tailieunhanh - Improved Outcomes in Colon and Rectal Surgery part 37

Improved Outcomes in Colon and Rectal Surgery part 37. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | improved outcomes in colon and rectal surgery other anastomotic configurations after resection in Crohn s disease. Dis Col Rectum 2007 50 10 1674-87. 132. Landsend E Johnson E Johannessen H Carlsen E. Longterm outcome after intestinal resection for Crohn s disease. Scand J Gastroenterol 2006 41 10 1204-8. 133. Steele SR. Operative management of Crohn s disease of the colon including anorectal disease. Surg Clin North Am 2007 87 3 611-3. 134. Penner RM Madsen KL Fedorak RN. Postoperative Crohn s disease. Inflamm Bowel Dis 2005 11 8 765-77. 135. Yamamoto T. Factors affecting recurrence after surgery for Crohn s Disease. World J Gastroenterol 2006 11 26 3971-9. 136. Thaler K Dinnewitzer A Oberwalder M et al. Assessment of long-term quality of life after laparoscopic and open surgery for Crohn s disease. Colorectal Dis 2005 7 375-81. 137. Casellas F Vivancos JL Badia X Vilaseca J Malagelada JR. Impact of surgery for Crohn s disease on health-related quality of life. Am J Gastroenterol 2000 95 1 177-82. 348 33 Ostomies Vance Y Sohn and Scott R Steele CHALLENGING CASE A 55-year-old morbidly obese male undergoes a low anterior resection with concomitant defunctioning loop ileostomy for a T2 rectal cancer. Six weeks postoperatively he presents to the clinic with an obvious parastomal hernia that is easily reducible. He complains of worsening pain difficulty with application of his ostomy appliances and symptoms of intermittent obstruction. CASE MANAGEMENT In this patient the optimal management includes reversal of the ostomy after ensuring that the distal anastomosis has healed. This is usually confirmed by a contrast study often a gastrograf-fin enema or CT scan with rectal contrast. An ostomy reversal ameliorates and addresses all of the symptoms including the hernia obstruction and pain. After reversal the skin of the ostomy can be primarily closed however extreme vigilance of the wound is necessary secondary to an increased rate of local wound infection. Depending on .