The results of anterior rectal resection with the formation of a hardware anastomosis in cancer patients

Purpose of the study. A retrospective analysis of the immediate results of performing anterior rectal resections in cancer. Materials and methods. In the Department of Abdominal Oncology No. 1 with a group of X-ray vascular methods of diagnosis and treatment of the clinic of the National Medical Research Centre for Oncology of the Ministry of Health of Russia treatment for rectal cancer operations of anterior rectal resection were performed in 334 patients, while in 143 (42.8 %) cases they were low. As a standard, total mesenteric excision and lymphoid dissection in volume D2 were performed. Combined surgical interventions were performed in 68 (20.4 %) patients for locally spread tumors. As a rule, they were resection in nature and were performed with tumor infiltration of adjacent organs (bladder with ureters, ovaries, uterus, vagina, small intestine, abdominal wall). Colorectal anastomosis using crosslinking devices was formed in all cases, in 316 (94.6 %) cases it was a "side – to-end" junction, in 18 patients – "end-to-end". A preventive proximal intestinal stoma was formed in 73 (21.9 %) cases, where 67 cases it was an ileostomy, and 6 – a transversostomy. The preventive proximal intestinal stoma was not formed among 261 patients. Results. After performing anterior resections for rectal cancer operations, the complications developed in 75 (22.5 %) patients. The most threatening and dangerous complication was the failure of the colorectal anastomosis, which was noted in 12 (3.5 %) cases.This complication occurred in 8.2 % (6 patients out of 73) of preventatively stoma-treated patients, in 2.3 % of patients without a stoma (6 patients out of 261).Conclusion. The use of a preventive proximal intestinal stoma allows you to form a colorectal anastomosis even in the presence of complicated forms of rectal cancer. The number of complications directly referred to the formation of a preventive proximal intestinal stoma is relatively small, but when planning surgery for uncomplicated rectal cancer, the probability of their possible occurrence should be taken into account.

The role of transanal drainage tube in low anterior resection for rectal cancer

Total mesorectal excision with low anterior resection has significantly improved the long-term outcomes of surgical treatment for rectal cancer, decreasing the local recurrence rate and increasing survival. However, total mesorectal excision is becoming one of the main factors for the development of colorectal anastomosis leakage, the rate of which reaches 20% in these operations. To minimize the complications associated with the inconsistency of the colorectal anastomotic suture, preventive intestinal stoma is formed when performing low anterior resections. That significantly worsen the quality of life of patients, their elimination requires re-hospitalization, and surgical interventions are accompanied by a high incidence of postoperative complications, reaching a rate of 20%, which has a significant impact on the cost of treatment for this category of patients. Transanal drainage is an alternative to the formation of preventive intestinal stoma and is devoid of its shortcomings. This literature review is devoted to an analysis of the effectiveness of transanal drainage in low anterior rectal resection. Until recently, transanal drainage has not yet gained popularity among surgeons due to the lack of evidence of its safety and effectiveness, and many studies are retrospective, including small samples. The review considered single-center, multicenter, randomized trials and a meta-analysis of the use of transanal drainage. Transanal drainage is an effective method for preventing the inconsistency of colorectal anastomotic suture, it is safe, and it surpasses the preventive intestinal stoma in a number of indicators.

893 Intestinal Stoma - A challenge for the Patient

Introduction Formation of intestinal stoma is a widely performed surgical procedure worldwide. It is associated with variable complications which can impact physical and mental health of the patient. The purpose of this study is to study the aspects (indications, complications, change in quality-of-life etc) and make necessary recommendations for quality improvement and to make patient experience better. Method study included 150 patients with stoma formation. Data categorised according to indications, complications, based on their response to change to quality of life. Results A total of 150 patients were included in this study. There were 89 male (59.3%), female (40.6%). 63 patients (42%) had loop ileostomy;38 patients (25.3%) had transverse colostomy. 77 patients (51.3%) had bowel malignancy, diverticular perforation in 19.3%. 21 patients (14%) mentioned change into their self-esteem following the surgery, 14% patients reported decline in their sexual life. Conclusions Pre & postoperative assessments should be carried out in detail with the patient to help them understand the implications of having a “stoma”. Stoma nurse involvement helps the patient to accept the changes to their life after the surgery. Psychological &sexual consultation helps in improving patient’s response to the challenge it may impose.

Experience in treating gastrointestinal tract perforations in newborns in the Republic of Uzbekistan

Introduction. Despite of the fact that necrotic enterocolitis (NEC) is a common surgical disease in newborns, a significant breakthrough in its treatment has not been made yet.Purpose. To analyze outcomes of surgical treatment at the NEC surgical stage in newborns.Material and methods. Outcomes after surgical treatment of 71 newborns with necrotic enterocolitis at its surgical stage, who were admitted to the hospital in 2015-2020, have been analyzed.Results and discussion. Diagnostic laparoscopy (DL) was prescribed if the surgical stage of the disease was not complicated with pneumoperitonitis. 37 patients had DL; of them 11 (29.7%) had conversion to laparotomy. In 26 (70.3%) patients, diagnostic laparoscopy was ended with therapeutic laparoscopy and video-assisted mini-laparotomy; among them there were 7 (26.9%) patients in whom gastric perforation was sutured. Resection of the necrotic part of the intestine with followed end-to-end anastomosis was made in 8 (30.7%) patients; in 11 (42.3%) patients, an intestinal stoma was created. In 45 newborns with the NEC surgical stage, surgeons chose the traditional surgical tactics. 34 (75.5%) patients with diagnosed pneumoperitoneum had laparocentesis to achieve decompression; 8 (17.7%) patients out of them died. 37 (82.2%) patients had laparotomy; in 5 (11.1%) out of them stomach perforations were sutured. In 32 (71.1%) patients, intestinal stomas were created. If to compare the obtained results after video-assisted laparoscopic surgeries, the mortality rate was as follows: 6 (23.1%) patients after laparoscopic interventions and 64.4% after traditional ones.Conclusion. Diagnostic laparoscopy at the surgical stage of necrotizing enterocolitis allows to select tactics for radical surgical treatment, to transfer surgical treatment into non-surgical one, thus minimizing surgical trauma what impacts positively the postoperative survival of patients.

Impact of preoperative education on ostomy patients quality of life

Human well-being is directly related to his health. Preoperative training of patients and selection of the optimal stoma location are probably the most important factors influencing the postoperative quality of life of stoma patients. Study aim - to determine the impact of preoperative training on the quality of life of stoma patients. Study methods. The analysis of the scientific literature and quantitative research was used for the survey, which was carried out by a written questionnaire. The patients interviewed were both inpatient and patients arriving for outpatient consultation. The survey was conducted in June-November, 2020, with the oral consent of the respondents. 150 questionnaires were distributed, 144 questionnaires were returned, but 6 of them were incomplete. Return of questionnaires - 92 percent. Results. The study found that patients, with whom the optimal bowel stoma location was not discussed before surgery, were significantly more likely to have poor quality of life, it also turned out that as many as one-fifth of patients did not receive any information about the stoma and were not acquainted with the peculiarities of intestinal stoma care, and almost half of the respondents received this information after the stoma opera-tion. Conclusions. Preoperative patient training and collaboration are directly related to patients’ quality of life after bowel stoma formation surgery.

Prospective Study of Clinical Profile and Early Complications of Ileostomy

BACKGROUND Ileostomy is a lifesaving procedure in cases like perforation, peritonitis, typhoid fever, tuberculosis, and trauma. Ileostomy serves the purpose of diversion, decompression, and exteriorisation. Construction of ileostomy is still a common and frequently performed procedure, even though it is a major advancement in the field of surgery. This study intends to evaluate the clinical profile of ileostomy and assess early postoperative complications of ileostomy. METHODS A total number of 36 patients admitted in MMIMSR, Mullana (Ambala), managed and operated with ileostomy were followed up closely from the day of admission in the hospital to the day of discharge. Different parameters were studied. RESULTS The clinical profile, techniques, complications, indications of ileostomy were studied in detail and along with various early complications encountered with ileostomy formation. The most common complication was peristomal irritation in 33 patients (91.7 %), followed by skin excoriation in 24 patients (66.7 %), fistula in 21 patients (58.3 %), high output stoma in 17 patients (47.2 %), stomal retraction in 3 patients (8.3 %), abscess in 2 patients (5.6 %), necrosis in 1 patient (2.8 %), and stenosis in 1 patient (2.8 %). CONCLUSIONS Construction of ileostomy and its management was associated with high rate of complications. However, most patients tolerated the complications of ileostomy well and the overall compliance was satisfactory. Loop ileostomy was the most commonly performed stoma and was associated with high rate of complications. KEY WORDS Intestinal Stoma, Complications, Loop Ileostomy, End Ileostomy, Skin Excoriation, Fistula, High Output Ileostomy

Prospective study of 30 cases of temporary ileostomy and their complication

Background: An intestinal stoma is an opening of the intestine or urinary tract onto the abdominal wall, constructed surgically or appearing inadvertently. An ileostomy involves exteriorization of the ileum on the abdominal skin. In rare instances, the proximal small bowel may be exteriorised as a jejunostomy. A colostomy is a connection of the colon to the skin of the abdominal wall. Methods: Data of patients, who were undergone for ileostomy construction in New Civil Hospital, Surat were collected prospectively regarding complete history, clinical features on examination, investigations and management. Results: The most common indication of ileostomy formation was ileal perforation in 46.6% patients followed by Intestinal obstruction in 16.6% patients, obstruction with gangrene in 13.3% patients, adhesion in 10% patients. In total of 30 patients loop ileostomy was performed in 17 patients and double barrel ileostomy in 13 patients. Peristomal skin irritation was the most common complication (90%) cases, followed by stomal necrosis/retraction (3.3%). Complications were recorded in all patients out which stomal complication seen in 96% of cases (29 out of 30). Of these peristomal skin excoriation was most common (90%) followed by wound related complications, present in 36.6% cases (11 out of 30 patients).Conclusions: In case of a high complication procedure like ileostomy, it is important to know regarding factors which can be avoided and managed. Knowing these factors which can be avoided or managed. Knowing these factors may help in attributing complications to surgical or technical factors, thereby providing opportunity to correct this error. Prediction of ileostomy complication helps in better management before occurrence of complication. It also helps in conservation of resources and better patient outcome.