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Follow-Up and Post-Operative Sequelae in Colorectal Cancer
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
Søren Laurberg, Peter Christensen
A temporary stoma after TME is widely practiced in order to avoid the consequences of an anastomotic leak. A recent revisit of a randomised study comparing TME surgery with or without a diverting stoma showed that patients with a diverting stoma had an increased risk of developing LARS five years after surgery.41 The precise aetiology is not known but could be related to diversion colitis or to changes in epithelial function of the terminal ileum, causing bile acid malabsorption, small bowel bacterial overgrowth or bacterial re-colonisation of the colon after the stoma reversal.
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
The principle function of the colon is absorption of water; 1000 mL of ileal content enters the caecum every 24 hours, of which only approximately 200 mL is excreted as faeces. Sodium absorption is efficiently accomplished by an active transport system, while chloride and water are absorbed passively. Fermentation of dietary fibre in the colon by the normal colonic microflora leads to the generation of short chain fatty acids, which are an important metabolic fuel for the colonic mucosa. Diversion of the faecal stream may lead to inflammatory changes in the colon downstream (diversion colitis). Absorption of nutrients including glucose, fatty acids, amino acids and vitamins can also take place in the colon.
Specimen handling
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Proctectomy specimens are common in clinical practices where ileal pouch reconstruction is performed. It is important to fix these specimens in a timely fashion and treat as outlined previously for all bowel resections. The most common finding in this setting is mucosal disease secondary either to residual IBD or diversion colitis. It is unusual to see transmural or mesorectal change and, if present, these areas need to be specifically examined.
Bowel vaginoplasty: a systematic review
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Konstantinos Georgas, Valerio Belgrano, My Andreasson, Anna Elander, Gennaro Selvaggi
The advantages of using a rectosigmoid transplant are its length, texture and appearance similar to a natural vagina; in addition, it provides a vaginal lining with natural lubrication. The production of mucus, however, may lead to excessive discharge. Although the neovaginal length is usually regarded as an advantage, it can also lead to stasis and dehydration of mucus in the deepest portion of the vagina. Complications such as diversion colitis (inflammation that occurs in the bypassed colonic tissue related to diversion of the fecal stream), ulcerative colitis, peritonitis, intestinal obstruction, junctional neuroma, adenocarcinoma, introital stenosis, mucocele and constipation have been reported [18,19]. Furthermore, the colonic mucosa is more vulnerable and thus more accessible to sexually transmitted diseases, including HIV [20].
Vaginal reconstruction with the modified rectosigmoid colon: surgical technique, long-term results and sexual outcomes
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Ömer Özkan, Özlenen Özkan, Anı Çinpolat, Nasuh Utku Doğan, Gamze Bektaş, Kemal Dolay, Alihan Gürkan, Cumhur Arıcı, Selen Doğan
Diversion colitis is another complication which could also be rarely observed after bowel vaginoplasty. Colitis could be observed 70–100% after colonic surgery but this complication was rarely reported after bowel vaginoplasties and the actual incidence is unknown [36,37]. In a recent study by van der Sluis, 64% of patients with bowel vaginoplasties presented with mild to moderate findings in colonoscopic follow-up of their bowel neo-vagina but most of the patients were symptom-free and these findings were only a colonoscopic diagnosis [37]. In a series of 42 transgender patients undergoing total laparoscopic vaginoplasties, two patients experienced mild colitis and required treatment [34]. In our study, we observed no diversion colitis since we did not need to perform routine colonoscopy of the neovagina. In addition, rare complications such as prolapse and development of adenocarcinoma in the vagina have also been reported [35,38]. Although donor site morbidity is potentially high, the relevant requirements for vaginal reconstruction are well met in the recipient site. Outcomes including a robust structure with a plentiful blood supply, long-term preservation of the aperture required for sexual relations, absence of dilation requirements, mucus productions providing lubrication, and a close to natural esthetic appearance are quite promising.