RESUMEN
BACKGROUND/AIMS: To assess if the laparoscopic reversal of Hartmann's can be attempted in all patients, without detriment to short or long-term outcomes if the patient is subsequently converted to open. METHODS: Retrospective review of a prospectively collected database of all reversals under 8 surgeons at a single unit over 105 months, two surgeons attempting laparoscopic reversal in all patients, two pre-selecting for the laparoscopic approach and four utilising the open approach. Long-term follow-up data for re-admissions, re-operations and incisional hernia rate obtained from a postal questionnaire. RESULTS: 45 laparoscopic and 50 primary open reversals were identified. There was no difference in the mean age or previous peritonitis rate in either group. Laparoscopic conversion rate was 29% (13 patients). On intention to treat analysis, a significant difference was identified in the overall 30-day post-operative surgical morbidity (8.9% Laparoscopic-attempted vs 26.0% Open, p = 0.030). There was no difference in operating times (mean 164 vs 172 min, p = 0.896) despite the 13 patients converted to an open procedure. Mean length of stay was significantly lower in the laparoscopic-attempted group at 6.8 days (5.2-8.4) vs 14.9 days (6.4-23.7) in the open group (p = 0.001). Anastomotic leak rates were not statistically different. The median follow up was 27 months (range 6-105); 60% of patients completed a postal follow-up questionnaire. There was no difference in short-term or long-term re-admission or reoperation rates. CONCLUSIONS: Laparoscopic reversal of Hartamann's is associated with shorter hospital stay and lower morbidity even in unselected patients. Long-term outcomes are similar.
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Colectomía/métodos , Neoplasias Colorrectales/cirugía , Laparoscopía/métodos , Anciano , Colectomía/efectos adversos , Femenino , Humanos , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIM: Standard laparoscopic splenic flexure mobilization is often hampered by redundant small bowel and usually necessitates additional ports. The retraction required runs the risk of inadvertent injury to the surrounding structures including the spleen. METHOD: We present a new technique that permits a safe, rapid and complete mobilization of the splenic flexure even for the more difficult patients. RESULTS: We have used it in 15 consecutive patients without mortality, re-operation or conversion to open surgery. CONCLUSION: The right lateral position for splenic flexure mobilization gives better exposure of the left upper quadrant allowing complete dissection of the splenic flexure from the tail of the pancreas facilitating mobilization even in more difficult cases.
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Colon Transverso/cirugía , Laparoscopía/métodos , Posicionamiento del Paciente/métodos , HumanosRESUMEN
BACKGROUND: Identifying Crohn's disease recurrence in symptomatic patients after ileocaecal resection is difficult. The aim of this study was to evaluate faecal concentrations of granulocyte degradation products in this setting. METHODS: A postoperative cohort of 13 patients was followed prospectively for 1 year with regular faecal calprotectin (FC) and lactoferrin (FL) measurements. A second postoperative cohort (median 24 months after resection) of 104 patients provided a single stool sample. Faecal measurements were compared with symptom diaries, the Harvey Bradshaw Index, endoscopic examination, C-reactive protein and platelet measurement. RESULTS: In the uncomplicated course, both markers normalized within 2 months. Both FC and FL correlated significantly with Harvey Bradshaw Index (P < 0.001). Twenty-eight patients with severely clinically active disease had high mean(s.e.) levels of FC (661.1(119.1) microg/g) and FL (116.6(32.2) microg/g); and 43 with clinically inactive disease had low levels of FC (70.2(27.1) microg/g) and FL (5.9(2.4) microg/g). In patients with mild to moderately clinically active disease, FC and FL identified individuals with and without recurrent inflammatory disease. Faecal markers were more accurate at predicting clinical disease activity than C-reactive protein, platelet count or endoscopic appearance. CONCLUSION: FC and FL are non-invasive tests that can help to identify disease recurrence in symptomatic postoperative patients.
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Enfermedad de Crohn/diagnóstico , Heces/química , Lactoferrina/análisis , Complejo de Antígeno L1 de Leucocito/análisis , Adolescente , Adulto , Anciano , Biomarcadores/análisis , Proteína C-Reactiva/metabolismo , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Adulto JovenRESUMEN
BACKGROUND: There is no consensus on the usage of erythropoietin in the immediate postoperative period to prevent anemia and delayed graft function. METHODS: A retrospective case note audit of renal transplants included hemoglobin (Hb) and serum creatinine (Scr) values preoperatively as well as at days 7, 14, 30, 60, and 90. Patients were categorized as those receiving erythropoietin during the first 6 months posttransplant (Epo+ve) and those not receiving any erythropoietin (Epo-ve). RESULTS: Hb decreased from 12.4 +/- 1.6 g/L preoperatively to 9.5 +/- 1.5 g/L at day 14 and then rose to 10.5 +/- 1.6 g/L at 1 month and 12.4 +/- 1.7 g/L at 3 months. There was no difference in absolute Hb values in three transplant groups. Scr decreased from 597.0 +/- 200.1 mmol/L preoperatively to 254.1 +/- 196.9 mmol/L at day 14 and continued to fall to 163.8 +/- 98.9 mmol/L at 1 month and 147.8 +/- 66.9 mmol/L at 3 months. There was no difference in absolute Hb values and delayed graft function in the three transplant groups. CONCLUSION: With respect to anemia and delayed graft function, the use of erythropoietin in the first 3 months had little impact. We suggest that such an expensive medication may be safely omitted in the immediate postoperative period.