Author Archives: John

Bismuth classification, detection, and management of Bile Duct Injury during laparoscopic cholecystectomy

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“Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success.”

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Role of Deficient DNA Mismatch Repair Status in Patients With Stage III Colon Cancer Treated With FOLFOX Adjuvant Chemotherapy

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“While most studies have found that patients with dMMR (vs proficient MMR [pMMR]) tumors have a more favorable stage-adjusted prognosis, other studies have not detected a significant difference in clinical outcome or have suggested that any favorable prognostic effect of dMMR is limited to patients with earlier-stage tumors. Furthermore, studies have shown that dMMR tumors may not benefit from fluorouracil-based adjuvant chemotherapy. However, the impact of MMR status remains controversial in the era of the standard FOLFOX adjuvant chemotherapy.
In a pooled analysis, we examined the association of MMR status with disease-free survival (DFS) in patients with stage III colon cancer treated with FOLFOX from 2 phase 3 randomized clinical trials.”

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Mouse study: polyphosphate administration may be an alternative approach to prevent anastomotic leak induced by collagenolytic bacteria

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“Despite decades of descriptive research, the etiology and pathogenesis of AL remains unknown. Although there is compelling evidence that microbes are the primary drivers of the pathogenesis of anastomotic leak, few efforts have been aimed at understanding and controlling the microbes that may complicated anastomotic healing.”

“A microbial cause for anastomotic leak was first proposed over 60 years ago and has been confirmed in multiple studies. The main clinical evidence for a microbial cause of anastomotic leak is indirect and is based on clinical trials in which the use of oral non-absorbable antibiotics significantly reduce the incidence of anastomotic leak”

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Management of the complex duodenal injury

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“Duodenal trauma is a rare occurrence existing in 1–4.7% of all abdominal trauma. Its posterior and partially retroperitoneal location shields it from most traumatic mechanisms. Colloquially referred to as the ‘surgical soul’, its proximity to complex regional anatomy makes duodenal trauma particularly at risk for biliary, pancreatic and major vascular injury with 68–86.5% of patients sustaining an associated injury.”

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Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: Foxtrot Study

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“Preoperative (neoadjuvant) chemotherapy and radiotherapy are substantially more effective than similar postoperative therapy in oesophageal, gastric, and rectal cancer. Earlier treatment might be more effective at eradicating micrometastatic disease than the same treatment 3 months later, the typical period between diagnosis and starting postoperative chemotherapy, particularly because surgery increases growth factor activity in the early postoperative period, promoting more rapid tumour progression.”

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Damage control in penetrating duodenal trauma

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“The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5% 1,2. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. These associated injuries create a significant challenge towards the early diagnosis and appropriate management. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently manage via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques (duodenal diverticulization, pyloric exclusion with or without gastrojejunostomy and pancreatoduodenectomy) without significant favorable outcomes and consequential increase in the rates of mortality.”

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TRANSPLANT SURGERY

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TopicArticles
KidneyLentine KL, et al. OPTN/SRTR 2020 Annual Data Report: Kidney. Am J Transplant. 2022 Mar;22 Suppl 2:21-136.  

Vincenti F, Charpentier B, Vanrenterghem Y, et al. A phase III study of belatacept-based immunosuppression regimens versus cyclosporine in renal transplant recipients (BENEFIT study). Am J Transplant. 2010 Mar;10(3):535-46. doi: 10.1111/j.1600-6143.2009.03005.x. PMID: 20415897.
LiverMazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996 Mar 14;334(11):693-9. PMID: 8594428.
Immuno-suppression