scholarly journals Operative Management of Anastomotic Leaks after Colorectal Surgery

2019 ◽  
Vol 32 (03) ◽  
pp. 190-195 ◽  
Author(s):  
Nicole Saur ◽  
E. Paulson
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Anastomotic Leak ◽  
Surgical Techniques ◽  
Perioperative Period ◽  
Operative Management ◽  
Nonoperative Treatment ◽  
Operative Exploration ◽  
Operative Findings

AbstractAnastomotic leak is associated with increased morbidity and mortality after colorectal surgery. Although surgical techniques have improved over time, anastomotic leak is still a reality in colorectal surgery with rates ranging from as low as 1% for low-risk anastomoses, such as enteroenteric or ileocolic, to 19% for high-risk coloanal anastomoses. There are many varied risk factors for anastomotic leak. However, many of the risk factors have not been definitively proven in high-quality studies. Presumably, risk factors are cumulative and every effort should be made to optimize modifiable risk factors in the perioperative period. Treatment of anastomotic leak should start with the determination of patient stability followed by resuscitation and diagnostic imaging or operative exploration. Operative findings will dictate surgical approach with the goal of controlling sepsis and stabilizing the patient. If nonoperative treatment is undertaken, close patient monitoring is necessary to ensure control of sepsis and that intervention is undertaken if the clinical picture changes. Early intervention at each stage is key to decreasing the morbidity of anastomotic leak.

Risk Factors for Anastomotic Leak, Consideration for Proximal Diversion, and Appropriate Use of Drains

2021 ◽  
Vol 34 (06) ◽  
pp. 366-370
Author(s):  
Joanne Favuzza
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
High Risk ◽  
Colorectal Surgery ◽  
Anastomotic Leak ◽  
Anastomotic Leaks ◽  
Appropriate Use ◽  
Preoperative Optimization ◽  
Colorectal Surgeons ◽  
Drain Placement

AbstractAnastomotic leaks are a major source of morbidity after colorectal surgery. There is a myriad of risk factors that may contribute to anastomotic leaks. These risk factors can be categorized as modifiable, nonmodifiable, and intraoperative factors. Identification of these risk factors allows for preoperative optimization that may minimize the risk of anastomotic leak. Knowledge of such high-risk features may also affect intraoperative decision-making regarding the creation of an anastomosis, consideration for proximal diversion, or placement of a drain. A thorough understanding of the interplay between risk factors, indications for proximal diversion, and utility of drain placement is imperative for colorectal surgeons.

scholarly journals More Becomes Less: Management Strategy Has Definitely Changed over the Past Decade of Splenic Injury—A Nationwide Population-Based Study

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Kwan-Ming Soo ◽  
Tsung-Ying Lin ◽  
Chao-Wen Chen ◽  
Yen-Ko Lin ◽  
Liang-Chi Kuo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Blood Transfusion ◽  
Management Strategy ◽  
Multivariate Logistic Regression Analysis ◽  
Operative Management ◽  
Population Based ◽  
Nonoperative Treatment ◽  
Hospital Length Of Stay ◽  
Noninvasive Treatment

Background. Blunt spleen injury is generally taken as major trauma which is potentially lethal. However, the management strategy has progressively changed to noninvasive treatment over the decade. This study aimed to (1) find out the incidence and trend of strategy change; (2) investigate the effect of change on the mortality rate over the study period; and (3) evaluate the risk factors of mortality.Materials and Methods. We utilized nationwide population-based data to explore the incidence of BSI during a 12-year study period. The demographic characteristics, including gender, age, surgical intervention, blood transfusion, availability of CT scans, and numbers of coexisting injuries, were collected for analysis. Mortality, hospital length of stay, and cost were as outcome variables.Results. 578 splenic injuries were recorded with an estimated incidence of 48 per million per year. The average 12-year overall mortality rate during hospital stay was 5.28% (29/549). There is a trend of decreasing operative management in patients (X2,P=0.004). The risk factors for mortality in BSI from a multivariate logistic regression analysis were amount of transfusion (OR 1.033,P<0.001, CI 1.017–1.049), with or without CT obtained (OR 0.347,P=0.026, CI 0.158–0.889), and numbers of coexisting injuries (OR 1.346,P=0.043, CI 1.010–1.842).Conclusion. Although uncommon of BSI, management strategy is obviously changed to nonoperative treatment without increasing mortality and blood transfusion under the increase of CT utilization. Patients with more coexisting injuries and more blood transfusion had higher mortality.

scholarly journals Anastomotic Leak after Colorectal Surgery. Our Experience in three Years.

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Kastriot Haxhirexha ◽  
Agron Dogjani ◽  
Lutfi Zylbehari ◽  
Nehat Baftiu ◽  
Ferizat Dika – Haxhirexha
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Anastomotic Leak ◽  
Intestinal Resection ◽  
Morbidity And Mortality ◽  
Multiple Risk Factors ◽  
Four Quadrant ◽  
Emergent Surgery ◽  
Large Bowel Resection

Background: One of the most severe complication after intestinal resection, often with catastrophic consequence for the patient is leakage from the anastomosis. The severity of complications after anastomotic leak may range from a small localized peritonitis or abscess formation without sepsis, to a development of a four quadrant peritonitis with septic shock. Until now despite the seriousness of this complications, the cause of anastomotic leakage are not yet definitively clear. Aim: The aim of this study is to submit our experience in treatment of patients with anastomotic leakage after intestinal resection and their outcome. Materials and Methods: The study included 63 patients with colorectal cancer operated in the Department of Surgery at the Clinical Hospital of Tetova. In all patients intestinal resection with end to end anastomosis was performed. Conclusions: Anastomotic leak after large bowel resection is a very serious complication with a great impact on patient’s morbidity and mortality.  Multiple risk factors are associated with occurrence of this complication whereas the more suspected are: preoperative anaemia, hypoalbuminemia, emergent surgery without adequate preparation of patient, intraoperative blood loss and blood transfusion during surgery etc. Early detection of AL is very important and helpful to improve the outcome of patients and to minimize postoperative rate of morbidity and mortality. Keywords: anastomotic leaks, colorectal surgery, risk factors  

Determination of the prevalence of helicobacter pylori oral infection in smoking patients with chronic generalized periodontitis on the background of chronic hyperacidal gastritis during treatment

2020 ◽  
Vol 40 (4) ◽  
pp. 50-54
Author(s):  
O. L. Zolotukhina ◽  
◽  
Ju. G. Romanova ◽  
O. V. Maslov ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Helicobacter Pylori ◽  
Oral Cavity ◽  
Urease Activity ◽  
Rapid Test ◽  
Oral Infection ◽  
Helicobacter Pylori Infection ◽  
Natural Origin ◽  
Periodontal Tissues

Diseases of periodontal tissues occupy one of the leading positions among modern dental problems, namely the multifactorial nature of these diseases. In modern dental science, the issue of the development of periodontal pathology against the background of somatic pathology and risk factors remains relevant. Pathology of periodontal tissues in 68–90 % of cases is accompanied by chronic diseases of the gastrointestinal tract. Today, there is no doubt that Helicobacter pylori infection can be present in the biotopes of the oral cavity and can affect the course of periodontal pathology. As you know, smoking is one of the important risk factors for the development of inflammatory-dystrophic diseases of periodontal tissues, which can aggravate the course of the latter. The purpose of the work is to determine the prevalence of oral Helicobacter pylori infection in tobacco-dependent patients with chronic generalized periodontitis on the background of chronic hyperacid gastritis during treatment. Patients who received the proposed therapeutic and prophylactic complex (ultraphonophoresis procedures with the created gel «Apisan», and probiotic drug BioGaia ProDentis and angioprotective drug of natural origin — Detralex) showed a gradual decrease in the level of total urease activity and, as a consequence, a decrease the prevalence of Helicobacter pylori infection in the oral cavity according to the results of a urease rapid test with material from the oral cavity, both in the presence of a risk factor — smoking, and in its absence. The use of the proposed therapeutic and prophylactic complex proved to be effective in reducing the prevalence of oral Helicobacter pylori infection in smoking patients and patients who do not smoke, with chronic generalized periodontitis against the background of chronic hyperacidal gastritis associated with Helicobacter pylori.

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