29 research outputs found

    The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

    Get PDF
    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

    Get PDF
    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.

    Get PDF
    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

    Get PDF
    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

    Get PDF
    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

    Endoscopy

    Get PDF
    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

    Get PDF
    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
    corecore