Diseases of the colon and rectum
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Fast-track (enhanced recovery) care pathways for colonic surgery are becoming increasingly popular; however, there have been concerns regarding protocol compliance, high readmission rates, and also the true impact on morbidity rates with these protocols. This study was conducted to assess the impact of a fast-track program for colonic surgery on hospital stay, complications, and readmission rates. ⋯ Fast-track is a safe and effective approach for reducing hospital stay and morbidity following major colonic surgery.
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Case Reports
Significant rectal bleeding as a complication of a fecal collecting device: report of a case.
We report the case of 65-year-old man who developed massive rectal bleeding associated with the use of a fecal collecting device: the Flexi-Seal Fecal Management System. A colonoscopy showed an acute laceration of the anterior rectal wall mucosa, 6 cm from the anal verge, with active bleeding. ⋯ Massive transfusion was required, and surgical endoscopic treatment was necessary to ensure hemostasis. This is, to our knowledge, the first such case to be reported.
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The oblique rectus abdominal myocutaneous flap is a seldom used flap design based on perforating vessels exiting the rectus near the umbilicus. Compared to other flaps, the oblique rectus abdominal myocutaneous flap provides increased soft tissue to fill pelvic dead space, with the further advantage of intact skin to close perineal defects. Here we detail the oblique rectus abdominal myocutaneous flap in achieving closure of complex perineal wounds. ⋯ The treatment of complex pelvic wounds, especially following pelvic radiation, is facilitated by the oblique rectus abdominal myocutaneous flap. This technique provides ample tissue for large pelvic wounds, including skin for perineal defects. Comparing our results to existing literature, the oblique rectus abdominal myocutaneous flap displays a favorable morbidity profile, providing a safe means of delivering well-vascularized tissue to the pelvic cavity and perineal floor.
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We sought to determine the nature and timing of complications after common anorectal operations by using a prospective quality tracking tool. ⋯ Complications after anorectal procedures are infrequent, typically minor, and occur after hospital discharge. Major complications reflect concomitant illness, not surgical quality. Meaningful outcome measures are needed to assess the quality of anorectal surgery.
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Comparative Study
Temporary sacral nerve stimulation for treatment of irritable bowel syndrome: a pilot study.
This study was designed to evaluate the effect of temporary sacral nerve stimulation in patients with diarrhea-predominant irritable bowel syndrome. ⋯ Temporary sacral nerve stimulation provides a significant reduction in diarrhea-predominant irritable bowel symptoms and improves quality of life. Further studies with permanent implantation and double-blind crossover ON-and-OFF-stimulation to evaluate the impact of placebo effect are needed.