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1.
Can Vet J ; 65(8): 825-828, 2024 Aug.
Article in English | MEDLINE | ID: mdl-39091476

ABSTRACT

A 9-week-old miniature Schnauzer dog was brought to a veterinary clinic because of an acute onset of vomiting. A 2 to 3-centimeter, round, firm structure in the mid-abdomen was palpated with a repeatable pain response. An exploratory laparotomy revealed a grossly cystic-appearing mass on the distal ileum. Resection and anastomosis were conducted. The histopathology report concluded the structure was an intestinal duplication, a rare congenital abnormality, with the structure sharing an outer muscular layer with the normal intestine. The resection was considered completely excised. The puppy recovered well and was clinically normal on follow-up examinations. The findings from this case suggest congenital abnormalities should always be included on a differential diagnosis list for all young animals, regardless of the presenting complaint.


Duplication intestinale chez un Schnauzer miniatureUn Schnauzer miniature âgé de 9 semaines a été présenté à une clinique vétérinaire pour cause d'apparition de vomissements aigus. Une structure ferme et ronde, de 2 à 3 cm de diamètre au milieu de l'abdomen était palpée avec une réponse à la douleur répétée. Une laparotomie exploratoire a révélé la présence d'une masse d'apparence kystique sur l'iléon distal. Une résection et une anastomose ont été effectuées. Le rapport d'histopathologie concluait que la structure était une duplication intestinale, une anomalie congénitale rare, et que la structure partageait une couche musculaire externe avec l'intestin normal. La résection a été considérée comme complètement excisée. Le chiot a bien récupéré et était cliniquement normal lors des examens de suivi. Les trouvailles dans le cas présent suggèrent que les anomalies congénitales devraient toujours être incluses dans la liste des diagnostics différentiels pour les jeunes animaux, indépendamment de la raison pour la consultation.(Traduit par Dr Serge Messier).


Subject(s)
Dog Diseases , Animals , Dogs , Dog Diseases/surgery , Dog Diseases/congenital , Dog Diseases/diagnosis , Dog Diseases/pathology , Male , Female , Ileum/surgery , Ileum/abnormalities , Ileum/pathology
2.
J Med Case Rep ; 18(1): 357, 2024 Aug 06.
Article in English | MEDLINE | ID: mdl-39103938

ABSTRACT

BACKGROUND: Heterotopic gastric mucosa (HGM) can be located in various parts of the gastrointestinal tract. As a rare anomaly in the small intestine, it can become complicated by intussusception, obstruction, gastrointestinal bleeding, and even peritonitis, leading to death. CASE PRESENTATION: This case report focuses on a 12-year-old Middle Eastern boy who presented with hematochezia and abdominal pain for a couple of days. A tagged Red blood cell (RBC) scan and Technetium scan revealed gastrointestinal bleeding at the lower abdomen, highly suggestive of the diagnosis of Meckel's diverticulum. Subsequently, exploratory laparotomy revealed contiguous and scattered mucosal lesions with multiple polyps of various sizes in the terminal ileum. Meckel's diverticulum was absent, and the patient was treated with resection and primary anastomosis. The resected tissue revealed extensive ectopic gastric mucosa and polypoid tissues. The patient recovered uneventfully and was discharged four days after the surgery. The symptoms did not recur within six months after his surgery. CONCLUSION: Our case demonstrated that despite the rarity of multiple polypoid gastric heterotopias in the terminal ileum, it should be considered as one of the differential diagnoses of gastrointestinal tract bleeding.


Subject(s)
Choristoma , Gastric Mucosa , Gastrointestinal Hemorrhage , Meckel Diverticulum , Humans , Male , Gastrointestinal Hemorrhage/etiology , Gastric Mucosa/pathology , Choristoma/complications , Choristoma/surgery , Choristoma/pathology , Meckel Diverticulum/complications , Meckel Diverticulum/surgery , Child , Ileal Diseases/surgery , Ileal Diseases/etiology , Diagnosis, Differential , Ileum/pathology , Ileum/surgery , Ileum/diagnostic imaging , Abdominal Pain/etiology , Treatment Outcome
3.
Medicine (Baltimore) ; 103(31): e39171, 2024 Aug 02.
Article in English | MEDLINE | ID: mdl-39093791

ABSTRACT

RATIONALE: Diffuse intestinal and mesenteric lipomatosis is a rare condition characterized by the overgrowth of adipose tissue in the intestines and mesentery. This case report aims to highlight the rare occurrence of chronic abdominal distention caused by this disease and its unique invasion into the muscle layer, which has not been previously reported. PATIENT CONCERNS: A 36-year-old woman with a 7-year history of abdominal distension was admitted to our hospital's Department of Gastrointestinal Surgery. DIAGNOSE: Abdominal and pelvic computed tomography revealed diffuse small intestinal lipomatosis. INTERVENTIONS: The patient underwent surgery. We performed an open-field ilectomy involving removal of all lipomatous intestines (250 cm). OUTCOMES: During the surgery, diffuse nodular ileal and mesenteric lipomatosis was confirmed, characterized by the presence of multiple nodular lipomas within the submucosal and muscular layers. The surgical intervention involved the resection of 250 cm of the affected ileum, followed by jejunoileal anastomosis. Postoperative pathology confirmed the diagnosis, with lesions observed in both the submucosa and muscle layers. The patient showed significant improvement in symptoms, with normal intestinal function and weight gain observed over a 10-month follow-up period, and no signs of recurrence. LESSONS: Diffuse intestinal and mesenteric lipomatosis can lead to long-term abdominal distension. Additionally, it may be involved in the muscle layer of the intestinal wall. Surgery is the primary treatment option for symptomatic intestinal lipomatosis.


Subject(s)
Lipomatosis , Mesentery , Humans , Female , Adult , Lipomatosis/surgery , Lipomatosis/pathology , Lipomatosis/complications , Lipomatosis/diagnosis , Mesentery/pathology , Mesentery/surgery , Ileal Diseases/surgery , Ileal Diseases/etiology , Ileal Diseases/diagnosis , Ileum/surgery , Ileum/pathology , Tomography, X-Ray Computed , Chronic Disease
4.
Langenbecks Arch Surg ; 409(1): 227, 2024 Jul 22.
Article in English | MEDLINE | ID: mdl-39037448

ABSTRACT

PURPOSE: Kono-S anastomosis, an antimesenteric, functional, end-to-end handsewn anastomosis, was introduced in 2011. The aim of this meta-analysis is to evaluate the safety and effectivity of the Kono-S technique. METHODS: A comprehensive search of MEDLINE (PubMed), Embase (Elsevier), Scopus (Elsevier), and Cochrane Central (Ovid) from inception to August 24th, 2023, was conducted. Studies reporting outcomes of adults with Crohn's disease undergoing ileocolic resection with subsequent Kono-S anastomosis were included. PRISMA and Cochrane guidelines were used to screen, extract and synthesize data. Primary outcomes assessed were endoscopic, surgical and clinical recurrence rates, as well as complication rates. Data were pooled using random-effects models, and heterogeneity was assessed with I² statistics. ROBINS-I and ROB2 tools were used for quality assessment. RESULTS: 12 studies involving 820 patients met the eligibility criteria. A pooled mean follow-up time of 22.8 months (95% CI: 15.8, 29.9; I2 = 99.8%) was completed in 98.3% of patients. Pooled endoscopic recurrence was reported in 24.1% of patients (95% CI: 9.4, 49.3; I2 = 93.43%), pooled surgical recurrence in 3.9% of patients (95% CI: 2.2, 6.9; I2 = 25.97%), and pooled clinical recurrence in 26.8% of patients (95% CI: 14, 45.1; I2 = 84.87%). The pooled complication rate was 33.7%. The most common complications were infection (11.5%) and ileus (10.9%). Pooled anastomosis leakage rate was 2.9%. CONCLUSIONS: Despite limited and heterogenous data, patients undergoing Kono-S anastomosis had low rates of surgical recurrence and anastomotic leakage with moderate rates of endoscopic recurrence, clinical recurrence and complications rate.


Subject(s)
Anastomosis, Surgical , Crohn Disease , Humans , Crohn Disease/surgery , Anastomosis, Surgical/methods , Anastomosis, Surgical/adverse effects , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Ileum/surgery , Recurrence , Colon/surgery
5.
Langenbecks Arch Surg ; 409(1): 221, 2024 Jul 18.
Article in English | MEDLINE | ID: mdl-39023536

ABSTRACT

INTRODUCTION: The Single Anastomosis Sleeve Ileal (SASI) bypass is a new bariatric surgery corresponding to an adaptation of the Santoro approach, consisting of a sleeve gastrectomy (SG) followed by loop gastroileostomy. Therefore, we aimed to systematically assess all the current literature on SASI bypass in terms of safety, weight loss, improvement in associated comorbidities, and complications. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) recommendations, we conducted a systematic review and meta-analysis by searching three databases (PubMed, Scopus, and Web of Science). We performed a meta-analysis of risk ratios and mean differences to compare surgical approaches for excessive weight loss, improvement/remission in type 2 diabetes mellitus (T2DM), hypertension (HT), dyslipidemia (DL), obstructive sleep apnea (OSA), and complications. Heterogeneity was assessed using the I2 statistic. RESULTS: Eighteen studies were included in the qualitative analysis and four in the quantitative analysis, comparing SASI bypass with SG and One-Anastomosis Gastric Bypass (OAGB). A comparison between Roux-en-Y Gastric Bypass (RYGB) and SASI bypass could not be performed. Compared to SG, the SASI bypass was associated with improved weight loss (MD = 11.32; 95% confidence interval (95%CI) [7.89;14.76]; p < 0.0001), and improvement or remission in T2DM (RR = 1.35; 95%CI [1.07;1.69]; p = 0.011), DL (RR = 1.41; 95%CI [1.00;1.99]; p = 0.048) and OSA (RR = 1.50; 95%CI [1.01;2.22]; p = 0.042). No statistically significant differences in any of the assessed outcomes were observed when compared with OAGB. When compared to both SG and OAGB, the complication rate of SASI was similar. CONCLUSION: Although studies with longer follow-up periods are needed, this systematic review and meta-analysis showed that SASI bypass has a significant effect on weight loss and metabolic variables. Variations in outcomes between studies reinforce the need for standardization.


Subject(s)
Weight Loss , Humans , Diabetes Mellitus, Type 2/surgery , Diabetes Mellitus, Type 2/complications , Obesity, Morbid/surgery , Treatment Outcome , Bariatric Surgery/methods , Bariatric Surgery/adverse effects , Gastric Bypass/methods , Gastric Bypass/adverse effects , Gastrectomy/methods , Gastrectomy/adverse effects , Sleep Apnea, Obstructive/surgery , Comorbidity , Ileum/surgery
6.
Obes Surg ; 34(8): 3124-3126, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38990484

ABSTRACT

The authors raise concerns regarding the study by Wafa et al. on the high rates of malnutrition and revisional surgery after single anastomosis sleeve ileal (SASI) bypass. The small sample size (30 patients), single-center design, and lack of multicenter data limit the generalizability of the findings. The authors question the learning curve of the surgeon and whether the high complication rates are due to the surgeon's experience or inherent to the SASI technique. The involvement and contribution of co-authors from different institutions are unclear, potentially introducing bias. The study lacks preoperative nutritional assessment data, making it difficult to determine if postoperative deficiencies are due to SASI or preexisting issues. The nutritional management and supplementation protocols are not detailed, and the mechanisms behind the high incidence of malnutrition are not discussed. A comparison with well-established bariatric procedures is missing, making it challenging to assess the relative risks and benefits of SASI. The authors conclude that more extensive, multicenter studies with comprehensive preoperative nutritional assessments, detailed management protocols, and long-term follow-up are needed to fully evaluate SASI. Until such data are available, SASI should be considered experimental and performed only in well-designed clinical trials with rigorous patient selection and monitoring.


Subject(s)
Malnutrition , Humans , Malnutrition/epidemiology , Malnutrition/etiology , Female , Obesity, Morbid/surgery , Male , Postoperative Complications/epidemiology , Reoperation/statistics & numerical data , Adult , Anastomosis, Surgical , Ileum/surgery , Nutrition Assessment , Treatment Outcome , Middle Aged
7.
Langenbecks Arch Surg ; 409(1): 206, 2024 Jul 05.
Article in English | MEDLINE | ID: mdl-38967821

ABSTRACT

BACKGROUND: There is a lack of literature on the length of the terminal ileum to be resected in right hemicolectomy for colon cancer. Therefore, we aimed to determine the mean ileal loop length and the effect of this variation on postoperative complications and long-term oncological outcomes in patients who underwent right hemicolectomy. METHODS: Right hemicolectomy surgeries performed for colon cancer in a tertiary care hospital between January 2011 and December 2018 were retrospectively analyzed from a prospective database. Two patient groups were established based on the mean length of the resected ileum above and below 7 cm. The two groups were compared for clinicopathological data, postoperative complications, mortality, long-term overall survival (OS) and disease-free survival (DFS). The factors contributing to OS and DFS were analyzed. RESULTS: The study included 217 patients. Body mass index (BMI) values were significantly higher in the ileum resection length > 7 cm group (p = 0.009). Pathological N stage, tumor diameter, and number of metastatic lymph nodes were significantly higher in the ileum resection length > 7 cm group (p = 0.001, p = 0.001, and p = 0.026, respectively). There was no significant difference for postoperative complication and mortality rates between the two groups. The mean follow-up period was 61.2 months (2-120) in all patients. The total number of deaths was 29 (11.7%) while the 60-month OS was 83.5% and 50-month DFS was 81.8%. There was no significant difference between the groups in terms of OS and DFS rates (p > 0.05). CONCLUSIONS: Excessive resection of the distal ileum in right hemicolectomy does not provide any benefit in terms of prognosis and complications.The ileum resection length and values close to it in our study appear to be sufficient.


Subject(s)
Colectomy , Colonic Neoplasms , Ileum , Postoperative Complications , Humans , Male , Colonic Neoplasms/surgery , Colonic Neoplasms/pathology , Colonic Neoplasms/mortality , Female , Colectomy/methods , Colectomy/adverse effects , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Middle Aged , Ileum/surgery , Ileum/pathology , Aged , Retrospective Studies , Prognosis , Adult , Survival Rate , Neoplasm Staging , Aged, 80 and over
8.
BMC Surg ; 24(1): 204, 2024 Jul 09.
Article in English | MEDLINE | ID: mdl-38982419

ABSTRACT

BACKGROUND: Single Anastomosis Duodeno-Ileal bypass (SADI) is becoming a key option as a revision procedure after laparoscopic sleeve gastrectomy (LSG). However, its safety as an ambulatory procedure (length of stay < 12 h) has not been widely described. METHODS: A prospective bariatric study of 40 patients undergoing SADI robotic surgery after LSG with same day discharge (SDD), was undertaken in April 2021. Strict inclusion and exclusion criteria were applied and the enhanced recovery after bariatric surgery protocol was followed. Anesthesia and robotic procedures were standardized. Early follow-up (30 days) analyzed postoperative (PO) outcomes. RESULTS: Forty patients (37 F/3 M, mean age: 40.3yo), with a mean pre-operative BMI = 40.5 kg/m2 were operated. Median time after LSG was 54 months (21-146). Preoperative comorbidities included: hypertension (n = 3), obstructive sleep apnea (n = 2) and type 2 diabetes (n = 1). Mean total operative time was 128 min (100-180) (mean robotic time: 66 min (42-85)), including patient setup. All patients were discharged home at least 6 h after surgery. There were four minor complications (10%) and two major complications (5%) in the first 30 days postoperative (one intrabdominal abscess PO day-20 (radiological drainage and antibiotic therapy) and one peritonitis due to duodenal leak PO day-1 (treated surgically)). There were six emergency department visits (15%), readmission rate was 5% (n = 2) and reintervention rate was 2.5% (n = 1) There was no mortality and no unplanned overnight hospitalization. CONCLUSIONS: Robotic SADI can be safe for SDD, with appropriate patient selection, in a high-volume center.


Subject(s)
Ambulatory Surgical Procedures , Anastomosis, Surgical , Duodenum , Obesity, Morbid , Robotic Surgical Procedures , Humans , Male , Female , Adult , Robotic Surgical Procedures/methods , Prospective Studies , Ambulatory Surgical Procedures/methods , Duodenum/surgery , Anastomosis, Surgical/methods , Obesity, Morbid/surgery , Middle Aged , Ileum/surgery , Bariatric Surgery/methods , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Tertiary Care Centers , Laparoscopy/methods , Gastrectomy/methods , Treatment Outcome
10.
Urol Pract ; 11(4): 753-759, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38899673

ABSTRACT

INTRODUCTION: We aimed to investigate the differences in perioperative outcomes, especially ureteroenteric strictures, between patients who underwent a stented ureteroenteric anastomosis at the time of robot-assisted radical cystectomy (RARC) and ileal conduit vs those who did not. METHODS: A retrospective review of our RARC database was performed (2009-2023). Patients were divided into those who received stented ureteroenteric anastomosis vs those who did not. Propensity score matching was performed in the ratio of 3 (stented ureteroenteric anastomosis) to 1 (stent-free) in terms of age, gender, BMI, race, American Society of Anesthesiologists score, neoadjuvant chemotherapy, Charlson Comorbidity Index, prior radiation therapy, previous abdominal surgery history, clinical T3/clinical T4 stage, preoperative metastasis, and preoperative hydronephrosis. A cumulative incidence curve was used to depict ureteroenteric strictures and a Cox regression model was used to identify variables associated with ureteroenteric strictures. RESULTS: Four hundred eighty-eight patients underwent RARC, 366 individuals underwent a stented ureteroenteric anastomosis, and 122 patients underwent a stent-free approach. There was no significant difference in 90-day overall complications, high-grade complications, readmissions, UTIs, leakage, and ileus (P > .05). Ureteroenteric strictures occurred at a rate of 13% and 18% at 1 and 2 years, respectively in the stented group, vs 7% and 10% in the stent-free group (P = .05). Stent placement was significantly associated with ureteroenteric strictures. CONCLUSIONS: Stent-free ureteroenteric anastomosis was associated with fewer strictures following RARC and ileal conduit.


Subject(s)
Anastomosis, Surgical , Cystectomy , Postoperative Complications , Robotic Surgical Procedures , Stents , Urinary Bladder Neoplasms , Urinary Diversion , Humans , Male , Female , Urinary Diversion/adverse effects , Urinary Diversion/methods , Retrospective Studies , Cystectomy/adverse effects , Cystectomy/methods , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Aged , Robotic Surgical Procedures/adverse effects , Robotic Surgical Procedures/methods , Stents/adverse effects , Constriction, Pathologic/etiology , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Urinary Bladder Neoplasms/surgery , Ureter/surgery , Ureteral Obstruction/surgery , Ureteral Obstruction/etiology , Ileum/surgery
11.
Langenbecks Arch Surg ; 409(1): 195, 2024 Jun 21.
Article in English | MEDLINE | ID: mdl-38904793

ABSTRACT

PURPOSE: SASI (single anastomosis sleeve ileal) bypass can lead to nutritional deficiencies, including disorders of iron metabolism and anemia. This study aims to evaluate the effect of SASI bypass on weight loss, anemia, and iron deficiency in patients with obesity during the follow-up period. METHODS: This study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass at our hospital between January 2020 and February 2022. RESULTS: The mean age of the patients was 42 years (range 22-58). The average duration of the follow-up period was 26 months. The mean percentage of excess weight loss (%EWL) was 90.1%, and total weight loss (%TWL) was 30.5%. During the postoperative observation period, anemia was identified in ten patients (25%), comprising 70% with normocytic anemia, 10% with microcytic anemia, and two macrocytic anemia cases (20%). Iron deficiency was observed in two patients (5%). CONCLUSION: SASI bypass is an effective bariatric procedure in weight loss outcomes. However, there may be an increased risk of anemia and iron metabolism disruptions associated with this procedure. The common limb length (250 vs. 300 cm) did not significantly impact hemoglobin, iron, TIBC, ferritin levels, or anemia incidence among patients undergoing SASI bypass. The decrease in postoperative ferritin levels signifies a depletion in tissue iron reserves, thereby emphasizing the necessity for surveillance of iron homeostasis parameters following SASI bypass.


Subject(s)
Ileum , Weight Loss , Humans , Adult , Female , Male , Middle Aged , Retrospective Studies , Ileum/surgery , Postoperative Complications/etiology , Obesity, Morbid/surgery , Obesity, Morbid/complications , Anemia , Anastomosis, Surgical , Bariatric Surgery/methods , Bariatric Surgery/adverse effects , Young Adult , Anemia, Iron-Deficiency , Iron/metabolism , Iron/blood
12.
BMC Urol ; 24(1): 118, 2024 Jun 10.
Article in English | MEDLINE | ID: mdl-38858691

ABSTRACT

PURPOSE: To present the experience of ileal ureter with ileocystoplasty (IUC), and compare the outcomes of IUC in minimally invasive procedures to open procedures. PATIENTS AND METHODS: From December 2017 to April 2023, twenty patients underwent IUC in open or minimally invasive (including laparoscopic and robotic) procedures. The baseline characteristics, perioperative data and follow-up outcomes were collected. Success was defined as relief of clinical symptoms, stable postoperative serum creatine and absence of radiographic obstruction. The perioperative and follow-up outcomes of open procedures and minimally invasive procedures were compared. RESULTS: The etiology included pelvic irradiation (14/20), urinary tuberculosis (3/20) and surgical injury (3/20). Bilateral ureter strictures were repaired in 15 cases. The surgeries conducted consisted of open procedures in 9 patients and minimally invasive procedures in 11 patients. Compared to open procedures, minimally invasive surgeries had less median estimated blood loss (EBL) (100 ml vs. 300 min, p = 0.010) and shorter postoperative hospitalization (27 d vs. 13 d, p = 0.004). Two patients in the open group experienced grade 3 complications (sigmoid fistula and acute cholecystitis in one patient, and pulmonary embolism in another patient). Over a median follow-up period of 20.1 months, the median bladder functional capacity was 300 ml, with a 100% success rate of IUC. CONCLUSION: IUC is feasible in both open and minimally invasive procedures, with acceptable complications and a high success rate. Minimally invasive procedures can have less EBL and shorter postoperative hospitalization than open procedure. However, prospective studies with larger groups and longer follow-up are needed.


Subject(s)
Ileum , Minimally Invasive Surgical Procedures , Ureter , Urinary Bladder , Urologic Surgical Procedures , Humans , Male , Female , Ileum/surgery , Adult , Treatment Outcome , Middle Aged , Urinary Bladder/surgery , Urologic Surgical Procedures/methods , Ureter/surgery , Minimally Invasive Surgical Procedures/methods , Retrospective Studies , Time Factors , Laparoscopy/methods , Aged , Robotic Surgical Procedures
14.
Colorectal Dis ; 26(7): 1415-1427, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38858815

ABSTRACT

AIM: Recent evidence challenges the current standard of offering surgery to patients with ileocaecal Crohn's disease (CD) only when they present complications of the disease. The aim of this study was to compare short-term results of patients who underwent primary ileocaecal resection for either inflammatory (luminal disease, earlier in the disease course) or complicated phenotypes, hypothesizing that the latter would be associated with worse postoperative outcomes. METHOD: A retrospective, multicentre comparative analysis was performed including patients operated on for primary ileocaecal CD at 12 referral centres. Patients were divided into two groups according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short-term results were compared. RESULTS: A total of 2013 patients were included, with 291 (14.5%) in the ICD group. No differences were found between the groups in time from diagnosis to surgery. CCD patients had higher rates of low body mass index, anaemia (40.9% vs. 27%, p < 0.001) and low albumin (11.3% vs. 2.6%, p < 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3% vs. 93.1%, p = 0.001) and higher conversion rates (9.3% vs. 1.9%, p < 0.001). CCD patients had a longer hospital stay and higher postoperative complication rates (26.1% vs. 21.3%, p = 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1% vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgery (OR 3.44, p = 0.001) and the requirement for multiple intraoperative procedures (OR 8.39, p = 0.030). CONCLUSION: Indication for surgery in patients who present with an inflammatory phenotype of CD was associated with better outcomes compared with patients operated on for complications of the disease. There was no difference between groups in time from diagnosis to surgery.


Subject(s)
Crohn Disease , Ileum , Phenotype , Postoperative Complications , Humans , Crohn Disease/surgery , Crohn Disease/complications , Female , Retrospective Studies , Male , Adult , Treatment Outcome , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Middle Aged , Ileum/surgery , Young Adult , Cecum/surgery , Laparoscopy/methods , Laparoscopy/statistics & numerical data , Laparoscopy/adverse effects , Operative Time , Length of Stay/statistics & numerical data , Time Factors
15.
Colorectal Dis ; 26(7): 1428-1436, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38881241

ABSTRACT

AIM: Crohn's disease has debilitating effects on patients' quality of life. Currently, there are limited data on the effect of anastomotic configuration on health-related quality of life after ileocaecal resection for Crohn's disease. This study aimed to assess the impact of Kono-S anastomosis on quality of life after ileocolic resection, compared to the conventional side-to-side anastomosis. METHOD: Patients with primary or recurrent Crohn's disease participating in the ongoing SuPREMe-CD trial were interviewed about quality of life using the Inflammatory Bowel Disease Questionnaire (IBDQ). The primary endpoint was disease-specific quality of life, assessed with IBDQ. Secondary outcomes were quality of life related to bowel symptoms, systemic symptoms, social function and emotional function. RESULTS: Of the 94 patients included, 51 (54%) received the conventional side-to-side anastomosis and 43 (46%) the Kono-S anastomosis. Demographics were comparable between the two groups. The IBDQ was assessed at a mean follow-up of 54.0 ± 18.7 months from surgical intervention. The mean total IBDQ score was 155.1 ± 28.07 in the conventional group and 163.8 ± 25.23 in the Kono-S group (P = 0.11). When considering bowel symptoms and social function, mean scores were 50.7 and 23.5 in the conventional group, and 56.3 and 26.5 in the Kono-S group (P = 0.002 and P = 0.02, respectively). Kono-S anastomosis was independently associated with improved quality of life regarding bowel symptoms (P = 0.006) and social function (P = 0.03) after correcting for other confounding factors on linear regression analysis. CONCLUSION: Compared to conventional side-to-side anastomosis, patients with Kono-S anastomosis presented significantly better bowel symptoms and social function scores at 54 months after surgery.


Subject(s)
Anastomosis, Surgical , Colon , Crohn Disease , Ileum , Quality of Life , Humans , Crohn Disease/surgery , Crohn Disease/psychology , Anastomosis, Surgical/methods , Female , Male , Adult , Ileum/surgery , Colon/surgery , Surveys and Questionnaires , Middle Aged , Treatment Outcome , Young Adult , Colectomy/methods
17.
Obes Res Clin Pract ; 18(3): 232-234, 2024.
Article in English | MEDLINE | ID: mdl-38944551

ABSTRACT

Transit bipartition (TB) emerges as a bariatric surgery alternative to Duodenal Switch (DS), emphasizing complete intestinal access and reduced malabsorption. By directly stimulating the distal ileum, TB promotes weight loss while preserving endoscopic duodenal access. This technique enhances anorexigenic hormones, aiding in satiety and weight loss, with lower malnutrition risks than DS. TB shows favorable short-term outcomes in weight management and comorbidity reduction, serving as a simpler, less malabsorptive option than DS. Nonetheless, long-term studies are essential for comprehensive efficacy assessment.


Subject(s)
Bariatric Surgery , Duodenum , Weight Loss , Humans , Bariatric Surgery/methods , Duodenum/surgery , Obesity, Morbid/surgery , Ileum/surgery , Treatment Outcome
18.
Medicine (Baltimore) ; 103(23): e38405, 2024 Jun 07.
Article in English | MEDLINE | ID: mdl-38847709

ABSTRACT

RATIONALE: Ileal perforation caused by the insertion of a drainage tube is a rare complication. Hence, the utilization of surgical drains in abdominal surgery remains controversial. At present, there is a trend to reduce the utilization of drains in abdominal surgery, although certain situations may necessitate their application. PATIENT CONCERNS: A 25-year-old Chinese woman presented with a history of right lower abdominal pain persisting for 10 days. Imaging examinations, including abdominal computed tomography and ultrasound, identified low-density lesions measuring 10 × 8 × 8cm3 in the right lower abdomen, which are consistent with perforated appendicitis complicated by a peri-appendiceal abscess. A laparoscopic appendectomy was carried out. On the 5th postoperative day, the drainage fluid changed to a grass-green color (80mL). Imaging with retrograde contrast through the drainage tube revealed that the 26 Fr silicon rubber drainage tube tip was positioned 50cm away from the ileocecal junction within the ileum. Both the ileal and ileocecal regions appeared well-developed. INTERVENTION AND OUTCOMES: Oral intake was suspended, and the patient received antacids, somatostatin, antibiotics, and total parenteral nutrition. On the 19th postoperative day, a follow-up imaging procedure using retrograde contrast through the drainage tube indicated that the tube tip was sealed. The treatment concluded on day 33 postoperatively, and the patient was discharged. DISCUSSION AND CONCLUSION: Ileal perforation due to an abdominal drainage tube following laparoscopic appendectomy constitutes a rare but serious complication. However, due to the adhesion and inflammatory changes around the abscess, laparoscopic dissection becomes a challenging and risky process, and the surgical skills and experiences are particularly important. Removing the abdominal drainage tube promptly based on the characteristics of the drainage fluid is recommended. The findings provide valuable insights for surgeons navigating similar challenges.


Subject(s)
Appendectomy , Appendicitis , Drainage , Ileum , Laparoscopy , Humans , Female , Adult , Appendectomy/methods , Appendectomy/adverse effects , Drainage/methods , Laparoscopy/methods , Laparoscopy/adverse effects , Appendicitis/surgery , Ileum/surgery , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Postoperative Complications/etiology , Postoperative Complications/surgery
19.
Sci Rep ; 14(1): 13247, 2024 06 10.
Article in English | MEDLINE | ID: mdl-38853155

ABSTRACT

The primary objective of this study was to compare short-term outcomes between Intracorporeal ileocolic anastomosis (IIA) and extracorporeal ileocolic anastomosis (EIA) after laparoscopic right hemicolectomy in patients with visceral obesity. The secondary objective was to identify risk factors associated with prolonged postoperative ileus (PPOI) after laparoscopic right hemicolectomy. This single-center retrospective study analyzed visceral obesity patients who underwent laparoscopic right hemicolectomy for primary bowel cancer between January 2020 and June 2023. Patients were categorized into IIA and EIA groups based on the type of anastomosis, and a 1:1 propensity score-matched analysis was performed. A total of 129 patients were initially included in this study, with 45 patients in each group following propensity score matching. The IIA group had significantly longer anastomosis times (p < 0.001), shorter incision length (p < 0.001), and shorter length of stay (p = 0.003) than the EIA group. Meanwhile, the IIA group showed a shorter time to first flatus (p = 0.044) and quicker tolerance of a solid diet (p = 0.030). On multivariate analysis, postoperative use of opioid analgesics is an independent risk factor for PPOI (OR: 3.590 95% CI 1.033-12.477, p = 0.044), while IIA is an independent protective factor (OR: 0.195 95% CI 0.045-0.843, p = 0.029). IIA remains a safe and feasible option for visceral obesity patients. It is also associated with a quicker recovery of bowel function and shorter length of stay when compared to EIA. Additionally, IIA is an independent protective factor for PPOI.


Subject(s)
Anastomosis, Surgical , Colectomy , Laparoscopy , Obesity, Abdominal , Postoperative Complications , Humans , Male , Female , Middle Aged , Anastomosis, Surgical/methods , Anastomosis, Surgical/adverse effects , Obesity, Abdominal/surgery , Retrospective Studies , Laparoscopy/methods , Laparoscopy/adverse effects , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Treatment Outcome , Aged , Colectomy/adverse effects , Colectomy/methods , Ileum/surgery , Colon/surgery , Risk Factors , Length of Stay , Ileus/etiology
20.
Pediatr Surg Int ; 40(1): 145, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38822835

ABSTRACT

PURPOSE: Preserving the ileocecal valve (ICV) has shown significant benefits. We present our experience with 18 infants who underwent ileocecal valve-preservation ileocecostomy (IVPI) with an extremely short distal ileum after primary ileostomy. METHODS: A retrospective analysis was conducted on IVPI cases between 2014 and 2020. Medical records were reviewed, including birth weight, age, primary diseases, length of ileus stump, surgical time and procedure, time to enteral feeding, postoperative hospital stay, and complications. RESULTS: Eighteen patients (male: female = 12:6, median birth weight 1305 (750-4000) g, median gestational age 29 + 5 (27 + 6-39 + 6) weeks) were included in the analysis. Causes of surgery included necrotizing enterocolitis (13), ileocecal intestinal atresia (1), ileum volvulus (2), meconium peritonitis (1), and secondary intestinal fistula (1). The median corrected age of ileostomy closure was 3.2 months (2.0-8.0 months). The distance from the distal ileal stoma to the ICV ranged from 0.5 to 2 cm. The median length of the residual bowel was 90 cm (50-130 cm). ICV-plasty was performed in 3 cases due to secondary ICV occlusion or stenosis. All patients resumed feeding within 6 to 11 days after surgery. The postoperative hospital stay ranged from 12 to 108 days (median: 16.5 days). Complications included incisional infections in 2 cases, anastomotic stricture and adhesive ileus in 1 case, nosocomial sepsis and septic shock in 1 case. All children showed normal growth and development during a 6-65 month follow-up. CONCLUSIONS: IVPI is safe and feasible for infants with an extremely short distal ileal stump. ICV-plasty could be applicable for cases with ileocecal occlusion/stenosis.


Subject(s)
Ileocecal Valve , Ileostomy , Humans , Male , Retrospective Studies , Ileocecal Valve/surgery , Female , Ileostomy/methods , Infant, Newborn , Infant , Ileum/surgery , Postoperative Complications
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