جستجوی مقالات مرتبط با کلیدواژه « anastomotic leakage » در نشریات گروه « پزشکی »

Although hypoalbuminemia is a well-known predictor of postoperative complications, including surgical site infection (SSI) and anastomotic leakage (AL) in gastrointestinal surgery patients, which requires necessary interventions before surgery, there is limited opportunity for preoper ative optimization and intervention in emergency color ectal surger ies.

Therefore, this study aimed to assess the r elationship between preoperativ e ser um albumin lev els and the dev elo p me n t o f S S I and AL in emer gency colorectal sur gery patients .Meth od s: I n this cohort study , patients who underw ent emergency colorectal surgery dur ing 17 months, w ere assessed. Albumin l e v e l w a s measur ed befor e surgery , and patients wer e followed for 1 month after surger y to identify the development of SSI and AL.

In total, 173 patients were enrolled in the study, but data analysis was performed on 170 patients. They were divided into hypoalbuminemia group (n=98, 57.6%) and non-hy poalbuminemia gr oup (n=72, 42.4%). T he mean ages of patients in each gr oup w er e 57.17±16.19 and 51.61±16.14 years old, respectively (P=0.028). The AL was observed in 4 (2.4 %) patients; 3 patients in the hypoa l bu mi n e mi a group and one patient in the non-hypoalbuminemia group (P=0.205, relative risk=2.33, 95% CI: 0.42-12.82). The SSI was observed in 13 patie nt s (7.6%) during the 1-month fol lo w-up; 8 patients (5.1%) had superficial SSI and 5 (3.2%) had deep ones. Albumin level was significantly low e r i n pat ient s with AL (2.9±0.48), co mpared to those without A L (3.6±0.7 g/dL ). M oreover, albumin level was higher in patients with SSI (3 .1 1 ±0 . 6 2) , compar ed to patients without SSI (3.6±0.7 g/dL). The incidence of complications, either AL or SSI, was significantly higher in hyp oal b um in em ia patients, compared to non-hy p o al b um i ne m i a p a t ie nts (P=0.017, Odds Ratio=4.24, 95% CI: 1.29-13.9). Adjusted OR for age was 3.82 (95% CI: 1.15-12.75, P=0.029); therefore, a 13.5% reduction in OR indicated that age is a confounding factor.

Pr eoper ative hy poalbuminemia w as significantly associated wi t h p o st-development of complications in emergenc y c ol o r e ct a l sur ger y and older age and lower preoperative albumin levels may ser ve as valuable indicators for the identification of patients at higher r isk of complications.

Anastomotic leak (AL) is a serious complication in digestive surgery. Early diagnosis might allow clinicians to anticipate appropriate management. The aim of this study was to assess the predictive value of amylase concentration in drain fluid for the early diagnosis of digestive tract AL.

Hundred and fourteen consecutive patients “at risk” of AL, in whom a flexible drainage was placed by surgeon’s choice after digestive anastomosis were included. Patients with eso‑gastric, bilio‑digestive, and pancreatic anastomoses were excluded. Drain amylase measurement (DAM) was routinely performed on postoperative day (POD) 1, 3, 5–7. DAM values were compared between patients with postoperative AL versus patients without AL. A receiver‑operating curve (ROC) with calculation of the areas under the ROC curves area under curves was performed and a cutoff value of DAM was calculated.

AL occurred in 25 patients (AL group) and 89 patients did not present AL (C group). The mean DAM was significantly higher in AL group versus C Group on POD 1, 3, and 5. A cutoff value of 307 IU/L predicted the occurrence of AL with a sensitivity and specificity of 91% and 100%, respectively. Positive and negative predictive values were 100% and 97.5%, respectively. Patients with AL had an elevated DAM prior to the appearance of any clinical signs of AL.

High level DAM could accurately predict AL for proximal and distal digestive tract anastomoses. This simple, noninvasive, and low‑cost method can accurately predict early AL and help physicians to perform appropriate imaging and treatment.

A newly appeared challenge for the healthcare system is the variety of clinical symptoms of COVID-19. In this research, we report 2 cases admitted to Modarres Hospital with unusual postoperative anastomotic failure.

In a 72-year-oldman with a perforated peptic ulcer in D2 and signs of leakage after the first operation and during the second operation due to massive unexpected hemorrhage, we found fully disrupted anastomosis on the second part of the duodenum. Accordingly, the suture ligature of the bleeding ulcer with the closure of the duodenal stump and loop gastrojejunostomy and tube duodenostomy were performed. During the postoperative period, he developed dyspnea, and the diagnostic test of SARSCoV-2 confirmed him as a case of COVID-19. Unfortunately, 1 week after the second surgery, evidence of anastomotic leakage appeared again by bile discharge from drains; although it was managed conservatively, he died because of respiratory failure. In another case, a 65-year-old woman was admitted to the emergency ward with closed-loop small bowel obstruction. After emergency laparotomy, resection of ischemic bowel with primary anastomosis was performed. The same as the previous case, she developed dyspnea, and the diagnostic test resulted positive for COVID-19. After 2 weeks, she was admitted to the hospital with signs of anastomotic leakage that was subsequently confirmed by abdominal computed tomography (CT); although it was managed conservatively, she died because of respiratory failure due to COVID-19.

These cases were unique in that intestinal microangiopathies can cause very severe problems, weaken the body, and eventually death, as we have seen in these 2 cases.

Preoperative evaluation needs objective measurement of the risk of anastomotic leakage (AL). This study aimed to determine if cardiovascular disease, evaluated by abdominal aortic calcification (AAC), was associated with AL after colorectal anastomoses. We conducted a retrospective case–control study on patients who underwent colorectal anastomosis between 2012 and 2016 at Reims University Hospital (France). Abdominal aortic calcification was the main variable of measurement.

We reviewed all patients who had a left‑sided colocolic or a colorectal anastomosis, all patients with AL were cases; 2 controls, or 3 when possible, without AL were randomly selected and matched by operation type, pathology, and age. For multivariate analysis, 2 logistic regression models were tested, the first one used the calcification rate as a continuous variable and the second one used the calcification rate ≥ 5% as a qualitative variable.

Forty‑five cases and 116 controls were included. In univariate analysis, the calcification rate and the percentage of patients with a calcification rate ≥5% were significantly higher in cases than in control groups (4.4 ± 5.5% vs. 2.5 ± 5.2%, odds ratio [OR] =1.6 95% CI: 1.1–2.5; n = 22, 49% and n = 34.3 3%, OR = 2.8 95% CI: 1.2–6.2). In multivariate models, calcification rate as a continuous variable and calcification rate ≥5% as qualitative variable were independent significant risk factors for AL (respectively, aOR = 1.8; 95% CI: 1.1–3,P = 0.01; aOR = 3.2; 95% CI: 1.4–7.55, P < 0.01).

AAC ≥5% should alert on a higher risk of AL and should lead to discussion about the decision of performing an anastomosis.

Sleeve gastrectomy is an effective procedure for weight loss. However, some serious complications may occur during this operation such as strictures, bleeding, and leak. According to previous studies, the rate of leak was 1.06%. Using endoscopic stents have been hampered by some drawbacks the most important of which is repeated migration. The current study aimed to discuss the prevalence and management of leak after laparoscopic sleeve gastrectomy operated at Modarres Hospital, Tehran, Iran.
This cross-sectional study was conducted on patients with morbid obesity undergone laparoscopic sleeve gastrectomy at Modarres Hospital, Tehran, Iran. In addition to the patients’ demographic data; their leak complications, first symptoms and signs, WBC count, and method of management were extracted and collected from their medical files.
A total number of 1263 patients were enrolled in this study. Of them 8(0.63%) patients suffered from leak after the operation. The mean (SD) age of patients with leak was 32.33(6.02) year. The mean (SD) BMI of patients with leak was 45.75(2.07) kg/m2. The mean (SD) of WBC count of the patients with leak was 13680(7272.68). The symptoms of the patients began on different days (3-240 day). Management of the patients was different but most of the patients underwent endoscopic stent.
It seems that stent insertion is a useful method for treatment of leak after sleeve gastrectomy, especially in immediate leak.