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Chikhladze S, Kupreishvili S, Korsake K, Sick O, Fink J, Seifert G, Läßle C, Nenova G, Höppner J, Glatz T, Fichtner-Feigl S, Marjanovic G. Recurring Anastomotic Leak-A Prospective Clinicopathological Investigation of a Distinct Disease Pattern. J Surg Res 2019; 239:201-207. [PMID: 30851519 DOI: 10.1016/j.jss.2019.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/14/2019] [Accepted: 02/06/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Intestinal anastomotic insufficiency (AI) is a common problem in visceral surgery associated with overexpression of matrix metalloproteinases (MMPs). In some patients it occurs more than once. The etiology of recurring anastomotic insufficiency (RAI) is not understood yet and should be addressed as an independent disease entity. MATERIALS AND METHODS Thirty nine consecutive patients with AI were treated at our university center and were included in this prospective study. Clinical data were evaluated by correlative statistical analysis to identify independent risk factors for RAI. Patients were divided in two groups: 18 patients had a single operative revision until restoration (group SAI), and 21 patients had two or more revisions (group RAI). Anastomotic tissue samples as well as untouched bowel wall were collected during reoperations for analysis of MMPs and tissue inhibitor of metalloproteinases (TIMP2). Clinical data were correlated with pathological observations. RESULTS Significant differences of clinical and molecular pathological data were found between the two groups. Transfusion of red blood cells until the first reoperation and alcohol abuse led to RAI and were the only independent risk factors for RAI in multivariate analysis. Overexpression of MMP-8, -9, and -13 in anastomotic tissue correlated with the administration of red blood cells during initial operation. Reduced expression of TIMP2 was frequent in nearly all patients without differences throughout the subgroups. CONCLUSIONS RAI seems to have an independent disease pattern. Transfusion of blood products is not only a known risk factor for AI but seems to significantly disturb the anastomotic healing process leading to RAI.
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Affiliation(s)
- Sophia Chikhladze
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany.
| | - Shota Kupreishvili
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany
| | - Kristina Korsake
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany
| | - Olivia Sick
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany
| | - Jodok Fink
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany
| | - Gabriel Seifert
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany
| | - Claudia Läßle
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany
| | - Gergana Nenova
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany
| | - Jens Höppner
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany
| | - Torben Glatz
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany
| | - Goran Marjanovic
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Center for Surgery, Freiburg, Germany
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152
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Financial Impact of Anastomotic Leakage in Colorectal Surgery. J Gastrointest Surg 2019; 23:580-586. [PMID: 30215201 DOI: 10.1007/s11605-018-3954-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/26/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anastomotic leakage after colorectal surgery is a complication that requires additional treatments strongly affecting the economic outcomes. We evaluated the use of resources and the economic burden associated with anastomotic leaks following colorectal surgery. METHODS Between January 2015 and December 2016, we retrospectively evaluated patients who underwent colorectal surgery with primary anastomosis. We compared the medical resource utilization and the DRG-based reimbursement of cases with uncomplicated surgery and cases complicated by anastomotic leakage. RESULTS Of the 95 patients included in the study, 87 (92%) presented an uneventful postoperative course and 8 patients (8%) developed an anastomotic leakage requiring surgery. The statistical analysis showed no significant differences in terms of demographics, risks factor, and operative results, except the length of hospital stay (9.7 vs. 29.1 days, p < 0.01). The cost for 87 uncomplicated cases was 1,535,297 EUR (average cost of 17,647 EUR), whereas the cost of the 8 patients with anastomotic leakage was 575,822 EUR (average cost of 71,978 EUR) (p < 0.01). For each patient, the hospital had 542 EUR profit in the uncomplicated group and a 12,181 EUR loss in the anastomotic leakage group (p < 0.01). The multiple R-squared line regression analysis showed that factors independently related to costs were age (p = 0.05) and length of hospital stay (p = 0.01). CONCLUSIONS In terms of economic impact, the occurrence of an anastomotic leakage has a large negative influence on medical resource utilization, so that, despite the complication-related increase of DRG-reimbursement, every complicated case represents a financial burden for the hospital.
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153
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Quick and simple; psoas density measurement is an independent predictor of anastomotic leak and other complications after colorectal resection. Tech Coloproctol 2019; 23:129-134. [PMID: 30790102 PMCID: PMC6441102 DOI: 10.1007/s10151-019-1928-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/17/2019] [Indexed: 12/19/2022]
Abstract
Background Radiologically defined sarcopenia has been shown to predict negative outcomes after cancer surgery, however radiological assessment of sarcopenia often requires additional software and standardisation against anthropomorphic data. Measuring psoas density using hospital Picture Archiving and Communication Systems (PACS), universally available in the UK, may have advantages over methods requiring the use of additional specialist and often costly software. The aim of this study was to assess the association between radiologically defined sarcopenia measured by psoas density and postoperative outcome in patients having a colorectal cancer resection. Methods All patients having a resection for colorectal cancer, discussed by the colorectal multi-disciplinary team in one institution between 1/1/15 and 31/12/15, were retrospectively identified. Mean psoas density at the level of the L3 vertebra was analysed from preoperative computed tomography (CT) scans to define sarcopenia using the Picture Archiving and Communication Systems (PACS). Postoperative complications and mortality were recorded. Results One hundred and sixty-nine patients had a colorectal resection for cancer and 140 of these had a primary anastomosis. Ninety-day mortality and 1-year mortality were 1.1% and 7.1%, respectively. Eighteen (10.7%) patients suffered a Clavien–Dindo grade 3 or 4 complication of which 6 (33%) were anastomotic leaks. In the whole cohort, sarcopenia was associated with an increased risk of Clavien–Dindo grade 3 or 4 complications [adjusted OR 6.33 (1.65–24.23) p = 0.007]. In those who had an anastomosis, sarcopenia was associated with an increased risk of anastomotic leak [adjusted OR 14.37 (1.37–150.04) p = 0.026]. Conclusions A quick and easy radiological assessment of sarcopenia by measuring psoas density on preoperative CT scan using software universally available in the UK is highly predictive of postoperative morbidity in colorectal cancer patients.
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154
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Colorectal surgery in Italy: a snapshot from the iCral study group. Updates Surg 2019; 71:339-347. [PMID: 30747374 DOI: 10.1007/s13304-018-00612-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/28/2018] [Indexed: 12/24/2022]
Abstract
During a recent prospective trial on early diagnosis of anastomotic leakage (AL) after colorectal surgery, we gathered a large database on more than 1500 procedures performed in 19 surgical centers in Italy over a 12-month period. Main purpose of the present paper is to show the epidemiological data about colorectal procedures and anastomotic leakage. Prospective enrollment for all elective colorectal resections with anastomosis (September 2017-September 2018). Primary endpoint was AL; secondary endpoints were morbidity and mortality rates, readmission and reoperation rates, and length of post-operative hospital stay (ClinicalTrials.gov; Identifier: NCT03560180). There were 1546 enrolled cases (56.9% of 2717 total resected cases). The rate of minimally invasive resections was 83.5%. Overall AL rate was 4.92% (76 cases; range per center 0-12.12%). Mean ± SD time to AL diagnosis was 5.95 ± 4.78 days (median 5, range 1-31). Overall morbidity rate was 30.20%, mortality 1.29% (20 cases; range per center 0-3.27), readmission 0.90%, and reoperation 6.92%. Mean ± SD post-operative LOS was 7.89 ± 5.97 days (median 6; range 1-120). AL significantly influenced all other secondary endpoints. This study offers a good snapshot of colorectal resections in Italy. There was a high rate of laparoscopic resections, reflecting the special interest in this kind of surgery by the participating centers. AL, morbidity, mortality, readmission and reoperation rates are compared to those reported in previous population-based studies. Compared to series dealing with open colorectal resections, the time to diagnosis of AL was shortened by several days.
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155
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Felder S, Lee JT. Techniques for Colorectal Anastomotic Construction Following Proctectomy and Variables Influencing Anastomotic Leak. CURRENT COLORECTAL CANCER REPORTS 2019. [DOI: 10.1007/s11888-019-00425-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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156
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Sims SM, Kao AM, Spaniolas K, Celio AC, Sippey M, Heniford BT, Kasten KR. Chronic immunosuppressant use in colorectal cancer patients worsens postoperative morbidity and mortality through septic complications in a propensity-matched analysis. Colorectal Dis 2019; 21:156-163. [PMID: 30244521 DOI: 10.1111/codi.14432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/17/2018] [Indexed: 12/27/2022]
Abstract
AIM Chronic immunosuppressant use increases the risk of septic complications after colectomy; however, adverse effects on other organ systems remain poorly understood. The aim of this study was to evaluate the multisystem organ effect(s) of chronic immunosuppressant(s) in colorectal cancer patients. METHODS This was a retrospective study. The American College of Surgeons National Surgical Quality Improvement database (2005-2012) was queried. The primary end-points were 30-day mortality and 30-day morbidity after colectomy in patients on chronic immunosuppressant(s) compared to a non-immunosuppressant cohort. RESULTS In total, 50 766 patients were identified, with 1203 (2.4%) taking chronic immunosuppressant(s). After propensity matching, 1197 patients in each cohort were evaluated with no differences seen in age, body mass index, male sex, wound classification, emergency case status, the presence of preoperative sepsis or operative time. On outcome analysis, 30-day mortality (5.7% vs 3.4%, P < 0.001) and 30-day overall morbidity (35.4% vs 29.0%, P = 0.001) were higher in patients on chronic immunosuppressant(s). Septic complications (10.6% vs 7.9%, P = 0.02) and surgical site infections (15.3% vs 12.3%, P = 0.03) were elevated with chronic immunosuppressant(s). There were no differences in cardiovascular, pulmonary, renal or neurological complications. Chronic immunosuppressant patients demonstrated longer total hospital stay (11.4 ± 11.7 vs 9.5 ± 9.4 days, P < 0.001) and postoperative length of stay (9.4 ± 9.2 vs 8.1 ± 7.6 days, P < 0.001). The limitation was that this was a retrospective study using a clinical dataset. CONCLUSION In this study, immunosuppressant use is associated with worsened infective complications, without contributing to organ-specific complications following colectomy. Significant thought should be given to anastomosis vs stoma creation to possibly prevent worsened morbidity and mortality. Future study is required to determine specific pathways for risk reduction.
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Affiliation(s)
- S M Sims
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - A M Kao
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - K Spaniolas
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Health Sciences Center, Stony Brook Medicine, Stony Brook, New York, USA
| | - A C Celio
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - M Sippey
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - B T Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - K R Kasten
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
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Machida E, Miyakura Y, Takahashi J, Tamaki S, Ishikawa H, Hasegawa F, Kikugawa R, Tsujinaka S, Lefor AK, Rikiyama T. Bevacizumab is associated with delayed anastomotic leak after low anterior resection with preoperative radiotherapy for rectal cancer: a case report. Surg Case Rep 2019; 5:14. [PMID: 30706233 PMCID: PMC6357210 DOI: 10.1186/s40792-019-0573-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/21/2019] [Indexed: 12/14/2022] Open
Abstract
Background Bevacizumab is an anti-angiogenesis agent used to treat patients with metastatic colorectal cancer and is associated with a variety of complications. We present a patient with rectal cancer who developed a delayed anastomotic leak more than 5 years after undergoing low anterior resection. Case report A 78-year-old man with hematochezia was diagnosed with two synchronous rectal cancers 7 years prior to presentation. Preoperative chemo-radiotherapy was given followed by a very low anterior resection. During follow-up, multiple lymph node metastases developed, which were treated with chemotherapy. First-line chemotherapy, capecitabine, oxizaliplatin, and bevacizumab, was given over 3 years, and second-line chemotherapy, capecitabine, irinotecan, and bevacizumab, was administered over a 3-month period. After the last treatment, the patient presented with pneumaturia and fecaluria. Computed tomography scan revealed extraluminal air between the prostate and rectum, adjacent to the anastomotic site. Ulceration and fistula formation were observed on colonoscopy, and contrast radiography demonstrated a fistula at the anastomotic site. An anastomotic-urethral fistula was diagnosed and transverse colostomy was performed. Conclusions This patient highlights a rare late adverse event at the anastomotic site associated with bevacizumab treatment and preoperative chemo-radiotherapy. Signs and symptoms suggesting anastomotic complications should be thoroughly evaluated during bevacizumab treatment, even long after surgical resection.
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Affiliation(s)
- Erika Machida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitamashi, Saitamaken, 330-8503, Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitamashi, Saitamaken, 330-8503, Japan.
| | - Jun Takahashi
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitamashi, Saitamaken, 330-8503, Japan
| | - Sawako Tamaki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitamashi, Saitamaken, 330-8503, Japan
| | - Hideki Ishikawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitamashi, Saitamaken, 330-8503, Japan
| | - Fumi Hasegawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitamashi, Saitamaken, 330-8503, Japan
| | - Rina Kikugawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitamashi, Saitamaken, 330-8503, Japan
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitamashi, Saitamaken, 330-8503, Japan
| | | | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitamashi, Saitamaken, 330-8503, Japan
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159
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Nakamoto H, Nishikawa M, Ishikawa T, Yokoyama R, Taketomi A. Simultaneous Laparoscopic Cholecystectomy and Combined Endoscopic and Laparoscopic Surgery for an Endoluminal Tumor of the Sigmoid Colon: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1-4. [PMID: 30598519 PMCID: PMC6323652 DOI: 10.12659/ajcr.911974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patient: Female, 70 Final Diagnosis: An endoluminal tumor Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Hiroki Nakamoto
- Department of Surgery, Abashiri-Kosei General Hospital, Abashiri, Hokkaido, Japan
| | - Makoto Nishikawa
- Department of Surgery, Abashiri-Kosei General Hospital, Abashiri, Hokkaido, Japan
| | - Takahisa Ishikawa
- Department of Surgery, Abashiri-Kosei General Hospital, Abashiri, Hokkaido, Japan
| | - Ryouji Yokoyama
- Department of Surgery, Abashiri-Kosei General Hospital, Abashiri, Hokkaido, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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160
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Applications of indocyanine green-enhanced fluorescence in laparoscopic colorectal resections. Updates Surg 2018; 71:83-88. [DOI: 10.1007/s13304-018-00609-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022]
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161
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de Bruin AFJ, Tavy ALM, van der Sloot K, Smits A, Ince C, Boerma EC, Noordzij PG, Boerma D, van Iterson M. Can sidestream dark field (SDF) imaging identify subtle microvascular changes of the bowel during colorectal surgery? Tech Coloproctol 2018; 22:793-800. [PMID: 30413998 DOI: 10.1007/s10151-018-1872-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/20/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recognition of a non-viable bowel during colorectal surgery is a challenging task for surgeons. Identifying the turning point in serosal microcirculatory deterioration leading up to a non-viable bowel is crucial. The aim of the present study was to determine whether sidestream darkfield (SDF) imaging can detect subtle changes in serosal microcirculation of the sigmoid after vascular transection during colorectal surgery. METHODS A prospective observational clinical study was performed at a single medical centre. All eligible participants underwent laparoscopic sigmoid resection and measurements were taken during the extra-abdominal phase. Microcirculation was measured at the transected bowel and 20 cm proximal to this point. Microcirculatory parameters such as Microvascular Flow Index (MFI), proportion of perfused vessels (PPV), perfused vessel density (PVD), total vessel density (TVD) and the Heterogeneity Index were determined. Data are presented as median (interquartile range) or mean ± standard deviation. RESULTS A total of 60 SDF images were acquired for 10 patients. Perfusion parameters and perfused vessel density were significantly lower at the transected bowel compared with the non-transected measurements [MFI 2.29 (1.96-2.63) vs 2.96 (2.73-3.00), p = 0.007; PPV 74% (55-83) vs 94% (86-97), p = 0.007; and PVD 7.61 ± 2.99 mm/mm2 versus 10.67 ± 1.48 mm/mm2, p = 0.009]. Total vessel density was similar between the measurement locations. CONCLUSIONS SDF imaging can identify changes of the bowel serosal microcirculation. Significantly lower serosal microcirculatory parameters of the vascular transected bowel was seen compared with the non-transected bowel. The ability of SDF imaging to detect subtle differences holds promise for future research on microvascular cut-off values leading to a non-viable bowel.
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Affiliation(s)
- A F J de Bruin
- Department of Anesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands.
| | - A L M Tavy
- Department of Anesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands
| | - K van der Sloot
- Department of Anesthesiologie and Pain Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | - A Smits
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - C Ince
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - E C Boerma
- Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - P G Noordzij
- Department of Anesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands
| | - D Boerma
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - M van Iterson
- Department of Anesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands
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162
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The effects of intraoperative ICG fluorescence angiography in laparoscopic low anterior resection: a propensity score-matched study. Int J Clin Oncol 2018; 24:394-402. [DOI: 10.1007/s10147-018-1365-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/31/2018] [Indexed: 12/22/2022]
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163
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Epidermal Cell Sheet Transplantation on an Anastomotic Site of the Small Intestine in an Experimental Animal Model. Int Surg 2018. [DOI: 10.9738/intsurg-d-18-00008.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective:
The present study was performed to examine the effects of anastomotic site tissue reconstruction by transplantation of epidermal cell sheets onto the small intestine in an animal model. Cell sheet engineering using cell sheets are used to construct monolayers and bilayers, which are then transplanted into organs. Clinical trials of the application of cell sheets to the cornea, esophagus, lung, and heart muscle are currently underway.
Methods:
The small intestine in female pig (20 kg) was cut 1.5 cm vertically at 6 points at 10-cm intervals, and Gambee sutures were applied at 5-mm intervals. The suture line was covered by epidermal cell sheets. Resection was performed 1 week after the operation.
Results:
Cell sheets applied to sutures in the small intestine survived and differentiated 1 week after transplantation. The small intestine showed marked thickening in the region of cell sheet transplantation, and the amount of connective tissue in the transplanted specimens was 2.54 times that in controls.
Conclusions:
Further studies are necessary to identify the strength of anastomosis and substances that may enhance collagen synthesis and healing at sites of anastomosis.
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164
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Woo IT, Park JS, Choi GS, Park SY, Kim HJ, Park IK. Clinical Outcomes of a Redo for a Failed Colorectal or Coloanal Anastomosis. Ann Coloproctol 2018; 34:259-265. [PMID: 30419724 PMCID: PMC6238803 DOI: 10.3393/ac.2018.05.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/04/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose Redo surgery in patients with a persistent anastomotic failure (PAF) is a rare procedure, and data about this procedure are lacking. This study aimed to evaluate the surgical outcomes of redo surgery in such patients. Methods Patients who underwent a redo anastomosis for PAF from January 2004 to November 2016 were retrospectively evaluated. Data from a prospective colorectal database were analyzed. Success was defined as the combined absence of any anastomosis-related complications and a stoma at the last follow-up. Results A total of 1,964 patients who underwent curative surgery for rectal cancer during this study period were included. Among them, 32 consecutive patients underwent a redo anastomosis for PAF. Thirteen patients of those 32 had major anastomotic dehiscence with a pelvic sinus, 12 had a recto-vaginal fistula, and 7 had anastomosis stenosis. There were no postoperative deaths. The median operation time was 255 minutes (range, 80–480 minutes), and the median blood loss was 80 mL (range, 30–1,000 mL). The overall success rate was 78.1%, and the morbidity rate was 40.6%. Multivariable analyses showed that the primary tumor height at the lower level was the only statistically significant risk factor for redo surgery (P = 0.042; hazard ratio, 2.444). Conclusion In our experience, a redo anastomosis is a feasible surgical option that allows closure of a stoma in nearly 80% of patients. Lower tumor height (<5 cm from the anal verge) is the only independent risk factor for nonclosure of defunctioning stomas after primary rectal surgery.
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Affiliation(s)
- In Teak Woo
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - In Kyu Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
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165
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Dinallo AM, Kolarsick P, Boyan WP, Protyniak B, James A, Dressner RM, Arvanitis ML. Does routine use of indocyanine green fluorescence angiography prevent anastomotic leaks? A retrospective cohort analysis. Am J Surg 2018; 218:136-139. [PMID: 30360896 DOI: 10.1016/j.amjsurg.2018.10.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/10/2018] [Accepted: 10/08/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Insufficient perfusion to anastomoses in colorectal surgery is known to lead to complications. This study aims to evaluate whether routine use of fluorescence angiography (FA) alters the incidence of anastomotic leaks after colorectal surgery. METHODS This was a retrospective study of 554 colorectal resections with and without the use of intraoperative fluorescence angiography. Anastomotic leak rates and whether angiography altered surgical management were the main outcomes measured. RESULTS The anastomotic leak rate was found to be 1.3% both with and without use of FA (p > 0.05). Significantly more alterations were made to planned anastomotic site in FA group (n = 13, 5.6%) as compared to the group prior to use of FA in whom no alterations were made (p < 0.05). CONCLUSIONS No significant difference was found in anastomotic leak rates between the two groups studied. Routine use of fluorescence angiography significantly altered intra-operative decision-making without discernible change in clinical outcome.
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Affiliation(s)
| | - Paul Kolarsick
- Monmouth Medical Center, 300 2nd Ave, Long Branch, NJ, 07740, USA
| | - William P Boyan
- Monmouth Medical Center, 300 2nd Ave, Long Branch, NJ, 07740, USA
| | - Bogdan Protyniak
- Geisinger Wyoming Valley Medical Center, 1000 E Mountain Blvd, Wilkes-Barre, PA, 1871, USA
| | - Abi James
- Monmouth Medical Center, 300 2nd Ave, Long Branch, NJ, 07740, USA
| | - Roy M Dressner
- Monmouth Medical Center, 300 2nd Ave, Long Branch, NJ, 07740, USA
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166
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Necrotizing Fasciitis Resulting from an Anastomotic Leak after Colorectal Resection. Case Rep Surg 2018; 2018:8470471. [PMID: 30305977 PMCID: PMC6164207 DOI: 10.1155/2018/8470471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/21/2018] [Accepted: 08/29/2018] [Indexed: 11/21/2022] Open
Abstract
One of the most feared complications in colorectal surgery is an anastomotic leak (AL) following a colorectal resection. While various recommendations have been proposed to prevent this potentially fatal complication, anastomotic leaks still occur. We present a case of an AL resulting in a complicated and fatal outcome. This case demonstrates the importance of high clinical suspicion, early recognition, and immediate management.
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167
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Lyra Junior HF, de Lucca Schiavon L, Rodrigues IK, Couto Vieira DS, de Paula Martins R, Turnes BL, Latini AS, D'Acâmpora AJ. Effects of Ghrelin on the Oxidative Stress and Healing of the Colonic Anastomosis in Rats. J Surg Res 2018; 234:167-177. [PMID: 30527470 DOI: 10.1016/j.jss.2018.09.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/20/2018] [Accepted: 09/12/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Anastomotic leakage is the deadliest complication of colonic procedures. Ghrelin is an orexigenic hormone with potent actions on growth hormone release and functions in the processes of growth, tissue inflammation, repair, and oxidative stress. We evaluated the hypothesis that the exogenous administration of ghrelin causes beneficial effects on the healing of colonic anastomosis. MATERIALS AND METHODS Sixty-four male Wistar rats were randomly assigned to eight subgroups receiving postoperative intraperitoneal administration of ghrelin (23 μg/kg/d) or saline after a colonic anastomosis. The anastomotic tissue was evaluated on the third, seventh, and 14th postoperative days. Anastomotic bursting pressure, histological parameters, hydroxyproline content, and tissue oxidative stress markers were compared. RESULTS There was a significant increase in the mean anastomotic bursting pressure in the ghrelin subgroup on the seventh postoperative day (P = 0.035). Histological evaluation demonstrated a significant difference in the neutrophilic infiltrate (P = 0.035) on the third and 14th d and in apoptosis (P = 0.004), granulation tissue (P = 0.011) and peritoneal inflammation (P = 0.014) on the 14th postoperative day. There was a statistically significant increase in the hydroxyproline content in the ghrelin subgroup on the 14th postoperative day (P = 0.043). There were significant differences in the nitrite tissue levels (P = 0.021) on day 3 and in reactive oxygen species (P = 0.012) on day 14. CONCLUSIONS The administration of ghrelin had beneficial anti-inflammatory and antioxidant effects, increasing the resistance of the anastomosis and the hydroxyproline tissue content in the postoperative period.
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Affiliation(s)
| | - Leonardo de Lucca Schiavon
- Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Igor Kunze Rodrigues
- Department of Surgery, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | | | - Roberta de Paula Martins
- Department of Biochemistry, Bioenergetics and Oxidative Stress Laboratory, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Bruna Lenfers Turnes
- Department of Biochemistry, Bioenergetics and Oxidative Stress Laboratory, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Alexandra Susana Latini
- Department of Biochemistry, Bioenergetics and Oxidative Stress Laboratory, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Armando José D'Acâmpora
- Department of Surgery, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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168
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Alexeev MV, Shelygin YA, Rybakov EG. [Prevention of colorectal anastomotic leakage by using of intraoperative fluorescent angiography: prospective trial data]. Khirurgiia (Mosk) 2018:47-51. [PMID: 30199051 DOI: 10.17116/hirurgia201808247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM To evaluate the effect of intraoperative fluorescent angiography on the incidence of colorectal anastomosis failure. MATERIAL AND METHODS Prospective, non-comparative study included 52 patients with rectal or sigmoid cancer who underwent surgery with stapled colorectal anastomosis. Intraoperative fluorescent angiography with indocyanine green was performed to determine colon perfusion. All patients underwent proctography with water-soluble contrast agent in 6-8 days after surgery in order to determine anastomotic leakage. RESULTS Fluorescent angiography was followed by changed volume of proximal colectomy in 14 (27%) patients due to inadequate blood supply of intestinal wall at previous surgical level. Additionally, 1-5 cm of intestinal wall were excised. Postoperative anastomotic leakage occurred in 3 (5.8%) patients. CONCLUSION Fluorescent angiography with indocyanine green is accompanied by reduced incidence of anastomotic failure in colorectal suregry.
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Affiliation(s)
- M V Alexeev
- Ryzhikh State Research Coloproctology Center of Healthcare Ministry of Russia; Russian Medical Academy of Continuing Professional Education of Healthcare Ministry of Russia
| | - Yu A Shelygin
- Ryzhikh State Research Coloproctology Center of Healthcare Ministry of Russia; Russian Medical Academy of Continuing Professional Education of Healthcare Ministry of Russia
| | - E G Rybakov
- Ryzhikh State Research Coloproctology Center of Healthcare Ministry of Russia
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169
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Barlas AM, Kuru S, Kismet K, Cavusoglu T, Bag YM, Senes M, Cihan N, Celepli P, Unal Y, Hucumenoglu S. Rectal application of argan oil improves healing of colorectal anastomosis in rats1. Acta Cir Bras 2018; 33:565-576. [PMID: 30110058 DOI: 10.1590/s0102-865020180070000002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/20/2018] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To investigate the possible effects of argan oil on the healing of colorectal anastomoses. METHODS n Group 1 (sham), laparotomy was performed and the colon was mobilized. In the control (Group 2) and argan oil (Group 3) groups, colonic resection and anastomosis were applied. To the control and sham groups, 2 mL of 0.9% NaCl was administred rectally, and in the argan oil group, 2 mL/day argan oil was applied rectally for 7 days. RESULTS The mean bursting pressures of the argan oil and sham groups were significantly higher than the values in the control group. A significant difference was determined between the tissue hydroxyproline and prolidase levels of control group and other groups. Histopathologically, argan oil showed significant beneficial effects on colonic wound healing. In the argan oil and sham groups, the tissue malondialdehyde and fluorescent oxidation product levels were found to be lower and total sulfhydryl levels were higher than the control group. CONCLUSIONS The rectally administered argan oil was observed to have significantly ameliorated wound healing parameters and exerted a significant antioxidant effect. This is the first study in the literature about the beneficial effects of argan oil on colorectal anastomoses.
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Affiliation(s)
- Aziz Mutlu Barlas
- MD, General Surgeon, Ankara Education and Research Hospital, Department of General Surgery, Ankara, Turkey. Conception and design of the study
| | - Serdar Kuru
- Associate Professor, Ankara Education and Research Hospital, Department of General Surgery, Ankara, Turkey. Design of the study and analysis of data
| | - Kemal Kismet
- Associate Professor, Ankara Education and Research Hospital, Department of General Surgery, Ankara, Turkey. Design of the study and manuscript writing
| | - Turgut Cavusoglu
- Associate Professor, Ankara Education and Research Hospital, Department of General Surgery, Ankara, Turkey. Critical revision
| | - Yusuf Murat Bag
- MD, General Surgeon, Ankara Education and Research Hospital, Department of General Surgery, Ankara, Turkey. Design of the study
| | - Mehmet Senes
- Associate Professor, Ankara Education and Research Hospital, Department of Biochemistry, Ankara, Turkey. Performed the biochemical analyses
| | - Neslihan Cihan
- MD, Biochemist, Ankara Education and Research Hospital, Department of Biochemistry, Ankara, Turkey. Performed the biochemical analyses
| | - Pinar Celepli
- MD, Pathologist, Ankara Education and Research Hospital, Department of Pathology, Ankara, Turkey. Histopathological examinations
| | - Yilmaz Unal
- MD, General Surgeon, Ankara Education and Research Hospital, Department of General Surgery, Ankara, Turkey. Conception of the study and interpretation of data
| | - Sema Hucumenoglu
- Full Professor, Ankara Education and Research Hospital, Department of Pathology, Ankara, Turkey. Histopathological examinations
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170
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Mangano A, Gheza F, Giulianotti PC. Iatrogenic spleen injury during minimally invasive left colonic flexure mobilization: the quest for evidence-based results. MINERVA CHIR 2018; 73:512-519. [DOI: 10.23736/s0026-4733.18.07737-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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171
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Indocyanine green fluorescence angiography: a new ERAS item. Updates Surg 2018; 70:427-432. [DOI: 10.1007/s13304-018-0590-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022]
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172
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Indocyanine green fluorescence angiography during low anterior resection for low rectal cancer: results of a comparative cohort study. Tech Coloproctol 2018; 22:535-540. [DOI: 10.1007/s10151-018-1832-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/31/2018] [Indexed: 01/06/2023]
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173
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Osland E, Memon B, Memon MA. Pharmaconutrition administration on outcomes of elective oncological surgery for gastrointestinal malignancies: is timing everything?-a review of published meta-analyses until the end of 2016. Transl Gastroenterol Hepatol 2018; 3:52. [PMID: 30225386 DOI: 10.21037/tgh.2018.07.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/30/2018] [Indexed: 01/01/2023] Open
Abstract
The last 25 years have seen an increasing number of publications attesting the benefits of pharmaconutrition in the management of patients undergoing elective oncological gastrointestinal surgery. A number of randomized controlled trials and meta-analyses suggest the use of pharmaconutrition in this group of patients produces superior outcomes to standard nutritional formulations in terms of postoperative infective complications, anastomotic breakdown and length of hospital stay. The use of pharmaconutrition products, therefore, has gained increasing acceptance for use in elective gastrointestinal oncological surgical populations and been incorporated into practice guidelines. However, there remains doubts as to the robustness of such data supporting these recommendation. This is because studies reporting improved outcomes with pharmaconutrition (I) frequently compare this intervention with non-equivalent control groups; (II) do not report on the actual nutritional provision received by study participants; (III) overlook the potential impact of industry funding on research conducted and (IV) do not adopt a multi-disciplinary approach to the research undertaken. For these reasons, a critical re-appraisal of the use and recommendations of pharmaconutrition in this group of patients is urgently warranted to resolve some of the above mentioned issues. The aim of this review was to analyse meta-analyses published until the end of 2016 in this area to highlight the strengths and weakness of the present research and prioritize certain areas which will benefit from future research.
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Affiliation(s)
- Emma Osland
- Department of Nutrition, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Breda Memon
- Sunnybank Obesity Centre, McCullough Centre, Sunnybank, Queensland, Australia
| | - Muhammed Ashraf Memon
- Sunnybank Obesity Centre, McCullough Centre, Sunnybank, Queensland, Australia.,Mayne Medical School, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Agricultural, Computational and Environmental Sciences, International Centre for Applied Climate Sciences and Centre for Health Sciences Research, University of Southern Queensland, Toowoomba, Queensland, Australia.,Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK
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174
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Risk Factors and Oncologic Outcomes of Anastomosis Leakage After Laparoscopic Right Colectomy. Surg Laparosc Endosc Percutan Tech 2018; 27:440-444. [PMID: 28915207 DOI: 10.1097/sle.0000000000000471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE We estimated the incidence of anastomosis leakage and explore possible risk factors and oncologic outcomes following laparoscopic right-side colon resection among colon cancer patients. MATERIALS AND METHODS We retrospectively analyzed 423 patients who were diagnosed with appendiceal, cecal, ascending, or hepatic flexure colon cancer who underwent laparoscopic colonic resection and anastomosis between September 2006 and July 2014. We compared short-term and long-term outcomes between no-leakage and leakage groups. RESULTS There were 16 cases of right-side anastomosis leakage in a total 423 colon cancer cases (3.78%). The risk of leakage was increased in smokers (odds ratio=6.592, P=0.007) and with a longer operating time (odds ratio=1.024, P<0.001). There were no significant differences between the groups in local recurrence (P=0.106), overall survival (P=0.055), or cancer-specific survival (P=0.235). CONCLUSIONS Smoking and long operating time are risk factors for right-side colon anastomosis. There were no significant differences in oncologic outcomes.
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175
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Cikot M, Kasapoglu P, Isiksacan N, Binboga S, Kones O, Gemici E, Kartal B, Alis H. The importance of presepsin value in detection of gastrointestinal anastomotic leak: a pilot study. J Surg Res 2018; 228:100-106. [DOI: 10.1016/j.jss.2018.02.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/14/2018] [Accepted: 02/27/2018] [Indexed: 02/07/2023]
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176
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Abstract
BACKGROUND Sigmoid volvulus is an uncommon cause of bowel obstruction that is historically associated with high morbidity and mortality. The objective of this study was to evaluate contemporary management of sigmoid volvulus and the safety of primary anastomosis in patients with sigmoid volvulus. METHODS The National Surgical Quality Improvement Project from 2012 to 2015 was queried for patients with colonic volvulus who underwent left-sided colonic resection. A propensity score-matched analysis was performed to compare patients with sigmoid volvulus undergoing colectomy with primary anastomosis without proximal diversion to colectomy with end colostomy. RESULTS Two thousand five hundred thirty-eight patients with sigmoid volvulus were included for analysis. Patients had a median age of 68 years (interquartile range, 55-80) and 79% were fully independent preoperatively. Fifty-one percent of operations were performed emergently. One thousand eight hundred thirteen (71%) patients underwent colectomy with anastomosis, 240 (10%) colectomy with anastomosis and proximal diversion, and 485 (19%) colectomy with end colostomy. Overall, 30-day mortality and morbidity were 5 and 40%, respectively. After propensity score matching, mortality, overall morbidity, and serious morbidity were similar between groups. CONCLUSIONS Sigmoid volvulus occurs in elderly and debilitated patients with significant morbidity, mortality, and lifestyle implications. In selected patients, anastomosis without proximal diversion in patients with sigmoid volvulus results in similar outcomes to colectomy with end colostomy.
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177
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Assessment of Bowel End Perfusion After Mesenteric Division: Eye Versus SPY. J Surg Res 2018; 232:179-185. [PMID: 30463716 DOI: 10.1016/j.jss.2018.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 05/02/2018] [Accepted: 06/01/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Anastomotic complications related to tissue ischemia cause morbidity in gastrointestinal (GI) surgery. Surgeons' standard practice to predict bowel perfusion is inspection of mesenteric perfusion before anastomosing bowel ends. Augmenting this assessment with fluorescent imaging is under study. A standardized system to evaluate this imaging has not yet been developed. This study compared the surgeon's intraoperative assessment to a novel GI-specific imaging analysis method. MATERIALS AND METHODS Forty-nine consecutive patients undergoing open or laparoscopic-assisted bowel resections were enrolled. After mesenteric division, the surgeon marked the site for bowel transection. Near-infrared fluorescence imaging was performed on the marked bowel ends. Imaging analysis identified theoretical transection sites based on the quantification of arterial and microvascular inflow (Perfusion) and venous outflow (Timing). The primary outcome was the measured disparity between the site marked by the surgeon using current standard of care parameters and the imaging-determined site. No clinical outcomes were assessed. RESULTS Seventy-two bowel end segments from 46 patients were analyzed. Disparity was found in 11 of 72 (15%) bowel end segments. In five (7%), the disparity was due to either Perfusion or Timing (single), and in six (8%), due to both Perfusion and Timing (combined). In the single disparity group, the median disparity distance was 2.0 cm by Perfusion and 4.0 cm by Timing, and in the combined group, 3.8 cm by Perfusion and 3.5 cm by Timing. Disparity (either single or combined) was in 25% of colon and 11.5% of small bowel (P = NS). Combined and single disparity had equivalent lengths of disparity distance (P = NS). CONCLUSIONS Imaging coupled with this GI-specific analysis provides objective, real-time, and interpretable data of intramural blood supply. A 15% disparity rate from current clinical practice was observed.
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178
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Patel Z, Thaha MA, Kyriacou PA. The effects of optical sensor-tissue separation in endocavitary photoplethysmography. Physiol Meas 2018; 39:075001. [PMID: 29894308 DOI: 10.1088/1361-6579/aacc1d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Intestinal anastomotic failure that occurs mainly due to ischaemia is a serious risk in colorectal cancer patients undergoing surgery. Surgeons continue to rely on subjective methods such as visual inspection to assess intestinal viability during surgery and there are no clinical tools to directly monitor viability postoperatively. A dual-wavelength reflectance optical sensor has been developed for continuous and dynamic monitoring of intestinal viability via the intestinal lumen. Maintaining direct contact between the sensor and the inner intestinal wall can be difficult in an intraluminal design, therefore impacting on signal acquisition and quality. This paper investigates the effect of direct contact versus variable distances between the sensor and the tissue surface of the buccal mucosa as a surrogate. APPROACH The in vivo study involved 20 healthy volunteers to measure the effect of optical sensor-tissue distances on the ability to acquire photoplethysmography signals and their quality. Signals were acquired from the buccal mucosa at five optical sensor-tissue distances. MAIN RESULTS Distances between 0 mm (contact) to 5 mm were the most optimal, producing signals of high quality and signal-to-noise ratio, resulting in reliable estimations of the blood oxygen saturation. Distances exceeding 5 mm compromised the acquired signals, and were of poor quality, thereby unreliably estimating the blood oxygen saturation. SIGNIFICANCE The developed optical sensor proved to be reliable for acquiring photoplethysmography signals for cases where distances between the optical sensor-tissue may arise during the assessment of intraluminal intestinal viability.
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Affiliation(s)
- Zaibaa Patel
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Science & Engineering, City, University of London, London, United Kingdom. Author to whom any correspondence should be addressed
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179
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Daglioglu YK, Duzgun O, Sarici IS, Ulutas KT. Comparison of platelet rich plasma versus fibrin glue on colonic anastomoses in rats. Acta Cir Bras 2018; 33:333-340. [PMID: 29768536 DOI: 10.1590/s0102-865020180040000005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 03/23/2018] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To compare platelet rich plasma (PRP) and fibrin glue about the effect of anastomotic healing. METHODS Thirty six Wistar-Albino male rats diveded into 3 groups according to control(Group1), PRP (Group 2) and fibrin glue(Tisseel VH) (Group 3). The colon was transected with scissor and subsequently an end to end anastomosis was performed using continuous one layer 6/0 vicryl sutures. Postoperative 7th day effect of anastomotic healing measuring with tissue hydroxyproline(TH) level and anastomotic bursting pressure(ABP); moreover comparison of cytokine (IL-6 and IL-10) and procalcitonin levels on 1st,3rd and 7th days. RESULTS There was no statistically significant difference of the ABP and hydroxyproline levels between PRP and fibrin glue on the 7th day. There was no statistically significant difference between levels of proinflammatory cytokine (IL-6) (P=0.41), anti-inflammatory cytokine (IL-10) (P=0.35), and procalcitonin levels (P=0.63) on 1, 3 and 7 days. CONCLUSION Fibrin glue and platelet rich plasma are shown to be effective in healing intestinal anastomoses without superior to each other.
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Affiliation(s)
- Yusuf Kenan Daglioglu
- Associate Professor, Department of Experimental Medical Research and Application Center, Faculty of Medicine, Cukurova University, Adana, Turkey. Critical revision
| | - Ozgul Duzgun
- MD, Department of Surgical Oncology, Umraniye Training and Research Hospital, Istanbul, Turkey. Conception, design, scientific, and intellectual content of the study; technical procedures
| | - Inanc Samil Sarici
- MD, Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey. Statistical analysis, manuscript writing, final approval
| | - Kemal Turker Ulutas
- MD, Department of Clinical Biochemistry, Kadirli State Hospital, Osmaniye, Turkey. Interpretation of data, critical revision
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180
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Gulcicek OB, Solmaz A, Yigitbas H, Ercetin C, Yavuz E, Ozdogan K, Biricik A, Akkalp AK, Uzun H, Kutnu M, Celebi F, Celik A. Role of diclofenac sodium and paracetamol on colonic anastomosis: An experimental rodent model. Asian J Surg 2018; 41:264-269. [DOI: 10.1016/j.asjsur.2017.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/26/2016] [Accepted: 01/05/2017] [Indexed: 02/07/2023] Open
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181
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Costales AB, Patil D, Mulya A, Kirwan JP, Michener CM. 2-Octylcyanoacrylate for the prevention of anastomotic leak. J Surg Res 2018; 226:166-172. [PMID: 29661283 DOI: 10.1016/j.jss.2018.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/08/2018] [Accepted: 01/17/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anastomotic leak after colorectal surgery is a significant cause of morbidity and mortality. The aim of this study was to evaluate the impact of a reinforced colo-colonic anastomosis with tissue adhesive, 2-octylcyanoacrylate (2-OCA), on the integrity of anastomotic healing as measured by anastomotic bursting pressure. METHODS Sixty-eight female Sprague-Dawley rats underwent a rectosigmoid colon transection and a sutured end-to-end anastomosis followed by randomization to receive no further intervention or reinforcement with the tissue adhesive, 2-OCA. After seven postoperative days, a macroscopic assessment of the anastomosis, mechanical assessment to determine anastomotic bursting pressure, and a detailed semi-quantitative histopathologic healing assessment were performed. RESULTS Thirty-four animals were randomized to each group. Study characteristics did not differ between the groups. There was also no difference in the degree of adhesions present postoperatively. Although there was no difference between the net proximal and distal luminal areas in the two groups (0.37 cm2versus 0.55 cm2, P = 0.26), the 2-OCA group exhibited evidence of stricture in 15% of anastomoses as compared with 3% in the suture-only group (P < 0.0001). Histologically, the presence of only fibroblasts density was statistically more evident in the 2-OCA group compared with the sutured-only anastomosis (P = 0.0183). There was not a significant increase in mechanical strength in the 2-OCA group (238.9 mm Hg) versus in the suture-only group (231.8 mm Hg). There was no difference in the rate of anastomotic leak in the 2-OCA as compared with the suture-only group (9.1 versus 8.8%). CONCLUSIONS Application of 2-OCA to reinforce a colo-colonic anastomosis clinically provides no benefit to its mechanical strength and detrimentally increases the rate of obstruction and/or stricture in this in vivo model.
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Affiliation(s)
- Anthony B Costales
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Deepa Patil
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Anny Mulya
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - John P Kirwan
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Chad M Michener
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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182
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Özçay N, Özdemir H, Besim H. Role of platelet-rich fibrin on intestinal anastomosis wound healing in a rat. ACTA ACUST UNITED AC 2018; 13:045006. [PMID: 29565259 DOI: 10.1088/1748-605x/aab8e1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of the present study is to investigate the role of platelet-rich fibrin (PRF) on the intestinal anastomotic wound healing in a mesenteric ischemia/reperfusion (I/R) rat model. METHODS Forty male Sprague Dawley rats were allocated into four groups: Group I (n = 10): anastomosis to normal bowel; Group II (n = 10): anastomosis after I/R injury; Group III (n = 10): anastomosis and PRF; Group IV: anastomosis after I/R and PRF. Animals were followed up for 7 days, then sacrificed. Anastomotic complications, anastomosis bursting pressures and histopathologic evaluations of the anastomoses were the study parameters. RESULTS The I/R injury caused more anastomotic adhesion and very low anastomotic bursting pressure when compared with the other groups (p < 0.01). Application of PRF onto the bowel, however, dramatically decreased the local complications and significantly increased the anastomosis bursting pressures (p < 0.01). Histologic evaluation of the anastomoses showed almost complete healing in all animals. The mean histologic scores of the animals were not different between the groups. CONCLUSION PRF has a beneficial effect on the intestinal healing process by prevention of local complications and increases the tensile strain of the anastomosis. This effect was more prominent, particularly when healing is disrupted. Therefore, we conclude that PRF could be an alternative treatment option to prevent anastomotic complications for elderly, co-morbid and emergency patients.
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Affiliation(s)
- Necdet Özçay
- Department of General Surgery, Near East University, Nicosia, Cyprus
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183
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Lee JA, Chico TJA, Renshaw SA. The triune of intestinal microbiome, genetics and inflammatory status and its impact on the healing of lower gastrointestinal anastomoses. FEBS J 2018; 285:1212-1225. [PMID: 29193751 PMCID: PMC5947287 DOI: 10.1111/febs.14346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/07/2017] [Accepted: 11/24/2017] [Indexed: 12/11/2022]
Abstract
Gastrointestinal resections are a common operation and most involve an anastomosis to rejoin the ends of the remaining bowel to restore gastrointestinal (GIT) continuity. While most joins heal uneventfully, in up to 26% of patients healing fails and an anastomotic leak (AL) develops. Despite advances in surgical technology and techniques, the rate of anastomotic leaks has not decreased over the last few decades raising the possibility that perhaps we do not yet fully understand the phenomenon of AL and are thus ill-equipped to prevent it. As in all complex conditions, it is necessary to isolate each different aspect of disease for interrogation of its specific role, but, as we hope to demonstrate in this article, it is a dangerous oversimplification to consider any single aspect as the full answer to the problem. Instead, consideration of important individual observations in parallel could illuminate the way forward towards a possibly simple solution amidst the complexity. This article details three aspects that we believe intertwine, and therefore should be considered together in wound healing within the GIT during postsurgical recovery: the microbiome, the host genetic make-up and their relationship to the perioperative inflammatory status. Each of these, alone or in combination, has been linked with various states of health and disease, and in combining these three aspects in the case of postoperative recovery from bowel resection, we may be nearer an answer to preventing anastomotic leaks than might have been thought just a few years ago.
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Affiliation(s)
- Jou A. Lee
- Department of Infection Immunity and Cardiovascular DiseaseThe Bateson CentreUniversity of SheffieldUK
| | - Timothy J. A. Chico
- Department of Infection Immunity and Cardiovascular DiseaseThe Bateson CentreUniversity of SheffieldUK
| | - Stephen A. Renshaw
- Department of Infection Immunity and Cardiovascular DiseaseThe Bateson CentreUniversity of SheffieldUK
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Assessment of MMP-2/-9 expression by fluorescence endoscopy for evaluation of anastomotic healing in a murine model of anastomotic leakage. PLoS One 2018; 13:e0194249. [PMID: 29566031 PMCID: PMC5863981 DOI: 10.1371/journal.pone.0194249] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 02/27/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Disturbance of intestinal wound closure leads to insufficient anastomotic healing and is associated with considerable morbidity following colorectal resections. Matrix metalloproteinases (MMPs) play a crucial role in regulation of wound closure. Here fluorescence endoscopy was evaluated for assessment of MMP-2/-9 expression during failed intestinal anastomotic healing. METHODS Distal colonic anastomoses were performed as a model for disturbed healing in 36 Balb/c mice. Healing was evaluated endoscopically, macroscopically, and histologically after 1, 3 and 5 days. For detection of MMP-2/-9 expression fluorescence endoscopy (FE) was used following i.v.-administration of a Cy5.5-labeled MMP-2/-9 specific tracer. FE was complemented by quantification of the fluorescence signal using the MS-FX PRO Optical Imaging System. An overall leakage score was calculated and correlated with the results of FE. RESULTS With increasing incidence of anastomotic leakage from POD1 (17%) to POD5 (83%) the uptake of the MMP tracer gradually increased (signal-to-noise ratio (SNR), POD1: 17.91 ± 1.251 vs. POD3: 30.56 ± 3.03 vs. POD5: 44.8 ± 4.473, P<0.0001). Mice with defective anastomotic healing showed significantly higher uptake compared to non-defective (SNR: 37.37± 3.63 vs. 26.16± 3.635, P = 0.0369). White light endoscopy and FE allowed evaluation of anastomotic healing and visualization of mucosal MMPs in vivo. Using FE based detection of MMPs in the anastomosis, an overall positive predictive value of 71.4% and negative predictive value of 66.6% was calculated for detection of anastomotic leakage. CONCLUSION During disturbed anastomotic healing increased expression of MMP-2/-9 was observed in the anastomotic tissue. Fluorescence endoscopy for detection of MMP-2/-9 during the healing process might be a promising tool for early identification of anastomotic leakage.
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Educational Benefits of Intraoperative Indocyanine Green Angiography for Surgical Beginners During Laparoscopic Colorectal Surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.7602/jmis.2018.21.1.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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186
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Lyra Junior HF, Rodrigues IK, Schiavon LDL, D`Acâmpora AJ. Ghrelin and gastrointestinal wound healing. A new perspective for colorectal surgery. Acta Cir Bras 2018; 33:282-294. [PMID: 29668782 DOI: 10.1590/s0102-865020180030000010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/28/2018] [Indexed: 12/21/2022] Open
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Salusjärvi JM, Carpelan-Holmström MA, Louhimo JM, Kruuna O, Scheinin TM. Intraoperative colonic pulse oximetry in left-sided colorectal surgery: can it predict anastomotic leak? Int J Colorectal Dis 2018; 33:333-336. [PMID: 29374306 DOI: 10.1007/s00384-018-2963-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND An anastomotic leak is a fairly common and a potentially lethal complication in colorectal surgery. Objective methods to assess the viability and blood circulation of the anastomosis could help in preventing leaks. Intraoperative pulse oximetry is a cheap, easy to use, fast, and readily available method to assess tissue viability. Our aim was to study whether intraoperative pulse oximetry can predict the development of an anastomotic leak. METHODS The study was a prospective single-arm study conducted between the years 2005 and 2011 in Helsinki University Hospital. Patient material consisted of 422 patients undergoing elective left-sided colorectal surgery. The patients were operated by one of the three surgeons. All of the operations were partial or total resections of the left side of the colon with a colorectal anastomosis. The intraoperative colonic oxygen saturation was measured with pulse oximetry from the colonic wall, and the values were analyzed with respect to post-operative complications. RESULTS 2.3 times more operated anastomotic leaks occurred when the colonic StO2 was ≤ 90% (11/129 vs 11/293). The mean colonic StO2 was 91.1 in patients who developed an operated anastomotic leak and 93.0 in patients who did not. With logistic regression analysis, the risk of operated anastomotic leak was 4.2 times higher with StO2 values ≤ 90%. CONCLUSIONS Low intraoperative colonic StO2 values are associated with the occurrence of anastomotic leak. Despite its handicaps, the method seems to be useful in assessing anastomotic viability.
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Affiliation(s)
- Johannes M Salusjärvi
- Department of Surgery, Päijät-Häme Central Hospital and University of Helsinki, Keskussairaalankatu 7, Lahti, 15850, Finland. .,University of Helsinki, Helsinki, Finland.
| | - Monika A Carpelan-Holmström
- Department of Surgery, Abdominal Center, Helsinki University Hospital, Haartmaninkatu 4, PL 340, 00029, Helsinki, HUS, Finland
| | - Johanna M Louhimo
- University of Helsinki, Helsinki, Finland.,Department of Surgery, Abdominal Center, Helsinki University Hospital, Haartmaninkatu 4, PL 340, 00029, Helsinki, HUS, Finland
| | - Olli Kruuna
- Department of Surgery, Abdominal Center, Helsinki University Hospital, Haartmaninkatu 4, PL 340, 00029, Helsinki, HUS, Finland
| | - Tom M Scheinin
- Department of Surgery, Abdominal Center, Helsinki University Hospital, Haartmaninkatu 4, PL 340, 00029, Helsinki, HUS, Finland
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188
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Hackethal A, Hirschburger M, Eicker SO, Mücke T, Lindner C, Buchweitz O. Role of Indocyanine Green in Fluorescence Imaging with Near-Infrared Light to Identify Sentinel Lymph Nodes, Lymphatic Vessels and Pathways Prior to Surgery - A Critical Evaluation of Options. Geburtshilfe Frauenheilkd 2018; 78:54-62. [PMID: 29375146 PMCID: PMC5778195 DOI: 10.1055/s-0043-123937] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 02/07/2023] Open
Abstract
Modern surgical strategies aim to reduce trauma by using functional imaging to improve surgical outcomes. This reviews considers and evaluates the importance of the fluorescent dye indocyanine green (ICG) to visualize lymph nodes, lymphatic pathways and vessels and tissue borders in an interdisciplinary setting. The work is based on a selective search of the literature in PubMed, Scopus, and Google Scholar and the authors' own clinical experience. Because of its simple, radiation-free and uncomplicated application, ICG has become an important clinical indicator in recent years. In oncologic surgery ICG is used extensively to identify sentinel lymph nodes with promising results. In some studies, the detection rates with ICG have been better than the rates obtained with established procedures. When ICG is used for visualization and the quantification of tissue perfusion, it can lead to fewer cases of anastomotic insufficiency or transplant necrosis. The use of ICG for the imaging of organ borders, flap plasty borders and postoperative vascularization has also been scientifically evaluated. Combining the easily applied ICG dye with technical options for intraoperative and interventional visualization has the potential to create new functional imaging procedures which, in future, could expand or even replace existing established surgical techniques, particularly the techniques used for sentinel lymph node and anastomosis imaging.
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Affiliation(s)
- Andreas Hackethal
- Tagesklinik Altonaer Straße, Frauenklinik an der Elbe, Hamburg, Germany
| | | | - Sven Oliver Eicker
- Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Mücke
- Mund-Kiefer-Gesichtschirurgie, St. Josefshospital, Krefeld-Uerdingen, Germany
| | - Christoph Lindner
- Gynäkologie und Geburtshilfe, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
| | - Olaf Buchweitz
- Tagesklinik Altonaer Straße, Frauenklinik an der Elbe, Hamburg, Germany
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de Geus-Oei LF, Hendriks T, van Goor H, Bremers AJA, Oyen WJG, Bleichrodt RP, Teeuwen PHE. Hybrid 18F-FDG PET/CT of colonic anastomosis. Nuklearmedizin 2017; 51:252-6. [DOI: 10.3413/nukmed-0493-12-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/23/2012] [Indexed: 11/20/2022]
Abstract
Summary18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a known method to diagnose inflammatory processes and thus may be a promising imaging technique to detect anastomotic bowel leak. The aim of this study was to assess postoperative FDG uptake in colorectal anastomosis in patients without suspicion of active infection or anastomotic leakage. Patients, methods: Design of a prospective observational pilot study in order to assess normal FDG uptake in the patient anastomosis after colorectal surgery. Patients that underwent colorectal surgery with primary anastomosis received FDG-PET of the abdomen, 2–6 days postoperatively. Results: 35 patients met the inclusion criteria. Three patients were not scanned for various reasons. Of the remaining 32 patients, one demonstrated an increased uptake of FDG at the site of the anastomosis. In the other 31 patients FDG uptake was negligible (n = 17) or scored as physiological (n = 14). None of the scanned patients developed a clinical relevant anastomotic leakage within the first 30 days after surgery. Conclusion: The present study shows that FDG uptake in colorectal anastomosis remains low within the first six days after surgery in patients without anastomotic leakage. Therefore, FDG-PET might be useful to investigate further as a tool to detect anastomotic leakage in an the early postoperative phase.
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190
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Blanco-Colino R, Espin-Basany E. Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 2017; 22:15-23. [PMID: 29230591 DOI: 10.1007/s10151-017-1731-8] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/31/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Indocyanine green (ICG) fluorescence imaging has been proven to be an effective tool to assess anastomotic perfusion. The aim of this systematic review and meta-analysis was to evaluate its efficacy in reducing the anastomotic leakage (AL) rate after colorectal surgery. METHODS PubMed, Scopus, WOS, Google Scholar and Cochrane Library were searched up to January 2017 for studies comparing fluorescence imaging with standard care. ClinicalTrials.gov register was searched for ongoing trials. The primary outcome measure was AL rate with at least 1 month of follow-up. ROBINS-I tool was used for quality assessment. A meta-analysis with random-effects model was performed to calculate odds ratios (ORs) from the original data. RESULTS One thousand three hundred and two patients from 5 non-randomized studies were included. Fluorescence imaging significantly reduced the AL rate in patients undergoing surgery for colorectal cancer (OR 0.34; CI 0.16-0.74; p = 0.006). Low AL rates were shown in rectal cancer surgery (ICG 1.1% vs non-ICG 6.1%; p = 0.02). There was no significant decrease in the AL rate when colorectal procedures for benign and malignant disease were combined. To date, there are no published randomized control trials (RCTs) on this subject, though 3 ongoing RCTs were identified. CONCLUSIONS ICG fluorescence imaging seems to reduce AL rates following colorectal surgery for cancer. However, the inherent bias of the non-randomized studies included, and their differences in AL definition and diagnosis could have influenced results. Large well-designed RCTs are needed to provide evidence for its routine use in colorectal surgery.
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Affiliation(s)
- R Blanco-Colino
- Department of Surgery, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - E Espin-Basany
- Department of Surgery, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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191
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van den Bos J, Al-Taher M, Schols RM, van Kuijk S, Bouvy ND, Stassen LPS. Near-Infrared Fluorescence Imaging for Real-Time Intraoperative Guidance in Anastomotic Colorectal Surgery: A Systematic Review of Literature. J Laparoendosc Adv Surg Tech A 2017; 28:157-167. [PMID: 29106320 DOI: 10.1089/lap.2017.0231] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The aims of this review are to determine the feasibility of near-infrared fluorescence (NIRF) angiography in anastomotic colorectal surgery and to determine the effectiveness of the technique in improving imaging and quantification of vascularization, thereby aiding in decision making as to where to establish the anastomosis. METHODS A systematic literature search of PubMed and EMBASE was conducted. Searching through the reference lists of selected articles identified additional studies. All English language articles presenting original patient data regarding intraoperative NIRF angiography were included without restriction of type of study, except for case reports, technical notes, and video vignettes. The intervention consisted of intraoperative NIRF angiography during anastomotic colorectal surgery to assess perfusion of the colon, sigmoid, and/or rectum. Primary outcome parameters included ease of use, added surgical time, complications related to the technique, and costs. Other relevant outcomes were whether this technique changed intraoperative decision making, whether effort was taken by the authors to quantify the signal and the incidence of postoperative complications. RESULTS Ten studies were included. Eight of these studies make a statement about the ease of use. In none of the studies complications due to the use of the technique occurred. The technique changed the resection margin in 10.8% of all NIRF cases. The anastomotic leak rate was 3.5% in the NIRF group and 7.4% in the group with conventional imaging. Two of the included studies used an objective quantification of the fluorescence signal and perfusion, using ROIs (Hamamatsu Photonics) and IC-Calc® respectively. CONCLUSIONS Although the feasibility of the technique seems to be agreed on by all current research, large clinical trials are mandatory to further evaluate the added value of the technique.
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Affiliation(s)
- Jacqueline van den Bos
- 1 Department of Surgery, Maastricht University Medical Center , Maastricht, The Netherlands .,2 NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University , Maastricht, The Netherlands
| | - Mahdi Al-Taher
- 1 Department of Surgery, Maastricht University Medical Center , Maastricht, The Netherlands
| | - Rutger M Schols
- 1 Department of Surgery, Maastricht University Medical Center , Maastricht, The Netherlands .,3 Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center , Maastricht, The Netherlands
| | - Sander van Kuijk
- 4 Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center , Maastricht, The Netherlands
| | - Nicole D Bouvy
- 1 Department of Surgery, Maastricht University Medical Center , Maastricht, The Netherlands .,2 NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University , Maastricht, The Netherlands
| | - Laurents P S Stassen
- 1 Department of Surgery, Maastricht University Medical Center , Maastricht, The Netherlands .,2 NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University , Maastricht, The Netherlands
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192
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Hoffmann H, Delko T, Kirchhoff P, Rosenthal R, Schäfer J, Kraljević M, Kettelhack C. Colon Perfusion Patterns During Colorectal Resection Using Visible Light Spectroscopy. World J Surg 2017; 41:2923-2932. [PMID: 28717916 DOI: 10.1007/s00268-017-4100-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The impact of blood supply to the anastomosis on development of anastomotic leakage is still a matter of debate. Considering that bowel perfusion may be affected by manipulation during surgery, perfusion assessment of the anastomosis alone may be of limited value. We propose perfusion assessment at different time points during surgery to explore the dynamics of bowel perfusion during colorectal resection and its impact on outcome. METHODS In this prospective cohort study, patients undergoing elective colorectal resection were eligible. Colon perfusion was evaluated using visible light spectroscopy. Main outcome was the difference in colon perfusion, quantified by measuring tissue oxygen saturation (StO2) in the colonic serosa, before and after anastomosis during surgery. RESULTS We included 58 patients between July 2013 and November 2015. Colon perfusion increased by an average of 5.9% StO2 during surgery (95% confidence interval 3.1, 8.8; P < 0.001). The number of patients with abnormal perfusion (defined as StO2 < 65%) decreased from 50% at the beginning to 24% by the end of surgery. Six patients (10%) developed anastomotic leaks (AL), of which five patients had abnormal perfusion at the beginning of surgery, whereas four patients had normal StO2 at the anastomosis. CONCLUSION Colon perfusion significantly increased during colorectal surgery. Considering that one quarter of patients had suboptimal anastomotic perfusion without developing AL, impaired blood flow at the anastomosis alone does not seem to be critical. Further investigations including more patients are necessary to evaluate the impact of perioperative parameters on colon perfusion, anastomotic healing and surgical outcome.
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Affiliation(s)
- Henry Hoffmann
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Tarik Delko
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Philipp Kirchhoff
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Rachel Rosenthal
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Juliane Schäfer
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Marko Kraljević
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Christoph Kettelhack
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
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Patel Z, Thaha MA, Kyriacou PA. Development of an intraluminal intestinal photoplethysmography sensor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:1840-1843. [PMID: 29060248 DOI: 10.1109/embc.2017.8037204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intestinal ischemia is a serious medical condition and can lead to life threatening sepsis. Currently, there are no reliable techniques available for directly monitoring intestinal viability for prolonged periods of time, and intraoperatively, the majority of the surgeons still rely on subjective methods, such as visual inspection to assess viability of the intestine. The development of an intraluminal optical sensor for monitoring intestinal viability is being proposed. The sensor will continuously monitor changes in blood volume and oxygen saturation. The developed reflectance photoplethysmography/pulse oximetry sensor comprises of two emitters (red and infrared) and a photodiode. A photoplethysmography processing and data acquisition system was also utilized. The prototype sensor was evaluated in a pilot study in the buccal mucosa of 12 healthy volunteers, given the locations similarity to the intestinal mucosa and its easy accessibility. Good quality photoplethysmography signals with high signal-to-noise ratio were acquired from the buccal mucosa in all the volunteers. Preliminary blood oxygen saturation values from the intraluminal sensor were in broad agreement with the standard finger pulse oximeter probes.
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194
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Cata J, Guerra C, Chang G, Gottumukkala V, Joshi G. Non-steroidal anti-inflammatory drugs in the oncological surgical population: beneficial or harmful? A systematic review of the literature. Br J Anaesth 2017; 119:750-764. [DOI: 10.1093/bja/aex225] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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195
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Grimm C, Harter P, Alesina PF, Prader S, Schneider S, Ataseven B, Meier B, Brunkhorst V, Hinrichs J, Kurzeder C, Heitz F, Kahl A, Traut A, Groeben HT, Walz M, du Bois A. The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery. Gynecol Oncol 2017; 146:498-503. [DOI: 10.1016/j.ygyno.2017.06.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/03/2017] [Accepted: 06/06/2017] [Indexed: 01/09/2023]
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196
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Despoudi K, Mantzoros I, Ioannidis O, Cheva A, Antoniou N, Konstantaras D, Symeonidis S, Pramateftakis MG, Kotidis E, Angelopoulos S, Tsalis K. Effects of albumin/glutaraldehyde glue on healing of colonic anastomosis in rats. World J Gastroenterol 2017; 23:5680-5691. [PMID: 28883693 PMCID: PMC5569282 DOI: 10.3748/wjg.v23.i31.5680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 06/08/2017] [Accepted: 07/24/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To evaluate the effect of local surgical adhesive glue (albumin/glutaraldehyde-Bioglue) on the healing of colonic anastomoses in rats.
METHODS Forty Albino-Wistar male rats were randomly divided into two groups, with two subgroups of ten animals each. In the control group, an end-to-end colonic anastomosis was performed after segmental resection. In the Bioglue group, the anastomosis was protected with extraluminar application of adhesive glue containing albumin and glutaraldehyde. Half of the rats were sacrificed on the fourth and the rest on the eighth postoperative day. Anastomoses were resected and macroscopically examined. Bursting pressures were calculated and histological features were graded. Other parameters of healing, such as hydroxyproline and collagenase concentrations, were evaluated. The experimental data were summarized and computed from the results of a one-way ANOVA. Fisher’s exact test was applied to compare percentages.
RESULTS Bursting pressures, adhesion formation, inflammatory cell infiltration, and collagen deposition were significantly higher on the fourth postoperative day in the albumin/glutaraldehyde group than in the control group. Furthermore, albumin/glutaraldehyde significantly increased adhesion formation, inflammatory cell infiltration, neoangiogenesis, and collagen deposition on the eighth postoperative day. There was no difference in fibroblast activity or hydroxyproline and collagenase concentrations.
CONCLUSION Albumin/glutaraldehyde, when applied on colonic anastomoses, promotes their healing in rats. Therefore, the application of protective local agents in colonic anastomoses leads to better outcomes.
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Affiliation(s)
- Kalliopi Despoudi
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Ioannis Mantzoros
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Orestis Ioannidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Aggeliki Cheva
- Department of Pathology, General Hospital “G. Papanikolaou”, 57010 Thessaloniki, Greece
| | - Nikolaos Antoniou
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Dimitrios Konstantaras
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Savvas Symeonidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | | | - Efstathios Kotidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Stamatis Angelopoulos
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Konstantinos Tsalis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
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Iwamoto M, Kawada K, Hida K, Hasegawa S, Sakai Y. Delayed anastomotic leakage following laparoscopic intersphincteric resection for lower rectal cancer: report of four cases and literature review. World J Surg Oncol 2017; 15:143. [PMID: 28764707 PMCID: PMC5540460 DOI: 10.1186/s12957-017-1208-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 07/22/2017] [Indexed: 12/26/2022] Open
Abstract
Background Anastomotic leakage (AL) is one of the most dreadful postoperative complications because it can result in increased morbidity and mortality as well as poorer long-term prognosis. Although most studies of AL limited their investigation time to a period of 30 days postoperatively, only a few studies have shown that AL can occur after that period. Here, we report four patients of rectal cancer with delayed AL following laparoscopic intersphincteric resection (ISR) and conduct a literature review on delayed AL. Case presentation Case 1 was a 67-year-old male who underwent laparoscopic partial ISR in July 2009. Although the patient was asymptomatic, an anastomotic-urethral fistula was observed 57 months after ISR. Case 2 was a 44-year-old female who underwent laparoscopic partial ISR in July 2008. She presented with discharge of gas and feces from her vagina, and an anastomotic-vaginal fistula was observed 14 months after ISR. Case 3 was a 74-year-old man who underwent laparoscopic partial ISR in August 2007. He presented with pneumaturia and fecaluria, and an anastomotic-urethral fistula was observed 4 months after ISR. Case 4 was a 68-year-old woman who underwent laparoscopic subtotal ISR for rectal cancer in February 2013 and partial hepatic resection for liver metastases in March 2013. She presented with anal pain and purulent perineal discharge, and an anastomotic-perineal fistula was observed 9 months after ISR. All four cases presented with fistula formation and required reoperation (establishment of a diverting ileostomy). Conclusions Since delayed AL is not a rare postoperative complication, surgeons need to provide long-term follow-up and remain alert to the possible development of delayed AL.
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Affiliation(s)
- Masayoshi Iwamoto
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan
| | - Kenji Kawada
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Koya Hida
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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198
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Wright EC, Connolly P, Vella M, Moug S. Peritoneal fluid biomarkers in the detection of colorectal anastomotic leaks: a systematic review. Int J Colorectal Dis 2017; 32:935-945. [PMID: 28401350 DOI: 10.1007/s00384-017-2799-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Anastomotic leak (AL) in colorectal surgery leads to significant morbidity, mortality and poorer oncological outcomes. Diagnosis of AL is frequently delayed as current methods of detection are not 100% sensitive or specific. 'Biomarkers', such as cytokines and markers of ischaemia, from the milieu of the anastomosis may aid early detection. This paper aims to review the evidence for their role in AL detection, allowing identification of targets for future research. METHODS A systematic review was performed using PubMed, MEDLINE and Cochrane Library databases. Papers concerning detection or prediction of AL with biomarkers were identified. References within the papers were used to identify further relevant articles. RESULTS Research has taken place in small cohorts with varying definitions of AL. Lactate has consistently been shown to be elevated in patients with intra-abdominal complications and ALs. pH on post-operative day 3 showed excellent specificity. Despite mixed results, a meta-analysis found that the cytokines tumour necrosis factor-α and interleukin-6 were elevated early in AL. Detection of bacteria in drain fluid by RT-PCR has good specificity but a high rate of false positives. CONCLUSIONS Peritoneal cytokines, lactate and pH have the potential to identify AL early. The consistency of the results for lactate and pH, alongside the fact that they are easy, quick and inexpensive to test, makes them the most attractive targets. Studies in larger cohorts with standardized definitions of AL are required to clarify their usefulness. Emerging biosensor technology may facilitate the development of small, low-cost and degradable intra-abdominal devices to measure peritoneal fluid biomarkers.
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Affiliation(s)
- Emma C Wright
- Department of General Surgery, Royal Alexandra Hospital, Ward 26 Day Room, Corsebar Road, Paisley, PA2 9PN, UK.
| | - Patricia Connolly
- Department of Biomedical Engineering, Wolfson Centre, University of Strathclyde, Glasgow, G4 0NW, UK
| | - Mark Vella
- Department of General Surgery, Royal Alexandra Hospital, Ward 26 Day Room, Corsebar Road, Paisley, PA2 9PN, UK
| | - Susan Moug
- Department of General Surgery, Royal Alexandra Hospital, Ward 26 Day Room, Corsebar Road, Paisley, PA2 9PN, UK
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199
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SAGES Technology and Value Assessment Committee safety and effectiveness analysis on immunofluorescence in the operating room for biliary visualization and perfusion assessment. Surg Endosc 2017. [DOI: 10.1007/s00464-017-5638-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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200
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Isaza-Restrepo A, Moreno-Mejia JF, Martin-Saavedra JS, Ibañez-Pinilla M. Low values of central venous oxygen saturation (ScvO 2) during surgery and anastomotic leak of abdominal trauma patients. World J Emerg Surg 2017. [PMID: 28649270 PMCID: PMC5477291 DOI: 10.1186/s13017-017-0139-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background There is a well known relationship between hypoperfusion and postoperative complications like anastomotic leak. No studies have been done addressing this relationship in the context of abdominal trauma surgery. Central venous oxygen saturation is an important hypoperfusion marker of potential use in abdominal trauma surgery for identifying the risk of anastomotic leak development. The purpose of this study was to identify the relationship between low values of central venous oxygen saturation and anastomotic leak of gastrointestinal sutures in the postoperative period in abdominal trauma surgery. Methods A cross-sectional prospective study was performed. Patients over 14 years old who required surgical gastrointestinal repair secondary to abdominal trauma were included. Anastomotic leak diagnosis was confirmed through clinical manifestations and diagnostic images or secondary surgery when needed. Central venous oxygen blood saturation was measured at the beginning of surgery through a central catheter. Demographic data, trauma mechanism, anatomic site of trauma, hemoglobin levels, abdominal trauma index, and comorbidities were assessed as secondary variables. Results Patients who developed anastomotic leak showed lower mean central venous oxygen saturation levels (60.0% ± 2.94%) than those who did not (69.89% ± 7.21%) (p = 0.010). Conclusions Central venous oxygen saturation <65% was associated with the development of gastrointestinal leak during postoperative time of patients who underwent surgery secondary to abdominal trauma.
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Affiliation(s)
- Andres Isaza-Restrepo
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia.,Mederi Hospital Universitario Mayor, Bogotá D.C., Colombia
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