E. Zacharakis

Effects of the use of fibrin glue around the colonic anastomosis of the rat.

Abstract.Background:This study was aimed at examining whether the addition of fibrin glue to a sutured colonic anastomosis improves its healing or not.Methods:We studied the effect of adding fibrin glue on a sutured colonic anastomosis. Thirty-six Wistar rats were randomized into two groups of 18 rats each. A sutured anastomosis was performed in all rats. Fibrin glue was applied around the anastomosis of the rats of group B. Rats were sacrificed on the eighth postoperative day.Results:The rate of anastomotic leakage was found not to be significantly different between the two groups. The mean bursting pressure of the colonic anastomoses was significantly higher in group B (fibrin-treated) than in group A.Conclusion:Fibrin glue application around a sutured anastomosis provides a safer anastomosis which is stronger than the sutured one.

The failed intraperitoneal colon anastomosis after colon resection

BackgroundThe purpose of this study is to present the incidence of anastomotic leakage after colon resection and intraperitoneal anastomosis for colorectal cancer.Patients and methodsIn the last ten years, 205 patients underwent colonic resection with intraperitoneal anastomosis for colon cancer. The surgical management of colorectal cancer consisted of 66 right hemicolectomies, 3 transverse colectomies, 17 left hemicolectomies, 98 sigmoid colectomies and 21 high anterior resections of the rectum. Diagnosis of leakage was made by clinical features, blood vessel examinations and abdominal CT-scans.ResultsAnastomotic leakage occurred in 5 out of 205 patients (2.4%). One of these patients underwent emergency surgery and the other 4 elective surgery; 3 by manual, 2 by mechanical suture. Three patients with anastomotic leakage were reoperated on days 4, 5 and 7, and 2 patients were treated conservatively. Two of the patients (20%) with anastomotic leakage died due to sepsis.ConclusionsEven though the rate of anastomotic leakage in patients with intraperitoneal anastomosis after colon resection for colorectal cancer is low, it remains a significant complication and a major cause of postoperative morbidity and mortality.

Long-term results after stapled haemorrhoidopexy for fourth-degree haemorrhoids: a prospective study with median follow-up of 6 years

BackgroundThe aim of our study was to assess our early and long-term results after stapled haemorrhoidopexy for fourth-degree haemorrhoids.MethodsOur study covers the time period from 1998 to 2002 and consists of 56 consecutive patients (33 men) with fourthdegree haemorrhoids who underwent stapled haemorrhoidopexy.ResultsDuring the postoperative period, 6 patients (10.7%) experienced pain for 7–14 days, which was treated with oral analgesia. Ten patients (17.8%) experienced gas incontinence and two of them also reported soiling. The incontinence subsided within 3–4 weeks. Median follow-up was 72.1 months (range, 55–56 months). Recurrence of the haemorrhoidal disease occurred in 33 patients (58.9%). The overall reintervention rate was 42.8%, as 24 patients required excisional haemorrhoidectomy by the Milligan-Morgan technique at a later stage.ConclusionsStapled haemorrhoidopexy seems to be a safe, low-pain but ineffective technique for the treatment of fourth-degree haemorrhoids, as it is accompanied by high recurrence and reintervention rates in the long term.

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.

Prognostic significance of CEA levels and positive cytology in peritoneal washings in patients with colorectal cancer

Objective  The aims of this prospective study were to determine carcinoembryonic antigen (CEA) levels and incidence of cytology in peritoneal washings of patients with colorectal cancer, correlate the results with various histopathological factors and determine their significance as prognostic factors of the disease.

Long-term results after stapled haemorrhoidopexy for third-degree haemorrhoids.

BackgroundStapled haemorrhoidopexy (SH) is associated with low postoperative pain but, when performed for advanced piles, carries high recurrence rates. The aim of our study was to assess our long–term results after SH for third–degree haemorrhoids.MethodsA total of 126 consecutive patients (67 men and 59 women) with third–degree haemorrhoids underwent SH in our unit between 1998 and 2002. Of these, 120 (95.2%) were followed up in the outpatient department after a median interval of 61.5 months (range, 38–84 months).ResultsDuring the postoperative period, 7 patients (5.8%) experienced pain for 5–12 days, which was treated with oral analgesia. Seven patients (5.8%) experienced gas incontinence and one of them also reported soiling; the incontinence subsided within 2–8 weeks. Recurrence of the haemorrhoidal disease occurred in 8 patients (6.6%).ConclusionsSH is a safe, low–pain and, in the long–term, effective technique for the treatment of third–degree haemorrhoids.

Contribution of insulin-like growth factor I to the healing of colonic anastomoses in rats.

The aim of this experimental study was to investigate the contribution of insulin-like growth factor I (IGF)-I in the colonic healing process when injected intraperitoneally after colon resection. Forty male Wistar rats were used. Rats in the control group were injected with 3 mL of a solution of 0.9% NaCl intraperitoneally after the operation and on postoperative day 2, 4, and 6. Rats in the IGF-I group received recombinant human IGF-I in a dose of 2 mg/kg body weight intraperitoneally, immediately after the colonic anastomosis was performed and on postoperative day 2, 4, and 6. All rats were killed on postoperative day 7. The hydroxyproline tissue content was significantly higher in the IGF-1 group than in the control group. The bursting pressures were also significantly higher in IGF-1 group than in the control group. The weight change between the groups differed significantly; in the control group the average weight decreased about 5% postoperatively, while in the IGF-1 group the average weight increased about 6%. The average inflammatory cell infiltration score was significantly higher in the control group. Neoagiogenesis did not differ significantly between the two groups. The fibroblast activity differed significantly between the two groups, as the control group had significantly less fibroblasts compared to the IGF-1 group. In conclusion, IGF-I when given intraperitoneally stimulates the healing of colonic anastomoses in the rats. Further studies are required in order to determine whether this effect is dose related.

An Unusual Presentation of Meckel Diverticulum as Strangulated Femoral Hernia

We report an unusual case of a patient with strangulated Meckel diverticulum in a femoral hernia. A 65-year-old woman presented with a nonradiating, constant pain in the right groin with associated nausea and anorexia. Physical examination revealed a tender, irreducible lump in the right groin area. At operation, a hernia sac containing a strangulated Meckel diverticulum was clearly recognized going through the femoral ring. A diverticulectomy was performed, and the femoral ring was closed with a polypropylene plug. No recurrence has been observed during the 3 year follow-up. Strangulated Meckel diverticulum in a femoral hernia remains a challenging diagnosis due to its extremely rare occurrence. Surgical exploration provides definite diagnosis of this rare condition.

Adrenal metastasis as first presentation of hepatocellular carcinoma

BackgroundMetastases from hepatocellular carcinoma (HCC) can be found in the lung and adrenal gland. We report case of a patient who presented with adrenal metastasis as the first clinical manifestation of HCC.Case presentationA patient was referred for surgical treatment for a tumor in retro-peritoneal space. The computerized tomography (CT) scan revealed a mass originating from the left adrenal gland. The patient underwent left adrenalectomy and the exploration of abdominal cavity did not reveal any other palpable lesions. Histologically, the resected lesion was a poorly differentiated metastatic tumor from HCC. Seven months later patient was readmitted complaining of cachexia, icterus, and significant weight loss. CT scan revealed hyperdense lesions of the liverConclusionHCC may have atypical presentations like in present case. Fine needle aspiration/tru-cut® biopsy might be useful in the investigation of an accidentally discovered adrenal mass regardless of the size and can lead to the detection of a primary tumor.

Stapled Haemorrhoidopexy for Haemorrhoids in Combination with Lateral Internal Sphincterotomy for Fissure-in-Ano

The aim of this prospective study is to describe the combined technique and results of stapled haemorrhoidopexy and lateral internal sphincterotomy for patients suffering from prolapsing 3rd-degree haemorrhoids and chronic fissure-in-ano. During the period from 1999 to 2004, 26 patients underwent combined surgical treatment for anal fissure and prolapsing symptomatic haemorrhoids. Preoperative and postoperative clinical evaluation and the patient’s degree of satisfaction were recorded. Early complications included faecal urgency (3 patients) and pain (2 patients). Complete continence was restored within 10 weeks in all patients except 1 who had persisting incontinence to flatus. All fissures healed completely within 4 weeks. No haemorrhoidal or fissure recurrence has been observed during follow-up. The combination of stapled haemorrhoidopexy and lateral internal sphincterotomy is a safe and effective procedure for the treatment of prolapsing 3rd-degree haemorrhoids and chronic anal fissures.