Postoperative Adhesive Intestinal Obstruction Research Articles

Лікування та профілактика спайкової кишкової непрохідності в дітей

Despite the achievements of modern pediatric surgery, to date there is no single comprehensive approach to the treatment and prevention of adhesive intestinal obstruction (AIO), both primary (prevention of adhesions formation after primary surgery) and secondary (prevention of recurrence). Purpose - to study the clinical effectiveness of treatment, primary and secondary prevention of postoperative intestinal adhesive obstruction in children. Materials and methods. An examination and analysis of medical records of 119 children aged 5 months to 17 years who were treated at the Pediatric Surgery Clinic of Ivano-Frankivsk National Medical University over the past 10 years for post-operative AIO was carried out. In 35 (29.41%) children a positive effect was achieved from conservative treatment. The remaining 84 (70.59%) children were operated on. Two groups of patients were formed: the comparison group - 38 (45.24%) children, who received traditional treatment, and the main group - 46 (54.76%) children, who were intraoperatively applied anti-adhesive gel to prevent recurrence of postoperative AIO. Results. It was established that postoperative AIO occurred in only 1 (1.19%) child after laparoscopic intervention, in the rest of the children primary surgical interventions were performed by an open method. In the comparative assessment of the postoperative course in two groups of patients, we drew attention to a more favorable course in the children of the main group, which was manifested by a faster recovery of peristalsis, a decrease in the duration of gastric stasis, a faster appearance of independent defecation, and a shorter period of inpatient treatment. When comparing the results of treatment between groups of patients, it was established that the frequency of recurrences of AIO in the main group of patients was 5.44 times lower than in children of the comparison group, and the frequency of relaparotomy for recurrent AIO was 7.28 times lower than in patients of comparison group. We did not observe complications associated with the use of anti-adhesive gel. We did not notice a significant difference in the results of treatment between patients who were treated with anti-adhesive gel of different composition (based on carboxymethylcellulose and sodium hyaluronate). Conclusions. The most effective method of primary prevention of postoperative adhesive intestinal obstruction is the use of laparoscopic primary surgical interventions. Intraoperative application of anti-adhesive gel is a highly effective and safe recurrence prevention method of adhesive intestinal obstruction in children. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Occurrence and Risk Factors for Acute Urinary Retention and Urinary Tract Infection in Patients Undergoing Urinary Drainage after Colorectal Resection.

This study aimed to explore the occurrence of acute urinary retention (AUR) and urinary tract infection (UTI) in patients undergoing urinary drainage after colorectal resection and analyse the risk factors. Clinical data of 167 patients with urinary drainage after colorectal resection in Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital from November 2020 to November 2022 were retrospectively analysed. Clinical data included age, gender, diabetes, hypertension, lesion location, surgical method, previous history of abdominal surgery, urinary system diseases (urinary calculi, benign prostatic hyperplasia and urethral stricture), use of antibiotics before surgery, use of analgesic and sedative drugs after surgery, postoperative extubation time and postoperative adhesive intestinal obstruction. The postoperative AUR and UTI in patients were statistically analysed. Univariate and multivariate logistic regression analyses were used to explore the risk factors and odds ratio (OR) for AUR and UTI. The incidences of AUR and UTI were 23.95% (40/167) and 16.77% (28/167). Patients were divided into AUR group (n = 40), non-AUR group (n = 127), UTI group (n = 28) and non-UTI group (n = 139). Logistic regression analysis showed that previous history of abdominal surgery (OR = 3.517, 95% CI: 1.005-12.313), urinary system diseases (OR = 8.253, 95% CI: 2.692-25.303), postoperative extubation time (OR = 0.536, 95% CI: 0.393-0.732) and postoperative adhesive intestinal obstruction (OR = 25.293, 95% CI: 6.747-94.827) were risk factors for AUR in patients with urinary drainage after colorectal resection (p < 0.05). Female (OR = 21.569, 95% CI: 1.094-425.138), long postoperative extubation time (OR = 26.218, 95% CI: 3.318-207.151) and urinary system diseases (OR = 8.647, 95% CI: 3.425-21.831) were risk factors for UTI in patients undergoing urinary drainage after colorectal resection (p < 0.05). Age and preoperative use of antibiotics were not key influencing factors for UTI (p > 0.05). Clinical attention is paid to high-risk factors and groups. Corresponding interventions are taken as soon as possible to reduce the occurrence of AUR and UTI and further improve the prognosis of patients with urinary drainage after colorectal resection.

Validation of appendiceal stump invagination in laparoscopic appendectomy.

There are various methods for appendiceal stump dissection, but the necessity for stump invagination remains unclear. This study aimed to assess the efficacy of appendiceal stump invagination in patients with acute appendicitis after laparoscopic appendectomy (LA). We enrolled 327 patients with acute appendicitis who underwent LA between 2012 and 2020. Perioperative variables and surgical outcomes were analyzed between the invagination of the appendiceal stump and noninvagination groups. Propensity score-matched analysis (PSM) was performed. More patients experienced severe inflammation and severe intra-abdominal contamination in the noninvagination group than in the invagination group. Patients in the noninvagination group had an older age, higher body mass index, and poorer American Society of Anesthesiologists physical status than the invagination group. Severe inflammation in the noninvagination group was associated with longer hospital stays and poorer postoperative complications than in the invagination group. PSM analysis was performed to minimize bias in the two groups. After PSM analysis, there were no significant differences in surgical site infection, postoperative intra-abdominal abscess, Clavien-Dindo class ≥IIIa, or postoperative stay between the two groups. During the follow-up period, the postoperative adhesive ileus was not significantly different between the invagination and noninvagination groups. Invagination of the appendiceal stump during LA is not necessary to prevent short- and long-term complications. Even in cases dissected using a laparoscopic endostapler, the appendiceal stump per se is not related to postoperative adhesive ileus.

Прогнозування ризику розвитку післяопераційної злукової кишкової непрохідності в дітей

Прогнозування ризику розвитку післяопераційної злукової кишкової непрохідності в дітей

Clinical cases of late postoperative adhesive intestinal obstruction after liver and kidney transplantation in children and surgical methods of their treatment

Abdominal adhesions are one of the most common complications in abdominal surgery. In 56-70 % it is the cause of small bowel obstruction, which often requires repeated surgery. To date, a few cases of late adhesive intestinal obstruction (LAIO) as a complication of organ transplantation in children have been described. The purpose of the study was to investigate clinical cases of LAIO in a 9-year-old child after liver transplantation, and in an 8-year-old child after kidney transplantation. Materials and methods. Clinical case I. A 62-day-old girl was treated with Kasai procedure before a liver transplantation, according to type III atresia of the biliary tract. Orthotopic liver transplantation of the left-lateral section from living related donor was performed at the age of 9 months. The surgeries were accompanied by damage to the mesothelium and trauma of the serous membrane, which led to the formation of intraabdominal adhesions. With the growth of the child there was a growth of abdominal organs and adhesions stretching. LAIO was diagnosed 8 years after first surgery. Clinical case II. The boy was diagnosed with hypoplastic dysplasia of the right kidney, left-side ureterohydronephrosis, resulting in chronic end-stage renal disease. Peritoneal dialysis was performed at the age of 6 years. The effect of dialysate on the mesothelium led to the formation of small intestine pseudo-diverticula. At the age of 7 years a bilateral nephrectomy and kidney transplantation from a deceased donor were performed. At the age of 8 LAIO was diagnosed. In both cases, children underwent adhesiolysis. The peritoneum was sutured from the lower and upper edges of the wound to the middle, so that a hole remained in the middle of the wound. A Nelaton catheter was inserted through the hole and 250 ml of sodium hyaluronate solution “Defensal” was injected into the left-lateral part, small pelvis and right lateral abdominal cavity. Then anterior abdominal wall was sutured. Results. The successful surgical treatment of LAIO in children using local adhesiolysis in combination with sodium hyaluronate was performed. The careful handling of vascular anastomoses and changes in organ topography were required during surgery. The purpose of the surgery on LAIO was not only to restore the chyme transport in the gastrointestinal tract, but also to release the small intestine from the adhesions with the normal anatomy and function preservation. The observation of children for 5 years indicate the effectiveness of intraabdominal application of sodium hyaluronate solution. Conclusion. The purpose of surgeries for LAIO after organ transplantation should be to restore the gastrointestinal patency and the functional capacity of the intestine, without violating the previous anatomy and prevention of recurrence. To prevent the intraabdominal adhesions, sodium hyaluronate can be used intraoperatively.

ПРОГНОЗИРОВАНИЕ РИСКА РАЗВИТИЯ СПАЕЧНОЙ НЕПРОХОДИМОСТИ КИШЕЧНИКА У ДЕТЕЙ В ЗАВИСИМОСТИ ОТ ГЕНОТИПА АЦЕТИЛИРОВАНИЯ

Objective. To determine the predictive value of the genetic polymorphism of the N-arylacetyltransferase-2 (NAT-2) gene for assessing the risk of postoperative adhesive intestinal obstruction in children. Methods. In all children (36 children with adhesive intestinal obstruction (main group) and 35 planned patients (comparative group)) the acetylation genotype was studied by detecting point mutations of the NAT-2 gene using allele-specific amplification method with analysis of apolymerase chain reaction-restrictionfragmentlengthpolymorphism. Results. The study of the frequency of mutations at position 481 revealed the greatest diversity of the studied variants of genotypes: 33.3% of the children of the main group were homozygous for the wild-type gene, 44.4% were heterozygotes, 22.2% of patients had a homozygous mutant gene. According to the NAT-2 * 6A genotype (G 590 - A), the majority of patients (55.6%) were heterozygotes, 44.4% were homozygotes with the wild-type of the gene. Not a single case of mutation at position 857 has been identified. Among the children of the main group, the share of «fast» acetylators was 69.4%, in the comparison group - 40.0% (χ&lt;sup&gt;2&lt;/sup&gt;=6.215; p=0.013). The development of postoperative adhesive intestinal obstruction in children with the “fast” acetylation genotype occurred in the absence of clinical and anamnestic risk factors and was characterized by a greater severity and prevalence of intra-abdominal adhesive process (PAI was (14.8±1.8) and (8.1±2.4 ), respectively). Conclusion. The risk of developing postoperative adhesive complications in children can be done preventively by determining the genetic polymorphism of the N-acetyltransferase-2 gene. The risk group for developing adhesive intestinal obstruction is made up of children who are the carriers of NAT-2 alleles and correspond to the genotype of «fast» and «moderate» acetylation. Children who are «fast» acetylators have a more pronounced intra-abdominal adhesion process and a higher risk of complications associated with excessive adhesion even in the absence of other risk factors. What this paper adds N-acetyltransferase 2 (NAT2) gene polymorphism as a prognostic risk factor for the development of adhesive intestinal obstruction in children has been studied. Children as the carriers of the «fast» acetylator genotype have a higher risk of developing intra-abdominal adhesions and therefore require more comprehensive preventive measures at all stages of possible influence.

CAUSES OF EARLY RELAPAROTOMIES IN SURGERY

Summary. Introduction. Despite the introduction of modern methods of diagnosis, tactics, and treatment of diseases of the abdominal organs, the risk of developing early postoperative complications remains high.&#x0D; The aim of this study is to clarify the causes of early postoperative complications and indications for their surgical treatment.&#x0D; Materials and methods. 3947 case histories of patients operated on for urgent indications were analyzed. In 73 cases, relaparotomies were performed in the early postoperative period (1.85 %).&#x0D; Results and discussion. The main nosologic unit, during the surgical treatment of which relaparotomies were performed, was acute appendicitis. Then there was a perforated pyloroduodenal ulcer and a strangulated hernia of various localization. The main indications for relaparotomy were progressive peritonitis, early adhesive intestinal obstruction, intra-abdominal abscesses, and infiltrates. In two cases, no pathology was detected during relaparotomy – there was an over diagnosis of postoperative peritonitis and anastomotic suture failure.&#x0D; Conclusion. 1. The main cause for relaparotomies in urgent surgery is the progression of preoperative peritonitis. 2. The second important cause is early postoperative adhesive intestinal obstruction. 3. Errors in intraoperative diagnostics, tactics, and techniques are the third leading cause of early relaparotomies.

Changing pattern of adult intestinal obstruction in Nigeria: A narrative review

Intestinal obstruction is a failure of craniocaudal propagation of intestinal contents and may be due to a mechanical or functional pathology. Acute mechanical intestinal obstruction is one of the leading causes of surgical admissions in most emergency departments worldwide and is a significant cause of morbidity and mortality, especially when associated with bowel gangrene or perforation. It accounts for 15% of all emergency visits from acute abdominal pain. In Nigeria and most of Africa, external hernias were the main causes of intestinal obstruction throughout the 20th century; however, at the onset of the 21st century, some reports have shown a rising frequency of adhesive obstruction in our environment. We conduct this narrative review to determine if there is a changing pattern of adult intestinal obstruction in Nigeria. Literature search was conducted by two independent reviewers. The keywords used were “adult,” “intestinal obstruction,” “cause,” and “Nigeria.” The keywords were combined using the Boolean logic. The keywords were searched in PubMed and Google Scholar. The overall mean age of the study population is 44.3 years, with a male-to-female ratio of 3.6:1. Of the 1435 cases of intestinal obstruction reported in the studies selected, post-operative adhesive intestinal obstruction was responsible for 590 of them, which is equivalent to 41.1% of all the obstruction. Obstructed external hernias were responsible for 357 cases of obstruction, which is equivalent to 25.9%. The most common cause of intestinal obstruction in Nigeria is post-operative adhesion.

Post-operative adhesive intestinal obstruction

Post-operative adhesive intestinal obstruction

Congenital biliary dilatation associated with intestinal malrotation

Abstract Congenital biliary dilatation (CBD) associated with intestinal malrotation (IM) has rarely been reported. We herein report three cases of pediatric CBD associated with IM that was incidentally found at surgery. The patients underwent total resection of the extrahepatic bile duct followed by hepaticoduodenostomy at the hepatic hilum or hepaticoduodenostomy as the definitive surgery for CBD. Ladd's procedure was simultaneously performed for asymptomatic IM. Postoperative adhesive intestinal obstruction occurred in all three patients, and conservative treatment was successful. Duodenogastric regurgitation was also observed as a biliary reconstruction-related complication, and conversion to hepaticojejunostomy at the hepatic hilum was performed in two of the three patients. We herein present the clinical course of these three patients and discuss the clinical significance of the association between CBD and IM in terms of the surgical strategy and in comparison with 12 previously reported cases.

Rare Forms of Intestinal Obstruction in Children

The article analyzes two rare cases of acquired intestinal obstruction in children. In the first child at the age of 2 years, who suffered a retrosternal total coloesophagoplasty for extended post-burn chemical esophageal stenosis, early postoperative adhesive intestinal obstruction appeared on the 8th day of the postoperative period, which was eliminated laparoscopically. The next day, against the background of drug stimulation of the intestine, a small intestinal invagination developed, diagnosed with ultrasound examination. Relaparotomy and disinvagination were performed.The second patient, the 15 years old girl, who had suffered from closed abdominal injury and a pancreatic injury, manifested the signs of high partial intestinal obstruction a day after the trauma occurred. Initially, its cause was considered to be hematoma of the omental bursa. Fibrogastroduodenoscopy (FGDS) and X-ray diagnostics did not reveal the cause of intestinal obstruction, but after FGDS procedure the patient’s condition improved within 3–4 days, and then the clinical signs of small bowel obstructive adhesion confirmed by X-ray and laparoscopy. With laparoscopy in the middle section of the small intestine, a hyperinflate “whitish” section about 12 cm long, dense in palpation, was identified, which was the cause of obstruction. Through minilaparotomic umbilical access from the abdominal cavity, a loop of the jejunum with a foreign body inside was exteriorized. With transverse enterotomy trihobezoar 10×4×4 cm was removed from the lumen, which moved from the stomach and led to obstruction of small intestine. The outcome of the treatment was good in both cases.

A prospective multi-center registry concerning the clinical performance of laparoscopic colorectal surgery using an absorbable adhesion barrier (INTERCEED\xae) made of oxidized regenerated cellulose

PurposeThe aim of this prospective multi-center registry was to evaluate the safety and clinical performance of INTERCEED® in laparoscopic colorectal surgery.MethodsThis study was a prospective, multi-center, single-arm registry wherein patients who received INTERCEED® in laparoscopic colorectal surgery were registered consecutively (UMIN-CTR 00001872). The primary outcome was the incidence rate of postoperative adhesive small intestinal obstruction within 6 months. The secondary outcomes were reoperation related to postoperative bleeding and anastomotic leak, surgical site infection (SSI) and anastomotic leak.ResultsBetween March 2012 and March 2015, a total of 202 patients were enrolled from six institutions. INTERCEED® was not applied in two patients, so 200 patients were analyzed using the full analysis set population. The incidence rate of postoperative adhesive intestinal obstruction was 1.0% (2/200). The total SSI rate was 3.5% (7/200), the deep incisional SSI rate was 0.0% (0/200), and the organ SSI rate was 0.0% (0/200). The incidence of anastomotic leak was 1.0% (2/200). Reoperation was performed in two cases: one for anastomotic leak and the other as cardiac surgery due to heart disease.ConclusionsUsing INTERCEED® in laparoscopic colorectal surgery is safe and may be useful for preventing postoperative adhesive small intestinal obstruction.

Evaluation of the role of oral gastrografin in management of simple adhesive small bowel obstruction in children

Background: The risk of post-operative adhesive small intestinal obstruction is highest during the first post-operative year. Bowel injury during adhesiolysis increases the post-operative morbidity. Consequently, the conservative management of small bowel obstruction has considerable interest. The aim of this study was to evaluate the therapeutic role of gastrografin in the management of small bowel obstruction.Methods: All patients with simple adhesive small bowel obstruction will be included and treated conservatively for 48hours unless there was evidence of strangulation. After the first 48hours all the patients were given oral gastrografin unless improved or signs of strangulation arise. The evaluating parameters are the success rate, time to start full oral feeding and total duration of hospital stay.Results: Twenty-five cases were included in which two of them developed clinical evidence of strangulation during the first 48hours and were explored. Three cases improved on the conservative treatment. The remaining twenty cases were given oral gastrografin. Fourteen cases out of twenty showed the contrast dye in their large bowel by 24hours. Those 14 cases tolerated full oral feeding earlier and had shorter hospital stay than the remaining 6 cases that declared treatment failure and underwent surgical exploration.Conclusions: The use of gastrografin as a preliminary step of non-surgical treatment of simple adhesive intestinal obstruction may be helpful. However, further randomized study on a large number of patients was needed.

The role of laparoscopic adhesiolysis in the treatment of patients with recurrent, adhesive intestinal obstruction Menoufia Medical Journal

Objective The aim of this study was to assess the role of laparoscopic adhesiolysis in the treatment of patients with recurrent attacks of adhesive intestinal obstruction. Background Adhesive intestinal obstruction represents a common clinical problem following abdominal surgery with a high recurrence rate. Once adhesion has formed, its only means of elimination is operative adhesiolysis. Theoretically, adhesiolysis performed through a laparoscope is expected to provide better outcomes than the conventional open procedure. Patients and methods This is a prospective study that was done on a consecutive sample of 20 patients who were admitted to Menoufia University Hospital and Damanhour Medical National Institute during the period between April 2016 and February 2017 with recurrent postoperative adhesive intestinal obstruction that improved with conservative management. Exclusion criteria were peritonitis, severe abdominal distension, pregnancy, liver diseases, and previously confirmed or strongly suspected abdominal malignancy. All patients had undergone elective laparoscopic adhesiolysis after obtaining informed consent. Patients were followed up for 6 months. The complications and the outcome of the operation were recorded. Results Postoperative adhesions were identified laparoscopically in all patients. In the majority of cases (80%), the location of adhesions was distal to the lower abdomen. Successful complete laparoscopic adhesiolysis was feasible in 18 (90%) patients. Conversion to laparotomy was required for two (10%) patients because of intestinal perforation (n = 1) or a convoluted mass of adherent bowel (n = 1). One recurrence of intestinal obstruction was noted over a follow-up period of 6 months and improved with conservative management. Conclusion Laparoscopic adhesiolysis for recurrent postoperative adhesive bowel obstruction is feasible and safe, with a high success rate in experienced hands and results in minimal perioperative morbidity.

REOPERATIONS IN HIGH RISK GROUP CHILDREN WITH CONGENITAL DIAPHRAGMATIC HERNIA

Background. Nowadays the survival of newborns with congenital diaphragmatic hernia (CDH) is increasing. That’s why high frequency of chronic diseases and surgical complications is predictable.Purpose: determination of the structure and frequency of CDH reoperation in children with high risk, retrospective evaluation of perinatal clinical and intraoperative risk factors for repeat surgery.Materials and methods. Prospectively established group of 68 high-risk children with CDH, which were operated and survived during the period from 2000 to 2014. Left-sided hernias were dominated (82%) and right-sided CDH were diagnosed in 18% of newborns. Correction of left-sided CDH were performed by laparotomy in 51 patients (88%), including upper midline laparotomy in 43 cases and in 8 patients upper transverse laparotomy was performed. Thoracotomy was performed in 19 patients. Also thoracotomy was preferred in right-sided CDH (66.7%). Plastic of the diaphragm in case of left-sided CDH was performed by own tissues in 50 patients (73.5%). Plastic with using synthetic materials was made in 17 patients (26.5%): Medical Teflon ePTFE (n = 8), patch in the form of "sandwich" ("Tutoplast-pericardium" and mash) was used in four patients, Gor-Tex (n = 3) and with "Tutoplast-pericardium" was performed in two patients.Results. 23 operations in 20 of 68 patients were performed (29.4%). The reason of performing reoperations were such disease: adhesive bowel obstruction - 8 (40%), including strangulation obstruction with necrosis - 2 (10%), recurrent hernia - 6 (30%), gastroesophageal reflux - 5 (25%), obstruction caused by malrotation- 1 (5%), spleen torsion - 1 (5%), funnel chest deformation - 1 (5%). In patient with left diaphragmatic dome agenesis and primary plastics using synthetic ePTFE patch surgical treatment for recurrence was performed twice - at the age of 6 months and 1 year. Antireflux procedure was performed in the early postoperative period in two children, and in three children in the age of 5 years. In all children antireflux operation was performed by Nissen method. Correction of the funnel chest deformation by Nuss method was performed in patient after plastic CDH by own tissues, combined with recurrent hernia. The cause of postoperative intestinal obstruction in most patients were adhesions (n=8) and in one case was malrotation. Adhesive intestinal obstruction was occurred in 6 patients after using laparotomic access, including two of them with necrosis and intestinal resection. In two patients adhesive intestinal obstruction was occurred after using thoracotomic access and obstruction was caused by solitary threadlike adhesion.Conclusions. There is a high probability of surgical complications and reoperations in patients with high risk who survived after the CDH correction. The main factors that determine the risk of recurrence of CDH are the size of the hernia defect and the way of surgical plastic of the diaphragm. Laparotomic access increases the risk of postoperative adhesive intestinal obstruction. It is essential to long-term observation of these children to find out the risk factors of specific surgical complications.

EVALUATION OF A SERIES OF PATIENTS OPERATED FOR ADHESIVE INTESTINAL OBSTRUCTIONS

Background: The risk of bowel obstruction after laparotomy in infants and children, especially in developing countries, has not been well researched. Objectives: The aim of this study was to perform a detailed analysis of adhesions and the risk factors for adhesion-associated intestinal obstruction after laparotomy in children. Methods: This retrospective study involved patients who were operated between January 1990 and January 2001 on for postoperative adhesive intestinal obstruction (AIO). Results: During a 11-year period, a total of 45 patients aged 6 days to 14 years (mean 7.75 years) were operated on after 1341 laparotomies. The incidence of AIO was 3.35%. Six (13.3%) patients were urgently operated on while 29 (64.4%) patients were operated on in the first 3 days. The patients were operated on at 6th postoperative day at the earliest and at 10 years at the latest. Each of two children with midgut volvulus (relative risk 50%) and jejunal atresia (relative risk 27.7%) were operated on twice. The mortality and morbidity rates were found to be 2.2% (1 patient) and 22.2%, respectively. AIO was most commonly observed after operations involving the pelvic area (77.7%). Appendectomy, trauma, invagination, and megacolon surgeries were the most common postoperative causes of AIO. Conclusion: This study showed that adhesions in children occurred more commonly after lower abdominal surgery. The risks were closely related to the site and type of the first surgery. Although the risk of having adhesions was very high in the first years, it also persists in the following years.

Combined robotic transanal total mesorectal excision (R-taTME) and single-site plus one-port (R-SSPO) technique for ultra-low rectal surgery-initial experience with a new operation approach.

Robot-assisted rectal surgery is gaining popularity, and robotic single-site surgery is also being explored clinically. We report our initial experience with robotic transanal total mesorectal excision (R-taTME) and radical proctectomy using the robotic single-site plus one-port (R-SSPO) technique for low rectal surgery. Between July 2015 and March 2016, 15 consecutive patients with ultra-low rectal lesions underwent R-taTME followed by radical proctectomy using the R-SSPO technique by a single surgeon. The clinical and pathological results were retrospectively analyzed. The median operative time was 473 (range, 335-569)min, and the estimated blood loss was 33 (range, 30-50)mL. The median number of lymph nodes harvested was 12 (range, 8-18). The median distal resection margin was 1.4 (range, 0.4-3.5)cm, and all patients had clear circumferential resection margins. We encountered a left ureteric transection intraoperatively in one patient, and another patient required reoperation for postoperative adhesive intestinal obstruction. There was no 30-day mortality. R-taTME followed by radical proctectomy using the R-SSPO technique for patients with low rectal lesions is technically feasible and safe without compromising oncologic outcomes. However, there were considerable limitations and a steep learning curveusing current robotic technology.

Conventional single-port laparoscopic appendectomy for complicated appendicitis in children: Efficient and cost-effective.

BACKGROUND:Laparoscopic appendectomy (LA) is gradually gaining popularity among paediatric surgeons for complicated appendicitis. A retrospective study was conducted to compare conventional single port LA, multiport LA and open appendectomy (OA) for complicated appendicitis in children.PATIENTS AND METHODS:From January 1995 from December 2014, 1,408 patients (604 girls, 804 boys) underwent surgery for uncomplicated and complicated appendicitis. The patient characteristics, operation times, duration of hospitalization, operative costs, and postoperative complications were recorded. A 10-mm 0° scope with a parallel eye piece and an integrated 6 mm working channel were inserted through an 11-mm “conventional umbilical port” for single port LA.RESULTS:A total of 314 patients with complicated appendicitis (128 girls, 186 boys) underwent appendectomy. Among these, 102 patients (32.4%) underwent single port LA, 17 patients (5.4%) underwent multiport LA and 195 patients (62.1%) underwent OA. The hospital stay of the single port LA group was significantly less (3.88 ± 1.1) compared with multiport LA (5.41 ± 1.2) and OA groups (6.14 ± 1.1) (P < 0.001). Drain usage, wound infection and adhesive intestinal obstruction rates were significantly high in the OA group. There was no significant difference between the groups in postoperative intraabdominal abscess formation. Single-port LA performed for complicated appendicitis was cheaper compared with the other groups.CONCLUSIONS:The present study has shown that single-port LA for complicated appendicitis can be conducted in a reasonable operative time; it shortens the hospitalization period, markedly reduces postoperative wound infection and adhesive intestinal obstruction rates and does not increase the operative cost.

Radiophotographically Controlled Nasointestinal Intubation to Treat Recurrent Postoperative Adhesive Ileus.

This study describes clinical experience and curative effect of radiophotographically controlled nasointestinal intubation in the treatment of small intestine arrangement in recurrent postoperative adhesive ileus. A 300-cm-long nasointestinal tube was installed into the jejunum through the nasal cavity under radiophotographic observation in 25 patients with recurrent postoperative adhesive ileus. The tube was advanced into the ileum by enterokinesia to relieve adhesive ileus and conduct small bowel arrangement. Duration of tube installation was 13±11min (range of 9-36min). The success rate was 88%. In 3 patients, assistance by a gastroscope was required. Twenty-one out of 25 patients were cured, making the cure rate of 84%. The time for intestinal arrangement was 18.5±3days. The patients were followed up for 6months to 2years; there was 1 case of recurrence, while other patients recovered smoothly with no recurrence. A non-surgical nasointestinal intubation under radiophotography is a simple, safe, and effective management with few complications and beneficial outcome in recurrent postoperative adhesive ileus.

Observation of the preventive effect of chitosan combined with acupuncture on abdominal postoperative adhesive ileus

Objective To observe the preventive effect of chitosan combined with acupuncture on abdominal postoperative adhesive ileus.Methods 46 patients undergoing abdominal surgery in our hospital from January 2012 to June 2013 were divided into experimental group and control group according to a random number table,26 cases in experimental group and 20 cases in control group.In the surgical procedure,control group received chitosan,while experimental group received chitosan and acupuncture.The incidence of adhesive ileus in two groups was compared.Results In experimental group,there were 23 cases of grade 0 adhesive ileus,1 case of grade Ⅰ ; in control group,there were 18 cases of grade 0 adhesive ileus,1 case of grade Ⅰ,1 case of grade Ⅱ.The incidence of adhesive ileus in experimental group was 3.85％,that in control group was 10.00％,with statistically significant difference (P ＜ 0.05).Conclusion Chitosan combined with acupuncture in the treatment of patients undergoing abdominal surgery can improve the prognosis and their quality of life. Key words: Chitosan; Acupuncture; Abdominal surgery; Adhesive ileus; Preventive effect