoscopic scoring of late rectal mucosal damage was performed using Gilinsky's classification. Serum levels of VEGF were analysed by the enzyme-linked immunosorbent assay method. RESULTS: Most patients presented with Grade 1 symptoms. Endoscopic assessment showed that most patients had Grade 1 late rectal mucosal damage. The predominant endoscopic finding was the presence of telangiectasia. Assessment of VEGF correlation between the control group and the degrees of endoscopic changes showed statistically significant differences for all three degrees (P < 0.0001, P = 0.0251 and P = 0.0005, respectively). Due to the small numbers of patients with Grades 2 and 3 symptoms using the RTOG/EORTC scoring system, they were grouped with Grades 1 and 4 respectively forming two groups for statistical purposes. VEGF expression differed significantly between controls and group I and between controls and group II (P = 0.0001, P = 0.0009, respectively). CONCLUSION: A significant increase in VEGF expression was found to correlate with clinical symptoms and endoscopic rectal mucosa changes in patients with ChRP, suggesting that it may play an important role in pathological angiogenesis.

Does C-reactive protein monitoring after colorectal resection with anastomosis give any practical benefit for patients with intra-abdominal septic complications?

AIM: This study aimed to assess the influence of the C-reactive protein (CRP) level on the early outcome after elective colorectal resection. METHOD: Patients with colorectal cancer operated on between 2006 and 2013 were identified retrospectively. They were divided into a study group operated on between 2010 and 2013 when CRP was measured routinely on the fourth postoperative day and a control group operated on between 2006 and 2009 when the CRP level was not measured routinely. Mortality, intra-abdominal septic complications (IASC), abscesses and anastomotic leakage (AL), the need for reoperation, the interval from index surgery to relaparotomy, length of hospital stay and imaging studies were compared by multivariate analysis. RESULTS: A total of 1189 patients were assessed, including 598 (50.3%) in the study group (mean age 61.3 ± 13 years; 282 female) and 591 (49.7%) in the control group (mean age 61.8 ± 11 years; 267 female). There were seven (1.2%) postoperative deaths in the study group and nine (1.5%) in the control group (P = 0.598). Abdominal ultrasound (US) was performed more often in the study group [97 (16.2%) vs 71 (12.0%); P = 0.037]. In the study group the interval to diagnosis of IASC was shorter than in the control group (5.7 ± 1.5 days vs 7.3 ± 1.3 days; P = 0.029). The decision to reoperate was also made earlier in the study group (6.2 ± 1.7 days vs 7.4 ± 2.8 days; P = 0.043). CONCLUSION: Routine measurement of CRP can help to make an earlier diagnosis of IASC and earlier decision for relaparotomy, without any influence on mortality or length of hospital stay.

Resection of the primary tumour or other palliative procedures in incurable stage IV colorectal cancer patients?

OBJECTIVE: The aims of the study were to analyse the early and late results of surgical treatment in patients with stage IV colorectal cancer (CRC) and to evaluate the effect of primary tumour resection and other clinical factors on survival. METHOD: A group of 134 patients with stage IV CRC was electively operated on between 1996 and 2000. The first group underwent resection of the primary tumour (52 patients; mean age 63.4 +/- 10.3) and the second group of patients underwent procedures without resection (82 patients; mean age 62.6 +/- 10.6). RESULTS: Postoperative morbidity occurred significantly more often (P = 0.041) in the first group--in 26 patients (50%) than in the second group - 19 patients (23.1%). The resection of the primary tumour increased the survival probability; hazard ratio (HR): 1.78; 95% confidence interval (CI): 1.21-2.78%; P = 0.004. Bi-lobar metastases increased mortality risk compared with uni-lobar; HR 2.32; 95% CI: 1.47-3.68; P = 0.0003. The 2-year survival rate in patients with uni-lobar metastases in the first group was 44.2%, in the second group: 30.7%; P = 0.023. CONCLUSION: Primary tumour resection in stage IV CRC increases the risk of postoperative complications. In the given setting, however, it results in an increased 2-year survival rate but it may not influence the 5-year survival rate. In patients with bi-lobar liver metastases resection of the primary tumour does not prolong survival time.

Modulation of Colorectal Cancer Risk by Polymorphisms in 51Gln/His, 64Ile/Val, and 148Asp/Glu of APEX Gene; 23Gly/Ala of XPA Gene; and 689Ser/Arg of ERCC4 Gene.

Polymorphisms in DNA repair genes may affect the activity of the BER (base excision repair) and NER (nucleotide excision repair) systems. Using DNA isolated from blood taken from patients (n = 312) and a control group (n = 320) with CRC, we have analyzed the polymorphisms of selected DNA repair genes and we have demonstrated that genotypes 51Gln/His and 148Asp/Glu of APEX gene and 23Gly/Ala of XPA gene may increase the risk of colorectal cancer. At the same time analyzing the gene-gene interactions, we suggest the thesis that the main factor to be considered when analyzing the impact of polymorphisms on the risk of malignant transformation should be intergenic interactions. Moreover, we are suggesting that some polymorphisms may have impact not only on the malignant transformation but also on the stage of the tumor.

Open and closed haemorrhoidectomy for fourth degree haemorrhoids--comparative one center study.

AIM: We compared results of two techniques of haemorrhoidectomy: open Milligan-Morgan (MM) and closed Ferguson (CF) techniques. Length of hospitalization, pain complaints, return to full activity, wound healing time were considered. METHODS: We included the group of 63 patients: 29 patients (16 women) were randomly allocated to MM operation and 34 patients (15 women) to CF operation. Follow-up study was performed after 2, 4, 24 weeks and six and eighteen months postoperatively. RESULTS: We did not note any statistically significant differences in relation to hospitalization time 30.9 days (MM) and 30.8 days (CF). Postoperative urine retention was similar: 5 (17.2%) patients (MM) and 7 (20.6%) patients (CF). No differences in the intensity of postoperative pain was observed. Patients returned to work after 293 days (MM) and 342 days (CF) (p = 0.059). We observed no infection of the wound in MM group but in four patients from CF group (11.8%); (p = 0.053). However overall wound healing time was shorter after CF method than after MM method: 233 vs. 274 days, respectively (p = 0.053). CONCLUSIONS: Our study confirms that the results after MM and CF haemorrhoidectomy are similar. We found a trend towards faster wound healing after CF procedure, however there was a trend towards higher wound infection in that group. There was also a trend towards shorter recovery time in patients after MM operation.