Surgeon Perspectives on Anastomotic Leaks and FluidAI’s StreamTM Platform: Integrating Qualitative Insights for Technological Innovation

Purpose: This article investigates the critical importance of integrating surgeons’ direct input into the development of innovative technologies that address gaps in surgical care, including those aimed at reducing anastomotic leaks (AL), a major complication in gastrointestinal surgery. While traditional quantitative research methods are prevalent, they often overlook the invaluable insights of the surgeons who manage these complications firsthand. Subjects and Methods: This study employs a qualitative approach, utilizing semi-structured interviews with 40 surgeons from various specialties, including general, bariatric, colorectal, trauma, hepato-biliary, and thoracic surgery. The interviews were designed to probe the needs of surgeons, challenges currently faced, and gaps in clinical practice, research, and technology for detection and/or management of AL. The data were analyzed using thematic analysis, which revealed significant gaps in current technologies for early detection and prevention of leaks. Results: Surgeons expressed strong interest in FluidAI’s Stream™ Platform, a non-invasive medical device designed to monitor postoperative drainage fluid in real-time, providing continuous data on AL risk. The ability of this platform to offer early prediction through pH and electrical conductivity analysis was particularly appealing to participants, who emphasized the importance of timely interventions in improving patient outcomes. The study’s findings highlight not only the clinical challenges but also the emotional toll that AL takes on surgeons, underlining the need for innovations that are both data-driven and humanistic. Conclusion: By centering surgeons’ perspectives, this research advocates for a human-centered approach to technological advancement, ensuring that new tools are both clinically effective and aligned with the real-world needs of surgical practitioners.

Utero-Cutaneous Fistula after Caesarean Section Delivery: Diagnosis and Management of a Rare Complication

Utero-cutaneous fistula following cesarean section is a rare occurrence. We present the case of a 34-year-old woman who presented to our department four years after her second cesarean section with a history of pain and blood discharge from a previous Pfannenstiel incision, during menstruation, with an absence of vaginal menstrual flow. Despite a prior surgical repair operation, her symptoms persisted. A pelvic MRI was done to confirm the diagnosis of utero-cutaneous fistula, and surgical management was pursued. This case report aims to contribute to the existing literature on utero-cutaneous fistula and provide insights into the diagnostic considerations and management strategies for this rare complication.

Risk factors for anastomotic fistula development after radical colon cancer surgery and their impact on prognosis

BACKGROUND Colon cancer is a common malignant tumor in the gastrointestinal tract that is typically treated surgically.However,postradical surgery is prone to complic-ations such as anastomotic fistulas.AIM To investigate the risk factors for postoperative anastomotic fistulas and their impact on the prognosis of patients with colon cancer.METHODS We conducted a retrospective analysis of 488 patients with colon cancer who underwent radical surgery.This study was performed between April 2016 and April 2019 at a tertiary hospital in Wuxi,Jiangsu Province,China.A t-test was used to compare laboratory indicators between patients with and those without postoperative anastomotic fistulas.Multiple logistic regression analysis was performed to identify independent risk factors for postoperative anastomotic fistulas.The Functional Assessment of Cancer Therapy-Colorectal Cancer was also used to assess postoperative recovery.RESULTS Binary logistic regression analysis revealed that age[odds ratio(OR)=1.043,P=0.015],tumor,node,metastasis stage(OR=2.337,P=0.041),and surgical procedure were independent risk factors for postoperative anastomotic fistulas.Multiple linear regression analysis showed that the development of postoperative anastomotic fistula(P=0.000),advanced age(P=0.003),and the presence of diabetes mellitus(P=0.015),among other factors,independently affected CONCLUSION Postoperative anastomotic fistulas significantly affect prognosis and survival rates.Therefore,focusing on the clinical characteristics and risk factors and immediately implementing individualized preventive measures are important to minimize their occurrence.

Biliary complications in liver transplantation: Impact of anastomotic technique and ischemic time on short- and long-term outcome

AIM: To elucidate the impact of various donor recipient and transplant factors on the development of biliary complications after liver transplantation.METHODS: We retrospectively reviewed 200 patients of our newly established liver transplantation(LT) program, who received full size liver graft. Biliary reconstruction was performed by side-to-side(SS), end-to-end(EE) anastomosis or hepeaticojejunostomy(HJ). Biliary complications(BC), anastomotic stenosis, bile leak, papillary stenosis, biliary drain complication, ischemic type biliary lesion(ITBL) were evaluated by studying patient records, corresponding radiologic imaging and reports of interventional procedures [e.g., endoscopic retrograde cholangiopancreatography(ERCP)]. Laboratory results included alanine aminotransferase(ALT), gammaglutamyltransferase and direct/indirect bilirubin with focus on the first and fifth postoperative day, six weeks after LT. The routinely employed external bile drain was examined by a routine cholangiography on the fifth postoperative day and six weeks after transplantation as a standard procedure, but also whenever clinically indicated. If necessary, interventional(e.g., ERCP) or surgical therapy was performed. In case of biliary complication, patients were selected, assigned to different complication-groups and subsequently reviewed in detail. To evaluate the patients outcome, we focussed on appearance of postoperative/post-interventional cholangitis, need for rehospitalisation, retransplantation, ITBL or death caused by BC.RESULTS: A total of 200 patients [age: 56(19-72), alcoholic cirrhosis: n = 64(32%), hepatocellular carcinoma: n = 40(20%), acute liver failure: n = 23(11.5%), cryptogenic cirrhosis: n = 22(11%), hepatitis B virus /hepatitis C virus cirrhosis: n = 13(6.5%), primary sclerosing cholangitis: n = 13(6.5%), others: n = 25(12.5%) were included. The median follow-up was 27 mo until June 2015. The overall biliary complication rate was 37.5%(n = 75) with anastomotic strictures(AS): n = 38(19%), bile leak(BL): n = 12(6%), biliary drain complication: n = 12(6%); papillary stenosis(PS): n = 7(3.5%), ITBL: n = 6(3%). Clinically relevant were only 19%(n = 38). We established a comprehensive classification for AS with four grades according to clinical relevance. The reconstruction techniques [SS: n = 164, EE: n = 18, HJ: n = 18] showed no significant impact on the development of BCs in general(all n < 0.05), whereas in the HJ group significantly less AS were found(P = 0.031). The length of donor intensive care unit stay over 6 d had a significant influence on BC development(P = 0.007, HR = 2.85; 95%CI: 1.33-6.08) in the binary logistic regression model, whereas other reviewed variables had not [warm ischemic time > 45 min(P = 0.543), cold ischemic time > 10 h(P = 0.114), ALT init > 1500 U/L(P = 0.631), bilirubin init > 5 mg/d L(P = 0.595), donor age > 65(P = 0.244), donor sex(P = 0.068), rescue organ(P = 0.971)]. 13%(n = 10) of BCs had no therapeutic consequences, 36%(n = 27) resulted in repeated lab control, 40%(n = 30) received ERCP and 11%(n = 8) surgical therapy. Fifteen(7.5%) patients developed cholangitis [AS(n = 6), ITBL(n = 5), PS(n = 3), biliary lesion BL(n = 1)]. One patient developed ITBL twelve months after LT and subsequently needed retransplantation. Rehospitalisation rate was 10.5 %(n = 21) [AS(n = 11), ITBL(n = 5), PS(n = 3), BL(n = 1)] with intervention or reinterventional therapy as main reasons. Retransplantation was performed in 5(2.5%) patients [ITBL(n = 1), acute liver injury(ALI) by organ rejection(n = 3), ALI by occlusion of hepatic artery(n = 1)]. In total 21(10.5%) patients died within the follow-up period. Out of these, one patient with AS developed severe fatal chologenic sepsis after ERCP.CONCLUSION: In our data biliary reconstruction technique and ischemic times seem to have little impact on the development of BCs.

Postoperative Early Standard and Sequential Nutritional Support in the Treatment of Gastroesophageal Anastomotic Fistula:a Case Report

GASTROESOPHAGEAL anastomotic fistula is aserious and potentially life-threatening complicationafter the resection of esophagus, gastricand cardia tumor.1 Before 1987, the incidenceof gastroesophageal anastomotic fistula is about 2%-4% inChina, and the mortality rate is as high as 50% or more.2 Inthe last 30 years, with the rapid development of clinicalnutrition support method, nutritional support.

Late anastomotic perforation following surgery for gastric neuroendocrine tumor complicated by perforated duodenal ulcer:a case report

Neuroendocrine tumors （NETs） are a group of neoplasms that are characterized by the secretion of a variety of hormones and diverse clinical syndromes. NETs are considered to be rare, but the incidence of NETs has increased rapidly in recent years. NETs provide a clinical challenge for physicians because they comprise a heterogeneous group of malignancies with a wide range of morphological, functional, and behavioral characteristics. Subtotal gastrectomy with Billroth II reconstruction is the mainstay of therapy in the management of gastric NETs complicated by perforated duodenal ulcer. Late perforation of anastomotic stoma as a long-term complication has been rarely reported. Here, we report a case of anastomotic perforation 5 years after subtotal gastrectomy due to perforated duodenal ulcer and gastric NETs.

Application of omental interposition to reduce pancreatic fistula and related complications in pancreaticoduodenectomy:A propensity score-matched study

BACKGROUND The life-threatening complications following pancreatoduodenectomy(PD),intraabdominal hemorrhage,and postoperative infection,are associated with leaks from the anastomosis of pancreaticoduodenectomy.Although several methods have attempted to reduce the postoperative pancreatic fistula(POPF)rate after PD,few have been considered effective.The safety and short-term clinical benefits of omental interposition remain controversial.AIM To investigate the safety and feasibility of omental interposition to reduce the POPF rate and related complications in pancreaticoduodenectomy.METHODS In total,196 consecutive patients underwent PD performed by the same surgical team.The patients were divided into two groups:An omental interposition group(127,64.8%)and a non-omental interposition group(69,35.2%).Propensity scorematched(PSM)analyses were performed to compare the severe complication rates and mortality between the two groups.RESULTS Following PSM,the clinically relevant POPF(CR-POPF,10.1%vs 24.6%;P=0.025)and delayed postpancreatectomy hemorrhage(1.4%vs 11.6%;P=0.016)rates were significantly lower in the omental interposition group.The omental interposition technique was associated with a shorter time to resume food intake(7 d vs 8 d;P=0.048)and shorter hospitalization period(16 d vs 21 d;P=0.031).Multivariate analyses showed that a high body mass index,nonapplication of omental interposition,and a main pancreatic duct diameter<3 mm were independent risk factors for CR-POPF.CONCLUSION The application of omental interposition is an effective and safe approach to reduce the CR-POPF rate and related complications after PD.

Post-Operative Complications of Transvesical Prostatic Adenomectomy at Bouake Teaching Hospital: Epidemiological, Diagnostic and Therapeutic Aspects

Introduction: The treatment of benign prostatic hyperplasia (BPH) responds to a medical aspect at first, the effectiveness of which is indisputable. However, the curative treatment is surgery. Trans-urethral resection of the prostate (TURP) represents the reference surgical technique when the technical platform is correct. In Bouaké, the FREYER HRYNTCHACK trans vesical approach is the technique used in our department. It sometimes leads to complications that can be life-threatening. The general objective of this work was to describe the morbidity and mortality of trans-bladder adenomectomy and their management at the Bouaké University Hospital. Material and Methods: This is a retrospective descriptive study carried out at the Bouaké Teaching Hospital over a period of 5 years from January 2016 to December 2022. It involved 150 patients operated on for BPH by the trans vesical route and who experienced postoperative complications. The parameters studied were age, postoperative complications, treatment, and mortality. Results: The mean age of the patients was 67.2 ± 7.37 years. Hemorrhage was the main immediate complication. Parietal suppuration, in 48% of cases, was the most common secondary complication, followed by vesicocutaneous fistula (18%), orchiepididymitis (15.33%) and urinary leakage (3.33). Late complications were: retrograde ejaculation in 73.33%, urethral stricture (10.66%) and sclerosis of the compartment (6.66%). Mortality was 1.33%. Conclusion: Post-operative complications of adenomectomies according to Freyer Hrynstchak remain dominated by infections. However, postoperative hemorrhage remains the surgeon’s fear because it can cause the death of the patient.

Complications of Circumcision: Epidemiological, Anatomo-Clinical and Therapeutic Aspects

Circumcision refers, in its most widespread form, to the total or partial removal of the foreskin, leaving the glans exposed. It is a ritual practice imposed by Mosaic law for Israelites, a tradition for Muslims, a rite of passage to adulthood for many people of Africa and the East. Circumcision is also a widely used therapeutic surgical procedure for a number of balanopreputial affections. The aim of this study was to list cases of circumcision complications received in a urological hospital (CHR Saint Louis) and to analyze their epidemiological, anatomo-clinical and therapeutic aspects. Patients and methods: This was a retrospective, descriptive study of circumcision complications, carried out in the urology department of the Saint Louis regional hospital in Senegal over a 5-year period (January 1, 2013 to December 31, 2017). Results: Thirty-three (33) complications of circumcision were collated. The mean age of patients was 7.63 years [9 months - 16 years]. Duration of time for Consultation varied according to the type of complication, with an average of 1.6 years [1 day - 10 years]. Penile granuloma accounted for 36.3% of the complications (n = 12), local infection for 30.3% (n = 10) and urethro-cutaneous fistula for 18.2% (n = 6). For six patients with urethro-cutaneous fistula, we performed urethro-cutaneous splitting in 5 patients, while the same complication necessitated urethroplasty in another patient. We noted five cases of verge plasty for verge granuloma, one glan reimplantation and one glan plasty for the two patients with glans amputation. Conclusion: Circumcision is a medical procedure widely practised throughout the world for medical, cultural and aesthetic reasons. In Africa, the lack of health coverage and the shortage of doctors explain why this surgical procedure is so common. In Senegal, circumcision is still carried out in the majority of cases by paramedical staff, which explains the high rate of complications.

Differences in examination results of small anastomotic fistula after radical gastrectomy with afterward treatments:A case report

BACKGROUND Gastrografin swallow,methylthioninium chloride test,and computed tomography(CT)are the main methods for postoperative anastomotic fistula detection.Correct selection and application of examinations and therapies are significant for the early diagnosis and treatment of small anastomotic fistulas after radical gastrectomy,which are conducive to postoperative recovery.CASE SUMMARY A 44-year-old woman underwent radical total gastrectomy for laparoscopic gastric cancer.The patient developed a fever after surgery.The methylthioninium chloride test and early CT suggested no anastomotic fistula,but gastrografin swallow and late CT showed the opposite result.The fistula was successfully closed using an endoscopic clip.The methylthioninium chloride test,gastrografin,and CT performed on different postoperative dates for small esophagojejunostomy fistulas are different.The size of the anastomotic fistula is an important factor for the success of endoscopic treatment.CONCLUSION The advantages and limitations of the diagnosis of different examinations of small esophagojejunostomy fistulas are noteworthy.The size of the leakage of the anastomosis is an important basis for selecting the repair method.

Direct visualization of postoperative aortobronchial fistula on computed tomography

BACKGROUND Postoperative aortobronchial fistula(ABF)is a rare complication that can occur in 0.3%-5.0%of patients over an extended period of time after thoracic aortic surgery.Direct visualization of the fistula via imaging is rare.AIM To investigate the relationship between computed tomography(CT)findings and the clinical signs/symptoms of ABF after thoracic aortic surgery.METHODS Six patients(mean age 71 years,including 4 men and 2 women)with suspected ABF on CT(air around the graft)at our hospital were included in this retrospective study between January 2004 and September 2022.Chest CT findings included direct confirmation of ABF,peri-graft fluid,ring enhancement,dirty fat sign,atelectasis,pulmonary hemorrhage,and bronchodilation,and the clinical course were retrospectively reviewed.The proportion of each type of CT finding was calculated.RESULTS ABF detection after surgery was found to have a mean and median of 14 and 13 years,respectively.Initial signs and symptoms were asymptomatic in 4 patients,bloody sputum was found in 1 patient,and fever was present in 1 patient.The complications of ABF included graft infection in 2 patients and graft infection with hemoptysis in 2 patients.Of the 6 patients,3 survived,2 died,and 1 was lost to follow-up.The locations of the ABFs were as follows:1 in the ascending aorta;1 in the aortic arch;2 in the aortic arch leading to the descending aorta;and 2 in the descending aorta.ABFs were directly confirmed by CT in 4/6(67%)patients.Peri-graft dirty fat(4/6,67%)and peri-graft ring enhancement(3/6,50%)were associated with graft infection,endoleaks and pseudoaneurysms were associated with hemoptysis(2/6,33%).CONCLUSION Asymptomatic ABF after thoracic aortic surgery can be confirmed on chest CT.CT is useful for the diagnosis of ABF and its complications.

Non-Fistulous Complications of Prolonged Obstructed Labour among Obstetric Fistula Patients in Southern Nigeria

Background: Long-term complications of prolonged obstructed labour are multisystemic, obstetric fistula about the most devastating. Efforts at controlling obstetric fistula pay little attention to the non-fistulous injuries which reduce the quality of life of the affected women even after a successful fistula repair. The objectives of this study were to determine the burden of the non-fistulous complications among fistula patients, identify these injuries and the factors associated with them. Methods: This cross-sectional study was conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria from July to December 2016. The hospital has performed over 2600 free fistula repairs. This study was approved by the Research and Ethics Committee of the hospital. The study population comprised of women who developed obstetric fistula following prolonged obstructed labour. Direct questioning, examination findings, operation findings and laboratory results, using a pre-tested, semi-structured and interviewer-administered proforma were used to collect data. Informed consent was obtained from the subjects. Data were analyzed using the Statistical Package for Social Sciences [SPSS] version 21. Frequency and proportions were used to describe categorical variables while means and standard deviation were used to describe continuous variables. Association between categorical variables and direct obstructed labour injuries was tested using chi-square test and predictors of obstructed labour injuries were determined using logistic regression. A P-value 0.05 was considered statistically significant. Results: One hundred and sixty one (161) women participated in the study. The mean age of the women was 33.4 years while the mean parity was 3.2. Non-fistulous complications of prolonged obstructed labour were found in 96.9% (156) of the women. These included cervical retraction (42.2%), obstetric nerve palsy (30.4%), vaginal scarring (29.8%), partial urethral loss (16.1%), anal sphincter injury (3.1%), cervical stenosis (5.0%) and urethral stenosis (3.7%). Others were ammoniacal dermatitis (29.2%), secondary amenorrhoea (21.7%), secondary infertility (9.3%), dyspareunia (6.8%), hypomenorrhea (1.2%) and bladder stone (3.7%). Majority (79.4%) of the women with cervical retraction had caesarean section (CS) as against 20.6% who had vaginal delivery. This was statistically significant (P 0.001). A higher proportion of participants with amenorrhea were delivered via CS (44.3%) compared to those who had vaginal delivery (21.2%). This was also statistically significant (P = 0.012). Neurologic injury was associated with primiparity although this was not statistically significant (P = 0.171). Conclusion: Almost all fistula patients also have non-fistulous complications of prolonged obstructed labour. Efforts to manage the fistula should equally address these complications. We advocate comprehensive care for identification and management of these injuries to improve the quality of life and overall well-being of these women. To reduce complications like cervical retraction, there should be an emphasis on safer caesarean section for women with prolonged obstructed labour.

Risk Factors of Early Complications after Pancreaticoduodenectomy in 200 Consecutive Patients

To study the risk factors for early complications after pancreaticoduodenectomy （PD）. Methods： Two hundred patients undergoing PD at our hospital between December 1996 and September 2002 were reviewed retrospectively. Standard PD was performed on 176 cases, standard PD with extended lymphadenectomy on 24 patients, whereas pylorus-preserving PD was not used. An end-toside combined with mucosa-to-mucosa pancreaticojejunostomy was performed on the patients with a hard pancreas and a dilated pancreatic duct, and a traditional end-to-end invagination pancreaticojejunostomy on the patients with a soft pancreas and a non-dilated duct. The risk factors with the potential to affect the incidence of complications were analyzed with SAS 8.12 software. Logistic regression was then used to determine the effect of multiple factors on early complications. Results： The overall rate of the major com- plications was 21% （42/200）, with the failure of pancreaticojejunal anastomosis being the most frequently encountered. Age （odds ratio [OR] 2.162）, diabetes mellitus （OR 4.086）, total serum bilirubin level （OR 7.556）, end-to-end pancreaticojejunostomy （OR 2.616）, T tube through the choledochojejunostomy （OR 0.100）, and blood transfusion over 1000 mL （OR 2.410） were the significant risk factors for the morbidity. Conclusion： The results from published series concerning morbidity after pancreaticoduodenectomy are not comparable because of lack of homogeneity between them. The knowledge of the complications rate in each particular department turns out essentially to provide the patient with tailored information about risks before surgery. Additionally, management of postoperative complications is essential for improving the results of this operation.

Efficacy and safety of over-the-scope clip: Including complications after endoscopic submucosal dissection

AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers sites.RESULTS: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing factors for the overall unsuccessful clinical cases. The location of the unsuccessful lesion was in the stomach. The median operation time in the successful cases was 18 min, and the average observation time was 67 d. During the observation period, none of the patients experienced any complications associated with OTSC placement. In addition, we successfully used the OTSC to close the perforation site after ESD in 6 patients. This was a single-center, retrospective study with a small sample size. CONCLUSION: The OTSC is effective for treating GI bleeding, fistulae as well as perforations, and the OTSC technique proofed effective treatment for perforation after ESD.

Colorectal anastomotic leakage: Aspects of prevention, detection and treatment

All colorectal surgeons are faced from time to time with anastomotic leakage after colorectal surgery. This complication has been studied extensively without a significant reduction of incidence over the last 30 years. New techniques of prevention, by innovative anastomotic techniques should improve results in the future, but standardization and "teachability" should be guaranteed. Risk scoring enables intra-operative decision-making whether to restore continuity or deviate. Early detection can lead to reduction in delay of diagnosis as long as a standard system is used. For treatment options, no firm evidence is available, but future studies could focus on repair and saving of the anastomosis on the one hand or anastomotical breakdown and definitive colostomy on the other hand.

Surgical complications after different therapeutic approaches for locally advanced rectal cancer

BACKGROUND Preoperative radiochemotherapy is widely used in locally advanced rectal cancer.It can improve local control of rectal cancer. However, some researchers believe it increases the incidence of surgical complications. They doubt its safety. Patients with locally advanced rectal cancer receive three different treatments in our hospital, including long-course radiochemotherapy, short-course radiotherapy,and surgery directly. We can compare their differences in postoperative complications.AIM To investigate surgical complications caused by different preoperative radiotherapy regimens.METHODS We retrospectively analyzed 1197 patients admitted between 2008 and 2010 with locally advanced rectal cancer. Three hundred and forty-six patients were treated with preoperative long-course radiochemotherapy(25 × 2 Gy) followed by total mesorectal excision(TME) 6–8 wk later, and 259 patients received short-course radiotherapy(10 × 3 Gy) and subsequently TME 7–10 d later. The remaining 592 patients underwent TME alone without neoadjuvant therapy. According to Clavien–Dindo classification, surgical complications were evaluated for up to 30 d after discharge from hospital.RESULTS There were no deaths in 30 d in all groups after treatment. The majorcomplications were anastomotic leakage and perineal wound complications. The results suggested that both long-course [odds ratio(OR) = 3.624, 95% confidence interval(CI): 1.689–7.775, P = 0.001] and short-course(OR = 5.150, 95%CI:1.828–14.515, P = 0.002) radiotherapy were associated with anastomotic leakage.Temporary ileostomy was a protective factor for anastomotic leakage(OR =6.211, 95%CI: 2.525–15.385, P < 0.001). The severity of anastomotic leakage did not increase in patients following preoperative radiotherapy(P = 0.411).Compared with TME alone, short-course radiotherapy was associated with an increase in perineal wound complications(OR = 5.565, 95%CI: 2.203–14.057, P <0.001), but long-course radiotherapy seemed safe regarding this complication(OR= 1.692, 95%CI: 0.651–4.394, P = 0.280). Although the severity of perineal wound complications increased in patients following short-course radiotherapy(P <0.001), additional intervention was not necessary.CONCLUSION Radiotherapy increased the incidence but not severity of anastomotic leakage.Short-course radiotherapy was also accompanied with perineal wound complications, but intervention appeared unnecessary to ameliorate the complications.

Early complications after interventions in patients with acute pancreatitis

AIM: To identify the possible predictors of early complications after the initial intervention in acute necrotizing pancreatitis.METHODS: We collected the medical records of 334 patients with acute necrotizing pancreatitis who received initial intervention in our center. Complications associated with predictors were analyzed.RESULTS: The postoperative mortality rate was 16% (53/334). Up to 31% of patients were successfully treated with percutaneous catheter drainage alone. The rates of intra-abdominal bleeding, colonic fistula, and progressive infection were 15% (50/334), 20% (68/334), and 26% (87/334), respectively. Multivariate analysis indicated that Marshall score upon admission, multiple organ failure, preoperative respiratory infection, and sepsis were the predictors of postoperative progressive infection (P &#x0003c; 0.05). Single organ failure, systemic inflammatory response syndrome upon admission, and C-reactive protein level upon admission were the risk factors of postoperative colonic fistula (P &#x0003c; 0.05). Moreover, preoperative Marshall score, organ failure, sepsis, and preoperative systemic inflammatory response syndrome were the risk factors of postoperative intra-abdominal bleeding (P &#x0003c; 0.05).CONCLUSION: Marshall score, organ failures, preoperative respiratory infection, sepsis, preoperative systemic inflammatory response syndrome, and C-reactive protein level upon admission are associated with postoperative complications.

Management of low colorectal anastomotic leak:Preserving the anastomosis

Anastomotic leak continues to be a dreaded complication after colorectal surgery, especially in the low colorectal or coloanal anastomosis. However, there has been no consensus on the management of the low colorectal anastomotic leak. Currently operative procedures are reserved for patients with frank purulent or feculent peritonitis and unstable vital signs, and vary from simple fecal diversion with drainage to resection of the anastomosis and closure of the rectal stump with end colostomy(Hartmann's procedure). However, if the patient is stable, and the leak is identified days or even weeks postoperatively, less aggressive therapeutic measures may result in healing of the leak and salvage of the anastomosis. Advances in diagnosis and treatment of pelvic collections with percutaneous treatments, and newer methods of endoscopic therapies for the acutely leaking anastomosis, such as use of the endosponge, stents or clips, have greatly reduced the need for surgical intervention in selected cases. Diverting ileostomy, if not already in place, may be considered to reduce fecal contamination. For subclinical leaks or those that persist after the initial surgery, endoluminal approaches such as injection of fibrin sealant, use of endoscopic clips, or transanal closure of the very low anastomosis may be utilized. These newer techniques have variable success rates and must be individualized to the patient, with the goal of treatment being restoration of gastrointestinal continuity and healing of the anastomosis. A review of the treatment of low colorectal anastomotic leaks is presented.

Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges

Anastomotic leak(AL)constitutes a significant issue in colorectal surgery,and its incidence has remained stable over the last years.The use of intra-abdominal drain or the use of mechanical bowel preparation alone have been proven to be useless in preventing AL and should be abandoned.The role or oral antibiotics preparation regimens should be clarified and compared to other routes of administration,such as the intravenous route or enema.In parallel,preoperative antibiotherapy should aim at targeting collagenase-inducing pathogens,as identified by the microbiome analysis.AL can be further reduced by fluorescence angiography,which leads to significant intraoperative changes in surgical strategies.Implementation of fluorescence angiography should be encouraged.Progress made in AL comprehension and prevention might probably allow reducing the rate of diverting stoma and conduct to a revision of its indications.

Can intraluminal devices prevent or reduce colorectal anastomotic leakage:A review

Colorectal anastomotic leakage is a serious complication of colorectal surgery, leading to high morbidity and mortality rates. In recent decades, many strategies aimed at lowering the incidence of anastomotic leakage have been examined. The focus of this review will be on mechanical aids protecting the colonic anastomosis against leakage. A literature search was performed using MEDLINE, EMBASE, and The Cochrane Collaborative library for all papers related to prevention of anastomotic leakage by placement of a device in the colon. Devices were categorised as decompression devices, intracolonic devices, and biodegradable devices. A decompression device functions by keeping the anal sphincter open, thereby lowering the intraluminal pressure and lowering the pressure on the anastomosis. Intracolonic devices do not prevent the formation of dehiscence. However, they prevent the faecal load from contacting the anastomotic site, thereby preventing leakage of faeces into the peritoneal cavity. Many attempts have been made to find a device that decreases the incidence of AL;however, to date, none of the devices have been widely accepted.