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At least 415 records · Page 23Linked to original sources
PubMed2001

Previous cholecystectomy, gastrectomy, and diabetes mellitus are not crucial risk factors for pancreatic cancer in patients with chronic pancreatitis.

INTRODUCTION: In the general population, cholecystectomy, diabetes, and chronic pancreatitis seem to be associated with an increased risk of developing pancreatic cancer. AIMS: We assessed whether previous cholecystectomy, gastrectomy, or diabetes mellitus may be risk factors for pancreatic cancer in patients with chronic pancreatitis. METHODOLOGY: We analyzed 853 patients with chronic pancreatitis (110 women, 743 men) with a median follow-up period of 14 years with particular reference to establishing which patients had previously undergone cholecystectomy or distal gastric resection (Billroth II anastomosis) or had diabetes or gallstone disease and the respective time scales involved. RESULTS: Pancreatic cancer developed in 17 patients with chronic pancreatitis after a median period of 8 years from onset of pancreatitis symptoms (range, 3-38 years). Excluding two cholecystectomies performed 1 year before diagnosis of cancer, cholecystectomy was performed in 7/17 (41%) patients with pancreatic cancer and in 381/836 (46%) of the other patients with chronic pancreatitis. Forty-nine (10%) patients with chronic pancreatitis and no pancreatic cancer had undergone cholecystectomy during the years before the onset of chronic pancreatitis, whereas none of the patients in whom a pancreatic malignancy developed had undergone cholecystectomy before the onset of chronic pancreatitis symptoms. Gastrectomies were performed in 116 patients (14%), 47 before the onset of chronic pancreatitis. Only 2/17 patients with pancreatic cancer had undergone previous gastrectomy, though in both cases only shortly before diagnosis of the cancer. Diabetes was diagnosed in 353 patients, but only in 30 (4%) before onset of chronic pancreatitis. Only 1/17 patients (6%) with pancreatic cancer had long-standing diabetes, whereas diabetes developed in 3/17 shortly before diagnosis of pancreatic cancer. CONCLUSIONS: Cholecystectomy, gastrectomy, and diabetes are not major risk factors for the development of pancreatic cancer in patients with chronic pancreatitis.

Cholecystectomy↗
PubMed2003

Hand-assisted laparoscopic total gastrectomy.

Although the standard method to manage gastric cancer is still radical gastrectomy, minimally invasive surgery is of great interest in early gastric cancer because of its potential impact on improving the quality of life, if the disease is curable. With its degree of technical difficulty, laparoscopic total gastrectomy has not yet met with widespread acceptance. However, using a hand-access device, a total gastrectomy and Roux-en-Y esophagojejunostomy with a D1 plus alpha lymph node dissection and omentectomy with an Ultrashear was performed in its entirety. The operation took 6 hours, and the blood loss was 500 mL. The patient recovered uneventfully and was discharged on the 16th postoperative day. In terms of recovery and quality of life, laparoscopic total gastrectomy is a technically feasible and reasonable option for the management of early gastric cancer in the proximal stomach, especially when an endoscopic mucosal resection is not indicated.

Adenocarcinoma↗
PubMed2003

Hand-assisted laparoscopic total gastrectomy for early gastric cancer.

Laparoscopy-assisted distal gastrectomy has been applied to the treatment of early gastric cancer in Japan. However, there have been few reports on the laparoscopy-assisted total gastrectomy mainly because of the difficulty of the procedure. Here, we report a series of cases where hand-assisted laparoscopic total gastrectomies were performed successfully. The mobilization of the greater curvature was performed laparoscopically. About 7-cm mini-laparotomy was made at the epigastrium and duodenal transection was performed with linear stapler. After dissection of suprapyloric and anterosuperior lymph nodes was performed through the mini-laparotomy, dissection of lymph nodes along the celiac artery, and the left gastric artery was performed by hand-assisted laparoscopic surgery. Roux-en-Y reconstruction was performed through the mini-laparotomy. We successfully performed this procedure in 5 patients. The mean operating time and blood loss were 275 minutes and 177.5 mL, respectively. Hand-assisted laparoscopic total gastrectomy is suitable and feasible for early gastric cancer.

Adenocarcinoma↗
PubMed2005

Preoperative imaging of surrounding arteries by three-dimensional CT: is it useful for laparoscopic gastrectomy?

One of the difficulties in laparoscopic gastrectomy is the identification of the feeding artery of the stomach. Recently, 3-dimensional computed tomographic angiography has enabled the noninvasive visualization of arteries surrounding the stomach. Preoperative 3-dimensional computed tomographic angiography may facilitate laparoscopic gastrectomy by obtaining a road map of the arteries of the stomach. Twenty-nine cases of gastric cancer were evaluated using 3-dimensional computed tomographic angiography before surgery. Three-dimensional computed tomographic angiography showed the left gastric artery in 29 patients (100%), the right gastroepiploic artery in 29 patients (100%), the right gastric artery in 24 patients (82.8%), and the left gastroepiploic artery in 21 patients (72.4%). The aberrant hepatic artery was detected in 6 patients, and the variant of the right gastric artery and the variant of the left gastric artery were detected in 5 cases and 1 case, respectively. All laparoscopic gastrectomy procedures were performed successfully without conversion to open surgery. Preoperative 3-dimensional computed tomographic angiography was considered to be useful for laparoscopic gastrectomy.

Adenocarcinoma↗
PubMed2006

Clinical significance of hiatal hernia in the development of gastroesophageal reflux after distal gastrectomy for cancer of the stomach.

BACKGROUND AND AIMS: The relationship between gastroesophageal reflux disease and sliding hernia is controversial, especially following distal partial gastrectomy in patients with gastric cancer. The aim of this study was to examine the relationship between gastroesophageal reflux disease and sliding hernia of the esophagus after distal gastrectomy using the gastroesophageal scintigraphy and endoscopy. METHODS: Forty-five distal gastrectomy patients diagnosed with cancer of the stomach were studied. Twenty-five patients presented with reflux symptoms, such as heartburn and/or regurgitation and 20 patients exhibited no reflux symptoms. All of the patients were examined by gastroesophageal scintigraphy and their reflux indices were determined. Thirty-eight of the patients underwent upper endoscopy and both sliding hernias and reflux symptoms were classified as mild or severe. RESULTS: Sliding hernias were diagnosed in all of the subjects and 65.8% of the patients exhibited reflux symptoms. Evidence of endoscopic esophagitis was noted in only 39.5% of the patients. The reflux indices for the mild and severe hernia groups were 5.03 +/- 2.2 and 10.3 +/- 6.4, respectively (P < 0.05). More severely symptomatic esophagitis was prevalent in the severe hernia group in comparison to the mild group (P < 0.05). CONCLUSION: The results suggest that the onset of gastroesophageal reflux after distal gastrectomy is induced by the surgical procedures and that hiatal hernia may be an important factor in the etiology of reflux esophagitis.

Biopsy↗
PubMed2005

Chromoendoscopic surveillance in hereditary diffuse gastric cancer: an alternative to prophylactic gastrectomy?

BACKGROUND: Hereditary diffuse gastric cancer (HDGC) is defined by germline mutations in the E-cadherin gene, CDH-1. The first family in which CDH-1 mutations were identified was a large Maori kindred, where lifetime penetrance is 70%. Prophylactic gastrectomy is an unacceptable option for many mutation carriers. The results of annual chromoendoscopic surveillance using the methylene blue/congo red technique in 33 mutation carriers over a five year period are described. PATIENTS AND METHODS: Thirty three confirmed CDH-1 mutation carriers (18 males, 15 females), median age 32 years (range 14-69), were enrolled in 1999-2003. Medical records, endoscopy, and pathology were reviewed retrospectively. RESULTS: Over five years, 99 surveillance endoscopies were performed, of which 93 were chromo-dye enhanced. Sixty nine chromoendoscopies were normal. In 24 procedures, 1-6 pale areas/stomach (size 2-10 mm) were detected post chromo-dye application (totalling 56 pale lesions). One biopsy was taken from each pale lesion: 23 lesions (41%) showed signet ring cell carcinoma (10 patients), 10 lesions (18%) gastritis (four patients), and 23 (41%) normal mucosa (10 patients). No chromo-dyes were used in six procedures with macroscopic lesions (two HDGC, four ulceration). Total gastrectomies from patients with carcinoma were macroscopically normal but pathological mapping showed multiple microscopic foci of early signet ring cell carcinoma. Correlation of chromoendoscopic and gastrectomy findings showed that congo red/methylene blue detected carcinoma foci 4-10 mm in size but not foci <4 mm. CONCLUSIONS: The use of chromoendoscopy following normal white light gastroscopy facilitated detection of early gastric carcinoma foci not visible with white light gastroscopy. If these findings are validated in other HDGC kindred, chromogastroscopy represents an improved surveillance technique that can be safely considered alongside prophylactic gastrectomy.

Adolescent↗
PubMed1963

The reliability and reproducibility of the Schilling test in primary malabsorptive disease and after partial gastrectomy.

A study of the reproducibility and reliability of the Schilling test in patients with primary malabsorptive disease and after partial gastrectomy is reported. The value of the test was assessed by repeated tests in each patient. Consistently normal or abnormal results were obtained in only one of the seven patients with primary malabsorptive disease and in only two of the eight patients who had undergone partial gastrectomy. From these results it is concluded that the result of a single test may be of little clinical value. Assessment of the results suggests that the mean value for a series of Schilling tests may give some indication of value clinically about the capacity to absorb radioactive vitamin B(12) at the time of the tests at least in patients who have undergone partial gastrectomy. The significance of the findings is discussed, particularly in relation to the aetiology of post-gastrectomy megaloblastic anaemia.

Anemia, Macrocytic↗
PubMed1992

Partial gastrectomy and subsequent gastric cancer risk.

STUDY OBJECTIVE: The aim was to analyse the relationship between partial gastrectomy and gastric cancer risk. DESIGN: This was a case control study, using a structured questionnaire to obtain problem orientated medical history and sociodemographic data. SETTING: The study was conducted in a network of hospitals in the Greater Milan area between January 1985 and February 1990. SUBJECTS: Subjects were 563 incident cases of histologically confirmed gastric carcinoma (347 males, 216 females, median age 60 years, range 28 to 74) and 1501 controls (885 males, 626 females, median age 58 years, range 23 to 74) in hospital for acute, non-neoplastic, non-digestive-tract disorders. Less than 3% of cases or controls refused to be interviewed. MEASUREMENTS AND MAIN RESULTS: Relative risks (RR) and the corresponding 95% confidence intervals (CI) were determined, adjusted for age and sex plus area of residence, education, and smoking when specified. Within 20 years after gastrectomy, the relative risk of gastric cancer was not significantly raised (RR = 1.2, 95% CI 0.5-2.8), but a positive association emerged after longer time intervals. The RR was 1.6 (95% CI 0.7-4.1) after 20 to 29 years, and 3.5 (95% CI 1.3-10.0) after 30 years or more. These results were consistent in the two sexes and in the subsequent age groups, and not materially influenced by allowance for a number of identified potential confounding factors using multivariate analysis. CONCLUSIONS: The risk of gastric cancer is increased in the long term (20 years or more) after gastrectomy. This is explainable in terms of increased intragastric carcinogen formation following gastrectomy, and/or potential similarities in aetiological correlates of gastric ulcer and carcinoma of the stomach.

Adult↗
PubMed2000

Prevalence of upper abdominal complaints in patients who have undergone partial gastrectomy.

Little is known about the long term occurrence and prevalence of upper abdominal complaints after previous partial gastrectomy. Therefore, a retrospective, uncontrolled, cross-sectional, descriptive, clinical, endoscopic study was done. A questionnaire was mailed to patients who had undergone partial gastrectomy and been sent for upper gastrointestinal endoscopy. Eight questions were scored on a five-point Likert scale, and a symptom score was calculated. During the five-year study period, 189 patients (137 men, 52 women) were identified as having had a partial gastrectomy--143 (76%) received the Billroth II operation and 46 (24%) received the Billroth I operation. The questionnaire was mailed to 124 patients, of whom 79 (64%) responded. Eighty-eight per cent of patients had undergone surgery more than 15 years earlier. Fifty-nine patients (75%) suffered from upper abdominal symptoms. Regurgitation of food, retrosternal heartburn and bile reflux occurred significantly more often in patients who underwent the Billroth II operation. The mean symptom score of patients who underwent Billroth I resection was significantly lower (4.5 [SD 3.6]) than that of patients who underwent Billroth II resection (7.1 [SD 4.4])(P=0.04). One or more symptoms indicative of dumping were found in 70% of patients who underwent Billroth II resection and in 59% of patients who underwent Billroth I resection (not significant). Many patients who had undergone a partial gastrectomy developed upper abdominal symptoms during long term follow-up that were not specifically linked to dumping.

Cross-Sectional Studies↗
PubMed2005

Laparoscopic gastrectomy for cancer.

There are three procedures for the management of early gastric cancer (EGC): laparoscopic wedge resection (LWR), intragastric mucosal resection (IGMR), and laparoscopic gastrectomy. LWR or IGMR can be applied to treat EGC without the risk of lymph node metastasis. However, owing to the recent technical advances in endoscopic mucosal resection for EGC, the use of laparoscopic local resection for these lesions has gradually decreased. On the other hand, laparoscopic gastrectomy with lymph node dissection, such as laparoscopy-assisted distal gastrectomy, is widely accepted for the treatment of EGC with the risk of lymph node metastasis. To establish the acceptability of laparoscopic gastrectomy with D2 lymph node dissection against advanced gastric cancers, safe techniques and new instruments must be developed. The following advantages of laparoscopic surgery for the treatment of gastric cancer have been well demonstrated: clinical course after operation, pulmonary function, immune response. In the future, laparoscopic surgeons have to design and implement education and training systems for standard laparoscopic procedures, evaluate clinical outcomes by multicentric randomized control trial studies, and clarify the oncological aspects of laparoscopic surgery in basic studies.

Gastrectomy↗
PubMed2005

Diagnostic and therapeutic endoscopic retrograde cholangiopancreaticography after Billroth II gastrectomy--safe provision in a district general hospital.

INTRODUCTION: Endoscopic retrograde cholangiopancreaticography (ERCP) is available in many district general hospitals in the UK. Most of the published literature on ERCP in cases with Billroth II gastrectomy reflects teaching hospital experience. The aim of this study was to evaluate this procedure in the district general hospital setting, over a 10-year period. PATIENTS AND METHODS: Details of 41 consecutive patients, whom had previously undergone Billroth II gastrectomy and were referred for ERCP were analysed for presenting symptoms and outcome of their ERCP. All procedures were carried out by a single radiologist using a conventional Olympus side-viewing duodenoscope. RESULTS: 48 examinations and 44 therapeutic procedures were carried out in 41 cases. Afferent loop intubation and cannulation of ampulla was successful in 87.5% and 98%, respectively. Two episodes of minor bleeding occurred after sphincterotomy, not requiring blood transfusion. One case of afferent loop perforation (2%) was repaired surgically. There were no cases of pancreatitis or death in this series. DISCUSSION AND CONCLUSIONS: The results show that ERCP after a Bilroth II gastrectomy can be safe and successful in the majority of cases when carried out by clinicians with a special interest, including those in a district general hospital However, experience with this procedure will diminish due to fewer indications for Billroth II gastrectomy and emergence of magnetic resonance cholangiopancreatography. It may be advisable to concentrate this technique in a few designated centres with skill and expertise.

Aged↗
PubMed1991

Drug-resistant tuberculosis after gastrectomy. Double jeopardy?

Although an increased incidence of Mycobacterium tuberculosis infection is found in patients after subtotal gastrectomy, to my knowledge, the potential for gastrectomy to alter the course and outcome of typical mycobacterial disease has not been noted. I report the case of a patient who developed tuberculosis after a Billroth II subtotal gastrectomy, malabsorbed his antibiotics, and subsequently manifested infection with a drug-resistant strain of M tuberculosis. Altered drug pharmacokinetics should be considered as an important metabolic consequence of subtotal gastrectomy.

Aged↗
PubMed1995

[Effect of gastrectomy on gallbladder motility: an experimental study].

Gallstone formation is frequently seen following gastric surgery. Since dysmotility and bile stasis of the gallbladder is considered as an important factor in the pathogenesis of gallstone formation, altered gallbladder motility due to gastric surgery may have a role in the development of post-gastrectomy gallstone formation. To test this hypothesis, the effect of distal partial gastrectomy on gallbladder motility were studied. Gastroduodenal and gallbladder contractions were recorded by chronically implanted strain gauge transducers under conscious state. Gallbladder volume changes were monitored using chronically indwelling gallbladder catheter. Fasted and fed motility were studied in control (n = 5) and gastrectomized (n = 3) dogs. Plasma concentration of putative hormone CCK was measured. Effect of CCK-OP and motilin on gallbladder emptying were also studied. In fasted state, gallbladder volume was periodically decreased synchronous with phase 3 of interdigestive migrating contractions (IMC) in the gastroduodenum in both group of dogs. The correlation between gastric and gallbladder contractions was preserved even following distal partial gastrectomy, though the frequency of phasic contractions during phase 3 of IMC was decreased in the gastrectomized dogs. Postprandial gallbladder emptying tend to decreased in the gastrectomized dogs, while there were no difference in the postprandial plasma CCK concentrations and CCK-OP induced gallbladder emptying between groups. Digestive period was shortened in the gastrectomized dogs, which resulted in early gallbladder refilling and prolonged interdigestive period. Decreased frequency of gallbladder phasic contractions during IMC and prolonged interdigestive period could cause bile stasis in the gallbladder, which may, in part, explain post-gastrectomy gallbladder formation.

Animals↗
PubMed1975

[Photo-optical observation on gastric motility after antrum preserving gastrectomy (author's transl)].

UNLABELLED: The movement of the stomach after gastrectomy was studied by cine-fluoroscopic and photo-optical technique in patients undergoing pylorus preserving gastrectomy (pyloric canal being preserved approximately 1.5 cm in 8 cases; group A) or antrum preserving gastrectomy (pyloric antrum being preserved 3-5 cm in 16 cases; group B). All patients were operated on in our clinic for a benign lesion located near the angle of the stomach. RESULTS: 1) In the early postoperative period, the oral gastric remnants showed remarkable dilatation in group A. The dilatation was also observed in group B, but less prominent. 2) For the recovery from the gastric dilatation and reappearance of gastric motility, it took much more time in group A than in group B. 3) Co-ordinated movements across the anastomotic site were recognized about one month after operation in group B and about two months in group A. 4) Antiperistalsis at the preserved antrum during an early postoperative period was observed in 2 of 16 cases in group B. The antiperistalsis in the two cases turned into normo-peristalsis in about two months. 5) From the results obtained, the preserved antrum showed an excellent functional drainage effect and plays an important role for the transportation of the gastric content. 6) In conclusion, antrum preserving gastrectomy results in a good postoperative gastric motility and is an excellent operative method for the benign lesions located near the angle of the stomach.

Adult↗
PubMedDate not supplied

[Fat absorption after total gastrectomy in rats submitted to Roux-en-Y or Rosanov-like double-transit technique].

PURPOSE: Steatorrhea is one of the most common complications in reconstruction after total gastrectomy. Many reconstruction techniques after total gastrectomy have been developed in order to avoid these undesirable effects, but each one of them has some inconvenience. In this experiment, a modified Rosanov technique that keeps duodenal transit, evaluation of fat absorption after gastrectomy was tested. METHODS: Three groups of rats with the same characteristics were used. Total gastrectomy was performed in two groups: one was operated on and transit was reestablished by the Roux-en-Y technique (group Y), while the other was submitted to the modified Rosanov technique (group R). Following surgery, a handmade hyper fatty diet (11% of fat) was offered. A third group (control - group C) was not operated but was submitted to the same conditions of the other groups, and used for reference steatocrit values. The animals underwent laparotomy 14 days after surgery and had their feces collected from cecum to determine their steatocrit by analysis of their values. RESULTS: Steatocrit values for groups R and C (mean 5.16% and 4.15% respectively) were similar (p > 0.1), while group Y had significantly higher values (mean = 28.18%, p = 0.0001 - p < 0,05). This was attributed to the fact that group R animals had their duodenal transit patent, decreasing the complications expected in the Roux-en-Y reconstruction. CONCLUSIONS: Steatorrhea in the modified Rosanov technique was similar to the control group, while Roux-en-Y reconstruction presented higher steatorrhea and fat malabsorption.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

[Morphologic changes of the lesser gastric curvature after segmental gastrectomy associated to proximal gastric vagotomy. Experimental study in dogs].

UNLABELLED: The segmental gastrectomy of the body of the stomach, combined with proximal gastric vagotomy, has been indicated in the treatment of duodenal ulcer, especially in patients with major risk of the recurrent ulceration. PURPOSE: To evaluate the histopathologic changes, secondaries to combined corporeal segmental gastrectomy and proximal gastric vagotomy, in the lesser curvature of the stomach. METHODS: Thirty-six adult mongrel dogs weighing between 10 to 20 kg were divided into three groups of twelve animals each: Group I animals (control) were submitted to laparotomy and gastric manipulation; Group II, animals underwent proximal gastric vagotomy; and Group III, animals underwent corporeal segmental gastrectomy combined with proximal gastric vagotomy. Each group was subdivided into two subgroups of six animals each, and according to the subgroup, the animals were then sacrificed on the third or in the eighth postoperative day. A fragment of the lesser curvature was removed from each stomach for microscopic study. RESULTS: Regarding edema, vascular congestion, inflammatory exudate, fibrosis and cell damage; histopathologic changes found in animals sacrificed in the same postoperative day were slight in Group I, moderate in Group II and intense in the group III. Although nonspecific, the character and site of the lesions were similar to the ones occurring in ischemic process. It was also observed a directly proportional relation between severity of morphologic changes and ischemic potentiality of surgical procedure. CONCLUSION: The segmental gastrectomy probably aggravated the arterial blood supply of the remnant of lesser curvature of the stomach, which was already compromised by devascularization consequent to proximal gastric vagotomy.

Animals↗
PubMed2004

Preoperative assessment of vascular anatomy around the stomach by 3D imaging using MDCT before laparoscopy-assisted gastrectomy.

OBJECTIVE: Our aim was to evaluate the efficacy of 3D imaging using MDCT in the preoperative assessment of the vascular anatomy around the stomach before laparoscopy-assisted gastrectomy. SUBJECTS AND METHODS. Thirty-six consecutive patients scheduled for laparoscopy-assisted distal gastrectomy were evaluated on MDCT. CT was performed at the arterial phase after a bolus IV injection of contrast material. Three-dimensional CT angiography (3D CTA) of the arterial and venous systems was reconstructed separately using a volume-rendering algorithm, and the images were fused. Three-dimensional CTA for the left gastric, right gastric, and replaced left hepatic arteries and the left gastric coronary vein was evaluated prospectively by three reviewers, and then a surgical correlation was made. RESULTS: In all 36 cases, the left gastric artery was correctly identified on 3D CTA. In 35 of 36 cases, the right gastric artery was correctly identified, whereas in one case, the right gastric artery could not be visualized on 3D CTA because of its small size. In 35 of 36 cases (i.e., one case with agenesis of the left gastric coronary vein was excluded), the left gastric coronary vein was correctly identified. In six cases, the replaced left hepatic artery was correctly identified on 3D CTA. All 36 cases underwent successful laparoscopy-assisted distal gastrectomy on the basis of the 3D CTA. Both the sensitivity and positive predictive values of 3D CTA revealed 100% correct determination of the left gastric artery, replaced left hepatic artery, and left gastric coronary vein. The sensitivity and positive predictive values for the right gastric artery were 97% and 100%, respectively. CONCLUSION: Three-dimensional CTA using MDCT clearly revealed individual vascular anatomies around the stomach and could play an important role in safely facilitating the laparoscopy-assisted gastrectomy procedure.

Algorithms↗
PubMed1990

Postoperative subphrenic abscess following gastrectomy for gastric cancer.

From 1985 to 1989, a total of 598 gastric cancer patients underwent gastrectomies in the First Department of Surgery at Kurume University School of Medicine. Of these, 24 patients (4.0%) incurred a subphrenic abscess, postoperatively. Subphrenic abscesses occurred most frequently after total gastrectomies at a rate of 17 of 197 (8.8%) cases. Leaking gastrointestinal anastomoses were responsible for 12 of the 17 (70.5%) abscesses. In 384 cases of distal gastrectomy, only 6 (1.6%) cases with a subphrenic abscess occurred, and only 3 were due to anastomotic leakage. Among the total of 24 cases with subphrenic abscesses, 16 (67%) were related to an anastomotic leakage including a pancreatic fistula, while the other 8 (33%) showed no leakage by contrast roentgenography. When chest roentgenography shows a pleural effusion and an elevation of the diaphragm, then a subphrenic abscess must be suspected. The majority of patients were treated by replacing the intraabdominal drainage catheter inserted during the gastrectomy with a larger catheter. The overall operative mortality rate was 4.1% due to a death in only one (MOF) patient.

Adult↗