Three-dimensional printing for preoperative rehearsal and intraoperative navigation during laparoscopic rectal cancer surgery with left colic artery preservation

BACKGROUND Prior studies have shown that preserving the left colic artery(LCA)during laparo-scopic radical resection for rectal cancer(RC)can reduce the occurrence of anasto-motic leakage(AL),without compromising oncological outcomes.However,anatomical variations in the branches of the inferior mesenteric artery(IMA)and LCA present significant surgical challenges.In this study,we present our novel three dimensional(3D)printed IMA model designed to facilitate preoperative rehearsal and intraoperative navigation to analyze its impact on surgical safety.AIM To investigate the effect of 3D IMA models on preserving the LCA during RC surgery.METHODS We retrospectively collected clinical dates from patients with RC who underwent laparoscopic radical resection from January 2022 to May 2024 at Fuyang People’s Hospital.Patients were divided into the 3D printing and control groups for sta-tistical analysis of perioperative characteristics.RESULTS The 3D printing observation group comprised of 72 patients,while the control group comprised 68 patients.The operation time(174.5±38.2 minutes vs 198.5±49.6 minutes,P=0.002),intraoperative blood loss(43.9±31.3 mL vs 58.2±30.8 mL,P=0.005),duration of hospitalization(13.1±3.1 days vs 15.9±5.6 days,P<0.001),postoperative recovery time(8.6±2.6 days vs 10.5±4.9 days,P=0.007),and the postoperative complication rate(P<0.05)were all significantly lower in the observation group.CONCLUSION Utilization of a 3D-printed IMA model in laparoscopic radical resection of RC can assist surgeons in understanding the LCA anatomy preoperatively,thereby reducing intraoperative bleeding and shortening operating time,demonstrating better clinical application potential.

Observation of therapeutic effect of lamp irradiation combined with purple gromwell oil gauze on alleviating intestinal colic in patients

BACKGROUND Intestinal colic is a common complication in patients who have undergone radical surgery for colorectal cancer.Traditional Chinese medicine has advantages,including safety and stability,for the treatment of intestinal colic.Lamp irra-diation for abdominal ironing has been applied in the treatment of many gas-trointestinal diseases.Purple gromwell oil has the effects of clearing heat,cooling blood,reducing swelling,and relieving pain.RESULTS The general effective rate in the observation group was 95.00%,which was significantly higher than that in the control group(86.67%,P<0.05).Before treatment,there was no significant difference in the duration of symptoms between the groups(P>0.05).After 1,2,3,and 4 d of treatment,the duration of symptoms in both groups were decreased,and the duration in the observation group was significantly lower than that in the control group(96.54±9.57 vs 110.45±11.23,87.26±12.07 vs 104.44±11.68,80.45±16.21 vs 99.44±14.95,73.18±15.58 vs 92.17±14.20;P<0.05).After 1,3,5,and 7 d of treatment,the NRS scores in both groups were decreased,and the NRS scores in the observation group were significantly lower than those in the control group(3.56±0.41 vs 4.04±0.58,3.07±0.67 vs 3.74±1.02,2.52±0.76 vs 3.43±0.85,2.03±0.58 vs 3.03±0.82;P<0.05).There was no significant difference in the rate of adverse reaction occurrence between the groups(P>0.05).CONCLUSION The use of lamp irradiation combined with purple gromwell oil gauze in patients with intestinal colic after radical surgery for colorectal cancer can reduce symptom duration,alleviate intestinal colic,and improve treatment efficacy,and this approach is safe.It is worth promoting the use of this treatment in clinical practice.

Early versus delayed laparoscopic cholecystectomy in uncomplicated biliary colic: An observational study

Objective:Biliary colic is a condition treated with laparoscopic cholecystectomy.However,the outcomes of surgery depend on early or delayed time points.Few research findings reported no benefits of early over delayed,on contra,other reported benefits.This study aims to compare the benefits associated with early and delayed laparoscopic cholecystectomy among uncomplicated biliary colic patients.Methods:This observational study included patients with right upper abdominal pain and abdominal ultrasound showing cholelithiasis.Patients who were admitted at the first and second visits(within 6 weeks of the first visit)were assigned to the early and delayed groups,respectively.All participants were followed up for one-week postsurgery.The diagnosis of the patient,postoperative hospital stay,duration of surgery and complications were noted and compared primarily.Results:A total of 80 patients were included,40 each in the early group and delayed group.The patients in the two groups had comparable mean ages(40.55±13.12 y vs.40.45±12.06 y,p=0.972).The early group had more female patients(72.5%vs.45.0%,p=0.012).The duration of hospital stay(2.18±0.38 d vs.2.68±1.04 d,p=0.009)and duration of surgery(61.63±3.64 min vs.71.13±16.19 min,p=0.001)were found to be significantly different between the early and delayed groups.Only 1(2.5%)patient in both groups was converted to open cholecystectomy.Recurrent biliary colic requiring hospital admission was seen in 1(2.5%)patient and 6(15.0%)patients,acute cholecystitis in 2(5.0%)and 6(15.0%),biliary pancreatitis in 1(2.5%)and 2(5.0%),and obstructive jaundice in 1(2.5%)and 1(2.5%)in the early and delayed groups,respectively,with insignificant differences(p>0.05).Conclusion:Early laparoscopic cholecystectomy decreases the operating time and duration of hospital stay.In terms of postoperative complications,our study did not find any significant difference between the groups.

Diagnostic value ultrasound signs of stones less than or equal to 10 mm and clinicoradiological variants of ureteric colic

Objective:To determine the diagnostic value of ultrasound signs of urinary stones less than or equal to 10 mm and to determine clinico-radiological variants of ureteric colic.Methods:A total of 455 ultrasound investigations were performed in patients referring to emergency department with urolithiasis and symptoms suspected of ureteric colic between January 2021 and May 2021.In addition to microscopic evaluation of urine sediment to detect different crystals and non-contrast spiral computed tomography to detect stones,B-mode and color Doppler sonography was performed to assess the presence of acoustic shadow(AS)and twinkle artifacts(TA)as possible signs of stone(s)in ureter.Results:While the sensitivity and specificity of AS and TA were higher than 90%in patients with stones greater than 5 mm;positive prognostic values of these parameters were found to be extremely low for stones with sizes of 1-3 mm with specificity and sensitivity values not exceeding 53%.The sensitivity and specificity of AS and TA in the upper and lower ureters were higher for stones greater than or equal to 5 than for compared to those less than 5 mm.At the same time,the diagnostic values of TA and AS for middle ureter stones were very limited.The most prevalent clinico-radiological variants of ureteric colic were types I,III,and V being observed in 39%,28% and 21% cases,respectively.Conclusion:Our results demonstrate that TA and AS parameters seem to have a very low sensitivity and specificity in the diagnosis of urinary stones less than 5 mm.The diagnostic value of TA and AS increase significantly in stones greater than or equal to 5 mm.Therefore,clinicians need to be very careful for overestimating the diagnostic values of TA and AS for stones less than 5 mm and non-contrast spiral computed tomography must be the method of choice for patients presenting to emergency department with ureteric colic.

Vascular anatomy of inferior mesenteric artery in laparoscopic radical resection with the preservation of left colic artery for rectal cancer

AIM To investigate the vascular anatomy of inferior mesenteric artery(IMA) in laparoscopic radical resection with the preservation of left colic artery(LCA) for rectal cancer. METHODS A total of 110 patients with rectal cancer who underwent laparoscopic surgical resection with preservation of the LCA were retrospectively reviewed. A 3 D vascular reconstruction was performed before each surgical procedure to assess the branches of the IMA. During surgery, the relationship among the IMA, LCA, sigmoid artery(SA) andsuperior rectal artery(SRA) was evaluated, and the length from the origin of the IMA to the point of branching into the LCA or common trunk of LCA and SA was measured. The relationship between inferior mesenteric vein(IMV) and LCA was also evaluated.RESULTS Three vascular types were identified in this study. In type A, LCA arose independently from IMA(46.4%, n = 51); in type B, LCA and SA branched from a common trunk of the IMA(23.6%, n = 26); and in type C, LCA, SA, and SRA branched at the same location(30.0%, n = 33). The difference in the length from the origin of IMA to LCA was not statistically significant among the three types. LCA was located under the IMV in 61 cases and above the IMV in 49 cases. CONCLUSION The vascular anatomy of the IMA and IMV is essential for laparoscopic radical resection with preservation of the LCA for rectal cancer. To recognize different branches of the IMA is necessary for the resection of lymph nodes and dissection of vessels.

Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer:A comprehensive review

Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision(CME) with central vascular ligation(CVL) for the multimodal management of right colon cancer. Historical and up-to-date anatomo-embryological concepts are analyzed in detail,focusing on the latest studies of the mesenteric organ,its dissection by mesofascial and retrofascial cleavage planes,and questioning the need for a new terminology in colonic resections. The rationale behind Laparoscopic CME with CVL is thoroughly investigated and explained. Attention is paid to the current surgical techniques and the quality of the surgical specimen,yielded through mesocolic,intramesocolic and muscularis propria plane of surgery. We evaluate the impact on long term oncologic outcome in terms of local recurrence,overall and disease-free survival,according to the plane of resection achieved. Conclusions are drawn on the basis of the available evidence,which suggests a pivotal role of laparoscopic CME with CVL in the multimodal management of right sided colonic cancer: performed in the right mesocolic plane of resection,laparoscopic CME with CVL demonstrates better oncologic results when compared to standard non-mesocolic planes of surgery,with all the advantages of laparoscopic techniques,both in faster recovery and better immunological response. The importance of minimally invasive mesoresectional surgery is thus stressed and highlighted as the new frontier for a modern laparoscopic total right mesocolectomy.

Treatment of Special Renal Colic with Ureteroscope and Holmium YAG Laser

Objective To investigate the method of emergent relief of special renal colic and treatment of ureter diseases causing renal colic. Methods By analyzing 63 cases of special renal colic treated with ureteroscope and Holmium YAG laser. Results 61 cases of renal colic were relieved in a short period of time and the original ureter diseases causing renal colic were cured. Conclusion Special renal colic could be treated with ureteroscope and Holmium YAG laser in a quick and effective manner.

Analgesic effect of paracetamol combined with low- dose morphine versus morphine alone on patients with biliary colic： a double blind, randomized controlled trial

BACKGROUND:Numerous drugs have been proposed to alleviate pain in patients with biliary colic,especially opioids,but still there is a tendency to use less narcotics because of their side effects and the unwillingness of some patients.The present study aimed to compare the analgesic effect of paracetamol combined with low-dose morphine versus morphine alone in patients with biliary colic.METHODS:A randomized double-blind controlled trial was performed in 98 patients with biliary colic,recruited from two emergency departments from August 2012 to August 2013.Eleven patients were excluded and the remaining were randomized into two groups:group A received 0.05mg/kg morphine+1 000 mg paracetamol in 100 m L normal saline and group B received 0.1 mg/kg morphine+normal saline(100 m L)as placebo.Pain scores were recorded using visual analogue scale(VAS)at baseline and 15 and 30 minutes after drug administration.Adverse effects and the need for rescue medication(0.75 g/kg intravenous fentanyl)were also reported within 60 minutes of drug administration.RESULTS:Before the infusion,the mean±SD VAS scores were 8.73±1.57 in group A and8.53±1.99 in group B.At 15 minutes after drug administration,the mean±SD VAS scores were2.16±1.90 in group A vs.2.51±1.86 in group B;mean difference was–0.35,and 95%CI–1.15 to 0.45(P=0.38).At 30 minutes the mean±SD VAS scores were 1.66±1.59 in group A vs.2.14±1.79 in group B;mean difference was–0.48,and 95%CI–1.20 to 0.24(P=0.19).The mean pain scores in the two groups at 15 and 30 minutes demonstrated no significant difference.CONCLUSION:Paracetamol combined with low-dose morphine may be effective for pain management in patients with biliary colic.

Enzyme pattern of biliary colic: A counterintuitive picture

AIM To evaluate the diagnostic value of serial biochemical blood tests in the diagnosis of biliary colic.METHODS Files were reviewed of 1039 patients who were admitted to the Share'e Zedek Medical Center emergency department between the years 2012-2013, and received the coding of acute biliary disease. Of these, the first 100 cases were selected that met the following criteria:(1) a diagnosis of biliary colic or symptomatic cholelithiasis;(2) at least two biochemical blood tests performed; and(3) 18 years of age or older. Patients with other acute biliary diseases were excluded. The biochemical profile of the patients was analyzed as were their clinical and radiological findings.RESULTS Three-quarters of the patients were women, whose average age of 37 years was younger than the averageof the men, at 50 years. According to their histories, 47% of the patients had previously known cholelithiasis. Pain in either the right upper quadrant or the epigastrium was the presenting symptom in 93% cases. The greatest change in serum biochemical results was seen during the first day of the patients' admissions. Alanine aminotransferase(ALT) showed the highest initial rise above the reference range, followed by aspartate aminotransferase(AST), gamma-glutamyl transferase(GGT), bilirubin and alkaline phosphatase(ALKP)- all these increases were statistically significant(P < 0.05). AST showed the sharpest decline followed by bilirubin and ALT. GGT and ALKP did not fall. A sharp rise and fall in liver enzymes, especially during the first day, most prominently in AST and ALT, was seen in 70% percent of cases. In 65% of cases trans-abdominal sonography did not give diagnostic findings.CONCLUSION Serial serum liver enzyme measurements are helpful in the initial diagnosis of acute biliary colic.

Renal Colic: Epidemiological, Clinical Etiological and Therapeutic Aspects at the Urology Department of the National Reference General Hospital of N’Djamena (Chad)

Introduction: Renal colic is a medico-surgical emergency in which complicated forms could progress to renal failure and nonfunctional kidney. The objective of our study is to describe the epidemiological, diagnostic and therapeutic aspects of renal colic at the urology department of the NGRH. Methods: This was a prospective study involving 101 patients followed up for renal colic. The study spanned from July 2015 to July 2016 at the urology department of the NGRH. Results: A total of 101 patients suffering from renal colic were enrolled in the study giving a prevalence of 5.1%. The mean age was 38.89 years with a standard deviation of 14.5 years and a sex ratio of 1:3. Flank or lumbar pain of crushing type (45.5%), constant and of severe intensity (61.4%) were the most frequent clinical characteristics. The plain abdominal radiography (Kidney-Ureter-Bladder) coupled with ultrasonography had a 100% sensitivity for the etiological diagnosis of renal colic. Urinary lithiasis was the most frequent cause with 73.3%. Uroculture revealed a urinary tract infection in 44 patients (43.6%). The most frequent germ isolated on the culture was Escherichia coli (27.7%). Renal function was abnormal in 34 patients (33.7%). Medical treatment was composed of analgesics, NSAIDs and antispasmodic representing 93.1%. Percutaneous nephrostomy was performed in 6.9%. Pyelolithotomy was the most frequently performed surgical procedure and was done in 11 patients that are 39.3%. Fifty seven patients (56.4%) got healed without sequelae;6 cases (5.9%) of recurrence and 2 deaths (2%) were recorded. Conclusion: Renal colic is common in urology. Urinary lithiasis was the major cause in our series. Renal function could be endangered in case of late management.

CLINICAL OBSERVATION ON AURICULAR POINT TREATMENT FOR 144 CASES OF BILIARY COLIC

In this study, 144 cases of biliary colic were treated by injecting Atropine in the auricu-lar points (Liver, Gallbladder). Among the 144 cases, 130 cases were markedly effective, 11 cases ef-fective and 3 cases ineffective, with the effective rate being 97. 90%. The results showed that therewas no difference between colic degrees, ages and analgesic effects. But analgesic effects for biliary as-cariosis and cholecystitis, cholelithiasis are much better than choledochal calculus (P【0.01).

Point Injection for Treating Nephritic Colic in 101 Cases

Since 1994, the authors have treated 101 cases of nephritic colic by point injection therapy and achieved good curative results.

Dietary treatment of colic caused by excess gas in infants:Biochemical evidence

AIM:To evaluate the impact of feeding colicky infants with an adapted formula on the hydrogen breath test and clinical symptoms.METHODS:Hydrogen expiration was measured by SC MicroLyzer gas chromatography at inclusion and 15 d after treatment with an adapted low-lactose formula in 20 colicky infants.RESULTS:All babies were symptomatic:85% with excess gas,75% with abnormal feeding pattern,and 85% with excessive crying.The hydrogen breath test at inclusion was abnormal:35 ± 3.1 ppm.After 15 d feeding with an adapted low-lactose formula,crying and flatulence decreased in 85% of patients (P < 0.001).For infants in whom no decrease of gas was reported,crying was still reduced (P < 0.01).Moreover,the feeding pattern was improved in 50% of infants when it was initially considered as abnormal.Finally,the hydrogen breath test decreased significantly (10 ± 2.5 ppm,P < 0.01).CONCLUSION:This study showed an association between clinical improvement and evidence of decreased levels of hydrogen when the infants were fed with a specially designed,low-lactose formula.

Point Injection for Treating Nephritic Colic

Since 1994, the authors have treated 101 cases of nephritic colic by point injection therapy and achieved good curative results. Of them, 70 cases were diagnosed as having renal or ureteral calculi confirmed by abdominal X-ray and B-ultrasonic examination; and the others had the following symptoms: 1) sudden onset; 2) angina in unilateral lumbar and abdominal regions; 3) percussion-induced pain in the ipsilateral kidney region; and 4) erythrocytes or visible blood in urine found by laboratory test.

Remission of Abdominal Colic During Enteroscopy by Injecting Vitamin K_3 into Zusanli Acupoint

In 1970s,sedatives or spasmolytics needed to beadministered 30 minutes prior to performingenteroscopy to relieve abdominal colic during theexamination.Owing to the improvement in operatingskills,such drugs are no more used today.However,anumber of patients still suffer from abdominal coliccaused by irritated colon in the process ofenteroscopy.For severe cases,the operator has nochoice but to suspend the examination.To find a

Colo-Colic Invagination on Lipoma

Intussusception in adults is rare and accounts for 1% to 5% of cases of acute bowel obstruction. Moreso, colic intussusception remains exceptional in adults and is usually secondary to an endoluminal lesion. Abdominal intestinal lipomas are rarely responsible for colonic invagination. They are often located on the caecum or the ascending colon and rarely on the left colon. We report the case of colo-colic invagination on a descending colon lipoma in a 50-year-old woman.

Incidence and risk factors for infantile colic in Iranian infants

AIM: To assess the incidence of infantile colic and its association with variable predictors in infants born in a community maternity hospital, Tehran, Iran. METHODS: In this prospective cohort study, mothers who gave birth to live newborns between February 21 and March 20, 2003 at the hospital were invited to join to the study. For every infant-mother dyad data were collected on infant gender, type of delivery, gestational age at birth, birth weight, birth order, and mother's reproductive history. Then mothers were given a diary to document the duration of crying/fussiness behav-iors of their infants for the next 12 wk. We scheduled home visits at the time the infants were 3 mo of age to collect the completed diaries and obtain additional information on infants' nutritional sources and identify if medications were used for colic relief. Cases of colic were identifi ed by applying Wessel criteria to recorded data. Chi-square and Mann-whitney U tests were used to compare proportions for non-parametric and para-metric variables, respectively. RESULTS: From 413 infants, follow-up was completed for 321 infants. In total, 65 infants (20.24%) satisfi ed the Wessel criteria for infantile colic. No statistical sig-nifi cance was found between colicky and non-colicky infants according to gender, gestational age at birth, birth weight, type of delivery, and, infant's feeding pattern. However, fi rstborn infants had higher rate for developing colic (P = 0.03). CONCLUSION: Colic incidence was 20% in this popu-lation of Iranian infants. Except for birth order status, no other variable was signifi cantly associated with in-fantile colic.

Anomalous origin and vulnerable course of left colic artery in relation to the pancreas—A case report

We report here an anomalous origin and course of left colic artery in relation to pancreas during routine dissection of the abdominal region in a 70-year-old male cadaver in the department of anatomy. The anomalous left colic artery took its origin from the superior mesenteric artery and immediately divided into right and left branches. The right branch passed through the transverse mesocolon to supply the left one third of the transverse colon. The left branch traversed to the left along the inferior border of the body of the pancreas and crossed the left kidney before supplying the left colic flexure of colon and descending colon. This aberrant course of the left branch of the left colic artery can be considered as a “vulnerable” course as it is liable to injury during pancreatic and renal surgeries since the artery is not expected to run along the inferior border of the pancreas. The pancreas, a retroperitoneal organ, is related to major arteries such as abdominal aorta, inferior vena cava, coeliac trunk and its main branches, superior mesenteric vessels, splenic and portal veins. Surgery of the pancreas therefore, not only needs a thorough knowledge of the normal course of branches of these vessels but also demands a good knowledge of possible anomalous vessels arising in this region.

Migrating Lump in Abdomen—Ileo-Colo-Colic Intussusception Up to the Rectum with Hypermobile Caecum and Ascending Colon

In pediatric age group, Intussusception is the most common cause of acute intestinal obstruction. They present with the classic clinical triad of colicky abdominal pain, vomiting and bloody stools. But clinically very few patients (20%) present with this classical symptoms. This article highlights an importance of suspecting intussusception by physician and rare presentations of intussusception lump in abdomen in a child with abdominal pain, gastrointestinal symptoms. Here a case reported of 16-year-old male child who presented with migrating lump in abdomen on and off with varied clinical presentation every time in single admission. Patient underwent laparotomy and manual reduction of intussusception was done. It is advisable to have high suspicion of intussusception while dealing with such cases.