Comparison of Anastomosis Evaluation Techniques Before Ileostomy Closure in Rectal Cancer Patients

Aim:Postoperative ileus, stricture, abscess, and sepsis can be prevented by ensuring that there is no deterioration in the integrity of the anastomosis before closure of the protective loop ileostomy for rectal cancer. The aim of this study is to investigate which technique is more appropriate to evaluate the anastomosis before ileostomy closure.Materials and Methods:Between 2011 and 2019, patients who underwent elective low anterior resection for rectal cancer and had a concomitant protective loop ileostomy were reviewed retrospectively. The patients included in the study were divided into 2 groups as those whose anastomosis evaluation was performed with digital rectal examination (DRE) alone and those who underwent flexible endoscopy (FE) with DRE.Results:Ninety-nine patients were included in the study. Sixty-one of the patients were male and 38 were female. The mean age of the patients was 59.36±11.47 years. In the preoperative period, DRE+FE was applied to 67 patients and only DRE to 32 patients. Complications were detected in 10 patients after ileostomy closure (stricture and ileus in 6 patients, anastomotic leakage in 3 patients, and surgical site infection in 1 patient). Of 89 patients without complications, 66 were in the DRE+FE group and 23 were in the DRE group (p<0.001).Conclusion:In order to minimize the complications related to the anastomosis, it is recommended to evaluate together with both DRE and FE, although the appropriate examination in the evaluation of anastomosis is still not clear before the protective loop ileostomy is closed

A rare cause of ileus: Meningomyelocele

Ankara,Ankara Numune Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği, Kolorektal Cerrahi BölümüNöral tüp defektleri, ayrık omurga ve meningomiyelosel hastalığı, kronik kabızlığın nedenlerinden biridir. Çocukluk çağında daha sık görüldüğü için meningomiyelosel kaynaklı ileusa ilk kez ileri yaşta tanı konması çok nadir bir durumdur. Olgu sunumumuzda bu konu tartışılacaktırNeural tube defects, spina bifida and meningomyelocele disease, are one of the causes of chronic constipation. The first diagnosis of meningomyeloceleinduced ileus in older age is very rare since it is a condition more commonly encountered in childhood. We discuss this issue in our case repor

Management and Morbidity of Major Pelvic Hemorrhage in Complex Abdominopelvic Surgery

Introduction: Hemorrhage is a challenging complication of pelvic surgery. This study aimed to analyze the causes, management, and factors associated with morbidity in patients experiencing major pelvic hemorrhage during complex abdominopelvic surgery. Methods: Patients who had major intraoperative pelvic hemorrhage during complex abdominopelvic surgery at 11 tertiary referral centers between 1997 and 2017 were included. Patient characteristics, management strategies to control bleeding, short- and long-term postoperative outcomes were evaluated retrospectively. Results: There were 120 patients with a mean age of 56.6 ± 2.4 years and a mean BMI of 28.3 ± 1 kg/m2. While 104 (95%) of the patients were operated for malignancy, 16 (5%) of the patients had surgery for a benign disease. The most common bleeding site was the presacral venous plexus 90 (75%). Major pelvic hemorrhage was managed simultaneously in 114 (95%) patients. Electrocauterization 27 (23%), pelvic packing 26 (22%), suturing 7 (6%), thumbtacks application 7 (6%), muscle welding 4 (4%), use of energy devices 2 (2%), and topical hemostatic agents 2 (2%) were the management tools. Combined techniques were used in 43 (36%) patients. Short-term morbidity and mortality rates were 48 (40%) and 2 (2%), respectively. High preoperative CRP levels (p = 0.04), history of preoperative radiotherapy (p = 0.04), longer bleeding time (p = 0.006), and increased blood transfusion (p = 0.005) were the factors associated with postoperative morbidity. Conclusion: Postoperative morbidity related to major pelvic hemorrhage can be reduced by optimizing the risk factors. Prehabilitation prior to surgery to moderate inflammatory status and prompt action with proper technique to control major pelvic hemorrhage can prevent excessive blood loss in complex abdominopelvic surgery