Oncological Clearance Following Resection of the Carcinoma Rectum: A Comparison between Laparoscopic and Open Anterior Resection.

Till the day the rectal cancer deaths in the world is in eighth position. For rectal cancer surgery, short-term benefits are expected to be similar for laparoscopic resection of rectum (LRR) and open resection of rectum (ORR). In Bangladesh though the rectal cancer is the sixteenth most common cause of cancer deaths, there is lack of data regarding outcomes of laparoscopic and open surgical approaches for carcinoma rectum. Purpose of study was to compare oncopathological outcomes by quality of surgical resection between LRR and ORR groups. The quasi experimental study was conducted among 46 subjects who attended in the Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University, Bangladesh from July 2020 to June 2021 with rectal adenocarcinoma within 15cm from the anal verge. Equal number of subjects were allocated for LRR and ORR group. Oncopathological end points such as circumferential resection margin (CRM), distal resection margin (DRM), lymph nodes and quality of mesorectal excision were assessed and compared. Here every patients have given their written consent for this study. Mean age of the subjects for LRR and ORR were 45.47±12.66 and 44.47±12.48 years respectively. Majority of the subjects were in age above 40 years (67.0%). The proportion of male (56.5%) were higher than those of female (43.5%). The complete resection was better in LRR (91.3%) than ORR (87.0%) group though statistically not significant. CRM was lower in LRR (0.0%) than ORR (13.0%) group in respect of frequency distribution. DRM was negative for both LRR and ORR group (95.7% each) and it was not statistically significant. ORR met the National Comprehensive Cancer Network (NCCN) criteria of harvesting 12 lymph nodes were as in LRR group 10 lymph nodes were harvested. The mean harvested lymph nodes were 12.2±5.55 and 10.1±5.55 in LRR and ORR group respectively. The study demonstrated that LRR is better (though statistically not significant) in respect of complete resection and CRM while in harvesting lymph nodes, ORR met the NCCN criteria but LRR does not. There is no difference observed regarding DRM in both groups. On oncopathological point of view both the group showed almost equally effective results. Laparoscopic surgery can be opted as the standard operative technique for surgical management of rectal cancer.

Clinical Significance of Faecal Calprotectin in Differentiating Inflammatory Bowel Disease from Irritable Bowel Syndrome.

Inflammatory bowel disease (IBD) is a chronic idiopathic inflammatory disorder of the gastrointestinal tract with relapsing and remitting course. Recurrent abdominal pain and discomfort in association with abnormal defecation in the absence of structural abnormality of the gut is the key feature of irritable bowel syndrome (IBS). Faecal biomarker may be used a precise tool in the differentiation of IBD and IBS. The aim of this study was to measure faecal calprotectin (FC) in patients with IBD and IBS and compare between them. This was a cross-sectional study done in the department of Gastroenterology, BSMMU, Bangladesh from May 2017 to August 2018. IBD patients were diagnosed on the basis of compatible history, clinical examination, laboratory, radiological and endoscopic findings. IBS patients were selected by using the Rome IV criteria. Quantitative faecal calprotectin ELISA (BUHLMANN Quantum Blue) test was done and compared between IBD and IBS patients. In this study, ninety (90) patients were enrolled, 45 patients with IBD and 45 patients with IBS. Mean age of the IBD patients was 32.24±9.76 years and IBS patients was 33.80±9.70 years. There were 28(62.2%) male and 17(37.8%) female patients with IBD and 30(66.7%) male and 15(33.3%) female patients with IBS. We found faecal calprotectin (FC) level was 445.68±237.35µg/gm in IBD patients and 39.16±17.31µg/gm in IBS patients. There was a significant difference of faecal calprotectin level between IBD and IBS patients (p-value <0.001). The sensitivity and specificity of faecal calprotectin to differentiate IBD from IBS was 91.1% and 86.7% respectively. The test accuracy was 88.9%. Area under ROC was 0.959 (95% CI, 0.909 to 1.0). This study showed that faecal calprotectin appears to be clinically useful, non-invasive, rapid and reliable marker to differentiate IBD from IBS.

Limberg Flap in Pilonidal Sinus: Experience in Shaheed Suhrawardy Medical College Hospital.

Pilonidal sinus disease is a common anorectal condition usually seen in young adult patients. Various methods have been described over the years and there is ongoing debate regarding the ideal method. This study was conducted to evaluate the advantages, results of rhomboid excision and Limberg flap reconstruction in the management of sacrococcygeal pilonidal sinus disease. This cross-sectional study was conducted in Surgery Unit-I of Department of Surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh a tertiary care centre from July 2016 to November 2017. It includes 19 patients who were treated for sacrococcygeal pilonidal sinus disease by Limberg (Rhomboid) flap. All patients that underwent the procedure had good postoperative outcome with minimal postoperative discomfort and were discharged in 3-4 days. There were 3 cases with complications. Limberg flap coverage is very effective for pilonidal disease with low complication rates, reduced hospital stay, low recurrence rates, earlier healing and shorter time off-work. This technique can be easily mastered and used as an indispensable tool for treating sacrococcygeal pilonidal sinus disease.