Background: Cancer of the left colon with obstruction (CLCO) is a serious disease. Many surgeons perform one-stage resection with the on-table wash-out of the colon. However, there is uncertainty concerning the necessity of wash-out and absolute clearness of the colon. Our goal was to clarify that. Patients and Methods: The data of 108 patients urgently operated due to CLCO from 1996 to 2005 were analyzed retrospectively and prospectively. Results: On-table wash-out was performed in 59 patients, and 49 patients were without it. Both groups were similar by age, gender, tumor site, and extent of operation. The rate of complications in the first and the second group was 30.5 and 28.6%, respectively. Suture leakage was observed in 8.5% of patients in the first group and 4.1% in the second group (total 6.5%). Most frequently, leakage was observed in cases of resection of the rectum (18.9%) (p = 0.04). The type of suture did not have any significant impact on the occurrence of leakages (p > 0.05). Intraoperative wash-out prolonged the duration of operation by 33.2 min (p < 0.001). The postoperative mortality rate in the first and the second group was 3.39% and 6.1%, respectively; (total 4.64%). Only 1 patient died due to the complications caused by suture leakage. Conclusion: One-stage surgery due to CLCO is safe, and intraoperative wash-out is not necessary.
Ávadas/tikslasMaþos molekulinës masës heparinai plaèiai vartojami klinikinëje praktikoje. Ðie antikoaguliantai skiriami tromboziniø komplikacijø profilaktikai. Naujausi tyrimai rodo, kad maþos molekulinës masës heparinai tromboembolizmà sergant vëþiu veikia efektyviau ir gali pailginti iðgyvenamumà. MetodaiStraipsnyje apþvelgiama naujausia literatûra apie maþos molekulinës masës heparinø poveiká tromboembolizmui. Pateikiamos daugiacentriø tyrimø apþvalgos ir iðvados. RezultataiMaþos molekulinës masës heparinai, slopindami koaguliacijos procesus, veikia naviko augimà, invazijà, metastazavimà ir angiogenezae, kartu pagerina iðgyvenamumà. IðvadosPo dideliø onkologiniø operacijø rekomenduojama ilgalaikë 2-4 savaièiø antitrombozinë terapija maþos molekulinës masës heparinais.Pagrindiniai þodþiai: maþos molekulinës masës heparinai, tromboembolinë liga, antitrombozinë terapija, onkologija Maþos molekulinës masës heparinø vaidmuo stabdant vëþinës ligos progresavimà Background/objectiveLow Molecular Mass Heparins (LMMH) are widely used in clinical practice. These anticoagulants are prescribed for the prophylaxis of thromboembolic complications. Recent trials have shown that low molecular mass heparins are effective more in cancer patients with thromboembolism and may lower their mortality. MethodsThe newest literature on the effectiveness of low molecular mass heparins in the management of thromboembolic disease is reviewed. Multicenter clinical trials are presented. ResultsBy inhibiting the coagulation processes, the LMMH exert a positive effect on tumor growth, invasion, metastasing, and angiogenesis, thus improving the survival. ConclusionLong-lasting 2-4 week antithrombolic LMMH therapy is recommended after major oncologic operations.
Center of General Surgery, Faculty of Medicine, Republican Vilnius University Hospital, Šiltnamių Str. 29, Vilnius, Lithuania E-mail: astasinskas@yahoo.fr; Juozas.Stanaitis@mf.vu.lt, juozas.stanaitis@vgpul.lt Introduction A change in procedure from open to laparoscopic reversal of Hartmann’s colostomy was implemented at our department between May 2009 and December 2010. The aim of the study was to investigate whether this change was beneficial for the patients. Methods The medical records of all patients who underwent colostomy reversal after a primary Hartmann’s procedure during the period from May 2009 to December 2010 were reviewed retrospectively in a case control study. Results A total of 13 patients were included. Six had a laparoscopic and 7 an open procedure. The two groups matched with regard to age, sex, the American Society of Anaesthestist (ASA) score, body mass index and indication for Hartmann’s operation. A significantly longer operation time was found for laparoscopic than for open surgery (median 285 versus 158 minutes,p < 0.001), but with a less blood loss (median 100 versus 600 ml, p < 0.001), faster return of bowel function (median three versus four days, p < 0.01) and a shorter postoperative hospitalization (median four versus six days, p < 0.01). No intraoperative complications occurred. One laparoscopic operation was converted (16.6%). There was no difference in postoperative complications between the two groups (10 versus 14%) and no anastomotic leaks. The total mortality was 0. Conclusion It is possible for trained laparoscopic general surgeons to perform laparoscopic reversal of Hartmann’s procedure as safely as in open surgery and with a faster recovery, shorter hospital stay and less blood loss despite a longer knife time. Therefore, it seems reasonable to offer patients a laparoscopic procedure at departments skilled in laparoscopic surgery and use it for standard colorectal surgery. Key words: laparoscopic reversal of Hartmann’s colostomy; restoration of intestinal continuity
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