Association of Glucagon-Like Peptide-1 Receptor Agonist Use With Risk of Gallbladder and Biliary Diseases

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“Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are recommended for patients with type 2 diabetes to control glycemia and reduce cardiovascular risk, and for patients with obesity to reduce weight. Given the wide-spread use of these drugs, potential safety concerns deserve attention.
Several randomized clinical trials (RCTs) have shown a higher rate of gallbladder disorders in patients who were randomized to GLP-1 RAs vs a placebo. However, whether
increased risk of gallbladder-related events is a class effect of GLP-1 RAs has not been established, and prescribing information for all GLP-1 RA medications does not provide a warning regarding increased risk of gallbladder disorders. In addition to gallbladder-related events, a post hoc analysis of the LEADER trial 8 found significantly increased risks of acute biliary obstruction in patients randomized to liraglutide compared with placebo. Because
GLP-1 RAs are generally prescribed at higher doses for weight loss rather than for control of type 2 diabetes, there may be differential effects on risk for gallbladder or biliary diseases depending on dose.”

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Primary versus Flap Closure of Perineal Defects following Oncologic Resection

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“Abdominoperineal resection and pelvic exenteration for resection of malignancies can lead to large perineal defects with significant surgical-site morbidity. Myocutaneous flaps have been proposed in place of primary closure to improve wound healing. A systematic review was conducted to compare primary closure with myocutaneous flap reconstruction of perineal defects following abdominoperineal resection or pelvic exenteration with regard to
surgical-site complications.”

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Non-Operative Management of Right Posterior Sectoral Duct Injury Following Laparoscopic Cholecystectomy

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“Iatrogenic bile duct injury is a major cause of morbidity and mortality following laparoscopic cholecystectomy, occurring in 0.5–1.4% of cases. The presence of variant biliary anatomy increases the risk of such injuries. Prior studies have estimated that 19–39% of the population have anatomic variations of the biliary tree. These aberrant ducts can be mistaken for the cystic duct and clipped or cauterized inadvertently.”

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Surgical technique in constructing the jejunojejunostomy and the riskof small bowel obstruction after Roux-en-Y gastric bypass

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“Laparoscopic Roux-en-Y gastric bypass (RYGB) surgery is an effective bariatric procedure with excellent outcomes in terms of weight loss and reducing co-morbidities. Large series have demonstrated that the procedure can be performed with low postoperative morbidity and very low mortality. However, concerns have been raised about long-term complications, especially small bowel obstruction (SBO).
In Sweden, RYGB is almost exclusively performed laparoscopically using the antecolic, antegastric Gothenburg technique. Since the technique was first described, alterations have been introduced to reduce the risk of internal herniation, but these modifications have been reported to increase the risk of kinking of the jejunojejunostomy (JJ). Our group has previously demonstrated that diagnostic laparoscopy in RYGB patients suffering from postprandial symptoms often reveals surgically correctable dysfunction/kinking at the JJ.”

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Management of afferent loop obstruction

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“Afferent loop obstruction is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. The operations most commonly associated with this complication are gastrectomy with Billroth II or Roux-en-Y reconstruction, and
pancreaticoduodenectomy with conventional loop or Roux-en-Y reconstruction. Etiology of afferent loop obstruction includes:
(1) entrapment, compression and kinking by postoperative adhesions
(2) internal herniation, volvulus and intussusception
(3) stenosis due to ulceration at the gastrojejunostomy site and radiation enteritis of the afferent loop
(4) cancer recurrence
(5) enteroliths, bezoars and foreign bodies.

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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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Complications of Jejunostomy Feeding Tubes

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“To help mitigate the perioperative risks of poor nutrition status, nutritional interventions via either parenteral or enteral techniques are available. For these reasons, especially in the
setting of foregut reconstruction and planned return to oncology therapy, our bias has been the use of postoperative jejunal feeding tube access in our surgical oncology population in
high-risk and nutritionally depleted patients. Jejunostomy feeding tubes are not without complication, however, with high reported rates of tube dysfunction. Jejunostomy tubes
can be easily dislodged, have imperfect seals at wound exit sites leading to leakage, and can be somewhat cumbersome for patients and caregivers to maintain. Some authors have
begun to advocate for the selective placement of jejunostomy tubes following gastric and esophageal resections.”

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