Risk factors for postoperative ileus after diverting loop ileostomy closure

Background: Postoperative ileus is one of the most common complications after diverting loop ileostomy closure. Some reports have investigated the risk factors for postoperative complications or ileus after ileostomy closure; however, these studies did not evaluate the index surgery sufficiently. In this study, we evaluated the risk factors, including the details of the index surgery, for ileus after diverting ileostomy closure. Methods: This was a retrospective study of patients who underwent ileostomy closure following index surgery for rectal cancer. Patients who developed postoperative ileus [POI (+)] and patients who did not [POI (−)] after ileostomy closure were compared. Results: Sixty-eight patients were evaluated and were divided into two groups: POI (+) (n = 11) and POI (−) (n = 57), and the groups were compared. There were no significant differences in the details of the index surgery, operative procedure, transanal total mesorectal excision, lateral lymph node dissection, operating time, or blood loss. The incidence of Clavien–Dindo grade ≥ III complications and adjuvant chemotherapy after index surgery were significantly higher in the POI (+) group. Conclusions: The incidence of Clavien–Dindo grade ≥ III complications and adjuvant chemotherapy after index surgery may increase the risk of postoperative ileus after ileostomy closure

Vascular variations encountered during laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer : a retrospective cohort study

Background: Laparoscopic surgery for cancer located in the transverse colon or splenic flexure is difficult because of vascular variability in this region and adjacent vital organs such as the pancreas, spleen, and duodenum. Methods: This retrospective cohort study involved 51 patients who underwent laparoscopic surgery for colon cancer at Tokushima University Hospital from July 2015 to December 2020. Variations of the middle colic artery (MCA), left colic artery (LCA), middle colic vein (MCV), and first jejunal vein (FJV) and short-term outcomes of laparoscopic surgery in patients with each vascular variation were evaluated. Results: Variations of the MCA, LCA, MCV, and FJV were classified into four, three, five, and three patterns, respectively. The short-term outcomes of laparoscopic surgery for transverse colon cancer in patients with MCA variations and those with FJV variations were evaluated, and no significant difference was found in the operation time, blood loss, postoperative complication rate, time from surgery to start of dietary intake, or time from surgery to discharge among the different variations. Additionally, no significant differences were found in the short-term outcomes of laparoscopic surgery for descending colon cancer in patients with LCA variations. Conclusion: Preoperative assessment of vascular variations may contribute to the stability of short-term outcomes of laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer

The Outcome of Repeated In Vitro Fertilization-Embryo Transfer Based on the Endometrial Thickness

Objective: To determine whether in vitro fertilization embryo transfer (IVF-ET) outcome is affect- ed by endometrial thickness. Design: Retrospective study. Setting: IVF-ET unit in Osaka Medical College. Patients: Twenty-eight patients with tubal infertility who became pregnant following IVF-ET between 1998-2000. All patients underwent 2 cycles of IVF-ET with long down-regulation protocol of Gonadotorophin releasing hormone analogue (GnRHa) and became pregnant following one of them. These fifty-six courses were divided into pregnant and non-pregnant courses. Main Outcome Measure(s): Endometrial thickness, serum E2 and LH levels, number of oocytes, fertilization rate, cleavage rate, high quality embryo rate and pregnancy rate were investigated. Results: The endometrium in the pregnant courses were thicker than those in the non-pregnant courses (P<0.05). Serum E2 level showed direct correlation with endometrial thickness (R=0.882, P < 0.001). The courses with endometrial thickness greater than or equal to 10 mm showed a signifi- cantly higher pregnancy rate than courses with endometrium of less than 10 mm. Although there was no statistical difference in high-quality embryo rate or number of transferred embryo rate between the two groups, the fertilization rate of the courses with endometrium greater than or equal to 10 mm was higher than that in the courses with endometrium less than 10 mm. Conclusion: Although the number of transferred embryos and embryo quality does not affect the pregnancy rate, endometrial thickness might play an important role in the success of IVF-ET