Lėtinės kolorektalinės fistulės gydymas naudojant OTSC kabutes: klinikinis atvejis

Anastomotic leakage in colorectal surgery is an infrequent but in some cases very serious or even lethal complication. The over-the-scope-clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested on animals, could be the answer for the patient with such situation. We present a case of 63-year-old man suturae insuffitiency at the 40th post-operative day. The conservative treatment was long and unsuccessful. The lesion was then closed with two subsequent clips, and the patient recovered well without major interventions. The lesion showed a normal healing on the follow-up.Kolorektalinės anastomozės nesandarumas nėra dažna, tačiau labai sunki, neretai ir mirtina komplikacija. OTSC kabutės („Ovesco“) buvo sukurtos virškinamojo trakto perforacijoms gydyti. Pirmiausia išbandytos eksperimentuojant su gyvūnais. Šios kabutės gali būti vienas iš nesandarumo ir (ar) fistulių gydymo metodų. Aprašome atvejį, kai 63 metų vyrui po kolorektalinės operacijos atsirado žarnų siūlės nesandarumas. Konservatyvus gydymas buvo nesėkmingas. Defektas panaikintas naudojant dvi „Ovesco“ kabutes, kurios uždėtos skirtingu metu. Stebėjimo laikotarpiu defektas sugijo

Treatment of chronic colorectal fistula with the over-the-scope-clipping system: a case report

Anastomotic leakage in colorectal surgery is an infrequent but in some cases very serious or even lethal complication. The over-the-scope-clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested on animals, could be the answer for the patient with such situation. We present a case of 63-year-old man suturae insuffitiency at the 40th post-operative day. The conservative treatment was long and unsuccessful. The lesion was then closed with two subsequent clips, and the patient recovered well without major interventions. The lesion showed a normal healing on the follow-up

Complicaciones del tratamiento de cáncer rectal. Informe de caso

La neoplasia de recto se considera una enfermedad frecuente y altamente mortal, su incidencia es mayor en los países desarrollados. El tratamiento implica conjunción de quimioterapia e intervenciones quirúrgicas cuyos beneficios aún están en discusión. Se reporta un caso de una paciente con neoplasia de recto medio tratada en Hospital Provincial Universitario Clínico-Quirúrgico Dr. Gustavo Aldereguía Lima. Se realiza intervención quirúrgica electiva. Presentó un deterioro del estado general durante la estancia hospitalaria y fallece 10 días después de la intervención

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Asymptomatic primary tumour in incurable metastatic colorectal cancer: is there a role for surgical resection prior to systematic therapy or not?

Introduction: The role of the resection of asymptomatic primary colorectal cancer in patients with incurable disease is questionable. Aim: To evaluate the impact of the resection of asymptomatic primary tumour on overall survival in patients with unresectable distant metastases. Material and methods : Patients treated in the National Cancer Institute, Lithuania, in the period 2008–2012, were selected retrospectively. The main inclusion criteria were: metastatic colorectal cancer (mCRC), endoscopically and histologically confirmed adenocarcinoma, without any symptoms for urgent operation, and at least one cycle of palliative chemotherapy administered. Information on patients’ age, gender, tumour histology, localization of the tumour, regional lymph node involvement, number of metastatic sites, surgery and systemic treatment was collected prospectively. Eligible patients for the study were divided into two groups according to the initial treatment – surgery (patients who underwent primary tumour resection) and chemotherapy (patients who received chemotherapy without surgery). The impact of initial treatment strategy, tumour size and site, regional lymph nodes, grade of differentiation of adenocarcinoma and application of biotherapy on overall cumulative survival was estimated using the Kaplan-Meier method. To compare survival between groups the log-rank test was used. Cox regression analysis was employed to assess the effects of variables on patient survival. Results: The study group consisted of 183 patients: 103 men and 80 women. The median age was 66 years (range: 37–91). There were no notable imbalances with regard to age, gender, number of metastatic sites, metastases (such as pulmonary, peritoneal, liver, metastases into non-regional lymph nodes and other metastases), the number of received cycles of chemotherapy, first line chemotherapy type or biological therapy. Only 27 (14.8%) patients received biological therapy and the majority of them (n = 25, 92.6%) were treated with bevacizumab. For surgically treated patients 1-year survival was 71.2% (95% CI: 62.1–78.5) and 5-year survival was 4.0% (95% CI: 1.0–10.5). In the chemotherapy group, survival rates were lower – 43.9% (95% CI: 31.4–55.7) and 1.7% (95% CI: 0.1–8.1), respectively. Better survival rates were in the palliative surgery group. Multivariate analysis using the Cox proportional hazards model revealed that the initial palliative surgery and the application of biological therapy were statistically significant independent prognostic factors for survival. Conclusions : Our findings suggest that palliative resectional surgery for the primary tumour in patients with incurable mCRC improves survival. Of course, one can argue that patients in the surgery group were “less problematic”. Prospective randomized trials are needed to delineate precisely the role of palliative surgery of the primary tumour in these patients

Low Anterior Resection Syndrome: What Have We Learned Assessing a Large Population?

Our goal was to assess the rate of symptoms commonly included in LARS score in a large general population. The study was based on a population-based design. We disseminated LARS scores through community online platforms and general practitioners throughout Lithuania. We received 8183 responses to the questionnaire. There were 142 (1.74%) participants who were excluded for lack of information. There were 6100 (75.9%) females and 1941 (24.1%) males. After adjusting for sex and age, male participants had a significant average score of 18.4 (SD &plusmn; 10.35) and female 20.3 (SD &plusmn; 9.74) p &lt; 0.001. There were 36.4% of participants who had minor LARS symptoms, and 14.2% who had major LARS symptoms. Overall, major LARS-related symptoms were significantly related to previous operations: 863 participants in the operated group (71.7%), and 340 in the non-operated group (28.3%; p0.001). In 51&ndash;75-year-old patients, major LARS was significantly more prevalent with 22.7% (p &lt; 0.001) and increasing with age, with a higher incidence of females after the age of 75. After excluding colorectal and perineal procedures, the results of multivariate logistic regression analysis indicated the use of neurological drugs and gynaecological operations were independent risk factors for major LARS&ndash;odd ratio of 1.6 (p = 0.018, SI 1.2&ndash;2.1) and 1.28 (p = 0.018, SI 1.07&ndash;1.53), respectively. The symptoms included in the LARS score are common in the general population, and there is a variety of factors that influence this, including previous surgeries, age, sex, comorbidities, and medication. These factors should be considered when interpreting the LARS score following low anterior resection and when considering treatment options preoperatively

Surgical treatment of combat colonic injuries in the Ukraine antiterrorist operation

This study obviously has some limitations. It comprises a retrospective analysis of data from a single centre. There is also possible selection bias as most of the combatants with severe colonic injuries died in battle or during transfer, and may not have been included in the study. However, this study includes the largest numbers coming from a Western country with very recent military action. Moreover, the survival and complication data are reliable and complete, and the analysis is very thorough and precise