Ileocecal valve syndrome and vitamin b12 deficiency after surgery: a multicentric prospective study

Does preservation of the ileocecal valve make a difference? A propensity score matched comparison of Deloyers procedure versus extended right hemicolectomy

BACKGROUND

When performing left hemicolectomies, surgeons might encounter difficulties when restoring bowel continuity. Ileocecal valve resection and performing an ileosigmoid anastomosis is one possible solution. An alternative is preserving the ileocecal valve by counterclockwise rotation of the remaining colon, ensuring a tension-free anastomosis. This study compares functional outcomes after Deloyers procedure and extended right colectomy with an ileosigmoid anastomosis.

METHODS

Between 2008 and 2021, we included patients who underwent Deloyers procedure. Using propensity score matching, controls who underwent extended right hemicolectomy were identified. Perioperative outcomes were compared and patients were questioned using the St. Marks-score and the EORTC-29CR.

RESULTS

We identified 19 patients who underwent the Deloyers procedure and 28 controls. Both groups had comparable mean age (61.4 years, p = 0.3), gender distribution (women: 40%, p = 0.19), ASA classification (p = 0.89) and BMI (26.8 kg/m2, p = 74). Deloyers patients were less often treated for oncologic indications (53% vs. 86%, p = 0.02). Postoperative morbidity (37% vs. 36%, p = 0.99) and mortality (0 vs. 4%, p = 0.99) were similar. Deloyers patients reported worse body perception (83.3 vs. 100, p = 0.02), but frequency of bowel movements (2 vs. 3, p = 0.09) and use of antimotility agents (8% vs. 0%, p = 0.22) were comparable. The overall and individual results of the St. Marks and EORTC QLQ-CR29 questionnaires showed no significant differences (p > 0.05).

CONCLUSION

In our study, patients who underwent Deloyers procedure showed no mortality and comparable morbidity, functional and quality of life outcomes to patients who underwent extended right hemicolectomy.

Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting

Many patients undergo small bowel and colon surgery for reasons related to malignancy, inflammatory bowel disease (IBD), mesenteric ischemia, and other benign conditions, including post-operative adhesions, hernias, trauma, volvulus, or diverticula. Some patients arrive in the operating theatre severely malnourished due to an underlying disease, while others develop complications (e.g., anastomotic leaks, abscesses, or strictures) that induce a systemic inflammatory response that can increase their energy and protein requirements. Finally, anatomical and functional changes resulting from surgery can affect either nutritional status due to malabsorption or nutritional support (NS) pathways. The dietitian providing NS to these patients needs to understand the pathophysiology underlying these sequelae and collaborate with other professionals, including surgeons, internists, nurses, and pharmacists. The aim of this review is to provide an overview of the nutritional and metabolic consequences of different types of lower gastrointestinal surgery and the role of the dietitian in providing comprehensive patient care. This article reviews the effects of small bowel resection on macronutrient and micronutrient absorption, the effects of colectomies (e.g., ileocolectomy, low anterior resection, abdominoperineal resection, and proctocolectomy) that require special dietary considerations, nutritional considerations specific to ostomized patients, and clinical practice guidelines for caregivers of patients who have undergone a surgery for local and systemic complications of IBD. Finally, we highlight the valuable contribution of the dietitian in the challenging management of short bowel syndrome and intestinal failure.

Repurposing an ACE Malone Channel for Continent Intermittent Catheterization During Re-augmentation Cecocystoplasty: The MACEtrofanoff Procedure

OBJECTIVE

To describe a surgical alternative option in select patients with neurogenic bladder and a history of Malone antegrade continence enema (MACE) who now require revision augmentation of the bladder, and/or creation of a new continent catherizable urinary channel (CCC).

METHODS

Herein, we describe a novel surgical approach for patients who have had prior MACE creation who subsequently require surgical revision and creation of a new CCC. Rather than the traditional approach of creating a new CCC utilizing bowel, we perform a cecocystoplasty and leave the previously created MACE intact. The prior MACE channel becomes repurposed as the new Mitrofanoff, which we have termed the MACEtrofanoff channel. Concomitant cecostomy tube placement for bowel management can be performed at the time of surgery.

RESULTS

We have successfully performed this procedure in 2 patients with good outcomes to date. This technique does not require the sacrifice of the prior appendix channel, nor require the formation of a new stoma and channel. Patients are able to adapt easily to clean intermittent catheterization through a channel they are already familiar with for their prior antegrade enemas.

CONCLUSION

In select patients, surgeons should consider the MACEtrofanoff procedure to avoid the added morbidity of further bowel mobilization.