Author Archives: John

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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Surgical Treatment of Enterocutaneous Fistula

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“Enterocutaneous Fistula (ECF) is defined as an abnormal connection between the gastrointestinal tract and the skin, and it requires labor-intensive medical management and surgical expertise. Complex wound management, severe malnutrition, frequent infectious complications, chronic pain, and depression require significant investment of health care resources and make the short-term and long-term care of these patients difficult.”

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Predictors of Short-Term Readmission After Pancreaticoduodenectomy

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“Readmissions are a common complication after pancreaticoduodenectomy and are increasingly being used as a performance metric affecting quality assessment, public reporting, and reimbursement. This study aims to identify general and pancreatectomy-specific factors contributing to 30-day readmission after pancreaticoduodenectomy, and determine the additive value of incorporating pancreatectomy-specific factors into a large national dataset.”
“Large registry analyses of pancreatectomy outcomes are markedly improved by the incorporation of granular procedure-specific data. These data emphasize the need for prevention and careful management of perioperative infectious complications, fluid management, thromboprophylaxis, and pancreatic fistulae.”

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Clinical Practice Update on Management of Ostomies

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“Enteral ostomies are common in the management of patients with gastrointestinal conditions, including colorectal cancer (CRC), inflammatory bowel disease (IBD), diverticular disease, intestinal trauma, and intestinal perforation. An estimated 750,000 Americans live with an ostomy and 130,000 new ostomy surgeries occur in the United States annually. People with ostomies often face postsurgical complications and challenges to daily self-care. Studies have suggested that adequate stomal care improves clinical outcomes and reduces hospitalizations. However, little guidance exists to support clinicians in managing patients with an ostomy beyond the immediate perioperative period.”

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