Gastrointestinal surgery in gynecologic oncology
J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan in An Atlas of Gynecologic Oncology, 2018
To be successful, a small bowel resection must completely remove the damaged or involved intestinal segment. Intestinal continuity must then be re-established using healthy ends of bowel with good blood supply that are reapproximated without tension. Tissues should be handled gently, and a watertight anastomosis should be achieved. There should be no downstream areas of obstruction that could adversely affect healing. The submucosal layer of the bowel wall is the most critical layer to incorporate into the anastomosis. There are several different means to effect a small bowel anastomosis. Staplers are commonly used. A handsewn anastomosis takes more time, but requires no special devices. It is important to be familiar with both methods of bowel anastomosis (Matos et al. 2001).
Soft tissue sarcomas
Pat Price, Karol Sikora in Treatment of Cancer, 2014
Surgical resections of GISTs need to address tumours that can range from small, pedunculated lesions to large lesions with adherence or invasion of surrounding tissues and organs. Thus the surgical approach can be quite varied but certain principles should be followed. Upon surgical exploration, the liver and peritoneal cavity should be examined for possible metastatic disease. GISTs uncommonly metastasize to lymph nodes so a regional lymphadenectomy is not required. Thus, for a pedunculated gastric tumour, wedge resection of the gastric wall along with resection of the tumour is adequate. Some gastric tumours encompass a large portion of the stomach and a formal distal, subtotal or even total gastrectomy may be required. For small bowel and colon tumours, segmental bowel resection can be performed. Small rectal GISTs can be removed through transanal procedures whereas larger tumours may require low anterior resection or even abdominal-perineal resection. Some large GISTs with significant necrosis are susceptible to tumour rupture and spillage, which can lead to intra-peritoneal spread of disease, so tumours should be manipulated carefully.
Benign Neoplasms of the Colon and Rectum
Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens in Neoplasms of the Colon, Rectum, and Anus, 2007
Bowel resection is reserved for cases in which complications such as carcinoma, bleeding, intussusception, and rectal prolapse develop (115). Surgery is not usually performed for improvement of protein-losing gastroenteropathy because the protein losing is usually not localized (120). Hanzawa et al. (120) reported a patient with Cronkhite-Canada syndrome with numerous polyps in the stomach, duodenum, and from cecum to transverse colon. The patient had severe hypoproteinemia and peripheral edema, unresponsive to conservative treatment including elemental diet and hyperalimentation. Scintigraphy with technetium TC99m-labeled human albumin (121,122) demonstrated a protein-losing region in the ascending colon. An ileo-right colectomy was performed. After the operation, the protein-losing enteropathy stopped; the ectodermal changes improved, and other polyps that was a secondary cause to malnutrition regressed.
Vitamin D levels in IBD: a randomised trial of weight-based versus fixed dose vitamin D supplementation
Published in Scandinavian Journal of Gastroenterology, 2020
Vladimir Kojecky, Jan Matous, Bohuslav Kianicka, Petr Dite, Zdena Zadorova, Jan Kubovy, Martina Hlostova, Michal Uher
Effective substitution in IBD patients may be influenced by certain disease specific factors. Terminal ileal resection has been linked to poor vitD absorption. Farraye et al. studied the dynamics of 25OHD levels following oral vitD administration in patients with both ileal form of CD or ileal resection. 25OHD concentration had no relationship to a particular resected bowel segment [20]. The resorption was proportionate to the length of the bowel resection. Nevertheless, small bowel resections of up to 100 cm (i.e. significantly more than a standard ileo-caecal resection), had no real impact on the efficacy of oral substitution. Other associations such as age and the disease duration did reach statistical significance, however, their contribution to overall variability was minimal.
An acute presentation of pediatric mesenteric lymphangioma: a case report and literature overview
Published in Acta Chirurgica Belgica, 2018
Céline Clement, Rob Snoekx, Pieter Ceulemans, Inez Wyn, Jan Matheï
If there are no complications at the time of diagnosis, alternative treatment methods can be considered to avoid extensive bowel resection in similar cases as ours. Sclerotherapy and systemic medical treatment, such as propranolol and sirolimus, have been investigated, but mostly in children with neck or head lymphangiomas [2,3]. OK-432 has been effective in treating recurrent lymphangioma after surgery by various authors, but it has little effect on lesions outside the neck and head region or on lesions larger than 5 cm [1,3,4,18]. So far it is unclear whether our case patient would benefit from prophylactic systemic therapy to avoid complications of the residual asymptomatic disease. In literature, no alternative to surgery has proven efficient yet for the treatment of ML [1,3,4,9,10,17,18].
Inflammatory bowel disease in South-Eastern Norway III (IBSEN III): a new population-based inception cohort study from South-Eastern Norway
Published in Scandinavian Journal of Gastroenterology, 2021
Vendel A. Kristensen, Randi Opheim, Gøri Perminow, Gert Huppertz-Hauss, Trond Espen Detlie, Charlotte Lund, Svend Andersen, Bjørn C. Olsen, Ingunn Johansen, Asle W. Medhus, Simen Vatn, Stephan Brackmann, Christine Olbjørn, Jon Rove, Magne Henriksen, Emma Elisabeth Løvlund, May-Bente Bengtson, Tone Bergene Aabrekk, Tor Tønnessen, Florin Berge Vikskjold, Hussain Yassin, Svein Oskar Frigstad, Audun Hasund, Ole Høie, Katharina Schmidt, Raziye Boyar Cetinkaya, Roald Torp, Erik Skogestad, Hans Kristian Holm, Tahir Riaz Ahmad, Øistein Hovde, Carl Magnus Ystrøm, Batool Aballi, Arnt Sagosen, Aina Pedersen, Stein Dahler, Jens Pallenschat, Petr Ricanek, Marte Lie Høivik
Disease phenotype, location, and extent were evaluated according to the Montreal classification [16] at time of diagnosis, and re-evaluated at each clinical follow-up. Change in phenotype at 1-year follow-up was defined by the appearance of newly affected segments or complications (stenosis or fistula) after the initial diagnostic work-up. Disease relapse was defined as symptoms of IBD that led to changes in the treatment. Numbers of relapses were registered and ‘chronic symptoms without remission’ during the observed periods were also registered. Local complications were defined as stenosis, fistula and/or abscess. Number of hospital admissions and total number of admitted days due to IBD were registered. Surgeries were registered as numbers of events, type of surgery (appendectomy, colectomy, segmental resection of colon, small bowel resection, perianal drainage of abscess, perianal fistula surgery), and for colectomy, its indication (acute severe colitis, refractory colitis, dysplasia/cancer). IBD-relevant medication (including elemental diet) was registered with the relevant drug and number of months during which the drug was used. The reason for stopping a biological drug was registered as ‘development of antibodies’, ‘side effects’, ‘non-response without antibodies’, or ‘other’. Curves visually illustrating disease course were also adapted from the IBSEN study [2].
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