Comparison of hartmann's procedure versus resection with primary anastomosis in management of left sided colon cancer obstruction: A prospective cohort study

The aim of our prospective study is to compare and analyze the results of two treatment methods of left-sided malignant colon obstruction: Hartmann's procedure (HP) and Resection with primary anastomosis (RPA). 90 Patients with diagnosis of left-sided malignant colon obstructions were enrolled in this study. The patients were assigned into two groups: Hartmann's procedure (HP) group and Resection and Primary anastomosis group (RPA). Several clinical characteristics were determined and compared between the groups: hospital stay days, duration of the surgery, postoperative complications (during 30 days after surgery) and mortality was assessed. 37 patients were enrolled in the Hartmann's procedure (HP) group and 53 patients were enrolled in the Primary anastomosis (RPA) group and had undergone different types of colon resections with primary anastomosis. There was 1mortality in HP group and 1 in RPA group. In RPA group, there were 7 complications (13.2%). 1 intraabdominal abscess after colorectal anastomosis, which was cured with antibiotic therapy and percutaneous drainage; 5 cases of wound infections, 1- leak of colorectal anastomosis and in Hartmann's procedure group there were 8 (21.6%) complications (7 - wound infections, 1-necrosis of colostomy). But this difference is not statistically reliable (p=0.110). In stenting RPA stay were - 6 days and in HP group, it was 8 days. This difference is statistically reliable (P=0.02). In case of left-sided malignant colon obstructions, Primary anastomosis intervention should be preferred, rather than Hartmann's procedure. In the future it's needed to perform the randomized trials, which will study the long-term outcomes (recurrence of cancer, survival rate) of this treatment method.

Comparison of the patient-controlled epidural and intravenous analgesia after open colorectal surgery: A randomized controlled trial

The goal of this study was to evaluate the efficacy of two common analgesic techniques: patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (IVPCA) in patients undergoing open colorectal surgeries. 130 patients were randomized in two groups: group I - n=65 (27 males, 38 females, age range 23-75) - whose postoperative period and pain was managed with PCEA; group II - n=65 (31 male, 34 female, age range 23-75) - whose postoperative period and pain was managed with IVPCA. There were no significant differences by demographic and preoperative factors between the groups. The study demonstrates, that both analgesia techniques in colorectal surgery patients, IVPCA and PCEA, resulted in high levels of satisfaction (as reflected by a median score of 4 on the 1-5 scale), and provided effective management of postoperative pain. There were no differences in the pain scores on the postoperative visual analogue scales, analgesic requirements and satisfaction score between groups. This indicates that IVPCA and Epidural PCA are equally effective to control the postoperative pain after open colorectal surgery.

Enhanced recovery after surgery vs traditional care in elective colorectal surgery: A retrospective cohort study

The objective and the goal of this study was to determine how ERAS guidelines affected on hospital stay days and other complications rates in case of elective colorectal surgery in our clinic, compared to traditional care methods. First of all, all team members including surgeons, anesthetists, nurses were being trained in ERAS guidelines principals during two months and we started active implementation process after this. 87 patients, who were needed to be done colorectal surgery treatment, were actively treated according to ERAS guidelines and these patients were gathered in experimental group. At the same time, we started to collect data retrospectively from last 2 years elective colorectal surgery cases and sorted them according to preoperative, intraoperative surgical and anesthesia data, postoperative analgesia, all type of complications. 120 patients were placed in traditional care group (control group). In traditional care group open colorectal surgery was associated with long length of stay 8-10 days. High rates of surgical site infection-24.2%, readmission rate during 30 days-30.8%, PONV-44.2%, respiratory complication-6.7%, deep vein thrombosis-3.3%, urinary retention-2.5%, prolonged postoperative ileus 16.7%. We included 87 patients in ERAS care group during 2 years. In this group our study showed big reduction of hospital stay days and it was average 5 days. Compared to traditional care group incidence of respiratory complications was 0, postoperative PONV- 6.9%, postoperative ileus-5.7%, deep vein thrombosis-0, urinary retention-0, readmission rate-0, surgical site infection-3.4%.

[BREATH TEST WITH LOCALLY PRODUCED 13С-UREA (TBILISI, GEORGIA) IN DIAGNOSTICS OF HELICOBACTER PYLORI INFECTION]

Comparative assessment of results of detection of Helicobacter pylori (Hp) infection by breath tests with standard and locally produced 13С urea was done in 213 patients with gastric and duodenal pathology, including those who already were undergone the surgery. Invasive endoscopic biopsy test including rapid urease test (RUT), smear cytology and histology were also performed (tissue samples were obtained after endoscopy or surgery). RUT was carried out with the help of URE-HP test kit. Serological test for Hp antibodies was performed by IFA using kit ELISA. 13С urea breath test (UBT) was conducted for the determination of 13/12CO2 in breath samples by using of infrared spectroscope. In I group (125 patients) UBT was performed with standard 13С urea, in II group (88 patients) with locally produced 13С urea. Based on 5 different methods of Hp infection testing Hp positivity in 172 (80,8%) and Hp negativity in 41 (19,2%) patients were revealed. 13С-UBT showed the highest diagnostic value (accuracy-97,5%, sensibility-97,0%, specificity-100%) in Hp infection diagnosis. The (accuracy, sensibility and specificity of breath test with locally issued 13С urea (98,7%, 98,5% and 100% respectively) are the same as those for BT with standard 13С urea (96,7%, 96,2% and 100% respectively). These parameters are also highly credible in control of treatment efficiency (96,7%, 90,0% and 100% respectively). The correlation of index DOB‰ of breath test with results of RUT was revealed In Hp positive patients. This can serve as a marker of Hp infection rate. Preliminarily, in pre-clinical experimental study, harmless of locally issued 13С-urea from point of view of acute/sub-acute toxicity and allergy development was confirmed. The advantages (noninvasiveness, simplicity, rapidity, safety) and high diagnostic value of UBT (with both standard as well as locally produced 13С-urea) provide the opportunity to offer 13С-UBT as screening method of Hp infection diagnosis. It also should be recommended as a method of choice for controlling of Hp treatment efficiency. Taking into the consideration all above-mentioned we may recommend locally produced 13С-urea (Tbilisi, Georgia) for certification and further application.

[Benchmarking study of effectiveness of simultaneous and isolated surgeries]

Benchmarking study was conducted on effectiveness of simultaneous and isolated surgeries in practice of obstetrics and gynecology. In terms of the work, data were analyzed on the isolated and simultaneous surgeries with the patients with combined gynecological and surgical pathologies, requiring operative treatment. Man group included 254 patients with combined abnormalities, who underwent simultaneous surgeries; control group included 122 patients who underwent surgical treatment for combined diseases consecutively in two stages, in different times. Periodicity of complications in early and late post-surgical periods was evaluated, as well as risk ratio (RR) and attributable risk (AR). Simultaneous surgery is safe method of treatment of combined gynecological and surgical abnormalities. Notwithstanding extension of duration of pre-surgical examinations and post- surgical hospital stay, simultaneous operations are considered to be opportunity for being cured from several combined abnormalities within one hospitalization and anesthesia, creating positive moral and psychological background for the patients and making additional argument in favor of their conducting.