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Diverticular disease consists of diverticulosis and diverticulitis. Diverticulosis is commonly encountered, and approximately 4% of patients with diverticulosis will progress to develop diverticulitis, which represents a significant health care burden in the United States. Diverticular disease has an increasing incidence both in the United States and globally as important risk factors, including obesity, are becoming more prevalent. The pathophysiology of diverticular disease remains incompletely understood, although geographic and population-based differences in its prevalence and anatomic distribution have generated several hypotheses as to the impact of genetic and environmental factors on development and disease progression. Uncomplicated diverticulitis has had a low mortality rate for the last several decades, but in-hospital mortality approaches 7% for patients with complicated diverticulitis who require emergent surgery. For patients that develop diverticulitis, recent population-based data have led to an improved understanding of which patients will suffer recurrent episodes. This knowledge has facilitated informed discussions with patients and has changed practice in terms of elective surgery.
Diverticular disease consists of diverticulosis and diverticulitis. Diverticulosis is commonly encountered, and approximately 4% of patients with diverticulosis will progress to develop diverticulitis, which represents a significant health care burden in the United States. Diverticular disease has an increasing incidence both in the United States and globally as important risk factors, including obesity, are becoming more prevalent. The pathophysiology of diverticular disease remains incompletely understood, although geographic and population-based differences in its prevalence and anatomic distribution have generated several hypotheses as to the impact of genetic and environmental factors on development and disease progression. Uncomplicated diverticulitis has had a low mortality rate for the last several decades, but in-hospital mortality approaches 7% for patients with complicated diverticulitis who require emergent surgery. For patients that develop diverticulitis, recent population-based data have led to an improved understanding of which patients will suffer recurrent episodes. This knowledge has facilitated informed discussions with patients and has changed practice in terms of elective surgery.
Rectal diverticula are extremely rare with an incidence of less than 0.1% of colonic diverticular disease cases, and the factors that contribute to their evolution are poorly understood. Majority of the cases are diagnosed incidentally, and they are usually clinically asymptomatic and carry a low risk of developing complications; therefore, treatment is not required in most cases. Surgery is generally performed only in the event of complications or when they become symptomatic, such as with the development of obstructive defecation with an impacted fecalith within the diverticulum. As it is a rare entity, there is currently no consensus on the surgical management of rectal diverticulum. Here, we describe a novel and effective method of surgical management of rectal diverticulum utilizing transanal minimally invasive surgery.
BACKGROUND: Postoperative complications of colorectal cancer surgery contribute to increased morbidity and mortality in patients. OBJECTIVES: Investigate the role of biochemical markers in serum and peritoneal fluid in the development of postoperative complications in patients with enteral anastomosis. DESIGN: Prospective. SETTING: University hospitals. PATIENTS AND METHODS: The studied population consisted of patients who underwent surgical treatment with created anastomosis or Hartmann's resection from April 2022 to April 2024, conducted at the Clinical-Hospital Center Kosovska Mitrovica and the University Clinical Center Kragujevac. Spearman's correlation coefficient (r s ) was used to test associations between categorical variables. MAIN OUTCOME MEASURES: Lactate, albumin, lactate dehydrogenase, and IgA antibodies were monitored as predictors of anastomotic dehiscence and general postoperative complications. SAMPLE SIZE: 52 RESULTS: The concentration of lactate in the drain fluid on the third postoperative day was statistically significantly higher in patients who did not develop anastomotic dehiscence ( P =.006). The concentration of IgA antibodies in the drain fluid on the third and fifth days post-surgery showed a moderate negative correlation with lactate concentration (r s =-.670, P =.012; r s =-.577, P =.039), repectively. There was a significantly higher concentration of albumin in the drain fluid on the third day post-surgery in patients who developed dehiscence ( P =.040), and on the seventh day post-surgery in those who did not develop dehiscence ( P =.001). The concentration of LDH on the third day in the drain fluid after surgery was statistically significantly higher in patients who did not develop dehiscence ( P =.020). There was a statistically significant difference in lactate concentration in the drain fluid on the third ( P <.001) and fifth days ( P =.041) post-surgery, as well as in albumin concentration on the third day post-surgery ( P =.024) with respect to the development of general postoperative complications. CONCLUSION: This study revealed significant differences in the concentrations of lactate, albumin, and LDH in the drain fluid on the third and fifth days post-surgery with respect to the development of complications. These results suggest that monitoring these markers may help in the early identification of patients at risk of complications such as dehiscence. LIMITATIONS: Limited literature on specific aspects of this study, including the absence of a control group, small sample size, and two-center study.
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