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Anastomotic leaks

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https://www.readbyqxmd.com/read/28324171/risk-factors-for-delayed-gastric-emptying-after-esophagectomy
#1
Frank Benedix, Tobias Willems, Siegfried Kropf, Daniel Schubert, Patrick Stübs, Stephanie Wolff
PURPOSE: Delayed gastric emptying (DGE) is a common functional disorder after esophagectomy with gastric tube reconstruction. Little is known about risk factors that can predict this debilitating complication. METHODS: Patients who underwent elective esophagectomy from 2008 to 2016 in a single center were retrospectively reviewed. Diagnosis of DGE was based on clinical, radiological, and endoscopic findings. Uni- and multivariate analyses were performed to identify patient-, tumor-, and procedure-related factors that increase the risk of DGE...
March 21, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28320053/management-of-colorectal-trauma-a-review
#2
REVIEW
Ju Yong Cheong, Anil Keshava
Traumatic colorectal injuries are common during times of military conflict, and major improvements in their care have arisen in such periods. Since World War II, many classification systems for colorectal trauma have been proposed, including (i) Flint Grading System; (ii) Penetrating Abdominal Trauma Index; (iii) Colonic/Rectal Injury Scale; and (iv) destructive/non-destructive colonic injuries. The primary goal of these classifications was to aid surgical management and, more particularly, to determine whether a primary repair or faecal diversion should be performed...
March 20, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28316311/pancreaticoduodenectomy-can-be-performed-safely-with-rare-employment-of-surgical-drains
#3
John W Kunstman, Lee F Starker, James M Healy, Ronald R Salem
Use of drain remains frequent following pancreaticoduodenectomy (PD) due to concern for postoperative pancreatic fistula (POPF) and anastomotic leak development. Despite controversy, a recent randomized trial suggested omitting drainage would result in a large increase in operative mortality. This study sought to comprehensively examine the effects of forgoing drainage in the large cohort of patients undergoing PD. A prospective cohort study of two consecutive groups undergoing PD was constructed. The initial group had operative drains placed in cases subjectively concerning for POPF development; the second cohort did not undergo operative drainage...
March 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28304142/biomarkers-and-anastomotic-leakage-in-colorectal-surgery-c-reactive-protein-trajectory-is-the-gold-standard
#4
Stephen R Smith, Peter Pockney, Ryan Holmes, Fiona Doig, John Attia, Elizabeth Holliday, Rosemary Carroll, Brian Draganic
BACKGROUND: Anastomotic leakage is a feared complication following colorectal surgery. Early prediction results in improved clinical outcome, but accurate predictive factors remain elusive. Many biomarkers have been studied with respect to diagnosis of anastomotic leakage but the concept of trajectory testing, using biomarkers, has not been assessed with regards to early diagnosis of anastomotic leak. METHODS: C-reactive protein (CRP), procalcitonin (PCT), white cell count (WCC) and gamma-glutamyl transferase were assessed for predictive utility in diagnosing anastomotic leakage with emphasis on identifying an association with change in their levels or trajectory...
March 17, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28303419/esophagectomy-for-cancer-in-octogenarians-should-we-do-it
#5
Elizabeth Paulus, Caroline Ripat, Vadim Koshenkov, Angela T Prescott, Kiran Sethi, Heather Stuart, Gregory Tiesi, Alan S Livingstone, Danny Yakoub
PURPOSE: Inconsistent data exists regarding esophagectomy outcomes in octogenarians undergoing transhiatal esophagectomy for esophageal cancer. METHODS: A retrospective review was performed for esophagectomy cancer patients between 2000 and 2012 at our tertiary referral center. Outcome data for octogenarians was compared to younger patients aged 20 to 79 years. A case-matched group of patients younger than 80 years old (n = 33) was included based on the Charlson comorbidity index with the octogenarian group (n = 33)...
March 16, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28292588/endoscopy-after-esophagectomy-safety-demonstrated-in-a-porcine-model
#6
Vignesh Raman, Karen L Moodie, Obinna O Ofoche, Larry R Kaiser, Cherie P Erkmen
BACKGROUND: Endoscopy is useful in assessing conduit ischemia and anastomotic leaks after esophagectomy but poses a theoretical threat of anastomotic disruption. We used a porcine model to evaluate the safety of endoscopy after esophagectomy. METHODS: We performed esophagectomies in 10 live pigs and performed endoscopy with progressive air insufflation and continuous intraluminal pressure monitoring. We stopped insufflation when the intraluminal pressure reached a plateau...
February 9, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28288055/development-of-a-core-outcome-set-for-clinical-effectiveness-trials-in-esophageal-cancer-resection-surgery
#7
Kerry N L Avery, Katy A Chalmers, Sara T Brookes, Natalie S Blencowe, Karen Coulman, Katie Whale, Chris Metcalfe, Jane M Blazeby
OBJECTIVE: Development of a core outcome set (COS) for clinical effectiveness trials in esophageal cancer resection surgery. BACKGROUND: Inconsistency and heterogeneity in outcome reporting after esophageal cancer resection surgery hampers comparison of trial results and undermines evidence synthesis. COSs provide an evidence-based approach to these challenges. METHODS: A long list of clinical and patient-reported outcomes was identified and categorized into outcome domains...
March 10, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28285387/development-and-external-validation-of-preoperative-risk-models-for-operative-morbidities-after-total-gastrectomy-using-a-japanese-web-based-nationwide-registry
#8
Hirotoshi Kikuchi, Hiroaki Miyata, Hiroyuki Konno, Kinji Kamiya, Ai Tomotaki, Mitsukazu Gotoh, Go Wakabayashi, Masaki Mori
BACKGROUND: Total gastrectomy is a relatively difficult and invasive procedure among gastrointestinal surgeries, and major morbidities following total gastrectomy can be serious and fatal. This study aimed to develop and validate preoperative risk models of morbidities associated with total gastrectomy using a Japanese web-based nationwide registry. METHODS: The national clinical database was used to retrieve the records of 39,253 patients who underwent total gastrectomy in 1,841 hospitals between January 1, 2011 and December 31, 2012...
March 11, 2017: Gastric Cancer
https://www.readbyqxmd.com/read/28281474/combined-laparoscopic-and-transanal-total-mesorectal-excision-for-rectal-cancer-initial-experience-and-early-results
#9
Morten Holt Thomsen, Henrik Ovesen, Jens Ravn Eriksen
INTRODUCTION: Incomplete specimens resulting in residual mesorectum in the patient and an increased risk of local recurrence remains a problem. We have introduced transanal-total mesorectal excision (Ta-TME) in our department to potentially overcome this problem due to more direct access to the lower pelvis in patients undergoing TME for rectal cancer and this article presents our initial experience with the new procedure. MATERIALS AND METHODS: Patients with a T1-T3 mid or low rectal cancer eligible for TME or intersphincteric abdominoperineal excision were selected for a combined transanal and transabdominal laparoscopic resection...
April 2017: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/28281115/laparoscopic-colectomy-in-obese-patients-a-comparison-of-laparoscopic-and-hand-assisted-laparoscopic-techniques
#10
Douglas M Overbey, Michelle L Cowan, Patrick W Hosokawa, Brandon C Chapman, Jon D Vogel
BACKGROUND: Recent American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP)-based evidence indicates that laparoscopic (LAP) colectomy results in improved outcomes compared to hand-assisted laparoscopic (HAL) colectomy in the general population. Previous comparative studies demonstrated that the HAL technique offers distinct advantages for obese patients. The aim of this study was to perform comparative analyses of HAL and LAP colectomy and low anterior resection (LAR) in obese patients...
March 9, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28280688/management-of-anastomosis-leakage-post-ralp-a-simple-trick-for-a-complex-situation
#11
Romain Diamand, Walid Al Hajj Obeid, Anna Accarain, Ksenija Limani, Eric Hawaux, Roland van Velthoven, Alexandre Peltier
A case of 74 years old male patient who underwent RALP with bladder neck reconstruction. Persistent vesicourethral anastomotic leak was seen at cystography. A self-made side fenestrated Foley catheter was used and on the day after, a complete reversal in fluid output between the Foley catheter and the drain was seen.
May 2017: Urology Case Reports
https://www.readbyqxmd.com/read/28277591/the-role-of-fluorescent-angiography-in-anastomotic-leaks
#12
Sarath Sujatha-Bhaskar, Mehraneh D Jafari, Michael J Stamos
Anastomotic leaks following colorectal anastomosis has substantial implications including increased morbidity, longer hospitalization, and reduced overall survival. The etiology of leaks includes patient factors, technical factors, and anastomotic perfusion. An intact anastomotic blood supply is especially crucial in the physiology of anastomotic healing. To date, no established intraoperative methods have been developed that reliably and reproducibly identify and prevent leak occurrence. Recently, fluorescent angiography (FA) with indocyanine green (ICG) has emerged as an innovative modality for intraoperative perfusion assessment...
March 9, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28275487/experiences-in-the-management-of-anastomotic-leakages-and-analysis-of-the-factors-affecting-leakage-healing-in-patients-with-esophagogastric-junction-cancer
#13
Ningning Ding, Yousheng Mao, Jie He, Shugeng Gao, Yue Zhao, Ding Yang, Kelin Sun, Guiyu Cheng, Juwei Mu, Qi Xue, Dali Wang, Jun Zhao, Yushun Gao, Xiangyang Liu, Dekang Fang, Jian Li, Yonggang Wang, Jinfeng Huang, Bing Wang, Liangze Zhang
BACKGROUND: It was reported in the literatures that the incidence of anastomotic leakage in patients with esophagogastric junction cancer decreased due to application of staplers and closure devices as well as gastric conduit technique in recent years, however, it increased slightly at our center since widely using the above devices and gastric conduit techniques from 2009. The objective of this study was to summarize our experiences in the management of anastomotic leakages and analyze the factors affecting leakage healing in the patients with esophagogastric junction cancer after surgical resection in recent 6 years...
February 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28273409/c-reactive-protein-as-a-predictor-of-anastomotic-leak-in-the-first-week-after-anterior-resection-for-rectal-cancer
#14
Ian S Reynolds, Michael R Boland, Frank Reilly, Alison Deasy, Muhammad Hamid Majeed, Joseph Deasy, John P Burke, Deborah A McNamara
Anastomotic leak (AL) after anterior resection results in increased morbidity, mortality and local recurrence.. The aim of this study was to assess the ability of C-reactive protein (CRP) to predict AL in the first week after anterior resection for rectal cancer METHODS: A retrospective review of a prospectively maintained database that included all patients undergoing anterior resection between January 2008 and December 2013 was performed. The ability of CRP to predict AL was assessed using area under the receiver-operating characteristic (auROC) curves...
March 8, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28270910/american-society-for-enhanced-recovery-aser-and-perioperative-quality-initiative-poqi-joint-consensus-statement-on-prevention-of-postoperative-infection-within-an-enhanced-recovery-pathway-for-elective-colorectal-surgery
#15
Stefan D Holubar, Traci Hedrick, Ruchir Gupta, John Kellum, Mark Hamilton, Tong J Gan, Monty G Mythen, Andrew D Shaw, Timothy E Miller
BACKGROUND: Colorectal surgery (CRS) patients are an at-risk population who are particularly vulnerable to postoperative infectious complications. Infectious complications range from minor infections including simple cystitis and superficial wound infections to life-threatening situations such as lobar pneumonia or anastomotic leak with fecal peritonitis. Within an enhanced recovery pathway (ERP), there are multiple approaches that can be used to reduce the risk of postoperative infections...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28268263/endoscopic-management-of-gastrointestinal-leaks-and-perforation-with-polyglycolic-acid-sheets
#16
Sojung Han, Hyunsoo Chung, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee
Gastrointestinal (GI) leakage, fistulae, and perforations can be serious and life threatening. There has been a paradigm shift in the management approach of these conditions, from surgical to conservative, including endoscopic management. Here, we report two cases of endoscopic closure of a GI fistula and perforation using polyglycolic acid (PGA) sheets with fibrin glue. The first case is of an anastomotic leak detected after subtotal gastrectomy with gastroduodenostomy. After failed application of endoclips, a PGA sheet was applied, and the fistula was successfully closed...
March 8, 2017: Clinical Endoscopy
https://www.readbyqxmd.com/read/28263043/the-relationship-between-method-of-anastomosis-and-anastomotic-failure-after-right-hemicolectomy-and-ileo-caecal-resection-an-international-snapshot-audit
#17
(no author information available yet)
BACKGROUND: Anastomosis technique following right sided colonic resection is widely variable and may affect patient outcomes. This study aimed to assess the association between leak and anastomosis technique (stapled versus handsewn) METHODS: This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a two-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, using a pre-specified definition...
March 6, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28260480/living-donor-liver-transplant-follow-up-a-singlecenter-experience
#18
Syed Mudassir Laeeq, Farina M Hanif, Nasir Hassan Luck, Rajesh Kumar Mandhwani, Jawed Iqbal, Syed Haider Mehdi
OBJECTIVES: Liver transplant is a definite treatment of decompensated liver disease. Because of the shortage of livers from deceased donors, living-donor liver transplant is becoming more common. Here, we analyzed our clinical experience in the follow-up care of these patients. MATERIALS AND METHODS: Liver transplant recipients seen at the Sindh Institute of Urology and Transplantation (Karachi, Pakistan) were included in this analysis. Baseline characteristics and follow-up events were recorded...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28255631/mentored-trainees-have-similar-short-term-outcomes-to-a-consultant-trainer-following-laparoscopic-colorectal-resection
#19
Henry D De'Ath, Laurence Devoto, Chaitanya Mehta, James Bromilow, Tahseen Qureshi
BACKGROUND: Laparoscopic colorectal surgery has a long learning curve. Using a modular-based training programme may shorten this. Concerns with laparoscopic surgery have been oncological compromise and poor surgical outcomes when training more junior surgeons. This study aimed to compare operative and oncological outcomes between trainees undergoing a mentored training programme and a consultant trainer. METHODS: A prospective study of all elective laparoscopic colorectal resections was undertaken in a single institution...
March 2, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28255626/the-diagnostic-value-of-routine-contrast-esophagram-in-anastomotic-leaks-after-esophagectomy
#20
Zhongwu Hu, Xiaowe Wang, Xush An, Wenjin Li, Yun Feng, Zhenbing You
BACKGROUND: Routine contrast esophagram has been shown to be increasingly limited in diagnosing anastomotic leaks after esophagectomy. METHODS: Patients undergoing esophagectomy from 2013 to 2014 at Huai'an First Peoples' Hospital were identified. We retrospectively analyzed patients who underwent routine contrast esophagram on postoperative day 7 (range 6-10) to preclude anastomotic leaks after esophagectomy. RESULTS: In 846 patients who underwent esophagectomy, a cervical anastomosis was performed in 286 patients and an intrathoracic anastomosis in 560 patients...
March 2, 2017: World Journal of Surgery
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