Lėtinės kolorektalinės fistulės gydymas naudojant OTSC kabutes: klinikinis atvejis

Anastomotic leakage in colorectal surgery is an infrequent but in some cases very serious or even lethal complication. The over-the-scope-clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested on animals, could be the answer for the patient with such situation. We present a case of 63-year-old man suturae insuffitiency at the 40th post-operative day. The conservative treatment was long and unsuccessful. The lesion was then closed with two subsequent clips, and the patient recovered well without major interventions. The lesion showed a normal healing on the follow-up.Kolorektalinės anastomozės nesandarumas nėra dažna, tačiau labai sunki, neretai ir mirtina komplikacija. OTSC kabutės („Ovesco“) buvo sukurtos virškinamojo trakto perforacijoms gydyti. Pirmiausia išbandytos eksperimentuojant su gyvūnais. Šios kabutės gali būti vienas iš nesandarumo ir (ar) fistulių gydymo metodų. Aprašome atvejį, kai 63 metų vyrui po kolorektalinės operacijos atsirado žarnų siūlės nesandarumas. Konservatyvus gydymas buvo nesėkmingas. Defektas panaikintas naudojant dvi „Ovesco“ kabutes, kurios uždėtos skirtingu metu. Stebėjimo laikotarpiu defektas sugijo

Treatment of chronic colorectal fistula with the over-the-scope-clipping system: a case report

Anastomotic leakage in colorectal surgery is an infrequent but in some cases very serious or even lethal complication. The over-the-scope-clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested on animals, could be the answer for the patient with such situation. We present a case of 63-year-old man suturae insuffitiency at the 40th post-operative day. The conservative treatment was long and unsuccessful. The lesion was then closed with two subsequent clips, and the patient recovered well without major interventions. The lesion showed a normal healing on the follow-up

The over-the-scope clipping system for treatment of chronic coloenteric fistula: a case report

Anastomotic leak in colorectal surgery is not very unusual. The over-the-scope clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested with animals, might be the choice for the patient. We presented the case of a 63-year-old man with chronic coloenteric fistula. Conservative treatment was unsuccessful. The orifice was then closed with two subsequent clips, and the patient recovered well. To our knowledge, this is the first successful case of coloenteric fistula treatment with Ovesco

Complicaciones del tratamiento de cáncer rectal. Informe de caso

La neoplasia de recto se considera una enfermedad frecuente y altamente mortal, su incidencia es mayor en los países desarrollados. El tratamiento implica conjunción de quimioterapia e intervenciones quirúrgicas cuyos beneficios aún están en discusión. Se reporta un caso de una paciente con neoplasia de recto medio tratada en Hospital Provincial Universitario Clínico-Quirúrgico Dr. Gustavo Aldereguía Lima. Se realiza intervención quirúrgica electiva. Presentó un deterioro del estado general durante la estancia hospitalaria y fallece 10 días después de la intervención

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Usefulness of Anorectal Manometry for Diagnosing Continence Problems After a Low Anterior Resection

PURPOSE: For several decades, the low anterior resection (LAR) with total mesorectal excision (TME) has been the gold standard for treating patients with rectal cancer. Up to 90% of patients undergoing sphincter-preserving surgery will have changes in bowel habits, so-called 'anterior resection syndrome.' This study examined patients' continence after a LAR for the treatment of rectal cancer. METHODS: This prospective study was performed between September 2014 and August 2015 at the National Cancer Institute and included 30 patients who underwent anorectal manometry preoperatively and at 3 and 4 months after a LAR, but 10 were excluded from further evaluation for various reasons. Wexner score was recorded preoperatively and 4 months after LAR (1 month after ileostomy repair). RESULTS: Postoperatively, 70% of patients complained of some degree of soiling (incontinence to liquid stool), and 30% experienced urgent defecation. Four months after surgery, these symptoms had somewhat abated. The anal resting pressure and the maximum squeezing pressure did not change significantly. Rectal capacity and compliance were reduced in all patients. The majority of patients demonstrated manometric anorectal changes and clinical anorectal function disorders during the first 4 months after surgery. The Wexner scores and the manometric findings showed no correlation. CONCLUSION: Many patients undergoing a LAR with TME for the treatment of rectal cancer experience some degree of incontinence postoperatively. Anorectal manometry may be used as an additional tool for evaluating problems with continence after a LAR. No correlation between the Wexner score and the manometric findings was observed

Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution&amp;apos;s Experience

PURPOSE: The purpose of this study was to look at our complication rates and recurrence rates, as well as the need for further radical surgery, in treating patients with benign and early malignant rectal tumors by using transanal endoscopic microsurgery (TEM). METHODS: Our study included 130 patients who had undergone TEM for rectal adenomas and early rectal cancer from December 2009 to December 2015 at the Department of Surgical Oncology, National Cancer Institute, Lithuania. Patients underwent digital and endoscopic evaluation with multiple biopsies. For preoperative staging, pelvic magnetic resonance imaging or endorectal ultrasound was performed. We recorded the demographics, operative details, final pathologies, postoperative lengths of hospital stay, postoperative complications, and recurrences. RESULTS: The average tumor size was 2.8 ± 1.5 cm (range, 0.5–8.3 cm). 102 benign (78.5%) and 28 malignant tumors (21.5%) were removed. Of the latter, 23 (82.1%) were pT1 cancers and 5 (17.9%) pT2 cancers. Of the 5 patients with pT2 cancer, 2 underwent adjuvant chemoradiotherapy, 1 underwent an abdominoperineal resection, 1 refused further treatment and 1 was lost to follow up. No intraoperative complications occurred. In 7 patients (5.4%), postoperative complications were observed: urinary retention (4 patients, 3.1%), postoperative hemorrhage (2 patients, 1.5%), and wound dehiscence (1 patient, 0.8%). All complications were treated conservatively. The mean postoperative hospital stay was 2.3 days. CONCLUSION: TEM in our experience demonstrated low complication and recurrence rates. This technique is recommended for treating patients with a rectal adenoma and early rectal cancer and has good prognosis