Laparoscopic versus open colectomy for obstructing right colon cancer: A systematic review and meta-analysis

Cirocchi, Roberto; Campanile, Fabio Cesare; Saverio, Salomone Di; Popivanov, Georgi; Carlini, Luigi; Pironi, Daniele; Taboła, Renata; Vettoretto, Nereo

doi:10.1016/j.jviscsurg.2017.09.002

Cited by 41 publications

(22 citation statements)

References 50 publications

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“…The retrospective design of a single-center study and the small cohort of patients with liver cirrhosis undergoing small bowel surgery may overpower the influence of the found predictors. Furthermore, this study includes only open surgical procedures, which are known to have a higher blood loss in a cohort without cirrhosis and may have a higher incidence of ascites and a higher rate of postoperative liver failure compared to minimally invasive procedures in patients with cirrhosis [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Postoperative Morbidity and Mortality after Small Bowel Surgery in Patients with Cirrhotic Liver Disease—A Retrospective Analysis of 76 Cases in a Tertiary Center

Wetterkamp

Beekum

Willis

et al. 2020

Biology

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(1) Purpose: As it is known, patients with liver cirrhosis (LC) undergoing colon surgery or hernia surgery have high perioperative morbidity and mortality. However, data about patients with LC undergoing small bowel surgery is lacking. This study aimed to analyze the morbidity and mortality of patients with LC after small bowel surgery in order to determine predictive risk factors for a poor outcome. (2) Methods: A retrospective analysis was performed of all patients undergoing small bowel surgery between January 2002 and July 2018 and identified 76 patients with LC. Postoperative complications were analyzed using the classification of Dindo/Clavien (D/C) and further subdivided (hemorrhage, pulmonary complication, wound healing disturbances, renal failure). A total of 38 possible predictive factors underwent univariate and multivariate analyses for different postoperative complications and in-hospital mortality. (3) Results: Postoperative complications [D/C grade ≥ II] occurred in 90.8% of patients and severe complications (D/C grade ≥ IIIB) in 53.9% of patients. Nine patients (11.8%) died during the postoperative course. Predictive factors for overall complications were “additional surgery” (OR 5.3) and “bowel anastomosis” (OR 5.6). For postoperative mortality, we identified the model of end-stage liver disease (MELD) score (OR 1.3) and portal hypertension (OR 5.8) as predictors. The most common complication was hemorrhage, followed by pulmonary complications, hydropic decompensation, renal failure, and wound healing disturbances. The most common risk factors for those complications were portal hypertension (PH), poor liver function, emergency or additional surgery, ascites, and high ASA score. (4) Conclusions: LC has a devastating influence on patients’ outcomes after small bowel resection. PH, poor liver function, high ASA score, and additional or emergency surgery as well as ascites were significant risk factors for worse outcomes. Therefore, PH should be treated before surgery whenever possible. Expansion of the operation should be avoided whenever possible and in case of at least moderate preoperative ascites, the creation of an anastomotic ostomy should be evaluated to prevent leakages.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Postoperative Morbidity and Mortality after Small Bowel Surgery in Patients with Cirrhotic Liver Disease—A Retrospective Analysis of 76 Cases in a Tertiary Center

Wetterkamp

Beekum

Willis

et al. 2020

Biology

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“…[ 27 – 35 ] The management of retroperitoneal abscess from visceral perforation in complicated diverticular disease is still a challenge during the common surgical treatment of colonic diverticulitis. [ 36 – 39 ]…”

Section: Discussionmentioning

confidence: 99%

Clinical signs of retroperitoneal abscess from colonic perforation

Ruscelli

Renzi²,

Polistena

et al. 2018

Medicine

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Rationale:Retroperitoneal colonic perforation is a rare cause of retroperitoneal abscess. It presents, more frequently in frail elderly patients, with heterogeneous signs and symptoms which hamper the clinical diagnosis. Subcutaneous emphysema with pneumomediastinum and iliopsoas muscle abscess are unusual signs. Colonic retroperitoneal perforation may be consequent to diverticulitis or locally advanced colon cancer. Due to the anatomy of the retroperitoneal space and different physiopathology, diverticular perforation may present with air and pus collection; on the other hand perforated colon cancer may cause groin mass and psoas abscess. We reported 2 cases of colonic retroperitoneal perforation from diverticulitis and locally advanced colon cancer, respectively. Aim of this report is to improve differential diagnosis based on clinical signs.Patients’ concerns:A 71-year-old man presented with pain in his left side, fatigue, fever, nausea, massive subcutaneous emphysema of the neck, and Blumberg sign in the left iliac fossa. A 67-year-old man presented with abdominal pain, sub-occlusion, left groin mass, left groin, and lower limb pain during walking, negative Blumberg sign.Diagnosis:In the first patient the computerized tomography revealed pneumoperitoneum, gas in the mesosigma, pneumomediastinum, wall thickening of the descending colon, and retroperitoneal collection from diverticular perforation. In the second patient abdominal CT scan found thickening of the sigmoid colon adherent to the iliopsoas and fluid collection.Interventions:In the first patient, a left hemicolectomy extending to the transverse colon, followed by a toilette and debridement of the retroperitoneum were performed. In the second patient, tumor of descending colon perforated in the retroperitoneum with iliopsoas abscess was treated with left hemicolectomy and a drainage of the abscess.Outcomes:The first patient underwent right colectomy with ileostomy in the 7th postoperative day for large bowel necrosis. He died of sepsis 2 days after. The second patient had regular postoperative and he is still alive.Lessons:The spread of retroperitoneal abscess in complicated colonic diverticulitis is different from that in advanced colonic cancer. The former can present with a subcutaneous emphysema, the latter with a groin mass. Hence a thorough clinical examination and radiological studies are needed to diagnose these conditions.

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“…Finally, three patients had a complete laparoscopic resection of the small bowel. Actually, this conversion rate is acceptable, especially in an emergency setting, but requires careful judgment and advanced laparoscopic skills [6].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, laparoscopic surgery has been broadly performed for small bowel obstruction. Laparoscopic surgery has not only high diagnostic value but also minimal invasiveness in comparison with open surgery even in emergency surgery [5,6]. erefore, because ISH has few specific clinical and radiological findings, laparoscopic surgery has clear advantages [7,8].…”

Section: Introductionmentioning

confidence: 99%

Intersigmoid Hernia: A Forgotten Diagnosis—A Systematic Review of the Literature over Anatomical, Diagnostic, Surgical, and Medicolegal Aspects

Chiarini

Ruscelli

Cirocchi

et al. 2020

Emergency Medicine International

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Introduction. Intersigmoid hernia is a hernia of the small bowel into the intersigmoid fossa. It is well known to be a rare condition. Recent reports reveal that the preoperative differentiation of intersigmoid hernias is difficult and the diagnosis is often confirmed during the laparotomic exploration. Due to the vague clinical manifestation in most cases, the surgical treatment is frequently delayed. Materials and Methods. In this study, we systematically reviewed the literature up to 2019 covering 114 studies and 124 patients with an intersigmoid hernia. The purpose of this work is to improve the understanding of the anatomical aspects, clinical presentation, diagnosis, and treatment of intersigmoid hernia so as to assist the preoperative differentiation of these hernias when presented as acute abdomen in the emergency department. Results. The diameter of the intersigmoid recess was reported with mean 2.65 cm (range 1–10 cm, SD 1.15 cm) and the length of the incarcerated small intestine was between 3 cm (min) and 150 cm (max): mean 25.25 cm, SD 35.04 cm. The diameter of the sigmoid recess was greater in patients who underwent resection due to strangulation (mean 3.31 cm, SD 1.53 cm) compared to those who underwent only reduction of the hernia (mean 2.35 cm, SD 0.74 cm). The time from onset to operation was less in patients undergoing resection surgery due to throttling (mean 3.03 days, SD 3.01 days) compared to those who underwent only a reduction of hernia incarceration (mean 8.49 days, SD 6.83 days). Conclusion. Intersigmoid hernia is often a forgotten diagnosis and a clinical challange due to its anatomical characteristics.

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Laparoscopic versus open colectomy for obstructing right colon cancer: A systematic review and meta-analysis

Cited by 41 publications

References 50 publications

Risk Factors for Postoperative Morbidity and Mortality after Small Bowel Surgery in Patients with Cirrhotic Liver Disease—A Retrospective Analysis of 76 Cases in a Tertiary Center

Risk Factors for Postoperative Morbidity and Mortality after Small Bowel Surgery in Patients with Cirrhotic Liver Disease—A Retrospective Analysis of 76 Cases in a Tertiary Center

Clinical signs of retroperitoneal abscess from colonic perforation

Intersigmoid Hernia: A Forgotten Diagnosis—A Systematic Review of the Literature over Anatomical, Diagnostic, Surgical, and Medicolegal Aspects

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