scholarly journals Role of biomarkers in predicting anastomotic leakage following colorectal surgeries

2020 ◽  
Vol 8 (7) ◽  
pp. 2562
Author(s):  
Mumtaz Din Wani ◽  
Ferkhand Mohi Ud Din ◽  
Aabid Rasool Bhat ◽  
Irshad Ahmad Kumar ◽  
Ashiq Hussain Raina ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Anastomotic Leak ◽  
Sensitivity And Specificity ◽  
Peritoneal Fluid ◽  
Clinical Symptoms ◽  
Colorectal Disease ◽  
Total Leukocyte Count ◽  
Drain Fluid ◽  
The Mean

Background: Recovery after surgery for patients with colorectal disease has improved with the advent of minimal access surgery and standardized recovery protocols. Despite these advances, anastomotic leakage remains one of the most dreaded complications following colorectal surgery, with rates of 3-27 per cent depending on specific risk factors. The aim of the study was to assess sensitivity and specificity of systemic and peritoneal drain-fluid bio-markers in early prediction of anastomotic leak; and to co-relate rise in levels of biomarkers and severity of clinical symptoms in patients who have undergone colo-rectal surgeries.Methods: The present study was a prospective observational study conducted on 60 patients in the Postgraduate Department of Surgery, Government Medical College, Srinagar after obtaining due ethical clearance over a period of two years.Results: The mean age was 54.87±11.901 years with 44 patients (73.3%) were males. Among systemic makers: the mean CRP level was 2.7800±0.500 mg/L, the mean total leukocyte count was 10.783±0.940 thousands and the mean serum procalcitonin level was 0.365±0.1385 ng/ml. Among peritoneal fluid drain bio-makers, the mean IL-6 level was 3551.066±1311.965 pg/ml, the mean IL-10 level was 628.533±460.358 pg/ml and the mean TNF-a level was 16.391±6.736 pg/ml. The anastomotic leak after colo-rectal surgery was noted in 16 patients (26.7%). In our study significant co-relation was noted between the rise in levels of peritoneal drain fluid biomarkers and severity of clinical symptoms but no significant co-relation was noted between the rise in levels of systemic markers and severity of clinical symptoms in patients who have undergone colo-rectal surgeries.Conclusions: Systemic biomarkers are poor predictors of anastomotic leak after colorectal surgery. But sensitivity and specificity of peritoneal fluid drain biomarkers in predicting anastomotic leak was significantly high.

scholarly journals Laparoskopinė storosios žarnos chirurgija: pirmoji patirtis Lietuvoje

2006 ◽  
Vol 4 (4) ◽  
pp. 0-0
Author(s):  
Gintarė Valeikaitė ◽  
Juozas Stanaitis ◽  
Nerijus Kaselis ◽  
Eligijus Poškus ◽  
Kęstutis Strupas ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Operative Time ◽  
Laparoscopic Colorectal Surgery ◽  
University Hospital ◽  
Colorectal Disease ◽  
City Hospital ◽  
Benign Colorectal Disease ◽  
The Mean ◽  
Vilnius University ◽  
Accepted Practice

Gintarė Valeikaitė1, Juozas Stanaitis2, Nerijus Kaselis3, Eligijus Poškus4, Kęstutis Strupas4, Dainius Pavalkis11 Kauno medicinos universiteto klinikų Chirurgijos klinika;2 Vilniaus universiteto Bendrosios ir plastinės chirurgijos, ortopedijos ir traumatologijos klinika;3 Klaipėdos apskrities ligoninės Chirurgijos skyrius;4 Vilniaus universiteto ligoninės Santariškių klinikų Pilvo chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas Šio straipsnio tikslas – įvertinti pirmąją laparoskopinės storosios žarnos chirurgijos praktiką Lietuvoje ir supažindinti su pasauline patirtimi. Metodai Sudarytas klausimynas išsiųstas keturiems pagrindiniams Lietuvos centrams, kuriuose atliekamos storosios žarnos laparoskopinės operacijos. Išnagrinėti 56 atliktų operacijų duomenys. Trisdešimt šeši (64,3%) pacientai buvo operuoti nuo vėžio: penkiolika – nuo riestinės, vienuolika – tiesiosios, keturi – kylančiosios, trys – aklosios, du – skersinės ir vienas – nusileidžiančiosios žarnos vėžio. Nuo nepiktybinių storosios ir tiesiosios žarnos ligų operuota dvidešimt (35,7%) pacientų: aštuoni – nuo divertikuliozės, aštuoni – tiesiosios žarnos iškritimo, keturi – pailgėjusios riestinės žarnos. Vidutinis moterų amžius – 64,9 metų, vyrų – 59,7 metų. Rezultatai Buvo atlikta septyniolika aukštų priekinių tiesiosios žarnos rezekcijų, vidutinė operacijos trukmė (VOT) – 203,9 min., penkiolika dešinių hemikolektomijų, VOT – 212 min., devynios kairios hemikolektomijos, VOT – 221,4 min., šešios riestinės žarnos rezekcijos, VOT – 194 min., trys riestinės ir tiesiosios žarnos rezekcijos, VOT – 220 min, aštuonios rektopeksijos, VOT – 179,5 min., viena tiesiosios žarnos ekstirpacija, VOT – 255 min. Visos žarnų jungtys buvo padarytos intrakorporaliniu būdu, išskyrus dešinę hemikolektomiją, kai jungtis padaroma išorėje per minilaparotominį pjūvį dešinėje pilvo sienos pusėje. Konversijos priežastys dviem atvejais buvo kraujavimas iš pasaito ir dviem atvejais – peraugęs į gretimus organus navikas. Vidutiniškai prieš operaciją ligoniai gulėjo 3,2 dienos, po operacijos – 8,3 dienos. Išvada Laparoskopinis metodas toliau vertinamas atliekant perspektyvųjį nacio nalinį tyrimą. Reikšminiai žodžiai: laparoskopija, storoji žarna, chirurgija First experience in laparoscopic colorectal surgery in Lithuania Gintarė Valeikaitė1, Juozas Stanaitis2, Nerijus Kaselis3, Eligijus Poškus4, Kęstutis Strupas4, Dainius Pavalkis11 Kaunas University of Medicine, Clinic of Surgery;2 Vilnius University Clinic of General, Plastic Surgery, Orthopedic and Traumatology;3 Klaipėda City Hospital;4 Vilnius University Hospital Santariškių Klinikos, Centre of Abdominal Surgery,Santariškių 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Objective To evaluate the first experience in laparoscopic colorectal surgery in Lithuania and to review the worldwild accepted practice. Methods A questionnaire was sent to four major centers performing laparoscopic colorectal surgery in Lithuania. Analysis of obtained data showed that 56 laparoscopic operations were performed. For colorectal cancer were operated 36 patients (64.3%): 11 for rectal, 15 for sigmoid, 4 for ascending colon, 3 for ceacal, 2 for transversal and 1 for descending colon cancer. For benign colorectal disease – 20 (35.7%): 8 for diverticular disease, 8 for rectal prolapse, 4 for constipation caused by sigmoid elongation. The mean age of males was 59.7 and of females – 64.9 years. Results There were performed 15 laparoscopic left hemicolectomies (the mean operative time (MOT) 212 min), 17 laparoscopic high rectal resections (MOT 203.9 min), 9 laparoscopic right hemicolectomies (MOT 221.4 min), 6 sigmoid resections (MOT 194 min), 3 sigmoid and rectal resections (MOT 220 min), 8 laparoscopic rectopexies (MOT 179.5 min) and one laparoscopic abdominoperineal resection, operative time 255 min. All the anastomoses were intracorporeal, except right hemicolectomies and sigmoid resections. The reasons for conversion were bleeding from mesenterium in 2 cases and advanced tumours in 2 cases. The mean preoperative stay was 3.2 and postoperative stay 8.3 days. Conclusions There could not be clear conclusions, and the laparoscopic method is being further evaluated by a prospective national trial. Key words: laparoscopic colorectal surgery

Detection of colon flora in peritoneal drain fluid after colorectal surgery: Can RT-PCR play a role in diagnosing anastomotic leakage?

2009 ◽  
Vol 79 (1) ◽  
pp. 67-70 ◽  
Author(s):  
N. Komen ◽  
M.C. Morsink ◽  
S. Beiboer ◽  
A. Miggelbrink ◽  
P. Willemsen ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Rt Pcr ◽  
Drain Fluid

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  

scholarly journals Matrix metalloproteinase-9 in relation to patients with complications after colorectal surgery: a systematic review

2020 ◽  
Vol 36 (1) ◽  
pp. 1-10
Author(s):  
Pim Edomskis ◽  
Max R. Goudberg ◽  
Cloë L. Sparreboom ◽  
Anand G. Menon ◽  
Albert M. Wolthuis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Matrix Metalloproteinase ◽  
Anastomotic Leakage ◽  
Animal Studies ◽  
Matrix Metalloproteinase 9 ◽  
Human Studies ◽  
Drain Fluid ◽  
Clinical Biomarker ◽  
Metalloproteinase 9

Abstract Purpose Anastomotic leakage (AL) is the most severe complication following colorectal resection and is associated with increased mortality. The main group of enzymes responsible for collagen and protein degradation in the extracellular matrix is matrix metalloproteinases. The literature is conflicting regarding anastomotic leakage and the degradation of extracellular collagen by matrix metalloproteinase-9 (MMP-9). In this systematic review, the possible correlation between anastomotic leakage after colorectal surgery and MMP-9 activity is investigated. Methods Embase, MEDLINE, Cochrane, and Web of Science databases were searched up to 3 February 2020. All published articles that reported on the relationship between MMP-9 and anastomotic leakage were selected. Both human and animal studies were found eligible. The correlation between MMP-9 expression and anastomotic leakage after colorectal surgery. Results Seven human studies and five animal studies were included for analysis. The human studies were subdivided into those assessing MMP-9 in peritoneal drain fluid, intestinal biopsies, and blood samples. Five out of seven human studies reported elevated levels of MMP-9 in patients with anastomotic leakage on different postoperative moments. The animal studies demonstrated that MMP-9 activity was highest in the direct vicinity of an anastomosis. Moreover, MMP-9 activity was significantly reduced in areas further proximally and distally from the anastomosis and was nearly or completely absent in uninjured tissue. Conclusion Current literature shows some relation between MMP-9 activity and colorectal AL, but the evidence is inconsistent. Innovative techniques should further investigate the value of MMP-9 as a clinical biomarker for early detection, prevention, or treatment of AL.

scholarly journals Evaluation of the inflammatory markers CCL8, CXCL5, and LIF in patients with anastomotic leakage after colorectal cancer surgery

2020 ◽  
Vol 35 (7) ◽  
pp. 1221-1230 ◽  
Author(s):  
F. Klupp ◽  
S. Schuler ◽  
C. Kahlert ◽  
N. Halama ◽  
C. Franz ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Surgery ◽  
Protein Expression ◽  
Anastomotic Leakage ◽  
Peritoneal Fluid ◽  
Inflammatory Markers ◽  
Expression Profiles ◽  
Expression Patterns ◽  
Predictive Biomarkers ◽  
Colorectal Cancer Surgery

Abstract Purpose Anastomotic leakage constitutes a dreaded complication after colorectal surgery, leading to increased morbidity and mortality as well as prolonged hospitalization. Most leakages become clinically apparent about 8 days after surgery; however, early detection is quintessential to reduce complications and to improve patients’ outcome. We therefore investigated the significance of specific protein expression profiles as putative biomarkers, indicating anastomotic leakage. Methods In this single-center prospective cohort study serum and peritoneal fluid samples—from routinely intraoperatively inserted drainages—of colorectal cancer patients were collected 3 days after colorectal resection. Twenty patients without anastomotic leakage and 18 patients with an anastomotic leakage and without other complications were included. Protein expression of seven inflammatory markers in serum and peritoneal fluid was assessed by multiplex ELISA and correlated with patients’ clinical data. Results Monocyte chemoattractant protein 2 (CCL8/MCP-2), leukemia-inhibiting factor (LIF), and epithelial-derived neutrophil-activating protein (CXCL5/ENA-78) were significantly elevated in peritoneal fluid but not in serum samples from patients subsequently developing anastomotic leakage after colorectal surgery. No expressional differences could be found between grade B and grade C anastomotic leakages. Conclusion Measurement 3 days after surgery revealed altered protein expression patterns of the inflammatory markers CCL8/MCP2, LIF, and CXCL5/ENA-78 in peritoneal fluid from patients developing anastomotic leakage after colorectal surgery. Further studies with a larger patient cohort with inclusion of different variables are needed to evaluate their potential as predictive biomarkers for anastomotic leakage.

Scrub typhus (Orientia tsutsugamushi), A rapidly spreading epidemic in Chennai - A standalone lab experience

2016 ◽  
Vol 5 (09) ◽  
pp. 4896
Author(s):  
Sripriya C.S.* ◽  
Shanthi B. ◽  
Arockia Doss S. ◽  
Antonie Raj I. ◽  
Mohana Priya
Keyword(s):  
Scrub Typhus ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
The Past ◽  
Igm Elisa ◽  
The Mean ◽  
Specific Symptoms ◽  
Symptoms And Signs

Scrub typhus (Orientia tsutsugamushi), is a strict intracellular bacterium which is reported to be a recent threat to parts of southern India. There is re-emergence of scrub typhus during the past few years in Chennai. Scrub typhus is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure to fatal disease. This study documents our laboratory experience in diagnosis of scrub typhus in patients with fever and suspected clinical symptoms of scrub typhus infection for a period of two years from April 2014 to April 2016 using immunochromatography and IgM ELISA methods. The study was conducted on 648 patients out of whom 188 patients were found to be positive for scrub typhus. Results also showed that pediatric (0 -12 years) and young adults (20 – 39 years) were more exposed to scrub typhus infection and female patients were more infected compared to male. The study also showed that the rate of infection was higher between September to February which also suggested that the infection rate is proportional to the climatic condition. Statistical analysis showed that the mean age of the patients in this study was 37.6, standard deviation was 18.97, CV % was 50.45. 

scholarly journals Hematological Profile of HIV-Infected Patients on First-Line Highly Active Antiretroviral Therapy and Its Correlation With CD4 Count

2021 ◽  
Author(s):  
John Jospeh Diamond Princy ◽  
Kshetrimayum Birendra Singh ◽  
Ningthoujam Biplab ◽  
Ningthoukhongjam Reema ◽  
Rajesh Boini ◽  
...  
Keyword(s):  
Platelet Count ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Cd4 Count ◽  
Total Leukocyte Count ◽  
Hiv Patients ◽  
Positive Correlation ◽  
Highly Active ◽  
The Mean

Abstract Introduction Human immunodeficiency virus (HIV) infection is a state of profound immunodeficiency. Disorders of hematopoietic system are a common but often overlooked complication of HIV infection. This can manifest at any stage of the disease but more commonly in the advanced stage with low CD4 count. Anemia is the most common hematological abnormality in HIV patients and prevalence ranges from 1.3 to 95%. As HIV disease progresses, the prevalence and severity of anemia also increase. Hence, this study was undertaken to assess the hematological parameters of HIV-infected patients on highly active antiretroviral therapy (HAART) at different treatment durations with the hope to improve the HAART outcome in HIV patients and its correlation with CD4 count. Methods This prospective longitudinal study enrolled 134 HIV-infected patients admitted to or attending the OPD in the Department of Medicine or Antiretroviral Therapy (ART) Center (Center of Excellence), Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, from 2018 to 2020. Complete hemogram, CD4 count, and other related-blood investigations were studied. Results The mean age of the study population was 39.9 ± 11.04 years. Of the 134 patients, 75 (56%) were males and 59 (44%) were females. Twelve (9%) patients had a history of injecting drug use (IDU). TLE (tenofovir, lamivudine, efavirenz) regimen was started on 112 (83.6%) patients and the majority of them (69/134 [51.5%]) had a CD4 count of 200 to 499 cells/mm3, which increased significantly 6 months after HAART to 99 to 1,149 cells/mm3, with a mean of 445 ± 217 cells/mm3. There were significant improvements in hemoglobin (Hb) levels, total leukocyte count (TLC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) after HAART indicating a positive correlation with CD4 count (p < 0.05). Thrombocytopenia was observed higher after HAART when compared to baseline. There was a positive correlation between platelet count and CD4 count. However, the mean corpuscular volume (MCV) and erythrocyte sedimentation rate (ESR) had a negative correlation with CD4 count. Conclusion The study inferred a strong positive correlation between CD4 and Hb levels, TLC, ANC, ALC, and platelet count after HAART with improvement in these values as CD4 count increases. Specific treatment intervention based on the changes in the immunohematological profile trends can help prevent most of the adverse effects on HIV patients in our community.

scholarly journals Drain fluid cryo-explant technique for treatment of superior bullous rhegmatogenous retinal detachment in young adults

2021 ◽  
Vol 13 ◽  
pp. 251584142098821
Author(s):  
Kamal A.M. Solaiman ◽  
Ashraf Mahrous ◽  
Hesham A. Enany ◽  
Ashraf Bor’i
Keyword(s):  
Young Adults ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Subretinal Fluid ◽  
Secondary Outcome ◽  
Eligibility Criteria ◽  
Retinal Breaks ◽  
Complicated Cataract ◽  
Drain Fluid ◽  
The Mean

Purpose: To evaluate the efficacy of the drain fluid cryo-explant (DFCE) technique for the management of uncomplicated superior bullous rhegmatogenous retinal detachment (RRD) in young adults. Patients and methods: A retrospective study that included eyes with uncomplicated superior bullous RRD in patients ⩽40 years old. DFCE technique consists of sequential drainage of subretinal fluid, intravitreal fluid injection, cryotherapy, and placement of a scleral explant(s). The primary outcome measure was anatomical reposition of the retina after a single surgery. Secondary outcome measures included improvement in best corrected visual acuity (BCVA) and any reported complication related to the procedure. Results: The study included 51 eyes which met the study eligibility criteria. The mean duration of detachment was 19.7 ± 6.4 days. A single retinal break was found in 31 eyes (60.8%), and more than one break were found in 20 eyes (39.2%). The mean number of breaks per eye was 1.72 ± 1.04. The mean detached area per eye was 7.21 ± 3.19 clock hours, and the macula was detached in 22 eyes (43.1%). Flattening of the retina and closure of all retinal breaks was achieved in all eyes after a single surgery. Late recurrence of retinal detachment occurred in two eyes (3.9%) due to proliferative vitreoretinopathy (PVR). No complicated cataract or iatrogenic retinal breaks were detected in all eyes. Conclusion: DFCE technique could be effectively used for treatment of uncomplicated superior bullous RRD in adults ⩽40 years. It is safe and provides good visualization during surgery with no iatrogenic retinal breaks or complicated cataract.

scholarly journals Early postoperative pain as a marker of anastomotic leakage in colorectal cancer surgery

2021 ◽  
Author(s):  
Petrus Boström ◽  
Johan Svensson ◽  
Camilla Brorsson ◽  
Martin Rutegård
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Pain ◽  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Population Based ◽  
Colorectal Cancer Surgery ◽  
Increased Risk ◽  
Independent Marker

Abstract Purpose Even though anastomotic leakage after colorectal surgery is a major clinical problem in need of a timely diagnosis, early indicators of leakage have been insufficiently studied. We therefore conducted a population-based observational study to determine whether the patient’s early postoperative pain is an independent marker of anastomotic leakage. Methods By combining the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry, we retrieved prospectively collected data on 3084 patients who underwent anastomotic colorectal surgery for cancer in 2014–2017. Postoperative pain, measured with the numerical rating scale (NRS), was considered exposure, while anastomotic leakage and reoperation due to leakage were outcomes. We performed logistic regression to evaluate associations, estimating odds ratios (ORs) and 95% confidence intervals (CIs), while multiple imputation was used to handle missing data. Results In total, 189 patients suffered from anastomotic leakage, of whom 121 patients also needed a reoperation due to leakage. Moderate or severe postoperative pain (NRS 4–10) was associated with an increased risk of anastomotic leakage (OR 1.69, 95% CI 1.21–2.38), as well as reoperation (OR 2.17, 95% CI 1.41–3.32). Severe pain (NRS 8–10) was more strongly related to leakage (OR 2.38, 95% CI 1.44–3.93). These associations were confirmed in multivariable analyses and when reoperation due to leakage was used as an outcome. Conclusion In this population-based retrospective study on prospectively collected data, increased pain in the post-anaesthesia care unit is an independent marker of anastomotic leakage, possibly indicating a need for further diagnostic measures.

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