Thomas Cataldo

Late stomal complications.

Ostomy creation is a common surgical procedure performed by a variety of surgical specialties. Complications associated with stomas are frequent and run the gamut from technical, mechanical, physiologic, and psychologic. The impact of these complications ranges from simple inconvenience to life threatening. The majority of these complications may not occur for years following creation of the stoma. In this article, the author reviews many of the late complications associated with stomas and options regarding their management.

Surgical Management of the Patient with Papillary Cancer

Papillary cancer is the most common thyroid cancer occurring in all age groups and is usually an indolent tumor, and patients have an excellent prognosis. The majority of patients with papillary cancer do well. It is for the small number of patients who do poorly that it is critical to carry out the appropriate initial operation. The recognized primary treatment of papillary cancer is surgical excision, and the controversy regarding lobectomy versus total thyroidectomy continues. We favor total thyroidectomy because it eradicates multicentric disease, facilitates postoperative radioactive iodine ablation, and allows thyroglobulin levels to be used as a tumor marker for follow-up. Total thyroidectomy should be done by an experienced surgeon to decrease morbidity. Otherwise a total lobectomy on the side of the nodule with subtotal removal on the opposite side is preferred to avoid serious postoperative complications.

Surgery for Ulcerative Colitis Is Associated with a High Rate of Readmissions at 30 Days

Background:Currently, the predictors of readmission after colectomy specifically for ulcerative colitis (UC) are poorly investigated. We sought to determine the rates and predictors of 30-day readmissions after colectomy for UC. Methods:Patients undergoing total proctocolectomy and end ileostomy, abdominal colectomy with end ileostomy, proctocolectomy with ileoanal pouch anastomosis (IPAA) formation and diverting ileostomy, one stage IPAA, or abdominal colectomy with ileorectal anastomosis at a tertiary care center between January 2002 and January 2012 for UC were included. Patients were identified using ICD-9 code 556.x. Each record was manually reviewed. The electronic record system was reviewed for demographic information, medical histories, UC history, medications, and data regarding the admission and discharge. Charts were reviewed for readmissions within 30 days of surgery. Univariate and multivariate analyses were performed using Stata v.13. Results:Two hundred nine patients with UC underwent a colectomy. Forty-three percent had a proctocolectomy with IPAA and diverting ileostomy and 32% had abdominal colectomy with end ileostomy. Seventy-six percent of surgeries were due to failure of medical therapy and 68% of patients were electively admitted for surgery. Thirty-two percent (n = 67/209) of the cohort was unexpectedly readmitted within 30 days. In multivariate model, proctocolectomy with IPAA and diverting ileostomy (odds ratio [OR] = 2.11; 95% CI, 1.06–4.19; P = 0.033) was the only significant predictor of readmission. Hospital length of stay >7 days (OR = 1.82; 95% CI, 0.98–3.41; P = 0.060), presence of limited UC (OR = 2.10; 95% CI, 0.93–4.74; P = 0.074), and steroid before admission (OR = 1.69; 95% CI, 0.90–3.2; P = 0.100) trended toward significance. Conclusions:Surgery for UC is associated with a high rate of readmission. Further prospective studies are necessary to determine the means to reduce these readmissions.

Anal Physiology: The Physiology of Continence and Defecation

The physiology of the anus and its surrounding structures is the physiology of continence and controlled defecation. This is a physiology of balance and continuous feedback and complex reflexes. Continence requires balance between the pressure inside the rectum and the combined tone of the internal and external sphincters. This chapter provides an overview of the anatomy, specifically the innervation of the anal complex with regard to how it affects normal and pathologic defecation. The neuro-sensory-motor aspects of the sequences of events of defecation are reviewed. Conditions that result in disordered defecation, pelvic pain, and complications outside the GI system are discussed.

Robotic Excision of Retrorectal Mass

BackgroundRetrorectal cysts make up a small but challenging group of pelvic masses, especially if they extend high into the pelvis. We present a case of successful robotic removal of a large retrorectal cyst.MethodsVideo presentation of a robotic excision of a retrorectal mass.ResultsWe present a case of robotic removal of a large retrorectal mass extending up to the S3 vertebra.DiscussionRobotic approach is a very useful tool for successful removal of large pelvic masses that cannot be removed by traditional posterior or trans perineal approach.

The impact of surgeon choices on costs associated with uncomplicated minimally invasive colectomy: you are not as important as you think

Abstract Background There is increasing public discussion about the escalating cost of healthcare in America. There are no published data regarding the contribution of individual surgeons’ choices on the cost of uncomplicated minimally invasive colectomy. Methods A review of a hospital cost-accounting database of the direct costs related to the index operation and post-operative care of all patients who underwent elective minimally invasive segmental colectomy over a 1-year period was performed. Results A total of 111 cases were enrolled in this study, 18 of which were performed robotically. The average direct cost after minimally invasive colectomy was

Prophylactic closed-incision negative-pressure wound therapy is associated with decreased surgical site infection in high-risk colorectal surgery laparotomy wounds

5536. The cost of robotic colectomy was 53% greater than laparoscopic (

Rectal Eversion Technique: A Method to Achieve Very Low Rectal Transection and Anastomosis With Particular Value in Laparoscopic Cases

7806 vs

Early Postoperative Small Bowel Obstruction associated with the use of V-loc™ Sutures during Surgery for Pelvic Organ Prolapse

5096, p < 0.001). There was no statistically significant difference in overall costs among laparoscopic cases performed by three surgeons (

Heterogeneity of colorectal cancer (CRC) in reference to KRAS proto-oncogene utilizing WAVE technology.

5099 vs