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Zhang B, Li X, Jiang C, Wang C, Que H, Zheng C, Ji Z, Tao X, Xu H, Shi C. Construction of PVA/OHA-Gs@PTMC/PHA double-layer nanofiber flexible scaffold with antibacterial function for tension free rectal in-situ reconstruction. Biomaterials 2025; 317:123064. [PMID: 39754964 DOI: 10.1016/j.biomaterials.2024.123064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 11/25/2024] [Accepted: 12/26/2024] [Indexed: 01/06/2025]
Abstract
The effective prevention and treatment of anastomotic leakage after intestinal anastomosis for colorectal diseases is still a major clinical challenge. In order to assist intestinal anastomosis healing and avoid anastomotic leakage caused by high tension, low blood supply or infection, we designed a double-layer nanofiber intestinal anastomosis scaffold, which was composed of electrospun PTMC/PHA nanofibers as the main layer, and electrospun PVA/OHA-Gs nanofibers with antibacterial properties as the antibacterial surface layer. This double-layer scaffold has good toughness, its maximum tensile force value could reach 8 N, elongation could reach 400 %, and it has hydrophilic properties, and its contact angle was about 60°. On the basis of reducing anastomotic tension and isolating intestinal contents, this double-layer nanofiber anastomotic scaffold not only played an antibacterial effect in the short term after surgery to reduce inflammatory response, but also had the characteristics of multiple three-dimensional network structure like extracellular matrix which could promote tissue healing. The PVA/OHA-Gs@PTMC/PHA scaffold was implanted into a rabbit model simulating mechanical intestinal obstruction, and the results showed that the nanofibers of the scaffold could be degraded in vivo while maintaining a certain stability, that is, the overall structure of the PVA/OHA-Gs@PTMC/PHA scaffold would not shrink and deform due to degradation in a certain period of time. Therefore, the treatment with this scaffold showed better healing at the anastomotic site. Compared to the direct anastomosis group and pure PTMC scaffold group, the double-layer scaffold group promoted a faster return to normal anastomotic strength within 7 days. This PVA/OHA-Gs@PTMC/PHA double-layer nanofiber flexible scaffold appears to be a promising therapeutic strategy to prevent anastomotic leakage after intestinal anastomosis.
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Affiliation(s)
- Bingxu Zhang
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325011, China
| | - Xujian Li
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325011, China
| | - Chuan Jiang
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China
| | - Chuanguang Wang
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China
| | - Haifeng Que
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China
| | - Cheng Zheng
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, 318000, China
| | - Zhixiao Ji
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325011, China
| | - Xudong Tao
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China
| | - Hongtao Xu
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China.
| | - Changcan Shi
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325011, China.
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Ben Hmido S, Abder Rahim H, Ploem C, Haitjema S, Damman O, Kazemier G, Daams F. Patient perspectives on AI-based decision support in surgery. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2025; 7:e000365. [PMID: 40182313 PMCID: PMC11966983 DOI: 10.1136/bmjsit-2024-000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 03/21/2025] [Indexed: 04/05/2025] Open
Abstract
Background Predictive machine learning in healthcare, especially in surgical decisions, is advancing swiftly. Yet, literature on patient views regarding predictive machine learning, specifically its use throughout the clinical course, is scarce. Views among patients who underwent colorectal surgery (CRS) on the use of intra-operative predictive machine learning (IPML) by surgeons, particularly those aiming to predict colorectal anastomotic leakage (CAL), were explored in this study. Objective This study investigated the views of patients who previously underwent CRS on the implementation of IPML models. Domains of interest were perceptions of IPML, perceived role in decision-making and information provided in the clinical encounter. Methods A qualitative research design was employed, using focus groups and semi-structured interviews with patients who had undergone CRS. Descriptive thematic analysis was used to analyse data and identify prevailing themes and attitudes. The associations in the code tree were established based on a co-occurrence table. The patient sample size was determined using a saturation analysis. Results A study with n=19 participants across four focus groups and seven interviews found a generally positive perception regarding the use of IPML models in CRS. Participants recognised their potential to enhance surgical decision-making but stressed the surgeon's role as the primary decision-maker, suggesting IPML models act as advisory tools, with surgeons able to override recommendations. Personalised communication and consideration of quality of life were emphasised, highlighting the need for a balanced integration of IPML models to support clinical judgement and the construction of patient preferences. Conclusion IPML in CRS is well-received by participants, provided that surgeons retain the ability to override model recommendations and document their decisions transparently. Trust in the surgeon remains a key factor in patient acceptance of IPML, reinforcing the need for clear explanations during consultation sessions. Regardless of the use of IPML, tailoring patient communication and addressing the quality-of-life impacts of anastomosis vs stoma are also critical.
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Affiliation(s)
- Sara Ben Hmido
- Department of Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
- Cancer Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | | | - Corrette Ploem
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, North Holland, The Netherlands
| | - Saskia Haitjema
- Experimental Cardiology, UMC Utrecht, Utrecht, The Netherlands
| | - Olga Damman
- Cancer Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
- Cancer Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
- Cancer Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands
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Khalid MU, Ali D, Wu JY, Lee H, Khan A. Impact and Measurement of Mechanical Tension in Bowel Anastomosis: A Scoping Review of the Current Literature. J Surg Res 2025; 308:161-173. [PMID: 40090052 DOI: 10.1016/j.jss.2025.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Revised: 01/13/2025] [Accepted: 02/10/2025] [Indexed: 03/18/2025]
Abstract
INTRODUCTION Creating a "tension-free anastomosis" is a fundamental principle in safe bowel surgery. This review aims to summarize the current literature regarding the measurement and impact of tension on bowel anastomoses. METHODS This scoping review was conducted using a systematic literature search in the PubMed, SCOPUS, and EMBASE databases. Data were synthesized in tables and summarized paragraphically, with studies assessed using the Newcastle-Ottawa scale. RESULTS Out of the 350 studies identified in the initial literature review, 25 were included in this study. Several studies indicated that anastomotic leak and tension are strongly associated, with the presence of tension making leaks up to 10 times more likely. However, no objective and clinically available methods exist to measure tension on bowel anastomosis in humans. Freedom from tension has traditionally been measured via surrogate measures of adequate bowel mobilization and subjective assessment by operating surgeons. Animal and cadaveric studies have been the frontier for objective measurement of wall tension. These studies use tensiometers to measure tension and automated machines or pulley and ratcheting systems to increase tension at specified intervals. However, these methods are universally destructive due to their design of measuring maximal tensile load and are not readily adaptable to the operating room. CONCLUSIONS The current literature does not address the objective measurement of bowel tension in live human subjects. Given the importance of tension, developing an objective, safe, intraoperative method to measure bowel wall tension would be a valuable surgical tool.
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Affiliation(s)
- Muhammad Usman Khalid
- Department of Neurological Surgery, Kentucky Neuroscience Institute, University of Kentucky, Lexington, Kentucky
| | - Danish Ali
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jie Ying Wu
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Hanjoo Lee
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Aimal Khan
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
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Mülküt F, Ofluoğlu CB. Development of a Clinical Framework-Anastomotic Leakage Prediction Score (CF-ALPS) After Colorectal Surgery. Diagnostics (Basel) 2025; 15:455. [PMID: 40002606 PMCID: PMC11854675 DOI: 10.3390/diagnostics15040455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 02/08/2025] [Accepted: 02/10/2025] [Indexed: 02/27/2025] Open
Abstract
Background: Anastomotic leakage (AL) is a severe complication of colorectal surgery and is associated with high morbidity, mortality, and prolonged hospital stay. Current predictive models vary in complexity and utility, highlighting the need for clinically accessible and accurate tools. This study aimed to develop and validate the clinical framework-anastomotic leakage prediction score (CF-ALPS) score, a practical and accessible risk prediction model for AL that integrates patient-, tumor-, and surgery-related factors. Methods: A retrospective cohort of 294 patients who underwent colorectal surgery between 2019 and 2024 was analyzed. Patients were categorized into the AL (n = 84) and non-AL groups (n = 210). The factors included age, sex, hypoalbuminemia, and comorbidities. Tumor-related factors included lymph node stage and neoadjuvant therapy, while surgical variables included urgency, duration, and type of procedure. The outcomes evaluated were the incidence of AL, duration of hospital stay, and in-hospital mortality. Independent predictors were identified using multivariate logistic regression analysis. The CF-ALPS score, which was developed from significant predictors, was validated using ROC curve analysis and 10-fold cross-validation. Results: A total of 294 patients who underwent colorectal surgery were included, of whom 84 (28.57%) developed AL. A male predominance was observed in the AL group (73.81% vs. 36.19%; p = 0.001). Nutritional status played a critical role, with significantly lower albumin levels in AL patients (2.8 ± 0.5 g/dL vs. 3.5 ± 0.4 g/dL; p < 0.001). Independent predictors of AL included hypoalbuminemia (<3.0 g/dL, OR: 0.52, p < 0.001), ASA score (OR, 1.85; p = 0.004), advanced lymph node stage (N2/N3, OR: 1.94, p = 0.037), neoadjuvant therapy (OR, 2.89; p = 0.002), and emergent surgery (OR, 1.67; p = 0.042). These variables formed the basis of the CF-ALPS score, which assigns weighted points based on the magnitude of their ORs. The CF-ALPS model achieved a ROC AUC of 0.82 (95% CI: 0.75-0.89) with a sensitivity of 85.0% and specificity of 78.0%. A cutoff score ≥7 demonstrated optimal risk stratification, classifying patients into high- and low-risk groups with a positive predictive value (PPV) of 72.0% and a negative predictive value (NPV) of 88.0%. Cross-validation yielded a moderate AUC of 0.44 (SD = 0.062). Conclusions: The CF-ALPS score offers a simple and effective tool for AL risk prediction in colorectal surgery, emphasizing its practicality and clinical integration. Although its predictive accuracy was moderate, further prospective multicenter validation is warranted.
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Affiliation(s)
- Fırat Mülküt
- Department of General Surgery, Sancaktepe Sehit Prof. Dr. İlhan Varank Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey
| | - Cem Batuhan Ofluoğlu
- Department of Gastroenterology Surgery, Sancaktepe Sehit Prof. Dr. İlhan Varank Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey;
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Ozdemir DB, Karayigit A, Tekin E, Kocaturk E, Bal C, Ozer I. The Effect of Local Papaverine Use in an Experimental High-Risk Colonic Anastomosis Model: Reduced Inflammatory Findings and Less Necrosis. J Clin Med 2024; 13:5638. [PMID: 39337124 PMCID: PMC11433639 DOI: 10.3390/jcm13185638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 09/09/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
Objectives: To assess the impact of topical papaverine administration in complete and incomplete colonic anastomosis, by examining bursting pressure, hydroxyproline concentration, collagen content, inflammation levels, inflammatory cell infiltration, neoangiogenesis, and necrosis grades. Methods: We performed an experimental study on rats, in which they were divided into the following 4 groups of 16 subjects each. Group 1 [complete anastomosis (CA) without papaverine (CA -P) group], Group 2 [CA with papaverine (CA +P) group], Group 3 [incomplete anastomosis (ICA) without papaverine (ICA -P) group], and Group 4 [ICA with papaverine (ICA +P) group]. Results: The lymphocyte infiltration score of the ICA +P3 (day 3) group was significantly higher compared to the ICA -P3 group (p = 0.018). The median Ehrlich-Hunt score (p = 0.012), inflammation score (p = 0.026), and neutrophil infiltration score (p = 0.041) of the CA +P7 (day 7) group were significantly lower than the corresponding data of the CA -P7 group. Additionally, the necrosis score of the ICA +P7 group was significantly lower than that of the ICA -P7 group (p = 0.014). Conclusions: Data from the current study reveal that, although topical papaverine seems to suppress inflammation in anastomosis tissue and reduce necrosis at 7 days, definite conclusions regarding its impact on anastomotic leak cannot be drawn without further studies investigating anastomotic wound healing and anastomotic leak, preferably with both shorter- and longer-term evaluations.
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Affiliation(s)
- Dursun Burak Ozdemir
- Department of Surgical Oncology, SBU Samsun Training and Research Hospital, 55090 Samsun, Turkey
| | - Ahmet Karayigit
- Department of Surgical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, 06200 Ankara, Turkey
| | - Emel Tekin
- Department of Pathology, Faculty of Medicine, Eskişehir Osmangazi University, 26480 Eskisehir, Turkey
| | - Evin Kocaturk
- Department of Medical Biochemistry, Faculty of Medicine, Eskişehir Osmangazi University, 26480 Eskisehir, Turkey
| | - Cengiz Bal
- Department of Biostatistics, Faculty of Medicine, Eskişehir Osmangazi University, 26480 Eskisehir, Turkey
| | - Ilter Ozer
- Department of Gastroenterology Surgery, Private Office, 06560 Ankara, Turkey
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Emile SH, Dourado J, Rogers P, Horesh N, Garoufalia Z, Gefen R, Wexner SD. Splenic flexure mobilization in left-sided colonic and rectal resections: A meta-analysis and meta-regression of factors associated with anastomotic leak and complications. Colorectal Dis 2024; 26:1332-1345. [PMID: 38757843 DOI: 10.1111/codi.16983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/06/2024] [Accepted: 03/16/2024] [Indexed: 05/18/2024]
Abstract
AIM Splenic flexure mobilization (SFM) is commonly performed during left-sided colon and rectal resections. The aim of the present systematic review was to assess the outcomes of SFM in left-sided colon and rectal resections and the risk factors for complications and anastomotic leak (AL). METHOD This study was a PRISMA-compliant systematic review. PubMed, Scopus and Web of Science were searched for studies that assessed the outcomes of sigmoid and rectal resections with or without SFM. The primary outcomes were AL and total complications, and the secondary outcomes were individual complications, operating time, conversion to open surgery, length of hospital stay (LOS) and pathological and oncological outcomes. RESULTS Nineteen studies including data on 81 116 patients (49.1% male) were reviewed. SFM was undertaken in 40.7% of patients. SFM was associated with a longer operating time (weighted mean difference 24.50, 95% CI 14.47-34.52, p < 0.0001) and higher odds of AL (OR 1.19, 95% CI 1.06-1.33, p = 0.002). Both groups had similar odds of total complications, splenic injury, anastomotic stricture, conversion to open surgery, (LOS), local recurrence, and overall survival. A secondary analysis of rectal cancer cases only showed similar outcomes for SFM and the control group. CONCLUSIONS SFM was associated with a longer operating time and higher odds of AL, yet a similar likelihood of total complications, splenic injury, anastomotic stricture, conversion to open surgery, LOS, local recurrence, and overall survival. These conclusions must be cautiously interpreted considering the numerous study limitations. SFM may have only been selectively undertaken in cases in which anastomotic tension was suspected. Therefore, the suboptimal anastomoses may have been the reason for SFM rather than the SFM being causative of the anastomotic insufficiencies.
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Affiliation(s)
- Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Justin Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Peter Rogers
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
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Masea JO, Arda F, Mchele G. Predictors of Colorectal Resection and Primary Anastomosis outcome at Muhimbili National Hospital. East Afr Health Res J 2024; 8:208-214. [PMID: 39296773 PMCID: PMC11407117 DOI: 10.24248/eahrj.v8i2.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/28/2024] [Indexed: 09/21/2024] Open
Abstract
Background Anastomotic leakage is among the most common complications after bowel resection and primary anastomosis, causing considerable morbidity and mortality. As a result it tends to affect the quality of life and increase burden to the patients and caretakers. This study focused on the assessment of the predictors and outcome of anastomotic leakage among patients who underwent large bowel surgery that involved resection and primary anastomosis. Methodology Hospital based prospective observational study at Muhimbili National Hospital. Data of the patients who underwent colorectal resection and primary anastomosis were collected by using a structured questionnaire. Consecutive recruitment sampling technique was applied to get the required sample size and followed for 30 days. Subjects' information including age, sex, perioperative information was documented and analyzed by using Statistical Package for the Social Sciences (SPSS) version 23 software. Results The study included 141 participants. Among those operated, 23 (16.3%) developed anastomotic leakage with a mortality rate of 30.4%. Predictors which were statistically significantly associated with anastomotic leakage were hypertension, body mass index > 30kg/m2, history of radiation therapy, female sex, high American Society of Anesthesiologists (ASA) grade III-IV score and peritonitis. Increased length of hospital stay, re-admission and re-operation rate together with high mortality are among the outcomes of anastomotic leakage found in this study. No loss to follow up event occurred. Conclusion Anastomotic leakage remains a considerable problem among patients undergoing large bowel surgery at Muhimbili National Hospital. From the study site, factors such as peritonitis, HIV/AIDS, hypertension, history of radiation, obesity, high ASA score (III-IV) and female sex were found to be independent predictors of anastomotic leakage. Optimization of co-morbidities conditions before surgery, choosing best surgical option such as creating temporary stoma versus primary anastomosis in dirty wound may help to reduce the rate of anastomotic leakage.
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Affiliation(s)
| | - Fransia Arda
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Ntampakis G, Pramateftakis MG, Anestiadou E, Bitsianis S, Ioannidis O, Bekiari C, Koliakos G, Karakota M, Tsakona A, Cheva A, Angelopoulos S. Experimental models of high-risk bowel anastomosis in rats: A systematic review. World J Exp Med 2024; 14:94135. [PMID: 38948424 PMCID: PMC11212746 DOI: 10.5493/wjem.v14.i2.94135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Anastomotic leaks remain one of the most dreaded complications in gastrointestinal surgery causing significant morbidity, that negatively affect the patients' quality of life. Experimental studies play an important role in understanding the pathophysiological background of anastomotic healing and there are still many fields that require further investigation. Knowledge drawn from these studies can lead to interventions or techniques that can reduce the risk of anastomotic leak in patients with high-risk features. Despite the advances in experimental protocols and techniques, designing a high-quality study is still challenging for the investigators as there is a plethora of different models used. AIM To review current state of the art for experimental protocols in high-risk anastomosis in rats. METHODS This systematic review was performed according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. To identify eligible studies, a comprehensive literature search was performed in the electronic databases PubMed (MEDLINE) and Scopus, covering the period from conception until 18 October 2023. RESULTS From our search strategy 102 studies were included and were categorized based on the mechanism used to create a high-risk anastomosis. Methods of assessing anastomotic healing were extracted and were individually appraised. CONCLUSION Anastomotic healing studies have evolved over the last decades, but the findings are yet to be translated into human studies. There is a need for high-quality, well-designed studies that will help to the better understanding of the pathophysiology of anastomotic healing and the effects of various interventions.
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Affiliation(s)
- Georgios Ntampakis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | | | - Elissavet Anestiadou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stefanos Bitsianis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Chryssa Bekiari
- Laboratory of Anatomy and Histology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
- Experimental and Research Center, Papageorgiou General Hospital of Thessaloniki, Thessaloniki 56403, Greece
| | - George Koliakos
- Laboratory of Biochemistry, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Maria Karakota
- Laboratory of Biochemistry, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Anastasia Tsakona
- Department of Pathology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Angeliki Cheva
- Department of Pathology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Stamatios Angelopoulos
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
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Wu SJ, Wu J, Kaser SJ, Roh H, Shiferaw RD, Yuk H, Zhao X. A 3D printable tissue adhesive. Nat Commun 2024; 15:1215. [PMID: 38331971 PMCID: PMC10853267 DOI: 10.1038/s41467-024-45147-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Tissue adhesives are promising alternatives to sutures and staples for joining tissues, sealing defects, and immobilizing devices. However, existing adhesives mostly take the forms of glues or hydrogels, which offer limited versatility. We report a direct-ink-write 3D printable tissue adhesive which can be used to fabricate bioadhesive patches and devices with programmable architectures, unlocking new potential for application-specific designs. The adhesive is conformable and stretchable, achieves robust adhesion with wet tissues within seconds, and exhibits favorable biocompatibility. In vivo rat trachea and colon defect models demonstrate the fluid-tight tissue sealing capability of the printed patches, which maintained adhesion over 4 weeks. Moreover, incorporation of a blood-repelling hydrophobic matrix enables the printed patches to seal actively bleeding tissues. Beyond wound closure, the 3D printable adhesive has broad applicability across various tissue-interfacing devices, highlighted through representative proof-of-concept designs. Together, this platform offers a promising strategy toward developing advanced tissue adhesive technologies.
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Affiliation(s)
- Sarah J Wu
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Jingjing Wu
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Samuel J Kaser
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Heejung Roh
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Ruth D Shiferaw
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Hyunwoo Yuk
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
- SanaHeal, Inc., Cambridge, MA, USA.
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
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Shin HH, Ryu JH. Bio-Inspired Self-Healing, Shear-Thinning, and Adhesive Gallic Acid-Conjugated Chitosan/Carbon Black Composite Hydrogels as Suture Support Materials. Biomimetics (Basel) 2023; 8:542. [PMID: 37999183 PMCID: PMC10669539 DOI: 10.3390/biomimetics8070542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
The occurrence of leakage from anastomotic sites is a significant issue given its potential undesirable complications. The management of anastomotic leakage after gastrointestinal surgery is particularly crucial because it is directly associated with mortality and morbidity in patients. If adhesive materials could be used to support suturing in surgical procedures, many complications caused by leakage from the anastomosis sites could be prevented. In this study, we have developed self-healing, shear-thinning, tissue-adhesive, carbon-black-containing, gallic acid-conjugated chitosan (CB/Chi-gallol) hydrogels as sealing materials to be used with suturing. The addition of CB into Chi-gallol solution resulted in the formation of a crosslinked hydrogel with instantaneous solidification. In addition, these CB/Chi-gallol hydrogels showed enhancement of the elastic modulus (G') values with increased CB concentration. Furthermore, these hydrogels exhibited excellent self-healing, shear-thinning, and tissue-adhesive properties. Notably, the hydrogels successfully sealed the incision site with suturing, resulting in a significant increase in the bursting pressure. The proposed self-healing and adhesive hydrogels are potentially useful in versatile biomedical applications, particularly as suture support materials for surgical procedures.
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Affiliation(s)
- Hyun Ho Shin
- Department of Chemical Engineering, Wonkwang University, Iksan 54538, Jeonbuk, Republic of Korea;
| | - Ji Hyun Ryu
- Department of Chemical Engineering, Wonkwang University, Iksan 54538, Jeonbuk, Republic of Korea;
- Department of Carbon Convergence Engineering, Wonkwang University, Iksan 54538, Jeonbuk, Republic of Korea
- Smart Convergence Materials Analysis Center, Wonkwang University, Iksan 54538, Jeonbuk, Republic of Korea
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11
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Hernández-González PI, Barquín J, Ortega-Ferrete A, Patón V, Ponce-Alonso M, Romero-Hernández B, Ocaña J, Caminoa A, Conde-Moreno E, Galeano J, Campo RD, García-Pérez JC. Anastomotic leak in colorectal cancer surgery: Contribution of gut microbiota and prediction approaches. Colorectal Dis 2023; 25:2187-2197. [PMID: 37743721 DOI: 10.1111/codi.16733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/15/2023] [Accepted: 07/08/2023] [Indexed: 09/26/2023]
Abstract
AIM To monitor prospectively the occurrence of colorectal anastomotic leakage (CAL) in patients with colon cancer undergoing resectional surgery, characterizing the microbiota in both faeces and mucosal biopsies of anastomosis. In a second stage, we investigated the ability to predict CAL using machine learning models based on clinical data and microbiota composition. METHOD A total of 111 patients were included, from whom a faecal sample was obtained, as well as biopsy samples from proximal and distal sites in the healthy margins of the tumour piece. The microorganisms present in the samples were investigated using microbial culture and 16S rDNA massive sequencing. Collagenase and protease production was determined, as well as the presence of genes responsible for expressing enzymes with these activities. Machine learning analyses were developed using clinical and microbiological data. RESULTS The incidence of CAL was 9.0%, and CAL was associated with collagenase/protease-producing Enterococcus. Significant differences were found in the microbiota composition of proximal and distal biopsy samples, but not in faecal samples, among patients who developed CAL. Clinical predictors of CAL were 5-day C-reactive protein and heart disease, whereas 3-day C-reactive protein and diabetes were negative predictors. CONCLUSION Biopsy samples from surgical margins, rather than faecal samples, are the most appropriate samples for exploring the contribution of the intestinal microbiota to CAL. Enterococci are only enriched in the anastomosis after surgery, and their collagenases and proteases are involved in the degradation of the anastomotic scar.
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Affiliation(s)
- Patricia I Hernández-González
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Grupo de Sistemas Complejos, Universidad Politécnica de Madrid, Madrid, Spain
| | - José Barquín
- Servicio de Cirugía General y Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Ortega-Ferrete
- Servicio de Cirugía General y Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Víctor Patón
- Grupo de Sistemas Complejos, Universidad Politécnica de Madrid, Madrid, Spain
| | - Manuel Ponce-Alonso
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBERINFEC, Madrid, Spain
| | - Beatriz Romero-Hernández
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBERESP, Madrid, Spain
| | - Juan Ocaña
- Servicio de Cirugía General y Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alejandra Caminoa
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Elisa Conde-Moreno
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Grupo de Biomarcadores y Dianas Terapeúticas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Galeano
- Grupo de Sistemas Complejos, Universidad Politécnica de Madrid, Madrid, Spain
| | - Rosa Del Campo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBERINFEC, Madrid, Spain
- Universidad Alfonso X El Sabio, Villanueva la Cañada, Spain
| | - Juan Carlos García-Pérez
- Servicio de Cirugía General y Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá de Henares, Alcalá de Henares, Spain
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12
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Tirelli F, Lorenzon L, Biondi A, Neri I, Santoro G, Persiani R. '4-Check' protocol for intraoperative anastomotic assessment during transanal total mesorectal excision: retrospective cohort study. BJS Open 2023; 7:zrad072. [PMID: 37535981 PMCID: PMC10400113 DOI: 10.1093/bjsopen/zrad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Anastomotic leakage is a major complication following rectal cancer surgery. The primary aim of this study was to investigate the efficacy of a protocol based on a quadruple intraoperative anastomotic assessment (4-Check) during transanal total mesorectal excision (TaTME). METHODS Patients who underwent TaTME for rectal cancer with primary anastomosis were reviewed and divided into two groups: before (pre-4-Check: April 2015 - April 2019) and after the implementation of the 4-Check protocol (May 2019 - May 2022). This protocol consisted of a multimodal anastomotic integrity assessment, including indocyanine green-evaluation of colonic stump and intraluminal anastomosis perfusion, a reverse air leak test and anastomotic doughnuts assessment. The primary outcome was incidence of clinical and/or radiological anastomotic leakage. The secondary outcome included intraoperative anastomosis defects and repairs and 30-day complication rate. Propensity score matching and multivariable analyses were performed. RESULTS Of 186 patients, 160 were selected: 86 patients in the pre-4-Check and 74 in the 4-Check group. After propensity score matching, there was no difference in postoperative anastomotic leakage (pre-4-Check versus 4-Check: 11.1 per cent versus 7.4 per cent; P = 0.50). However, in the 4-Check group, the intraoperative detection of defects and repairs was significantly increased (P = 0.03), and the number of complications was reduced (pre-4-Check versus 4-Check: 33.3 per cent versus 9.3 per cent, P = 0.004). Multivariable analyses confirmed that the use of the 4-Check protocol, the detection of anastomotic defects and increased albumin levels were associated with a reduced number of complications. CONCLUSION The 4-Check protocol allowed the intraoperative detection and repair of anastomotic defects. Anastomotic leakage rates were not reduced; however, 30-day complication rates were lower after implementation of this protocol.
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Affiliation(s)
- Flavio Tirelli
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Laura Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alberto Biondi
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ilaria Neri
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gloria Santoro
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Persiani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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13
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Popov S, Paderin N, Chistiakova E, Ptashkin D, Vityazev F, Markov PA, Erokhin KS. Effect of Chitosan on Rheological, Mechanical, and Adhesive Properties of Pectin-Calcium Gel. Mar Drugs 2023; 21:375. [PMID: 37504906 PMCID: PMC10381555 DOI: 10.3390/md21070375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
In the present study, chitosan was included in the pectin ionotropic gel to improve its mechanical and bioadhesive properties. Pectin-chitosan gels P-Ch0, P-Ch1, P-Ch2, and P-Ch3 of chitosan weight fractions of 0.00, 0.25, 0.50, and 0.75 were prepared and characterized by dynamic rheological tests, penetration tests, and serosal adhesion ex vivo assays. The storage modulus (G') and loss modulus (G″) values, gel hardness, and elasticity of P-Ch1 were significantly higher than those of P-Ch0 gel. However, a further increase in the content of chitosan in the gel significantly reduced these parameters. The inclusion of chitosan into the pectin gel led to a decrease in weight and an increase in hardness during incubation in Hanks' solution at pH 5.0, 7.4, and 8.0. The adhesion of P-Ch1 and P-Ch2 to rat intestinal serosa ex vivo was 1.3 and 1.7 times stronger, whereas that of P-Ch3 was similar to that of a P-Ch0 gel. Pre-incubation in Hanks' solution at pH 5.0 and 7.4 reduced the adhesivity of gels; however, the adhesivity of P-Ch1 and P-Ch2 exceeded that of P-Ch0 and P-Ch3. Thus, serosal adhesion combined with higher mechanical stability in a wide pH range appeared to be advantages of the inclusion of chitosan into pectin gel.
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Affiliation(s)
- Sergey Popov
- Institute of Physiology of Federal Research Centre "Komi Science Centre of the Urals Branch of the Russian Academy of Sciencesk", 167982 Syktyvkar, Russia
| | - Nikita Paderin
- Institute of Physiology of Federal Research Centre "Komi Science Centre of the Urals Branch of the Russian Academy of Sciencesk", 167982 Syktyvkar, Russia
| | - Elizaveta Chistiakova
- Institute of Physiology of Federal Research Centre "Komi Science Centre of the Urals Branch of the Russian Academy of Sciencesk", 167982 Syktyvkar, Russia
| | - Dmitry Ptashkin
- Institute of Physiology of Federal Research Centre "Komi Science Centre of the Urals Branch of the Russian Academy of Sciencesk", 167982 Syktyvkar, Russia
| | - Fedor Vityazev
- Institute of Physiology of Federal Research Centre "Komi Science Centre of the Urals Branch of the Russian Academy of Sciencesk", 167982 Syktyvkar, Russia
| | - Pavel A Markov
- The Federal State Budgetary Institution "National Medical Research Center of Rehabilitation and Balneologyk", 121099 Moscow, Russia
| | - Kirill S Erokhin
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, 119991 Moscow, Russia
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14
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Hu X, Grinstaff MW. Advances in Hydrogel Adhesives for Gastrointestinal Wound Closure and Repair. Gels 2023; 9:282. [PMID: 37102894 PMCID: PMC10138019 DOI: 10.3390/gels9040282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
Millions of individuals undergo gastrointestinal (GI) tract surgeries each year with common postoperative complications including bleeding, perforation, anastomotic leakage, and infection. Today, techniques such as suturing and stapling seal internal wounds, and electrocoagulation stops bleeding. These methods induce secondary damage to the tissue and can be technically difficult to perform depending on the wound site location. To overcome these challenges and to further advance wound closure, hydrogel adhesives are being investigated to specifically target GI tract wounds because of their atraumatic nature, fluid-tight sealing capability, favorable wound healing properties, and facile application. However, challenges remain that limit their use, such as weak underwater adhesive strength, slow gelation, and/or acidic degradation. In this review, we summarize recent advances in hydrogel adhesives to treat various GI tract wounds, with a focus on novel material designs and compositions to combat the environment-specific challenges of GI injury. We conclude with a discussion of potential opportunities from both research and clinical perspectives.
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Affiliation(s)
| | - Mark W. Grinstaff
- Departments of Chemistry and Biomedical Engineering, Boston University, Boston, MA 02215, USA
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15
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Caballero-Herrero MJ, Jumilla E, Buitrago-Ruiz M, Valero-Navarro G, Cuevas S. Role of Damage-Associated Molecular Patterns (DAMPS) in the Postoperative Period after Colorectal Surgery. Int J Mol Sci 2023; 24:ijms24043862. [PMID: 36835273 PMCID: PMC9958549 DOI: 10.3390/ijms24043862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Anastomotic leakage (AL) is a defect of the intestinal wall at the anastomotic site and is one of the most severe complications in colorectal surgery. Previous studies have shown that the immune system response plays a significant role in the development of AL. In recent years, DAMPs (damage-associated molecular patterns) have been identified as cellular compounds with the ability to activate the immune system. The NLRP3 inflammasome plays an important role in the inflammatory responses which are mediated by DAMPs such as ATP, HSP proteins or uric acid crystals, when found in extracellular environments. Recent publications suggest that systemic concentration of DAMPs in patients with colorectal surgery may determine the inflammatory process and have a role in the occurrence of AL and other post-surgery complications. This review provides valuable knowledge about the current evidence supporting this hypothesis and highlights the possible role of these compounds in postoperative processes, which could open a new path to explore new strategies to prevent possible post-surgical complications.
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Affiliation(s)
- María José Caballero-Herrero
- Molecular Inflammation Group, Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120 Murcia, Spain
| | - Esther Jumilla
- Molecular Inflammation Group, Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120 Murcia, Spain
| | - Manuel Buitrago-Ruiz
- General and Digestive System Surgery, Morales Meseguer University Hospital, 30008 Murcia, Spain
| | - Graciela Valero-Navarro
- General and Digestive System Surgery, Morales Meseguer University Hospital, 30008 Murcia, Spain
- Surgical Research in Health Area, Institute of Biosanitary Research Pascual Parrilla (IMIB), Department of Surgery, Pediatrics, Obstetrics and Gynecology, University of Murcia, 30100 Murcia, Spain
- Correspondence: (G.V.-N.); (S.C.); Tel.: +34-968360900 (ext. 2358) (G.V.-N.); +34-868885039 (S.C.)
| | - Santiago Cuevas
- Molecular Inflammation Group, Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120 Murcia, Spain
- Correspondence: (G.V.-N.); (S.C.); Tel.: +34-968360900 (ext. 2358) (G.V.-N.); +34-868885039 (S.C.)
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16
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Gaidarski III AA, Ferrara M. The Colorectal Anastomosis: A Timeless Challenge. Clin Colon Rectal Surg 2022; 36:11-28. [PMID: 36619283 PMCID: PMC9815911 DOI: 10.1055/s-0042-1756510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Colorectal anastomosis is a sophisticated problem that demands an elaborate discussion and an elegant solution. "Those who forget the past are condemned to repeat it." George Santayana, Life of Reason , 1905.
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Affiliation(s)
| | - Marco Ferrara
- Colon and Rectal Clinic of Orlando, Orlando, Florida,Address for correspondence Marco Ferrara, MD Colon and Rectal Clinic of Orlando110 West Underwood ST, Suite A, Orlando, FL 32806
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17
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Zhong X, Xie X, Hu H, Li Y, Tian S, Qian Q, Jiang C, Ren X. Trans-Anastomotic Drainage Tube Placement After Hand-Sewn Anastomosis in Patients Undergoing Intersphincteric Resection for Low Rectal Cancer: An Alternative Drainage Method. Front Oncol 2022; 12:872120. [PMID: 35965574 PMCID: PMC9365931 DOI: 10.3389/fonc.2022.872120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022] Open
Abstract
Anastomotic leakage (AL) is a common complication after intersphincteric resection (ISR). It significantly reduces quality of life and causes great distress to patients. Although traditional drainage (e.g., anal and pelvic catheters) may reduce the impact of AL to some extent, their role in reducing the incidence of AL remains controversial. In this study, we developed a novel drainage technique involving the placement of drainage tubes through the gap between sutures during handsewn anastomosis, to reduce the occurrence of anastomotic leakage. We retrospectively analyzed 34 consecutive patients who underwent intersphincteric resection requiring handsewn anastomosis between February 1, 2017, and January 1, 2021. Patients were classified into the trans-anastomotic drainage tube group (TADT, n = 14) and the non-TADT group (n = 20) based on whether trans-anastomotic tube placement was performed. The incidence of postoperative complications, such as AL, was compared between the two groups, and anal function of patients at 1-year post-ISR was evaluated. Six cases of AL occurred in the non-TADT group, while none occurred in the TADT group; this difference was statistically significant (p=0.031). The TADT group also had a shorter hospital stay (p=0.007). There were no other significant intergroup differences in operation time, blood loss, pain score, anastomotic stenosis, intestinal obstruction, or incidence of wound infection. In the 30 patients (88.2%) evaluated for anal function, there were no significant intergroup differences in stool frequency, urgency, daytime/nocturnal soiling, Wexner incontinence score, or Kirwan grading. Taken together, trans-anastomotic tube placement is a novel drainage method that may reduce AL after ISR requiring handsewn anastomosis and without adversely affecting anal function.
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Affiliation(s)
- Xinjian Zhong
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, China
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Xiaoyu Xie
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, China
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Hang Hu
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, China
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Yi Li
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, China
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Shunhua Tian
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, China
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Qun Qian
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, China
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Congqing Jiang
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, China
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, China
- *Correspondence: Congqing Jiang, ; Xianghai Ren,
| | - Xianghai Ren
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Key Laboratory of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
- Colorectal and Anal Disease Research Center, Medical School of Wuhan University, Wuhan, China
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, China
- *Correspondence: Congqing Jiang, ; Xianghai Ren,
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18
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Kryzauskas M, Bausys A, Dulskas A, Imbrasaite U, Danys D, Jotautas V, Stratilatovas E, Strupas K, Poskus E, Poskus T. Comprehensive testing of colorectal anastomosis: results of prospective observational cohort study. Surg Endosc 2022; 36:6194-6204. [PMID: 35146557 DOI: 10.1007/s00464-022-09093-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anastomotic leakage remains one of the most threatening complications in colorectal surgery. Intraoperative testing of anastomosis may reduce the postoperative anastomotic leakage rates. This study aimed to investigate a novel comprehensive intraoperative colorectal anastomosis testing technique to detect the failure of the anastomosis construction and to reduce the risk of postoperative leak. METHODS This multi-centre prospective cohort pilot study included 60 patients who underwent colorectal resection with an anastomosis at or below 15 cm from the anal verge. Comprehensive trimodal testing consisted of indocyanine green fluorescence angiography, tension testing, air-leak, and methylene blue leak tests to evaluate the perfusion, tension, and mechanical integrity of the anastomosis. RESULTS Ten (16.7%) patients developed an anastomotic leakage. Trimodal test was positive in 16 (26.6%) patients and the operative plan was changed for all of them. Diverting ileostomy was performed in 14 (87.5%) patients. However, two (12.5%) patients still developed clinically significant anastomotic leakage (Grade B). Forty-four (73.4%) patients had a negative trimodal test, preventive ileostomy was performed in 19 (43.2%), and five (11.4%) patients had clinically significant anastomotic leakage (Grade B and C). CONCLUSION Trimodal testing identifies anastomoses with initial technical failure where reinforcement of anastomosis or diversion can lead to an acceptable rate of anastomotic leakage. Identification of well-performed anastomosis could allow a reduction of ileostomy rate by two-fold. However, anastomotic leakage rate remains high in technically well-performed anastomoses.
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Affiliation(s)
- Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str., 03101, Vilnius, Lithuania.
| | - Augustinas Bausys
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str., 03101, Vilnius, Lithuania
| | | | | | - Donatas Danys
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Valdemaras Jotautas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str., 03101, Vilnius, Lithuania
| | | | - Kestutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str., 03101, Vilnius, Lithuania
| | - Eligijus Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str., 03101, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str., 03101, Vilnius, Lithuania
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19
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Biondi A, Di Mauro G, Morici R, Sangiorgio G, Vacante M, Basile F. Intracorporeal versus Extracorporeal Anastomosis for Laparoscopic Right Hemicolectomy: Short-Term Outcomes. J Clin Med 2021; 10:jcm10245967. [PMID: 34945264 PMCID: PMC8705171 DOI: 10.3390/jcm10245967] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Laparoscopic right hemicolectomy represents an effective therapeutic approach for right colon cancer (RCC). The primary aim of this study was to evaluate bowel function recovery, length of hospital stay, operative time, and the number of general and anastomosis-related postoperative complications from intracorporeal anastomosis (ICA) vs. extracorporeal anastomosis (ECA); the secondary outcome was the number of lymph nodes retrieved. This observational study was conducted on 108 patients who underwent right hemicolectomy for RCC; after surgical resection, 64 patients underwent ICA and 44 underwent ECA. The operative time was slightly longer in the ICA group than in the ECA group, even though the difference was not significant (199.31 ± 48.90 min vs. 183.64 ± 35.80 min; p = 0.109). The length of hospital stay (7.53 ± 1.91 days vs. 8.77 ± 3.66 days; p = 0.036) and bowel function recovery (2.21 ± 1.01 days vs. 3.45 ± 1.82 days; p < 0.0001) were significantly lower in the ICA group. There were no significant differences in postoperative complications (12% in ICA group vs. 9% in ECA group), wound infection (6% in ICA group vs. 7% in ECA group), or anastomotic leakage (6% in ICA group vs. 9% in ECA group). We did not observe a significant difference between the two groups in the number of lymph nodes collected (19.46 ± 7.06 in ICA group vs. 22.68 ± 8.79 in ECA group; p = 0.086). ICA following laparoscopic right hemicolectomy, compared to ECA, could lead to a significant improvement in bowel function recovery and a reduction in the length of hospital stay in RCC patients.
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Affiliation(s)
- Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.M.); (G.S.); (F.B.)
| | - Gianluca Di Mauro
- Unit of General Surgery, University Hospital Policlinico-San Marco, 95123 Catania, Italy;
| | - Riccardo Morici
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.M.); (G.S.); (F.B.)
| | - Giuseppe Sangiorgio
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.M.); (G.S.); (F.B.)
| | - Marco Vacante
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.M.); (G.S.); (F.B.)
- Correspondence:
| | - Francesco Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.M.); (G.S.); (F.B.)
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Morimoto M, Taniguchi K, Yamamoto O, Naka T, Sugitani A, Fujiwara Y. Preoperative white blood cell count predicts anastomotic leakage in patients with left-sided colorectal cancer. PLoS One 2021; 16:e0258713. [PMID: 34669737 PMCID: PMC8528338 DOI: 10.1371/journal.pone.0258713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/04/2021] [Indexed: 01/09/2023] Open
Abstract
To determine whether preoperative white blood cell (WBC) counts reflect risk of anastomotic leak (AL) for patients with colorectal cancer (CRC), we retrospectively examined data from records of 208 consecutive patients who had undergone resections for left-sided CRC, including their clinicopathological parameters and preoperative laboratory data. The diagnostic value of WBC count for AL was evaluated and compared with those of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio and platelet count × C-reactive protein level multiplier (P-CRP) value; optimal cut-off values were derived from receiver operating characteristic curves. AL was observed in 11 of the 208 patients (5.3%). Compared with the no-AL group, the AL group had a significantly higher mean WBC count and smoking rate. In multivariate analysis, WBC count and smoking were independent risk factors for AL. Compared with the other tested inflammatory indicators, the cut-off value for WBC (6,200/μL) had the highest sensitivity (81.8%) and negative predictive value (98.4%), as well as the lowest likelihood ratio (0.289). Preoperative WBC count could therefore be a convenient predictor of AL in patients with left-sided CRC.
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Affiliation(s)
- Masaki Morimoto
- National Hospital Organization, Yonago Medical Center, Yonago, Japan
- Faculty of Medicine, Division of Gastrointestinal Surgery, Department of Surgery, Tottori University, Yonago, Japan
| | - Kenjiro Taniguchi
- National Hospital Organization, Yonago Medical Center, Yonago, Japan
| | - Osamu Yamamoto
- National Hospital Organization, Yonago Medical Center, Yonago, Japan
| | - Takuji Naka
- National Hospital Organization, Yonago Medical Center, Yonago, Japan
| | - Atsushi Sugitani
- National Hospital Organization, Yonago Medical Center, Yonago, Japan
| | - Yoshiyuki Fujiwara
- Faculty of Medicine, Division of Gastrointestinal Surgery, Department of Surgery, Tottori University, Yonago, Japan
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21
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Carboni F, Valle M. Letter to Baeza-Murcia M et al. 'Early diagnosis of anastomotic leakage in colorectal surgery: prospective observational study of the utility of inflammatory markers and determination of pathological levels". Updates Surg 2021; 74:789-790. [PMID: 34596835 DOI: 10.1007/s13304-021-01184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Fabio Carboni
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy.
| | - Mario Valle
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy
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22
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Abstract
Background In the last two decades, there has been a Copernican revolution in the decision-making for the treatment of Diverticular Disease. Purpose This article provides a report on the state-of-the-art of surgery for sigmoid diverticulitis. Conclusion Acute diverticulitis is the most common reason for colonic resection after cancer; in the last decade, the indication for surgical resection has become more and more infrequent also in emergency. Currently, emergency surgery is seldom indicated, mostly for severe abdominal infective complications. Nowadays, uncomplicated diverticulitis is the most frequent presentation of diverticular disease and it is usually approached with a conservative medical treatment. Non-Operative Management may be considered also for complicated diverticulitis with abdominal abscess. At present, there is consensus among experts that the hemodynamic response to the initial fluid resuscitation should guide the emergency surgical approach to patients with severe sepsis or septic shock. In hemodynamically stable patients, a laparoscopic approach is the first choice, and surgeons with advanced laparoscopic skills report advantages in terms of lower postoperative complication rates. At the moment, the so-called Hartmann’s procedure is only indicated in severe generalized peritonitis with metabolic derangement or in severely ill patients. Some authors suggested laparoscopic peritoneal lavage as a bridge to surgery or also as a definitive treatment without colonic resection in selected patients. In case of hemodynamic instability not responding to fluid resuscitation, an initial damage control surgery seems to be more attractive than a Hartmann’s procedure, and it is associated with a high rate of primary anastomosis.
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