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Predictive factors for anastomotic leakage after laparoscopic colorectal surgery 被引量:50
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作者 Antonio Sciuto Giovanni Merola +4 位作者 Giovanni D De Palma Maurizio Sodo Felice Pirozzi umberto M bracale umberto bracale 《World Journal of Gastroenterology》 SCIE CAS 2018年第21期2247-2260,共14页
Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mor... Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage. 展开更多
关键词 LAPAROSCOPIC COLORECTAL SURGERY COLORECTAL SURGERY Anastomotic leakage LAPAROSCOPY Risk factor RECTAL cancer Diverting STOMA
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Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art 被引量:6
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作者 Roberto Peltrini Mauro Podda +9 位作者 Simone Castiglioni Maria Michela Di Nuzzo Michele D'Ambra Ruggero Lionetti Maurizio Sodo Gaetano Luglio Felice Mucilli Salomone Di Saverio umberto bracale Francesco Corcione 《World Journal of Gastroenterology》 SCIE CAS 2021年第38期6374-6386,共13页
Indocyanine green(ICG)fluorescence imaging is widely used in abdominal surgery.The implementation of minimally invasive rectal surgery using new methods like robotics or a transanal approach required improvement of op... Indocyanine green(ICG)fluorescence imaging is widely used in abdominal surgery.The implementation of minimally invasive rectal surgery using new methods like robotics or a transanal approach required improvement of optical systems.In that setting,ICG fluorescence optimizes intraoperative vision of anatomical structures by improving blood and lymphatic flow.The purpose of this review was to summarize all potential applications of this upcoming technology in rectal cancer surgery.Each type of use has been separately addressed and the evidence was investigated.During rectal resection,ICG fluorescence angiography is mainly used to evaluate the perfusion of the colonic stump in order to reduce the risk of anastomotic leaks.In addition,ICG fluorescence imaging allows easy visualization of organs such as the ureter or urethra to protect them from injury.This intraoperative technology is a valuable tool for conducting lymph node dissection along the iliac lymphatic chain or to better identifying the rectal dissection planes when a transanal approach is performed.This is an overview of the applications of ICG fluorescence imaging in current surgical practice and a synthesis of the results obtained from the literature.Although further studies are need to investigate the real clinical benefits,these findings may enhance use of ICG fluorescence in current clinical practice and stimulate future research on new applications. 展开更多
关键词 Indocyanine green Fluorescence imaging Near infrared Rectal cancer Total mesorectal excision Anastomotic leakage
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Colorectal resection in deep pelvic endometriosis: Surgical technique and post-operative complications
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作者 Marco Milone Andrea Vignali +9 位作者 Francesco Milone Giusto Pignata Ugo Elmore Mario Musella Giuseppe De Placido Antonio Mollo Loredana Maria Sosa Fernandez Guido Coretti umberto bracale Riccardo Rosati 《World Journal of Gastroenterology》 SCIE CAS 2015年第47期13345-13351,共7页
AIM: To investigate the impact of different surgical techniques on post-operative complications after colorectal resection for endometriosis.METHODS: A multicenter case-controlled study using the prospectively collect... AIM: To investigate the impact of different surgical techniques on post-operative complications after colorectal resection for endometriosis.METHODS: A multicenter case-controlled study using the prospectively collected data of 90 women(22 with and 68 without post-operative complications) who underwent laparoscopic colorectal resection for endometriosis was designed to evaluate any risk factors of post-operative complications. The prospectively collected data included: gender, age, body mass index, American Society of Anesthesiologists risk class, endometriosis localization(from anal verge), operative time, conversion, intraoperative complications, and post-operative surgical complications such as anastomotic dehiscence, bleeding, infection, and bowel dysfunction.RESULTS: A similar number of complicated cases have been registered for the different surgical techniques evaluated(laparoscopy, single access, flexure mobilization, mesenteric artery ligation, and transvaginal specimen extraction). A multivariate regression analysis showed that, after adjusting for major clinical, demographic, and surgical characteristics, complicated cases were only associated withendometriosis localization from the anal verge(OR = 0.8, 95%CI: 0.74-0.98, P = 0.03). After analyzing the association of post-operative complications and each different surgical technique, we found that only bowel dysfunction after surgery was associated with mesenteric artery ligation(11 out of 44 dysfunctions in the mesenteric artery ligation group vs 2 out of 36 cases in the no mesenteric artery ligation group; P = 0.03).CONCLUSION: Although further randomized clinical trials are needed to give a definitive conclusion, laparoscopic colorectal resection for deep infiltrating endometriosis appears to be both feasible and safe. Surgical technique cannot be considered a risk factor of post-operative complications. 展开更多
关键词 ENDOMETRIOSIS BOWEL COMPLICATION Technique LAPAROSCOPY MESENTERIC ARTERY
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