Techniques in coloproctology
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Fournier's gangrene is a potentially fatal necrotizing fasciitis affecting the perineum and genital area. The usual treatment includes prompt surgical debridement and, in many cases, a diverting colostomy. We present two cases of Fournier's gangrene that were treated with extensive local debridement and rectal diversion with a new device for faecal matter management, avoiding the need for a colostomy.
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Randomized Controlled Trial Comparative Study
Do we still need to restrict preoperative fluid administration in ambulatory anorectal surgery under spinal anaesthesia?
This study was undertaken to determine the effect of a restricted versus a standard intravenous fluid regimen on urinary retention and readiness for discharge after surgery for benign anorectal disease. ⋯ In minor anorectal surgery under spinal anaesthesia with ropivacaine, standard fluid regimen provides stable haemodynamic variables without urinary retention.
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Comparative Study
Early predictors of anastomotic leaks after colectomy.
An anastomotic leak after colorectal surgery is associated with significant morbidity and decreased survival. Our aim was to identify the early predictors of anastomotic leaks. ⋯ The earliest clinical predictors of an anastomotic leak are pulmonary and/or neurological. Awareness of these findings might help in early diagnosis and treatment of an anastomotic leak.
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The objective of this review is to present a current opinion on the management of small-bowel obstruction. The topic is limited to small-bowel obstruction secondary to postoperative adhesions. ⋯ We attempt to give readers a concise insight into the evidence available in the English language literature. This paper does not offer a comprehensive review of the topic; rather it highlights some relevant issues and then outlines what role, if any, laparoscopic surgery should play in the management of adhesive small-bowel obstruction.