Category Archives: Gastroenterology

Left ventricular assist device infections resulting from gastrointestinal-tract fistulas

Posted on by
Reply

“Despite the benefits provided by continuous-flow left ventricular assist devices (LVADs), such as the HeartMate-II (HM-II), pump-related infection remains a potential complication of LVAD use. The following factors contribute to LVAD infection: malnutrition, diabetes, obesity,
prolonged hospitalization, postoperative bleeding, hematoma formation, reoperation, multiorgan failure, and sepsis.Device-related infection entails an increased hospital stay and increased risk of death. Therefore, bridge-to-transplant patients with LVAD-related infections are upgraded to status IA, classified as the highest level of urgency, on the transplant waiting list.”

Continue reading →

Enterocutaneous Fistulas: Causes and Managemen

Posted on by
Reply

“Despite advances in medical technology and surgical care, the management of enterocutaneous fistulas remains one of the most challenging problems faced by physicians. Success depends on an expert multidisciplinary team, access to long-term enteral and parenteral nutrition support, advanced wound care, optimal medical management and meticulous, methodical, surgical decision-making and technique. Management is complex and multiphasic.Improved survival rates for many morbid problems have resulted in a growing population of patients with increasingly complex fistulas. This article reviews the etiologies as
well as classic and evolving management strategies for this problem.”

Continue reading →

Risk Factors for Pancreatic Fistula after Stapled Gland Transection

Posted on by
Reply

“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.”

Continue reading →

Importance of duodenal stump reinforcement to prevent stump leakage after gastrectomy

Posted on by
Reply

“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.”

Continue reading →

Management of the difficult duodenal stump

Posted on by
Reply

Burch JM, Cox CL, Feliciano DV, Richardson RJ, Martin RR. Management of the difficult duodenal stump. Am J Surg. 1991 Dec;162(6):522-6.

Full-text for Emory users.

Abstract: Leakage from the duodenal stump has been the most feared complication of the Billroth II reconstruction following gastric resection. The purpose of our study was to evaluate four methods of duodenal stump closure in 200 patients. One hundred and forty-seven (74%) patients had duodenal ulcers; 28 (14%) had gastric ulcers; and 25 (13%) had a variety of other inflammatory conditions. The most common indication for operation was acute hemorrhage (51%), followed by perforation (24%), intractability (15%), and obstruction (10%). Conventional duodenal closures were performed in 160 (80%) patients, Nissen’s closure in 25 (13%), Bancroft’s closure in 6 (3%), and tube duodenostomy in 9 (5%). Duodenal leaks occurred in four (2.5%) patients with conventional closures and in three (33%) patients with tube duodenostomies. No leaks occurred in patients with Nissen’s or Bancroft’s closures. The hospital mortality rate for the series was 9.5%; however, no patient who developed a duodenal leak died. We conclude that Nissen’s and Bancroft’s closures were safe and effective, but that tube duodenostomy did not reliably prevent uncontrolled leakage.

Continue reading →

Surgical Treatment of Enterocutaneous Fistula

Posted on by
Reply

“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.”

Continue reading →

Predictors of Short-Term Readmission After Pancreaticoduodenectomy

Posted on by
Reply

“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.”

Continue reading →