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Xue X, Zeng H, Chen D, Zheng B, Liang B, Xu D, Lin S. Comparing the short-term clinical outcomes and therapeutic effects of different colectomies in patients with refractory slow-transit constipation in eastern countries: a network meta-analysis. Updates Surg 2024; 76:411-422. [PMID: 38329678 DOI: 10.1007/s13304-024-01762-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
Surgical treatment has been widely used in patients with refractory slow transit constipation (RSTC). The aim of this network meta-analysis (NMA) was to compare the effects of different colectomies on short-term postoperative complications and quality of life in patients with RSTC. Electronic literature searches were performed in the PubMed, Web of Science, EMBASE, WANFANG DATA, and Cochrane Central Register of controlled trials databases and were searched up to December 2022. Selected to compare the short-term clinical outcomes and quality of life of the treatment of RSTC. A random-effects Bayesian NMA was conducted to assess and rank the effectiveness of different surgical modalities. This study included a total of six non-randomized controlled trials involving 336 subjects. It was found that subtotal colectomy with cecorectal anastomosis (CRA) demonstrated superior effectiveness in several aspects, including reduced hospital stay (MD 0.06; 95% CI [0.02, 1.96]), shorter operative time (MD 4.75; 95% CI [0.28, 14.07]), lower constipation index (MD 0.61; 95% CI [0.04, 1.71]), improved quality of life (MD 4.42; 95% CI [0.48, 4.42]). Additionally, in terms of short-term clinical outcomes, subtotal colectomy with ileosigmoidal anastomosis (SC-ISA) procedure ranked the highest in reducing small bowel obstruction (OR 0.24; 95% CI [0.02, 0.49]), alleviating abdominal pain (OR 0.53; 95% CI [0.05, 1.14]), minimizing abdominal distension (OR 0.33; 95% CI [0.02, 0.65]), and reducing incision infection rates (OR 0.17; 95% CI [0.01, 0.33]). Furthermore, SC-ISA ranked as the best approach in terms of patient satisfaction (OR 0.66; 95% CI [0.02, 1.46]). Based on our research findings, we recommend that CRA be considered as the preferred treatment approach for patients diagnosed with RSTC.
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Affiliation(s)
- Xueyi Xue
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No. 105 Jiuyi North Road, Longyan, 364000, Fujian, China
| | - Hao Zeng
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No. 105 Jiuyi North Road, Longyan, 364000, Fujian, China
- Fujian Medical University, Fuzhou, China
| | - Dongbo Chen
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No. 105 Jiuyi North Road, Longyan, 364000, Fujian, China
| | - Biaohui Zheng
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No. 105 Jiuyi North Road, Longyan, 364000, Fujian, China
| | - Baofeng Liang
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No. 105 Jiuyi North Road, Longyan, 364000, Fujian, China
- Department of Outpatient Services, Shanghang County Hospital, Longyan, Fujian, China
| | - Dongbo Xu
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No. 105 Jiuyi North Road, Longyan, 364000, Fujian, China
| | - Shuangming Lin
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No. 105 Jiuyi North Road, Longyan, 364000, Fujian, China.
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Pescatori M. Evaluating occult causes of disease: the tricompartmental PNEI approach and the importance of the microbiome. Tech Coloproctol 2024; 28:36. [PMID: 38381266 DOI: 10.1007/s10151-023-02901-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- M Pescatori
- Unità di Colonproctologia, Clinica Parioli, Rome, Italy.
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3
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Carpinteyro-Espín P, Santes O, Moctezuma-Velazquez P, Navarro-Iñiguez JA, Navarro-Navarro A, Salgado-Nesme N. Deloyers procedure compared to ileorectal anastomosis as restoration techniques of bowel continuity after extended left colon resection. ANZ J Surg 2022; 93:956-962. [PMID: 36196846 DOI: 10.1111/ans.18084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Restoration of bowel continuity after left extended colectomy may be challenging because the remaining colon may not reach the rectal stump without tension to perform a safe anastomosis. Performing a total colectomy with ileorectal anastomosis (IRA) is an option, but the quality of life can be significantly impaired due to loose stools and an increase in bowel frequency. In contrast, the preservation of the right colon and ileocaecal valve in the Deloyers procedure (DP) might ensure a better stool consistency and bowel transit, and therefore a superior quality of life. MATERIALS AND METHODS A transverse study comparing patients that underwent DP versus patients with an IRA was performed. Postoperative morbidity, mortality, functional outcomes, and quality of life were analysed between groups. Quality of life after the surgical procedure was assessed with the SF-36 V2® health survey. RESULTS A total of 16 patients with DP and 32 with IRA were included. The groups had similar demographic characteristics concerning age, sex, body mass index, ASA classification, diagnosis and Charlson comorbidity index. The median follow-up was 55 months for DP and 99 months for IRA. Postoperative complications were similar in both groups. Patients in the DP group had fewer bowel movements (P = 0.01), tenesmus (P = 0.04) and use of loperamide (P = 0.03). DP patients achieved better scores in physical pain (P = 0.02) and general health (P < 0.01) than IRA patients. CONCLUSIONS DP for intestinal continuity restoration after extended left colon resection is a safe and feasible alternative, possibly achieving better functional outcomes and quality-of-life compared to IRA.
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Affiliation(s)
- Paulina Carpinteyro-Espín
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Oscar Santes
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paulina Moctezuma-Velazquez
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Julio A Navarro-Iñiguez
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Adolfo Navarro-Navarro
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Noel Salgado-Nesme
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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4
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Perivoliotis K, Baloyiannis I, Tzovaras G. Cecorectal (CRA) versus ileorectal (IRA) anastomosis after colectomy for slow transit constipation (STC): a meta-analysis. Int J Colorectal Dis 2022; 37:531-539. [PMID: 35020001 DOI: 10.1007/s00384-022-04093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION We conducted this meta-analysis, to compare cecorectal (CRA) and ileorectal anastomosis (IRA), regarding perioperative safety and efficacy, in patients submitted to colectomy for refractory slow transit constipation (STC). METHODS This study followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. To identify all eligible records, a systematic literature search in the electronic scholar databases (Medline, Scopus, Web of Science) was performed. RESULTS Overall, 5 trials and 291 patients were included in this meta-analysis. Pooled comparisons confirmed the comparability of the two techniques regarding perioperative complications (p = 0.55). CRA was associated with a shorter operation (p = 0.0004) and hospitalization duration (p = 0.001). Although there was no difference in terms of gastrointestinal symptoms, functional outcomes, and patient satisfaction, CRA resulted in lower long-term Wexner scores (p < 0.0001). CONCLUSION Due to several study limitations, further large-scale RCTs are required to verify the findings of the present meta-analysis.
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Affiliation(s)
- Konstantinos Perivoliotis
- Department of Surgery, General Hospital of Volos, Polymeri 134, Volos, 38222, Greece. .,Viopolis, University of Thessaly, Larissa, 41500, Greece.
| | - Ioannis Baloyiannis
- Department of Surgery, Mezourlo, University Hospital of Larissa, Larissa, 41110, Greece
| | - George Tzovaras
- Department of Surgery, Mezourlo, University Hospital of Larissa, Larissa, 41110, Greece
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5
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Chaichanavichkij P, Vollebregt PF, Tee SZY, Scott SM, Knowles CH. Slow-transit constipation and criteria for colectomy: a cross-sectional study of 1568 patients. BJS Open 2021; 5:6289804. [PMID: 34052848 PMCID: PMC8164778 DOI: 10.1093/bjsopen/zrab049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background Colectomy remains a treatment option for a minority of patients with slow-transit constipation (STC) refractory to conservative treatment. However careful patient selection is essential to maximize benefits and minimize risk of adverse outcome. This study determined the proportion of patients with chronic constipation that would meet criteria for colectomy based on recent European graded practice recommendations derived by expert consensus. Methods Retrospective application of graded practice recommendations was undertaken on a prospectively maintained data set of consecutive adult patients with chronic constipation who underwent whole-gut transit studies using radio-opaque markers. Primary analysis applied contraindications achieving high level of expert consensus (normal whole-gut transit as an absolute contraindication and faecal incontinence as a relative contraindication for colectomy). Secondary analysis applied contraindications with less certain consensus. Results Primary analysis of 1568 patients undergoing a whole-gut transit study between January 2004 and March 2016 found 208 (13.3 per cent) met published criteria to be selected for colectomy, with 974 excluded for normal whole-gut transit and 386 for faecal incontinence. Secondary analysis demonstrated high prevalence of other relative contraindications to colectomy: 165 concomitant upper gastrointestinal symptoms, 216 abdominal pain (including 126 irritable bowel syndrome), and 446 evacuation disorder. The majority of patients (416 of 594) had two or more relative contraindications. If these patients were excluded, only 26 (1.7 per cent) chronically constipated patients retrospectively met selection criteria for colectomy. Conclusions The retrospective application of selection criteria is a limitation. However, the data highlight the high prevalence of factors associated with poor postoperative outcome and provide further caution to surgeons undertaking colectomy for STC.
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Affiliation(s)
- P Chaichanavichkij
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - P F Vollebregt
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - S Z Y Tee
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S M Scott
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - C H Knowles
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
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Seow-En I, Ke TW, Chang SC, Chen WTL. Laparoscopic retrojejunal trans-mesenteric anastomosis for extended left-sided colorectal resections - a new solution to an old problem. Colorectal Dis 2021; 23:1262-1267. [PMID: 33340441 DOI: 10.1111/codi.15501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 02/08/2023]
Abstract
AIM Following extended left-sided colorectal resection, creation of the anastomosis can be challenging due to insufficient length of the remaining proximal and distal bowel. Retroileal pull-through and the Deloyers procedure are feasible but require ligation of the middle colic vessels and additional right colonic mobilization. The aim of this study was to describe our initial experience with an alternative technique for performing tension-free anastomosis following minimally invasive left-sided resection. METHOD This was a retrospective case series of all patients who underwent a retrojejunal trans-mesenteric pull-through following elective laparoscopic left-sided colorectal surgery between September 2019 and September 2020. Placing the retrojejunal window 15-20 cm distal to the duodenojejunal junction allows the transverse colon to pass via the most direct route through the base of the proximal jejunal mesentery to the distal colon or rectal stump instead of passing over the small bowel, yielding additional length for the anastomosis. An accompanying video demonstrates this technique for three different case scenarios. RESULTS Seven consecutive patients underwent this approach following colorectal resection; three had inherently shorter left colons, two had synchronous left-sided tumours and two had inadvertent intraoperative marginal artery injury. There were no anastomotic complications or early postoperative morbidity related to the mesenteric window. The additional time taken for the procedure ranged from 5 to 35 min. The risk of complications related to extended left-sided resections may possibly be reduced, although further studies are required to evaluate this. CONCLUSION Retrojejunal trans-mesenteric pull-through is a novel, but straightforward, safe and useful option for reducing tension in laparoscopic left-sided colorectal anastomoses.
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Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore.,Division of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tao-Wei Ke
- Division of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Chi Chang
- Division of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - William Tzu-Liang Chen
- Division of Colorectal Surgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
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Verkuijl SJ, Jonker JE, Trzpis M, Burgerhof JGM, Broens PMA, Furnée EJB. Functional outcomes of surgery for colon cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2020; 47:960-969. [PMID: 33277056 DOI: 10.1016/j.ejso.2020.11.136] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/21/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION As survival rates of colon cancer increase, knowledge about functional outcomes is becoming ever more important. The primary aim of this systematic review and meta-analysis was to quantify functional outcomes after surgery for colon cancer. Secondly, we aimed to determine the effect of time to follow-up and type of colectomy on postoperative functional outcomes. MATERIALS AND METHODS A systematic literature search was performed to identify studies reporting bowel function following surgery for colon cancer. Outcome parameters were bowel function scores and/or prevalence of bowel symptoms. Additionally, the effect of time to follow-up and type of resection was analyzed. RESULTS In total 26 studies were included, describing bowel function between 3 to 178 months following right hemicolectomy (n = 4207), left hemicolectomy/sigmoid colon resection (n = 4211), and subtotal/total colectomy (n = 161). In 16 studies (61.5%) a bowel function score was used. Pooled prevalence for liquid and solid stool incontinence was 24.1% and 6.9%, respectively. The most prevalent constipation-associated symptoms were incomplete evacuation and obstructive, difficult emptying (33.3% and 31.4%, respectively). Major Low Anterior Resection Syndrome was present in 21.1%. No differences between time to follow-up or type of colectomy were found. CONCLUSION Bowel function problems following surgery for colon cancer are common, show no improvement over time and do not depend on the type of colectomy. Apart from fecal incontinence, constipation-associated symptoms are also highly prevalent. Therefore, more attention should be paid to all possible aspects of bowel dysfunction following surgery for colon cancer and targeted treatment should commence promptly.
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Affiliation(s)
- Sanne J Verkuijl
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Jara E Jonker
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M A Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Edgar J B Furnée
- Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Kent I, Gilshtein H, Wexner SD. The retro-ileal pull-through technique for colorectal and coloanal anastomosis. Tech Coloproctol 2020; 24:943-946. [PMID: 32506342 DOI: 10.1007/s10151-020-02244-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Performing a tension-free anastomosis following extensive left-sided colorectal resection can be challenging due to limited length. The retro-ileal pull-through approach, where the colon is carefully delivered to the pelvis through a mesenteric window made under the ileocolic vessels, is a technique to perform such an anastomosis. METHODS This series is a retrospective review of patients who underwent a colorectal or coloanal anastomosis using the retro-ileal pull-through approach. Patient demographics, operative reports, and short-term outcomes were reviewed. RESULTS Seven patients had a retro-ileal pull-through technique with colorectal or coloanal anastomosis. The cohort included 3 patients who had a Hartman's reversal, 3 who had a redo colorectal anastomosis and one in whom this technique was used in an acute setting for sigmoid colectomy for acute perforated diverticulitis with primary anastomosis. Successful implementation of the technique was achieved in all patients with good short-term outcomes. CONCLUSIONS In our cohort of patients, a retro-ileal pull-through technique was shown to be a successful approach to achieve a tension-free colorectal or coloanal anastomosis in various scenarios. This technique may prevent performing an ileorectal anastomosis or a permanent colostomy. We believe that this approach should be popularized among colorectal surgeons dealing with complicated colorectal operations.
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Affiliation(s)
- I Kent
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - H Gilshtein
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - S D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
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Xie XY, Sun KL, Chen WH, Zhou Y, Chen BX, Ding Z, Yu XQ, Wu YH, Qian Q, Jiang CQ, Liu WC. Surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis vs total colectomy with ileorectal anastomosis for intractable slow-transit constipation. Gastroenterol Rep (Oxf) 2019; 7:449-454. [PMID: 31857907 PMCID: PMC6911993 DOI: 10.1093/gastro/goz014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/02/2018] [Accepted: 10/22/2018] [Indexed: 12/16/2022] Open
Abstract
Background Few studies have compared the surgical outcomes of different surgical procedures currently used to treat refractory colonic slow-transit constipation (STC), despite the increase in the number of cases. This study aimed to analyse the long-term surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis (SC-ACRA) vs total colectomy with ileorectal anastomosis (TC-IRA) for severe STC. Methods Between January 2005 and January 2015, we retrospectively collected clinical data of 55 patients who underwent TC-IRA (n = 35) or SC-ACRA (n = 20) for severe STC at our institution. The post-operative functional outcomes between the two groups were compared. Results There were no significant differences in age (P = 0.655), sex (P = 0.234), period of constipation (P = 0.105) and defecation frequency (P = 0.698) between the TC-IRA and SC-ACRA groups. During a median follow-up period of 72 months (range, 12–120 months), there were no significant differences between the TC-IRA and SC-ACRA groups regarding the median number of bowel movements per day [3 (1/6–7) vs 3 (1/6–5), P = 0.578], Cleveland Clinic Florida Constipation Score [2 (0–20) vs 2 (0–19), P = 0.454], Cleveland Clinic Incontinence Score [0 (0–5) vs 0 (0–2), P = 0.333] and Gastrointestinal Quality of Life Index [122 (81–132) vs 120 (80–132), P = 0.661]. Moreover, there was no significant difference in the incidence of post-operative complications between the two groups (37.1% vs 25.0%, P = 0.285). Conclusions Our findings indicate that both TC-IRA and SC-ACRA are effective treatments for severe STC, with similar long-term outcomes.
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Affiliation(s)
- Xiao-Yu Xie
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.,Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China
| | - Kong-Liang Sun
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Wen-Hao Chen
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Yan Zhou
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.,Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China
| | - Bao-Xiang Chen
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Zhao Ding
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Xue-Qiao Yu
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Yun-Hua Wu
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Qun Qian
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.,Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, Hubei, P. R. China.,Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, Hubei, P. R. China
| | - Cong-Qing Jiang
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.,Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, Hubei, P. R. China
| | - Wei-Cheng Liu
- Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, P. R. China.,Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, Hubei, P. R. China
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10
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Ghinea R, Avital S, Katz E, Shpitz B, White I. A surgical solution to regain bowel continuity following an extended left colectomy-reviving and extending the indication for a "Flip-Flop" procedure. Int J Colorectal Dis 2018; 33:95-97. [PMID: 29080993 DOI: 10.1007/s00384-017-2922-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Extended left hemicolectomy might be necessary for several indications. Once the resection is completed, it would be difficult or impossible to anastomose the transverse colon to the rectum due to the difficulty in mobilizing the transverse colon to reach for a tension-free rectal anastomosis. The aim of this report is to present the "Flip-Flop" technique to overcome this challenging situation. The procedure is based on a surgical technique published in the early 1960s to avoid permanent stoma after proctectomy and consists of changing the location of the right colon to reach the rectum. METHODS Clinical parameters, surgical aspects, and postoperative outcome of patients that underwent the flip-flop procedure following an extended left colectomy in our medical service was reviewed. RESULTS Three patients underwent a flip-flop procedure after an extended left colectomy performed for various reasons. The surgical technique is detailed in a step by step manner. Patients had uneventful postoperative recovery with an adequate functional outcome. CONCLUSIONS We believe that this approach should be revived and be considered also in cases when the full length of the rectum is preserved to avoid ileo-rectal anastomosis or a high-tension colocolonic anastomosis. Popularization of this surgical solution among surgeons is highly important.
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Affiliation(s)
- Ronen Ghinea
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Avital
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel. .,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ephraim Katz
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Shpitz
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ian White
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Sciuto A, Grifasi C, Pirozzi F, Leon P, Pirozzi REM, Corcione F. Laparoscopic Deloyers procedure for tension-free anastomosis after extended left colectomy: technique and results. Tech Coloproctol 2016; 20:865-869. [PMID: 27928685 DOI: 10.1007/s10151-016-1562-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Deloyers procedure, which includes inversion of the right colon around the axis of the ileocolic vessels, can be used to achieve a well vascularized, tension-free colorectal anastomosis after extended left colectomy. The aim of this study is to report our technique and outcome in a series of ten consecutive patients who underwent right colonic transposition by laparoscopic approach. METHODS Charts were retrospectively reviewed to analyze postoperative outcome and bowel function. A video was recorded to demonstrate the procedure. RESULTS Conversion was required in one (10%) patient due to extensive adhesions. No intraoperative complications were recorded. Anastomotic leakage occurred in one (10%) case and was managed with peritoneal lavage and ileostomy. Six months after surgery, all patients reported a median number of 2.5 (range 2-3) bowel movements per day with solid stool consistency. Neither anastomotic stricture nor bowel ischemia was found at 1-year endoscopic follow-up. CONCLUSION Our experience shows that laparoscopic right colonic transposition is a safe and feasible procedure and provides good functional outcomes.
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Affiliation(s)
- A Sciuto
- Department of General, Laparoscopic and Robotic Surgery, Azienda Ospedaliera Specialistica dei Colli - Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy
| | - C Grifasi
- Department of General, Laparoscopic and Robotic Surgery, Azienda Ospedaliera Specialistica dei Colli - Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy
| | - F Pirozzi
- Department of Abdominal Surgery, Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, FG, Italy
| | - P Leon
- Department of General, Laparoscopic and Robotic Surgery, Azienda Ospedaliera Specialistica dei Colli - Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy
| | - R E M Pirozzi
- School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - F Corcione
- Department of General, Laparoscopic and Robotic Surgery, Azienda Ospedaliera Specialistica dei Colli - Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy.
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12
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Heneghan HM, Martin ST, Winter DC. Segmental vs extended colectomy in the management of hereditary nonpolyposis colorectal cancer: a systematic review and meta-analysis. Colorectal Dis 2015; 17:382-9. [PMID: 25510173 DOI: 10.1111/codi.12868] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 10/27/2014] [Indexed: 12/13/2022]
Abstract
AIM The optimal surgical approach to the management of colorectal cancer in the setting of hereditary nonpolyposis colorectal cancer (HNPCC) is contentious. While some advocate total colectomy, others perform segmental resection followed by regular endoscopic surveillance. This systematic review evaluates the evidence for segmental colectomy (SC) and total (extended) colectomy (TC) in the management of HNPCC. METHOD Two major databases (PubMed and Cochrane) were searched using predefined terms. All original articles, published in English, comparing the oncological outcomes of SC and TC in HNPCC patients from January 1950 to July 2013 were included. RESULTS Eighty-four studies were identified. After applying exclusion criteria, six studies involving 948 patients were included (mean age 47.4 years, 51.8% male). SC was more commonly performed than TC (n = 780; 82.3%). Mean follow-up was 106.5 months. Metachronous high-risk adenomas were detected more often after SC, although the difference was not statistically significant (23.4% vs 9.6%; OR 2.258, P = 0.057). Metachronous cancers occurred more frequently after SC than after TC (23.5% vs 6.8%; OR 3.679, P < 0.005). However, there was no difference in overall survival (90.7% vs 89.8% for SC and TC, respectively; P = 0.085). Only one study reported operative mortality (0% in each group), there was no report of operative morbidity or functional outcome. CONCLUSION The optimal surgical approach in the management of HNPCC remains unclear. More adenomas and cancers occur after SC than after TC but there certainly is no evidence to suggest that more radical surgery leads to improved survival.
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Affiliation(s)
- H M Heneghan
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
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13
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Burton AM, Hovick SR, Peterson SK. Health behaviors in patients and families with hereditary colorectal cancer. Clin Colon Rectal Surg 2013; 25:111-7. [PMID: 23730226 DOI: 10.1055/s-0032-1313782] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
It is estimated that 5 to 10% of all colorectal cancer (CRC) cases are attributed to a hereditary cause. The primary hereditary cancer syndromes that confer an increased risk for colorectal cancers are Lynch syndrome/hereditary nonpolyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP). Through genetic testing, health care providers can identify patients and families who carry gene mutations and subsequently are at a substantially greater risk for developing colorectal cancer than the general population. Genetic testing provides risk information not only about an individual patient, but also his or her biological relatives. A variety of risk-reduction behaviors (including screening, surgery, and health and lifestyle behaviors) have been examined in Lynch syndrome and FAP populations. The research indicates that screening behaviors are less than optimal, although the rates vary from study to study. Prophylactic colectomy is the primary course of treatment for individuals who test positive for a FAP mutation, but the results are inconclusive for cancer-unaffected Lynch syndrome mutation carriers. Although research suggests that the adoption of healthy lifestyles and behaviors (e.g., diet, physical activity, weight control, smoking cessation, limited alcohol consumption) could have a favorable impact on colon cancer burden, there is minimal data on how these behaviors may moderate cancer risk among those at risk of hereditary colon cancer. To date, we know very little about the actual health and lifestyle behaviors of those at risk of hereditary colon cancer. Genetic testing and counseling at risk individuals may resolve uncertainty about their personal and familial cancer risk and provide information to guide and personalize decisions about their future health care.
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Affiliation(s)
- Allison M Burton
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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14
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Abstract
For the select small number of constipated patients that cannot be managed medically, surgical options should be considered. Increases in our knowledge of colorectal physiology and experience have fostered improvements in patient evaluation and surgical management. Currently, patients with refractory colonic inertia are offered total abdominal colectomy and ileorectal anastomosis, often with laparoscopic techniques. With proper patient selection, the results have been excellent for resolving the frequency and quality of bowel movements. However, symptoms such as bloating and abdominal pain, which may be related to irritable bowel syndrome rather than the colonic inertia, may persist.
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15
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Lu LS, Ding WX. Surgical treatment of ulcerative colitis. Shijie Huaren Xiaohua Zazhi 2010; 18:3125-3128. [DOI: 10.11569/wcjd.v18.i29.3125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis (UC) is an inflammatory disease of the colon. Medicinal treatment is the standard therapy for UC. However, almost 20%-30% of UC patients fail to respond to medicinal treatment and need to receive surgical treatment. Nowadays, the extensive use of laparoscopic surgery and double stapling technique has greatly decreased the incidence of trauma and complications associated with surgical treatment of UC. Surgical treatment of UC has attracted more and more attention of clinicians.
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16
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Abstract
For the select small number of constipated patients who cannot be managed medically, surgical options should be considered. Increases in our knowledge of colorectal physiology and experience have fostered improvements in evaluation and surgical management of patients. Currently, patients with refractory colonic inertia are offered total abdominal colectomy and ileorectal anastomosis. With proper selection of patients, the results have been excellent for resolving the frequency and quality of bowel movements. However, symptoms such as bloating and abdominal pain, which may be related to irritable bowel syndrome rather than the colonic inertia, may persist.
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Affiliation(s)
- David E Beck
- Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
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17
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Glasgow SC, Birnbaum EH, Kodner IJ, Fleshman JW, Dietz DW. Recurrence and quality of life following perineal proctectomy for rectal prolapse. J Gastrointest Surg 2008; 12:1446-51. [PMID: 18516652 DOI: 10.1007/s11605-008-0531-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 04/14/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical outcome and quality of life (QOL) following perineal proctectomy for rectal prolapse remain poorly documented. METHODS From 1994 to 2004, patients with full-thickness rectal prolapse were treated exclusively with perineal proctectomy independent of age or comorbidities. Subjective patient assessments and recurrences were determined retrospectively from hospital and clinic records. Consenting patients completed the gastrointestinal quality of life index (GIQLI). RESULTS Perineal proctectomy was performed in 103 consecutive patients with a median age of 75 years (range 30-94). Most patients underwent concurrent levatorplasty (anterior 85.8%, posterior 67.9%). Durable results were obtained in all patients; the recurrence rate was 8.5% over a mean follow-up of 36 months. Preoperatively, 75.5% of patients reported fecal incontinence, and 32.1% had obstructed defecation. Incontinence significantly improved post-proctectomy (41.5%, p < 0.001), as did constipation (10.4%, p < 0.001). GIQLI respondents reported satisfaction following proctectomy with 63% scoring within one standard deviation of healthy controls. Patients with recurrent prolapse reported a lower QOL. Risk factors for recurrence included duration of prolapse, need for posterior levatorplasty, and prior anorectal surgery. CONCLUSIONS Perineal proctectomy provides significant relief from fecal incontinence and obstructive symptoms caused by rectal prolapse, with an acceptable recurrence rate and low morbidity.
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Affiliation(s)
- Sean C Glasgow
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, MO, USA
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18
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Feng Y, Jianjiang L. Functional outcomes of two types of subtotal colectomy for slow-transit constipation: ileosigmoidal anastomosis and cecorectal anastomosis. Am J Surg 2008; 195:73-7. [PMID: 18082545 DOI: 10.1016/j.amjsurg.2007.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Revised: 02/05/2007] [Accepted: 02/05/2007] [Indexed: 12/20/2022]
Abstract
BACKGROUND Some patients with severe slow-transit constipation may benefit from subtotal colectomy, but there is no consensus on standard operative mode. The aim of the study was to compare the functional outcomes of subtotal colectomy with cecorectal anastomosis (CRA) with those of subtotal colectomy with ileosigmoidal anastomosis (ISA) in patients with severe slow-transit constipation. METHODS Records of 79 patients who received preoperative investigation to confirm slow transit at our institution from 1989 to 2004 and subsequently received colectomy with CRA (n = 34) or colectomy with ISA (n = 45) were reviewed. The mean follow-up was 2 years (range 1-15). RESULTS Postoperative defecation frequency increased and symptoms such as bloating and abdominal pain decreased in both groups. More CRA patients than ISA patients experienced persistent constipation and continued using laxatives or enemas at the 12-month follow-up. More ISA patients (93.3%) than CRA patients (73.5%) were satisfied with the procedure, whereas some patients in both groups complained of excessively high stool frequency and fecal incontinence. CONCLUSION Both CRA and ISA procedures increase the number of bowel movements; however, ISA results in higher defecation frequency, less use of laxatives and enemas, and higher patient satisfaction.
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Affiliation(s)
- Ye Feng
- Department of Colorectal Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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bin Mohd Zam NA, Tan KY, Ng C, Chen CM, Wong SK, Chng HC, Tay KH, Eu KW. Mortality, morbidity and functional outcome after total or subtotal abdominal colectomy in the asian population. ANZ J Surg 2005; 75:840-3. [PMID: 16176220 DOI: 10.1111/j.1445-2197.2005.03552.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study reviews the functional outcome and satisfaction of patients after subtotal or total colectomy (STTC). METHODS A retrospective review of patients who underwent STTC between June 1999 and September 2003 was performed. A standardized questionnaire was formulated and phone interviews were conducted with these patients. RESULTS There were 50 patients who underwent STTC during this period. The most common indications were bleeding diverticular disease, patients with synchronous colorectal cancers or polyps and left-sided colonic obstruction. The presence of ischaemic heart disease and the development of perioperative acute coronary syndrome were found to be statistically significant predictors of 30 day mortality with P = 0.01 and 0.05, respectively. Phone interviews were successfully conducted in 33 patients. The patients interviewed were between 4 and 54 months postsurgery. Ninety-four percent reported that they were either happy or satisfied. Cleveland Clinic Incontinence Score (CCIS) revealed good or perfect continence in 94% of patients. Less than one-quarter of those interviewed had five or more bowel movements in a day while most had either two or three bowel movements a day. Patient satisfaction after STTC correlated strongly with the severity of CCIS and number of bowel movements a day (P < 0.01). Also, those with less than five bowel movements a day were more likely to report a better satisfaction (P < 0.01). CONCLUSION Subtotal or total colectomy is associated with a good functional outcome and most patients were satisfied with their bowel function on follow-up.
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Abstract
BACKGROUND Fecal incontinence is a common problem within society from childhood through to the elderly. Its clinical assessment has focussed on severity and frequency of soiling episodes but it is increasingly recognized to have an impact on physical, psychological and social well-being (quality of life [QOL]). This is likely to be particularly important in childhood. The aim of the present study was to critically evaluate the development and application of disease-specific QOL measures, focusing particularly on their use in children. METHODS Generally recognized disease-specific QOL measures for fecal incontinence were identified and their generation and validation were critically evaluated. RESULTS Six instruments were identified: Ditesheim and Templeton QOL Scoring System, Manchester Health Questionnaire, Hirschsprung's Disease/Anorectal Malformation Quality of Life Questionnaire (HAQL), Gastrointestinal Quality of Life Index (GIQLI), Fecal Incontinence TyPE Specification, and the Fecal Incontinence Quality of Life Scale (FIQL). Although the FIQL appeared to be the better tool for adults with fecal incontinence because it was brief and had the best validity and reliability, it needed further modification to become appropriate for use in children. In particular, items relating to sexual activity were inappropriate. CONCLUSION Neither the FIQL nor other disease-specific instruments met basic psychometric standards for use in children with fecal incontinence. Substantial revision of currently available instruments will be required to meet the needs of this population.
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Affiliation(s)
- Misel Trajanovska
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
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McGrath DR, Spigelman AD. In the beginning there was colectomy: current surgical options in familial adenomatous polyposis. Hered Cancer Clin Pract 2004; 2:153-60. [PMID: 20233459 PMCID: PMC2840002 DOI: 10.1186/1897-4287-2-4-153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Accepted: 11/15/2004] [Indexed: 12/11/2022] Open
Abstract
Multiple colonic polyps, almost guaranteed colorectal cancer by the age of forty-five and an increased risk of non-colonic cancers characterise the autosomal dominant condition Familial Adenomatous Polyposis (FAP) [1]. The patients and families faced with such a diagnosis present many difficult management challenges, both surgical and non-surgical. We discuss the current surgical options for treatment of the more significant manifestations of FAP arising in the colorectum and duodenum as well as desmoid disease
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Affiliation(s)
- Daniel R McGrath
- Discipline of Surgical Science, University of Newcastle, Australia.
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