Colonic Stenting
Stanley M Goldberg in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Surgical intervention for colonic obstruction carries significant risks to the patient compounded by the risk of colonic perforation as the colon proximal to the point of obstruction distends. In the presence of a competent ileocecal valve, a ‘closed loop’ may lead eventually to gross cecal distension and, in extreme circumstances, cecal perforation. In patients with localized obstructing disease, the choice of surgical procedure is dependent on the position of the lesion. For right-sided colonic lesions, resection and construction of an ileocolic anastomosis is usual, whereas management of left-sided colonic lesions is more complex and often necessitates formation of an end colostomy after resection. Stamatakis et al . 1 showed that 59 percent of patients who present with left-sided colonic obstruction had a successful one-stage surgical resection, while 41 percent underwent a Hartmann procedure. The reversibility of this stoma was variable. Patients with advanced malignant disease are often frail and surgical management may involve either a colonic bypass procedure, resection with stoma formation, formation of a stoma alone, or no procedure at all.
Pelvic Actinomycosis: a Malignant Appearing Mass. A Case Report
Published in Acta Chirurgica Belgica, 2009
Y. Pirenne, W. Bouckaert, G. Vangertruyden
Pelvic actinomycosis is a rare complication of a long-term intrauterine contraceptive device. Early diagnosis is important, as clinical and radiological imaging may mimic a malignant pathology and lead to radical and unnecessary surgery. We report a case of pelvic actinomycosis in a woman who had used an intrauterine contraceptive device for the last 13 years. The actinomycosis appeared as a malignant pelvic mass with invasion into the sigmoid and left ureter, with high-grade stenosis of these structures. Because of its rapidly developing obstructive character, an urgent Hartmann procedure with resection of the uterus and both ovaries was performed. Histology revealed actinomycosis. With this case we want to illustrate that for a woman presenting with an intrauterine contraceptive device and a malignant appearing mass in the pelvis, pelvic actinomycosis must be considered in the list of differential diagnosis, so that appropriate diagnostic work out and treatment can be made.
Low Hartmann’s procedure or intersphincteric abdominoperineal resection in the primary treatment of low rectal cancer; a survey among surgeons evaluating current practice
Published in Acta Chirurgica Belgica, 2019
Emma Westerduin, Marinke Westerterp, Willem A. Bemelman, Pieter J. Tanis, Anna A. van Geloven
Background: Low Hartmann's procedure (LHP) and intersphincteric abdominoperineal resection (iAPR) are both surgical options in the treatment of distal rectal cancer when there is no intention to restore bowel continuity. This study aimed to evaluate current practice among members of the Dutch Association of Coloproctology (WCP). Methods: An online survey among members of the WCP who represent 66 Dutch hospitals was conducted. The survey consisted of 15 questions addressing indications for surgical procedures and complications. Results: Surgeons from 37 hospitals (56%) responded. Thirty-six percent does not distinguish low from high Hartmann's procedures based on estimated length of the rectal remnant. Overall, iAPR was the preferred technique in 86%. If asking whether operative approach would be different in tumours at 1 cm from the pelvic floor compared to 5 cm distance, 62% stated that they would consider a different technique. The incidence of pelvic abscess after LHP was thought to be higher, equal or lower than iAPR in 36%, 36% and 21%, respectively, with the remaining respondents not answering this question. Conclusions: The vast majority of the respondents considers iAPR as the preferred non-restorative procedure for rectal cancer not invading the sphincter complex, which contradicts with population based data from 2011.
Techniques and technology evolution of rectal cancer surgery: a history of more than a hundred years
Published in Minimally Invasive Therapy & Allied Technologies, 2016
Marco Maria Lirici, Cristiano G. S. Hüscher
History of rectal cancer surgery has shown a continuous evolution of techniques and technologies over the years, with the aim of improving both oncological outcomes and patient's quality of life. Progress in rectal cancer surgery depended on a better comprehension of the disease and its behavior, and also, it was strictly linked to advances in technologies and amazing surgical intuitions by some surgeons who pioneered in rectal surgery, and this marked a breakthrough in the surgical treatment of rectal cancer. Rectal surgery with radical intent was first performed by Miles in 1907 and the procedure he developed, abdomino-perineal resection, became a gold standard for many years. In the following years and over the last century other procedures were introduced which became new gold standards: Hartmann's procedure, anterior rectal resection, total mesorectal excision (TME); the last one, developed by Heald in 1982, is the present gold standard treatment of rectal cancer. At the same time, new technologies were developed and introduced into the clinical practice, which enhanced results of surgery and even made possible performing new operations: leg-rests, stapling devices, instruments, appliances and platforms for laparoscopic surgery and transanal rectal surgery. In more recent years the transanal approach to TME has been introduced, which might improve oncologic results of surgery of the rectum. Ongoing randomized studies, future systematic reviews and metanalyses will show whether the transanal approach to TME will become a new gold standard.
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- Colon Cancer
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