Suture Patterns for Gastrointestinal Surgery

Abstract Background The aim of this systematic review was to identify all methods to quantify intraoperative fluorescence angiography (FA) of the gastrointestinal anastomosis, and to find potential thresholds to predict patient outcomes, including anastomotic leakage and necrosis. Methods This systematic review adhered to the PRISMA guidelines. A PubMed and Embase literature search was performed. Articles were included when FA with indocyanine green was performed to assess gastrointestinal perfusion in human or animals, and the fluorescence signal was analysed using quantitative parameters. A parameter was defined as quantitative when a diagnostic numeral threshold for patient outcomes could potentially be produced. Results Some 1317 articles were identified, of which 23 were included. Fourteen studies were done in patients and nine in animals. Eight studies applied FA during upper and 15 during lower gastrointestinal surgery. The quantitative parameters were divided into four categories: time to fluorescence (20 studies); contrast-to-background ratio (3); pixel intensity (2); and numeric classification score (2). The first category was subdivided into manually assessed time (7 studies) and software-derived fluorescence–time curves (13). Cut-off values were derived for manually assessed time (speed in gastric conduit wall) and derivatives of the fluorescence–time curves (Fmax, T1/2, TR and slope) to predict patient outcomes. Conclusion Time to fluorescence seems the most promising category for quantitation of FA. Future research might focus on fluorescence–time curves, as many different parameters can be derived and the fluorescence intensity can be bypassed. However, consensus on study set-up, calibration of fluorescence imaging systems, and validation of software programs is mandatory to allow future data comparison.

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Ex vivo mechanical testing of various suture patterns for use in tendon plating

Veterinary Surgery ◽

10.1111/vsu.13659 ◽

2021 ◽

Author(s):

Michael J. Hale ◽

Eric M. Zellner ◽

Jaron H. Naiman ◽

Karl H. Kraus

Keyword(s):

Mechanical Testing ◽

Ex Vivo ◽

Suture Patterns

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Endoscopic Internal Drainage and Low Negative Pressure Endoscopic Vacuum Therapy for anastomotic leaks after oncologic upper gastrointestinal surgery

Endoscopy ◽

10.1055/a-1375-8151 ◽

2021 ◽

Author(s):

Carlo Jung ◽

Rachel Hallit ◽

Annegret Müller-Dornieden ◽

Melanie Calmels ◽

Diane Goere ◽

...

Keyword(s):

Negative Pressure ◽

Treatment Duration ◽

Treatment Success ◽

Univariate Analysis ◽

Gastrointestinal Surgery ◽

Vacuum Therapy ◽

Internal Drainage ◽

Upper Gi ◽

Endoscopic Internal Drainage ◽

Endoscopic Vacuum Therapy

Background: Endoscopic internal drainage (EID) with double pigtail stents and low negative pressure endoscopic vacuum therapy (EVT) are treatment options for leakages after upper GI oncologic surgery. We aimed to compare the effectiveness of these techniques. Patients and methods: Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtails were changed every 4 weeks, EVT was repeated every 3-4 days until leak closure. Results: 35 EID and 27 EVT patients were included, with a median leak size of 0.75 cm (0.5-1.5). Overall treatment success was 100% [CI 90; 100] in EID vs. 85.2% [CI 66.3; 95.8] in EVT, p=0.03. The median number of endoscopic procedures was 2 (2; 3) vs. 3 (2; 6.5), p<0.01 and the median treatment duration was 42 (28; 60) vs. 17 days (7.5; 28), p<0.01, for EID vs. EVT, respectively. Conclusion: EID and EVT provide high closure rates for upper GI anastomotic leakages. EVT provides a shorter treatment duration at the cost of a higher number of procedures.

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Tissue stress from laparoscopic grasper use and bowel injury in humans: establishing intraoperative force boundaries

BMJ Surgery, Interventions, & Health Technologies ◽

10.1136/bmjsit-2021-000084 ◽

2021 ◽

Vol 3 (1) ◽

pp. e000084

Author(s):

Amanda Farah Khan ◽

Matthew Kenneth MacDonald ◽

Catherine Streutker ◽

Corwyn Rowsell ◽

James Drake ◽

...

Keyword(s):

Small Bowel ◽

Tissue Injury ◽

Ex Vivo ◽

Gastrointestinal Surgery ◽

Convenience Sample ◽

Thickness Change ◽

Novel Device ◽

Significant Difference ◽

Laparoscopic Grasper

ObjectivesWe aim to determine what threshold of compressive stress small bowel and colon tissues display evidence of significant tissue trauma during laparoscopic surgery.DesignThis study included 10 small bowel and 10 colon samples from patients undergoing routine gastrointestinal surgery. Each sample was compressed with pressures ranging from 100 kPa to 600 kPa. Two pathologists who were blinded to all study conditions, performed a histological analysis of the tissues. Experimentation: November 2018–February 2019. Analysis: March 2019–May 2020.SettingAn inner-city trauma and ambulatory hospital with a 40-bed inpatient general surgery unit with a diverse patient population.ParticipantsPatients were eligible if their surgery procured healthy tissue margins for experimentation (a convenience sample). 26 patient samples were procured; 6 samples were unusable. 10 colon and 10 small bowel samples were tested for a total of 120 experimental cases. No patients withdrew their consent.InterventionsA novel device was created to induce compressive “grasps” to simulate those of a laparoscopic grasper. Experimentation was performed ex-vivo, in-vitro. Grasp conditions of 0–600 kPa for a duration of 10 s were used.ResultsSmall bowel (10), M:F was 7:3, average age was 54.3 years. Colon (10), M:F was 1:1, average age was 65.2 years. All 20 patients experienced a significant difference (p<0.05) in serosal thickness post-compression at both 500 and 600 kPa for both tissue types. A logistic regression analysis with a sensitivity of 100% and a specificity of 84.6% on a test set of data predicts a safety threshold of 329–330 kPa.ConclusionsA threshold was discovered that corresponded to both significant serosal thickness change and a positive histological trauma score rating. This “force limit” could be used in novel sensorized laparoscopic tools to avoid intraoperative tissue injury.

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Selective Decontamination of the Digestive Tract to Prevent Postoperative Pneumonia and Anastomotic Leakage after Esophagectomy: A Retrospective Cohort Study

Antibiotics ◽

10.3390/antibiotics10010043 ◽

2021 ◽

Vol 10 (1) ◽

pp. 43

Author(s):

Robin Janssen ◽

Frans Van Workum ◽

Nikolaj Baranov ◽

Harmen Blok ◽

Jaap ten Oever ◽

...

Keyword(s):

Cohort Study ◽

Anastomotic Leakage ◽

Digestive Tract ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Protective Factor ◽

Gastrointestinal Surgery ◽

Surgical Site Infections ◽

Selective Decontamination ◽

Postoperative Pneumonia

Infectious complications occur frequently after esophagectomy. Selective decontamination of the digestive tract (SDD) has been shown to reduce postoperative infections and anastomotic leakage in gastrointestinal surgery, but robust evidence for esophageal surgery is lacking. The aim was to evaluate the association between SDD and pneumonia, surgical-site infections (SSIs), anastomotic leakage, and 1-year mortality after esophagectomy. A retrospective cohort study was conducted in patients undergoing Ivor Lewis esophagectomy in four Dutch hospitals between 2012 and 2018. Two hospitals used SDD perioperatively and two did not. SDD consisted of an oral paste and suspension (containing amphotericin B, colistin, and tobramycin). The primary outcomes were 30-day postoperative pneumonia and SSIs. Secondary outcomes were anastomotic leakage and 1-year mortality. Logistic regression analyses were performed to determine the association between SDD and the relevant outcomes (odds ratio (OR)). A total of 496 patients were included, of whom 179 received SDD perioperatively and the other 317 patients did not receive SDD. Patients who received SDD were less likely to develop postoperative pneumonia (20.1% vs. 36.9%, p < 0.001) and anastomotic leakage (10.6% vs. 19.9%, p = 0.008). Multivariate analysis showed that SDD is an independent protective factor for postoperative pneumonia (OR 0.40, 95% CI 0.23–0.67, p < 0.001) and anastomotic leakage (OR 0.46, 95% CI 0.26–0.84, p = 0.011). Use of perioperative SDD seems to be associated with a lower risk of pneumonia and anastomotic leakage after esophagectomy.

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Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery

Open Medicine ◽

10.1515/med-2020-0210 ◽

2020 ◽

Vol 15 (1) ◽

pp. 709-713

Author(s):

Piergiorgio Fedeli ◽

Richard Justin Davies ◽

Roberto Cirocchi ◽

Georgi Popivanov ◽

Paolo Bruzzone ◽

...

Keyword(s):

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Gastrointestinal Surgery ◽

Vitamin B1 ◽

Wernicke’S Encephalopathy ◽

Wernicke's Encephalopathy ◽

Vitamin Intake ◽

Unbalanced Diet ◽

Prolonged Hospital ◽

Care Costs

AbstractCarl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke’s disease is mainly observed in alcoholic patients, due to decreased vitamin intake as a consequence of an unbalanced diet, and a reduction of absorption due to the effects of alcohol. Likewise, inadequate vitamin intake is prevalent in older patients. Wernicke’s encephalopathy due to inappropriate total parenteral nutrition (TPN) occurs infrequently; recently, there is an increase in the literature concerning Wernicke’s encephalopathy in patients after general and bariatric surgeries. We present two cases of Wernicke’s encephalopathy after oncologic gastrointestinal surgery by failure to administer vitamin B1 during TPN; to our knowledge, these are the first two cases of Wernicke’s encephalopathy after colorectal surgery for cancer. In our opinion, timely diagnosis and treatment are mandatory to avoid nonfunctional recovery and consequent malpractice legal actions as well as an increase in the health-care costs correlated with the prolonged hospital stay and with the nonfunctional recovery.

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