Laparoscopic surgery for complex and recurrent Crohn's disease

Crohn's disease(CD) is a chronic inflammatory disease of digestive tract. Approximately 70% of patients with CD require surgical intervention within 10 years of their initial diagnosis, despite advanced medical treatment alternatives including biologics, immune suppressive drugs and steroids. Refractory to medical treatment in CD patients is the common indication for surgery. Unfortunately, surgery cannot cure the disease. Minimally invasive treatment modalities can be suitable for CD patients due to the benign nature of the disease especially at the time of index surgery. However,laparoscopic management in fistulizing or recurrent disease is controversial. Intractable fibrotic strictures with obstruction, fistulas with abscess formation and hemorrhage are the surgical indications of recurrent CD,which are also complicating laparoscopic treatments.Nevertheless, laparoscopy can be performed in selected CD patients with safety, and may provide better outcomes compared to open surgery. The common complication after laparoscopic intervention is postoperative ileus seems and this may strongly relate excessive manipulation of the bowel during dissection. But additionally, unsuccessful laparoscopic attempts requiring conversion to open surgery have been a major concern due to presumed risk of worse outcomes. However, recent data show that conversions do not to worsen the outcomes of colorectal surgery in experienced hands. In conclusion, laparoscopic treatment modalities in recurrent CD patients have promising outcomes when it is used selectively.

Minimally invasive management of anastomotic leaks in colorectal surgery

Anastomotic leakage is an unfortunate complication of colorectal surgery. This distressing situation can cause severe morbidity and significantly affects the patient's quality of life. Additional interventions may cause further morbidity and mortality. Parenteral nutrition and temporary diverting ostomy are the standard treatments of anastomotic leaks. However, technological developments in minimally invasive treatment modalities for anastomotic dehiscence have caused them to be used widely. These modalities include laparoscopic repair, endoscopic self-expandable metallic stents, endoscopic clips, over the scope clips, endoanal repair and endoanal sponges. The review aimed to provide an overview of the current knowledge on the minimally invasive management of anastomotic leaks.

Quality of life after colorectal surgery:A prospective study of patients compared with their spouses

BACKGROUND Although radical surgery for colorectal cancer improves the oncological outcomes,a significant portion of patients suffer from alterations in their quality of life(QoL).There are many studies investigating the QoL of patients who have colorectal cancer but none of these focus on the QoL of spouses.AIM To compare the QoL of patients after colorectal surgery to the QoL of spouses.METHODS This prospective study consisted of patients who were married and who underwent surgery at the University of Ankara,Department of Surgery between March 2006 and November 2010.Patients’spouses were also enrolled.The study was approved by the Ethics Committee of the Faculty of Medicine,Ankara University,and all patients provided written informed consent.The study included patients who underwent curative surgery for colorectal carcinoma[n=100;abdominoperineal excision(n=33),low anterior resection(n=33),left hemicolectomy(n=34)]and their spouses(n=100).The patients and spouses completed the Medical Outcome Study 36-item Short Form Survey(SF-36)and the World Health Organization Disability Assessment Schedule II(WHODAS-II)preoperatively and at postoperative months 15 to 18.RESULTS During this 4.5-year study period,273 patients with sigmoid or rectal cancer were admitted to the hospital.Of these patients,119 were eligible and willing to participate.Eleven patients had either systemic or locally inoperable disease,three patients had a severe surgical complication,and five patients were lost to followup.Therefore,a total of 100 patients completed the follow-up period.There was a statistically significant positive correlation between the disability scores of patients and the scores of their spouses for some of the WHODAS-II subscales,such as“self-care,”“life activities,”and“participation in society,”as well as for the total WHODAS-II score.There was also a positive correlation between the QoL of patients and the QoL of their spouses in most of the SF-36 subscales.Statistically significant correlations were observed for the“bodily pain,”“general health,””vitality,”“social function,”“emotion,”“mental health,”and mental component summary score subscales of the SF-36.When gender differences were evaluated,the QoL of male patients’spouses changed more when compared with female patients’spouses for all of the WHODAS-II subscales.Colorectal cancer surgery has a significant effect on the QoL of both patients and their spouses,these effects were more significant among male patients’spouses.CONCLUSION Preoperative counseling regarding potential problems should therefore collectively address patient and their spouse as a couple rather than the patient alone,particularly for patients undergoing low anterior resection and abdominoperineal resection procedures.