scholarly journals Outcomes of Open Side to End Antegrade Colorectal Single Stapler Anastomosis Versus Open End to End Retrograde Trans-anal Colorectal Single Stapler Anastomosis in Non-emergent Sigmoid and Rectal Cancers. Randomized Controlled Clinical Trial

2021 ◽  
Author(s):  
Tamer.A A.M. Habeeb ◽  
Gamal Osman ◽  
Amr Ibrahim ◽  
Abd-Elrahman M. Metwalli ◽  
Mohamed Ibrahim Mansour ◽  
...  
Keyword(s):  
Anastomotic Leak ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Open Side ◽  
Rectal Cancers ◽  
Group A ◽  
Stapling Anastomosis ◽  
Stapler Anastomosis ◽  
End To End ◽  
End Group

Abstract Introduction: Cancer rectum and sigmoid is increasing nowadays. Resection is done by open and laparoscopic approaches. Laparoscopic approach is not available in many sites worldwide. Aim of this study: To analyze the outcomes of open side to end (antegrade) colorectal single stapling anastomosis versus open end to end (retrograde) Trans-anal colorectal stapling anastomosis in non-emergent sigmoid and rectal cancers open surgery in adults.Patients and Methods: Randomized controlled trial was performed on patients with sigmoid and rectal cancers between September 2016 and September 2018. Results: The majority of studied group were between 50-70 years with mean of 62.58±12.3 years and 61.03±13.98 years in group A and group B respectively. Intraoperative data showed no significant difference was founded between studied group except at operative time and mean anastomotic time as group A was significantly shorter. Univariate analysis showed that perioperative blood loss, length of stay, reoperation, inpatient death, infection and bleeding were significantly associated with leakage. Multivariate analysis of anastomotic leak showed that infection is the only independent predictors for anastomotic leak. There is statistically significant change as regard range of bowel frequency in end to end group only (p=0.04) and there is statistically significant difference as regard incontinence for Flatus in side to end group only (p=0.00) .There is statistically significant change in both group regard Incontinence for liquid stools(p=0.00) and Clustering of stool(p=0.00 and p=0.043).The quality of life in Antegrade group significantly drop at 6 months and return to baseline after that as regard PWB, FWB and CCS with no difference as regard SWB & EWB while in retrograde group, the same change happened only as regard PWB & FWB but SWB and CCS percentage didn’t return to baselineConclusion: The side-to-end anastomoses approach is a safe approach of anastomosis and may be used as alternative to retrograde approach.

scholarly journals Outcomes of Side to End versus End to End Colorectal Anastomosis in Non-emergent Sigmoid and Rectal Cancers. Randomized Controlled Clinical Trial.

2021 ◽  
Author(s):  
Tamer.A.A.M.Habeeb ◽  
Hatem Mohammad ◽  
TamerWasefy ◽  
Mohamed Ibrahim Mansour
Keyword(s):  
Controlled Trial ◽  
Univariate Analysis ◽  
Colorectal Anastomosis ◽  
Controlled Clinical Trial ◽  
Randomized Controlled ◽  
Antegrade Approach ◽  
Significant Difference ◽  
Rectal Cancers ◽  
End To End ◽  
Significant Change

Abstract Purpose The outcomes of open side-to-end colorectal anastomosis versus open end to end colorectal anastomosis in non-emergent sigmoid and rectal cancers open surgery in adults were compared. Methods A randomized controlled trial on individuals with sigmoid and rectal cancers was conducted between September 2016 and September 2018. Results The majority of the participants in the study were between the ages of 50 and 70 years, with a mean age of 62.58±12.3 years in the side-to-end anastomotic group (SEA group = group A = antegrade approach) and 61.03±13.98 years in the end-to-end anastomotic group (EEA group = group B = retrograde approach), respectively. Except for the operative time, intraoperative data revealed no significant differences between the studied groups, and the SEA group revealed that the mean anastomotic time was significantly shorter. Perioperative blood loss, length of stay, reoperation, inpatient death, infection, and bleeding were all revealed to be significantly associated with leakage in univariate analysis. In a multivariate analysis of anastomotic leaks, infection was the only independent predictor. There is a statistically significant change regarding the range of bowel frequency in the EEA group only (p = 0.04). There is a statistically significant difference regarding incontinence for Flatus in the SEA group only (p = 0.00). A statistically significant change in both groups regards incontinence for liquid stools (p = 0.00) and clustering of stools (p = 0.00 and p = 0.043). The quality of life (QOL) in the SEA group significantly dropped at 6 months and returned to baseline after that as regards PWB, FWB, and CCS with no difference as regards SWB & EWB, while in the EEA group, the exact change happened only as regard PWB & FWB, but SWB and CCS percentage did not return to baseline. Conclusion The SEA group offers a safe and approach alternative to the EEA group.

Transthoracic anastomotic leak after esophagectomy: Still a catastrophe?

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 126-126
Author(s):  
Martin McCarter ◽  
Carrie Ryan ◽  
Robert Meguid ◽  
Alessandro Paniccia
Keyword(s):  
Anastomotic Leak ◽  
Transhiatal Esophagectomy ◽  
Leak Rate ◽  
Esophagogastric Anastomosis ◽  
Nominal Data ◽  
Cervical Anastomosis ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Cervical Esophagogastric Anastomosis ◽  
Meta Analyses

126 Background: Leaks from intrathoracic esophagogastric anastomosis are thought to be associated with higher rates of morbidity and mortality than leaks from cervical anastomosis. We challenge this assumption, and hypothesize that there is no significant difference in mortality based on the position of the esophagogastric anastomosis. Methods: A systematic literature search was conducted using PubMed and Embase databases on all studies published between January 2000 and June 2015 comparing transthoracic (TTE) and transhiatal (THE) esophagectomies. Studies that used alternate reconstruction approaches were excluded. Outcomes analyzed were leak rate, leak-associated mortality, overall 30-day mortality, and overall morbidity. Meta-analyses were performed using Mantel Haenszel statistical analyses on studies that reported on leak rates of both approaches. Nominal data are presented as frequency and interquartile range (IQR); measures of the association between treatments and outcomes are presented as odds ratio (OR) with 95% confidence interval (CI). Results: Twenty-one studies (including 3 randomized controlled trials) were included comprising of 7167 patients (54% TTE). THE approach yields a higher anastomotic leak rate (12%; IQR: 11.6% - 22.1%) than TTE (9.8%; IQR: 6.0% - 12.2%) (OR: 1.83 [0.34-06.92]), without any difference in leak-associated mortality (7.1% TTE vs. 4.6% THE; OR: 1.83, [0.39-8.52]). There was no difference in overall 30-day mortality (3.9% TTE vs. 4.3% THE; OR: 0.86, [0.66-1.13]) and morbidity (59.0% TTE vs. 66.6% THE; OR: 0.76, [0.37-1.59]). Conclusions: Transthoracic esophagectomy is associated with a lower leak rate and does not result in higher morbidity or mortality than transhiatal esophagectomy. The previously assumed higher rate of transthoracic leak-associated mortality is overstated, thus allowing surgeon discretion and other factors to influence the choice of intrathoracic versus cervical esophagogastric anastomosis.

scholarly journals Randomized Controlled Clinical Trial Comparing Transurethral Eneucleation and Resection of Prostate and Trans-urethral Resection of Prostate in the Management of Benign Prostatic Hyperplasia

2017 ◽  
Vol 7 (3) ◽  
pp. 216-220
Author(s):  
Md Mehedi Hasan ◽  
Samira Rahat Afroze ◽  
Muhammad Abdur Rahim ◽  
Muhammad Abdus Salam
Keyword(s):  
Controlled Trial ◽  
Ethical Review ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Transurethral Resection Of Prostate ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Transurethral resection of prostate (TURP) is the predominant surgical procedure for benign prostatic hypertension (BPH) but is not devoid of complications like capsular perforation, drop in Hb%, drop in Na+, residual adenoma; hence endeavors are evolving to combat such complications. A newer technique transurethral enucleation and resection of prostate (TUERP) has been devised to solve these problems. This study was designed to compare the safety and the efficacy of newer technique, TUERP with widely practiced TURP Methods: This randomized controlled trial was done at BSMMU, after getting ethical approval from the ethical review committee of the institute, from January to October, 2009. A total of 60 BPH patients were purposively enrolled in this study, after obtaining informed written consent and they were randomized as control, Group A (30 patients, underwent TURP) and experimental group, Group B (30 patients, underwent TEURP).Results: The mean preoperative Hb% level of Group A was 15.1 gm% (SD ± 0.5) and perioperative Hb% level was 13.04 gm% (SD ± 6.06). There was significant difference (P <0.05). The mean preoperative Hb% of Group B was 15.2 gm% (SD ± 0.5) and perioperative Hb% was 15.2 gm% (SD ± 0.48). There was no difference (P >0.05). The mean preoperative Na + of Group A was 140 mmol/l (SD ± 4.1) and perioperative Na+ was 126 mmol/l (SD ± 6.8). There was significant difference (P<0.01). The mean preoperative Na+ of Group B was 136 mmol/l (SD ± 4) and perioperative Na+ was 136 mmol/l (SD ± 2.70). There was no difference (P >0.05).Conclusion: TUERP eliminates drop in Hb% and Na+which are usual consequences following TURP. Thus TUERP can be advocated in the treatment of BPH as it also allows completeresection down to surgical capsule.Birdem Med J 2017; 7(3): 216-220

scholarly journals Study of clinical outcome of patients undergoing intestinal anastomoses with single layer extramucosal technique and double layer anastomoses

2021 ◽  
Author(s):  
Arvind Rai ◽  
Sukantth R. J.
Keyword(s):  
Anastomotic Leak ◽  
Double Layer ◽  
Statistical Tests ◽  
Intestinal Anastomosis ◽  
Single Layer ◽  
Layer Versus ◽  
Intestinal Anastomoses ◽  
Significant Difference ◽  
Group A ◽  
Group B

 Background: Intestinal anastomosis is one of the common surgeries for cases like bowel obstruction, incarcerated hernias, benign and malignant tumours of small and large bowel. The ideal intestinal anastomosis does not leak and allow normal function of the gastrointestinal tract. This study compared single layer versus double layer  intestinal anastomosis in terms of duration, postoperative complications like anastomotic leak.Methods: A total of 100 patients admitted in Hamidia hospital, based on history and clinical examinations and radiological examinations, placed in two groups, group A (single layer anastomosis) and group B (double layer anastomosis) and were operated by a qualified surgical specialist. Data analysis of anastomotic time, anastomotic leak was done and statistical tests of significance were applied. A p value less than 0.05 is considered as significant.Results: In group A (single layer) the time required to perform in 30 (60%) patients is between 16-20 minutes. In double layer, maximum were done in between 26 to 30 minutes, 32 (64%). In our study of 100 patients, there were 6 anastomotic leaks, of which four of them were in group A (single layer) and 2 of them in group B (double layer).Conclusions: In our study, the duration required to perform a single layer intestinal anastomosis is significantly lesser when compared to double layer. There is no significant difference in anastomotic leak between two groups. Less time with no difference in complications, a move towards single layer anastomosis should be preferred.

scholarly journals The role of glucomannan fiber in childhood functional constipation

2016 ◽  
Vol 56 (2) ◽  
pp. 95
Author(s):  
Indiana Aulia ◽  
Supriatmo Supriatmo ◽  
Emil Azlin ◽  
Atan Baas Sinuhaji
Keyword(s):  
Controlled Trial ◽  
Functional Constipation ◽  
Boarding School ◽  
Chi Square ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Rome Iii ◽  
Group A ◽  
Group B

its most common type is functional constipation. The dietary fiber may be useful in childhood functional constipation management, but unfortunately the role of fiber in functional constipation is still less developed.Objective To determine the role of glucomannan in treatment of childhood functional constipation.Methods A crossover randomized controlled trial (RCT) was done from May until July 2012 in a boarding school in Medan, North Sumatera. The subjects were children with functional constipation aged 7 to 12 years. Subjects were randomised into two group receiving glucomannan fiber as polysaccharide gel (group A) and maltodextrin as placebo (group B) with each dose of 100 mg/kg/day (maximum of 5 g/day) diluted in 50 ml water/500 mg for 4 weeks, then after a wash out period we did the crossover of the two groups. Frequency and consistency of stools were recorded into diary sheet for 4 and 8 weeks of treatment. Functional constipation has been diagnosed based on Rome III criteria. Data was analyzed using independent T-test and Chi-square test.Results A total of 36 subjects were eligible with each group consisting of 18 subjects and mean of weight of 25 kg. We found significant difference in stool frequency, treated on glucomannan with P= 0.002 before and P = 0.0001 after the wash out period. For stool consistency, we found difference while treated on glucomannan 9/18 (P= 0.034) in 4 weeks before and 11/18 (P = 0.008) in 4 weeks after the wash out period.Conclusion Glucomannan has significant effect to improve functional constipation especially in 4 weeks treatment.

scholarly journals Post-turbinectomy Nasal Packing with Merocel versus Glove Finger Merocel: A Prospective, Randomized, Controlled Trial

2018 ◽  
Vol 97 (3) ◽  
pp. 64-68 ◽  
Author(s):  
Rani Abu Eta ◽  
Ephraim Eviatar ◽  
Jacob Pitaro ◽  
Haim Gavriel
Keyword(s):  
Tranexamic Acid ◽  
Controlled Trial ◽  
Visual Analog Scale Score ◽  
Controlled Clinical Trial ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Significant Difference ◽  
Acid Consumption ◽  
Glove Finger ◽  
Group A

Nasal packs are widely used after septoplasty and turbinectomy. We conducted a prospective, randomized, controlled clinical trial including 100 patients who underwent septoplasty with/or without turbinectomy randomized into two groups. In the first group (the Merocel group), a standard tampon was inserted at the end of surgery. In the second group (the glove finger group), the tampon was first placed inside a glove finger. The main outcomes measured were pain and bleeding during the postoperative period and during tampon removal. Consumption of pain killers and tranexamic acid were also recorded. The mean visual analog scale score 12 hours after surgery and during tampon removal in the Merocel group were 6.78 and 8.92, respectively, compared to 4.06 and 5.27, respectively, in the glove finger group (p < 0.001). A statistically significant difference in the bleeding rate and tranexamic acid consumption during tampon removal in favor of the Merocel group was shown (p < 0.001). The use of Merocel in a glove finger is significantly less painful, although a higher chance of bleeding is reported. The influence of the surgeon's experience in using this technique needs further investigation.

scholarly journals Comparison of marsupialization under nasal endoscopy versus lacrimal probing for treatment of congenital dacryocystoceles: a report of 40 cases

2020 ◽  
Author(s):  
Yan-Hui Cui ◽  
Peng Sun ◽  
Li-Xing Tang ◽  
Cheng-Yue Zhang ◽  
Qian Wu ◽  
...  
Keyword(s):  
Success Rate ◽  
Reoperation Rate ◽  
Nasal Endoscopy ◽  
Controlled Study ◽  
Lacrimal Duct ◽  
Nasal Endoscope ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background: This study was performed to compare the efficacy of marsupialization under nasal endoscopy versus lacrimal probing for the treatment of congenital dacryocystocele. Methods: A prospective randomized controlled study. Forty neonates (43 eyes) diagnosed with congenital dacryocystoceles were divided into Group A (nasal endoscopic marsupialization) and Group B (lacrimal probing). The patients were followed up for 1 year after surgery. The efficacy, incidence of complications, and reoperation rate were compared between the two groups. Results: The male:female ratio was 25:15 patients (27:16 eyes). In Group A, the success rate was 100%, the incidence of complications was 5%, and the reoperation rate was 0%. In Group B, the success rate was 90%, the incidence of complications was 20%, and the reoperation rate was 30%. There was no significant difference in the success rate between the two groups, but the incidence of complications and the reoperation rate in the lacrimal probing group(Group B) were significantly higher than those in the nasal endoscopic marsupialization group(Group A). Conclusion: In the treatment of congenital dacryocystoceles, nasal endoscope marsupialization has the same success rate as lacrimal duct probing, but the former is more effective and safer in clinical practice.

scholarly journals Increase of PlGF (Placental Growth Factor) Level After Administration of Dydrogesterone in Pregnancy

KnE Medicine ◽  
2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Dewi Karlina Rusly
Keyword(s):  
Folic Acid ◽  
Controlled Clinical Trial ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Before And After ◽  
Group A ◽  
Study Population ◽  
The Mean ◽  
Group B ◽  
In Pregnancy

<p><strong>Aim:</strong> To observe the effect of Dydrogesterone administration in pregnancy on PlGF level</p><p><strong>Methods:</strong> This is a randomized controlled clinical trial. Study population has been divided into two groups. Group A consists of 20 women who receive only Folic acid 5 mg a day for 4 weeks time. Group B consists of 20 women who receive Dydrogesterone 2x10 mg a day and Folic acid 5 mg a day for 4 weeks. PlGF has been measured twice. First measurement was done before drug administration, while the second measurement has been done during 18<sup>th</sup> weeks of pregnancy. The changes on PlGF level before and after treatment from each group has been analyzed using SPSS 17.</p><p><strong>Results:</strong> 40 pregnant women have been recruited for this study. There are no differences based on the patient’s age, number of pregnancy and parity, gestational age and body weight between each group.  The mean levels of PlGF in both groups before intervention shows no significant difference (p = 0091 or p&gt; 0.05), 40.80 pg/mL vs.  25.95 pg / mL. The mean levels of PlGF in group A after 4 weeks administration of Folic acid is 89.60 pg / mL. It shows the escalation of 48.8 pg / mL. The elevation of PlGF level in group A shows significant difference (p = 0.000 or p &lt;0.05) after 4 weeks Folic acid treatment.The mean levels of PlGF in group B after 4 weeks administration of Dydrogesterone and Folic acid is 212.15 pg / mL. It shows the escalation of 186.20 pg / mL. The elevation of PlGF level in group B shows significant difference (p = 0.000 or p &lt;0.05) after 4 weeks Dydrogesterone and Folic acid treatment.</p><p><strong>Conclusion:</strong> Dydrogesterone treatment can increase the level of PlGF.</p>

scholarly journals Single layer versus double layer intestinal anastomoses: a comparative study

2020 ◽  
Vol 7 (9) ◽  
pp. 2991
Author(s):  
Ajit Kumar ◽  
Vinod Kumar
Keyword(s):  
Comparative Study ◽  
Anastomotic Leak ◽  
Double Layer ◽  
Intestinal Anastomosis ◽  
Single Layer ◽  
Anastomosis Group ◽  
Layer Versus ◽  
Intestinal Anastomoses ◽  
Significant Difference ◽  
End To End

Background: There are still conflicting views regarding suitability of single layer and double layer anastomotic technique. This prospective single blinded randomized comparative study conducted at Rajendra Institute of Medical Sciences to assess various aspects viz. safety, efficacy, duration of hospital stays and chances of perforation in single- and double-layer anastomotic surgery.Methods: 26 patients each in single layer and double layer anastomosis group were included in the study.  Single layer intestinal anastomosis was carried using extramucosal technique with 2-0 vicryl suture (round body). Double layer anastomosis was carried out using interrupted 3-0 silk lembert sutures for the outer layer and a continuous 2-0 vicryl for the inner layer. End to end colocolic, end to end ileocolic, end to side ileocolic, end to end ileoileal, side to side ileoileal, end to end jejunoileal and end to end jejunojejunal anastomosis were performed. Each group was compared for anastomotic leak, time required to construct the anastomosis, cost incurred, and length of hospital stay.Results: Findings of the study indicated that single layer is economical in comparison to double layer anastomosis and took significant less time to operate. There was no significant difference in hospital stay of the patients in two groups. There was no anastomotic leak in group-S (single layer) while one (3.8%) patient in group-D (double layer) suffered from anastomotic leak.Conclusions: It was concluded that single layer anastomosis method is beneficial and safe as it required less operative time, suturing material and no leak took place after surgery.

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