Risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions

BACKGROUNDThe incidence of retrorectal lesions is low, and no consensus has been reachedregarding the most optimal surgical approach. Laparoscopic approach has theadvantage of minimally invasive. The risk factors influencing perioperativecomplications of laparoscopic surgery are rarely discussed.AIMTo investigate the risk factors for perioperative complications in laparoscopicsurgeries of retrorectal cystic lesions.METHODSWe retrospectively reviewed the medical records of patients who underwentlaparoscopic excision of retrorectal cystic lesions between August 2012 and May2020 at our hospital. All surgeries were performed in the general surgerydepartment. Patients were divided into groups based on the lesion location anddiameter. We analysed the risk factors like type 2 diabetes mellitus, hypertension,the history of abdominal surgery, previous treatment, clinical manifestation,operation duration, blood loss, perioperative complications, and readmission ratewithin 90 d retrospectively.RESULTSSevere perioperative complications occurred in seven patients. Prophylactictransverse colostomy was performed in four patients with suspected rectal injury.Two patients underwent puncture drainage due to postoperative pelvic infection.One patient underwent debridement in the operating room due to incisioninfection. The massive-lesion group had a significantly longer surgery duration,higher blood loss, higher incidence of perioperative complications, and higherreadmission rate within 90 d (P < 0.05). Univariate analysis, multivariate analysis,and logistic regression showed that lesion diameter was an independent riskfactor for the development of perioperative complications in patients whounderwent laparoscopic excision of retrorectal cystic lesions.CONCLUSIONThe diameter of the lesion is an independent risk factor for perioperative complicationsin patients who undergo laparoscopic excision of retrorectal cystic lesions.The location of the lesion was not a determining factor of the surgical approach.Laparoscopic surgery is minimally invasive, high-resolution, and flexible, and itsuse in retrorectal cystic lesions is safe and feasible, also for lesions below the S3level.

Innovative integration of lung ultrasound and wearable monitoring for predicting pulmonary complications in colorectal surgery:A prospective study

BACKGROUND Postoperative pulmonary complications(PPCs)are common in patients who undergo colorectal surgery.Studies have focused on how to accurately diagnose and reduce the incidence of PPCs.Lung ultrasound has been proven to be useful in preoperative monitoring and postoperative care after cardiopulmonary surgery.However,lung ultrasound has not been studied in abdominal surgeries and has not been used with wearable devices to evaluate the influence of postoperative ambulation on the incidence of PPCs.AIM To investigate the relationship between lung ultrasound scores,PPCs,and postoperative physical activity levels in patients who underwent colorectal surgery.METHODS In this prospective observational study conducted from November 1,2019 to August 1,2020,patients who underwent colorectal surgery underwent daily bedside ultrasonography from the day before surgery to postoperative day(POD)5.Lung ultrasound scores and PPCs were recorded and analyzed to investigate their relationship.Pedometer bracelets measured the daily movement distance for 5 days post-surgery,and the correlation between postoperative activity levels and lung ultrasound scores was examined.RESULTS Thirteen cases of PPCs was observed in the cohort of 101 patients.The mean(standard deviation)peak lung ultrasound score was 5.32(2.52).Patients with a lung ultrasound score of≥6 constituted the high-risk group.High-risk lung ultrasound scores were associated with an increased incidence of PPCs after colorectal surgery(logistic regression coefficient,1.715;odds ratio,5.556).Postoperative movement distance was negatively associated with the lung ultrasound scores[Spearman’s rank correlation coefficient(r),-0.356,P<0.05].CONCLUSION Lung ultrasound effectively evaluates pulmonary condition post-colorectal surgery.Early ambulation and respiratory exercises in the initial two PODs will reduce PPCs and optimize postoperative care in patients undergoing colorectal surgery.