Restoration Of Intestinal Continuity Research Articles

A case of acute intestinal obstruction caused by Burkitt’s lymphoma

Acute intestinal obstruction is a multifactorial disease. Its causes may be intra-abdominal adhesions, volvulus, bezoar, gallstones, foreign bodies, intestinal tumors, etc. In rare cases, acute intestinal obstruction may be associated with intussusception, which is relatively rare in adults. The purpose of this work is to demonstrate a clinical case of acute small bowel obstruction caused by Burkitt lymphoma. During treatment for a herpetic infection, the patient underwent surgical treatment — ileostomy because of acute intestinal obstruction. In the postoperative period, the patient was hospitalized due to intestinal bleeding; during diagnostic colonoscopy, intussusception of the ileum into the ascending colon was detected; diagnostic laparoscopy, laparotomy, right-sided hemicolectomy with resection of the greater omentum, restoration of intestinal continuity with elimination of the stoma,and formation of an anastomosis were performed. The material obtained intraoperatively was sent for pathomorphological examination, including the method of fluorescent hybridization, which revealed a rearrangement of the 8th chromosome in the region of localization of the MYC gene in tumor cells, and a diagnosis of Burkitt lymphoma was established. The oncological council determined the chemotherapy treatment protocol. According to the literature, Burkitt lymphoma can debut in the cutaneous form, and it is necessary to carry out a differential diagnosis, including chickenpox. There is currently no information about intestinal complications occurring in the cutaneous form of Burkitt lymphoma. It is possible that in the described case, the initially established diagnosis of herpetic infection was incorrect, and Burkitt lymphoma occurred in the cutaneous form.

Restoration of intestinal continuity following emergency sigmoid colectomy for sigmoid volvulus: An American College of Surgeons National Surgical Quality Improvement Program analysis using coarsened exact matching.

There is limited data to guide decision-making between performing a primary anastomosis and fashioning an end colostomy following emergency sigmoid colectomy for patients with sigmoid volvulus. The aim of this study was to compare the outcomes of these two approaches. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2006 to 2021 was retrospectively analyzed. Missing data were multiply imputed, and coarsened exact matching was performed to generate matched cohorts. Rates of major complications and other postoperative outcomes were evaluated among patients who had a primary anastomosis as compared with matched controls who had an end colostomy following emergency sigmoid colectomy. Overall, 4041 patients who had a primary anastomosis and 1240 who had an end colostomy met the inclusion criteria. After multiple imputation and coarsened exact matching, 895 patients who had a primary anastomosis had a matched control. The rate of major complications was lower in patients who had an end colostomy (33.2% vs. 36.7%), but this difference was not statistically significant (OR 0.86, 95% CI 0.70-1.05). Results were similar in subgroup analyses of higher-risk patients. There were no significant differences in overall complication rate, mortality, length of hospital stay, or readmission rate. Patients with a colostomy were more likely to be discharged to a care facility (OR 1.35, 95% CI 1.09-1.67). Differences in rates of major complications and many other outcomes after primary anastomosis as compared with end colostomy were not statistically significant following emergency sigmoid colectomy for sigmoid volvulus.

Factors affecting quality of life in rectal cancer survivors who have undergone laparoscopic surgery: patient-reported outcomes over 10 years at a single institution.

Colorectal cancer survivors have many problems affecting their quality of life (QOL). Traditional follow-up focuses on the detection of recurrence rather than QOL. Efforts are being made to assess patient-reported outcomes (PROMS) more formally. Such changes may enable patients to consider QOL factors when deciding on treatment. Patients who underwent laparoscopic surgery for rectal cancer between 2005 and 2015 at a single institution were identified and sent European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR29 QOL questionnaires. QOL and the impact of radiotherapy, chemotherapy and formation of end colostomy were assessed. Some 141 patients were identified: 12 died and 118 (83.7%) responded, of whom 101 completed the questionnaires and 17 declined to participate; 11 were lost to follow-up. Mean age was 67 years, median follow-up was 58 months. Median QOL score was 6 (maximum 7) and 4.5% of patients reported a poor QOL score (<4). Significant rectal/perianal pain, sexual dysfunction and urinary symptoms were reported in 3.6%, 10.9% and 2.7% of respondents, respectively. Significant differences between treatment groups were uncommon. All cohorts reported similar QOL, functional and symptom scores. These results compare favourably with the published data. Future studies may benefit from baseline assessment to better assess treatment impact, prescient in an increasingly elderly and comorbid population. This paper establishes that good PROMs are achievable with laparoscopic surgery for rectal cancer. It identifies limited differences in QOL between treatment modalities. Restoration of intestinal continuity and end colostomy result in similar QOL. This may address common concerns regarding stomata, sexual function and low anterior resection syndrome in this cohort.

Case Report: Strangulated Hernia on a Flange between Meckel's Diverticulum and the Appendix

Introduction: Meckel's diverticulum is a very common abnormality of the digestive tract, most often asymptomatic but revealed by a complication; Among these complications, occlusion, which has multiple mechanisms, one of the mechanisms is internal hernia. Case report we present the case of a young woman of 28 years old admitted to the emergency department for occlusion on an internal hernia strangulated through an abnormal orifice made of a flange between the appendix and a Meckel's diverticulum. the patient she was admitted urgently to the operating room. Treatment consisted of resection of the necrotic ileum including the meckel's diverticulum with an ileostomy, and an appendectomy. Peritoneal cavity lavage and drainage. the postoperative period was uneventful. The patient was discharged from the hospital on the fifth day after the operation. readmitted two months later for the restoration of intestinal continuity. Discussion: Internal hernias are rare, most of them remaining asymptomatic. Are responsible for bowel obstruction in 0.5 to 4.1% of cases. Meckel's diverticulum is the most common birth defect of the gastrointestinal tract. It most often remains asymptomatic, although, it can be revealed by a complication. complications can be haemorrhagic, obstructive, infectious, or tumorous. Mechanical occlusion is the most common complication in adults; it represents 24 to 53%. CT scan is the reference examination. Conclusion: Any abrupt-onset occlusive syndrome with dilated small loops in a central location in the abdominal cavity should, in a subject with no surgical history, raise the hypothesis of a strangulated internal hernia in principle.

Cancer in the Anal Transition Zone and Ileoanal Pouch following Surgery for Ulcerative Colitis.

Restorative proctocolectomy with ileal pouch-anal anastomosis remains the gold standard treatment for patients with ulcerative colitis who desire restoration of intestinal continuity. Despite a significant cancer risk reduction after surgical removal of the colon and rectum, dysplasia and cancers of the ileal pouch or anal transition zone still occur and are a risk even if an anal canal mucosectomy is performed. Surgical care and maintenance after ileoanal anastomosis must include consideration of malignant potential along with other commonly monitored variables such as bowel function and quality of life. Cancers and dysplasia of the ileal pouch are rare but sometimes difficult-to-manage sequelae of pouch surgery.

Generalized Infantile Myofibromatosis with Extensive Small Bowel Involvement in a Neonate.

Infantile myofibromatosis is a rare benign congenital tumour that often regresses spontaneously but may pose therapeutic challenges in its widespread visceral form. We present the case of a full-term neonate with generalized infantile myofibromatosis including ubiquitous subcutaneous and muscular nodules, a tumour in the mastoid and disseminated intestinal involvement. The intestinal tumours led to a mechanical ileus with intestinal perforation within the first days of life. After partial small bowel resection and necessary proximal jejunostomy the boy was dependent on total parenteral nutrition. Chemotherapy with vinblastine and methotrexate was started and was temporarily supplemented with imatinib. Feeding stayed impossible despite tumour shrinkage. At the age of 4.5 months, restoration of intestinal continuity with further stricturoplasties was performed which - for the first time - allowed complete oral feeding. Chemotherapy was continued for further two months. Currently, the child is in good general condition with growth and further disease regression. This report suggests that massive visceral involvement of infantile myofibromatosis may require extensive intestinal surgery, as conservative therapy cannot resolve the disease and its sequelae.

Rectal Cancer and Radiation in Colitis.

Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer. When IBD patients develop a rectal cancer, this should be treated with the same oncological principles and guidelines as the general population. Rectal cancer treatment includes surgery, chemotherapy, and radiation therapy (RT). Many IBD patients will require a total proctocolectomy with an ileal-pouch anal anastomosis (IPAA) and others, restoration of intestinal continuity may not be feasible or advisable. The literature is scarce regarding outcomes of IPAA after RT. In the present review, we will summarize the evidence regarding RT toxicity in IBD patients and review surgical strategies and outcomes of IPAA after RT.

Results of application of the technique of the extraperitoneal closure of loop intestinal stoma

The OBJECTIVE was to evaluate the efficacy and safety of the original technique of extraperitoneal closure of a loop intestinal stoma.METHODS AND MATERIALS. A comparative analysis of the results of surgical treatment of 80 ostomy patients who underwent reconstructive and restorative interventions was carried out. The main group included 40 patients operated on according to the original method of extraperitoneal closure of the intestinal stoma. The control group consisted of 40 patients who underwent restoration of the intestinal tract continuity using a standard method with intra-abdominal access.RESULTS. The incidence of postoperative complications in the main and control groups was 10 % and 22.5 %, and the failure of the intestinal anastomosis was 5 % and 7.5 %, respectively (p&gt;0.05). After applying the original technique, this complication in no case led to the development of peritonitis, and the closure of the intestinal fistula was achieved by local treatment. In two patients of the control group, anastomosis failure led to the development of peritonitis, which required relaparotomy with separation of the anastomosis and reformation of the stoma, which prevented the goal of hospitalization from being realized. In the main group restoration of intestinal continuity was achieved in all patients.CONCLUSION. The use of the original technique for extraperitoneal closure of loop intestinal stoma can reduce the incidence of complications, prevent the development of peritonitis in case of anastomosis failure, creating prerequisites for increasing the efficiency of the reconstructive and restorative stage of treatment.

The safety and effectiveness of Santulli enterostomy in neonatal intestinal conditions.

As an end stoma, Santulli enterostomy provides early restoration of intestinal continuity without formal laparotomy. Short amputation of the common limb enables closure on a side to restore anatomic continuity without sacrificing valuable intestine; additionally, the procedure is simple and safe. Most newborns who require enterostomy might benefit from Santulli enterostomy; however, several pediatric surgeons lack information regarding this procedure. Therefore, we have reviewed our experience about Santulli enterostomy and explore the advantages and indications in neonatal intestinal conditions. The clinical data of 76 neonates who underwent enterostomywere obtained. The patients were divided into two groups: the Santulli group with 33 cases who underwent Santulli enterostomy, and the control group with 43 cases who underwent double- or single-lumen ostomy. The general data of the two groups were analyzed, and the perioperative/postoperative complications, clinical data and the long-term outcomes were compared. There was no difference in the demographic informations, the level of enterostomy, the rate of high-sight stoma, the operative time and bleeding of enterostomy between the two groups. Compared to the control group, the operative time of ostomy closure was less in the Santulli group (53.00 vs. 152.47, P < 0.001). The duration of parenteral nutrition (27.45 vs. 44.56, P = 0.010), the mean interval of initial enterostomy to stomal closure (131.21 vs. 216.42, P < 0.001), and length of stay (46.00 vs. 67.60, P = 0.007) were shorter, while the incidence of postoperative complications and hospitalization costs (11.21 vs. 15.49, P = 0.006) were lower. The Santulli procedure can reduce the morbidity of high output ostomy (2 vs. 10, P = 0.042) and short bowel syndrome (3 vs. 132, P = 0.025), shorten the discrepancy of diameter between the proximal and distal segments, maximize the available intestine, and monitor the movement of the distal bowel. The length of incision was shorter, and the catch-up growth was significantly faster in the Santulli group. Santulli enterostomy is a superior procedure in the treatment of neonatal intestinal conditions, in terms of fewer complications, faster catch-up growth, shorter hospitalization time and treatment duration. It should be the procedure of choice in several newborns with intestinal conditions that require ostomy.

Плановые лапароскопические резекции кишечника у детей с болезнью Крона

Currently, laparoscopic operations are widely used in pediatric surgical practice (both emergency and elective surgery). Separately, it is worth noting the difficulty of performing reconstructive surgical interventions using endovideosurgical technologies in pediatric coloproctology and surgery of inflammatory bowel diseases (Crohn's disease, ulcerative colitis, etc.). Objective. Present the experience of performing laparoscopic reconstructive surgical interventions in pediatric patients with Crohn's disease. Patients and methods. For the period from 2005 to 2023, 64 children with various forms of Crohn's disease on the basis of the FNCC of children and adolescents of the FMBA of Russia (Moscow), Morozovskaya DGKB (Moscow) underwent planned reconstructive laparoscopic interventions: ileocecal resection, resection of the small and large intestine with equipment side-to-side anastomosis, rectal resection with manual low colorectal anastomosis, subtotal colectomy. Results. The average surgery time was 150 minutes. In the postoperative period, complications developed in 6 children (9.4%). The duration of postoperative hospitalization averaged 7 days. In 6 cases, postoperative complications were noted, in 4 cases (inflammatory changes from the umbilical wound and the formation of the intestinal fistula here) it was possible to resolve them conservatively through antibacterial therapy and local treatment. But in the 2 remaining cases, repeated interventions were required due to the failure of the hardware suture and the formed stricture in the anastomosis zone. Conclusion. Treatment of children with complicated forms of Crohn's disease should be carried out in specialized centers with the participation of a multidisciplinary team of specialists at all stages of treatment. With the correct selection of patients and the timing of surgery, the laparoscopic technique allows efficient and safe resection and restoration of intestinal continuity at any location and length of strictures. Key words: Crohn's disease, inflammatory bowel disease, apparatus anastomosis, children, laparoscopy, laparoscopic resection

S100 Long-Term Outcomes of S-Pouch Configured Ileal Pouch-Anal Anastomosis

Background: The ileal pouch-anal anastomosis (IPAA) is the gold standard for restoration of intestinal continuity after a total proctocolectomy, with the J-pouch most commonly used. S-pouches are more recently infrequently performed, and often in the setting of mesenteric length problems. We analyzed the indications and outcomes of S-pouches in the prior to and since the 21st century. Methods: A prospectively maintained pouch database (1983 - 2015) was queried to identify patients with an S-pouch with underlying inflammatory bowel disease. The cohort was stratified into groups based on the time of operation: before 2000 (group 1) and after 2000 (group 2). Patients’ demographics, postoperative complications, cumulative Kaplan – Meier pouch survival, function, and quality of life (QoL) were analyzed. Results: A total of 349 patients were identified: group 1 – 314 patients and group 2 – 35 patients. The median follow-up in group 1 was 12 years (16-24) vs 4 (2-10) years in group 2 (P < 0.001). Patients were comparable in terms of age, gender, BMI, and ASA scores (all p>0.05). The histopathological diagnoses were also similar in group 1 (UC 77%, CD 10%, IC 13%) vs group 2 (UC 65%, CD 6%, IC 29%), P = 0.07. The median preoperative duration of IBD was significantly longer in group 2: 11(4 - 18) years vs group 1: 7 (3-11), P < 0.001. Group 1 was treated with steroids more (62% vs 25%, P < 0.001). The majority underwent colectomy for medically refractory disease; however, dysplasia was present more in group 2 (28% vs 14%), P < 0.001. After 2000, the 3-stage approach was utilized more frequently: 18.5% vs 31%; P = 0.01. Single-stage IPAA were more common in group 1 (5% vs 0%), while handsewn anastomoses were more common in group 2: 69% vs 36%, P = 0.003. The majority had challenges reaching the pelvis leading to S-pouch creation with 37% patients in group 2 sighting bulky and short mesentery due to obesity and had proximal stoma creation. The median hospital length of stay was significantly longer in the group 1: 9 (8-11) days compared to group 2: 5 (4-6.5) days, P < 0.001. The overall morbidity was similar between the groups (group 1 vs group 2, 85% vs 74%, P = 0.12). There were significantly more anastomotic separations in group 2: 25% compared to group 1 (5%), P = 0. 001. The rates of anastomotic stricture and fistula were comparable. The estimated Kaplan-Meier pouch survival was better in group 1 compared to group 2: at 1-year (99% vs 90%), 5-years (96% vs 85%), and at 10-years (94% vs 85.3%), respectively, P = 0.001. The number of stools were also comparable between the groups, group 1 vs 2: 6 (4-9) vs 6 (5-9), P = 0.81. The quality of life did not differ in group 2 vs 1: 0.7 (0.6 – 0.9) vs 0.8 (0.7 – 0.9), P = 0.18. Conclusion(s): S-pouches are less frequently used since 2000, with more recent S-pouch construction showing higher rates of leak and pelvic sepsis yet allowing adequate reach to allow pouch construction in most patients.

Crohn's of the Pouch: Now What?

Total proctocolectomy and ileal pouch anal anastomosis (IPAA) is the gold standard surgical treatment for the majority (∼90%) of ulcerative colitis (UC) patients. In cases of carefully selected Crohn's colitis patients without small bowel or perianal involvement an "intentional IPAA" may be a viable option for disease resection and restoration of intestinal continuity. More commonly, Crohn's is incidentally found either in the resection specimen or, more commonly, when inflammatory complications subsequently arise after pouch construction for UC or indeterminate colitis. These incidental Crohn's pouches may be diagnosed early or late period post-IPAA. Crohn's may manifest within the pouch, in the proximal small bowel, and/or distally in the rectal cuff or anus. Like intestinal Crohn's, Crohn's disease of the pouch may be of an inflammatory, fibrostenosing, or fistulizing phenotype. Treatment depends on the phenotype and includes medical treatment, most commonly in the form of tumor necrosis factor inhibitor medications; however, the newer small molecules offer a potential treatment for these patients. Surgery first entails treating the sequelae of Crohn's and is typically staged. In up to 60% of Crohn's pouches, particularly in fistulizing disease and/or recalcitrant perianal disease, the pouch fails and must be defunctioned or excised. In patients with Crohn's pouches in situ long term, outcomes including quality of life are comparable to patients who underwent IPAA for UC.

OC-090 Heterotopic Ossification in a Laparostomy Wound Complicating Reconstruction– a Case Report

Abstract Introduction Heterotopic Ossification (HO) is a benign process of osseous matrix deposition in extra-skeletal tissues; it is well recognised in the orthopaedic setting, especially after blast injury, but is a rare phenomenon following abdominal surgery and is likely under reported. The aetiology is unclear but may be due to differentiation of local mesenchymal cells into osteoblasts leading to calcification of the extracellular matrix, or damage to xiphoid or pubis causing liberation of bone-forming cells into the wound. Case Report A 46-year-old man, presented with perforated diverticulitis and underwent an emergency Hartmann's procedure with temporary abdominal closure. Sequential returns to theatre failed to achieve fascial closure and he was managed as a laparostomy. Two years later he underwent reversal of Hartmann's with complex abdominal wall reconstruction (CAWR) – the procedure was complicated by an unrecognised ring of HO around the edge of his laparostomy wound, which necessitated additional excision of fascia. Only partial fascial closure could be achieved leaving an 8×4cm bridge over polypropylene mesh. After a complicated post-operative course, he was discharged home with intestinal continuity and healed abdominal wounds. Discussion Pre-operative review of the 2-D axial CT images failed to identify the almost complete ring of HO clearly evident on 3-D reconstructions which impacted on the outcome of the CAWR; 3-D reconstructions should be routinely reviewed. It is commoner in males, those with prolonged ICU intubation, hollow viscus injury and non-closure of the fascia. Restoration of intestinal continuity can be safely performed with complex abdominal wall reconstruction.

Deloyers procedure compared to ileorectal anastomosis as restoration techniques of bowel continuity after extended left colon resection.

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. 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. 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. 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.

Management of Diverticulitis in Renal Transplant Patients.

Renal transplant patients presenting with diverticulitis remain a clinical challenge for health care professionals. Secondary to immunosuppression, renal transplant recipients are often considered for early operative intervention due to concerns for an unreliable physical exam and feared morbidity and mortality associated with non-operative management. This study aimed to evaluate trends in management of renal transplant patients with diverticulitis at a quaternary referral center. One hundred ninety-one renal transplant patients admitted to the hospital with diverticulitis were identified. Of this cohort, 71 (37%) underwent surgical resection, of which 20 (28%) were performed emergently. The overall 30-day operative mortality was 8% (6/71), of which there was a significant difference between emergent (25%, 5/20) and elective (2%, 1/51) groups (P = .006). Patients who underwent elective surgery were more likely to receive a minimally invasive approach (51%) and were significantly more likely to undergo stoma reversal (P = .006). Our study shows that not all renal transplants with diverticulitis will require operative intervention and many can be safely treated non-operatively. Elective resection and surgical management should be considered on an individual basis. Patients treated with elective resection were more likely to undergo a minimally invasive approach and restoration of intestinal continuity.

Is Hartmann's Pouch an Option in the Management of Acute Severe Ulcerative Colitis?

Background: The surgical management of remnant rectosigmoid after subtotal colectomy with end ileostomy for acute severe ulcerative colitis remains controversial with respect to the need to perform sigmoidostomy or Hartmann’s pouch. The aim of this retrospective study was to investigate whether Hartmann’s pouch may be a safe option. Methods: Thirty-eight Hartmann’s pouches were performed between January 2003 and December 2015. We looked at morbidity (with a focus on the occurrence of pelvic sepsis and leakage of the rectal stump) and the rate of restored intestinal continuity. Results: Nineteen patients had surgical complications. Seven had an intra-abdominal collection, only one of which was in the pelvis, and the patient had to be reoperated. Only one patient had a reopening of the rectal stump, which was revealed by rectal bleeding. Twenty-six patients (68.4%) underwent further proctectomy with ileal J-pouch anal anastomosis with no difficulty in localizing or mobilizing the rectal stump and no major surgical complications. Conclusions: Hartmann’s pouch may be considered in patients with acute severe ulcerative colitis, with low rates of morbidity and pelvic sepsis. The restoration of intestinal continuity is possible after this procedure without any special difficulty.

Quality of life in Tunisian colorectal cancer patients: a cross-sectional study.

Quality of life (QOL) of colorectal cancer (CRC) patients has been little studied in Tunisia. The aim of this work was to evaluate the QOL of CRC patients and to identify factors that may influence it. A cross-sectional, study spread was made over a period of 6months on patients with CRC treated in the department of Medical Oncology of Farhat Hached University Hospital of Sousse. The EORTC questionnaires translated and validated in Arabic (QLQ-C30 and QLQ-CR29) were used. 142 patients diagnosed with colon or rectal cancer were enrolled. The overall QOL score was 58.5 ± 29.1. The emotional and sexual functional dimensions were the most affected, especially in women and patients under 50years of age. QOL scores were higher in patients who were in complete remission (71.4 ± 24.7) and in good general condition (63.7 ± 26.6) physical activity may have a significant influence on all functional dimensions of QOL (p < 0.001). Fatigue was significantly (p < 0.001) more present when there was a sedentary lifestyleradiotherapy, palliative chemotherapy (1st and 2nd line) and targeted therapy. Evaluating quality of life of patients with colorectal cancer in Tunisia is necessary especially those under 50years old and in women. Laparoscopic surgery with restoration of intestinal continuity, less toxic palliative chemotherapy protocols, more accessibility to new radiotherapy technics will improve QOL of CRC patients. Physical activity and nutrition support are also essential in promoting QOL of these patients.

Intestinal Continuity Alleviates Pediatric Intestinal Failure-Associated Liver Disease.

BackgroundType I short bowel syndrome (SBS) occurs after a critical reduction in the functional gut mass and resection of intestinal continuity after ileostomy or jejunostomy for necrotizing enterocolitis (NEC), intestinal atresia or other causes. SBS is often accompanied with intestinal failure-associated liver disease (IFALD) who requires long-term parenteral nutrition (PN). Our study aimed to observe the effect of intestinal continuity on the hepatic function of pediatric intestinal failure (IF) patients with type I SBS.MethodsThe pre-and post-anastomosis medical records of 35 pediatric patients with type I SBS from April 2013 to April 2019 were reviewed retrospectively. The average growth (cm/month) in the proximal and distal small bowel lengths was calculated as the growth in intestinal length (cm)/the duration (month) from enterostomy to anastomosis. The changes in hepatic function from enterostomy to anastomosis were evaluated by assessment of hepatic function before anastomosis for 6 weeks and after anastomosis for 4 weeks.ResultsThe average growth in proximal intestinal length was 9.3 cm/month (±7.2) in neonates and 2.8 cm/month (1.3, 11.9) in infants and children, and in distal intestinal length was 1.5 cm/month (0, 2.7) in neonates and 0.4 cm/month (0, 1.4) in infants and children. The incidence of IFALD was 28.6% 1 month before anastomosis and 20.0% 1 month after anastomosis (p < 0.05).ConclusionIn pediatric type I SBS with IFALD, restoration of intestinal continuity may alleviate liver injury. There was an intestinal compensatory effect on the growth in the intestinal length after resection, and better results were seen in neonates in terms of intestinal length growth.

Redo surgery after low anterior resection for chronic pelvic sinus and anastomotic disruption. Could pull-through procedure with delayed anastomosis be a feasible alternative? Case reports and narrative review.

IntroductionA considerable step forward in low rectal cancer resection has been done in the last decades. Maintaining total mesorectal excision as the gold standard treatment, new techniques such as Trans-Anal Mini-Invasive Surgery (TAMIS) and Trans-Anal Total Mesorectal Excision (TATME), which have been added to improve skills in laparoscopic and robotic surgery, currently represent the advancement of this procedure. Despite improvements in surgical techniques, complications after low anterior resection for rectal cancer still remain a challenge. Drainage and colostomy are the main treatments used to overcome the problem caused by anastomosis failure, and most patients will never been restored. Different techniques of redo surgery could be proposed to deal complex cases, although remaining high risk procedures.Case presentationWe present two clinical cases with a late complication of the colorectal anastomosis: one with a late leakage of low colorectal anastomoses, treated with Hartman procedure, that developed a pelvic chronic sinus; the another one with complete anastomotic disruption after massive suture bleeding; both treated with delayed pull-through anastomosis, according to Turnbull-Cutait technique. We also made a review of relative literature, in order to back our therapeutic iters.DiscussionBoth the procedures were carried out satisfactorily, with restoration of intestinal continuity and good anastomotic result. It allows the resolutions of the chronic sepsis caused by the pelvic sinus and maintenance of intestinal continuity with a good Wexner incontinence score. Literary review demonstrated that this procedure still remains undervalued and not widely exploited.ConclusionDelayed pull-through coloanal anastomosis could be considered as a valid option, in order to preserve intestinal continuity in septic or complicated low colorectal anastomosis.

Laparoscopic duodenal switch

Laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS) is a technically challenging operation that requires extensive surgical dissection, transection and restoration of intestinal continuity, and advanced laparoscopic suturing skills.