Improvement of peri-operative patient management to enable outpatient colectomy.

AIM OF THE STUDY: Outpatient left colectomy has been described in several small series or case reports. We conducted a prospective study to determine whether an optimized management approach could allow performance of this procedure in a broader patient population. PATIENTS AND METHODS: Between December 2014 and December 2015, all eligible patients were prospectively and consecutively included in this study. They all underwent surgery following the same outpatient management protocol. After discharge, patients were followed by home health nurses with surgeon follow-up visits on days 10 and 21 (D10, D21) or earlier, if necessary. RESULTS: During this period, 56 patients underwent a left colectomy, 47 of whom met the inclusion criteria. Seven patients refused the outpatient care approach, leaving a total of 40 patients included (8 ASA 3 [American Society of Anesthesiologists], 24 ASA 2, 8 ASA 1). All but one of the patients were able to return home the same evening. Bowel motility was restored on D1 for most patients. Two patients had abdominal pain that required a follow-up visit before D10 but their subsequent course was uneventful. No patient was re-hospitalized. An uncomplicated post-operative course was confirmed at follow-up visits on D10 and D21. CONCLUSION: Our study confirms that outpatient left colectomy is feasible for most patients, including fragile patients and/or those undergoing more complex procedures. Communication and close coordination by all stakeholders as well AS optimal organization of downstream patient care are essential to guarantee quality and safety.

[Massive rectal bleeding after appendectomy: report of 2 further cases and review of the literature]. / Hémorragie digestive basse massive après appendicectomie: à propos de deux nouveaux cas et revue de la littérature.

Massive rectal bleeding complicating appendectomy is extremely rare. This study describes two cases of severe gastrointestinal haemorrhage from an appendiceal stump, occurring one and seven days after appendectomy respectively. The two cases were successfully treated by emergency cecal resection. We reviewed the other previously reported etiologies of massive rectal bleeding after appendectomy for appendicitis.

[Late rejection of Mersylene mesh used for promontory fixation with colonic obstruction]. / Intolérance des bandelettes de Mersylène dans les suites tardives d'une promontofixation responsable d'un syndrome occlusif colique.

We describe a case of colonic obstruction in a 48-year-old woman, 3. 5 years after surgery for genito-urinary prolapse. The causal agent was the Mersylene mesh used for promontory fixation. Late rejection of this kind of prosthesis has been described previously, but such a digestive complication is exceptional.