Anastomotic LeakageFollowing Colorectal Surgery

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“Anastomotic leakage is a common yet one of the most feared complications following colorectal surgery. Dehiscence of the anastomosis can result in fatal complications such as peritonitis, abscess formation, and sepsis, thereby increasing morbidity and mortality, cost and length of hospital stay. Multiple factors contribute to the development of anastomotic dehiscence. Several studies have been published identifying various risk factors that may play a role in causing AL.” (Sripathi)

“Anastomotic leak in colorectal surgery is a multifactorial complication associated with an increased morbidity and mortality rate. It has remained the most feared complication over the past several years, despite numerous studies and technological advances like robotic surgery, staplers, and other anastomotic techniques. The clinical significance of reviewing and summarizing the risk factors of AL is to identify high-risk patients. Awareness and understanding of these factors will provide an opportunity to offer more comprehensive preoperative patient counseling.” (Sripathi)

Sripathi
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Relationship Between the Number of Intersections of Staple Lines and Anastomotic Leakage

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“The number of intersections of staple lines is associated with anastomotic leakage, and the inversion technique is a useful method for avoiding anastomotic leakage. Using an appropriate technique by skilled operator, double stapling technique for laparoscopic
anterior resection is safe and feasible.”

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Laparoscopic intracorporeal colorectal anastomosis with double stapling technique is difficult because of the unsuitable cutting angle associated with using a linear stapler in the narrow pelvic cavity. Consequently, we sometimes have used multiple stapler firings during division of the rectum. Because of the long and tilted linear staple line placed on the rectal stump, a circular anastomotic plane can create multiple intersections of staple lines and dog-ears. Anastomotic leakage is a major problem in patients with colorectal cancer who have
undergo laparoscopic surgery. Despite technical improvements in laparoscopic surgery, recent studies have reported that the anastomotic leakage rate remains at 6.3% to 13.7%.” (Lee)

Lee
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Evaluation of pre- and post- operative cognitive function and neurodegenerative markers

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“One of the largest controversies in perioperative medicine over the last quarter century has been whether anesthesia and surgery contribute to long-term cognitive decline and/or the development of dementia in older adults. This question has major public health implications, since approximately half of adults over 65 will undergo at least one surgery, and over 120,000 Americans will die of Alzheimer’s disease (AD) per year.”

“Neurocognitive changes after non-cardiac, non-neurologic surgery in the majority of cognitively healthy, community-dwelling older adults are unlikely to be related to postoperative changes in AD neuropathology (as assessed by CSF Aβ, tau or p-tau-181p levels or the p-tau-181p/Aβor tau/Aβratios).”

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“Although the authors acknowledge that cognitive deterioration following surgery is a common phenomenon, there is little evidence that anesthesia itself or other surgical and patient factors can cause or accelerate cognitive decline and AD. The existing controversy in the field between animal and human studies highlights the need for transitioning from population-based studies to high-quality clinical studies especially with regards to dementia.” (Tsolaki)

Tsolaki

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Cognitive decline of elderly patients after anesthesia

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“Postoperative neurocognitive decline is a meaningful concern to patients and represents a significant and expanding challenge to health care in the US and worldwide. Surgeons and anesthesiologists should assess, discuss, and optimize associated potential risks for each patient before surgery. Best practices and interventions can begin before surgery and extend well into the recovery period. To be most effective, these strategies require family engagement and the involvement of an interdisciplinary health care team and comprehensive systems of care.” (Vacas)

Vacas

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Diagnosis and Management of Morel-Lavallée Lesion

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“The diagnosis of an MLL ideally is made by physical examination of the patient, but advanced imaging modalities can be used to provide additional information. Typically, CT of the area of interest is obtained, especially when a pelvic or acetabular injury is present. Small and large lesions often can be identified in this manner.”

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Overview of Morel Lavallee Lesion

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“The Morel-Lavallee lesion clinically presents as a painful fluctuant swelling at the site of involvement. Concerning the recent literature available, this lesion is also termed as Morel-Lavallée seroma, posttraumatic soft tissue cyst, post-traumatic extravasation, or Morel-Lavallée effusion. This lesion may be missed at the time of initial assessment and can present later, potentially leading to increasing difficulty in management and long-term morbidity.”

“The most common causes of Morel-Lavallee lesions are high-velocity trauma, crush injuries, and blunt trauma. Overall, approximately twenty-five percent of all patients who develop Morel-Lavallee lesions have been involved in a road traffic accident. This lesion is commonly associated with underlying fractures, especially of the proximal femur, pelvis, and acetabulum. One of the most commonly involved regions is the greater trochanter, accounting for more than sixty percent of the cases”

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