“Esophageal perforations are difficult to diagnose and have a high mortality rate. The existing studies on esophageal perforations address treatment by anatomic location and by cause, but few focus specifically on iCEPs. The management of iCEPs is controversial. There is a need for additional prospective studies comparing treatment options for iCEPs to establish a gold standard treatment and to assess for the expanding role of endoscopic interventions.” (Chen)
“Transesophageal echocardiography (TEE) is a commonly performed procedure, either in an
intra-operative setting of a cardiac surgical procedure or a nonoperative setting, such as to evaluate for an intracardiac thrombi.”
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Anal fistulas
Sugrue J, et al. Sphincter-Sparing Anal Fistula Repair: Are We Getting Better? Dis Colon Rectum. 2017 Oct;60(10):1071-1077. doi: 10.1097/DCR.0000000000000885.
Vogel JD, et al. Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula Dis Colon Rectum. 2016 Dec;59(12):1117-1133. doi: 10.1097/DCR.0000000000000733.
Sirany AM, et al. The ligation of the intersphincteric fistula tract procedure for anal fistula: a mixed bag of results Dis Colon Rectum. 2015 Jun;58(6):604-12. doi: 10.1097/DCR.0000000000000374.
Diverticulitis:
Francis NK, et al. EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice Surg Endosc. 2019 Sep;33(9):2726-2741. doi: 10.1007/s00464-019-06882-z.
Fissures
Murad-Regadas SM, et al. How much of the internal sphincter may be divided during lateral sphincterotomy for chronic anal fissure in women? Morphologic and functional evaluation after sphincterotomy Dis Colon Rectum. 2013 May;56(5):645-51. doi: 10.1097/DCR.0b013e31827a7416.
Stewart DB Sr, et al. Clinical Practice Guideline for the Management of Anal Fissures Dis Colon Rectum. 2017 Jan;60(1):7-14. doi: 10.1097/DCR.0000000000000735.
Thornton MJ, et al. Prospective manometric assessment of botulinum toxin and its correlation with healing of chronic anal fissure Dis Colon Rectum. 2005 Jul;48(7):1424-31. doi: 10.1007/s10350-005-0025-9.
Hemorrhoids
Davis BR, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids Dis Colon Rectum. 2018 Mar;61(3):284-292. doi: 10.1097/DCR.0000000000001030.
Nelson DW, et al. Prophylactic antibiotics for hemorrhoidectomy: are they really needed? Dis Colon Rectum. 2014 Mar;57(3):365-9. doi: 10.1097/DCR.0b013e3182a0e522.
Nienhuijs S, et al. Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids Cochrane Database Syst Rev. 2009 Jan 21;2009(1):CD006761. doi: 10.1002/14651858.CD006761.pub2.
Rectal prolapse
Bordeianou L, et al. Clinical Practice Guidelines for the Treatment of Rectal Prolapse Dis Colon Rectum. 2017 Nov;60(11):1121-1131. doi: 10.1097/DCR.0000000000000889.
Colon cancer
Allaix ME, Rebecchi F, Fichera A. The Landmark Series: Minimally Invasive (Laparoscopic and Robotic) Colorectal Cancer Surgery. Ann Surg Oncol. 2020 Oct;27(10):3704-3715.
Alonso S, Saltz L. The Landmark Series: Chemotherapy for Non-Metastatic Colon Cancer. Ann Surg Oncol. 2021 Feb;28(2):995-1001.
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Pneumatosis Intestinalis:
Sanford Z, et al Updates on the Utility of Diagnostic Laparoscopy in the Management of Pneumatosis Intestinalis: An Improvement to the Current Treatment Algorithm. Surg Innov. 2018 Dec;25(6):648-650.
Rectal Cancer
Peacock O, Chang GJ. The Landmark Series: Management of Lateral Lymph Nodes in Locally Advanced Rectal Cancer. Ann Surg Oncol. 2020 Aug;27(8):2723-2731.
Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021 Jan;22(1):29-42. doi: 10.1016/S1470-2045(20)30555-6. Epub 2020 Dec 7. Erratum in: Lancet Oncol. 2021 Feb;22(2):e42. PMID: 33301740.
Conroy T, Lamfichekh N, Etienne P, Rio E, Francois E, Mesgouez-Nebout N, et al. Total neoadjuvant therapy with mFOLFIRINOX versus preoperative chemoradiation in patients with locally advanced rectal cancer: final results of PRODIGE 23 phase III trial, a UNICANCER GI trial. J Clin Oncol 2020;38(15 Suppl.):4007.
“Mesh properties and position within the abdominal wall are the primary determinants in the ability to salvage mesh in the event of PMI. Mesh placed in an intraperitoneal position is rarely salvageable. Similarly, microporous, multifilament, and composite mesh constructs required complete mesh removal in most cases. However, macroporous, monofilament PP mesh in an extraperitoneal position can be salvaged in 72.2% of cases, positively impacting both the need for reoperation for mesh removal and subsequent hernia
recurrence.” (Warren)
“Surgical site infections (SSI) are common complications after open ventral hernia repair (OVHR), potentially requiring further intervention. Incidence of surgical site occurrence was significantly lower after G 1 C irrigation (Grp 1, 28.1%; Grp 2, 35.4%; Grp 3, 19.7%; P < 0.001). Incidence of SSI was significantly lower after G 1 C irrigation, but not G
alone (Grp 1, 16.5%; Grp 2, 15.2%; and Grp 3, 5.4%; P < 0.001). Multivariate logistic regression demonstrated significantly increased SSI with contaminated wounds (OR 2.96; 95% confidence interval (CI) 1.39–6.21), dirty wounds (OR 3.84; 95% CI 1.49–9.69), and chronic obstructive pulmonary disease (OR 3.70; 95% CI 2.16–6.38), as expected. Use of G 1 C was an independent predictor of decreased SSI (OR 0.33; 95% CI 0.16–0.67). Irrigation with a combined G 1 C antibiotic irrigation significantly reduces the incidence of surgical site infection after OVHR with mesh.” (Fatula)
“According to our results, a CT scan triggered by clinical suspicion must be considered the first-line procedure to detect a postoperative leak following primary sleeve gastrectomy or Roux-en-Y gastric bypass.”
A multivariate analysis showed the following adverse risk factors for AL: age > 65 years, hemoglobin < 8.0 g/dL and malnourishment. A multivariable model for AL showed a strong optimism-adjusted discrimination (concordance index, 0.675).
Surgical Focus 