Laparoscopic resection for colorectal diseases: short-term outcomes of a single center
INTRODUCTIONLaparoscopic colorectal surgery provides less postoperative pain, better cosmesis, shorter hospital stay and earlier patient mobilization (1, 2). Jacobs et al. (3) performed the first laparoscopic colon resection in 1991 (3). However, it took time to be adopted due to its technical difficulties, lack of clinical evidence, the learning curve and fear of tumor seeding (4, 5). The recently published case series proved that there was no significant difference between open and laparoscopic colorectal surgery in terms of tumor recurrence, distant metastasis rates and disease free survival (6-8). Although laparoscopy is still not the gold standard in colorectal surgery, its advantages in experienced hands are acknowledged (9). In our study, we presented 33 cases who underwent laparoscopic colorectal resection for benign or malignant diseases.
MATERIAL AND METHODSThirty-three patients underwent laparoscopic colorectal surgery between January 2013-September 2014. An ethics committee approval was obtained from Marmara University. Our prospective database consisted of information on patient demographics, pathology reports (TNM stage, number of dissected lymph nodes), operation type, complications and length of hospital stay.All the patients were evaluated for presence of locoregional disease and distant metastasis with colonoscopy, computed thoracic and abdominal tomography and/or pelvic magnetic resonance imaging. Patients were informed on laparoscopic surgery and their consents were obtained. Locally advanced rectal cancers were treated with neoadjuvant chemotherapy and radiation therapy. Preoperative bowel preparation was achieved by sodium phosphate containing purgatives, and the antibiotic prophylaxis consisted of 2 gr Cefazolin and 500 mg Metronidazole. A second antibiotic dose was administered in operations lasting longer than 4 hours. Low molecular weight heparins were applied for thrombo-emboli prophylaxis with a dose adjusted for body weight 12 hours before the operation.Under general anesthesia, a 1 cm supra-umbilical skin incision was done followed by Veress needle insertion for carbon dioxide insufflation up to 10-12 millimeter mercury (mmHg). Mesocolic excision was performed for colon tumors and total mesorectal excision was performed for rectal cancers. To avoid seeding and surgical site infection, a wound protector was used in all operations (Alexis® O™ Retrac-
199Objective: Even though, laparoscopy is not accepted as the current gold standard in colorectal surgery, it can be performed as safely as open surgery. It is also widely accepted that the technique has many advantages. In this study, we evaluated the results of 33 patients with laparoscopic colorectal resection.
Material and Methods:Thirty-three patients who underwent laparoscopic colon surgery between January 2013 and September 2014 in the General Surgery Clinic at Marmara University Hospital were included in the study. Patients were evaluated in te...
Introduction: The urachus or median umbilical ligament is a fibrous cord originating from the allantoic canal's involution. It extends from the bladder dome to the posterior umbilicus. A partial or a total defect of the urachus channel's obliteration after the fifth month of gestation can be the origin of urachal abnormalities. A complication of symptomatic urachal anomalies occurs when the cyst fistulizes to adjacent viscera. We report the first case of a diverticulosis-related sigmoid-urachal-scrotal cyst in a 55-year-old patient. Case Report: A 55-year-old male visited the clinic with intermittent fever, lower abdominal pain, swelling in the groin and scrotal area. Abdominal examination revealed a diffuse tender in the lower abdomen and suprapubic area. Non-contrast abdominal CT imaging showed a cystic lesion with an air-fluid level and possibly debris positioned superiorly to the bladder at the abdominal wall. The sigmoid colon seemed attached to this cystic lesion. Air observed in the scrotum and subcutaneous. The damaged part of the sigmoid colon was repaired. Then the abscess was drained. Urachus was wholly resected and removed. After five days of follow-up, the patient was discharged without any problem. A severely inflamed urachus was found in pathology. Conclusion: Although it is rare and its symptoms are non-specific, the urachal abscess should be suspected if there is persistent fever and suprapubic pain, especially in patients with diverticula. It is recommended to remove it when the diagnosis is made, considering the complications that may occur.
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