The first colproctrectomy with the formation of a pelvic intestinal reservoir was performed in 1970. Since then, the technique has been thoroughly tested and currently it is the gold standard in the surgical treatment of ulcerative colitis and familial adenomatous polyposis. This operation allows to improve the quality of patients’ life, reducing the need to form a permanent ileostomy, improving the psychomotional, social and physical rehabilitation of patients. However, this intervention is associated with a high risk of postoperative complications. Impairment of the the pelvic reservoir functioning, as well as the addition of infection, are terrible complications that significantly worsen the patient’s quality of life. Surgeons performing this type of surgery have to face a number of intraoperative and postoperative complications that require repeated interventions. The aim of the study is to improve the results of treatment of patients with the small bowel reservoir. A review and analysis of the literature is performed in this issue. Successful results of performing colproctectomy with the formation of a pelvic enteric reservoir depend on careful preoperative planning, experience of the surgeon, prevention of intra‑ and postoperative complications.
Aim: To study and evaluate degree of morphological changes in intima of great saphenous vein (GSV) in patients of different age groups in health and in venous disease. Materials and methods: We investigated autopsy material of GSV in 60 deceased patients and postoperative material of GSV in 80 patients with venous disease. Four age groups were formed: young age, middle age, older and elderly age. Totally there were 280 GSV fragments. Histological, morphometric, electron microscopic and biochemical studies were performed. Results: Our results are mainly consistent with the reference data. However, we carried out a comparative study of intima structure in norm and with venous disease in patients of different age. At the same time due to agerelated decline in varicose veins morphological changes are progressing. There are areas of endothelium atrophy and signs of fibrotic replacement in young and middle age patients with venous disease, whereas in older and elderly patients desquamation of endothelium and sclerosis were observed. Conclusion: Progressive degeneration in older and elderly patients with varicose veins promotes morphological changes of GSV and progression of the disease on histological and ultrastructural level that worsens endothelial dysfunction.
Purpose To outline the preliminary experience of the da Vinci® robotic system used in a Moscow tertiary colorectal referral center for an unselected range of benign and malignant rectal conditions. Methods Prospective non-randomized single-center study which analyzed results of 26 robotic rectal resections performed between january 2014 and december 2016. Results The cohort included 10 females and 16 males (mean total age 61.6 years). Three patients underwent surgery for benign rectal villous adenomas. The median overall ASA score was 4 (ranged from 2 to 5). Of the surgeries, there were 19 total mesorectal excisions with 6 patients undergoing a multivisceral resection. The mean operating time was 358 minutes with a mean blood loss of 203 mL. All total mesorectal excision specimens were adjudged according Philip Quirke classification as mesorectal plane – Grade 3 with a mean of 18.5 lymph nodes identified (from 12 to 35). Of these there were 10 patients (38.5%) with lymph node metastases. After surgery the average pain score was 2.1 out of 10 on the “Visual-Analogue Pain Intensity Scale” and 1.5 score out of 10 on the “Brief Pain Inventory with Quality of Life”. Anal continency after rectal resection with total mesorectal excisions estimated according Wexner Scale: 10 days after surgery average score was −3.1 and a 6 month after surgery −1.6 score. The median length of hospital stay was 11 days (from 10 to 15). Conclusion Our initial experience with a totally robotic rectal resection has shown the technique to be safe and feasible, particularly in patients where conventional laparoscopic rectal resection would be anticipated to be challenging.
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