Postoperative cervical anastomotic fistula treated with a biologic glue

Anastomotic fistula is a dreadful complication of colon and rectal surgery that can put life into danger, being common after colorectal surgery. The preoperative lymphocyte neutrophil ratio (NLR) is known as a prognostic marker for colorectal cancer patients. The existence of a predictive marker of anastomotic fistula in colorectal cancer patients is not fully undestood, so we proposed to investigate the utility of preoperative NLR as a predictor of anastomotic fistula formation. This study the Neutrophils and lymphocytes were detected from periferic blood using flow citometry. We retrospectively evaluated 161 patients with colorectal cancer, who were treated curatively, in which at least one anastomosis was performed, comparing NLR values between patients who had fistula and those with normal healing, then comparing the group with low NLR, with the group with increased NLR, after finding the optimal value of NLR using the ROC curve.The optimal value of the NLR after establishing the cutoff value was 3.07. Between the low NLR group (n=134) and the high NLR group (n=27), were observed statistically significant differences in fistula (p [0.001) and death (p=0.001). The odds ratio for failure in the group with increased NLR was 10.37, which means that patients with NLR]3.54 have a chance of developing anastomotic fistula greater than 10.37 comparable to patients with lower NLR. We suggest the preoperative use of NLR can be used as a predictive marker of anastomotic fistula than can increase the quality of preoperative preparation and therefore the establishment of the optimal surgical technique that can lead to anastomotic fistula risk decrease.

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666 EARLY EXTUBATION AFTER ESOPHAGECTOMY IS SAFE. A SYSTEMATIC REVIEW AND META-ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doab052.666 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Maria Serafim ◽

Clara Santos ◽

Marina Orlandini ◽

Letícia Datrino ◽

Guilherme Tavares ◽

...

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Risk Difference ◽

Pulmonary Complications ◽

Mean Difference ◽

Early Extubation ◽

Icu Length Of Stay ◽

Anastomotic Fistula

Abstract Esophagectomy has high morbidity and mortality, mainly due to pulmonary complications. Consequently, ventilatory support is a cornerstone in postoperative management. However, there is still no consensus on the timing for extubation. There is a fear that untimely extubation would lead to a high risk for an urgent reintubation. On the other hand, there is a risk for pulmonary damage in prolonged intubation. Thus, the present study aimed to compare early and late extubation after esophagectomy. Methods A systematic review was carried out on PubMed, Lilacs, Cochrane Library Central, and Embase, comparing early and late extubation after esophagectomy. The primary outcome was reintubation. Secondary outcomes included mortality; complications; pulmonary complications; pneumonia; anastomotic fistula; length of hospital stay; and ICU length of stay. The inclusion criteria were: a) clinical trials and cohort studies; b) adult patients (> 18 years); and c) patients with esophageal cancer undergoing esophagectomy. The results were summarized by risk difference and mean difference. 95% confidence interval and random model were applied. Results Four articles were selected, comprising 490 patients. Early extubation did not increase the risk for reintubation, with a risk difference of 0.01 (95%CI -0.03; 0.04). Also, there was no difference for mortality −0.01 (95%CI -0.04; 0.03); complications −0.09 (95%CI -0.22; 0.05); pulmonary complications −0.05 (95%CI -0.13; 0.03); pneumonia −0.06 (95% CI-0.18; 0.05); anastomotic fistula −0.01 (95% CI -0.09; 0.08). In addition, there was no significant mean difference for: length of hospital stay −0.10 (95%CI -0.38; 0.1); and ICU length of stay 0.00 (95%CI -0.22; 0.22). Conclusion Early extubation after esophagectomy does not increase the risk for reintubation, mortality, complications, and lenght of stay.

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Effect of hyperbaric oxygen therapy on esophagojejunal anastomosis healing in rats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502008000600004 ◽

2008 ◽

Vol 23 (6) ◽

pp. 491-496 ◽

Cited By ~ 3

Author(s):

João Domingos Lionço ◽

Lívia Caprara Lionço ◽

Lucas Torely Filippi ◽

Clarissa Caprara Lionço ◽

Bernardo Volkweiss ◽

...

Keyword(s):

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Breaking Strength ◽

Suture Line ◽

Collagen Concentration ◽

Esophagojejunal Anastomosis ◽

Group A ◽

Anastomotic Fistula ◽

Group B

PURPOSE: To evaluate hyperbaric oxygen therapy (HBO) after esophagojejunal anastomosis in a rat experimental model and the effect of HBO on the healing of esophagojejunal anastomosis in gastrectomized rats. METHODS: Forty adult male Wistar rats, weighing 322 g to 506 g, were divided into two random groups. In group A (control group), 20 rats were subjected to total gastrectomy. In group B, 20 rats were similarly gastrectomized, but also received postoperative HBO treatment for 90 minutes/day for seven days. All rats were sacrificed on the eighth postoperative day and evaluated according to the following study variables: a) presence of anastomotic fistula; b) evaluation of esophagojejunal anastomosis healing by measuring the breaking strength at the suture line as per Hendriks & Mastboom; and c) determining the collagen concentration in the anastomosis, as per Kovács criteria. For the comparative statistical analysis between groups, Student's "t" test was used. A value of p<0.05 was considered significant. RESULTS: There was a 20% mortality rate. There were five deaths in group A and three in group B (p=N.S.). There was only one anastomotic fistula in each group, and neither caused any morbidity or death. Breaking strength measured at the suture line (p=0.528) and collagen concentration determined at the esophagojejunal anastomosis (p=0.89) were not significantly different between Groups A and B. CONCLUSION: Hyperbaric oxygen therapy did not affect the healing process of esophagojejunal anastomosis.

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Risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01557-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jin-Xi Huang ◽

Song-Ming Hong ◽

Qiang Chen ◽

Zeng-Chun Wang ◽

Dian-Ming Wu ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Birth Weight ◽

Oesophageal Atresia ◽

Prognostic Nutritional Index ◽

Anastomotic Stenosis ◽

Multivariate Logistic Regression ◽

One Stage ◽

Nutritional Index ◽

Anastomotic Fistula

Abstract Background Oesophageal atresia is a congenital malformation of the oesophagus and a serious malformation of the digestive system, postoperative complications include acute respiratory failure, pneumonia, anastomotic fistula, anastomotic stenosis, tracheal stenosis, gastroesophageal reflux and eosinophilic oesophagitis, anastomotic fistula is one of the important causes of postoperative death. The objective of this study is to identify the risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia. Methods A retrospective analysis was performed on the clinical data of 107 children with congenital oesophageal atresia who underwent one-stage anastomosis in our hospital from January 2013 to December 2018. Single-factor and multivariate logistic regression analyses were performed to determine the risk factors for anastomotic fistula and anastomotic stenosis. Results A total of 107 children with oesophageal atresia underwent one-stage anastomosis, and the incidence of anastomotic fistula was 26.2%. The probability of anastomotic stenosis in the long term was 52.3%, and the incidence of refractory stenosis (dilation ≥5 times) was 13.1%. Analysis of the clinical count data in the anastomotic fistula group and non-anastomotic fistula group showed that preoperative albumin (F = 4.199, P = 0.043), low birth weight (F = 7.668, P = 0.007) and long gap defects (F = 6.107, P = 0.015) were risk factors for postoperative anastomotic fistula. Further multivariate logistic regression analysis showed that low birth weight (Wald2 = 4.499, P = 0.034, OR = 2.775) and long gap defects (Wald2 = 6.769, P = 0.009, OR = 4.939) were independent risk factors for postoperative anastomotic fistula. Premature delivery (F = 5.338, P = 0.023), anastomotic fistula (F = 11.381, P = 0.001), endoscopic surgery (F = 6.343, P = 0.013), preoperative neutrophil count (F = 8.602, P = 0.004), preoperative low albumin (F = 8.410, P = 0.005), and a preoperative prognostic nutritional index < 54 (F = 5.54, P = 0.02) were risk factors for refractory anastomotic stenosis in children. Further multivariate logistic regression analysis showed that postoperative anastomotic fistula (Wald2 = 11.417, P = 0.001, OR = 8.798), endoscopic surgery (Wald2 = 9.633, P = 0.002, OR = 4.808), and a prognostic nutritional index < 54 (Wald2 = 4.540, P = 0.002, OR = 2.3798) were independent risk factors for refractory anastomotic stenosis. Conclusion Low birth weight and long gap defects are important predictors of postoperative anastomotic fistula, and the possibility of refractory anastomotic stenosis should be considered. The long-term risk of anastomotic stenosis was increased in children undergoing endoscopic surgery and in those with a preoperative prognostic nutritional index < 54.

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