Does preoperative enteral or parenteral nutrition reduce postoperative complications in Crohn’s disease patients?

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“Surgery is frequently needed in Crohn’s Disease (CD) patients who have malnutrition. Patients with CD are at a risk of malnutrition secondary to decreased oral intake, malabsorption, and inflammation. The prevalence of malnutrition in IBD patients is profound: 60–80% of IBD patients are anemic, 39–81% are iron deficient, 20–60% are vitamin B12
deficient, 36–54% are folate deficient, and 25–80% have hypoalbuminemia. This high prevalence of malnutrition presents a challenge in the surgical management of CD patients because poor preoperative nutritional status has been linked to increase postoperative complications.
Therefore, nutritional optimization using enteral nutrition (EN) and total parenteral nutrition (TPN) have been used for many years to improve the nutritional status of CD patients in hopes of decreasing postoperative complications.”

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Venous Thromboembolism Prevention in Emergency General Surgery

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“Venous thromboembolism (VTE) represents the most preventable cause of morbidity and mortality in hospitalized patients, and the Agency for Healthcare Research and Quality (AHRQ) suggests appropriate VTE prophylaxis as a top patient safety practice. The burden of operative and nonoperative emergency general surgery (EGS) is increasing and represents 7% of all hospital admissions in the United States. The reported rate of VTE among patients undergoing EGS is approximately 2.5%. Numerous observational studies, quality improvement studies, randomized clinical trials, reviews, and practice management guidelines are available to guide acute care surgeons in VTE prevention for patients with trauma. However, little guidance is available for the emergency general surgeon. Patients undergoing EGS represent a challenge regarding VTE prevention. Despite the substantial number of annual EGS admissions, little is known about the risk of VTE or the use of mechanical and/or pharmacologic prophylaxis in EGS patients. Furthermore, although guidelines for VTE prophylaxis are available, they are difficult to interpret in the context of admission to an EGS service for an acute condition, particularly when admissions to such services include as many as 70% of patients who do not require operative intervention.”

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Association of Model for End-Stage Liver Disease Score With Mortality in Emergency General Surgery Patients

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“Emergency general surgery (EGS) is associated with increased rates of morbidity and mortality compared with non-emergent general surgery cases.8 Patients undergoing EGS are approximately 2.5 times more likely to experience a significant complication and have a 6-fold increase in mortality relative to non-EGS patients. The underlying causes of this increased morbidity and mortality are not fully understood, but medical comorbidities and physiological derangements are likely to be contributing factors. Although surgical risk calculation tools such as the American College of Surgeons National Surgical Quality Improvement Project Surgical Risk Calculator are used to gain an objective sense of surgical risk stratification, such tools have yet to be comprehensively studied in this patient population and do not include the use of liver disease–specific assessment tools such as the MELD score in the prediction of outcomes among patients with CLD undergoing EGS.”

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Cannabis use is associated with a small increase in the risk of postoperative nausea and vomiting

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“As cannabinoid compounds have been shown to be effective treatments for chemotherapy induced nausea and vomiting (CINV), it seems reasonable to conjecture that cannabis use could exert a prophylactic or therapeutic effect for patients at risk for or suffering from postoperative nausea and vomiting (PONV). While several studies have examined the role of therapeutically administered cannabinoids in the prevention and treatment of PONV, almost nothing is known about the impact of chronic use of cannabis on the risk for developing PONV. The present investigation examines whether an association exists between patient-described use and/or frequency of cannabis and the occurrence of PONV following general anesthesia.”

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Gastrointestinal Stromal Tumors of the Stomach: Is There Any Advantage of Robotic Resections?

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“Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the digestive system. They account for less than 3% of all gastrointestinal malignancies, with an annual incidence rate estimated at 10–20 cases per million population in the United States. The most frequent anatomical location is the stomach (approximately 60% of cases). Although the introduction of tyrosine kinase inhibitors has changed the therapeutic algorithm of GISTs, surgical resection with negative margins remains the main treatment option for localized resectable tumors.”

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Laparoscopic entry techniques

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“Laparoscopy is a surgical procedure commonly used in gynaecology whereby a laparoscope is used to gain intra-abdominal access via less extensive incisions. Evidence suggests that laparoscopy provides significant benefits compared to laparotomy in terms of surgical outcomes for patients and costs for healthcare providers. Unlike in conventional open surgery, the surgeon is usually unable to visualise the initial entry into the peritoneal cavity. Most laparoscopic complications occur during the initial entry. These may happen
at several stages including Veress needle insertion, creation of a pneumoperitoneum, and primary trocar insertion. Opinion is divided as to the safest entry technique, and clinical practice is varied. Although gynaecologists commonly use a closed method of entry, other surgical specialties routinely use open methods of entry.”

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The Importance of Abdominal Wall Closure After DefinitiveSurgery for Enterocutaneous Fistula

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“In the case of enterocutaneous fistula (ECF) initial medical therapy aims to stabilize the patient, optimize the nutritional status and control of infections and fistula output. When surgery is required, extensive adhesiolysis, bowel resection and anastomosis along with abdominal wall reconstruction are necessary. The primary endpoint in patients undergoing surgical treatment with ECF as well as in the case of intestinal stomas, is to solve the intestinal defect, thus leaving in secondary terms other problems such as ventral hernias.
The simultaneous treatment of fistula/stoma closure with abdominal wall defect closure has been widely debated since some argue that the risk of complications such as anastomotic leakage is increased due to prolonged surgery and anesthetic time. However, various studies are reporting good results in patients undergoing simultaneous stoma with giant wall defect correction surgery, without increased risks and rates of complications.”

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