29 research outputs found
The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery
ACKNOWLEDGEMENTS Review and editing: S.R. Brown, Professor of Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. Email [email protected]. Patient summary: R.G. Arnott, Retired Professor, Patient Liaison Group, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK. Email [email protected]. Delphi review: C.P. Macklin. BMedSci BM BS FRCS DM, Consultant Colorectal Surgeon, Mid Yorkshire Hospitals, UK. Email [email protected] reviewedPublisher PD
Mastering Endo-Laparoscopic and Thoracoscopic Surgery
This is an open access book. The book focuses mainly on the surgical technique, OR setup, equipments and devices necessary in minimally invasive surgery (MIS). It serves as a compendium of endolaparoscopic surgical procedures. It is an official publication of the Endoscopic and Laparoscopic Surgeons of Asia (ELSA). The book includes various sections covering basic skills set, devices, equipments, OR setup, procedures by area. Each chapter cover introduction, indications and contraindications, pre-operative patient’s assessment and preparation, OT setup (instrumentation required, patient’s position, etc.), step by step description of surgical procedures, management of complications, post-operative care. It includes original illustrations for better understanding and visualization of specific procedures. The book serves as a practical guide for surgical residents, surgical trainees, surgical fellows, junior surgeons, surgical consultants and anyone interested in MIS. It covers most of the basic and advanced laparoscopic and thoracoscopic surgery procedures meeting the curriculum and examination requirements of the residents
Laparoscopic approach in diverticular disease. Review of the literature.
Εισαγωγή/Σκοπός: Η εκκολπωματική νόσος αποτελεί ένα βασικό υγειονομικό πρόβλημα
και μία από τις συνηθέστερες διαταραχές του γαστρεντερικού συστήματος στις
αναπτυγμένες βιομηχανικά δυτικές χώρες, προκαλώντας σημαντική νοσηρότητα και
θνητότητα. Σε αυτή την ανασκόπηση της βιβλιογραφίας, σκοπός μας είναι να
εκτιμήσουμε την δυνατότητα και αποτελεσματικότητα της λαπαροσκοπικής
προσέγγισης στην εκλεκτική καθώς και στην επείγουσα αντιμετώπιση της
εκκολπωματικής νόσου.
Υλικά και μέθοδοι: Διεξήχθη βιβλιογραφική έρευνα άρθρων χρησιμοποιώντας την
ηλεκτρονική βάση δεδομένων MEDLINE του PubMed. Από τα 341 άρθρα που
αναγνωρίστηκαν, τα 279 αποκλείστηκαν καταλήγοντας σε 62 πλήρη άρθρα για
ανασκόπηση. Η τελική μας ανασκόπηση περιέλαβε 16 άρθρα.
Αποτελέσματα: Τα δέκα έξι άρθρα που συμπεριλήφθηκαν στην τελική ανασκόπηση
αποτελούνταν από έξι αναδρομικές μελέτες, πέντε προοπτικές μελέτες, δύο
τυχαιοποιημένες δοκιμές, μία συστηματική ανασκόπηση και μεταανάλυση, και δύο
συστηματικές ανασκοπήσεις. Επτά άρθρα μελετούσαν την εκλεκτική λαπαροσκοπική
σιγμοειδεκτομή, επτά άρθρα πραγματεύονταν την λαπαροσκοπική περιτοναϊκή πλύση
και δύο άρθρα την επείγουσα λαπαροσκοπική σιγμοειδεκτομή για εκκολπωματίτιδα με
διάτρηση. Η εκλεκτική λαπαροσκοπική προσέγγιση είναι εφικτή και ασφαλής. Η
λαπαροσκοπική περιτοναϊκή πλύση έχει αναδειχτεί ως ασφαλής και αποτελεσματική
ελάχιστα επεμβατική μέθοδος για την αντιμετώπιση της εκκολπωματίτιδας με
διάτρηση. Επιπλέον, σε επιλεγμένους ασθενείς, η επείγουσα λαπαροσκοπική
σιγμοειδεκτομή θα μπορούσε επίσης να είναι εφικτή για εκκολπωματίτιδα με
διάτρηση και γενικευμένη περιτονίτιδα.
Συμπεράσματα: Η λαπαροσκοπική προσέγγιση μπορεί να αποτελέσει μια ασφαλή και
αποτελεσματική επιλογή στην εκλεκτική καθώς και στην επείγουσα αντιμετώπιση της
εκκολπωματικής νόσου. Μεγάλες, προοπτικές, τυχαιοποιημένες μελέτες θα πρέπει να
διεξαχθούν ώστε να επιβεβαιωθούν αυτά τα ευρήματα.Background/Aim: Diverticular disease is a first class healthcare problem and
one of the most common gastrointestinal disorders in western industrialized
countries, causing significant morbidity and mortality. In this review of the
literature, we aim to assess the feasibility and effectiveness of the
laparoscopic approach in both elective and emergency setting of diverticular
disease.
Materials and methods: A bibliographic search of articles was performed using
the electronic database MEDLINE from PubMed. Of 341 articles identified, 279
were excluded, resulting in 62 full text articles for review. Our final review
included 16 articles.
Results: The sixteen articles included in the final review consisted of six
retrospective studies, five prospective studies, two randomized controlled
trials, one systematic review and metaanalysis, and two systematic reviews.
Seven articles considered elective laparoscopic sigmoid resection, seven
articles evaluated laparoscopic peritoneal lavage and two articles considered
emergency laparoscopic sigmoid resection for perforated diverticulitis. The
elective laparoscopic approach is feasible and safe. Laparoscopic peritoneal
lavage has emerged as a safe and effective minimally invasive procedure for the
treatment of perforated diverticulitis. Furthermore, in selected patients,
emergency laparoscopic sigmoidectomy could also be feasible for perforated
diverticulitis with generalized peritonitis.
Conclusions: Laparoscopic approach can be a safe and effective option in both
elective and emergency setting of diverticular disease. Large, prospective,
randomized studies should be conducted to confirm these findings
Mastering Endo-Laparoscopic and Thoracoscopic Surgery
This is an open access book. The book focuses mainly on the surgical technique, OR setup, equipments and devices necessary in minimally invasive surgery (MIS). It serves as a compendium of endolaparoscopic surgical procedures. It is an official publication of the Endoscopic and Laparoscopic Surgeons of Asia (ELSA). The book includes various sections covering basic skills set, devices, equipments, OR setup, procedures by area. Each chapter cover introduction, indications and contraindications, pre-operative patient’s assessment and preparation, OT setup (instrumentation required, patient’s position, etc.), step by step description of surgical procedures, management of complications, post-operative care. It includes original illustrations for better understanding and visualization of specific procedures. The book serves as a practical guide for surgical residents, surgical trainees, surgical fellows, junior surgeons, surgical consultants and anyone interested in MIS. It covers most of the basic and advanced laparoscopic and thoracoscopic surgery procedures meeting the curriculum and examination requirements of the residents
Colorectal cancer in young adults: improving identification and management of familial gastrointestinal cancer syndromes
This thesis evaluates colorectal cancer (CRC) outcomes in young adults and explores various
approaches of improving identification and management of individuals with genetic familial
gastrointestinal (GI) cancer syndromes such as Lynch syndrome (LS) and familial
adenomatous polyposis (FAP). Several research methodologies were utilised to address
various hypothesis.
Firstly, we evaluated differences in clinicopathological features between early onset CRC
(adults less than 40 years of age) and late onset CRC and the prevalence of familial
gastrointestinal (GI) cancer syndromes in the young adults with CRC. This thesis demonstrated
that 28% of EOCRC had hereditary GI cancer syndromes. The rectum was the most common
site of CRC and EOCRC tend to present with poor histological features and advanced disease.
Although young age was not an independent prognostic factor, EOCRC had worse diseasefree
survival.
To improve management of individuals at risk of EOCRC, this thesis explored phenotypic and
genotypic factors that can be optimised to improve diagnosis, surveillance and surgical
Colorectal Cancer in Young Adults: Improving Identification and Management of Familial Gastrointestinal Cancer Syndromes
4
outcomes in LS and FAP. In FAP, we demonstrated that attenuated FAP is an obsolete term
due to observed phenotypic and genotypic variability. We also found that the rate of
adenoma of progression in the preoperative colorectum and postoperative rectal remnant
was slow (12.5 and 5.5 polyps/year respectively). Therefore, tailored endoscopic surveillance
and polypectomy (rectum) are appropriate surveillance strategies. Furthermore, surgical
outcomes in individuals undergoing prophylactic surgery for can be improved by ileodistal
anastomosis (IDSA), a modification of the conventional ileorectal anastomosis.
Finally, this thesis demonstrates that pre-operative screening for LS using mismatch repair
immunohistochemistry (MMR IHC) testing on preoperative endoscopic biopsy and metastatic
tissue is feasible. In the event of LS CRC, a systematic review and meta-analysis demonstrated
that extended colectomy should be considered in young individuals with higher risk MMR
pathogenic variant to reduce the risk of metachronous CRC.Open Acces
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Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.
BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted
Endoscopy
Endoscopy is a fast moving field, and new techniques are continuously emerging. In recent decades, endoscopy has evolved and branched out from a diagnostic modality to enhanced video and computer assisting imaging with impressive interventional capabilities. The modern endoscopy has seen advances not only in types of endoscopes available, but also in types of interventions amenable to the endoscopic approach. To date, there are a lot more developments that are being trialed. Modern endoscopic equipment provides physicians with the benefit of many technical advances. Endoscopy is an effective and safe procedure even in special populations including pediatric patients and renal transplant patients. It serves as the tool for diagnosis and therapeutic interventions of many organs including gastrointestinal tract, head and neck, urinary tract and others
25th International Congress of the European Association for Endoscopic Surgery (EAES) Frankfurt, Germany, 14-17 June 2017 : Oral Presentations
Introduction: Ouyang has recently proposed hiatal surface area (HSA) calculation by multiplanar multislice computer tomography (MDCT) scan as a useful tool for planning treatment of hiatus defects with hiatal hernia (HH), with or without gastroesophageal reflux (MRGE). Preoperative upper endoscopy or barium swallow cannot predict the HSA and pillars conditions. Aim to asses the efficacy of MDCT’s calculation of HSA for planning the best approach for the hiatal defects treatment. Methods: We retrospectively analyzed 25 patients, candidates to laparoscopic antireflux surgery as primary surgery or hiatus repair concomitant with or after bariatric surgery. Patients were analyzed preoperatively and after one-year follow-up by MDCT scan measurement of esophageal hiatus surface. Five normal patients were enrolled as control group. The HSA’s intraoperative calculation was performed after complete dissection of the area considered a triangle. Postoperative CT-scan was done after 12 months or any time reflux symptoms appeared. Results: (1) Mean HSA in control patients with no HH, no MRGE was cm2 and similar in non-complicated patients with previous LSG and cruroplasty. (2) Mean HSA in patients candidates to cruroplasty was 7.40 cm2. (3) Mean HSA in patients candidates to redo cruroplasty for recurrence was 10.11 cm2. Discussion. MDCT scan offer the possibility to obtain an objective measurement of the HSA and the correlation with endoscopic findings and symptoms. The preoperative information allow to discuss with patients the proper technique when a HSA[5 cm2 is detected. During the follow-up a correlation between symptoms and failure of cruroplasty can be assessed. Conclusions: MDCT scan seems to be an effective non-invasive method to plan hiatal defect treatment and to check during the follow-up the potential recurrence. Future research should correlate in larger series imaging data with intraoperative findings