Resection of an end-colostomy stricture with a circular stapling device

1996 ◽  
Vol 83 (11) ◽  
pp. 1581-1581 ◽  
Author(s):  
J. M. Ramia ◽  
A. Ibarra ◽  
J. Alcalde
Keyword(s):  
Stapling Device ◽  
End Colostomy ◽  
Colostomy Stricture

Introducing the circular stapling device atraumatically with the use of a second anvil

2001 ◽  
Vol 3 (1) ◽  
pp. 65-66
Author(s):  
U. R. Khan ◽  
H. Gallagher ◽  
P. J. Finan
Keyword(s):  
Stapling Device

scholarly journals Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

2021 ◽  
Author(s):  
Eric M. Haas ◽  
Thais Reif de Paula ◽  
Roberto Luna-Saracho ◽  
Melissa Sara Smith ◽  
Jean-Paul J. LeFave
Keyword(s):  
Complicated Diverticulitis ◽  
Intracorporeal Anastomosis ◽  
Natural Orifice ◽  
Abdominal Incision ◽  
Stepwise Approach ◽  
Stapling Device ◽  
Video Recordings ◽  
Conversion Rates ◽  
Technical Modifications ◽  
Instrument Control

Abstract Background Totally intracorporeal surgery for left-sided resection carries numerous potential advantages by avoiding crossing staple lines and eliminating the need for an abdominal incision. For those with complicated diverticulitis, minimally invasive surgery is known to be technically challenging due to inflamed tissue, distorted pelvic anatomy, and obliterated tissue planes, resulting in high conversion rates. We aim to illustrate the stepwise approach and modifications required to successful complete the robotic Natural-orifice IntraCorporeal anastomosis with transrectal specimen Extraction (NICE) procedure in this cohort. Methods Consecutive, elective, unselected patients presenting with complicated diverticulitis defined as fistula, abscess and stricture underwent the NICE procedure over a 24-month period. Demographic and intraoperative data were collected, and video recordings were reviewed and edited on encrypted server. Results A total of 60 patients (50% female) underwent the NICE procedure for complicated diverticulitis with a mean age of 58.9 years and mean BMI of 30.7 kg/m2. The mean operative time was 231.6 min. All cases (100%) were achieved with intracorporeal anastomosis using a circular stapling device. All but one patient (98.3%) had successful transrectal extraction of the specimen. Forty-four (73%) of the specimens required a specimen-thinning maneuver to successfully extract the specimen and there were no conversions. We identified seven key technical modifications and considerations to facilitate successful completion of the procedure which are illustrated, including early release of the disease, mesentery-sparing dissection, dual instrument control of the mesenteric vasculature, release of the rectal reflection, use of NICE back table, specimen-thinning maneuver, and closure of the rectal cuff. Conclusion We present a stepwise approach with key modifications to successfully achieve totally robotic intracorporeal resection for those presenting with complicated diverticulitis. This approach may help overcome the technical challenges and provide a foundation for reproducible results.

scholarly journals Diversion colitis: a trigger for ulcerative colitis in the in-stream colon?

Gut ◽  
1999 ◽  
Vol 44 (2) ◽  
pp. 279-282 ◽  
Author(s):  
A G Lim ◽  
F L Langmead ◽  
R M Feakins ◽  
D S Rampton
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Risk Factor ◽  
Large Intestine ◽  
Bowel Disease ◽  
Rectosigmoid Colon ◽  
Diversion Colitis ◽  
End Colostomy ◽  
Microscopic Features ◽  
Inflammatory Bowel

The aetiology of ulcerative colitis is unknown. Two patients without pre-existing inflammatory bowel disease in whom end colostomy for faecal incontinence was complicated by diversion colitis in the defunctioned rectosigmoid colon, are described. In both instances, colitis with the clinical, colonoscopic, and microscopic features of ulcerative colitis developed about a year later in the previously normal in-stream colon proximal to the colostomy. These cases suggest that diversion colitis may be a risk factor for ulcerative colitis in predisposed individuals and that ulcerative colitis can be triggered by anatomically discontinuous inflammation elsewhere in the large intestine.

scholarly journals Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation

2015 ◽  
Vol 100 (6) ◽  
pp. 984-988 ◽  
Author(s):  
Giulia Montori ◽  
Giacomo Di Giovanni ◽  
Zeineb Mzoughi ◽  
Cedric Angot ◽  
Sophie Al Samman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Laboratory ◽  
Left Thigh ◽  
Left Colon ◽  
Colon Perforation ◽  
Emergency Laparotomy ◽  
Computed Tomography Scan ◽  
End Colostomy ◽  
Retroperitoneal Perforation ◽  
Tomography Scan

Left colon perforation usually occurs in complicated diverticulitis or cancer. The most frequent signs are intraperitoneal abscess or peritonitis. In cases of retroperitoneal colonic perforation, diagnosis may be difficult. A 59-year-old woman presented with left thigh pain and with abdominal discomfort associated with mild dyspnea. Computed tomography scan showed air bubbles and purulent collection in the retroperitoneum, with subcutaneous emphysema extending from the left thigh to the neck. Computed tomography scan also revealed portal vein gas and thrombosis with multiple liver abscesses. An emergency laparotomy revealed a perforation of the proximal left colon. No masses were found. A left colectomy was performed. The retroperitoneum was drained and washed extensively. A negative pressure wound therapy was applied. A second-look laparotomy was performed 48 hours later. The retroperitoneum was drained and an end colostomy was performed. Intensive Care Unit postoperative stay was 9 days, and the patient was discharged on the 32nd postoperative day. Pneumoretroperitoneum and pneumomediastinum are rare signs of colonic retroperitoneal perforation. The diagnosis may be delayed, especially in the absence of peritoneal irritation. Clinical, laboratory, and especially radiologic parameters might be useful. Surgical treatment must be prompt to improve prognosis.

Off-Pump Atrial Septal Defect Closure Using the Universal Cardiac Introducer®

2009 ◽  
Vol 4 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Gerard M. Guiraudon ◽  
Douglas L. Jones ◽  
Daniel Bainbridge ◽  
John T. Moore ◽  
Chris Wedlake ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Image Guidance ◽  
Septal Defect ◽  
Tracking System ◽  
Doppler Imaging ◽  
Atrial Septal Defect Closure ◽  
Off Pump ◽  
Stapling Device ◽  
Future Design ◽  
Asd Closure

Objective Optimal atrial septal defect (ASD) closure should combine off-pump techniques with the effectiveness and versatility of open-heart techniques. We report our experience with off-pump ASD closure using the Universal Cardiac Introducer (UCI) in a porcine model. The goal was to create an ASD over the fossa ovale (FO) and position a patch over the ASD under ultrasound (US) imaging and augmented virtual reality guidance. Methods An US probe (tracked with a magnetic tracking system) was positioned into the esophagus (transesophageal echocardiographic probe) for real-time image-guidance. The right atrium (RA) of six pigs was exposed via a right lateral thoracotomy or medial sternotomy. The UCI was attached to the RA wall. A punching tool was introduced via the UCI, navigated and positioned, under US guidance, to create an ASD into the FO. A patch with its holder and a stapling device were introduced into the RA via the UCI. The patch was positioned on the ASD. Occlusion of the ASD was determined using US and Doppler imaging. Results The FO membrane was excised successfully in all animals. US image-guidance provided excellent visualization. The patch was positioned in all cases with complete occlusion of the ASD. The stapling device proved too bulky, impeding circumferential positioning. Conclusions Using the UCI, ASD closure was safe and feasible. US imaging, combined with virtual and augmented reality provided accurate navigating and positioning. This study also provided valuable information on the future design of anchoring devices for intracardiac procedures.

scholarly journals There is no correlation between a delayed gastric conduit emptying and the occurrence of an anastomotic leakage after Ivor-Lewis esophagectomy

2022 ◽  
Author(s):  
Benjamin Babic ◽  
Lars Mortimer Schiffmann ◽  
Hans Friedrich Fuchs ◽  
Dolores Thea Mueller ◽  
Thomas Schmidt ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
High Volume ◽  
Gastric Conduit ◽  
Common Finding ◽  
Type Ii ◽  
Ivor Lewis ◽  
Stapling Device ◽  
Ivor Lewis Esophagectomy ◽  
Cervical Reconstruction ◽  
Prolonged Hospital

Abstract Introduction Esophagectomy is the gold standard in the surgical therapy of esophageal cancer. It is either performed thoracoabdominal with a intrathoracic anastomosis or in proximal cancers with a three-incision esophagectomy and cervical reconstruction. Delayed gastric conduit emptying (DGCE) is the most common functional postoperative disorder after Ivor-Lewis esophagectomy (IL). Pneumonia is significantly more often in patients with DGCE. It remains unclear if DGCE anastomotic leakage (AL) is associated. Aim of our study is to analyze, if AL is more likely to happen in patients with a DGCE. Patients and methods 816 patients were included. All patients have had an IL due to esophageal/esophagogastric-junction cancer between 2013 and 2018 in our center. Intrathoracic esophagogastric end-to-side anastomosis was performed with a circular stapling device. The collective has been divided in two groups depending on the occurrence of DGCE. The diagnosis DGCE was determined by clinical and radiologic criteria in accordance with current international expert consensus. Results 27.7% of all patients suffered from DGCE postoperatively. Female patients had a significantly higher chance to suffer from DGCE than male patients (34.4% vs. 26.2% vs., p = 0.040). Pneumonia was more common in patients with DGCE (13.7% vs. 8.5%, p = 0.025), furthermore hospitalization was longer in DGCE patients (median 17 days vs. 14d, p < 0.001). There was no difference in the rate of type II anastomotic leakage, (5.8% in both groups DGCE). All patients with ECCG type II AL (n = 47; 5.8%) were treated successfully by endoluminal/endoscopic therapy. The subgroup analysis showed that ASA ≥ III (7.6% vs. 4.4%, p = 0.05) and the histology squamous cell carcinoma (9.8% vs. 4.7%, p = 0.01) were independent risk factors for the occurrence of an AL. Conclusion Our study confirms that DGCE after IL is a common finding in a standardized collective of patients in a high-volume center. This functional disorder is associated with a higher rate of pneumonia and a prolonged hospital stay. Still, there is no association between DGCE and the occurrence of an AL after esophagectomy. The hypothesis, that an DGCE results in a higher pressure on the anastomosis and therefore to an AL in consequence, can be refuted. DGCE is not a pathogenetic factor for an AL.

scholarly journals Doughnut bother! Histopathological examination of anastomotic doughnuts following colorectal anastomosis does not change patient management

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Steven Dixon ◽  
Hannah Barrow ◽  
Jane Hughes
Keyword(s):  
Patient Management ◽  
Residual Disease ◽  
Histopathological Examination ◽  
Colorectal Anastomosis ◽  
Complete Response ◽  
Patient Treatment ◽  
Histopathological Analysis ◽  
Retrospective Case ◽  
Female Ratio ◽  
Stapling Device

Abstract Introduction The use of a circular stapling device to create an anastomosis following colonic or rectal resection is common practice in the United Kingdom. Histopathological analysis of the anastomotic doughnuts produced takes time and resources, but does it ever change patient management? The aim of this study was to review the examination of doughnuts and whether patient treatment was altered by the findings. Method A retrospective case note review of all cases involving anastomotic doughnuts in a single trust between December 2010 and January 2018, was performed. Results There were 435 cases identified, male to female ratio was 2.0:1, age range 20–86 years and a median age of 66 years. 376 Doughnut samples were received by the pathology department (86.4%) and 354 were examined (81.4%). The disease processes involved were adenocarcinoma (n = 352, 80.9%), diverticular disease (n = 47, 10.8%), no residual disease/complete response (n = 22, 5.1%), adenoma (n = 7, 1.6%), mucinous (n = 5, 1.1%), Crohn’s disease (n = 1, 0.2%) and neuroendocrine (n = 1, 0.2%). Benign adenomatous change was identified in 4 cases (0.9%). No doughnuts examined contained dysplastic or malignant changes. Conclusion The histological examination of anastomotic doughnuts is extremely unlikely to identify malignant change and subsequently does not change patient management. Pathology departments could save time and resources by not routinely examining doughnuts.

scholarly journals P001 IS PROPHYLACTIC MESH IS ROUTINELY REQUIRED FOR STOMA CONSTRUCTION? IDENTIFICATION OF THE ‘TARGET GROUP’

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Ahmed Hassan ◽  
Wei Toh ◽  
James Ayathamattam ◽  
Zachary Thomas ◽  
Ondrej Ryska
Keyword(s):  
Controlled Trial ◽  
Cost Benefit ◽  
Prophylactic Mesh ◽  
Nice Guidelines ◽  
Prophylactic Measures ◽  
Increased Risk ◽  
End Colostomy ◽  
Randomised Controlled

Abstract Background Evidence to support routine prophylactic mesh insertion during stoma construction is conflicting. The PREVENT randomised controlled trial (RCT) suggested lower incidence of parastomal hernia (PSH) with prophylactic mesh but with no quality of life or cost benefit. Another two RCTs has shown no prophylactic benefit (STOMAMESH & STOMA-const). Although European Hernia guidelines recommends routine prophylactic mesh in end-colostomy, NICE guidelines suggest mesh on individual basis not routinely. Aim To identify the group with higher risk to develop a symptomatic PSH when prophylactic mesh should be considered Material and Methods A single center retrospective review of all stoma formed. Younger patient than 18 years and patients who had less than 6 months’ follow-up were excluded. Development of PSH was confirmed by radiological evidence or direct intra-operative visualization Results 194 patients between January 2015 till December 2019 were included with mean follow-up of 15.7±13.5 months where 91 patients developed PSH. On multivariate analysis, older age (&gt;65) (OR 2.3, 95% CI 1.08 – 4.99, p 0.03) and Obesity (OR 5.8, 95% CI 2.53 – 13.57, p 0.00) were risk factors of developing PSH. Among the PSH group, 28 were symptomatic (31%). Symptomatic subgroup had higher ASA (ASA &gt;2) than asymptomatic subgroup (50% Vs 27%, p 0.05) Conclusions Obese patients older than 65 years are at increased risk of PSH. IF their ASA &gt;2 this PSH is likely to become symptomatic. This is the group who should benefit the most from prophylactic measures including mesh insertion and should be targeted for future trials

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