E. Christoforidis

Effects of steroid on the healing of colonic anastomoses in the rat

BackgroundThe aim of this experimental study was to evaluate the effects of steroid on colonic anastomosis in a rat model.MethodsForty female Wistar rats were randomised into two groups. After resection of a 1-cm segment of the transverse colon, an end-to-end sutured anastomosis was performed. In the rats of the control group 2 ml of solution 0.9% NaCl was injected once daily intraperitoneally perioperatively. Rats of the steroid group received intraperitoneally once daily, and on the same perioperative days, hydrocortisone (5 mg/kg body weight in 2 ml solution NaCl). All the rats were sacrificed on the 8th postoperative day and the anastomoses were examined macroscopically. The bursting pressure measurements were recorded and anastomoses were graded histologically.ResultsDehiscence rate was significantly higher in the steroid group than in the control group (p<0.001). Mean bursting pressure was significantly lower in the steroid group compared to the control group (p<0.001). Colonic healing process assessed as inflammatory cell infiltration and collagen deposition was significantly lower in the steroid group than in the control group (p<0.001, p=0.03 respectively).ConclusionsPerioperative steroid treatment adversely affects healing of colonic anastomoses in the rat.

Low anterior resection without defunctioning stoma

Abstract. The aim of our study was to determine the anastomotic leakage rate after the performance of low anterior resection without protective stoma. During the time period from 1989 to 2001, 82 consecutive patients underwent low anterior resection for rectal carcinoma without protective stoma. Thirteen anastomoses were hand sewn (15.8%) and the remaining 69 (84.2%) were constructed with the use of a circular stapling gun. The mean distance of the anastomoses from the anal margin was 6.2 cm (range, 3–9 cm). None of the 82 low anterior resections was covered by a defunctioning stoma. Clinical anastomotic leakage occurred in 4 patients (4.9%) and 4 other patients presented radiologically detected leakage (4.9%). No death occurred in the 8 patients that presented anastomotic dehiscence. Non-specific complications were detected in 11 (13.4%) of 82 patients. In conclusion, the low leakage rate of the anastomoses in our patients allows us to recommend low anterior resection without defunctioning stoma.

The healing of colon anastomosis covered with fibrin glue after early postoperative intraperitoneal chemotherapy.

AbstractBackgroundAfter colon resection for colonicncancer, the administration of antineoplastic agents maynprolong survival by killing residual cancer calls and preventingnmetastasis, but may also slow anastomotic healing.nThis study was designed to determine the effects of 5-fluorouraciln(5-FU) and leucovorin (LEV), injected intraperitoneally,non the healing of colonic anastomoses with ornwithout fibrin glue (FG) covering.MethodsSixty ratsnwere randomized to one of four groups. After resection ofna transverse colon segment, an end-to-end sutured anastomosisnwas performed. Rats in the 5-FU+LEV and the 5-nFU+LEV+FG groups received 5-FU+LEV intraperitoneally.nThe colonic anastomoses of the rats in the FG group andnin the 5-FU+LEV+FG group were covered with fibrinnglue. All rats were killed on postoperative day 8. Burstingnpressure measurements were recorded and the anastomosesnwere examined macroscopically and histologically.ResultsThe leakage rate of the anastomoses was significantlyndifferent among groups. Specifically, the leakagenrate was significantly higher in the 5-FU+LEV groupn(40%) than in the FG and in the 5-FU+LEV+FG groupsnwhere there were no leakages (p=0.017). The mean adhesionnformation score was significantly higher in rats of then5-FU+LEV group, compared to the control (p=0.023), thenFG (p=0.006) and the 5-FU+LEV+FG (p=0.006) groups.nBursting pressures were significantly lower in the 5-FU+LEV group than in the other groups (p<0.001). Also,nbursting pressures were significantly lower in the controlngroup compared to the FG and 5-FU+LEV+FG groupsn(p<0.001). Rats in the 5-FU+LEV+FG group had significantlyngreater neoangiogenesis and fibroblast activity thannthose in the 5-FU+LEV group (p=0.025).ConclusionThenearly intraperitoneal postoperative administration of 5-fluorouracilnplus leucovorin impaired colonic wound healing.nHowever, the application of fibrin glue prevented the deleteriousneffect of chemotherapy.

A comparison of the simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately, for the treatment of haemorrhoids: a prospective randomized trial.

Objectiveu2002 To compare simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately for the treatment of 2nd degree haemorrhoids.

The endoscopic management of persistent bile leakage after laparoscopic cholecystectomy

BackgroundBile leakage after laparoscopic biliary surgery is a surgical challenge in which endoscopy can play an important role.MethodsA total of 26 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) in our department. Patients with evidence of major ductal injury were treated surgically. In all other cases, endoscopic sphincterotomy was performed, any retained bile duct stones were removed, and a biliary endoprosthesis or a nasobiliary catheter was inserted on a selective basis.ResultsERCP was successful in 24 patients. Seven patients were treated surgically after cholangiography revealed major ductal injury. Two more patients were eventually operated on due to bile peritonitis. Of the other 15 patients, 11 had leakage from the cystic duct and four had leakage from the gallbladder bed. Bile duct stones were removed from eight patients, an endoprosthesis were inserted in five patients, and a nasobiliary catheter was inserted in two patients. Bile leakage was treated successfully in all 15 patients with no further complications.ConclusionERCP is a means of safe diagnosing the cause of a bile leakage and offers a definitive treatment in most cases.

The handsewn anastomosis after colon resection due to colonic cancer

AimThe purpose of our study is to present the results of the handsewn single-layer interrupted extramucosal anastomosis following colon cancer.Patients and methodsIn the period between 1989 and 2009, 276 intestinal anastomoses were fashioned following colon resection using single-layer interrupted extramucosal 3/0 Vicryl.ResultsThe mean hospital stay was 8.2xa0days. Twenty-three patients had postoperative complications, and the total morbidity was 8.3%. Seven anastomotic leakages occurred (2.5%). The mortality rate was 2.5%.ConclusionThe single-layer anastomosis with interrupted extramucosal sutures after colon resection is safe and effective.

Submucosal Lipoma of the Ascending Colon as a Source of Massive Lower Gastro-intestinal Bleeding : a Case Report

Abstract Colonic lipomas are relatively uncommon lesions. They have been documented as the source of massive low gastro-intestinal bleeding in only five previous reports in the English language literature. We report an extremely rare case of massive haemorrhage caused by an ascending colon submucosal lipoma and review the pathophysiology, diagnosis and management.

Thoracic Splenosis Twenty-Nine Years after Traumatic Splenectomy Mimicking Intrathoracic Neoplasm

Thoracic splenosis refers to a condition of ectopic splenic tissue in the thoracic cavity. It is usually a consequence of splenic tissue seeding in the pleural cavity after thoracoabdominal trauma. A rare case of thoracic splenosis, in a 62-year-old man who had had a traumatic splenectomy due to thoracoabdominal trauma 29 years earlier, is reported. The patient, a heavy smoker, was admitted for evaluation of a left-side thoracic lesion discovered on a plain chest film. Bronchoscopy, CT scan and needle biopsy proved inconclusive for the diagnosis. Exploratory thoracotomy was necessary to establish the diagnosis. During the operation, a thoracic splenosis was confirmed. To date, only 28 cases of thoracic splenosis have been reported in the literature. The purpose of this report is to present a new case of splenosis of the thoracic cavity simulating intrathoracic neoplasm.

Endoscopic management of retained bile stones with an indwelling T-tube

BackgroundEndoscopic sphincterotomy (ES) is widely used for the treatment of residual bile duct stones in patients who had common bile duct (CBD) exploration and T-tube insertion.MethodsIn a 4-year period 45 patients were referred for endoscopic removal of residual bile duct stones. All patients had been operated 7–15 days earlier for choledocholithiasis and had a T-tube in the common bile duct (CBD).ResultsFour patients were excluded. Three patients had a periampullary carcinoma and the fourth patient had no residual stone seen at cholangiography. All patients had a successful ES, conventional in 34, precut-knife in 3, and with the rendezvous technique in 4 patients. In 24 patients, all having stones distal to the T-tube, complete clearance of the CBD was achieved during one session and the T-tube was removed after 48 h. In the remaining 17 patients (15 having stones proximal to the T-tube), the T-tube had to be removed first and following stone extraction, a plastic stent was inserted in the CBD. Complete bile duct clearance and stent removal was achieved in a second session 3–4 weeks later. There were no serious complications or biliary related symptoms after the procedures and after a mean follow-up period of 18 months.ConclusionThe endoscopic technique is safe and efficient for the treatment of residual stones after CBD exploration with a T-tube insertion, offering immediate cure compared to the percutaneous techniques. It is also an ideal method for the diagnosis of periampullary carcinomas.

Endoscopic management strategies in relation to the severity of acute cholangitis.

Background and Study Aims Acute cholangitis (AC) and especially suppurative cholangitis due to biliary lithiasis is an emergency situation that requires urgent biliary decompression. The aim of the study is to present our policy for the treatment of AC due to choledocholithiasis, endoscopically. Methods In a 4-year period, 71 patients presenting AC, due to lithiasis, underwent endoscopic retrograde cholangio-pancreatography and endoscopic sphincterotomy (ES). All patients had fever, jaundice, abdominal pain, and in case of suppurative cholangitis hemodynamic instability. Most of them seemed to be high-risk candidates for surgery. Results Forty-nine patients had AC and 22 patients had acute obstructive suppurative cholangitis (AOSC). ES (conventional or needle-knife biliary fistulotomy) was successful in 69 out of 71 (97%) patients. Two patients were eventually operated and were excluded from statistical analysis. Fifty of the 69 patients (72%) had a complete bile duct clearance in 1 session. Conventional ES, complete bile duct clearance, and other endoscopic maneuvers (balloon, basket, lithotripsy) were significantly more frequent in the AC group (P<0.001). Needle-knife biliary fistulotomy, and stent insertion were significantly more frequent in the AOSC group (P<0.001). Endoscopical treatment had low morbidity and total hospital stay time. Conclusions ES is the procedure of choice for the treatment of AC offering definite treatment with low morbidity and short hospitalization. Urgent biliary decompression with minimal endoscopic maneuvers is crucial for the outcome of patients having AOSC.