Laparoscopic restorative proctectomy with ileal J-Pouch in patient with Ulcerative Colitis - A video vignette

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the procedure of choice for patients with ulcerative colitis (UC) requiring surgery. We present herein the technical aspect of the laparoscopic approach for completion proctectomy and IPAA. We report the case of a 42-years old female patient known for a refractory to medical treatment UC for a few years who underwent a three-stage procedure: firstly a laparoscopic total abdominal colectomy with terminal ileostomy. After a satisfying clinical evolution at 3 months, a laparoscopic restorative proctectomy with IPAA was performed. We present herein the video of this procedure. The completion proctectomy was realized by a laparoscopic approach and the ileal J-pouch was created extracorporally through the stoma orifice A 18cm ileal pouch was then created and anastomosed to the anal canal. A routine diverting loop ileostomy was created. The postoperative course was uneventful. The video summarizes the different steps of the procedure and shows the technical details of a laparoscopic restorative proctectomy with IPAA

Gestion des stomies d’alimentation et de dérivation

Une stomie est l’abouchement du tube digestif à la peau, que celui-ci soit réalisé par le biais d’un dispositif médical ou consécutif à une intervention chirurgicale dérivant le tube digestif. Les objectifs d’une stomie peuvent être de suppléer à une alimentation par voie anatomique, de décomprimer le tube digestif ou de protéger une partie du tube digestif ou le périnée en aval. Les stomies peuvent être réalisées à tous les niveaux du tube digestif et être de différents types, en fonction des montages anatomiques réalisés. Leur prise en charge, ainsi que celle de leurs potentielles complications, dont l’incidence peut atteindre 80 %, nécessite des connaissances spécifiques dont la description est l’objectif du présent article

Lateral lymph node dissection for rectal cancer: is it necessary?

Rectal cancer constitutes a major public health issue according to their incidence and the number of deaths per year. Total mesorectal excision have been considered as the gold standard treatment since 1990s for mid and low rectal tumors. However, when cancer spreads to lateral lymph nodes located along the iliac and obturator arteries, Western and Japanese guidelines differ: whereas Western surgeons consider it as an advanced disease and uses neoadjuvant radiochemotherapy, Japanese surgeons define it as a local disease and proceed to lateral lymph node dissection. Herein, we review the current literature regarding both therapeutic strategies, looking for potential improvements for patients with rectal cancer

Does Prophylactic Negative-Pressure Wound Therapy Prevent Surgical Site Infection After Laparotomy? A Systematic Review and Meta-analysis of Randomized Controlled trials.

Funder: University of GenevaBACKGROUND: Prophylactic negative-pressure wound therapy (pNPWT) may prevent surgical site infection (SSI) after laparotomy, but existing meta-analyses pooling only high-quality evidence have failed to confirm this effect. Recently, several randomized controlled trials (RCTs) have been published. We performed an updated systematic review and meta-analysis to determine if pNPWT reduces the incidence of SSI after laparotomy. METHODS: MEDLINE, Embase, CENTRAL and Web of Science were searched on the 25.08.2021 for RCTs reporting on the incidence of SSI in patients who underwent laparotomy with and without pNPWT. The systematic review was compliant with the AMSTAR2 recommendation and registered into PROSPERO. Risk ratios (RR) for SSI in patients with pNPWT, and risk difference (RD) between control and pNPWT patients, were obtained using random effects models. Heterogeneity was quantified using the I2 value, and investigated using subgroup analyses, funnel plots and bubble plots. Risk of bias of included RCTs was assessed using the RoB2 tool. RESULTS: Eleven RCTs were included, representing 973 patients who received pNPWT and 970 patients who received standard wound dressing. Pooled RR and RD between patients with and without pNPWT were of, respectively, 0.665 (95% CI 0.49-0.91, I2: 38.7%, p = 0.0098) and -0.07 (95% CI -0.12 to -0.03, I2: 53.6%, p = 0.0018), therefore demonstrating that pNPWT decreases the incidence of SSI after laparotomy. Investigation of source of heterogeneity identified a potential small-study effect. CONCLUSION: The protective effect of pNPWT against SSI after laparotomy is confirmed by high-quality pooled evidence

Prophylactic negative-pressure wound therapy prevents surgical site infection in abdominal surgery: an updated systematic review and meta-analysis of randomized controlled trials and observational studies

Prevention of surgical site infection (SSI) is a public health challenge. Our objective was to determine if pNPWT allows preventing SSI after laparotomy

The role of perineal application of prophylactic negative-pressure wound therapy for prevention of wound-related complications after abdomino-perineal resection: a systematic review

Closed perineal wounds often fail to heal by primary intention after abdomino-perineal resection (APR) and are often complicated by surgical site infection (SSI) and/or wound dehiscence. Recent evidence showed encouraging results of prophylactic negative-pressure wound therapy (pNPWT) for prevention of wound-related complications in surgery. Our objective was to gather and discuss the early existing literature regarding the use of pNPWT to prevent wound-related complications on perineal wounds after APR

One-step totally robotic Hartmann reversal and complex abdominal wall reconstruction with bilateral posterior component separation: a technical note

Aim: This paper describes a robotic approach to combined gastrointestinal continuity restoration and complex abdominal wall reconstruction after Hartmann's procedure complicated by large midline and parastomal hernias. Methods: A robotic Hartmann reversal is performed, followed by robotic retromuscular abdominal wall reconstruction of all ventral defects with bilateral posterior component separation using the double-docking approach. Surgical steps are thoroughly described, and the accompanying video highlights critical steps of the procedure, anatomical landmarks and technical details relevant to successful completion. Results: Complete restoration of the anatomy was achieved with an operative time of 6.5 h. Mobilization occured on day 1, and bowels were opened on day 3. Surgical discharge was possible on day 5. No intra-operative surgical complication occurred and follow-up at 6 months showed no recurrence or mid-term complication. Conclusion: Combined minimally invasive reconstruction of the gastrointestinal tract and abdominal wall was feasible using a robotic system. In addition, potential advantages of postoperative rehabilitation and reduced surgical site complications are suggested. Prospective evaluation of the technique is ongoing.</p