Small Bowel Anastomosis Research Articles

062. Satisfying Outcome of 24-Hours Post Operation Feeding Following Bowel Anastomosis Surgery: A Systematic Review and Meta-Analysis

Background: Gastrointestinal anastomosis surgery does not have standardized postoperative feeding practices. The majority of surgeons used to believe that early enteral feeding (EEF) after bowel resection and anastomosis could be harmful and cause stress on the anastomosis site, increasing the risk of leakage. This study compared EEF patients whose nutrition started for the first 24 hours with delayed enteral feedings (DEF) during bowel anastomosis surgery Case: This systematic review and meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. All extracted data was presented in the table, summarized narratively, and analyzed statistically using forest plots through a relative risk (RR) with a fixed effect model test. Results: This research included 444 participants from 6 studies, including 196 in the EEF group and 248 in the DEF group. From the analysis, the incidence of leakage, gastrointestinal symptoms of abdominal distention and vomiting, fever, and surgical site infection (SSI) were lower in the EEF group although not significant, with statistical values in order namely; leakage (RR 0.39, p=0.10); abdominal distention (RR 0.67, p=0.11), vomiting (RR 0.88, p=0.53); fever (RR 0.61, p=0.005) and SSI (RR 0.42; p=0.002). Length of stay (LOS) was found to be statistically significant shortened in the EEF group (Mean Difference 2.23 days; P < 0.00001). Conclusion: The EEF group had a statistically insignificant lower incidence of leakage, gastrointestinal symptoms, fever, and SSI and statistically significant shorter LOS. Twenty-four hours post-operation enteral feeding showed a satisfactory outcome, so we recommend it in either small or large bowel anastomosis surgery.

807 Reliability of Simulation-Based Assessment of Surgical Technical Skills

Abstract Aim To examine the reliability of surgical trainees’ assessment data from a structured simulation training and assessment programme. Method The General Surgical Skills Programme is a simulation-based surgical training programme integrated within the clinical training pathway for surgical trainees across London. It is tailored to each trainee’s level of training and subspecialty. The ‘Junior’ pathway involves nine training sessions and one assessment session performing three procedures (Inguinal hernia [IH], laparoscopic cholecystectomy [LC] and small bowel anastomoses [SBA]). Within the scope of the Programme, skills assessment data collection was initiated in 2012. Data collected includes demographics and training data (grade/subspecialty/case numbers). Each procedure is assessed by two consultant surgeons using two procedure specific assessment tools, a visual analogue scale (VAS) and competency assessment tool (CAT). Reliability analyses were performed using SPSS for ‘Junior’ data over a four-year period. Results In total, 355 surgical trainees (Male = 199, Female = 154, Missing = 2) were assessed from 2014 to 2017 (2014 n=105; 2015 n=92; 2016 n=89; 2017 n=69). Both assessment tools showed satisfactory inter-item reliability (IH-CAT α=.794-.903, LC-CAT α=.837–910, IH-VAS α=.851-.991, LC-VAS α=.831-.986, SBA-VAS α=.778-.984). Inter-rater reliability, ICC (1,2), was good to poor across all tools. (IH-CAT .345-.510, IH-VAS .243-.600, LC-CAT .271-.766, LC-VAS .157-.678, SBA-VAS .225-.278). Conclusions The assessment tools used within the Programme both demonstrate satisfactory inter-item reliability. Inter-rater reliability is variable, highlighting a potential utility for assessor training within the Programme.

Educational value of a novel telestration device for surgical coaching-a randomized controlled trial.

Communication is fundamental to effective surgical coaching. This can be challenging for training during image-guided procedures where coaches and trainees need to articulate technical details on a monitor. Telestration devices that annotate on monitors remotely could potentially overcome these limitations and enhance the coaching experience. This study aims to evaluate the value of a novel telestration device in surgical coaching. A randomized-controlled trial was designed. All participants watched a video demonstrating the task followed by a baseline performance assessment and randomization into either control group (conventional verbal coaching without telestration) or telestration group (verbal coaching with telestration). Coaching for a simulated laparoscopic small bowel anastomosis on a dry lab model was done by a faculty surgeon. Following the coaching session, participants underwent a post-coaching performance assessment of the same task. Assessments were recorded and rated by blinded reviewers using a modified Global Rating Scale of the Objective Structured Assessment of Technical Skills (OSATS). Coaching sessions were also recorded and compared in terms of mentoring moments; guidance misinterpretations, questions/clarifications by trainees, and task completion time. A 5-point Likert scale was administered to obtain feedback. Twenty-four residents participated (control group 13, telestration group 11). Improvements in some elements of the OSATS scale were noted in the Telestration arm but there was no statistical significance in the overall score between the two groups. Mentoring moments were more in the telestration Group. Amongst the telestration Group, 55% felt comfortable that they could perform this task independently, compared to only 8% amongst the control group and 82% would recommend the use of telestration tools here. There is demonstrated educational value of this novel telestration device mainly in the non-technical aspects of the interaction by enhancing the coaching experience with improvement in communication and greater mentoring moments between coach and trainee.

Automatic and real-time tissue sensing for autonomous intestinal anastomosis using hybrid MLP-DC-CNN classifier-based optical coherence tomography.

Anastomosis is a common and critical part of reconstructive procedures within gastrointestinal, urologic, and gynecologic surgery. The use of autonomous surgical robots such as the smart tissue autonomous robot (STAR) system demonstrates an improved efficiency and consistency of the laparoscopic small bowel anastomosis over the current da Vinci surgical system. However, the STAR workflow requires auxiliary manual monitoring during the suturing procedure to avoid missed or wrong stitches. To eliminate this monitoring task from the operators, we integrated an optical coherence tomography (OCT) fiber sensor with the suture tool and developed an automatic tissue classification algorithm for detecting missed or wrong stitches in real time. The classification results were updated and sent to the control loop of STAR robot in real time. The suture tool was guided to approach the object by a dual-camera system. If the tissue inside the tool jaw was inconsistent with the desired suture pattern, a warning message would be generated. The proposed hybrid multilayer perceptron dual-channel convolutional neural network (MLP-DC-CNN) classification platform can automatically classify eight different abdominal tissue types that require different suture strategies for anastomosis. In MLP, numerous handcrafted features (∼1955) were utilized including optical properties and morphological features of one-dimensional (1D) OCT A-line signals. In DC-CNN, intensity-based features and depth-resolved tissues' attenuation coefficients were fully exploited. A decision fusion technique was applied to leverage the information collected from both classifiers to further increase the accuracy. The algorithm was evaluated on 69,773 testing A-line data. The results showed that our model can classify the 1D OCT signals of small bowels in real time with an accuracy of 90.06%, a precision of 88.34%, and a sensitivity of 87.29%, respectively. The refresh rate of the displayed A-line signals was set as 300 Hz, the maximum sensing depth of the fiber was 3.6 mm, and the running time of the image processing algorithm was ∼1.56 s for 1,024 A-lines. The proposed fully automated tissue sensing model outperformed the single classifier of CNN, MLP, or SVM with optimized architectures, showing the complementarity of different feature sets and network architectures in classifying intestinal OCT A-line signals. It can potentially reduce the manual involvement of robotic laparoscopic surgery, which is a crucial step towards a fully autonomous STAR system.

Is extereme cytoreductive surgery beneficial to survival ın malignant peritoneal mesothelioma?

Introduction Malign peritoneal mesothelioma (MPM) is an uncommon disease that is difficult to treat. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) are the gold standards for treating MPM. Sometimes extreme cytoreductive surgery (eCRS) is required to achieve complete cytoreduction, which is one of the most important prognostic factors. There is limited information in the literature about the contribution of eCRS in patients with MPM. In this study, we aimed to investigate the impact of eCRS on survival and perioperative outcomes. Methods The Department of Surgical Oncology at Cumhuriyet University database was retrospectively reviewed for MPM patients who underwent CRS-HIPEC between January 2004 and December 2018. Patients who underwent CRS-HIPEC were divided into eCRS and less extensive CRS (leCRS) groups. A resection of ≥5 organs or ≥3 small bowel anastomoses were defined as eCRS. Both groups were compared regarding survival, demographic information, and perioperative outcomes. Results A total of 31 patients were included. eCRS-HIPEC was used in 15 patients. Complete cytoreduction (CC score 0/1) was achieved in all 31 patients. Compared to leCRS, the eCRS group had a longer median length of stay, longer intensive care unit stay, a higher median peritoneal cancer index (PCI), higher intraoperative blood loss, more frequent occurrence of any complication, and a longer operative time (all p values < 0.001). Clavien Dindo 3–4 complications, ASA, and gender were similar in both groups of patients (p > 0.05). It was found that there was no significant difference between the OS of the eCRS and leCRS groups (37.5 vs. 42.8 months, p = 0.895). Conclusions Rates of serious complications and morbidity are similar in patients undergoing eCRS compared to leCRS. In patients with high PCI and multiorgan involvement, complete cytoreduction can be achieved by performing eCRS, and survival results equivalent to those with low PCI can be achieved.

Peritonectomy and resection of mesentery during Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer: A phase I-II trial

ObjectiveTo describe the surgical technique, assess feasibility, efficacy, and safety of peritonectomy and/or resection of mesentery (P-Rme) during Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer (OC). MethodsIn April 2009 we registered a protocol study on the safety and feasibility of P-Rme. In the period April 2009–December 2022, 687 patients with FIGO stage IIIC-IV ovarian cancer underwent VPD. One hundred and twenty-nine patients (18.7%) had extensive disease on the mesentery and underwent P-Rme. Feasibility was assessed as the number of procedures completed. Efficacy was measured as the rate of Complete Resection (CR). Safety was defined by the intra- and post-operative morbidity rate specifically associated with these procedures. ResultsIn all patients P-Rme was successfully completed. P-me was performed in 82 patients and R-me in 47, both procedures in 23 patients. CR was achieved in all 129 patients with an efficacy of 100%. Intra-operatively 5 patients out of 129 experienced small bowel loop surgical devascularization. They required small bowel resection and anastomosis. The procedure specific morbidity was 3.8%. No post-operative complication was related to P-Rme. At 64 months median follow-up, survival outcomes in the study group were similar to patients in the control group. ConclusionOverall, almost 20% of the VPD patients needed P-Rme to obtain a CR. P-Rme was a safe and effective step during VPD. The rate of CR in the study group was 100% achieved thanks to the addition of the P-Rme. No procedure specific post-operative complications occurred but 3.8% of the patients had unplanned additional surgery related to these procedures.

Small bowel anastomosis in emergency surgery.

Emergency laparotomy is associated with a high morbidity and mortality rate. The decision on whether to perform an anastomosis or an enterostomy in emergency small bowel resection is guided by surgeon preference alone, and not evidence based. We examined the risks involved in small bowel resection and anastomosis in emergency surgery. A retrospective study from 2016 to 2019 in a university hospital in Denmark, including all emergency laparotomies, where small-bowel resections, ileocecal resections, right hemicolectomies and extended right hemicolectomies where performed. Demographics, operative data, anastomosis or enterostomy, as well as postoperative complications were recorded. Primary outcome was the rate of bowel anastomosis. Secondary outcomes were the anastomotic leak rate, mortality and complication rates. During the 3.5-year period, 370 patients underwent emergency bowel resection. Of these 313 (84.6%) received an anastomosis and 57 (15.4%) an enterostomy. The 30-day mortality rate was 12.7% (10.2% in patients with anastomosis and 26.3% in patients with enterostomy). The overall anastomotic leak rate was 1.6%, for small-bowel to colon 3.0% and for small-bowel to small-bowel 0.6%. A primary anastomosis is performed in more than eight out of 10 patients in emergency small bowel resections and is associated with a very low rate of anastomotic leak.

BS P01 Case Report: Emergency Laparotomy for Retrograde Intussusception after Roux-en-Y Gastric Bypass

Abstract Background Roux-en-Y gastric bypass (RYGB) is a common operation performed to treat obesity and associated co-morbidities. When done with weight management programs, it is associated with 60% excess weight loss. A rare complication is retrograde intussusception (RI), which can require emergency surgery due to risk of bowel ischaemia and necrosis. We report a case of a 66-year-old female who developed intermittent then acute RI, requiring urgent laparotomy for reduction of the intussusception and small bowel resection of the perforated invaginated segment. Her case is compared to the literature available, and a pathophysiological mechanism aiming to explain post-RYGB RI is proposed. Methods We compare the case of a patient with RI post-RYGB, to the available literature. The literature search was done on PubMed: “retrograde intussusception AND Roux-en-Y”. Results were limited to English language and human species. Paediatric and Maternity journals were excluded. The patient is a 66-year-old female who had a laparoscopic RYGB for obesity in 2018; and lost 106% excess weight. In 2022, she presented with laparoscopic evidence of a resolved intussusception. In 2023, she was re-admitted with CT and laparotomy-confirmed RI and small bowel obstruction at the jejuno-jejunal anastomosis. She was managed with small bowel resection and anastomosis. Results The non-specific clinical presentation of RI makes prompt diagnosis challenging. Usually, patients have abdominal pain and lack peritonism. Severe cases may present with bowel ischaemia, as the intussuscepted segment can have compromised vascularity. Hence, prompt diagnosis and timely management is essential to reduce morbidity and mortality. CT-AP is the diagnostic imaging test of choice, but delay in diagnosis of &amp;gt;48h may increase mortality to 50% due to delayed intervention. The surgical management is emergency surgery with gentle reduction of the intussusception. Resection of the invaginated small bowel segment with anastomosis may be indicated if there is bowel ischaemia. Conclusions We report the case of a patient with RI post-RYGB, with evidence of gut dysmotility prior to intussusception. The literature suggests that dysmotility disorders could underpin RI, as 80% of cases are anti-peristaltic. Obesity has a strong association with slow gastric and intestinal motility, likely due to impaired gut-brain biochemical messaging and altered gut microbiota. RYGB will disrupt these pathways, and we hypothesize that this may lead to further motility dysregulation. However, further research is necessary to provide supporting evidence. Nevertheless, this report provides a helpful reminder to prompt urgent investigation in patients who present with non-specific abdominal pain post-RYGB.

Characterizing the Suture Pullout Force for Human Small Bowel.

Performing a small bowel anastomosis, or reconnecting small bowel segments, remains a core competency and critical step for the successful surgical management of numerous bowel and urinary conditions. As surgical education and technology moves toward improving patient outcomes through automation and increasing training opportunities, a detailed characterization of the interventional biomechanical properties of the human bowel is important. This is especially true due to the prevalence of anastomotic leakage as a frequent (3.02%) postoperative complication of small bowel anastomoses. This study aims to characterize the forces required for a suture to tear through human small bowel (suture pullout force, SPOF), while analyzing how these forces are affected by tissue orientation, suture material, suture size, and donor demographics. 803 tests were performed on 35 human small bowel specimens. A uni-axial test frame was used to tension sutures looped through 10 × 20 mm rectangular bowel samples to tissue failure. The mean SPOF of the small bowel was 4.62±1.40 N. We found no significant effect of tissue orientation (p = 0.083), suture material (p = 0.681), suture size (p = 0.131), age (p = 0.158), sex (p = .083), or body mass index (BMI) (p = 0.100) on SPOF. To our knowledge, this is the first study reporting human small bowel SPOF. Little research has been published about procedure-specific data on human small bowel. Filling this gap in research will inform the design of more accurate human bowel synthetic models and provide an accurate baseline for training and clinical applications.

Intestinal anastomoses in children: Experience of pediatric surgeons in the Russian Federation

BACKGROUND: In pediatric surgery, intestinal anastomosis is a standard and responsible operative method used for all age groups. Although advancements in medical technology have significantly changed and expanded the range of surgical interventions, many questions remain, including the safety of intestinal anastomosis in newborns with significant segment discordance, the use of laparoscopic intestinal sutures, the use of mechanical stitching devices, and intestinal anastomosis in peritonitis.&#x0D; AIM: To determine current problems and future directions in the field of intestinal anastomosis in children in the Russian Federation.&#x0D; MATERIALS AND METHODS: The study is based on data from 4,558 intestinal anastomosis operations, including 1,735 in newborns, provided by the chief pediatric surgeons of 75 constituent entities of the Russian Federation during 20212022, including the Donetsk and Lugansk Peoples Republics. Based on a questionnaire, the data were summarized and statistically processed.&#x0D; RESULTS: The study reports on the results of intestinal anastomosis in children in the Russian Federation across various segments of the intestine and age groups. The risks of failure and re-reconstruction significantly increased when duodenal anastomosis was performed laparoscopically and in settings of peritonitis or a compromised intestinal wall (p 0.05). Conversely, the use of laparoscopy and suturing devices in older children for small intestine anastomosis was carried out practically without complications. However, it was performed twice as often in emergencies and against the background of combined problems. In general, the results of small bowel anastomosis under poor conditions were statistically insignificant from intestinal anastomosis with stoma closure (p 0.05). The data revealed that colon surgery, repeated reconstructions, duodenal anastomoses, and small intestine anastomoses in newborns with poor blood flow to the intestinal wall posed the highest risks of anastomotic failure. Small and large intestine surgery in newborns has the highest mortality rate, particularly with peritonitis and circulatory disorders.&#x0D; CONCLUSIONS: Thus at the current stage of development, intestinal anastomosis in the Russian Federation is characterized by good results, the expansion of indications for anastomosis in conditions of compromised intestine or peritonitis, and the use of laparoscopic techniques and mechanical staplers.

Morphological features of bordering zones with anastomosis during surgical correction of congenital intestinal obstruction

Introduction. Despite the numerous studies carried out to improve the technique for abdominal operations using new suture materials, stitching technologies and various types of intestinal sutures, the failure of intestinal anastomoses sutures remains a serious surgical problem in both adult and pediatric practice. The purpose of our study is a comparative analysis of the healing of the interintestinal fistula using various types of sutures in an experiment on animals (newborn rabbits). Materials and methods. The experiment was performed on 15 newborn rabbits with reproduction of a model of intestinal obstruction at the level of the ileum and the imposition of end-to-end small-intestinal anastomoses and de Lorimier-Harrison plication with interrupted and continuous sutures. 3 groups were formed: the imposition of a plication anastomosis using a single-row continuous suture (group I (n = 5)), an end-to-end anastomosis using a single-row continuous suture (group II (n = 5)), group III (n = 5) - end-to-end anastomosis with a single-row interrupted suture. With the help of modern morphological research methods, the degree of the infiltrative-destructive process in the peri-anastomosed areas has been studied. Results. It was found that when using all types of sutures in the areas surrounding the anastomosis (with an implicit advantage of a continuous suture), similar morphological changes were observed, indicating the remodeling of the mucous membrane (RM), low regenerative potential of the small intestine. Deeper degenerative changes in the small intestine SO were observed during the correction of intestinal obstruction using an interrupted suture. Conclusion. The use of a continuous suture (in some cases (3 out of 5) has some advantage over the interrupted suture in the form of a relative preservation of the proliferative compartment zone with the presence of highly specialized cells. Counting Paneth cells, as an indicator of the regenerative capabilities of the small intestine CO, is a promising and objective method for assessing the quality small bowel anastomosis.

Incidence and associated morbidity of sarcopenia in non-malignant small and large bowel anastomosis: propensity score-matched analysis

PurposeSarcopenia is a prognostic factor for poor outcomes in colorectal cancer, but data are scarce in colorectal surgery for benign conditions where patients could benefit from a deferral of surgery to enter a prehabilitation programme. We assessed the incidence of sarcopenia and complications in patients with benign colorectal disease.MethodsPatients who underwent elective non-malignant colorectal surgery during 2018–2022 were retrospectively identified. The cross-sectional psoas area was calculated using computed tomography (CT) imaging mid-3rd lumbar vertebrae. Sarcopenia was determined using gender-specific cut-offs. The primary outcome was complications measured by the comprehensive complication index (CCI).ResultsOf 188 patients identified, 39 (20.7%) were sarcopenic. Patients diagnosed with sarcopenia were older (63 vs. 58 years, p = 0.047) and had a reduced BMI (24.7 vs. 27.38 kg/m2, p = 0.001). Sarcopenic patients had more complications (82.1 vs. 64.4%, p = 0.036), and CCI was statistically but not clinically higher (20.9 vs. 20.9, p = 0.047). On univariate linear regression analysis, age ≥ 65 years old, ASA grade ≥ 3, active smokers, sarcopenia, and preoperative anaemia were predictive of CCI. Propensity score-matched analysis was performed, matching 78 cases to remove selection bias, which demonstrated sarcopenia had no impact on postoperative complications. On multivariate analysis, age (p = 0.022), smoking (p = 0.005), and preoperative anaemia (p = 0.008) remained predictive of CCI.ConclusionSarcopenia is prevalent in one-fifth of patients undergoing benign colorectal surgery. Taking advantage of the longer preoperative waiting periods, sarcopenia could be explored as a target for prehabilitation programmes to improve outcomes.

OC-032 SAFETY OF PERFORMING CONCOMITANT GASTROINTESTINAL RESECTIONAL SURGERY WITH COMPLEX ABDOMINAL WALL RECONSTRUCTION

Abstract Aim The literature regarding combined complex abdominal wall reconstruction (CAWR) and gastrointestinal surgery (GIS) is limited and largely suggests staged procedures due to a reported increased incidence of surgical site occurences (SSO), hernia recurrence and anastomotic leak. However this exposes patients to the risks of two substantial procedures and having general anaesthetic twice. This study aimed to evaluate outcomes of single-stage GIS involving a substantial GI resection with CAWR. Materials &amp; Methods Analysis of a 8 years prospectively maintained single surgeon CAWR database of 205 patients identified 14 such patients who had undergone concomitant CAWR GIS cases (5 segmental colonic resections, 2 completion proctectomies, 5 Hartmann's reversals and 2 small bowel resection and anastomoses) but excluding cholecystectomy, gynaecological surgery and adhesiolysis alone. Results CAWR-GIS mean operating time was significantly longer (5.8hrs vs 3.8hrs) with an increased incidence of post-operative ileus (40% vs 18%, p&amp;lt;0.05) with increased mean length of stay as expected (7.8 days v/s 5.1 days). There was a slightly higher incidence of SSO but there were no anastomotic leaks. Hernia recurrence rate at 2 years follow up was 10% which is comparable to our cohort (8%). None of the 14 patients required reoperation within 30 days or mesh explantation yet. 11 patients had a synthetic mesh and 3 patients had a bio-synthetic mesh used. Patients informally reported high satisfaction for having undergone combined procedures. Conclusion Concomitant intestinal surgery during complex abdominal wall repair can be performed safely without increased risk of hernia recurrence, mesh infections or anastomotic leak.

Multiple Intestinal Atresia with Combined Immunodeficiency, a New Gene Arises

We present here a single case report of a 2-day-old female born to a 29-year-old G4P3→4 Swartzentruber Amish mother at 35 weeks gestation that presented with abdominal distension and failure to pass meconium.Family history was positive for a cousin born with multiple intestinal atresia (MIA) and combined immunodeficiency (CID) who died in his first month of life. A primary immune deficiency targeted gene panel was done, covering TTC7A, in addition to 206 other genes, with no known mutations identified.An exploratory laparotomy was performed on DOL4 with MIA observed, as well as malrotation without volvulus. Repair of pyloric atresia and multiple small bowel resections and anastomosis were performed. She was kept NPO with TPN and NG suctioning of gastric contents for bowel rest.Immunologic profiling revealed low CD3+ cells (578/µL), very low CD8+ T cells (23/µL), low CD4+ T cells (485/µL), normal NK and B cell counts, low levels of serum IgM (< 10 mg/dL) with normal levels of IgG (likely maternal) and IgA. Mitogen stimulation testing was normal. Sanger sequencing showed a homozygous c.4867 T>G (p.Tyr1623Asp) mutation in PIK4A confirming the diagnosis of Gastrointestinal Defects and Immunodeficiency Syndrome 2 (GIDID2). Despite surgery, the patient continued to have large volume NG output without return of bowel function. Other treatment options, including long term TPN, potential small bowel and liver transplants, and HSCT were discussed, but the family elected for hospice given the poor prognosis. She passed away on DOL 28. PI4KIIIα, encoded by PI4KA, catalyzes the conversion of phosphatidyl inositol to phosphatidyl inositol-4-phosphate while using TTC7A as a scaffolding protein. This process is critical for development of enterocyte polarity and actomyosin contractility in multiple cell types. PI4KA mutations have only recently been implicated in causing MIA with CID and can be missed in many genetic screens. GIDID2 is a devastating disease in which intestinal surgery provides only an immediate mechanical fix, without improving mortality. Further research on the molecular mechanisms that govern GIDID2 is critically needed to identify new treatment modalities. Furthermore, awareness of PI4KA mutations in newborns with MIA with CID is critical, particularly in Amish populations.

A comparative study of single layer versus double layer small bowel anastomosis

Background: There are various gastrointestinal surgeries in which we require small bowel anastomosis. Bowel anastomosis is quite common in different bowel pathology. Bowel anastomosis can be done by hand sewn or y stapler. In hand sewn anastomosis, we can do single layer or double layer anastomosis. Method: The study was carried out in 50 patients between August 2019 to March 2020. In this study, we have included all the patients who require small bowel end to end anastomosis in either elective surgeries or emergency surgeries. Patients who require proximal stoma formation and other than small bowel anastomosis are excluded. In present study, patients were randomly allocated in two groups: group A (n=25) includes single layer(interrupted) hand sewn bowel anastomosis and group B two layer (Connell and seromuscular) handsewn bowel anastomosis. Author have compared two groups in terms of intraoperative time and postoperative leak. Results: This shows that there is significantly reduce in intraoperative time in group A patient while there is no significant difference in postoperative complication or postoperative leak between two groups. Conclusions: There is no significant difference in single layer and double layer technique of bowel anastomosis.

Closed or Unclosed Mesentery? A Meta-analysis of Internal Herniation After Laparoscopic Roux-en-Y Gastric Bypass.

During the laparoscopic Roux-en-Y gastric bypass procedure, closing mesentery or not was still controversial according to preexisted studies. So, the current meta-analysis aimed to compare the outcome of closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass. Fifteen studies were included, enrolling 53,488 patients. Based on the outcome of analysis, regarding internal hernia, Petersen space's IH, jejunal mesenteric's IH, hospital days, and reoperation, closure of the mesentery was better than non-closure. Besides, small bowel obstruction, anastomosis ulcer, stenosis, leakage, bleeding, gastrointestinal perforation, and postoperative BMI of patients show no difference between non-closure and closure.

Comparative early histologic healing quality of magnetic versus stapled small bowel anastomosis.

Successful anastomotic healing is critical to preventing complications after intestinal surgery. We aimed to compare the early healing of end-to-end small bowel anastomosis by self-forming magnets with surgical stapling in a porcine model. Six Yorkshire pigs underwent 2 simultaneous small bowel anastomoses using a circular stapler and self-forming magnet technique. The primary outcome was healing quality, measured by 4 histologic features: inflammatory cell infiltration, collagen formation, grade of inflammation, and bacterial infiltration at the anastomosis. The samples were evaluated at days 1, 3, and 7. Gross evaluation of anastomotic integrity was a secondary outcome. The self-forming magnet group displayed significant differences at each time point. On day 1, the stapled group displayed dense inflammatory cell infiltration and extensively ulcerated intestinal layers with significant edema. The self-forming magnet group showed less inflammatory infiltrate, and all intestinal layers remained compressed in direct apposition. By day 3, the self-forming magnet group already exhibited neovascularization with scant bacterial colonies. By contrast, stapled anastomoses had large areas of inflammation separating collagen fibers with prevalent bacterial infiltrations. On day 7, self-forming magnet anastomoses were characterized by robust neovascularization, maturing granulation tissue, and mucosal re-epithelization without significant inflammation. Meanwhile, stapled samples had persisting dense inflammation, tissue cavities with hemorrhage, and immature fibrous tissue. Grossly, the self-forming magnet created a patent lumen without defect, whereas stapled anastomoses demonstrated focal areas of serosal separation. Bowel anastomosis by self-forming magnets is associated with superior early histologic healing metrics, including early seal generation through mechanical compression, decreased inflammation, early neovascularization, lower bacterial infiltration, and faster re-epithelization.

Surgical correction of mid gut volvulus presenting as acute intestinal obstruction and multiple jejunal diverticula with sealed off perforation-a case report

Multiple diverticulosis of the jejunum is an uncommon pathology of the small bowel. The incidence of diverticulum of small intestine varies from 0.3 to 1.2%, out of which duodenal diverticula are common that jejunal. This rare jejunal diverticula is usually asymptomatic in course, which made it more difficult in establishing this diagnosis. This may rarely lead to complications such as perforation, haemorrhage, obstruction which may be due to adhesions, volvulus, and intussusception. We herein report a case of a 72-year-old female patient with no comorbidities presented to ER with complaints of abdominal distention, lower abdominal pain, vomiting for 3 days. Pre-op evaluation revealed midgut volvulus with intestinal obstruction. Explorative Laparotomy revealed multiple diverticula in jejunum. Midgut volvulus was operated by resection and anastomosis of small bowel.

Littre’s hernia: A Surgical dilemma. (Case Report)

Meckel’s diverticulum in a hernia sac is designated as a Littre’s hernia. It is an uncommon type of hernia. The diagnosis is invariably made at the time of surgery. Resection anastomosis of the adjacent segment of the small bowel with the diverticulum is a contentious issue. A case of Littre’s hernia is reported. A case of Littre’s hernia in a17 year old boy is reported to highlight the diagnostic and therapeutic issues confronting the attending surgeon. A short segment resection anastomosis of the small bowel along with the Meckel’s diverticulum was done. A herniorrhaphy was done with no complications. The diagnostic challenges and the dilemma of selecting the best option for removing the Meckel’s diverticulum and choice of hernia repair are discussed. Littre’s hernia is invariably diagnosed intraoperatively. A short segment resection anastomosis of the adjacent small bowel along with the Meckel’s diverticulum prevents complications arising due to the diverticulum. A herniorrhaphy for a young patient and the use of an absorbable mesh for other age groups is advisable.

Small bowel anastomosis in peritonitis compared to enterostomy formation: a systematic review.

Anastomotic leakage after small bowel resection in emergency laparotomy is a severe complication. A consensus on the risk factors for anastomotic leakage has not been established, and it is still unclear if peritonitis is a risk factor. This systematic review aimed to evaluate if an entero-entero/entero-colonic anastomosis is safe in patients with peritonitis undergoing abdominal acute care surgery. A systematic literature review based on PRISMA guidelines was performed, searching the databases Pubmed/MEDLINE, Cochrane Library, and Science Direct for studies of anastomosis in peritonitis. Patients with an anastomosis after non-planned small bowel resection (ischemia, perforation, or strangulation), including secondary peritonitis, were included. Elective laparotomies and colo-colonic anastomoses were excluded. Due to the etiology, traumatic perforation, in-vitro, and animal studies were excluded. This review identified 26 studies of small-bowel anastomosis in peritonitis with a total of 2807 patients. This population included a total of 889 small-bowel/right colonic resections with anastomoses, and 242 enterostomies. All studies, except two, were retrospective reviews or case series. The overall mortality rates were 0-20% and anastomotic leakage rates 0-36%. After performing a risk of bias evaluation there was no basis for conducting a meta-analysis. The quality of evidence was rated as low. There was no evidence to refute performing a primary small-bowel anastomosis in acute laparotomy with peritonitis. There is currently insufficient evidence to label peritonitis as a risk factor for anastomotic leakage in acute care laparotomy with small-bowel resection. The review was registered with the PROSPERO register of systematic reviews on 14/07/2020 with the ID: CRD42020168670.