Long-term functional outcome after tubular laparoscopic sigmoid resection for diverticular disease.

PURPOSE: Sigmoid resection for diverticular disease is a frequent surgical procedure in the Western world. However, long-term bowel function after sigmoid resection has been poorly described in the literature. This study aims to assess the long-term bowel function after tubular sigmoid resection with preservation of inferior mesenteric artery (IMA) for diverticular disease. METHODS: We retrospectively identified patients who underwent sigmoid resection for diverticular disease between 2002 and 2012 at a tertiary referral center in northern Germany. Using well-validated questionnaires, bowel function was assessed for fecal urgency, incontinence, and obstructed defecation. The presence of bowel dysfunction was compared to baseline characteristics and perioperative outcome. RESULTS: Two hundred and thirty-eight patients with a mean age of 59.2 ± 10 years responded to our survey. The follow-up was conducted 117 ± 32 months after surgery. At follow-up, 44 patients (18.5%) had minor LARS (LARS 21-29) and 35 (15.1%) major LARS (LARS ≥ 30-42), 35 patients had moderate-severe incontinence (CCIS ≥ 7), and 2 patients (1%) had overt obstipation (CCOS ≥ 15). The multivariate analysis showed that female gender was the only prognostic factor for long-term incontinence (CCIS ≥ 7), and ASA score was the only preoperative prognostic factor for the presence of major LARS at follow-up. CONCLUSION: Sigmoid resection for diverticular disease can be associated with long-term bowel dysfunction, even with tubular dissection and preservation of IMA. These findings suggest intercolonic mechanisms of developing symptoms of bowel dysfunction after disruption of the colorectal continuity that are so far summarized as "sigmoidectomy syndrome."

Factor inhibiting HIF-1 (FIH-1) modulates protein interactions of apoptosis-stimulating p53 binding protein 2 (ASPP2).

The asparaginyl hydroxylase factor inhibiting HIF-1 (FIH-1) is an important suppressor of hypoxia-inducible factor (HIF) activity. In addition to HIF-α, FIH-1 was previously shown to hydroxylate other substrates within a highly conserved protein interaction domain, termed the ankyrin repeat domain (ARD). However, to date, the biological role of FIH-1-dependent ARD hydroxylation could not be clarified for any ARD-containing substrate. The apoptosis-stimulating p53-binding protein (ASPP) family members were initially identified as highly conserved regulators of the tumour suppressor p53. In addition, ASPP2 was shown to be important for the regulation of cell polarity through interaction with partitioning defective 3 homolog (Par-3). Using mass spectrometry we identified ASPP2 as a new substrate of FIH-1 but inhibitory ASPP (iASPP) was not hydroxylated. We demonstrated that ASPP2 asparagine 986 (N986) is a single hydroxylation site located within the ARD. ASPP2 protein levels and stability were not affected by depletion or inhibition of FIH-1. However, FIH-1 depletion did lead to impaired binding of Par-3 to ASPP2 while the interaction between ASPP2 and p53, apoptosis and proliferation of the cancer cells were not affected. Depletion of FIH-1 and incubation with the hydroxylase inhibitor dimethyloxalylglycine (DMOG) resulted in relocation of ASPP2 from cell-cell contacts to the cytosol. Our data thus demonstrate that protein interactions of ARD-containing substrates can be modified by FIH-1-dependent hydroxylation. The large cellular pool of ARD-containing proteins suggests that FIH-1 can affect a broad range of cellular functions and signalling pathways under certain conditions, for example, in response to severe hypoxia.

Laparoscopic spleen-preserving distal pancreatectomy.

PURPOSE: For a long time, laparoscopic pancreatic surgery was simply a matter of extended diagnostics without a simultaneous resection. METHODS: The increase of experience in complex laparoscopic procedures combined with a substantial improvement in technical equipment has led to the possibility of performing pancreatic resections laparoscopically. RESULTS: In contrast to the experimental laparoscopic pancreaticoduodenectomy, laparoscopic distal pancreatectomy has proved its safety and efficacy. CONCLUSION: In order to avoid splenectomy-associated complications, such as the OPSI-syndrome or formation of abscesses in the splenic area, the spleen-preserving technique is more favorable. Due to ischemia caused by the resection of the splenic vessels, as well as portal hypertension in the long-term follow-up, those vessels should remain untouched. The following article and video describe our approach for laparoscopic spleen-preserving distal pancreatectomy with sparing of the splenic vessels.

Voiding and sexual dysfunction after deep rectal resection and total mesorectal excision: prospective study on 52 patients.

OBJECTIVE: Voiding and sexual dysfunction after deep rectal resection have been described with various frequencies in the literature. In this study, we prospectively evaluated the baseline preoperative voiding and sexual function in a cohort of patients undergoing deep rectal resection with mesorectal excision to determine any pre-existing abnormalities. Postoperatively, we sought first to determine the frequency of a urinary or sexual dysfunction, secondly whether there is a time-dependent change of a dysfunction and thirdly whether there is a relationship between postoperative urological dysfunction and the patient's age. PATIENTS AND METHODS: Fifty-two patients (36 men and 16 women) with a primary rectal carcinoma were prospectively examined directly before and after the operation, as well after the third and sixth postoperative month. The preoperative urological evaluation consisted of a careful voiding and sexual history, uroflowmetry and a sonographic residual urine determination. A detailed sexual history was obtained via the use of a questionnaire. RESULTS: Urological dysfunction: Preoperatively, 49 of the 52 patients had a completely normal bladder function and three patients had post void residual >100 ml. Postoperatively, 12 of the 49 patients with normal preoperatively urinary function had voiding dysfunction, but only four male patients had residual urine in the third postoperative month. Therefore, in about 90% of the patients, postoperative bladder function became normal and only 10% suffered from vesical denervation after 6 months. We could not determine a relationship between the degree of bladder dysfunction and the patient's age due to a relatively small patient cohort in this study. Sexual dysfunction: Preoperatively, 36 (seven women, 29 men) of the 52 patients were potent and had regular sexual intercourse. Eleven men specified a limited erection, but all had occasional sexual intercourse. One of the potent men experienced no ejaculation. Postoperatively, eight of the 29 men were impotent and two of the 29 men experienced retrograde ejaculation. Therefore, 30% of the preoperatively potent men had sexual dysfunction postoperatively. There was no correlation between the postoperative impotence and the age of the patients at the time of surgery. Although it is likely that the potency may diminish with advanced age, the incidence of impotence was not higher in the older patients of our study. CONCLUSIONS: The results of our study underline the importance of risk estimation for possible postoperative urological dysfunction by means of preoperative urologic evaluation in this patient collective. Of patients with postoperative bladder dysfunction, 90% improved within 6 months after surgery and only 10% continued to have bladder dysfunction beyond 6 months, indicating irreversible nerve damage.