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anastomotic leakage

Felipe Donoso, Helene Engstrand Lilja
Background Since 2005, infants with esophageal atresia (EA) in our unit are given prophylactic proton pump inhibitors (PPI) after repair until 1 year of age. The aims of this study were to identify risk factors for anastomotic strictures (AS) and to assess the efficacy of postoperative PPI prophylaxis in reducing the incidence of AS compared with symptomatic PPI. Methods Patients who underwent EA repair from 1994 to 2013 in our unit were included in this retrospective observational study approved by the local ethics review board...
October 21, 2016: European Journal of Pediatric Surgery
Qingbin Wu, Chengwu Jin, Tao Hu, Mingtian Wei, Ziqiang Wang
AIM: To compare intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in laparoscopic right colectomy (LRC) in terms of intraoperative and postoperative outcomes. METHODS: A systematic literature search with no limits was performed in PubMed and Embase. The last search was performed on April 9, 2016. The outcomes of interests included intraoperative outcomes (operative time, blood loss, length of incision, conversion, lymph nodes harvested, and intraoperative complications) and postoperative outcomes (time to first flatus, time to first defecation, time to liquid diet, length of hospital stay, postoperative complications, mortality, ileus, anastomotic leakage, anastomotic bleeding, wound infection, hernia, and intra-abdominal abscess)...
October 21, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Lucas Goense, Peter S N van Rossum, Jelle P Ruurda, Marco van Vulpen, Stella Mook, Gert J Meijer, Richard van Hillegersberg
BACKGROUND: Concerns have been raised regarding the toxicity of neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer that could contribute to an increased risk of postoperative complications. The aim of this study was to determine the influence of the radiation dose to the gastric fundus on the risk of postoperative anastomotic leakage in patients undergoing nCRT followed by transthoracic esophagectomy. METHODS: Between January 2012 and July 2015, 97 consecutive patients who underwent nCRT followed by transthoracic esophagectomy were included in this single-center cohort study...
October 17, 2016: Annals of Thoracic Surgery
Charbel Karam, Sally Lord, Rohan Gett, Alan P Meagher
BACKGROUND: Leak rates of over 5% following anastomoses between the ileum and colon continue to be reported in large series and are associated with substantial morbidity and with mortality rates of 10-20%. In 1994, we began performing circumferentially oversewn inverted stapled anastomoses in patients undergoing ileo-colic anastomoses or ileostomy closure. It has become increasingly apparent that this method is associated with a low risk of leakage, which we should report. METHODS: The anastomotic technique described was used in all patients undergoing ileo-colic anastomosis or closure of ileostomy by surgeon 1 (1994-2015) and in all ileo-colic anastomoses by surgeon 2 (2007-2015)...
October 20, 2016: ANZ Journal of Surgery
E Hain, L Maggiori, G Manceau, C Mongin, J Prost À la Denise, Y Panis
BACKGROUND: The effect of anastomotic leakage on oncological outcomes after total mesorectal excision (TME) is controversial. This study aimed to assess the influence of symptomatic and asymptomatic anastomotic leakage on oncological outcomes after laparoscopic TME. METHODS: All patients who underwent restorative laparoscopic TME for rectal adenocarcinoma with curative intent from 2005 to 2014 were identified from an institutional database. Asymptomatic anastomotic leakage was defined by CT performed systematically 4-8 weeks after rectal surgery, with no relevant clinical symptoms or laboratory examination findings during the postoperative course...
October 20, 2016: British Journal of Surgery
Masanori Yamada, Koji Nakai, Kentaro Inoue, Takeshi Hijikawa, Hiroaki Kitade, Kazuhiko Yoshioka, Masanori Kon
An 81-year-old man underwent total gastrectomy with Roux-en-Y reconstruction for cardiac cancer in our department. He developed high fever on postoperative day 3, and pathological examination showed WBC and CRP level of 12,000/mL and 29.983mg/dL, respectively. A diagnosis of anastomotic leakage was confirmed using enhanced abdominal CT scanning that demonstrated free air around the esophagojejunalanastomosis after totalgastrectomy. The drainage tube was replaced by a 12 Fr sump tube because of leakage on postoperative day 10...
October 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Emiliano Tognoli, Matte Leoni, Daniele Morelli, Elisa Sottotetti, Antonia Martinetti, Stefano Signoroni, Carlotta Galeone, Gianfranco Gallino
Unrestrained activation of the proteolytic systems in anastomotic tissue during repair has been implicated in the pathogenesis of anastomotic leakage. We hypothesized that this mechanism may promote an up-regulation of the urokinase-type plasminogen activator system and a spillover of Soluble Urokinase-type Plasminogen Activator Receptor (suPAR) into blood. In this retrospective analysis patients with anastomotic leakage were compared to a group of matched uncomplicated patients. Anastomotic leakage complicated patients had significantly higher suPAR (p=0...
October 19, 2016: Wound Repair and Regeneration
K Krajinovic, S Reimer, T Kudlich, C T Germer, A Wiegering
BACKGROUND: Anastomotic leakage (AL) is one of the most common and serious complications following visceral surgery. In recent years, endoluminal vacuum therapy has dramatically changed therapeutic options for AL, but its use has been limited to areas easily accessible by endoscope. CASE PRESENTATION: We describe the first use of endoluminal vacuum therapy in the small intestine employing a combined surgical and endoscopic "rendezvous technique" in which the surgeon assists the endoscopic placement of an endoluminal vacuum therapy sponge in the jejunum by means of a pullback string...
December 2016: Surgical Case Reports
S J van Rooijen, D Huisman, M Stuijvenberg, J Stens, R M H Roumen, F Daams, G D Slooter
BACKGROUND: Colorectal anastomotic leakage (CAL) is a major surgical complication in intestinal surgery. Despite many optimizations in patient care, the incidence of CAL is stable (3-19%) [1]. Previous research mainly focused on determining patient and surgery related risk factors. Intraoperative non-surgery related risk factors for anastomotic healing also contribute to surgical outcome. This review offers an overview of potential modifiable risk factors that may play a role during the operation...
October 15, 2016: International Journal of Surgery
Frans van Workum, Stefan A W Bouwense, Misha D P Luyer, Grard A P Nieuwenhuijzen, Donald L van der Peet, Freek Daams, Ewout A Kouwenhoven, Marc J van Det, Frits J H van den Wildenberg, Fatih Polat, Suzanne S Gisbertz, Mark I van Berge Henegouwen, Joos Heisterkamp, Barbara S Langenhoff, Ingrid S Martijnse, Janneke P Grutters, Bastiaan R Klarenbeek, Maroeska M Rovers, Camiel Rosman
BACKGROUND: Currently, a cervical esophagogastric anastomosis (CEA) is often performed after minimally invasive esophagectomy (MIE). However, the CEA is associated with a considerable incidence of anastomotic leakage requiring reintervention or reoperation and moderate functional results. An intrathoracic esophagogastric anastomosis (IEA) might reduce the incidence of anastomotic leakage, improve functional results and reduce costs. The objective of the ICAN trial is to compare anastomotic leakage and postoperative morbidity, mortality, quality of life and cost-effectiveness between CEA and IEA after MIE...
October 18, 2016: Trials
T Li, L Cui, G Wang, X F Ling, C S Hou, L X Wang, Z Xu
To investigate the effect and feasibility of total laparoscopy to treat hepatolithiasis using gallbladder-hepatic duct subcutaneous tunnel. Retrospective analysis was conducted of the case data of 11 patients with hepatolithiasis who underwent total laparoscopic treatment using gallbladder-hepatic duct subcutaneous tunnel from January 2010 to October 2014. The operation time, blood loss, postoperative complications and recurrence of stones were recorded.All the cases completed the operation.The average hospital-stay was 9...
October 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Jun Watanabe, Mitsuyoshi Ota, Yusuke Suwa, Atsushi Ishibe, Hidenobu Masui, Kaoru Nagahori
INTRODUCTION: Single-incision laparoscopic colectomy is technically limited because of such factors as instrument crowding, in-line viewing, and insufficient countertraction. In particular, it is technically difficult to cut the distal rectum from the umbilicus using an articulating linear stapler in single-incision laparoscopic anterior resection. TECHNIQUE: After treating the mesorectum, the 5-mm trocar is replaced with a 12-mm trocar. The cartridge of the curved stapler is mounted while the shaft of the stapler is inserted into the 12-mm port extracorporeally...
November 2016: Diseases of the Colon and Rectum
Vanessa Verdin, Joseph Weerts, David Francart, Constant Jehaes, David Magis, Paul Magotteaux, Laurine Mattart, Benoit Monami, Christian Wahlen, Serge Markiewicz
BACKGROUND: Rectal adenocarcinomas surgery morbidity and mortality might be impaired by neoadjuvant therapy. We performed this retropsective study to be compared with the PROCARE study running afterwards. METHODS: We performed a retrospective study of 95 patients operated on for rectal adenocarcinoma in a single institution during the period of 2007-2009. We used logistic regression to estimate the relationship between possible predictive parameters of anastomotic leakage (AL)...
October 17, 2016: Acta Chirurgica Belgica
Jia-Bin Wang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Chang-Ming Huang
BACKGROUND: Comorbidity is a predictor of postoperative complications in gastrectomy. However, it remains unclear which comorbidities are predictors of postoperative complications in gastric cancer patients who have undergone laparoscopy-assisted total gastrectomy (LATG). The purpose of this study was to evaluate the effect of comorbidities on the surgical outcomes of patients with gastric cancer after LATG. METHODS: We retrospectively collected data on 1657 gastric cancer patients who underwent LATG between January 2008 and December 2015...
October 14, 2016: Surgical Endoscopy
Shuanhu Wang, Jingjing Liu, Shan Wang, Hongyun Zhao, Sitang Ge, Wenbin Wang
BACKGROUND: Anastomotic leakage is a serious complication associated with anterior resection for rectal cancer, the long-term effects of which are unclear. Therefore, a systematic review and meta-analysis were conducted to evaluate the impact of anastomotic leakage on disease recurrence and survival. METHODS: We searched PubMed, Embase, and the Cochrane Library databases from their inception to January 2016. Studies evaluating the oncologic impact of anastomotic leakage were included in the meta-analysis...
October 14, 2016: World Journal of Surgery
Joo Hyun Park, SiHyun Cho, Young Sik Choi, Seok Kyo Seo, Byung Seok Lee
The objective of this study was to evaluate whether robotic tubal reanastomosis after segmental resection of tubal pregnancy is a feasible means of preserving tubal integrity and natural fertility in those with compromised contralateral tubal condition.The study was performed at a university medical center in a retrospective manner where da Vinci robotic system-guided segmental resection of tubal ectopic mass followed by reanastomosis was performed to salvage tubal patency and fertility in those with a single viable fallopian tube...
October 2016: Medicine (Baltimore)
Yuri Tanaka, Mitsuro Kanda, Chie Tanaka, Daisuke Kobayashi, Akira Mizuno, Naoki Iwata, Masamichi Hayashi, Yukiko Niwa, Hideki Takami, Suguru Yamada, Tsutomu Fujii, Goro Nakayama, Hiroyuki Sugimoto, Michitaka Fujiwara, Yasuhiro Kodera
BACKGROUND: Gastrectomy with systemic lymphadenectomy is the standard of care for resectable gastric cancer (GC), but it is sometimes associated with postoperative morbidity. Predicting complications is therefore an essential part of risk management in clinical practice. The renal function is routinely evaluated before surgery by blood examinations to determine dose of medication and infusion. However, the value of various parameters of renal function in prediction of postoperative complications remain unclear...
October 12, 2016: Gastric Cancer
Wen-Tao Zhao, Ning-Ning Li, Dan He, Jin-Yan Feng
BACKGROUND: Transanal tubes (TTs) have been used to prevent and reduce anastomotic leakage after rectal cancer surgery. The aim of this review was to investigate the efficacy and safety of the TT. METHODS: A systematic literature search was performed to identify randomized controlled trials and controlled clinical trials assessing the clinical efficacy and safety of TTs in rectal cancer surgery. RESULTS: Seven trials with 1609 participants were included...
October 12, 2016: World Journal of Surgery
Chien-Hung Chiu, Yin-Kai Chao, Yu-Wen Wen, Hsien-Kun Chang, Chen-Kan Tseng, Yun-Hen Liu
BACKGROUND: Esophageal cancer has the propensity to spread in a longitudinal manner (either proximally or distally), potentially resulting in the unexpected presence of microscopic disease at grossly tumor-free margins. The clinical significance of this phenomenon in patients treated with chemoradiotherapy (CRT) remains unclear. The purpose of this study was to investigate the prevalence, predictors, and prognostic impact of microscopically positive proximal resection margins (PPRMs) in patients with esophageal squamous cell carcinoma (ESCC) who received CRT...
October 11, 2016: World Journal of Surgery
Kristina Guyton, John C Alverdy
Surgery involving the gastrointestinal tract continues to prove challenging because of the persistence of unpredictable complications such as anastomotic leakage and life-threatening infections. Removal of diseased intestinal segments results in substantial catabolic stress and might require complex reconstructive surgery to maintain the functional continuity of the intestinal tract. As gastrointestinal surgery necessarily involves a breach of an epithelial barrier colonized by microorganisms, preoperative intestinal antisepsis is used to reduce infection-related complications...
October 12, 2016: Nature Reviews. Gastroenterology & Hepatology
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