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prevention and control of postoperative anastomotic leak

Yi Wang
Dispite continual improvements in diagnostic and management techniques, anastomotic leak (AL) remains one of the most devastating consequences of rectal cancer surgery. Recently, many investigations have attempted to identify the risk factors and established risk model to predict and prevent anastomotic leakage after low anterior resection. The distance between the lower edge of rectal cancer and the anal verge measured by magnetic resonance imaging was demonstrated as one of the independent risk factors associated with AL...
2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Carlos Valenzuela-Salazar, Martin E Rojano-Rodríguez, Sujey Romero-Loera, Mario E Trejo-Ávila, Joseph Bañuelos-Mancilla, Roberto Delano-Alonso, Mucio Moreno-Portillo
BACKGROUND: Postoperative anastomotic leaks, bleeding and stenosis are major causes of morbidity after laparoscopic Roux-en-Y gastric bypass (LRYGB). Retrospective studies suggest that intraoperative endoscopy reduces the incidence of these complications. METHODS: We conducted a prospective randomized controlled trial in a single institution between March 2013 and January 2016. Patients were assigned to one of two groups: LRYGB with Intraoperative Endoscopy (IOE) or LRYGB without IOE...
February 2018: International Journal of Surgery
Francesco Guerra, Giuseppe Giuliani, Diego Coletta, Marcello Boni, Fabio Rondelli, Paolo Pietro Bianchi, Andrea Coratti
BACKGROUND: Anastomotic leakage is one of the most feared complications of rectal resections. The role of drains in limiting this occurrence or facilitating its early recognition is still poorly defined. We aimed to study whether the presence of prophylactic pelvic drains affects the surgical outcomes of patients undergoing rectal surgery with extraperitoneal anastomosis. METHODS: PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized controlled trials comparing drained with undrained anastomoses following rectal surgery...
December 12, 2017: Digestive Surgery
Solomon Tong, Jonathan Gower, Austin Morgan, Kyle Gadbois, Gordon Wisbach
BACKGROUND: Obstructive sleep apnea is common in morbidly obese patients, and noninvasive positive pressure ventilation (NIPPV) is the standard treatment. Postoperatively, NIPPV is highly effective in preventing hypoxia and apneic episodes; however, the concern of gastric distention leading to increased risk of an anastomotic dehiscence limits universal acceptance. OBJECTIVE: To perform a systematic review of the literature to determine if the use of NIPPV during immediate post-bariatric surgery care is safe...
July 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Sanjiv K Hyoju, Robin E Klabbers, Melissa Aaron, Monika A Krezalek, Alexander Zaborin, Mara Wiegerinck, Neil H Hyman, Olga Zaborina, Harry Van Goor, John C Alverdy
OBJECTIVE: The objective of this study was to determine the effect of polyphosphate on intestinal bacterial collagenase production and anastomotic leak in mice undergoing colon surgery. BACKGROUND: We have previously shown that anastomotic leak can be caused by intestinal pathogens that produce collagenase. Because bacteria harbor sensory systems to detect the extracellular concentration of phosphate which controls their virulence, we tested whether local phosphate administration in the form of polyphosphate could attenuate pathogen virulence and prevent leak without affecting bacterial growth...
February 3, 2017: Annals of Surgery
Karen J Dickinson, Kenneth Wang, Lizhi Zhang, Mark S Allen, Stephen D Cassivi, Francis C Nichols, Robert Shen, Dennis A Wigle, Shanda H Blackmon
BACKGROUND: Endoscopic mucosal resection (EMR) and esophagectomy are treatment options for cT1 esophageal adenocarcinoma. Our aim was to study outcomes for patients undergoing EMR then esophagectomy. METHODS: We identified patients undergoing EMR and esophagectomy for cT1 esophageal adenocarcinoma over 10 years. EMR histology was used to predict nodal involvement with a risk-scoring tool. Patient demographics, surgical techniques, pathology, postoperative outcomes, and survival were recorded...
March 2017: Annals of Thoracic Surgery
Cloë L Sparreboom, Zhou-Qiao Wu, Jia-Fu Ji, Johan F Lange
Colorectal anastomotic leakage (CAL) remains a major complication after colorectal surgery. Despite all efforts during the last decades, the incidence of CAL has not decreased. In this review, we summarize the available strategies regarding prevention, prediction and intervention of CAL and categorize them into three categories: communication, infection and healing disturbances. These three major factors actively interact during the onset of CAL. We aim to provide an integrated approach to CAL based on its etiology...
August 28, 2016: World Journal of Gastroenterology: WJG
Peng Ye, Jin-Lin Cao, Qiu-Yuan Li, Zhi-Tian Wang, Yun-Hai Yang, Wang Lv, Jian Hu
BACKGROUND: The greater omentum has been found to be immunologically competent in protecting abdominal organs from inflammation. Anastomotic omentoplasty has been used and proven effective in preventing anastomotic leaks after an esophagectomy. However, pulmonary complications are still a substantial problem after an esophagectomy. This study investigated the benefits of mediastinal transposition of the omentum, a modification of the conventional omental wrapping technique, in controlling overall postoperative intrathoracic complications...
July 2016: Journal of Thoracic Disease
Hiroyuki Kitagawa, Tomoaki Yatabe, Tsutomu Namikawa, Masaya Munekage, Kazuhiro Hanazaki
AIM: This study investigated the efficacy of an artificial pancreas in managing postoperative glycemic levels for patients after esophagectomy. PATIENTS AND METHODS: We reviewed 107 patients with esophageal cancer who underwent esophagectomy, and had postoperative glucose management using the artificial pancreas. The target blood glucose level (TBGL) range was 90-140 mg/dl. Achievement rate of TBGL, total insulin use, number of severe hypoglycemic (<40 mg/dl) events, surgical complications and length of hospitalization (LOH) were evaluated...
August 2016: Anticancer Research
Joanne Guay, Mina Nishimori, Sandra Kopp
BACKGROUND: Gastrointestinal paralysis, nausea and vomiting and pain are major clinical problems following abdominal surgery. Anaesthetic and analgesic techniques that reduce pain and postoperative nausea and vomiting (PONV), while preventing or reducing postoperative ileus, may reduce postoperative morbidity, duration of hospitalization and hospital costs. This review was first published in 2001 and was updated by new review authors in 2016. OBJECTIVES: To compare effects of postoperative epidural analgesia with local anaesthetics versus postoperative systemic or epidural opioids in terms of return of gastrointestinal transit, postoperative pain control, postoperative vomiting, incidence of anastomotic leak, length of hospital stay and costs after abdominal surgery...
July 16, 2016: Cochrane Database of Systematic Reviews
Peng Zheng, Jianmin Xu
Anastomotic leak is a major complication after colorectal resection. Risk factors for anastomotic leak include patient and disease related factors, preoperative factors(e.g. use of neoadjuvant chemoradiation and mechanical bowel preparation), intraoperative factors(e.g. anastomotic techniques, performing of water injection test, preventive colostomy, and surgical procedures, etc; postoperative factors, such as postoperative medication use, etc. Early diagnosis of anastomotic fistula is crucial, which can be made by combining laboratory examination with imaging examination or take the prediction and diagnosis model as reference...
April 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
V K Kapoor
UNLABELLED: Pancreato-duodenectomy (PD) is the procedure of choice for management of resectable periampullary and pancreatic cancers and some patients with chronic pancreatitis. PD is one of the most major GI/ HPB surgical procedures performed involving resection of multiple organs and reconstruction with multiple anastomoses. While mortality of PD has been brought down to less than 5% morbidity still remains high.Patients undergoing PD are usually elderly with comorbidities - general complications of a major operation e...
February 2016: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Elke Van Daele, Dirk Van de Putte, Wim Ceelen, Yves Van Nieuwenhove, Piet Pattyn
OBJECTIVES: Oesophageal carcinoma (EC) remains an aggressive disease. Despite extensive changes in therapeutic modalities, surgical resection remains the first choice therapy for curable oesophageal cancer patients. Anastomotic sites are prone to serious complications such as leakage, fistula, bleeding and stricture. Leakage of the anastomosis (AL) remains one of the main causes of postoperative morbidity and mortality. The purpose of this study was to identify predictors associated with postoperative leakage after Ivor Lewis oesophagectomy and its consequences in a single centre...
January 2016: Interactive Cardiovascular and Thoracic Surgery
Minako Kobayashi, Masato Kusunoki
Preoperative preparation of the bowel includes two methods, mechanical bowel preparation (MBP) to remove gross feces and oral antibiotic bowel preparation (OABP) to reduce the colonic bacterial load. MBP and OABP have been performed since the 1940s to 1950s. MBP is routinely performed to reduce the morbidity and mortality of elective colorectal surgery and has been a surgical dogma since the early 1970s. However, numerous prospective, randomized, controlled trials and meta-analyses have questioned the need for MBP in elective colorectal surgery, and a meta-analysis showed that significantly more anastomotic leaks were found after MBP...
July 2015: Nihon Geka Gakkai Zasshi
Min-Ki Kim, Dae-Youn Won, Jin-Kwon Lee, Won-Kyung Kang, Jun-Gi Kim, Seong Taek Oh
PURPOSE: To investigate the efficacy and safety of the transanal tube (TAT) in preventing anastomotic leak (AL) in rectal cancer surgery. METHODS: Clinical data of the patients who underwent curative surgery for mid rectal cancer from February 2010 to February 2014 were reviewed retrospectively. Rectal cancers arising 5 to 10 cm above the anal verge were selected. Patients were divided into the ileostomy, TAT, or no-protection groups. Postoperative complications including AL and postoperative course were compared...
May 2015: Annals of Surgical Treatment and Research
Maria Widmar, Dustin R Cummings, Emily Steinhagen, Alana Samson, Abigail R Barth, Adrian J Greenstein, Alexander J Greenstein
BACKGROUND: Oversewing staple lines may be a novel way to reduce anastomotic complications after primary ileocolic resections for Crohn's disease (CD). STUDY DESIGN: This is a single-institution, non-concurrent cohort study of CD patients undergoing primary ileocolic resections (ICR) with stapled anastomoses from 2007 to 2013. Demographic and clinical characteristics were collected. Propensity scores were calculated for oversewing versus not. Postoperative outcomes within 30 days of surgery were collected...
May 2015: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Dennis Raahave
The present studies explored whether faecal retention in the colon is a causative factor in functional bowel disease, appendicitis, and haemorrhoids. Faecal retention was characterized by colon transit time (CTT) after radio-opaque marker ingestion and estimation of faecal loading on abdominal radiographs at 48 h and 96 h. Specific hypotheses were tested in patients (n = 251 plus 281) and in healthy random controls (n = 44). A questionnaire was completed for each patient, covering abdominal and anorectal symptoms and without a priori grouping...
March 2015: Danish Medical Journal
Takeshi Ikeda, Masato Sasaki, Narihisa Yamada, Atsushi Takamori, Sawaka Tanabe, Akitoshi Okada, Kayo Sakon, Tae Mizunaga, Takaaki Koshiji
BACKGROUND: This study evaluated the feasibility and efficacy of a new operative method for controlling intraoperative air leaks using free pericardial fat pads as a covering sealant in pulmonary resection. METHODS: To manage air leaks that must be controlled in pulmonary resection at the first water sealing test, collected free pericardial fat was used as a covering sealant and sewn on by the suture closing the lesion. In cases of uncontrolled air leaks at the second sealing test, fibrin glue was used to fill the residual lesion between the fat and visceral pleura...
April 2015: Annals of Thoracic Surgery
Ji-Gang Dai, Quan-Xing Liu, Xu-Feng Den, Jia-Xin Min
AIM: To examine the efficiency of oesophageal flap valvuloplasty and wrapping suturing technique in decreasing the rate of postoperative gastrooesophageal reflux disease in a dog model. METHODS: We operated on 10 dogs in this study. First, we resected a 5-cm portion of the distal oesophagus and then restored the continuity of the oesophageal and gastric walls by end-to-end anastomosis. A group of five dogs was subjected to the oesophageal flap valvuloplasty and wrapping suturing technique, whereas another group (control) of five dogs was subjected to the stapling technique after oesophagectomy...
December 14, 2014: World Journal of Gastroenterology: WJG
Yong Yuan, Xiaoxi Zeng, Yang Hu, Tianpeng Xie, Yongfan Zhao
BACKGROUND: Oesophagectomy followed by oesophagogastrostomy is the preferred treatment for early-stage oesophageal cancer. It carries the risk of anastomotic leakage after oesophagogastric anastomosis, which causes considerable morbidity and mortality and is one of the most dangerous complications. Omentoplasty has been recommended by some researchers to prevent anastomotic leaks associated with oesophagogastrostomy. However, the value of omentoplasty for oesophagogastrostomy after oesophagectomy has not been systematically reviewed...
2014: Cochrane Database of Systematic Reviews
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