Introduction: Na experimentálnu verifikáciu vitality žalúdočného tubulu pred ezofagektómiou je nevyhnutná existencia jednoduchého modelu. Ischémia je hlavná príčina dehiscencie ezofagogastrickej anastomózy a následného leaku anastomózy. Ischemická príprava žalúdočného tubulu pred ezofagektómiou je potencionálna možnosť ako zamedziť rozvoju nežiaducich komplikácií. Avšak technika ako aj optimálne načasovanie ischemizácie ostávajú nejasné. Metody: Samce potkanov plemena Sprague-Dawley (n=24) boli náhodne rozdelené do štyroch skupín: ischemická skupina s odberom vzoriek po 1 hodine od ischémie (I1H), ischemická skupina s odberom vzoriek 1 deň od ischémie (I1D), ischemická skupina s odberom vzoriek 7 dní od ischémie (I7D) a kontrolná skupina (C). Ischémia bola navodená ligáciou a. gastrica sinistra a aa. gastricae breves. Vzorky boli histologicky a makroskopicky verifikované a stanovený bol počet a percentuálne zastúpenie jednotlivých imunokompetentných buniek. Výsledky: V skupine I1H bola pozorovaná ischemická denudácia s mukozálnymi eróziami a celkový počet eozinofilov bol signifikantne vyšší (p<0.05) v tejto skupine v porovnaní so skupinami I1D a I7D. V skupine I1D bola pozorovaná redukcia zápalu a parciálna regenerácia žalúdočnej mukózy. V skupine I7D bola pozorovaná takmer kompletná architektonická regenerácia žalúdočného epitelu a počet polymorfonukleárov bol signifikantne nižší (p<0,05) ako v skupine I1D. Záver: Ischemické poškodenie ligáciou žalúdočných tepien bolo predominantne pozorované v skupinách I1H a I1D avšak nie v skupine I7D. Táto práca prezentuje jednoduchú metódu verifikácie ischemických zmien žalúdočného tubulu.
Introduction: A reproducible and simple model is essential for verifying gastric conduit vitality before esophagectomy. Ischemia is a major cause of esophagogastric anastomotic dehiscence and leakage. Ischemic conditioning of the stomach prior to esophageal surgery has been shown to lower the incidence of postoperative complications, including anastomotic leakage. However, the optimal timing and technique of ischemization remain uncertain. Methods: Male Sprague-Dawley rats (n=24) were randomly divided into four groups: ischemic group – samples collected 1 hour after ischemia (I1H), ischemic group – samples collected 1 day after ischemia (I1D), ischemic group – samples collected 7 days after ischemia (I7D), and control group (C). Ischemia was induced by ligation of the left gastric (LGA) and short gastric arteries (SGA). The samples were verified using histological and macroscopic analysis, and the number and percentage of immunocompetent cells were determined. Results: One hour after ischemization (I1H), ischemic denudation with mucosal erosion was observed, and the total number of eosinophils was significantly higher (p<0.05) in the I1H group compared to the I1D and I7D groups. One day after ischemia (I1D), there was a reduction in the inflammatory response with partial regeneration of gastric mucosa. In the I7D group, nearly complete architectural regeneration of mucosal epithelium was documented. The total count of polymorphonuclears was significantly lower (p<0.05) compared to the I1D group. Conclusion: Ischemic mucosal injury after LGA and SGA ligation was observed dominantly in the I1H and I1D groups, but not in I7D group. In conclusion, this study presents a simple method for verifying gastric ischemic changes.
- MeSH
- anastomóza chirurgická * MeSH
- ezofagektomie metody MeSH
- ezofágus chirurgie krevní zásobení patologie MeSH
- ischemický postconditioning metody MeSH
- krysa rodu rattus MeSH
- netěsnost anastomózy etiologie prevence a kontrola MeSH
- potkani Sprague-Dawley MeSH
- žaludek chirurgie krevní zásobení patologie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- zvířata MeSH
Úvod: Laparoskopická sleeve gastrektomie (LSG) patří mezi nejčastěji prováděné bariatrické výkony. Rovněž je ale spojena se závažnými a potenciálně život ohrožujícími komplikacemi souvisejícími se staplerovou linii, jako je „leak“ ze žaludku a krvácení. Kazuistika: Popisujeme případ operačního řešení časné píštěle mezi žaludkem a slezinou 3 týdny po LSG. Svou pozornost jsme zaměřili na diagnostiku a možnosti léčby této závažné komplikace. Závěr: Snaha o snížení četnosti výskytu leaku po LSG zahrnuje celou řadu nejrůznějších opatření. Je vhodné mít odborné znalosti nejen v primární bariatrické operativě, ale také v řešení problémů a reoperací v gastrointestinální chirurgii. Základním předpokladem úspěšné terapie je individualizace přístupu a multidisciplinární týmová spolupráce.
Introduction: Laparoscopic sleeve gastrectomy (LSG) is one of the most performed bariatric procedures. But it is also associated with serious and potentially life-threatening staple line-related complications, such as stomach leak and bleeding. Case report: The article describes a case of surgical treatment of an early fistula between the stomach and the spleen 3 weeks after LSG. We have focused our attention on the diagnosis and possible treatment options for this potentially life-threatening complication. Conclusion: Efforts to reduce the frequency of leakage after LSG include a number of different measures. It is advisable to have expert knowledge not only in primary bariatric surgery, but also in the management of problems and reoperations in gastrointestinal surgery. An individualized approach and multidisciplinary teamwork are essential for successful therapy.
- MeSH
- bariatrická chirurgie MeSH
- gastrektomie * metody škodlivé účinky MeSH
- laparoskopie metody škodlivé účinky MeSH
- lidé MeSH
- morbidní obezita chirurgie MeSH
- netěsnost anastomózy MeSH
- píštěle chirurgie MeSH
- pooperační komplikace chirurgie diagnóza etiologie MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Both anastomotic leak (AL) and conduit necrosis (CN) after oesophagectomy are associated with high morbidity and mortality. Therefore, the identification of preoperative, modifiable risk factors is desirable. The aim of this study was to generate a risk scoring model for AL and CN after oesophagectomy. METHODS: Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018-December 2018. Definitions for AL and CN were those set out by the Oesophageal Complications Consensus Group. Univariate and multivariate analyses were performed to identify risk factors for both AL and CN. A risk score was then produced for both AL and CN using the derivation set, then internally validated using the validation set. RESULTS: This study included 2247 oesophagectomies across 137 hospitals in 41 countries. The AL rate was 14.2% and CN rate was 2.7%. Preoperative factors that were independent predictors of AL were cardiovascular comorbidity and chronic obstructive pulmonary disease. The risk scoring model showed insufficient predictive ability in internal validation (area under the receiver-operating-characteristic curve [AUROC] = 0.618). Preoperative factors that were independent predictors of CN were: body mass index, Eastern Cooperative Oncology Group performance status, previous myocardial infarction and smoking history. These were converted into a risk-scoring model and internally validated using the validation set with an AUROC of 0.775. CONCLUSION: Despite a large dataset, AL proves difficult to predict using preoperative factors. The risk-scoring model for CN provides an internally validated tool to estimate a patient's risk preoperatively.
- MeSH
- anastomóza chirurgická * MeSH
- chronická obstrukční plicní nemoc MeSH
- ezofagektomie * MeSH
- ezofágus chirurgie patologie MeSH
- hodnocení rizik MeSH
- index tělesné hmotnosti MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory jícnu * chirurgie patologie MeSH
- nekróza * MeSH
- netěsnost anastomózy * epidemiologie etiologie MeSH
- rizikové faktory MeSH
- ROC křivka MeSH
- senioři MeSH
- žaludek chirurgie patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Anastomotický leak je v kolorektální chirurgii závažnou komplikací. Problematikou poruch hojení střevní anastomózy se zabývá řada experimentálních prací zejména ve smyslu aplikovaného výzkumu. Design zvířecích modelů je přitom různorodý a výsledky jednotlivých prací jsou těžko porovnatelné. Tato práce pojednává souhrnně o hlavních bodech problematiky plánování zvířecích modelů střevních anastomóz, které jsou jednotlivě rozebrány. Hlavní částí textu je popis modelu defektní střevní anastomózy prasete. Anastomóza je v modelu konstruována s lokalizovanou protruzí sliznice. Zvířata jsou pooperačně sledována 3 týdny, monitorovány jsou jak klinický stav, tak změny vitálních hodnot, laboratorních parametrů, je prováděno v definovaných bodech CT vyšetření. Na konci observačního období jsou odebrány vzorky, hodnocen makroskopický nález v dutině břišní, skórování adhezí, známky leaku či poruch pasáže. Histologicky jsou preparáty hodnoceny jak standardními metodami analyzujícími vaskularitu, zánětlivou infiltraci a podíl kolagenu, tak metodami vyvinutými de novo pro potřeby experimentu, jako je analýza integrity střevní stěny v místě slizniční protruze. Experimentálního modelu si ceníme pro možnost systematické a podrobné analýzy stavu zhojení anastomózy v kombinaci s podrobným observačním protokolem, jež vytvářejí klinicky relevantní výsledky.
Anastomotic leak is a serious complication in colorectal surgery. The problem of intestinal anastomosis healing disorders is dealt with by a number of experimental studies, especially in applied research. The design of animal models is diverse and the results of individual studies are difficult to compare. This paper summarizes the main issues of planning animal models of intestinal anastomoses, which are discussed individually. The main part of the text is a description of the defective intestinal anastomosis model of the pig. The anastomosis is constructed in the model with a localized mucosal protrusion. The animals are monitored for 3 weeks postoperatively, the clinical condition and changes in vital values and laboratory parameters are monitored, and CT examinations are performed at defined points. At the end of the observation period, samples are taken, macroscopic findings in the abdominal cavity are evaluated, adhesions are scored, and signs of leakage or passage disorders are assessed. The preparations are evaluated histologically both by standard methods analyzing vascularity, inflammatory infiltration and the proportion of collagen, and by methods developed de novo for the needs of the experiment, such as the analysis of the integrity of the intestinal wall at the site of the mucosal protrusion. We value the experimental model for the possibility of a systematic and detailed analysis of the healing state of the anastomosis in combination with a detailed observation protocol, which produces clinically relevant results.
Millions of patients every year undergo gastrointestinal surgery. While often lifesaving, sutured and stapled reconnections leak in around 10% of cases. Currently, surgeons rely on the monitoring of surrogate markers and clinical symptoms, which often lack sensitivity and specificity, hence only offering late-stage detection of fully developed leaks. Here, we present a holistic solution in the form of a modular, intelligent suture support sealant patch capable of containing and detecting leaks early. The pH and/or enzyme-responsive triggerable sensing elements can be read out by point-of-need ultrasound imaging. We demonstrate reliable detection of the breaching of sutures, in as little as 3 hours in intestinal leak scenarios and 15 minutes in gastric leak conditions. This technology paves the way for next-generation suture support materials that seal and offer disambiguation in cases of anastomotic leaks based on point-of-need monitoring, without reliance on complex electronics or bulky (bio)electronic implantables.
- MeSH
- časná diagnóza MeSH
- hydrogely * MeSH
- lidé MeSH
- netěsnost anastomózy * diagnostické zobrazování MeSH
- senzitivita a specificita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Backsground: Esophagectomy is burdened by a significant percentage of morbidity and mortality. Anastomotic leak is one of the dreaded complications. Case report: A 69-year-old man with a diagnosis of distal oesophageal carcinoma was indicated for laparoscopy-assisted transhiatal hybrid esophagectomy with gastric tube anastomosis on a cervical oesophagus stump. During postoperative period CT examination repeatedly ruled out an anastomotic leak. On day 10, COVID-19 infection was detected. Late presentation of the anastomotic leak developed on day 22. Discussion: The late manifestation of the anastomotic leak is relatively unusual. COVID-19 may have been involved in these complications by microvascular thrombosis and dysregulation of the inflammatory process. Conclusion: COVID-19 can interfere with postoperative tissue healing and the care management in COVID positive patients should contemplate this.
- MeSH
- anastomóza chirurgická metody škodlivé účinky MeSH
- COVID-19 komplikace MeSH
- dehiscence operační rány diagnostické zobrazování MeSH
- drenáž MeSH
- ezofagektomie * škodlivé účinky MeSH
- ezofágus diagnostické zobrazování MeSH
- lidé MeSH
- nádory jícnu chirurgie diagnóza terapie MeSH
- netěsnost anastomózy diagnostické zobrazování terapie MeSH
- píštěl jícnu diagnóza komplikace MeSH
- pooperační komplikace * diagnostické zobrazování terapie MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE: The aim of this experimental study was to test the method of prevention of postoperative complications, especially infectious, in partial dehiscence following stapler anastomosis in rectal surgeries. METHODS: The method includes the application of a hyaluronic acid-based gel in combination with triclosan, which has antibacterial properties. The gel was applied to the space around the rectum with an artificial, precisely defined dehiscence so that the dehiscence was separated from the rest of pelvis and the peritoneal cavity to avoid the spread of infection. The study included 30 female pigs. The rectosigmoid colon was mobilized and transected completely. Anastomosis was constructed with circular staplers. A perforator was then used to create precisely defined artificial dehiscence. Subsequently the lesser pelvis was filled with hyaluronic gel such that the site of artificial dehiscence was covered completely. RESULTS: All animals survived for 14 days until the second-look revision with no signs of failure in the anastomosis healing, local inflammation, and sepsis or postoperative complications, such as chills, refusal of liquid or feed, abdominal distension, and bowel obstruction. CONCLUSION: Hyaluronic acid applied as a precursor solution around the rectal anastomosis fills the lesser pelvis perfectly. It prevents the leakage of intestinal contents in the lesser pelvis. Triclosan as an antibacterial substance prevents the spread of inflammation in the pelvis or even in the abdominal cavity.
- MeSH
- anastomóza chirurgická metody MeSH
- antibakteriální látky terapeutické užití MeSH
- kyselina hyaluronová MeSH
- lidé MeSH
- nádory rekta * chirurgie MeSH
- netěsnost anastomózy MeSH
- pánev chirurgie MeSH
- pooperační komplikace prevence a kontrola MeSH
- prasata MeSH
- rektum chirurgie MeSH
- triclosan * MeSH
- zánět MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Anastomotic leak after low anterior rectal resection is a dreadful complication. Early diagnosis, prompt management of sepsis followed by closure of anastomotic defect may increase chances of anastomotic salvage. In this randomized experimental study, we evaluated two different methods of trans-anal anastomotic repair. METHODS: A model of anastomotic leak was created in 42 male pigs. Laparoscopic low anterior resection was performed with anastomosis created using a circular stapler with half of the staples removed. Two days later, animals were randomized into a TAMIS (trans-anal minimally invasive surgery) repair, endoscopic suture (ENDO) or control group with no treatment (CONTROL). Signs of intraabdominal infection (IAI), macroscopic anastomotic healing and burst tests were evaluated to assess closure quality after animals were sacrificed on the ninth postoperative day. RESULTS: Closure was technically feasible in all 28 animals. Two animals had to be euthanized due to progressive sepsis at four and five days after endoscopic closure. Healed anastomosis with no visible defect was observed in 10/14 and 11/14 animals in TAMIS and ENDO groups, respectively, versus 2/14 in CONTROL (p < 0.05). Overall IAI rate was significantly lower in TAMIS (4/14; p = 0.006) and ENDO (5/14; p = 0.018) compared to CONTROL (12/14). Burst tests confirmed sealed closure in healed anastomosis with a median failure pressure of 190 (110-300) mmHg in TAMIS and 200 (100-300) mmHg in ENDO group (p = 0.644). CONCLUSION: In this randomized experimental study, we found that both evaluated techniques are effective in early repair of dehiscent colorectal anastomosis with a high healing rate.
INTRODUCTION: Surgical experience and hospital procedure volumes have been associated with the risk of severe complications in expert centers for endometriosis in France. However, little is known about other certified units in Central European countries. MATERIAL AND METHODS: This retrospective observational study included 937 women who underwent surgery for colorectal endometriosis between January 2018 and January 2020 in 19 participating expert centers for endometriosis. All women underwent complete excision of colorectal endometriosis by rectal shaving, discoid or segmental resection. Postoperative severe complications were defined as grades III-IV of the Clavien-Dindo classification system including anastomotic leakage, fistula, pelvic abscess and hematoma. Surgical outcomes of centers performing less than 40 (group 1), 40-59 (group 2) and ≥60 procedures (group 3) over a period of 2 years were compared. RESULTS: The overall complication rate of grade III and IV complications was 5.1% (48/937), with rates of anastomotic leakage, fistula formation, abscess and hemorrhage in segmental resection, discoid resection and rectal shaving, respectively, as follows: anastomotic leakage 3.6% (14/387), 1.4% (3/222), 0.6% (2/328); fistula formation 1.6% (6/387), 0.5% (1/222), 0.9%; (3/328); abscess 0.5% (2/387), 0% (0/222) and 0.6% (2/328); hemorrhage 2.1% (8/387), 0.9% (2/222) and 1.5% (5/328). Higher overall complication rates were observed for segmental resection (30/387, 7.8%) than for discoid (6/222, 2.7%, P = 0.015) or shaving procedures (12/328, 3.7%, P = 0.089). No significant correlation was observed between the number of procedures performed and overall complication rates (rSpearman = -0.115; P = 0.639) with a high variability of complications in low-volume centers (group 1). However, an intergroup comparison revealed a significantly lower overall severe complication rate in group 3 than in group 2 (2.9% vs 6.9%; P = 0.017) without significant differences between other groups. CONCLUSIONS: A high variability in complication rates does exist in centers with a low volume of activity. Major complications may decrease with an increase in the volume of activity but this effect cannot be generally applied to all institutions and settings.
- MeSH
- absces komplikace etiologie MeSH
- endometrióza * komplikace chirurgie MeSH
- kolorektální chirurgie * škodlivé účinky MeSH
- kolorektální nádory * komplikace chirurgie MeSH
- laparoskopie * metody MeSH
- lidé MeSH
- nemoci rekta * chirurgie MeSH
- netěsnost anastomózy epidemiologie etiologie chirurgie MeSH
- pooperační komplikace etiologie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
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- MeSH
- Bacteroidetes patogenita MeSH
- Firmicutes patogenita MeSH
- kolorektální nádory epidemiologie etiologie mikrobiologie terapie MeSH
- lidé MeSH
- mikrobiota fyziologie imunologie MeSH
- netěsnost anastomózy etiologie mikrobiologie MeSH
- střeva krevní zásobení mikrobiologie patologie MeSH
- střevní mikroflóra * fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
