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Malignant Large Bowel Obstruction
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Alexander Heriot, J. Alastair D. Simpson
If a single-stage operation is undertaken for large bowel obstruction, there are two operative options for resolution of the obstruction and removal of the tumour to consider. These are either segmental colectomy or subtotal colectomy. The SCOTIA trial randomised 91 patients with colonic obstruction to subtotal colectomy or segmental colectomy.22 Mortality and anastomotic leak was similar between subtotal and segmental colectomy at 13% vs. 11% and 8.5% vs, 5%, respectively. Bowel function was more frequent in the subtotal group, and a significantly greater proportion of the subtotal patients had a permanent stoma (15% vs. 2%). The study concluded that segmental colectomy was the preferred option to subtotal colectomy. Two other prospective single-centre studies reported similar results with respect to mortality,23,24 though Torralba et al. reported a higher anastomotic leak rate in the segmental group. There have been a number of reports on subtotal colectomy for obstruction, all of which have demonstrated similar mortality and anastomotic leak rates to the comparative studies already described.15 Bowel frequency is between one and four times per day and is worse for more distal anastomoses to the rectum.25
The large intestine
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Proctocolectomy and ileostomy This operation removes all the colon and rectum, removing any risk of colorectal neoplasia or colitic symptoms, but it leaves a permanent stoma. It has a lower complication rate compared with a pouch procedure, although the perineal wound can be problematic (10% fail to heal) and stoma problems are common. It is indicated for patients who are not candidates for restorative surgery due to sphincter problems or patient preference. The colectomy is performed as above. Provided there is no concern regarding rectal cancer, a close rectal dissection may be performed to minimise damage to the pelvic nerves, avoiding erectile and bladder dysfunction. An intersphincteric excision of the anus is undertaken, which results in a smaller perineal wound and fewer healing problems. A permanent end ileostomy is formed. The position of the ileostomy should be carefully chosen by the patient with the help of a stoma care nurse specialist.
Inflammatory Bowel Disease
Published in Mary J. Marian, Gerard E. Mullin, Integrating Nutrition Into Practice, 2017
Gearry et al. evaluated the FODMAP diet in 72 IBD patients (52 CD, 20 UC) and found an improvement in abdominal pain, bloating, flatus, and diarrhea in patients who were compliant with the diet. No endoscopic endpoints were evaluated, so it is unclear if the symptomatic improvement resulted from a treatment of concomitant irritable bowel syndrome symptoms rather than the inflammatory disease [42]. A pilot study investigated eight UC patients with a history of colectomy with either an ileal pouch formation or an ileorectal anastomosis. The FODMAP diet decreased the median number of stools from eight to four in the patients without pouchitis, but did not help in patients with pouchitis. The authors concluded that a low-FODMAP diet may help decrease the number of bowel movements in colectomy patients without pouchitis [43].
Triumph against cancer: invading colorectal cancer with nanotechnology
Published in Expert Opinion on Drug Delivery, 2021
Preksha Vinchhi, Mayur M. Patel
Surgical approach for the treatment of colon cancer includes Colectomy i.e. surgical removal of the part of the colon or full colon (depending on the tumor spread) and en bloc resection of surrounding lymph nodes. Colectomy can be termed as hemicolectomy, segmental resection or partial colectomy in the case of the removal of only some part of the colon, while removal of the whole colon is called total colectomy. Either open surgery or laparoscopic resection can be done to perform colectomy. Even though laparoscopic surgery is found to be as safe as open surgery, there are some limitations associated with laparoscopic surgery like problems associated due to previous abdominal surgeries, advanced disease stage, obesity, etc [22,39]. Loop colostomy or permanent colostomy is often required in which a stoma is formed for diverting feces in a bag placed outside the body. Avoiding the need for permanent colostomy is an essential target to be achieved by surgeons. However, employing highly precise surgical techniques and recent stapling devices, the permanent colostomy can be generally avoided except when the anal sphincter is also involved in very low rectal tumors. The surgical procedure widely used in the treatment of rectal cancer is total mesorectal excision (TME) that includes removal of rectum, mesorectum, and mesorectal fascia. Surgical procedures like laparoscopy-assisted TME, transanal excision, low anterior resection, abdominoperineal resection, coloanal anastomosis, proctectomy, etc. are also employed depending on the location of the tumor [40].
Treatment and outcome of ulcerative colitis during the first 10 years after diagnosis in a prospectively followed population-based cohort
Published in Scandinavian Journal of Gastroenterology, 2021
Anders Rönnblom, Urban Karlbom
Earlier Swedish experience has demonstrated an operation frequency of 28% after 10 years with the disease, with similar figures during different time periods 1955–1984 [26] and similar results have been presented from Denmark [27]. A study starting in the early nineties from our neighbour country Norway showed an operation risk of 9.8% [28]. A systematic review including studies published until 31 March 2016, concluded that the cumulative risk of colectomy after 10 years is around 15% [29]. In a Chinese study on 172 patients diagnosed between 1985 and 2006 and followed for a median time of 7.0 years, the colectomy frequency was 7.6% after 10 years [30] and a recent study from Korea demonstrated an operation frequency of only 2.2% after 10 years [31] .These later studies give support to observations of a probably more benign disease course in Asia [32,33].
Special considerations for biologic medications in pediatric ulcerative colitis
Published in Expert Opinion on Biological Therapy, 2020
Logan Jerger, Jeffrey S. Hyams
In more recent literature, experts in the field have recommended initial doses higher than indicated on the drug label for those pediatric patients with acute severe ulcerative colitis experiencing steroid refractory disease. Further investigation of individuals requiring increased doses of infliximab identified pediatric patients in the hospital setting with colitis-predominant IBD [19]. Despite the lack of evidence to support initial higher doses in pediatric patients, the use of higher initial doses of infliximab in the United States is common [20]. One proposed alternative induction regimen has been the use of 10 mg/kg/dose–compared to typical dosing of 5 mg/kg/dose–with repeat dosing at this same, increased dose in 3–5 days if no response is observed [21]. If no response is appreciated after an additional 3–5 days, a colectomy is considered. Alternatively, pending response and timing of response, infliximab dosing and interval are altered based on therapeutic drug monitoring. Data assessing outcomes of this proposed protocol and comparison to standard dosing are limited, however.