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Studies reveal that ileal pouch-anal anastomosis (IPAA) has long-term success. These reports, however, use well-selected cohorts and exclude patients presenting with fulminant colitis (FC). Herein, we aimed to characterize long-term functional outcomes in patients with fulminant ulcerative colitis (UC) undergoing IPAA.A prospective database identified patients who underwent IPAA between 1998 and 2008. Patients with FC and chronic UC were matched by age, gender, date of surgery, and follow-up duration. Clinical and laboratory parameters, immunomodulator use at the time of surgery, and functional outcomes were compared.Forty patients with FC and 73 patients with chronic UC were identified. Preoperative albumin, hemoglobin, leukocyte count, and steroid dose were significantly different for those with FC. Average survey follow-up was 5.2 years for FC and 6.7 years for chronic UC patients. Functional outcomes were not significantly different. The 3-year fistula-free rate was 91.4 versus 98.6 % and the 3-year stricture-free rate was 79.3 versus 87.2 % for FC versus chronic UC patients, respectively.Patients undergoing colectomy for FC secondary to UC have similar long-term functional outcomes after IPAA despite significantly worse presentation. This study confirms that IPAA is an appropriate and durable treatment for patients with FC.

The aim of our study was to compare the outcomes of periampullary and extra-ampullary duodenal adenocarcinomas and segmental duodenal resection versus pancreatoduodenectomy and to evaluate prognostic factors. We performed a retrospective review of all adults treated for duodenal adenocarcinoma by operative resection at a large tertiary referral center from 1994 to 2009. One hundred twenty-four patients had an operation for duodenal adenocarcinoma over a 15-year period (periampullary, n = 25, and extra-ampullary, n = 99). Ninety-nine patients (80%) underwent curative resection, including 24 (96%) with periampullary and 75 (76%) with extra-ampullary carcinomas. The average number of lymph nodes sampled was eight with segmental resection and 12 with pancreatoduodenectomy (p

Verschiedene minimal-invasive Methoden sind zur Resektion von Rektumkarzinomen beschrieben worden. Jedoch sind die aktuellen Ergebnisdaten fur diese Ansatze von einzelnen Kliniken mit hohen Fallzahlen nach wie vor begrenzt. Unser Ziel war die Untersuchung von Ergebnissen bei Patienten, die sich in unserer Klinik aktuell einer minimal-invasiven Operation wegen eines Rektumkarzinoms unterzogen hatten. Eine retrospektive Analyse zur Evaluierung von Kurzzeitvorteilen und onkologischen Ergebnissen wurde bei Patienten durchgefuhrt, die zwischen 2004 und 2007 einen minimal-invasiven Eingriff wegen eines Rektumkarzinoms gehabt hatten. Insgesamt 100 konsekutive Patienten (61 Manner, medianes Alter 62) mit einem medianen Follow-up von 1,8 Jahren wurden ausgewahlt. Bei 67 wurde eine handassistierte laparoskopische Operation (HALS) und bei 33 eine laparoskopisch assistierte (LA) durchgefuhrt; 72 Patienten hatten eine anteriore, 27 eine abdominoperineale Resektion und ein Patient hatte eine totale Proktokolektomie. Die Tumorstadien waren Stadium 1 (21%), Stadium 2 (17%), Stadium 3 (56%) und Stadium 4 (6%). Im Median wurden 16 Lymphknoten entfernt, ein distaler Rand von 3,4 cm sowie ein in 99% negativer zirkumferenzieller Absetzungsrand erreicht. Das 3-Jahres-Uberleben, erkrankungsfrei und gesamt, betrug 86,2 bzw. 94,5%. Drei Falle erforderten eine Konversion. Der mediane Zeitraum bis zur Nahrungsaufnahme und erster Stuhlentleerung betrug 3 Tage und die mediane Dauer des Aufenthalts 5 Tage. Aufenthaltsdauer, Zeitraum bis zu flussiger Nahrung, Inzisionslange und Schmerzscores waren bei einem LA-Ansatz geringer verglichen mit HALS (p

Several minimally invasive techniques have now been described for rectal cancer resection. Current outcome data for these approaches from high volume, single institutions remain limited. Our aim was to review outcomes in patients undergoing minimally invasive surgery for rectal cancer at our institution in the current era. A retrospective analysis was done to assess short-term benefits and oncologic outcomes in patients undergoing minimally invasive surgery for rectal cancer between 2004 and 2007. One-hundred consecutive patients (61 men, median age 62) with a median follow-up of 1.8 years were identified. Sixty-seven had hand-assisted laparoscopic surgery (HALS), while 33 were done laparoscopic-assisted (LA). Seventy-two patients underwent anterior resection, 27 an abdominal perineal resection, and 1 a total proctocolectomy. Tumor stage was stage 1 (21%), stage 2 (17%), stage 3 (56%), and stage 4 (6%). A median of 16 lymph nodes, a median 3.4 cm distal margin, and a 99% negative circumferential margin was achieved. The 3-year disease-free and overall survivals were 86.2 and 94.5%, respectively. Three cases required conversion. Median time to both diet and first bowel movement was 3 days, and median length of stay was 5 days. Length of stay, time to soft diet, incision length, and pain scores were less using a LA approach compared to HALS (P

BACKGROUND: Evidence supports single-dose preoperative antibiotic (ABX) prophylaxis for breast surgery; however, limited data exist regarding the incidence and type of antibiotic complications postoperatively. METHODS: Breast/axillary surgeries between July 2004 and June 2006 were reviewed. Complications were analyzed by antibiotic group: preoperative prophylaxis, postoperative prophylaxis, and therapeutic intent. The Fisher exact test was used to compare complication rates. RESULTS: A total of 389 patients underwent breast/axillary surgeries during the study period. A total of 363 (93%) patients received ABX: 353 (91%) received a single preoperative dose, 91 (23%) received postoperative ABX prophylaxis, and 76 (201%) received ABX for therapeutic intent. Among patients receiving ABX, 15 (4%) had an ABX-related complication. The ABX-related complication rate was significantly higher among those receiving postoperative prophylaxis (5.5%; 5 of 91) compared with those receiving preoperative ABX alone (0%; 0 of 214) (P = .002). CONCLUSIONS: Drug-related complications were uncommon with preoperative ABX prophylaxis. Considering the potential complications of ABX after breast surgery, the use of postoperative prophylaxis should be reexamined.

A single preoperative prophylactic dose of an intravenous antibiotic with antistaphylococcal activity is standard of care for breast and axillary surgical procedures. Some surgeons also prescribe postoperative prophylaxis for all patients with drains to prevent infection despite its lack of proven efficacy.A retrospective chart review of patients with breast and/or axillary surgical procedures between July 2004 and June 2006 were included. Data were collected on patient demographics, procedure types, and use of prophylactic antibiotics. Surgical site infection (SSI) was defined by means of Centers for Disease Control and Prevention criteria, including patients meeting the physician diagnosis criterion if an antibiotic was prescribed for a clinical diagnosis of cellulitis. chi(2) and Fisher's exact tests were used to compare SSI rates.Three hundred fifty-three patients with 436 surgical sites who received either preoperative or both pre- and postoperative antibiotic were analyzed. Overall, the SSI rate was 7.8% (34 of 436 surgical sites). Eighty-five patients (24%) with 127 surgical sites were provided both preoperative and postoperative prophylactic antibiotics. The SSI rates did not differ statistically (P = .67) for the groups that did (95% confidence interval, 4.8-15.0; 11 of 127 surgical sites, 8.7%) and did not receive postoperative antibiotic prophylaxis (95% confidence interval, 5.0-11.0; 23 of 309, 7.4%).Although the overall number of patients who developed SSI was relatively small, there was no reduction in the SSI rate among those who received postoperative antibiotic prophylaxis. Because of the potential adverse events associated with antibiotic use, further evaluation of this practice is required.

treatment. 3 We hypothesized that seromas occur more frequently in extensive surgical procedures or in those that require a drainage tube. In addition, we theorized that seroma and surgical site infection (SSI) were directly correlated.The aims of this study were to evaluate the frequency of seromas that require intervention, to assess variation based on the extent of the breast or axillary surgical procedure, and to evaluate the incidence of SSI in relation to seroma occurrence.

The classifications of acute uncomplicated diverticulitis and complicated diverticulitis have served us well for many years. However, in recent years, we have noted the prevalence of variations of uncomplicated diverticulitis, which have not precisely fit under the classification of ‘acute resolving uncomplicated diverticulitis’, which manifests itself with the typical left lower quadrant pain, fever, diarrhea, elevated white blood count, and CT findings, such as stranding, and which resolves fairly promptly and completely on oral antibiotic therapy. For these other variations, we would suggest we use the term chronic diverticulitis, as a subset of uncomplicated diverticulitis, meaning there is no abscess, stricture, or fistula, but the episode does not respond to the usual antibiotic treatment, and there is a rebound symptomatology once the treatment has stopped, or there is continuing subliminal inflammation that continues, typically, for several weeks after the initial episode without complete resolution. This variation could also be termed ‘smoldering’ diverticulitis. A second variation of uncomplicated diverticulitis should be termed atypical diverticulitis, since this variant does not manifest all of the usual components of acute diverticulitis, particularly an absence of fever, and even white blood count elevation, and there may be a lack of diagnostic evidence of acute diverticulitis. This diagnosis must be compared with diarrhea-predominant irritable bowel syndrome, and it is sometimes very difficult to distinguish between these two entities. The character of the pain in irritable bowel syndrome is typically cramping intermittently, compared with the more constant pain in smoldering diverticulitis. In our study by Horgan, McConnell, Wolff and coworkers, 5% of 930 patients who underwent sigmoid resection fit into this category of atypical uncomplicated diverticulitis. These 47 patients all had diverticulosis, and 76% that had surgery had evidence of acute and chronic inflammation, and 15% had an unsuspected pericolonic abscess. There was no mortality and a low complication mortality rate (4.2%). Complete resolution of symptoms was achieved in 76.5 with 80% being pain free. Therefore, this is mostly a diagnosis of exclusion, and clinicians must be careful to perform a thorough workup and evaluation before proceeding to surgery with this as a diagnosis. Ischemic colitis is also in the differential diagnosis, and many patients who have diverticulitis, have irritable bowel syndrome as well, so caution must be used in predicting positive outcomes after surgery in these patients.

The classification of complicated and uncomplicated diverticulitis has been used for many years. We note variations in the course of uncomplicated diverticulitis. We propose and describe three categories of uncomplicated diverticulitis. A review was performed on 907 patients who underwent sigmoid resection for diverticulitis between January 1, 2005 and December 30, 2009 at Mayo Clinic, Rochester. Overall, 223 individuals were excluded as they were not uncomplicated diverticulitis. The remaining 684 patients were divided into three classifications as follows: 54 (7.9 %) atypical, 66 (9.6 %) chronic/smoldering, and 564 (82 %) acute resolving. Data elements abstracted included demographics, preoperative symptoms, imaging and endoscopy, operative and pathologic findings, postoperative complications, and resolution of symptoms. The 30-day complication rate of the atypical, chronic/smoldering, and acute groups was 26 %, 22 %, and 35 %, respectively. Resolution of symptoms for the atypical and chronic/smoldering groups was 93 % and 89 %, respectively. Only two patients in the acute resolving group required an operation for recurrence. A spectrum of clinical presentation for uncomplicated diverticulitis may require different approaches. A select group of patients with chronic/smoldering and atypical disease will continue to be burdened by symptoms. The success of surgical intervention was greater than 89 % in both groups with acceptable morbidity, and should remain an option.