Purpura rheumatoid, also known as Henoch-Schönlein syndrome (HSP) is a small vessels vasculitis associated with immune complex deposits of IgA. Altough it predominantly affects children, it can occur at any age. Gastrointestinal symptoms are frequent, but varying according to clinical series, and may include pain, diarrhea and bleeding. We report the case of a 64-year-old woman who had a relapse of her rheumatoid purpura presenting with terminal ileitis that resulted in an occlusion.
{"title":"Rheumatoid purpura and gastrointestinal obstruction","authors":"Florian Martinet-Kosinski , Ophélie Bacoeur-Ouzillou , Géraud Galvaing , Johan Gagnière","doi":"10.1016/j.soda.2024.100187","DOIUrl":"10.1016/j.soda.2024.100187","url":null,"abstract":"<div><div>Purpura rheumatoid, also known as Henoch-Schönlein syndrome (HSP) is a small vessels vasculitis associated with immune complex deposits of IgA. Altough it predominantly affects children, it can occur at any age. Gastrointestinal symptoms are frequent, but varying according to clinical series, and may include pain, diarrhea and bleeding. We report the case of a 64-year-old woman who had a relapse of her rheumatoid purpura presenting with terminal ileitis that resulted in an occlusion.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"17 ","pages":"Article 100187"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-25DOI: 10.1016/j.soda.2024.100188
Clément Louis-Gaubert, Bastien Le Floc'h, Heithem Jeddou
{"title":"Main surgical steps of right posterior sectionectomy (with video)","authors":"Clément Louis-Gaubert, Bastien Le Floc'h, Heithem Jeddou","doi":"10.1016/j.soda.2024.100188","DOIUrl":"10.1016/j.soda.2024.100188","url":null,"abstract":"","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"17 ","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1016/j.soda.2024.100185
Omar Gutierrez Moreno, Nicolas Arredondo Mora, Oscar Rincon Barbosa, Francisco Gil Quintero
Background
Bowel obstruction caused by adhesion syndrome is a prevalent condition in emergency departments, presenting significant economic and morbidity challenges. While nonsurgical approaches succeed in 70–90% of cases, surgery becomes necessary for nonresponsive patients. This study aims to identify predictors of non-operative management failure in patients with bowel obstruction upon emergency room admission.
Methods
A retrospective cross-sectional analytical study was conducted from 2015 to 2022 at Hospital Militar Central, focusing on patients with bowel obstruction secondary to adhesion syndrome. Comparative analysis of medical and surgical histories and admission laboratory values aimed to identify possibles factors associated with non-operative management failure and subsequent surgical intervention.
Results
Among 354 patients with bowel obstruction, 130 met inclusion criteria, of whom 98 responded to non-operative treatment and 32 experienced treatment failure. Significant differences were found between groups, including age (p: 0.035), history of two or more abdominal surgeries (10.2% vs. 25%, p: 0.01), appendectomy (17% vs. 37%, p: 0.01), previous surgical intervention for bowel obstruction (22.5% vs. 9.38%, p: 0.008), and hospital stay duration (4.26 vs. 13.2 days, p: 0.001). In multivariate analysis using Poisson regression, age had a prevalence ratio (PR) of 1.01 [95% CI (1.00; 1.02), p < 0.04] for non-operative management failure, the history of peritonitis had a PR of 3.83 [95% CI (2.34; 6.26), p < 0.001], while each unit increase in lactate showed a PR increase of 1.24 [95% CI (0.99; 1.57), p 0.05].
Conclusion
Age, history of peritonitis, and elevated lactate values upon emergency room admission are predictive factors for non-operative management failure in bowel obstruction in the population studied.
{"title":"Associated factors with nonoperative management failure in bowel obstruction","authors":"Omar Gutierrez Moreno, Nicolas Arredondo Mora, Oscar Rincon Barbosa, Francisco Gil Quintero","doi":"10.1016/j.soda.2024.100185","DOIUrl":"10.1016/j.soda.2024.100185","url":null,"abstract":"<div><h3>Background</h3><div>Bowel obstruction caused by adhesion syndrome is a prevalent condition in emergency departments, presenting significant economic and morbidity challenges. While nonsurgical approaches succeed in 70–90% of cases, surgery becomes necessary for nonresponsive patients. This study aims to identify predictors of non-operative management failure in patients with bowel obstruction upon emergency room admission.</div></div><div><h3>Methods</h3><div>A retrospective cross-sectional analytical study was conducted from 2015 to 2022 at Hospital Militar Central, focusing on patients with bowel obstruction secondary to adhesion syndrome. Comparative analysis of medical and surgical histories and admission laboratory values aimed to identify possibles factors associated with non-operative management failure and subsequent surgical intervention.</div></div><div><h3>Results</h3><div>Among 354 patients with bowel obstruction, 130 met inclusion criteria, of whom 98 responded to non-operative treatment and 32 experienced treatment failure. Significant differences were found between groups, including age (p: 0.035), history of two or more abdominal surgeries (10.2% vs. 25%, p: 0.01), appendectomy (17% vs. 37%, p: 0.01), previous surgical intervention for bowel obstruction (22.5% vs. 9.38%, p: 0.008), and hospital stay duration (4.26 vs. 13.2 days, p: 0.001). In multivariate analysis using Poisson regression, age had a prevalence ratio (PR) of 1.01 [95% CI (1.00; 1.02), <em>p</em> < 0.04] for non-operative management failure, the history of peritonitis had a PR of 3.83 [95% CI (2.34; 6.26), <em>p</em> < 0.001], while each unit increase in lactate showed a PR increase of 1.24 [95% CI (0.99; 1.57), p 0.05].</div></div><div><h3>Conclusion</h3><div>Age, history of peritonitis, and elevated lactate values upon emergency room admission are predictive factors for non-operative management failure in bowel obstruction in the population studied.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"16 ","pages":"Article 100185"},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1016/j.soda.2024.100183
Hermann Kessler, Scott R. Steele, Lukas Schabl
Background
Total mesorectal excision, involves the resection of an intact tumor specimen with its full lymphatic drainage and blood supply within a predefined plane. This technique resulted in significantly better oncological outcomes in rectal cancer surgery. Hohenberger described the Complete Mesocolic Excision, comprising sharp dissection of the mesocolic visceral plane avoiding tumor spread within the peritoneal cavity. Several studies have since demonstrated superior long-term oncological outcomes in colon carcinoma.
Case Presentation
A 22-year-old woman with Crohn's disease since the age of 4 years presented with several nodules along the entire colon on colonoscopy. Biopsies evidenced high grade dysplasia in the rectum and a carcinoma in the sigmoid colon. Preoperatively, no distant metastases were found. Laparoscopic proctocolectomy with Complete Mesocolic and Total Mesorectal Excision was performed. Multiple foci of carcinoma were identified and a yield of 312 lymph nodes, 102 positive, was achieved.
Results
This video shows a systematic approach to laparoscopic proctocolectomy with simultaneous with Complete Mesocolic and Total Mesorectal Excision, which includes medial to lateral colon mobilization, central vascular tie and lymph node dissection, with accurate dissection of the complete mesocolon leaving its surfaces intact. The same principles were used distally in continuing the dissection around the mesorectum.
Conclusion
Proctocolectomy with Complete Mesocolic and Total Mesorectal Excision combines two gold standard techniques in the surgical treatment of colon and rectal cancer. Both techniques have been shown to benefit patients with improved oncologic outcomes. The technique demonstrated here could become the standard oncologic procedure for patients with synchronous colon and rectal cancers.
{"title":"Laparoscopic proctocolectomy in Crohn's disease with complete mesocolic excision and total mesorectal excision","authors":"Hermann Kessler, Scott R. Steele, Lukas Schabl","doi":"10.1016/j.soda.2024.100183","DOIUrl":"10.1016/j.soda.2024.100183","url":null,"abstract":"<div><h3>Background</h3><div>Total mesorectal excision, involves the resection of an intact tumor specimen with its full lymphatic drainage and blood supply within a predefined plane. This technique resulted in significantly better oncological outcomes in rectal cancer surgery. Hohenberger described the Complete Mesocolic Excision, comprising sharp dissection of the mesocolic visceral plane avoiding tumor spread within the peritoneal cavity. Several studies have since demonstrated superior long-term oncological outcomes in colon carcinoma.</div></div><div><h3>Case Presentation</h3><div>A 22-year-old woman with Crohn's disease since the age of 4 years presented with several nodules along the entire colon on colonoscopy. Biopsies evidenced high grade dysplasia in the rectum and a carcinoma in the sigmoid colon. Preoperatively, no distant metastases were found. Laparoscopic proctocolectomy with Complete Mesocolic and Total Mesorectal Excision was performed. Multiple foci of carcinoma were identified and a yield of 312 lymph nodes, 102 positive, was achieved.</div></div><div><h3>Results</h3><div>This video shows a systematic approach to laparoscopic proctocolectomy with simultaneous with Complete Mesocolic and Total Mesorectal Excision, which includes medial to lateral colon mobilization, central vascular tie and lymph node dissection, with accurate dissection of the complete mesocolon leaving its surfaces intact. The same principles were used distally in continuing the dissection around the mesorectum.</div></div><div><h3>Conclusion</h3><div>Proctocolectomy with Complete Mesocolic and Total Mesorectal Excision combines two gold standard techniques in the surgical treatment of colon and rectal cancer. Both techniques have been shown to benefit patients with improved oncologic outcomes. The technique demonstrated here could become the standard oncologic procedure for patients with synchronous colon and rectal cancers.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"16 ","pages":"Article 100183"},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.soda.2024.100186
Valentine Martin , Délia Berrada , Antoine Duclos , Stéphanie Polazzi , Jean-Yves Mabrut , Olivier Monneuse , Mustapha Adham , Olivier Glehen , Eddy Cotte , Guillaume Passot , Société de Chirurgie de Lyon*
Background
Intestinal obstruction is one of the most frequent emergencies in gastrointestinal surgery and can concern patients of all ages and be life threatening. Postoperative mortality is reported to be higher in elderly patients, but there is currently no published study encompassing all patients regardless of their treatment. The aim of the present study was to compare outcomes between older and younger patients deceased after all kind bowel obstruction treated surgically or not.
Methods
We retrospectively included all consecutive patients declared dead following bowel obstruction, from 2007 to 2020, in 3 University hospital in Lyon, France. Patients were classified according to age, <75 and ≥75 years based on the definition of elderly patients of the French Haute Autorité de Santé. Patient's selection was made with the hospital discharge database and medical records were collected from the local electronic database.
Results
A total of 222 patients were included; 130 patients were aged ≥75 years and 92 < 75 years. Most patients did not show signs of severity at admission. Patients ≥75 years had a higher rate of death by acute respiratory distress (p = 0.02), while there is a trend to a higher frequency of death by general deterioration in a context of advanced cancer in the younger group (p = 0.06).
Conclusion
Intra-hospital death after bowel obstruction concerns patients of all ages, treated surgically or not. Elderly patients die from respiratory complications, and younger ones die from general deterioration in context of cancer. Most deceased patients did not show signs of severity at admission.
{"title":"Comparision of attributes between young and old patients who died in hospital after bowel obstruction: A multicenter retrospective cohort study","authors":"Valentine Martin , Délia Berrada , Antoine Duclos , Stéphanie Polazzi , Jean-Yves Mabrut , Olivier Monneuse , Mustapha Adham , Olivier Glehen , Eddy Cotte , Guillaume Passot , Société de Chirurgie de Lyon*","doi":"10.1016/j.soda.2024.100186","DOIUrl":"10.1016/j.soda.2024.100186","url":null,"abstract":"<div><h3>Background</h3><div>Intestinal obstruction is one of the most frequent emergencies in gastrointestinal surgery and can concern patients of all ages and be life threatening. Postoperative mortality is reported to be higher in elderly patients, but there is currently no published study encompassing all patients regardless of their treatment. The aim of the present study was to compare outcomes between older and younger patients deceased after all kind bowel obstruction treated surgically or not.</div></div><div><h3>Methods</h3><div>We retrospectively included all consecutive patients declared dead following bowel obstruction, from 2007 to 2020, in 3 University hospital in Lyon, France. Patients were classified according to age, <75 and ≥75 years based on the definition of elderly patients of the French Haute Autorité de Santé. Patient's selection was made with the hospital discharge database and medical records were collected from the local electronic database.</div></div><div><h3>Results</h3><div>A total of 222 patients were included; 130 patients were aged ≥75 years and 92 < 75 years. Most patients did not show signs of severity at admission. Patients ≥75 years had a higher rate of death by acute respiratory distress (<em>p</em> = 0.02), while there is a trend to a higher frequency of death by general deterioration in a context of advanced cancer in the younger group (<em>p</em> = 0.06).</div></div><div><h3>Conclusion</h3><div>Intra-hospital death after bowel obstruction concerns patients of all ages, treated surgically or not. Elderly patients die from respiratory complications, and younger ones die from general deterioration in context of cancer. Most deceased patients did not show signs of severity at admission.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"16 ","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.soda.2024.100184
Mohammad Rida Farhat , Mariam Hijazi , Zahraa H. Moussawi , Fatima EL Hayek , Francesco Chio
Background
There exist multiple complications related to laparoscopic cholecystectomy, whether the procedure or the technique adopted. Portal vein thrombosis (PVT) is a rare complication observed in several procedures and exceptionally rare following laparoscopic cholecystectomy.
Case presentation
a 35-year-old lady on oral contraceptives for 15 years presented to the emergency department 5 days post uneventful laparoscopic cholecystectomy with epigastric pain and tenderness. She was found to have proximal portal vein thrombosis on computed tomography. The patient was treated with weight-based therapeutic low molecular weight heparin. Symptoms resolved and she was discharged on direct oral anticoagulant for 3 months. A repeated scan showed recanalization of the portal vein.
Conclusion
PVT is a rare complication post laparoscopic cholecystectomy, though it should be one of the differential diagnosis for a patient presenting with abdominal symptoms post-surgery, even without having associated risk factors. A high index of suspicion should be maintained and if confirmed, investigations for risk factors are crucial for the appropriate management.
{"title":"Portal vein thrombosis after laparoscopic cholecystectomy","authors":"Mohammad Rida Farhat , Mariam Hijazi , Zahraa H. Moussawi , Fatima EL Hayek , Francesco Chio","doi":"10.1016/j.soda.2024.100184","DOIUrl":"10.1016/j.soda.2024.100184","url":null,"abstract":"<div><h3>Background</h3><div>There exist multiple complications related to laparoscopic cholecystectomy, whether the procedure or the technique adopted. Portal vein thrombosis (PVT) is a rare complication observed in several procedures and exceptionally rare following laparoscopic cholecystectomy.</div></div><div><h3>Case presentation</h3><div>a 35-year-old lady on oral contraceptives for 15 years presented to the emergency department 5 days post uneventful laparoscopic cholecystectomy with epigastric pain and tenderness. She was found to have proximal portal vein thrombosis on computed tomography. The patient was treated with weight-based therapeutic low molecular weight heparin. Symptoms resolved and she was discharged on direct oral anticoagulant for 3 months. A repeated scan showed recanalization of the portal vein.</div></div><div><h3>Conclusion</h3><div>PVT is a rare complication post laparoscopic cholecystectomy, though it should be one of the differential diagnosis for a patient presenting with abdominal symptoms post-surgery, even without having associated risk factors. A high index of suspicion should be maintained and if confirmed, investigations for risk factors are crucial for the appropriate management.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"16 ","pages":"Article 100184"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21DOI: 10.1016/j.soda.2024.100180
Robin Glorieux , Edward Willems , Marc Miserez
Laparoscopic aortobifemoral bypass surgery is a frequently performed procedure for occlusive arterial disease. Gastrointestinal complications such as paralytic ileus are common. However, internal hernia is a rare complication and the treatment can be technically difficult.
We present the case of a 62-year-old male patient presenting at the emergency department with clinical signs of intestinal obstruction: abdominal distension and pain, vomiting and absence of flatus and stools. Four years prior he had a laparoscopic aortobifemoral bypass in the treatment of occlusive arterial disease. CT scan showed a closed loop obstruction of small intestine. An urgent laparoscopy was planned. On exploration, an internal herniation of the small intestine was found through an opening below the right iliac branch of the aortobifemoral graft, creating a closed loop obstruction. The bowel was reduced. As there was no option to close the opening with a peritoneal flap, an omentoplasty was performed occluding the opening to prevent recurrence.
Internal hernia underneath the vascular graft of an aortobifemoral bypass is very rare. To our knowledge only one case has been described in the current available literature, this was treated with a peritoneal flap. Closing the defect can be technically difficult, especially when it is not possible to create a peritoneal flap, in our case this was not possible because the bypass surgery was 4 years prior. Omentoplasty can be an efficient and durable surgical solution to this problem.
{"title":"Internal hernia of small bowel after laparoscopic aortobifemoral bypass surgery treated with omentoplasty: A case report with video","authors":"Robin Glorieux , Edward Willems , Marc Miserez","doi":"10.1016/j.soda.2024.100180","DOIUrl":"10.1016/j.soda.2024.100180","url":null,"abstract":"<div><div>Laparoscopic aortobifemoral bypass surgery is a frequently performed procedure for occlusive arterial disease. Gastrointestinal complications such as paralytic ileus are common. However, internal hernia is a rare complication and the treatment can be technically difficult.</div><div>We present the case of a 62-year-old male patient presenting at the emergency department with clinical signs of intestinal obstruction: abdominal distension and pain, vomiting and absence of flatus and stools. Four years prior he had a laparoscopic aortobifemoral bypass in the treatment of occlusive arterial disease. CT scan showed a closed loop obstruction of small intestine. An urgent laparoscopy was planned. On exploration, an internal herniation of the small intestine was found through an opening below the right iliac branch of the aortobifemoral graft, creating a closed loop obstruction. The bowel was reduced. As there was no option to close the opening with a peritoneal flap, an omentoplasty was performed occluding the opening to prevent recurrence.</div><div>Internal hernia underneath the vascular graft of an aortobifemoral bypass is very rare. To our knowledge only one case has been described in the current available literature, this was treated with a peritoneal flap. Closing the defect can be technically difficult, especially when it is not possible to create a peritoneal flap, in our case this was not possible because the bypass surgery was 4 years prior. Omentoplasty can be an efficient and durable surgical solution to this problem.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"16 ","pages":"Article 100180"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21DOI: 10.1016/j.soda.2024.100151
Francesco Roscio, Eleonora Monti, Federico Clerici, Francesco Maria Carrano, Ildo Scandroglio
Background
The aim of the study is to evaluate the effectiveness of REctal Anastomotic Leak (REAL) score for predicting the risk of anastomotic leakage in patients undergoing laparoscopic anterior rectal resection with total mesorectal excision (lapARR-TME) for rectal cancer.
Methods
This prospective study collected data on patients' medical history, surgery, hospital stay, and short-term outcome. We calculated the REAL score for each patient and statistically compared those who experienced an anastomotic leak to those who did not. Additionally, we conducted a univariate and multivariate analysis on other factors that may have influenced outcomes.
Results
The study included 57 patients with a mean age of 70 years and a Charlson Comorbidity Index of 6.1 ± 1.9. 57.9% of patients had a loop ileostomy fashioned and Indocyanine green (ICG) angiography was used during surgery in 53.3% of cases. There were 6 cases of anastomotic leakage, with 4 treated surgically and 2 conservatively. Patients with anastomotic leak had a significantly higher REAL score than those without (71.3 ± 20.5 vs. 33.7 ± 21.3). The 30-day readmission and mortality rates were 5.3% and 0%, respectively. Low preoperative serum albumin levels, preoperative blood transfusions, and the absence of ICG angiography during surgery were factors significantly associated with an increased risk of anastomotic leakage according to both univariate and multivariate analyses.
Conclusions
The REAL score may be a helpful tool for evaluating the risk of anastomotic leak in patients undergoing lapARR-TME. Further investigation is needed to evaluate the incorporation of additional modifiable factors such as hypoalbuminemia, preoperative transfusion rate, and the use of ICG angiography during surgery.
{"title":"Improving outcomes in laparoscopic anterior rectal resection: The benefits of REAL score in preoperative risk assessment for anastomotic leak","authors":"Francesco Roscio, Eleonora Monti, Federico Clerici, Francesco Maria Carrano, Ildo Scandroglio","doi":"10.1016/j.soda.2024.100151","DOIUrl":"10.1016/j.soda.2024.100151","url":null,"abstract":"<div><h3>Background</h3><div>The aim of the study is to evaluate the effectiveness of REctal Anastomotic Leak (REAL) score for predicting the risk of anastomotic leakage in patients undergoing laparoscopic anterior rectal resection with total mesorectal excision (lapARR-TME) for rectal cancer.</div></div><div><h3>Methods</h3><div>This prospective study collected data on patients' medical history, surgery, hospital stay, and short-term outcome. We calculated the REAL score for each patient and statistically compared those who experienced an anastomotic leak to those who did not. Additionally, we conducted a univariate and multivariate analysis on other factors that may have influenced outcomes.</div></div><div><h3>Results</h3><div>The study included 57 patients with a mean age of 70 years and a Charlson Comorbidity Index of 6.1 ± 1.9. 57.9% of patients had a loop ileostomy fashioned and Indocyanine green (ICG) angiography was used during surgery in 53.3% of cases. There were 6 cases of anastomotic leakage, with 4 treated surgically and 2 conservatively. Patients with anastomotic leak had a significantly higher REAL score than those without (71.3 ± 20.5 vs. 33.7 ± 21.3). The 30-day readmission and mortality rates were 5.3% and 0%, respectively. Low preoperative serum albumin levels, preoperative blood transfusions, and the absence of ICG angiography during surgery were factors significantly associated with an increased risk of anastomotic leakage according to both univariate and multivariate analyses.</div></div><div><h3>Conclusions</h3><div>The REAL score may be a helpful tool for evaluating the risk of anastomotic leak in patients undergoing lapARR-TME. Further investigation is needed to evaluate the incorporation of additional modifiable factors such as hypoalbuminemia, preoperative transfusion rate, and the use of ICG angiography during surgery.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"16 ","pages":"Article 100151"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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