Category Archives: Colorectal Surgery

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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Small bowel obstructions following the use of barbed suture

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“Barbed suture has been adopted across all surgical specialties. One of the infrequent complications seen with the use of barbed suture is small bowel obstructions (SBOs). In this study, we perform a review of the literature and the Manufacturer and User Facility Device Experience Database (MAUDE) to characterize SBOs after the use of barbed sutures
in a variety of operative procedures.”

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Diagnosis of Anastomotic Leak

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“Anastomotic leaks after colorectal surgery is associated with increased morbidity and
mortality. Understanding the impact of anastomotic leaks and their risk factors can
help the surgeon avoid any modifiable pitfalls. The diagnosis of an anastomotic leak can
be elusive but can be discerned by the patient’s global clinical assessment, adjunctive
laboratory data and radiological assessment. The use of inflammatory markers such as
C-Reactive Protein and Procalcitonin have recently gained traction as harbingers for a
leak. A CT scan and/or a water soluble contrast study can further elucidate the location
and severity of a leak. Further intervention is then individualized on the spectrum of
simple observation with resolution or surgical intervention.”

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Predictive factors of splenic injury in colorectal surgery

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“Splenic injury is a major intraoperative complication of abdominal surgery and places patients at a higher risk of morbidity and mortality, of longer operating time, and of longer hospital stay. Splenic injuries may be managed nonoperatively or by splenorrhaphy, partial splenectomy, or complete splenectomy. Because splenectomy is reported to have higher mortality rates than splenorrhaphy, great effort is taken to preserve the spleen; however, excessive blood loss can mandate splenectomy.”

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Standardized Algorithms for Management of Anastomotic Leaks and Related Abdominal and Pelvic Abscesses After Colorectal Surgery

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“The risk factors and incidence of anastomotic leak following colorectal surgery are well reported in the literature. However, the management of the multiple clinical scenarios that may be encountered has not been standardized.”
In this study, “management scenarios were divided into those for intraperitoneal anastomoses, extraperitoneal (low pelvic) anastomoses, and anastomoses with proximal diverting stomas. Management options were then based on the clinical presentation and radiographic findings and organized into three interconnected algorithms.”

Recommendations for the management of intraperitoneal anastomotic leak with references to the pertinent sections of this article for more information. KEY: IV ABX=intravenous antibiotics; CT=computed tomographic; WSCE=water soluble contrast enema; CT A/P=computed tomographic scan of the abdomen and pelvis
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Techniques for intraoperative evaluation of bowel viability inmesenteric ischemia:

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“Acute mesenteric ischemia (AMI) accounts for approximately 1:1000 acute hospital admissions in the United States, and the incidence is on the rise likely due to an aging population as well as the prolonged survival of critically ill patients. AMI can be caused by a reduction in blood flow from arterial occlusion, venous occlusion, arterial vasospasm, or a low-flow state. Regardless of the etiology of the disease, rapid diagnosis and treatment of AMI is of critical importance”

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