Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
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Comparative Study
Laparoscopic restorative proctocolectomy with and without previous subtotal colectomy.
Laparoscopic techniques have been applied to the procedure of restorative proctocolectomy (RPC). The aim of this study was to compare the outcomes of patients after laparoscopic ileal pouch-anal anastomosis (IPAA) with restorative proctocolectomy (RPC) and without previous colectomy [restorative proctectomy (RP)] and to highlight some technical tips. ⋯ Laparoscopic IPAA is not only safe and feasible for the virgin abdomen but also for patients with a previous emergency colectomy through a midline laparotomy incision.
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The National Institute for Clinical Excellence (NICE) has recommended laparoscopic resection as an alternative to open surgery for patients with colorectal cancer. The aim of this study was to evaluate the current uptake of laparoscopic colorectal surgery in Great Britain and Ireland. ⋯ Laparoscopic colorectal surgery is being performed by more than half (53%) of colorectal consultants nationwide, although only a quarter of all procedures are being undertaken laparoscopically.
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Idiopathic pruritus ani is a common perianal condition that can be refractory to diligent perineal care. We wished to evaluate the efficacy and side effects of intradermal methylene blue for the treatment of refractory pruritus ani. ⋯ Treatment of refractory pruritus ani by intradermal injection of methylene blue is effective and generally well tolerated.
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'Fast-track' rehabilitation has been shown to accelerate recovery, reduce general morbidity and decrease hospital stay after elective colonic surgery. Despite this evidence, there is no information on the acceptance and utilization of these concepts among the entirety of Austrian and German surgeons. ⋯ Although there is an evident benefit of fast-track management, the survey shows that they are not yet widely used as a routine in Austria and Germany.
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Case Reports
Case report of uncontrollable pelvic bleeding--managed by a previously unreported method (QuikClot).
Pelvic haemorrhage can be difficult to control. Several measures including packing, drawing pins, stenting and embolization are available. We present a case where these measures failed to control catastrophic pelvic bleeding while operating in the pelvis to excise a dumbbell tumour involving the right S1 nerve root. ⋯ QuikClot is an inert substance and acts as a selective sponge. This product is licensed for external use by the British military. We felt that 'internal' use of Quikclot in this situation might be lifesaving and was applied to the bleeding area, stopping the bleeding immediately.