“Anastomotic leak (AL) represents a dreaded complication following colorectal surgery, with a prevalence of 1-19 per cent. There remains a lack of consensus regarding factors that may predispose to AL and the relative risks associated with them. The objective was to perform a systematic review of the literature, focusing on the role of preoperative, intraoperative and postoperative factors in the development of colorectal ALs.”
“Statistics regarding ostomy-related metrics remain elusive in the United States because of underreporting and coding limitations. The estimated number of ostomates in the United States is 750,000 to 1 million, with approximately 150,000 new ostomies created each year. Stoma creation has a relatively high rate of associated morbidity, ranging from 20% to 80%; peristomal skin complications and parastomal hernia (PSH) are the most common associated morbidities. A population-based study using the Michigan Surgical Quality Collaborative, which included 4250 patients, identified a 37% unadjusted surgical complication rate for elective cases involving an ostomy and 55% unadjusted surgical complication rate for emergency cases involving an ostomy. In this study, risk-adjusted stoma-related morbidity rates varied significantly among hospitals, indicating a potential to improve outcomes in outlying institutions.”
“Although surgery is the recommended treatment for adult intussusception, the optimal surgery remains controversial. Although abdominal computed tomography (CT) scan has
proven useful in diagnosing intussusception, it has limited value in discriminating whether a lead point is malignant, benign, or idiopathic. Reduction at surgery may avoid excessive bowel resection, although it can theoretically increase the risk of potential intraluminal seeding or venous tumor dissemination.
The aim of this study was to determine what the appropriate surgical procedure for adult intussusception is, depending on location of the intussusception or other specific situations.”
“Acute perforated diverticulitis with peritonitis is a feared complication of diverticular disease. The incidence in Western countries is estimated to be 1.85 per 100 000 population per year for purulent peritonitis. Even with optimal treatment, perforated diverticulitis has a high morbidity and mortality. Traditionally, the standard treatment has been emergency surgery with resection of the diseased bowel, often with colostomy creation. Studies have indicated that laparoscopic lavage with drainage and antibiotics might be a treatment option in perforated diverticulitis. So far, 3 European randomized clinical trials have shown somewhat different results, and no clear advantages have been demonstrated with laparoscopic lavage, except a lower stoma rate at 1-year follow-up. Nine meta-analyses and systematic reviews of the short-term and 1-year results of these trials have been published in the last 4 years, with divergent conclusions. No long-term results on laparoscopic lavage have yet been published.”
“Right hemicolectomy is considered one of the simplest colorectal major procedures and is often considered an appropriate first step for residents and young fellows. Despite this, complications after right hemicolectomy for cancer are common, at ≈30%, and postoperative mortality is reported to be ≈3%. Anastomotic leak (AL) after right hemicolectomy for cancer is a major contributor to this short-term morbidity and mortality. The document AL rate after right hemicolectomy ranges widely, from 1.3% to 8.4%. This also has a significant impact on healthcare costs and major oncologic consequences, as demonstrated by the higher cancer recurrence rate after AL.”
“Colorectal cancer is the second-leading cause of cancer-related mortality in both the United States and Europe. With respect to prognosis, increasing evidence has suggested that systemic inflammation is a key predictor of disease progression and survival for colorectal cancer patients undergoing surgery. Furthermore, whereas red blood cell (RBC) transfusions may be life-saving in some circumstances, there has been growing evidence that transfusions are associated with adverse postoperative outcomes, including infectious complications and cancer recurrence. These detrimental effects are thought to be related to systemic inflammation and transfusion-related immunomodulation (TRIM). Whereas the exact mechanisms remain unknown, TRIM seems to be related to various immunologic changes, including decreased interleukin (IL)-2 production, monocyte and cytotoxic cell activity inhibition, increased suppressor T-cell activity, and immunosuppressive prostaglandin release.”
“Despite their frequent occurrence, DD are asymptomatic in 95% of cases, while 1 to 5% eventually become symptomatic. Intervention is indicated only for symptomatic duodenal diverticula(DD). Complications related to DD are rare but may be very severe; they include biliary or pancreatic obstruction, duodenal obstruction, perforation, or hemorrhage.
Endoscopic treatment is usually the first-line approach to biliopancreatic complications related to juxtapapillary DD and also for hemorrhagic complications. Indirect surgical
treatments include bilio-enteric bypasses and even duodenal exclusion. Direct surgical treatment consists of duodenal diverticulectomy, which has significant morbidity and mortality; prophylactic excision of asymptomatic DD is therefore not recommended.”
