The influence of Mechanical bowel preparation in elective colorectal surgery for diverticulitis

Background: Mechanical bowel preparation (MBP) has been shown to have no influence on the incidenc

Value of sacral nerve stimulation in the treatment of severe faecal incontinence: A comparison to the artificial bowel sphincter

Objective: Sacral nerve stimulation (SNS) is a recent treatment option in the management of severe faecal incontinence (FI) that offers promising results. The aim of this study was to compare SNS to artificial bowel sphincter (ABS) implanted patients to assess the rationale of this approach in achieving satisfying functional results and improved quality of life (QoL). Method: Among 27 patients tested (December 2001 and April 2004), 15 patients were successfully managed with SNS. They were compared to 15 matched patients implanted with ABS in a previous period (control group). Assessment of continence level (Cleveland Clinic score), constipation score (Knowles, Eccersley, Scott Score) and QoL (Short-Form 36) were prospectively collected. Results: Both groups were comparable for clinical parameters (age, gender, anal testing and aetiology of incontinence) and anal physiology. The mean postoperative continence score was significantly higher in the SNS group [9.4 (±3.3) vs 5.7 (±3.9), P <0.01]; however, the mean constipation score was higher in the ABS group (6.3 ± 6.3 vs 12.8 ± 5.7, P < 0.01). The mean QoL score was similar in both groups. The mean follow-up after implantation was 15 (±9) months in the SNS group, and 43 (±33) months in the ABS group. Conclusion: In this study, SNS offers satisfying results in terms of QoL, similar to that of ABS. Although it seems to be less effective in restoring continence level, symptoms of outlet obstruction are more frequent after ABS. This SNS approach should be proposed as a first-line treatment of FI in selected patients. ABS should remain an option that can improve function. © Journal compilation © 2009 The Association of Coloproctology of Great Britain and Ireland

Results of resection for volvulus of the right colon.

The aim of the present study was to retrospectively evaluate the results of resection for volvulus of the right colon. Over a 17-year period, 45 patients (33 women) of mean age 64 years were admitted with acute right colon volvulus. Preoperative diagnosis was obtained in 53% of the cases. A right hemicolectomy was performed in all the cases, with primary anastomosis in 43 cases and double ileal and transverse stomy in 2 cases. Gangrene was observed in 23 patients (51%). Postoperative mortality was 6.6% (3 patients) due to septic shock and multi-organ failure in 2 cases, and respiratory failure in the other cases. Postoperative morbidity was 20% (9 patients), including 2 cases of anastomotic leaks. On the basis of this study and a review of the literature, it appears that right hemicolectomy is the treatment of choice for volvulus of the right colon, as it avoids all risk of recurrence and mortality is lower than that obtained with conservative treatment

Laparoscopic colectomy for sigmoid diverticulitis in obese and nonobese patients: a prospective comparative study.

BACKGROUND: The aim of this prospective comparative study was to assess the outcome of laparoscopic colectomy for sigmoid diverticulitis in normal-weight, overweight, and obese patients. METHODS: From January 1995 to December 2000, all patients (n = 77) undergoing an elective colectomy for sigmoid diverticulitis were enrolled in the study. The patients were divided into three groups: Group 1 (n = 29) consisted of healthy, normal-weight patients (BMI, 18-24.9); group 2 (n = 27) consisted of overweight patients (BMI, 25.0-29.9); group 3 (n = 21) consisted of obese patients (BMI, 30.0-39.9). Groups 2 and 3 were compared with group 1. RESULTS: Group 1 was comprised of 13 women and 16 men with a mean age of 58.4 years (range, 37-78); group 2, was comprised of 13 women and 14 men with a mean age of 55.2 years (range, 31-83); group 3, was comprised of 13 women and 14 men with a mean age of 54.1 years (range, 33-86). There was no difference among the three groups in ASA classification, postoperative length of hospital stay, or inpatient rehabilitation. The operating time did not differ for groups 1 and 2 (187 vs 210 min, p = 0.6), but it was shorter in group 1 than in group 3 (187 vs 247 min, p = 0.003). The conversion rate was similar for all three groups: 17.2% in group 1, 14.8% in group 2, and 19% in group 3. The postoperative period during which parenteral analgesics were required did not differ between groups 1 and 2 (5.7 vs 7.7 days, p = 0.1), but it was longer for group 3 (8.5 days, p = 0.03). The morbidity rate was similar for all three groups: 17.2% in group 7, 14.8% in group 2, and 19% in group 3. There were no perioperative deaths. CONCLUSIONS: Data from the present study suggest that laparoscopic colectomy for sigmoid diverticulitis can be applied safely in overweight and obese patient

Laparoscopic vs open colectomy for sigmoid diverticulitis: a prospective comparative study in the elderly.

BACKGROUND: The aim of this prospective comparative study was to assess the outcome of laparoscopic and open colectomy for sigmoid diverticulitis in patients aged \u3e/=75 years. METHODS: From January 1993 to December 1998, all patients 75 years of age and older undergoing an elective colectomy for sigmoid diverticulitis were included in the study. The patients were divided into the following two groups: group 1 (n = 22) consisted of patients who underwent a laparoscopic procedure; group 2 (n = 24) consisted of patients who underwent an open procedure. RESULTS: In group 1, there were 12 women and 10 men with a mean age of 77.2 years (range, 75-82); in group 2, there were 14 women and 10 men with a mean age of 78 years (range, 76-84) (p = 0.37). There was no difference between the groups in ASA classification. The operative time was shorter in group 2 (136 vs 234 mins). The postoperative period during which parenteral analgesics were required (5.4 vs 8.2 days, p = 0.001), postoperative morbidity (18% vs 50%, p = 0.02), postoperative length of hospital stay (13.1 vs 20.2 days, p = 0.003), and the inpatient rehabilitation (6 vs 15 patients, p = 0.01) were significantly shorter for group 1 than for group 2. There were no perioperative deaths. The conversion rate was 9% in group 1. CONCLUSION: The data from the present study suggest that laparoscopic colectomy for sigmoid diverticulitis can be applied safely to older patients with fewer complication, less pain, shorter hospital stay, and a more rapid return to preoperative activity levels than that seen with open colorectal resection

[Morbidity after stapled haemorrhoidectomy: long-term results about 140 patients and review of the literature].

AIM: The aim of this study was to determine the results and the complications of the treatment of hemorrhoids with circular stapler with a follow-up of 18 months, and to review the complications in the literature. METHODS: From April 1998 to August 1999, 140 patients (83 males and 57 females) with an average age of 43.8 years (range: 19-83 years) underwent haemorrhoidectomy using a circular stapler in three university hospital centers. The degree of hemorrhoids has been classified: three cases of degree II, 97 cases of degree III, and 40 cases of degree IV. All the patients were prospectively evaluated at two weeks, two and 18 months after surgery. RESULTS: The average length of the operation was 18 minutes (range: 8-60 minutes). Mean hospital stay was 36 hours (range: 8-72 hours). There was no intraoperative complication. There was no mortality. The postoperative complication rate was 7.8% (N = 11): there were five cases of bleeding that two complicated by a submucosal hematoma (one was infected and needed a rectotomy on day 21), two cases of urinary retention, and two cases of external hemorrhoid thrombosis. The bleeding occurred in the 12 hours after surgery except for one patient with antivitamin K whith presented a secondary bleeding on day 16. At 18 months, five patients presented a moderate asymptomatic stricture dilated on digital examination. Two patients complained of persistent skin tags. Neither functional trouble nor incontinence to gas, liquids, or solids was presented. With a mean follow-up of 40 months, 90% (N = 112) of the patients were fully satisfied. CONCLUSIONS: Treatment of hemorrhoids with circular stapler appears to be effective with 96% of patients fully satisfied at 18 months. The morbidity rate was low, and no higher than the diathermy excision hemorrhoidectomy. The results are directly dependent on the practice that required a learning, and not on the technique itself

Laparoscopic colectomy for sigmoid diverticulitis: a prospective study in the elderly.

BACKGROUND/AIMS: The aim of this prospective study was to determine the feasibility and the complications or benefits of laparoscopic colectomy for sigmoid diverticulitis in patients aged 75 years or more. METHODOLOGY: From January 1993 to December 1999, 85 patients underwent an elective colectomy for sigmoid diverticulitis. Twenty-two patients over 75-years old (group 1) were compared to 63 younger patients (group 2). RESULTS: In group 1, there were 12 women and 10 men, with a mean age of 77.2 years (range: 75-82); In group 2, there were 35 women and 28 men, with a mean age of 53.7 years (range: 38-74) (P = 1.10-14). The operative time was shorter in group 2 (183 vs. 234 min). There was no difference between the 2 groups with regard to the postoperative period during which parenteral analgesics were required (5.4 vs. 5.2 days, P = 0.48) and the postoperative morbidity (18% vs. 14%, P = 0.06). Postoperative length of hospital stay (13.1 vs. 8.8 days, P = 0.003) was shorter in group 2 than in group 1. There was no perioperative mortality. Conversion rate was 9% (group 1) and 6% (group 2) (P = 0.6). CONCLUSIONS: In summary, data from the present study suggest that laparoscopic colectomy for sigmoid diverticulitis can be applied safely to older patients with fewer complications, less pain, shorter hospital stay and a rapid return to preoperative activity levels

Laparoscopic versus open cholecystectomy: a prospective comparative study in the elderly with acute cholecystitis.

The aim of this prospective comparative study was to determine the feasibility and the efficacy of laparoscopic cholecystectomy for acute cholecystitis in patients older than 75 years of age and to compare the results with those of open cholecystectomy. From January 1992 to December 1999, 139 patients older than 75 years of age underwent cholecystectomy for acute cholecystitis. The two groups of patients with cholecystolithiasis included 50 patients who underwent laparoscopic cholecystectomy (group 1) and 89 patients who underwent open cholecystectomy (group 2). Group 1 consisted of 30 women and 20 men, with a mean age of 81.9 years (range, 75-98). Group 2 consisted of 51 women and 38 men, with a mean age of 81.9 years (range, 75-93). There was no difference in the American Society of Anesthesiologists classification in both groups. The length of the surgery (103.3 vs. 149.7 minutes), postoperative length of stay (7.7 vs. 12.7 days), and inpatient rehabilitation (15 vs. 42 patients) were significantly shorter in group 1 than in group 2. The postoperative morbidity rate was not different between the groups. There was no mortality in group 1, but four patients died in group 2 (P = 0.29). The conversion rate was 32% (n = 16) in group 1. In summary, laparoscopic cholecystectomy in elderly patients with acute cholecystitis is safe and effective. Laparoscopic cholecystectomy in elderly patients restores them to the best possible quality of life with the lowest cost to them physiologically