No abstract

Esophageal leiomyoma is a rare disease commonly reported in middle-aged patients with a male predominance. Many patients are asymptomatic, and a few may present with symptoms such as dysphagia and chest pain. However, heartburn is only reported in patients with accompanying hiatal hernia. We hereby report a giant lower esophageal leiomyoma with concomitant hiatal hernia in a young Vietnamese female, who presented with refractory gastroesophageal reflux symptoms. The diagnosis was challenging as the tumor grew outward. As a consequence, the patient did not experience dysphagia and the tumor was hardly detected under endoscopy. The hiatal hernia in this patient was probably related to the presence of the leiomyoma. It is important to look carefully for submucosal tumor at the lower esophagus and cardia under endoscopy in patients with similar manifestations.

Background: To perform a one-stage operation safely in selected patients with left-sided colonic obstruction, many surgeons have considered intraoperative colonic irrigation as an indispensable step. Recently, studies have shown that step is unnecessary. The aim of this study was to identify the early results of a one-stage operation without intraoperative colonic irrigation in the treatment of left-sided colonic obstruction. Methods: This case series included patients who had resectable left-sided colonic obstruction and were admitted to Nhan Dan Gia Dinh Hospital from January 2008 to December 2018. All patients were treated by one-stage operation without intraoperative colonic irrigation. The early results were described, focusing on mortality, anastomotic-related complications, operative time and length of hospital stay. Results: There were 74 patients with a mean age of 50 years (range 20–81 years). Colorectal cancer accounted for 86.4% of cases. The median operative time was 158 ± 42 min (range 65–285 min). One patient (1.4%) died on postoperative day 6 due to pneumonia and multiorgan failure. Three patients (4.1%) had major anastomotic leakage, 4 patients (5.4%) had minor anastomotic leakage, 9 patients (12.2%) had wound infection, 4 patients (5.4%) had intraabdominal fluid collection, and 1 patient (1.4%) had an early adhesive small bowel obstruction. The median length of hospital stay was 9 ± 3 days (range 5–24 days). The method was successful in 70/74 patients (94.6%). Conclusions: With properly selected patients and experienced GI surgeons, a one-stage operation without intraoperative colonic irrigation is an effective and safe alternative for resectable left-sided colonic obstruction. Highlights:

Background: In 2018, the Enhanced Recovery After Surgery (ERAS) Society recommended against routine drainage after colorectal surgery. However, the evidence is relatively old and few studies were performed in low-to-middle income country (LMIC) setting. This study aimed to compare outcomes of laparoscopic colectomy with and without prophylactic drainage for colon cancer.Methods: A retrospective study was performed from 2018 to 2021 with patients who underwent laparoscopic colectomy with D3 lymphadenectomy for colon cancer. The use of prophylactic drainage was depended on routine practice of surgeons. Outcomes were postoperative complications and postoperative hospital length of stay. The drain and no-drain groups were compared using propensity score-matched (PSM) analysis.Results: The study included 143 patients (59 in the drain group and 84 in the no-drain group). The PSM resulted in 94 patients (47 in each group). Median age was 62 years. The most frequent was right hemicolectomy (33.6%), followed by left hemicolectomy (32.2%), sigmoid colectomy (21%), extended right hemicolectomy (9.8%), transverse hemicolectomy (2.1%), and total colectomy (1.4%). Postoperative hospital stay was significantly shorter in the no-drain group (median of 5 versus 6 days). The no-drain group also had lower rate of complications (23.8% versus 30.5% and 23.4% versus 34% before and after matching respectively) and less severe complications based on Clavien-Dindo classification, but the difference was not significant.Conclusions: Laparoscopic colectomy without prophylactic drainage is safe in the treatment of colon cancer. This approach can shorten postoperative hospital stay and should be applied even in the LMIC setting.Main novel aspect: Laparoscopic colectomy without prophylactic drainage for colon cancer can be applied in low-to-middle income settings.