Author Archives: John

Standardized Algorithms for Management of Anastomotic Leaks and Related Abdominal and Pelvic Abscesses After Colorectal Surgery

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“The risk factors and incidence of anastomotic leak following colorectal surgery are well reported in the literature. However, the management of the multiple clinical scenarios that may be encountered has not been standardized.”
In this study, “management scenarios were divided into those for intraperitoneal anastomoses, extraperitoneal (low pelvic) anastomoses, and anastomoses with proximal diverting stomas. Management options were then based on the clinical presentation and radiographic findings and organized into three interconnected algorithms.”

Recommendations for the management of intraperitoneal anastomotic leak with references to the pertinent sections of this article for more information. KEY: IV ABX=intravenous antibiotics; CT=computed tomographic; WSCE=water soluble contrast enema; CT A/P=computed tomographic scan of the abdomen and pelvis
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Management of Postoperative Complications Following Operations for Breast Cancer

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At bottom of post Surgical Clinics of North America issue on postoperative complications.

“The reported complication rates after breast cancer surgery are low, with rates ranging
from 2% to 50%, and are reportedly more common when performed in conjunction with axillary surgery and immediate breast reconstruction. A breakdown by procedure type has shown morbidity rates between 5% and 50% after mastectomy and from 3% to 35% after lumpectomy with or without reconstruction.”

Hilli
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Permanent Hypoparathyroidism After Thyroidectomy

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“Hypoparathyroidism (HP) is a recognized but serious complication of thyroidectomy. Conventional techniques for parathyroid autograft (PA) occur with the insertion of parathyroid slices in muscle pockets and have a published incidence of HP of 4%–8%. The purpose of this study was to analyze the incidence of HP after thyroidectomy at our center, where we have used a modified technique for PA.”

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Techniques for intraoperative evaluation of bowel viability inmesenteric ischemia:

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“Acute mesenteric ischemia (AMI) accounts for approximately 1:1000 acute hospital admissions in the United States, and the incidence is on the rise likely due to an aging population as well as the prolonged survival of critically ill patients. AMI can be caused by a reduction in blood flow from arterial occlusion, venous occlusion, arterial vasospasm, or a low-flow state. Regardless of the etiology of the disease, rapid diagnosis and treatment of AMI is of critical importance”

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Transjugular intrahepatic portosystemic shunt before abdominal surgery in cirrhotic patients

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“Abdominal surgery is occasionally needed in cirrhotic patients and is associated with high morbidity and mortality rates. It has been suggested that the main determinant of short- and long-term survival is the degree of liver failure, as evaluated by the presence of ascites, low serum albumin level and coagulation disorders. In addition, the degree of portal
hypertension may be an independent predictor for operative bleeding, postoperative ascites leakage or variceal rupture; this may also influence survival. Transjugular intrahepatic portosystemic shunt (TIPS) placement is much less invasive than surgical shunts and can be performed in patients with a significant degree of liver insufficiency. Therefore, it has been suggested that preoperative TIPS placement may improve the prognosis of cirrhotic patients, submitted to abdominal surgery.”

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Anorectal Infections in Neutropenic Leukemia Patients

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“Anorectal infections in neutropenic leukemia patients are a significant and potentially life-threatening complication. The pathogenesis of this condition is not entirely understood and believed to be multifactorial, including mucosal injury as a result of cytotoxic drugs, profound neutropenia and impaired host defense. Establishing an early diagnosis is key and often made clinically on the basis of signs and symptoms, but also from imaging studies demonstrating perianal inflammation or fluid collection. The management of anorectal infections in neutropenic leukemia patients is not straightforward, as there are no well-conducted studies on this entity.”

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Influence of diabetes on postoperative complications following colorectal surgery

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“Diabetes continues to be a significant comorbidity that needs to be accounted for during surgical planning. Furthermore, undiagnosed diabetes or ‘pre-diabetes’ results in an underestimation of the true number of patients with diabetes having colorectal
surgery, with studies reporting that the true prevalence of diabetes in hospitalised patients has been understated by up to 40%. In the existing literature, poor glycemic control and hyperglycemia has been associated with impaired wound healing and increased susceptibility to infections,leading to an elevated risk of postoperative complications.”

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