The effect of therankeron D6 on the healing of intestinal anastomosis in dogs

Introduction: Acute mesenteric ischemia has a high morbidity and mortality and constitutes an intraoperative challenge in the management of ischemic areas. In this context, we analyze the use of indocyanine green fluorescence to assess intestinal vascularization through 3 clinical cases. Case presentation: we present 3 clinical cases operated for acute mesenteric ischemia. Evaluation of intestinal viability is performed under infrared light after intravenous infusion of 25 mg of indocyanine green. Case 1 is a 42-year-old male with multiple antecedents of severe vascular disease, presenting with a massive acute mesenteric ischemia involving multiple intestinal segments. Fluorescence allows two adjusted bowel resections with double intestinal anastomosis. Case 2 is a 74-year-old woman with a history of non-anticoagulated atrial fibrillation who is decided to perform an urgent surgery when an esophageal, gastric and portal system pneumatosis is observed, as indirect signs of ischemia, in urgent CT. During the surgical act there is an ischemia of the terminal ileum and right colon without clear signs of involvement at the esophageal-gastric level. The assessment after administration of ICG discriminates the clear ischemic involvement from terminal ileum to ascending colon and patched in the transverse and left colon, without esophageal or gastric involvement. Case 3 is a 49-year-old woman with aortoiliac and visceral Takayasu disease and revascularization surgery of the celiac trunk. Given the increase in abdominal pain, a new CT scan demonstrates colonic pneumatosis. Urgent laparotomy shows necrosis at the level of the left colon and hypoperfusion of the cecum. The administration of ICG finds a lack of uptake of the entire colon. A subtotal colectomy with ileostomy and mucous fistula is performed. Introduction: Acute mesenteric ischemia has a high morbidity and mortality and constitutes an intraoperative challenge in the management of ischemic areas. In this context, we analyze the use of indocyanine green fluorescence to assess intestinal vascularization through 3 clinical cases. Case presentation: we present 3 clinical cases operated for acute mesenteric ischemia. Evaluation of intestinal viability is performed under infrared light after intravenous infusion of 25 mg of indocyanine green. Case 1 is a 42-year-old male with multiple antecedents of severe vascular disease, presenting with a massive acute mesenteric ischemia involving multiple intestinal segments. Fluorescence allows two adjusted bowel resections with double intestinal anastomosis. Case 2 is a 74-year-old woman with a history of non-anticoagulated atrial fibrillation who is decided to perform an urgent surgery when an esophageal, gastric and portal system pneumatosis is observed, as indirect signs of ischemia, in urgent CT. During the surgical act there is an ischemia of the terminal ileum and right colon without clear signs of involvement at the esophageal-gastric level. The assessment after administration of ICG discriminates the clear ischemic involvement from terminal ileum to ascending colon and patched in the transverse and left colon, without esophageal or gastric involvement. Case 3 is a 49-year-old woman with aortoiliac and visceral Takayasu disease and revascularization surgery of the celiac trunk. Given the increase in abdominal pain, a new CT scan demonstrates colonic pneumatosis. Urgent laparotomy shows necrosis at the level of the left colon and hypoperfusion of the cecum. The administration of ICG finds a lack of uptake of the entire colon. A subtotal colectomy with ileostomy and mucous fistula is performed. Conclusions: The fluorescence with ICG provides a better visualization of the intestinal vascularization in the AMI, and allows to determine the limits of the affected tissue to perform adjusted resections.

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Commentary on Early Enteral Feeding Versus Traditional Feeding in Neonatal Congenital Gastrointestinal Malformation Undergoing Intestinal Anastomosis: A Randomized Multicenter Controlled Trial of an Enhanced Recovery After Surgery (ERAS) Component

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2021.03.013 ◽

2021 ◽

Author(s):

Mary Brindle ◽

Kurt Heiss

Keyword(s):

Enteral Feeding ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Intestinal Anastomosis ◽

Early Enteral Feeding

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Factors Influencing the Outcome of Intestinal Anastomosis

The American Surgeon ◽

10.1177/000313481107700929 ◽

2011 ◽

Vol 77 (9) ◽

pp. 1169-1175 ◽

Cited By ~ 12

Author(s):

Juan J. LujÁN ◽

ZoltÁN H. NÉMeth ◽

Patricia A. Barratt-Stopper ◽

Rami Bustami ◽

Vadim P. Koshenkov ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Blood Loss ◽

Surgical Site Infection ◽

Bowel Disease ◽

Intestinal Anastomosis ◽

Significant Risk ◽

Left Colon ◽

Site Infection ◽

Intraoperative Blood Loss ◽

Inflammatory Bowel

Anastomotic leak (AL) is one of the most serious complications after gastrointestinal surgery. All patients aged 16 years or older who underwent a surgery with single intestinal anastomosis at Morristown Medical Center from January 2006 to June 2008 were entered into a prospective database. To compare the rate of AL, patients were divided into the following surgery-related groups: 1) stapled versus hand-sewn, 2) small bowel versus large bowel, 3) right versus left colon, 4) emergent versus elective, 5) laparoscopic versus converted (laparoscopic to open) versus open, 6) inflammatory bowel disease versus non inflammatory bowel disease, and 7) diverticulitis versus nondiverticulitis. We also looked for surgical site infection, estimated intraoperative blood loss, blood transfusion, comorbidities, preoperative chemotherapy, radiation, and anticoagulation treatment. The overall rate of AL was 3.8 per cent. Mortality rate was higher among patients with ALs (13.3%) versus patients with no AL (1.7%). Open surgery had greater risk of AL than laparoscopic operations. Surgical site infection and intraoperative blood transfusions were also associated with significantly higher rates of AL. Operations involving the left colon had greater risk of AL when compared with those of the right colon, sigmoid, and rectum. Prior chemotherapy, anticoagulation, and intraoperative blood loss all increased the AL rates. In conclusion, we identified several significant risk factors for ALs. This knowledge should help us better understand and prevent this serious complication, which has significant morbidity and mortality rates.

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The art of robotic colonic resection: a review of progress in the past 5 years

Updates in Surgery ◽

10.1007/s13304-020-00969-2 ◽

2021 ◽

Author(s):

Hongyi Liu ◽

Maolin Xu ◽

Rong Liu ◽

Baoqing Jia ◽

Zhiming Zhao

Keyword(s):

Robotic Surgery ◽

Hospital Stay ◽

Intraoperative Complications ◽

Intestinal Anastomosis ◽

Length Of Hospital Stay ◽

Colonic Resection ◽

Surgical Performance ◽

Conversion To Open Surgery ◽

Minimal Invasiveness ◽

The Past

AbstractSurgery is developing in the direction of minimal invasiveness, and robotic surgery is becoming increasingly adopted in colonic resection procedures. The ergonomic improvements of robot promote surgical performance, reduce workload for surgeons and benefit patients. Compared with laparoscopy-assisted colon surgery, the robotic approach has the advantages of shorter length of hospital stay, lower rate of conversion to open surgery, and lower rate of intraoperative complications for short-term outcomes. Synchronous robotic liver resection with colon cancer is feasible. The introduction of the da Vinci Xi System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has introduced more flexibility to colonic operations. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. Single-port robotic colectomy reduces the number of robotic ports for better looking and faster recovery. Intestinal anastomosis methods using totally robotic surgery result in shorter time to bowel function recovery and tolerance to a solid diet, although the operative time is longer. Indocyanine green is used as a tracer to assess blood supplementation in the anastomosis and marks lymph nodes during operation. The introduction of new surgical robots from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes. The present article reviews recent advances in robotic colonic resection over the past five years.

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