Extensive Colonic Resection Research Articles

Clinical cases of surgical treatment of bowel infarction caused by acute mesenteric ischemia combined with colon cancer

The article contains description of such serious pathology in emergency surgery as bowel infarction caused by acute mesenteric ischemia in two patients with colorectal cancer admitted to Tatarstan regional clinical cancer center. Patients were admitted for emergency indications with the clinic of an acute abdomen. Both patients underwent an emergency surgery of laparotomy, enterectomy with colon resection and anastomosis. Both patients had satisfactory immediate postoperative results. One patient died 8 months later due to the progression of the underlying disease, the second one is alive to the present day with a satisfactory quality of life and the only complain of frequent loose bowel movements. Most patients with acute mesenteric ischemia are operated on with trial diagnostic laparotomy, and mortality rate for this pathology reaches 90% or more. The presented clinical cases familiarize physicians with an opportunity of successful surgical treatment of patients with acute mesenteric ischemia combined with colon cancer and demonstate expediency and need for surgical interventions with extensive colon resection.

Hand-Assisted Laparoscopic (HAL) Multiple Segmental Colorectal Resections: Are They Feasible and Safe?

The objective of this study was to evaluate the short-term outcomes of synchronous hand-assisted laparoscopic (HAL) segmental colorectal resections. The surgical options for synchronous colonic pathology include extensive colonic resection with single anastomosis, multiple synchronous segmental resections with multiple anastomoses, or staged resections. Traditionally, multiple open, synchronous, segmental resections have been performed. There is a lack of data on HAL multiple segmental colorectal resections. A retrospective chart review was compiled on all patients who underwent HAL synchronous segmental colorectal resections by all the colorectal surgeons from our Group during the period of 1999 to 2014. Demographics, operative details, and short-term outcomes are reported. During the period, 9 patients underwent HAL synchronous multiple segmental colorectal resections. There were 5 women and 4 men, with median age of 54 (24-83) years and median BMI of 24 (19.8-38.7) kg/m(2). Two patients were on long-term corticosteroid therapy. The median operative time was 210 (120-330) minutes and median operative blood loss was 200 (75-300) mLs. The median duration for return of bowel function was 2 days and the median length of stay was 3.5 days. We had 2 minor wound infections. There were no deaths. Synchronous segmental colorectal resections with anastomoses using the hand-assisted laparoscopic technique are safe. Early conversion to open and use of stomas are advisable in challenging cases.

Expression of AQPs 3, 8 and 9 in the residual colonic mucosa of rats with extensive colon resection

Expression of AQPs 3, 8 and 9 in the residual colonic mucosa of rats with extensive colon resection

Metachronous colorectal cancer risk for mismatch repair gene mutation carriers: the advantage of more extensive colon surgery

BackgroundSurgical management of colon cancer for patients with Lynch syndrome who carry a mismatch repair (MMR) gene mutation is controversial. The decision to remove more or less of the colon...

Incidence of synchronous and metachronous colorectal carcinoma.

Two hundred and twenty-three patients with colorectal carcinoma were treated consecutively at the University Hospital of South Manchester from May 1976 to January 1981. Twenty-four patients (10.7 per cent) were found to have more than one colorectal carcinoma. In 18 patients this was recognized either immediately or within 6 months of the initial diagnosis--synchronous carcinoma. In the other six cases a second carcinoma was found at a later time--metachronous carcinoma. The incidence of synchronous, and consequently the combined incidence of synchronous and metachronous carcinoma, was higher than previously documented. The anatomical distribution of the multiple carcinomas and the sex incidence in these patients was similar to that seen in patients with a single carcinoma of the large bowel. A high association of adenomatous polypi with multiple large bowel carcinomas was observed. The possibility of more extensive colonic resection in the younger patient with a favourable carcinoma is discussed.

Reliability of intraoperative frozen sections in the management of Hirschsprung’s disease

Background The use of a 1-stage pull-through for Hirschsprung’s disease (HD) is dependent on accurate identification of the normally innervated bowel on intraoperative frozen sections (IOFS). The authors wished to determine the incidence and sources of error during this process. Methods All HD patients undergoing IOFS over a 15-year period were reviewed. Results Three hundred four patients underwent a total of 700 IOFS. In 9 cases (3%), there was discrepancy between IOFS and permanent sections. Two of these were false-positive (ganglion cells incorrectly believed to be present at IOFS); both required a second operation as a result of the error. Seven were false-negative (presence of ganglion cells not recognized at IOFS); none required a subsequent operation, but 2 had a significantly more extensive colonic resection than was necessary. Responsible factors included sampling from the transition zone, freezing artifact, and misinterpretation of ganglion cells in very young patients owing to pathologist inexperience. There was significant variability in the error rate among the 11 pathologists. However, the numbers were too small for statistical analysis to determine whether there was a correlation between the rate of errors and the volume of cases done or years of experience. Conclusions Error in reading of IOFS is rare but can have significant repercussions in patient care. Multiple factors, including technical issues and pathologist experience, may have a role in contributing to these errors.

Prophylaxis of uric acid stone in patients with inflammatory bowel disease following extensive colonic resection

Prophylaxis of uric acid stone in patients with inflammatory bowel disease following extensive colonic resection

Prophylaxis of uric acid stone in patients with inflammatory bowel disease following extensive colonic resection.

Seven patients (13.0%) among 54 patients with inflammatory bowel disease treated by extensive colonic resection were complicated by renal stone. The mean urinary pH value in cases complicated by renal stones (5.3 +/- 0.4) was significantly lower than among those without stones (6.1 +/- 0.3, P less than 0.01). Sodium bicarbonate (4 gm/day, q.i.d.) was given to 11 patients with renal stones and/or hematuria, whose urinary pH was lower than 5.0 or whose urinary sediments were positive for uric acid crystals since Oct. 1985. Their urinary pH and Na concentration increased significantly and no renal stone complication has been seen in the treated group.

Large Colon Resection

With large colon resection and anastomosis, up to 95 per cent of the length of the large colon has been successfully removed. A hand-sewn end-to-end anastomosis is effective for lesions in the left dorsal colon and pelvic flexure. Transection and a side-to-side anastomosis with stapling equipment is most effective for extensive resections (greater than 50 per cent). Horses with extensive colon resection (95 per cent) have permanent deficiencies of water absorption and digestion of cellulose and protein. Fermentative capacity is reduced, owing to decreased particulate matter retention time in the smaller capacity colon. These deficits are minimized with alfalfa hay as the source of forage (fed at 2 per cent of the body weight), and normal blood variables and body weight can be maintained. Voluntary intake increases to help maintain a positive nutrient balance. Grass hay, owing to the higher cell wall content, is inadequate as the sole source of energy and protein, and weight loss will occur. Ad libitum intake of water is recommended at all times, owing to the increased fecal water loss.