Definitive surgical treatment of enterocutaneous fistula

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“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 longterm care of these patients difficult. The
subsequent operative management often requires lengthy procedures in hostile abdomens with abundant adhesions and surrounding inflammation. In addition to the significant risk of mortality, morbidity can be equally as devastating.”

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Differential diagnosis in inflammatory bowel disease colitis

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“Distinction between Crohn’s disease of the colon-rectum and ulcerative colitis or inflammatory bowel disease (IBD) type unclassified can be of pivotal importance for a tailored clinical management, as each entity often involves specific therapeutic strategies and prognosis. Nonetheless, no gold standard is available and the uncertainty of diagnosis may frequently lead to misclassification or repeated examinations. Hence, we have performed a literature search to address the problem of differential diagnosis in IBD colitis, revised current and emerging diagnostic tools and refined disease classification strategies. Nowadays, the differential diagnosis is an untangled issue, and the proper diagnosis
cannot be reached in up to 10% of patients presenting with IBD colitis.”

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Japanese Gastric Cancer Treatment Guidelines 2021

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“The sixth edition of the Japanese Gastric Cancer Treatment Guidelines was completed in July 2021, incorporating new evidence that emerged after publication of the previous edition. It consists of a text-based “Treatments” part and a “Clinical Questions” part including recommendations and explanations for clinical questions. The treatments parts include a comprehensive description regarding surgery, endoscopic resection and chemotherapy for gastric cancer. The clinical question part is based on the literature search and evaluation by an independent systematic review team.”

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Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)

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“Liver resection is used increasingly for the management of a variety of benign and malignant conditions. These data have paralleled substantial advances in perioperative management and operative techniques that have improved the safety of, and extended the indications for, liver resection over the past 2 decades. Extended liver resections, liver resections in diseased liver or liver parenchyma affected by chemotherapy, and repeat
or staged liver resections are being used to achieve curative resection and extend long-term survival. The resulting small functional remnant liver volumes and compromised liver function in these patients increase the risk for the development of posthepatectomy liver failure (PHLF). Despite the introduction of functional and imaging measures to assess preoperatively the size and function of the future liver remnant, as well as the use of
portal vein embolization as a preventive intervention, PHLF remains a major concern and has been shown to be a predominant cause of hepatectomy-related mortality.”

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Implications of leukocytosis following distal pancreatectomy splenectomy (DPS) and association with postoperative complications

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“Distal pancreatectomy with splenectomy (DPS) is performed to remove pathology of the body and/or tail of the pancreas. The spleen and the left side of the pancreas share blood supply, and often tumor involvement, thus splenectomy is often performed along with distal
pancreatectomy. DPS is an operation that carries a greater than 30% risk of postoperative complications, including infection, postoperative pancreatic fistula (POPF), intraabdominal abscesses, and pneumonia, among others. In addition to these immediate postoperative
complications, splenectomy itself is known to confer long‐term susceptibility to infection, sepsis, thrombosis, and other sequelae. Our goal was to identify factors that could prompt early investigation and treatment of both infectious and major complications.”

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Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT)

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“Resections of the pancreas reaching to the left of the superior mesenteric vein are defined as distal pancreatectomy. Most distal pancreatectomies are done electively (84%) as a result of chronic pancreatitis (24%), other benign diseases (22%), malignant diseases (18%), neuroendocrine tumours (14%), and pancreatic pseudocysts (6%). The remaining 16% are emergency cases after abdominal trauma or miscellaneous pathological
diagnoses. A systematic review supports the evidence that postoperative pancreatic fistula formation represents a major source of postoperative morbidity (13–64%) and is associated with several further complications, such as intra-abdominal abscess, wound infection, sepsis, malabsorption, and haemorrhage.
A meta-analysis of the most favoured and reported techniques (stapler trans-section and closure vs scalpel trans-section and hand-sewn closure of the pancreatic remnant) did
not define the optimum surgical technique of pancreatic stump closure. Therefore, the multicentre randomised DISPACT trial was designed to assess the effect of stapler
versus hand-sewn closure on formation of postoperative pancreatic fistula after distal pancreatectomy.”

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2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula

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“Eleven years after its definition, postoperative pancreatic fistula (POPF) still remains one of the most harmful complications after pancreatic resection. Despite all the advances and technical modifications developed during this past decade to prevent POPF, the incidence of this dreaded complication still ranges between 3–45 % of pancreatic operations at high-
volume centers. Updating the ISGPF classification is both relevant and clinically important,
because POPF remains the single main determinant of serious postoperative morbidity and mortality related to pancreatic resection and plays a major role in terms of operation-related mortality, morbidity, hospital stay, and economic impact.”

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