Sigmoid Surgery Research Articles

Laparoscopy sigmoidectomy- an intracorporeal anastomosis for minimally invasive approach to sigmoid surgery in our center: a case report

Laparoscopy sigmoidectomy- an intracorporeal anastomosis for minimally invasive approach to sigmoid surgery in our center: a case report

Association of Perioperative Regional Analgesia with Postoperative Patient-Reported Pain Outcomes and Opioid Requirements: Comparing 22 Different Surgical Groups in 23,911 Patients from the QUIPS Registry.

(1) Background: In many surgical procedures, regional analgesia (RA) techniques are associated with improved postoperative analgesia compared to systemic pain treatment. As continuous RA requires time and experienced staff, it would be helpful to identify settings in which continuous RA has the largest benefit. (2) Methods: On the basis of 23,911 data sets from 179 German and Austrian hospitals, we analyzed the association of perioperative RA with patient-reported pain intensity, functional impairment of movement, nausea and opioid use for different surgeries. Regression analyses adjusted for age, sex and preoperative pain were performed for each surgery and the following groups: patients receiving continuous RA (surgery and ward; RA++), RA for surgery only (RA+−) and patients receiving no RA (RA−−). (3) Results: Lower pain scores in the RA++ compared to the RA−− group were observed in 13 out of 22 surgeries. There was no surgery where pain scores for RA++ were higher than for RA−−. If maximal pain, function and side effects were combined, the largest benefit of continuous RA (RA++) was observed in laparoscopic colon and sigmoid surgery, ankle joint arthrodesis, revision (but not primary) surgery of hip replacement, open nephrectomy and shoulder surgery. The benefit of RA+− was lower than that of RA++. (4) Discussion: The additional benefit of RA for the mentioned surgeries is larger than in many other surgeries in clinical routine. The decision to use RA in a given surgery should be based on the expected pain intensity without RA and its additional benefits.

Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

BackgroundAnastomotic leakage (AL) significantly impairs short-term outcomes. The impact on the long-term outcomes remains unclear. This study aimed to identify the risk factors for AL and the impact on long-term survival in patients with left-sided colorectal cancer.MethodsNine-hundred patients with left-sided colorectal carcinoma who underwent sigmoid or rectal resection were enrolled in the study. Risk factors for AL after sigmoid or rectal resection were identified, and long-term outcomes of patients with and without AL were compared.ResultsAL rates following sigmoid and rectal resection were 5.1% and 10.7%, respectively. Higher ASA score (III–IV; OR = 10.54, p = 0.007) was associated with AL in patients undergoing sigmoid surgery on multivariable analysis. Male sex (OR = 2.40, p = 0.004), CCI score > 5 (OR = 1.72, p = 0.025), and T3/T4 stage tumors (OR = 2.25, p = 0.017) were risk factors for AL after rectal resection on multivariable analysis. AL impaired disease-free and overall survival in patients undergoing sigmoid (p = 0.009 and p = 0.001) and rectal (p = 0.003 and p = 0.014) surgery.ConclusionASA score of III–IV is an independent risk factor for AL after sigmoid surgery, and male sex, higher CCI score, and advanced T stage are risk factors for AL after rectal surgery. AL impairs the long-term survival in patients undergoing left-sided colorectal surgery.

Bowel dysfunction after sigmoid resection underestimated: Multicentre study on quality of life after surgery for carcinoma of the rectum and sigmoid

AimThe Low Anterior Resection Syndrome (LARS) severely affects quality of life (QoL) after rectal cancer surgery. There are no data about functional complaints after sigmoid cancer surgery. We investigated LARS and QoL in patients with a resection for sigmoid cancer versus patients who had surgery for rectal cancer. Methods506 patients after resection for rectal or sigmoid cancer who were at least one year colostomy-free were included between January 2008 and December 2013. Bowel function was assessed by the LARS-Score. QoL was assessed by the EORTC QLQ-C30 and -CR29 questionnaires. QoL was compared between the LARS score categories and tumour height categories. Results412 respondents (81.5%) could be included for the analyses. The median interval since treatment was 5 years, and the median age at the follow-up point was 72 years. Major LARS increased significantly with decreasing tumour height from one fifth in sigmoid carcinoma to 90% in low rectum carcinoma. Female gender (OR = 2.162; 95% CI: 1.349–3.467), postoperative temporary diverting stoma (OR = 3.457; 95% CI: 2.019–5.919) and tumours located in the middle (OR = 3.193; 95% CI: 1.696–6.010) or lower rectum (OR = 8.247; 95% CI: 1.672–40.678) were independently associated with the development of major LARS. Patients with major LARS fared significantly worse in most QOL domains. ConclusionsFor the first time, we found that functional abdominal complaints after sigmoid surgery are a major problem, with a negative effect on QoL, even 5 years after treatment. Patients need to be adequately informed about these long-term complaints.

Single-Incision Laparoscopic Surgery (SILS) Assisted Sigma Resection Via Pfannenstiel Incision for Complicated Diverticulitis

Background: Single-incision laparoscopic surgery (SILS) is frequently used for indications such as appendectomy, cholecystectomy or sigmoid surgery. Usually, an umbilical incision is used as access and for specimen retrieval. However, the umbilical access for SILS is linked with technical limitations in the pelvic area. Here we use a Pfannenstiel incision for SILS sigma or anterior rectum resection for complicated diverticulitis. Methods: An SILS sigma or anterior resection was performed using a Pfannenstiel access to the abdominal cavity. A Gelport (Applied Medical) with three trocars was used. In one patient, an elective resection after initially conservative treatment for a covered perforation was performed, two patients underwent resection due to an abscess and fistula (into the urinary bladder or vagina), and in two patients an early resection was performed due to abdominal abscesses. All patients suffered from sigmoid diverticulitis, which was stage IIb according to Hansen and Stock. Results: The operation time ranged from 89 to 280 min. There were no conversions, and no additional trocars were used. The postoperative hospital stay ranged from 5 to 14 days. All patients were discharged without any intraoperative or postoperative complications. Conclusions: SILS sigma or anterior rectum resection for complicated diverticulitis can be performed via a Pfannenstiel incision. This approach provides direct visualization and access into the pelvis as well as the option to benefit from open surgery devices. The Pfannenstiel incision may generally be recommended for the favorable cosmetic effect and the very low rate of incisional hernias, as reported in the literature.

Endometriosis Surgical Strategy: Our Experience

Study Objective: To assess the improvement of the patient's symptoms, surgical time and complications of our surgical strategy for the treatment of deep endometriosis. Design: Retrospective analysis of 116 procedures. Setting: Strasbourg University Hospitals and IRCAD / EITS. Patients: 116 patients with deep endometriosis which were symptomatic and/or infertile. Intervention: Laparoscopic treatment of patients with deep endometriosis. Measurements and Main Results: The mean age of the patients was 32 years-old and 51,7% were infertile women. In terms of symptoms 85,3% had dysmenorrhea (mean score=7), 69% had dyspareunia, 42,2% had pelvic chronic pain, 37,1% had digestive complains (diarrhea, constipation, rectorrhagia or dyschezia) and 31% had urinary complains (dysuria, haematuria, symptoms of pyelonephritis or renal colic). We performed sigmoid surgery because of endometriosis in 23 cases (19,8%), small bowel surgery in 4 (3,4%) cases, bladder surgery in 11 cases, ureter surgery in 60 (51,7%) cases, excision of endometriotic lesions in the cul-de-sac in 78 (67,2%) cases and in the uterosacral ligament in 50 (43,1%) cases and ovary surgery in 55 (47,4%) cases. The mean time of surgery was 137 minutes (60-300min). We had 3 cases of intra-operative complications: 1 case of bowel injury, 1 of bladder injury and 1 of right ureter injury. In the pos-operative evaluation we lost 34 cases. In the 82 patients that went to follow-up, their complains were improved: 89% referred improvement in the dysmenorrhea level, 74,4% in the dyspareunia and 57,3% in the pelvic chronic pain. Only 5 cases referred the same or new digestive complains and only 3 cases referred the same or new urinary symptoms after surgery. It was necessary to re-operate 9 cases because of recurrence of the symptoms, but only 6 cases had residual endometriosis. Conclusion: This work demonstrates that our surgical strategy for deep endometriosis improves the patients complains, with less surgical time and with a low rate of complications.

Diverticular disease–associated colitis: progression to severe chronic ulcerative colitis after sigmoid surgery

Recent articles have described a segmental colitis involving an area of diverticulosis within the sigmoid colon, but sparing the rest of the bowel. This disease is similar to ulcerative colitis in its clinical presentation and endoscopic and histologic appearance, but by definition does not involve the rectum or proximal colon. Several different terms have been used to describe this syndrome; they include diverticular disease–associated colitis, 1 Makapugay LM Dean PJ. Diverticular disease–associated chronic colitis. Am J Surg Path. 1996; 20: 94-102 Crossref PubMed Scopus (158) Google Scholar chronic segmental colitis associated with diverticula, 2 Peppercorn MA. Drug-responsive chronic segmental colitis association with diverticula: a clinical syndrome in the elderly. Am J Gastroenterol. 1992; 87: 609-612 PubMed Google Scholar segmental colitis, 3 Cawthorn SJ Gibbs NM Marks CG. Segmental colitis: a new complication of diverticular disease. Gut. 1983; 24 ([abstract]): A500 Google Scholar sigmoiditis, 4 Hart J Baert F Hanauer S. Sigmoiditis: a clinical spectrum of pathologic features, including a distinctive form of IBD. Mod Pathol. 1995; 8 ([abstract]): 62-350 Google Scholar and endoscopic crescent fold disease. 5 Gore S Shepherd NA Wilkinson SP. Endoscopic crescent fold disease of the sigmoid colon: the clinical and histological spectrum of a distinctive endoscopic appearance. Int J Colorect Dis. 1992; 7: 76-81 Crossref PubMed Scopus (87) Google Scholar Only five cases have been reported in which there was progression from segmental sigmoid disease to typical chronic ulcerative colitis; the response to specific therapy and subsequent clinical progress were not described.