Colon cancer is one of the most prevalent cancers globally,especially in the older age group.A large number of older patients undergoing surgery for colon cancer suffer from postoperative cognitive dysfunction(POCD).T...Colon cancer is one of the most prevalent cancers globally,especially in the older age group.A large number of older patients undergoing surgery for colon cancer suffer from postoperative cognitive dysfunction(POCD).The trial by Bu et al demonstrated that dexmedetomidine(Dex)significantly reduced the incidence of POCD compared to placebo in individuals undergoing colon cancer surgery.Additionally,better cerebral oxygenation and lower cerebral injury markers were reported with the use of Dex.The trial has some limitations,such as a single-center design and a smaller sample size,and further studies with larger patient populations and robust multi-center designs are warranted to establish these findings.展开更多
AIM: To see the possibility of avoiding routine colostomy in patients presenting with unprepared bowel. METHODS: The cohort is composed of 103 patients, of these, 86 patients presented as emergencies (self- inflected ...AIM: To see the possibility of avoiding routine colostomy in patients presenting with unprepared bowel. METHODS: The cohort is composed of 103 patients, of these, 86 patients presented as emergencies (self- inflected and iatrogenic colon injuries, stab wounds and blast injury of the colon, volvulus sigmoid, obstructing left colon cancer, and strangulated ventral hernia). Another 17 patients were managed electively for other colon pathologies. During laparotomy, the involved segment was resected and the two ends of the colon were brought out via a separate colostomy wound. One layer of interrupted 3/0 silk was used for colon anastomosis. The exteriorized segment was immediately covered with a colostomy bag. Between the 5th and 7th postoperative day, the colon was easily dropped into the peritoneal cavity. The defect in the abdominal wall was closed with interrupted nonabsorbable suture. The skin was left open for secondary closure. RESULTS: The mean hospital stay (± SD) was 11.5 ± 2.6 d (8-20 d). The exteriorized colon was successfully dropped back into the peritoneal cavity in all patients except two. One developed a leak from oesophago- jejunostomy and from the exteriorized colon. She subsequently died of sepsis and multiple organ failure (MOF). In a second patient the colon proximal to the exteriorized anastomosis prolapsed and developed severe serositis, an elective ileo-colic anastomosis (to the left colon) was successfully performed. CONCLUSION: Exteriorized colon anastomosis is simple, avoids the inconvenience of colostomy and can be an alternative to routine colostomy. It is suitable where colostomy is socially unacceptable or the facilities and care is not available.展开更多
文摘Colon cancer is one of the most prevalent cancers globally,especially in the older age group.A large number of older patients undergoing surgery for colon cancer suffer from postoperative cognitive dysfunction(POCD).The trial by Bu et al demonstrated that dexmedetomidine(Dex)significantly reduced the incidence of POCD compared to placebo in individuals undergoing colon cancer surgery.Additionally,better cerebral oxygenation and lower cerebral injury markers were reported with the use of Dex.The trial has some limitations,such as a single-center design and a smaller sample size,and further studies with larger patient populations and robust multi-center designs are warranted to establish these findings.
文摘AIM: To see the possibility of avoiding routine colostomy in patients presenting with unprepared bowel. METHODS: The cohort is composed of 103 patients, of these, 86 patients presented as emergencies (self- inflected and iatrogenic colon injuries, stab wounds and blast injury of the colon, volvulus sigmoid, obstructing left colon cancer, and strangulated ventral hernia). Another 17 patients were managed electively for other colon pathologies. During laparotomy, the involved segment was resected and the two ends of the colon were brought out via a separate colostomy wound. One layer of interrupted 3/0 silk was used for colon anastomosis. The exteriorized segment was immediately covered with a colostomy bag. Between the 5th and 7th postoperative day, the colon was easily dropped into the peritoneal cavity. The defect in the abdominal wall was closed with interrupted nonabsorbable suture. The skin was left open for secondary closure. RESULTS: The mean hospital stay (± SD) was 11.5 ± 2.6 d (8-20 d). The exteriorized colon was successfully dropped back into the peritoneal cavity in all patients except two. One developed a leak from oesophago- jejunostomy and from the exteriorized colon. She subsequently died of sepsis and multiple organ failure (MOF). In a second patient the colon proximal to the exteriorized anastomosis prolapsed and developed severe serositis, an elective ileo-colic anastomosis (to the left colon) was successfully performed. CONCLUSION: Exteriorized colon anastomosis is simple, avoids the inconvenience of colostomy and can be an alternative to routine colostomy. It is suitable where colostomy is socially unacceptable or the facilities and care is not available.
