Background: The most frequently encountered complication of anastomotic surgery is fistula. In addition to the medical history of the patient, local conditions, the operative moment and surgical technique that were chosen, a series of some other factors can interfere, leading to suture disunity. Aim: The aim of the study was to analyze the existence of a relationship between the use of cecostomy (as a mechanism of temporary diversion) and the frequency of anastomotic fistulas. Materials and methods: We conducted a retrospective study, over a period of 7 years, between 2011-2018 taking into consideration 194 patients who benefited from resections completed with anastomoses in the transverse colon, descending colon, sigmoid and rectum. They were divided into two categories: patients who benefited from cecostomy and patients for whom we did not use this technique. The frequency of fistulas was analyzed for the two main groups and in association with each type of surgery. Results: It was observed the existence of a relationship between the appearance of fistulas and the use of a decompression mechanism such as cecostomy in the sense of a lower number of fistulas for the first situation (2.66%) compared to 11.76% for cases without cecostomy (p=0.034). The duration of hospitalization in the group with cecostomy was shorter than in those without this derivative stoma and the postoperative recovery was good. Conclusions: Cecostomy is a useful protection for the anastomosis line, with the advantage that, when the tube is suppressed, the stoma will spontaneously close.
Gallstones disease (GD) is a common pathology, with an incidence of approx. 20% in developed countries, a third of these cases being symptomatic. The paper aims to identify the diagnostic and therapeutic features of acute manifestations of gallstones during the COVID-19 pandemic. Materials and method: A retrospective, comparative study was performed of the cases presented to the emergency room (ER) and hospitalized for acute manifestations of gallstones in April-June 2020 vs similar period of 2019. The data regarding clinical form, associated pathology, therapeutic management were analyzed from the ER presentation register, hospitalization sheets and surgical protocols. Results: During the COVID-19 pandemic, the number of hospitalized cases for acute cholecystitis and other acute manifestations of GD was significantly lower than in the same period last year (21 vs 49 patients). In both study groups the main form of presentation was acute catarrhal cholecystitis (52.4% vs 63.2%). During the SARS-Cov-2 pandemic, we report an increased incidence of complicated forms, mainly hydrops (23.8% vs. 4.1%, p <0.05) and angiocholitis (19% vs. 4.1%, p <0.05). Conservative treatment was chosen more frequently during the pandemic (48% vs. 29%). For operated patients, laparoscopic cholecystectomy was the main option, performed in 85.7% in both groups. Conclusions: We maintain that laparoscopic cholecystectomy remains the gold standard for acute cholecystitis, even in the COVID-19 pandemic, as it guarantees the best outcomes for the patients. Conservative management may be an option for mild cases, but it carries the risk of recurrence of symptoms and increased incidence of severe complications.
