Author Archives: John

Enterocutaneous fistula formation after cardiac transplantation due to injury from LVAD driveline migration

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Abstract

“A man in his early 20s with heart failure with reduced ejection fraction secondary to non-compaction cardiomyopathy (Titin (TTN) gene mutation positive) was transitioned from left ventricular assist device (LVAD) mechanical support to heart transplantation. Transplantation was successful; however, LVAD explantation resulted in innumerable complications secondary to penetration of the driveline into the peritoneal cavity. He developed an enterocutaneous fistula which led to concurrent malnutrition, poor wound healing, systemic infection, and allograft rejection in a patient less than 1 month after heart transplantation on immunosuppression.”

Tan, Derek W et al. “Enterocutaneous fistula formation after cardiac transplantation due to injury from LVAD driveline migration.” BMJ case reports vol. 16,6 e254696. 22 Jun. 2023 Emory Users Request Article via Interlibrary Loan

Left ventricular assist device infections resulting from gastrointestinal-tract fistulas

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“Despite the benefits provided by continuous-flow left ventricular assist devices (LVADs), such as the HeartMate-II (HM-II), pump-related infection remains a potential complication of LVAD use. The following factors contribute to LVAD infection: malnutrition, diabetes, obesity,
prolonged hospitalization, postoperative bleeding, hematoma formation, reoperation, multiorgan failure, and sepsis.Device-related infection entails an increased hospital stay and increased risk of death. Therefore, bridge-to-transplant patients with LVAD-related infections are upgraded to status IA, classified as the highest level of urgency, on the transplant waiting list.”

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Enterocutaneous Fistulas: Causes and Managemen

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“Despite advances in medical technology and surgical care, the management of enterocutaneous fistulas remains one of the most challenging problems faced by physicians. Success depends on an expert multidisciplinary team, access to long-term enteral and parenteral nutrition support, advanced wound care, optimal medical management and meticulous, methodical, surgical decision-making and technique. Management is complex and multiphasic.Improved survival rates for many morbid problems have resulted in a growing population of patients with increasingly complex fistulas. This article reviews the etiologies as
well as classic and evolving management strategies for this problem.”

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Risk Factors for Pancreatic Fistula after Stapled Gland Transection

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“Distal Pancreatectomy (DP) is performed for both benign and malignant conditions affecting the body and tail of the pancreas. DP is also performed for chronic pancreatitis and occasionally for abdominal trauma. With improvements in imaging, surgical technology and technique, and postoperative care, the mortality from DP at high-volume centers is approximately 1 per cent. Despite the low mortality rate from DP, the morbidity rate from this procedure remains high (24 to 64 per cent in some series) with pancreatic fistula (PF) as
a common concern. Even with the use of linear stapling devices, fibrin glue, somatostatin analogs, thermal sealing devices, and mesh staple line reinforcement, PF continues to be a burden to patient quality of life and healthcare resources for those patients undergoing DP.”

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Perioperative hemostasis for patients with hemophilia

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“The successful surgical management of patients with hemophilia requires advanced preoperative planning. A formal treatment plan should be determined and distributed well in advance of any invasive procedure or surgery and is best done under the guidance of a hemophilia treat ment center (HTC).”

“Prior to surgery, the patient’s diagnosis should be confirmed with laboratory testing, rather than prior patient report. It is particularly important to differentiate severe von Wille
brand’s disease from hemophilia A. A preoperative history should include a review of baseline hemostatic needs that considers the frequency of breakthrough bleeding and the use of prophylactic and breakthrough hemostatic agents as well as surgical history, prior use of hemostatic support, and any bleeding complications.”

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Unplanned Reoperations, Emergency Department Visits and Hospital Readmission After Thyroidectomy

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“Emergency Department visits and hospital readmission after thyroidectomy are common, and there are several practices that can reduce their occurrence. Routine postoperative calcium and vitamin D supplementation may reduce rates of postoperative hypocalcemia, and avoiding postoperative hypertension may decrease the risk of neck hematoma development and the need for reoperation. Older age, thyroid cancer, dependent functional status, higher ASA score, diabetes, chronic obstructive pulmonary disease, steroid use, hemodialysis, and recent weight loss increase the risk of hospital readmission after thyroid surgery. By further identifying risk factors for reoperation, ED visits, and readmission, this review may assist practitioners in optimizing perioperative care and therefore reducing patient morbidity and mortality after thyroid operations.”

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Importance of duodenal stump reinforcement to prevent stump leakage after gastrectomy

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“Duodenal stump leakage (DSL) is a postoperative complication specific to patients with the formation of a blind endof the duodenum, e.g., Roux-en-Y or Billroth-II reconstruction. The incidence of DSL after radical gastrectomy with a duodenal stump ranges between 1.8% and 7.7%, with a mortality rate of 7–67%.”
“Although manual reinforcement of the duodenal stump is equally effective in preventing DSL development in both laparoscopic and open surgeries, it may not be routinely performed because of its technical difficulty during laparoscopic gastrectomies.”

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