Surgical management of rectal foreign bodies: A single-center experience.

BACKGROUND: Rectal foreign bodies (RFBs) are one of the rare clinical presentations in colorectal surgical practice, with an increasing incidence over the recent years. Due to the lack of standardized treatment options, the management of RFBs can be chal-lenging. This study aimed to evaluate our diagnostic and therapeutic approach to RFBs and to suggest a management algorithm. METHODS: All patients with RFBs who hospitalized between January 2010 and December 2020 were retrospectively reviewed. Patient demographics, RFB insertion mechanism, inserted objects, diagnostic findings, management, complications, and outcomes were all evaluated. An algorithm for clinical management was developed depending on the center's experience. RESULTS: The cohort consisted of 21 patients, 17 (81%) were males. The median age was 33 years (ranging, 19-71). Sexual prefer-ences were the reason for RFB in 15 (71.4%) patients. In 17 (81%) patients, the RFB size over 10 cm. In 4 (19%) patients, RFBs were removed transanally without anesthesia in the emergency department; in the remaining 17 (81%), they were removed under anesthesia. Among these, RFBs were removed transanally under general anesthesia in 2 (9.5%) patients; with the assistance of a colonoscope under anesthesia in 8 (38%) patients; by milking towards the transanal route during laparotomy in 3 (14.2%) patients; and with the Hartmann procedure without restoration of bowel continuity in 4 (19%) patients. The median hospital stay was 6 days (ranging, 1-34 days). The Clavien-Dindo grade III-IV complication rate was 9.5%, and no post-operative mortality was observed. CONCLUSION: RFBs can usually be successfully removed transanally in the operating room with appropriate anesthetic technique and proper surgical instrument selection.

Long-Term Outcomes of Patients With Amyloidosis Following Kidney Transplant.

OBJECTIVES: Reported graft and patient survival rates in amyloidosis after renal transplant differ considerably between studies. MATERIALS AND METHODS: Group 1 included 24 patients who had end-stage renal disease secondary to amyloidosis. Group 2 (the control group) included 24 consecutive patients who had kidney disease secondary to various causes other than amyloidosis. Comparisons between groups were made for kidney and patient survival rates and other complications following kidney transplant. We also compared survival rates of patients in group 1 versus another control group that included patients with amyloidosis who were treated with hemodialysis (group 3; n = 25). RESULTS: Mean follow-up was 109.5 ± 79.8 months. Biopsy-proven acute rejection and graft failure rates were not significantly different between groups. In group 1 versus group 2, the cumulative 10-year and 20-year patient survival rates were 68.2% versus 86.1% and 36.9% versus 60.3%, respectively (P = .041). Survival was not significantly different in group 1 compared with group 2 and group 3, although patients in group 3 had significantly shorter duration of time to death after the start of renal replacement therapy. CONCLUSIONS: Patient survival may be lower in kidney transplant recipients with amyloidosis compared with patients with end-stage renal disease due to other causes. However, graft failure and acute rejection rates seem to be similar.

Comparison of Resection and Liver Transplant in Treatment of Hepatocellular Carcinoma.

OBJECTIVES: Hepatic resection and liver transplant are regarded as 2 potentially curative treatments for hepatocellular carcinoma. Here, we compared both options in patients with hepatocellular carcinoma secondary to cirrhosis seen at a single center over 12 years. MATERIALS AND METHODS: We evaluated early complications and survival of patients with hepatocellular carcinoma treated with liver transplant (57 patients) or hepatic resection (36 patients) at our center between 1998 and 2010. RESULTS: The 34-month mean follow-up period was similar for both treatment groups. The liver transplant group had a longer hospital stay than the hepatic resection group (P ⟨ .001). Patients with Child-Turcotte-Pugh A stage were treated by hepatic resection more than by liver transplant (P ⟨ .001),with Child-Turcotte-Pugh B stage patients treated by liver transplant more than by hepatic resection (P = .03). All patients with Child-Turcotte-Pugh C stage had liver transplant. Both treatment groups had similar postoperative complications and early postoperative mortality rates, but liver transplant resulted in longer overall (P = .001) and higher event-free (P = .001) survival than hepatic resection. Among the liver transplant group, 57.8% of patients met the Milan criteria. Patients who met Milan criteria were treated by liver transplant statistically more than hepatic resection, and these patients had longer overall survival (P = .01) and higher event-free survival (P ⟨ .001) than patients who had hepatic resection. Hepatocellular carcinoma recurrence rates were higher after hepatic resection (P = .232). CONCLUSIONS: In patients with hepatocellular carcinoma, hospital stay was longer after liver transplant, but morbidity and mortality rates for liver transplant versus hepatic resection were similar. However, overall and event-free survival rates were better after liver transplant than after hepatic resection. These results suggest that liver transplant should be considered as the primary treatment option for patients with hepatocellular carcinoma secondary to cirrhosis.

Adult morgagni hernia: a single center experience of 5 cases and review of literature.

Morgagni hernia is a rare congenital anomaly arising through the fusion defect between the septum transversum and sternum. Diagnosis is usually confusing as the presentation may be asymptomatic as well as with respiratory symptoms, abdominal and/or retrosternal pain, abdominal fullness or gastrointestinal obstruction. In this paper, we discussed the clinical presentation and management of this rare situation with five consecutive cases. Between 2009 and 2015, five cases underwent surgery for Morgagni hernia (3 laparoscopic and 2 open repair); one patient had recurrent hernia after 7 months from laparoscopic surgery. This case is the first recurrence in the literature after laparoscopic repair in an adult group. In Morgagni hernias, the only treatment is surgery, which can be performed by transthoracic, transabdominal, laparoscopic or thoracoscopic approaches. The issues of using mesh and reducing the hernia sac are still controversial.

Adult morgagni hernia: A single-center experience of five cases and a review of literature.

Morgagni hernia is a rare congenital anomaly arising from the fusion defect between the septum transversum and sternum. The diagnosis is usually difficult since the presentation may be asymptomatic or with respiratory symptoms, abdominal and/or retrosternal pain, abdominal fullness, or gastrointestinal obstruction. In this report, we discuss the clinical presentation and management of this rare condition in five consecutive cases. Between 2009 and 2015, five cases underwent surgery for Morgagni hernia (three laparoscopic and two open repair surgeries); one patient developed recurrent hernia 7 months after the laparoscopic surgery. This case is the first reported recurrence in literature following laparoscopic repair in adults. Surgery is the only treatment option for Morgagni hernias, which can be performed through transthoracic, transabdominal, laparoscopic, or thoracoscopic approach. The issues of using mesh and reducing the hernial sac remain controversial.