Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures

Procedure for prolapsing hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry low postoperative pain, but may be followed by unusual and severe postoperative complications. This review deals with the pathogenesis, prevention and treatment of adverse events that may occasionally be life threatening. PPH and STARR carry the expected morbidity following anorectal surgery, such as bleeding, strictures and fecal incontinence. Complications that are particular to these stapled procedures are rectovaginal fistula, chronic proctalgia, total rectal obliteration, rectal wall hematoma and perforation with pelvic sepsis often requiring a diverting stoma. A higher complication rate and worse results are expected after PPH for fourth-degree piles. Enterocele and anismus are contraindications to PPH and STARR and both operations should be used with caution in patients with weak sphincters. In conclusion, complications after PPH and STARR are not infrequent and may be difficult to manage. However, if performed in selected cases by skilled specialists aware of the risks and associated diseases, some complications may be prevented

Laparoscopic colonic resection in fast-track patients does not enhance short-term recovery after elective surgery

<p>Background: Laparoscopic colorectal surgery has been claimed to enhance recovery when compared with open surgery. The aim of our study was to investigate whether laparoscopic colorectal resection improved recovery with the use of a multimodal rehabilitation programme.</p> <p>Method: We carried out a prospective audit of 80 patients undergoing elective colorectal resection between November 2003 and March 2005. All patients underwent a fast-track protocol with early feeding, mobilization and a fluid and sodium restriction regime. Recovery was measured in terms of return of gastrointestinal function, hospital stay, complications and quality of life measures.</p> <p>Results: Of the 80 patients in the study 22 underwent laparoscopic resection and 58 had open surgery. Patients were well matched for all baseline characteristics. The groups were not significantly different in terms of opioid or antiemetic use. They were also similar in median time to first flatus (69 h vs 69 h, P = 0.36) and median time to first bowel motion (127 h vs 101 h, P = 0.07). There was no difference in median hospital stay (5.8 days vs 5.9 days, P = 0.87) or complications (P = 0.46) between the laparoscopic and open group. There were no significant differences in Short Form 36 scores between the two groups for any of the components measured.</p> <p>Conclusion: Laparoscopic colorectal resection does not appear to reduce the duration of ileus or hospital stay with the use of a multimodal rehabilitation regime. Further large randomized trials are required to confirm these findings.</p&gt

The accuracy of colonoscopic localisation of colorectal tumours: a prospective, multi-centred observational study

Background and aims: Colonoscopy is essential for accurate pre-operative colorectal tumour localisation, but its accuracy for localisation remains undetermined due to limitations of previous work. This study aimed to establish the accuracy of colonoscopic localisation and to determine how frequently inaccuracy results in altered surgical management. Method: A prospective, multi-centred, powered observational study recruited 79 patients with colorectal tumours that underwent curative surgical resection. Patient and colonoscopic factors were recorded. Pre-operative colonoscopic and radiological lesion localisations were compared to intra-operative localisation using pre-defined anatomical bowel segments to determine accuracy, with changes in planned surgical management documented. Results: Colonoscopy accurately located the colorectal tumour in 64/79 patients (81%). Five out of 15 inaccurately located patients required on-table alteration in planned surgical management. Pre-operative imaging was unable to visualise the primary tumour in 23.1% of cases, a finding that was more prevalent amongst bowel screener patients compared to symptomatic patients (45.8% vs. 13%; p = 0.003). Conclusion: Colonoscopic lesion localisation is inaccurate in 19.0% of cases and occurred throughout the colon with a change in on-table surgical management in 6.3%. With CT unable to visualise lesions in just under a quarter of cases, particularly in the screening population, preoperative localisation is heavily reliant on colonoscopy

Tephrostratigraphy of An Loch Mór, Inis Oírr, western Ireland: implications for Holocene tephrochronology in the northeastern Atlantic region

Twelve definable cryptotephra layers younger than c. 8600cal. BP are reported from lacustrine core material taken from An Loch Mór, Inis Oírr, Aran Islands, western Ireland. The geochemistry of these shard layers, which represent more Holocene tephras than previously geochemically characterized from any European site outside the proximal volcanic influence of Italy or Iceland, is presented. Of these tephras, four may correlate with known Iceland-derived tephra horizons (Vo 1477, HI, Lairg A and H5); one appears to have two possible named correlatives (Hoy;‘Lairg B’ at Sluggan Bog, N Ireland); another has a plausible correlative (AD 860A); but two others represent Icelandic tephras apparently not previously reported on Iceland itself, including a tephra that has geochemistry very similar to Hl (AD 1104) but which dates to c. cal. AD 840. Four tephras that date from the period c. AD 40-1400 have a distinct geochemical signature that relates to Jan Mayen, 750km to the northeast of Iceland and some 1800km distant from An Loch Mór. The results contribute substantially to the chronology of the sediments from An Loch Mór and, at the international level, to the tephrostratigraphy of the northeast Atlantic region. The well-attested Icelandic H4 tephra (from a Hekla eruption of c. 4260cal. BP) was not recorded; it is suggested that An Loch Mór lies south of its recordable distribution in this part of the northeast Atlantic region. Taken together with work at other sites, the findings point to a wealth of potential tephra isochrons in Holocene deposits of the northeast Atlantic seaboard. It is clear also that calcareous lake sediments can be as fruitful a source of tephras as peats. Potential problems relating to dating and geochemical fingerprinting of tephra layers in individual sites are highlighted with reference to the Lairg tephras as recorded in Scotland and Northern Ireland, and to the Hoy tephra that has been described from Orkney

Proteolytic activation of receptor-bound anthrax protective antigen on macrophages promotes its internalization

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74041/1/j.1462-5822.2000.00052.x.pd