Endoscopic colostomy with percutaneous colopexy: an animal feasibility study

Abstract

Background: Indications for colostomy in colorectal diseases are obstruction of the large bowel, such as in cancer, diverticular disease in the acute phase, post-radiotherapy enteritis, complex perirectal fistulas, anorectal trauma and severe anal incontinence. Some critically ill patients cannot tolerate an exploratory laparotomy, and laparoscopic assisted colostomy also requires general anesthesia.Objective: To evaluate the feasibility, safety and efficacy of performing colostomy assisted by colonoscopy and percutaneous colopexy.Materials and methods: Five pigs underwent endoscopic assisted colostomy with percutaneous colopexy. Animals were evaluated in post-operative days 1, 2, 5 and 7 for feeding acceptance and colostomy characteristics. On day 7 full colonoscopy was performed on animals followed by exploratory laparotomy.Results: Average procedure time was 27 minutes (21-54 min). Postoperative mobility and feeding of animals were immediate after anesthesia recovery. Position of the colostomy, edges color, appearance of periostomal area, as well as its function was satisfactory in four animals. Retraction of colostomy was present in one pig. The colonoscopy and laparotomy control on the seventh day were considered as normal. A bladder perforation that was successfully repaired through the colostomy incision occurred in one pig. The main limitation of this study is its experimental nature.Conclusion: Endoscopic assisted colostomy with percutaneous colopexy proves to be a safe and effective method with low morbidity for performing colostomy in experimental animals, with possible clinical application in humans.

Intra-abdominal desmoid tumors in familial adenomatous polyposis: How much do clinical and surgical variables interfere with their development?

“… 10 Similarly, a lower risk after IRA was identified one year later in a national French database (12% vs. 25%, p = 0.02). 15 On the other hand, other studies 13 , 24 , 27 demonstrated no differences between RPC and IRA, including one multicenter study 14 with 2260 patients and one meta-analysis containing 1260 patients. 28 In a retrospective review including 558 FAP patients only with IADT.…”

“…Besides the lack of standardization and treatment bias that may limit interpretation, it is possible to extract some ideas from single-centers 24 and multicenter retrospective studies 10 , 13 , 15 , 25 that addressed how the surgical approach could interfere with DT risk. This comparison identified only one study demonstrating a significant difference favoring laparoscopic surgery (4.3% vs. 13%, p = 0.04).…”

“…According to the Cleveland Clinic study, DT development is more likely to occur when pelvic dissection is included. 24 They believed that the ileal-pouch anastomosis caused mesenteric tension, a difficult-to-detect impact. However, this belief was disproved.…”

Manejo Quirúrgico del Prolapso Rectal

“…m Microcirugía Endoscópica Transanal (TEM) Esta técnica quirúrgica es utilizada en su mayoría para casos de prolapso rectal incompleto u oculto, donde el defecto es muy proximal al punto de inicio, siendo así más complicada o imposible la realización de un abordaje transperineal con engrapadora o Delamore. A los pacientes que presentan lo anteriormente descrito se les puede ofrecer manejo endoscópico, ya que, ha demostrado facilidad y seguridad del uso endoscopio para la fijación endoluminal del recto la cual ha demostrado menor tasa de hospitalización, menor tiempo de recuperación y que no tiene un efecto perjudicial a largo plazo sobre la función anorrectal; siendo una técnica quirúrgica mínimamente invasiva para el manejo del prolapso rectal oculto (14,25) .…”