Category Archives: Colorectal Surgery

Colonic Interposition After Adult Oesophagectomy

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“Higher rates of morbidity and mortality following colonic conduits are reported to be due to be associated with longer operating times and the additional colo-gastric and colo-colic anastomoses. Yet, colonic conduits have the advantages of being longer, acid resistant, and possess an excellent blood supply. No consensus regarding the optimum site of colonic conduit (right vs. left) or placement route (posterior mediastinal, retrosternal or subcutaneous) exists. The operation is usually carried out based on individual surgeons’ preferences and experience, and in the absence of randomised controlled trials, this situation is likely to continue. The aim of this systematic review and meta-analysis was
to determine the optimal site of colonic conduit and route of placement after adult oesophagectomy.”

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ACR Appropriateness Criteria® Suspected Small-Bowel Obstruction

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“Small-bowel obstruction (SBO) is responsible for up to 16% of hospital admissions for abdominal pain with mortality ranging between 2% and 8% overall, and as high as 25%
when associated with bowel ischemia. Radiologic imaging plays the key role in the diagnosis and management of SBO because neither patient presentation, the clinical examination, nor laboratory testing are sufficiently sensitive or specific enough to diagnose or guide management. Imaging not only diagnoses the presence of SBO but also can aid in the differentiation of high-grade from low-grade obstruction. This differentiation helps to guide referring physicians between surgical treatment for high-grade or complicated SBO versus conservative management with enteric tube decompression.”

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Chronic intestinal failure and short bowel syndrome in Crohn’s disease

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“Chronic intestinal failure (CIF) is a rare but feared severe complication of
Crohn’s disease, with 60% of patients permanently dependent on parenteral nutrition.
This review aims to summarize the knowledge available in the current literature
describing recent advances in the management and treatment of adult patients with
CIF, with emphasis on patients with Crohn’s disease. Moreover, it aims to further
understanding of modern approaches to CIF complications such as catheter-related
bloodstream infections and intestinal failure-associated liver disease.”

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Emergency Colorectal Surgery in Those with Cirrhosis: Outcomes and predictors of mortality

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“Individuals with cirrhosis have higher post-operative morbidity and mortality following major abdominal surgery compared to those without cirrhosis. To quantify this added risk, observational studies and prediction models have been described; however, the majority were derived from historic cohorts and may not reflect the changing epidemiology of
liver disease or advances in both the medical management of cirrhosis and perioperative practices in this high-risk group.”

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Bleeding After Hemorrhoidectomy in Patients on Anticoagulation Medications

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“It has been estimated that approximately 4.4% of the United States population has symptomatic hemorrhoids, contributing to as many as 2.5 million ambulatory visits
annually. Excisional hemorrhoidectomy is the preferred treatment for grade 3-4 hemorrhoids and patients unresponsive to non-operative treatment. Despite being a relatively quick, outpatient procedure, one potential serious complication includes post-hemorrhoidectomy
bleeding. Reported rates of this complication have varied. Studies suggest that .4-10% of hemorrhoidectomy cases will be complicated by bleeding and many requiring a second intervention.”

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Bleeding After Hemorrhoidectomy in Patients on Anticoagulation Medications

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“It has been estimated that approximately 4.4% of the United States population has symptomatic hemorrhoids, contributing to as many as 2.5 million ambulatory visits annually. Excisional hemorrhoidectomy is the preferred treatment for grade 3-4 hemorrhoids and patients unresponsive to non-operative treatment. Despite being a relatively quick, outpatient procedure, one potential serious complication includes post-hemorrhoidectomy bleeding. Reported rates of this complication have varied. Studies suggest that .4-10% of hemorrhoidectomy cases will be complicated by bleeding and many requiring a second intervention. Among risk factors that have been associated with delayed bleeding are male sex, post-operative constipation, and the use of laxatives. Scarce data exist on the association of baseline oral anticoagulation or antiplatelet medications with delayed bleeding.”

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High ileostomy output: A practical review of pathophysiology, causes,and management

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“An estimated 100,000 surgical cases result in the creation of a stoma annually, of which approximately 40,000 are ileostomies. Given the truncation of the gastrointestinal (GI) tract and loss of the colon, ileocecal valve, and “ileal brake”, ileostomy patients are high risk for impaired sodium and water gastrointestinal absorption. Unsurprisingly, such alterations can lead to serious complications such as electrolyte derangements, dehydration, and acute kidney injury.”
“Though the definition of high-ileostomy output is debatable, it is typically recognized that a total ileostomy output exceeding 1.4 L per day has a potential of leading to such complications. An estimated 2030% of ileostomy patients experience high output in the early
postoperative period which imparts increases in morbidity, healthcare resource utilization, and length of inpatient stay.”

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