Type Of Anastomosis Research Articles

Analysis of risk factors for surgical site infection and other postoperative complications in patients following loop ileostomy reversal.

<b>Introduction:</b> Loop ileostomy reversal (LIR) procedure is still associated with a relatively high risk of complications. Surgical site infection (SSI) is the most common complication in this group of patients. SSI leads to prolonged hospital stays, delays the adjuvant therapy, and increases hospital costs.<b>Aim:</b> The aim of the study was to analyze the risk factors for SSI in patients following loop ileostomy reversal procedure.<b>Material and methods:</b> A single-center retrospective analysis was conducted in a tertiary reference center. Finally, 65 patients following loop ileostomy reversal procedure performed between 2018 and 2022 were enrolled in the study. Data were collected retrospectively based on the available medical charts. The study group comprised 23 women (35%) and 42 men (65%) with a mean age of 48.9 14.5 years and a mean body mass index of 24.3 4.9 kg/m<sup>2</sup> . The most common indication for index surgery was ulcerative colitis (33%) and colorectal cancer (29%). Preferably, handsewn anastomosis was performed (n = 42; 64.6%).<b>Results:</b> The most important parameter evaluated in the above study was the diagnosis of surgical site infection, which influenced e.g. hospitalization after surgery, the need for antibiotic therapy, or C-reactive protein (CRP) values. Nine patients (13.8%) were diagnosed with SSI during their hospital stay (more than 86% without SSI). In the group with SSI, hospital stay exceeded 13 days compared to almost 6 days in the group without SSI (P = 0.00009). The time of the procedure had a statistically significant correlation with antibiotic therapy introduction (P = 0.01). The type of intestinal anastomosis had a significant impact on the operative time (P = 0.0011) and the time of hospital stay after surgery (P = 0.04).<b>Conclusions:</b> Most of the analyzed clinical factors were directly related to the impact on the duration of postoperative hospitalization. The duration of hospitalization is an independent and undeniable factor increasing the risk of other postoperative complications and significantly increasing the cost of hospitalization. Another factor that has a large clinical impact on postoperative treatment is the presence of comorbidities which make patients more likely to develop SSI, CRP increase, or the need for antibiotic therapy. An important factor was the level of CRP, the elevated value of which may be a predictor of many negative aspects in postoperative treatment.

Endovascular management of a ruptured hepatic artery pseudoaneurysm after liver transplantation presenting as hemobilia

Vascular and biliary complications can still occur among liver transplants despite advances in surgical technique and immunosuppression. Rupture of a hepatic artery pseudoaneurysm is a rare but lethal complication after liver transplantation and often manifests as acute gastrointestinal bleeding. It occurs in < 3% of cases with an associated mortality as high as 50% especially if diagnosed late. A high index of suspicion may decrease consequent morbidities and potential graft loss. Infection and type of biliary anastomosis are commonly identified risk factors in the development of a pseudoaneurysm. Angiography usually identifies the location which is commonly at the site of anastomosis. Frequent management options include surgical revascularization requiring re-operation or endovascular intervention with the use of coils and stents. No consensus yet as to the standard treatment has been established. We present a case of a 40-year-old male having a ruptured hepatic artery pseudoaneurysm with an arteriobiliary fistula after performing a deceased donor liver transplant managed with endovascular placement of a stent. Patient remains asymptomatic with patent hepatic artery after 6 months of follow-up.

A Comparative Analysis of Laparoscopic Gastrectomy Versus Laparoscopic-Assisted Gastrectomy: The Overall and Disease-Free Survival.

Gastric cancer remains a significant global health challenge with varied survival rates, emphasizing the need for research into effective surgical treatments. In this retrospective study, we compared the 72-month overall and disease-free survival between laparoscopic gastrectomy (LG) and laparoscopic-assisted gastrectomy (AG) in a cohort of 139 patients treated for gastric cancer. The analysis revealed that patients undergoing LG exhibited a significantly higher overall survival rate at 72 months compared to those undergoing AG. Although disease-free survival rates were comparable between the two groups, LG showed a marginal advantage. Subgroup analyses based on the type of gastrectomy and anastomosis demonstrated varied survival probabilities, with laparoscopic-assisted partial gastrectomy yielding the most favorable outcomes. These results highlight the importance of the choice of surgical technique in influencing survival outcomes in gastric cancer.

Stapled vs handsewn anastomosis and anastomotic leaks in gastric cancer surgery—a population-based nationwide study in Finland

BackgroundThere is a lack of evidence regarding anastomotic technique and postoperative complications in gastric cancer surgery. The aim of the study was to evaluate whether there are differences between stapled and hand-sewn anastomosis and anastomotic leaks. MethodsThis was a population based, retrospective, nationwide cohort study in Finland using the Finnish National Esophago-Gastric Cancer Cohort (FINEGO). Gastrectomy patients with available postoperative complication data were included. Logistic regression analysis was used to calculate the odds ratios (OR) with 95% confidence intervals (CI), adjusted for calendar period of surgery, age at surgery, sex, comorbidity, tumor stage, neoadjuvant therapy, minimally invasive surgery, type of gastrectomy, radical resection, and type of anastomosis. ResultsOf the 2164 patients, 472 (21.8%) of all patients had hand-sewn anastomosis and 1692 (78.2%) of all patients had stapled anastomosis. In the unadjusted analysis, anastomotic leaks were significantly lower in the hand-sewn group (HR 0.42, 95% CI 0.22-0.79) compared to the stapled group, but after adjustment for known prognostic factors, this association was no longer significant (HR 0.57, 95% CI 0.27-1.21). In the analysis stratified by gastrectomy type (distal, or total) no differences in anastomotic leaks were observed between anastomotic techniques. ConclusionIn this population-based nationwide study, anastomotic technique (stapled, or hand-sewn) was not associated with anastomotic leaks in any, distal or total, gastrectomy.

Results of Primary Arteriovenous Fistulas Formation with Different Types of Anastomoses in the Early Postoperative Period in Patients on Programmed Hemodialysis

The study includes the analysis of the results of using the different types of arteriovenous anastomoses in the formation of arteriovenous fistulas and their impact on fistula maturation in the early postoperative period. One of the main aspects of the work is to determine the optimal type of anastomosis to ensure the proper functioning of arteriovenous fistula that is an important element of vascular access in patients on renal replacement therapy. It is important to consider such factors as the diameter of formed arteriovenous fistula, the blood flow velocity through it, the incidence of complications and the duration of its functioning. The study also takes into account the impact of patients’ characteristics, such as age, condition of arteries and veins, as well as general health indicators on the results of surgery. Taking these factors into account allows to identify the groups of patients who can benefit most from a particular type of anastomosis.&#x0D; During the sample period, 384 patients with terminal stage of renal failure aged 20 to 84 years undergoing programmed hemodialysis, the native arteriovenous fistula was formed. It was found that 94.01 % of arteriovenous fistulas were successful in the early postoperative period. The average age of these patients was 44.2 years, while unsuccessful cases developed in people with an average age of 66.8 years. It was also found that within an hour after surgery for the formation of an arteriovenous fistula with the type end-to-side anastomosis, its diameter increases from 2.08±0.42 mm to 2.96±1.68 mm, and the blood flow velocity increases from 21.4±7.6 ml/min to 212.4±74.6 ml/min. The risk factor for effective fistula formation, in addition to age, is the diameter of vessels, anatomical features of the venous system, the presence of concomitant pathology (primarily diabetes mellitus).&#x0D; The obtained results can serve as a basis for the developing of recommendations for the optimal choice of anastomosis type for certain categories of patients who will undergo renal replacement therapy. The study is aimed at improving the results of surgical treatment and increasing the quality of life of patients with chronic renal failure.

Kono-S anastomosis in Crohn's disease: initial experience in pediatric patients.

Children diagnosed with Crohn's disease (CD) often undergo ileocecal resection (ICR) during childhood. Anastomotic recurrence is a frequent finding following this procedure. Data addressing the effect of the anastomosis type on disease recurrence are scarce in the pediatric population. The Kono-S anastomosis has shown promise in reducing endoscopic, clinical, and surgical recurrence rates in adults. We aimed to report our experience with Kono-S anastomosis in children, focusing on its feasibility and postoperative complications. We retrospectively analyzed pediatric CD patients who underwent ICR with Kono-S anastomosis between August 2022 and May 2023. Data on demographics, clinical characteristics, surgery, hospitalization, and follow-up including colonoscopy were collected. Complications were classified using the Clavien-Dindo classification. Twelve patients (7 females, 58.3%) were included. Six (50%) of the patients had the B3 luminal form of the disease (according to Paris classification). Median surgery duration was 174 (interquartile range [IQR] 161-216) minutes. Anastomosis creation took a median of 62 (IQR, 54.5-71) minutes. Median hospitalization length was 6 (IQR 4-7) days. No short- or mid-term complications were observed. Median follow-up duration was 9.5 (IQR 6.8-12) months. According to our results, Kono-S anastomosis is safe and feasible in pediatric CD patients, with no observed postoperative complications. These findings support the potential benefit of using Kono-S anastomosis as a treatment approach in children with CD.

Optimising surgical anastomosis in ileocolic resection for Crohn’s disease with respect to recurrence and functionality: two international parallel randomized controlled trials comparing handsewn (END-to-end or Kono-S) to stapled anastomosis (HAND2END and the End2End STUDIES)

BackgroundThe most common intestinal operation in Crohn’s disease (CD) is an ileocolic resection. Despite optimal surgical and medical management, recurrent disease after surgery is common. Different types of anastomoses with respect to configuration and construction can be made after resection for example, handsewn (end-to-end and Kono-S) and stapled (side-to-side). The various types of anastomoses might affect endoscopic recurrence and its assessment, the functional outcome, and costs. The objective of the present study is to compare the three types of anastomoses with respect to endoscopic recurrence at 6 months, gastrointestinal function, and health care consumption.MethodsThis is a randomized controlled multicentre superiority trial, allocating patients either to side-to-side stapled anastomosis as advised in current guidelines or a handsewn anastomoses (an end-to-end or Kono-S). It is hypothesized that handsewn anastomoses do better than stapled, and end-to-end perform better than the saccular Kono-S. Two international studies with a similar setup will be conducted mainly in the Netherlands (End2End) and Italy (HAND2END). Patients diagnosed with CD, aged over 16 years in the Netherlands and 18 years in Italy requiring (re)resection of the (neo)terminal ileum are eligible. The first part of the study compares the two handsewn anastomoses with the stapled anastomosis. To detect a clinically relevant difference of 25% in endoscopic recurrence, a total of 165 patients will be needed in the Netherlands and 189 patients in Italy. Primary outcome is postoperative endoscopic recurrence (defined as Rutgeerts score ≥ i2b) at 6 months. Secondary outcomes are postoperative morbidity, gastrointestinal function, quality of life (QoL) and costs.DiscussionThe research question addresses a knowledge gap within the general practice elucidating which type of anastomosis is superior in terms of endoscopic and clinical recurrence, functionality, QoL and health care consumption. The results of the proposed study might change current practice in contrast to what is advised by the guidelines.Trial registrationNCT05246917 for HAND2END and NCT05578235 for End2End (http://www.clinicaltrials.gov/).

Risk factors of postoperative complications and their effect on survival after laparoscopic gastrectomy for gastric cancer.

The association between postoperative complications and long-term survival after laparoscopic gastrectomy (LG) for gastric cancer (GC) remains uncertain. This study aimed to determine the incidence and risk factors of postoperative complications and evaluate their impact on survival outcomes in patients undergoing LG. A retrospective study was conducted on 621 patients who underwent LG for gastric adenocarcinoma between March 2015 and December 2021. Postoperative complications were classified according to the Clavien-Dindo classification, with major complications defined as Grade III or higher. Logistic regression models with stepwise backward procedure were used to identify risk factors for complications. To assess the impact of postoperative complications on survival, uni- and multi-variable Cox proportional hazard models were used for overall survival (OS) and disease-free survival (DFS). Overall rate of postoperative complications was 17.6% (109 patients); 33 patients (5.3%) had major complications. Independent risk factors for major complications were Charlson comorbidities index (OR [95% CI], 1.87 [1.09-3.12], p-value = 0.018 for each one score increase), and type of anastomosis (OR [95% CI], 0.28 [0.09-0.91], p-value = 0.029 when comparing Billroth II with Billroth I). Multivariable analysis identified major complications as an independent prognostic factor to reduce OS (HR [95% CI], 2.32 [1.02-5.30], p-value = 0.045) and DFS (HR [95% CI], 2.63 [1.37-5.06], p-value = 0.004). Other prognostic factors for decreased survival outcomes were tumor size, presence of invasive lymph nodes, and T4a stage. Major complications rate of LG for GC was approximately 5.3%. Charlson comorbidities index and type of anastomosis were identified as risk factors for major postoperative complications. Major complications were demonstrated to pose adverse impact on survival outcomes.

Anastomotic techniques for small intestinal obstruction in horses. A scoping review.

Small bowel obstruction (SBO) is a significant cause of surgery in adult horses presenting with colic pain. SBOs often require resection and anastomosis. While various techniques for intestinal anastomoses have been developed, it remains uncertain if any fully meet our clinical needs. To conduct a scoping review of publications on anastomosis techniques and outcomes for the treatment of SBO. Scoping review. A literature review was conducted using the CAB, Web of Science, Scopus, and PubMed databases. Peer-reviewed scientific articles in English, published between 1992 and 2023, were included. A quality assessment was performed for potentially eligible articles. Experimental studies, case reports, and case series with less than five cases were excluded and relevant data on study methods and sample size were extracted and charted from remaining articles. Anastomosis type and outcome were reported for articles considered potentially eligible for meta-analysis. Articles in which only overall outcome was reported or details on type of anastomosis were not reported were excluded for the final charting. Of 3024 articles, 210 underwent a quality assessment. The most common study designs were case reports and case series (64.3%), followed by experimental studies (17.1%). After further exclusions, 104 articles met the inclusion criteria. In only 42 articles detailed data on type of anastomosis and relative outcome were reported. A total of 23 anastomosis types were reported for the treatment of SBO, with 6 different outcomes evaluated. Both short- and long-term survival rates consistently exceed 70% for all types of anastomosis (jejuno-jejunal, jejuno-ileal, and jejunocaecal). Non-English language studies and conference proceedings were excluded. The body of literature focused on surgical treatment for SBO exhibits low-quality evidence. Several techniques of anastomosis were described for different pathologies. However, there is a lack of homogeneity in reporting outcome for each surgical technique. Furthermore, outcomes considered varied significantly among studies and were sometimes poorly reported, although success rates are generally high. Overall, there is a need for better-structured studies on existing and commonly used techniques before comparing techniques and exploring other innovative approaches.

13. KONO-S TYPE ANASTOMOSIS VS LATERO-LATERAL ANASTOMOSIS IN CROHN'S DISEASE: CASE-SERIES REVIEW

Abstract Introduction Up to 80% of patients with Crohn's disease will require surgical treatment in their lifetime. Furthermore, given the high rate of disease recurrence at the site of the anastomosis, many of these patients will require more than one surgery. In 2003, Kono et al. described the KONO-S anastomosis (KSA) as a surgical option to reduce recurrences. At present, there are still no studies that allow us to affirm, with certainty, this theory. Methods A retrospective study was performed reviewing the anastomoses performed in patients with ileocolic Crohn's disease from June 2018 to October 2022. Results A total of 15 patients were analyzed. All patients underwent scheduled surgery. The type of anastomosis was KONO-S type in 33.3% (5) and latero-lateral type in 66.7% (10). The approach was laparoscopic in 86.7% (13). In 60% (9) surgery was indicated for stenosing disease. During the follow-up period, 26.7% (4) presented Clavien Dindo III or IV complications. After hospital discharge, 46.7% (7) of patients presented disease recurrence (either clinical or through imaging), with a recurrence rate of 60% and 20%, respectively, in patients with latero-lateral anastomosis compared to KSA. Conclusion KONO-S type anastomosis (KSA) is a type of anastomosis that could reduce recurrences of Crohn's disease. However, more studies with a larger sample size are needed to evaluate this claim.

Controversies in IPAA for Ulcerative Colitis: A Systematic Review of Different Anastomotic Techniques.

Available techniques for IPAA in ulcerative colitis include handsewn, double-stapled, and single-stapled anastomoses. There are controversies, indications, and different outcomes regarding these techniques. To describe technical details, indications, and outcomes of 3 specific types of anastomoses in restorative proctocolectomy. Systematic literature review for articles in the PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Studies describing outcomes of the 3 different types of anastomoses, during pouch surgery, in patients undergoing restorative proctocolectomy for ulcerative colitis. IPAA technique. Postoperative outcomes (anastomotic leaks, overall complication rates, and pouch function). Twenty-one studies were initially included: 6 studies exclusively on single-stapled IPAA, 2 exclusively on double-stapled IPAA, 6 studies comparing single-stapled to double-stapled techniques, 6 comparing double-stapled to handsewn IPAA, and 1 comprising single-stapled to handsewn IPAA. Thirty-seven studies were added according to authors' discretion as complementary evidence. Between 1990 and 2015, most studies were related to double-stapled IPAA, either only analyzing the results of this technique or comparing it with the handsewn technique. Studies published after 2015 were mostly related to transanal approaches to proctectomy for IPAA, in which a single-stapled anastomosis was introduced instead of the double-stapled anastomosis, with some studies comparing both techniques. A low number of studies with handsewn IPAA technique and a large number of studies added at authors' discretion were the limitations of this strudy. Handsewn IPAA should be considered if a mucosectomy is performed for dysplasia or cancer in the low rectum or, possibly, for re-do surgery. Double-stapled IPAA has been more widely adopted for its simplicity and for the advantage of preserving the anal transition zone, having lower complications, and having adequate pouch function. The single-stapled IPAA offers a more natural design, is feasible, and is associated with reasonable outcomes compared to double-stapled anastomosis. See video from symposium.

Strategic Approaches to Intraflap Anastomosis: Navigating Conjoined DIEP Flap Reconstruction-A Comprehensive Roadmap.

For patients desiring autologous breast reconstruction without adequate abdominal tissue volume, the deep inferior epigastric perforator (DIEP) flap may be stacked or combined with other flaps for bilateral reconstruction. Various combinations of anastomoses have been described in the literature. We sought to describe a framework for intraflap anastomoses. A retrospective review of 17 patients who underwent conjoined DIEP flaps with intraflap anastomoses with a single surgeon was performed. Patient demographics, comorbidities, operative details, and complications were reviewed. A framework scheme was developed for the type of intraflap anastomosis performed. Between 2016 and 2020, 17 patients underwent conjoined DIEP flaps for unilateral breast reconstruction. Fourteen patients had delayed reconstruction. Eleven patients underwent an intraflap anastomosis in which a medial perforator on the left hemiabdomen flap was anastomosed with a distal lateral row perforator in the right hemiabdomen flap (type A). Four patients underwent an intraflap anastomosis in which a left lateral perforator was anastomosed to a right distal lateral row perforator (type B). Two patients underwent an intraflap anastomosis in which the left superficial inferior epigastric vessel was anastomosed to a right lateral row perforator (type C). Complications included reoperation (11.8%), partial flap loss (5.9%), seroma (23.5%), and hematoma (11.8%). We report a detailed framework for intraflap anastomoses of conjoined DIEP flap reconstruction including superficial inferior epigastric artery/superficial inferior epigastric vessel options. Knowledge of this comprehensive framework will allow surgeons to identify the type of intraflap anastomoses required for the anatomy they encounter and will standardize reporting of surgical technique in the literature.

Evaluation of the Factors Associated with Post-Operative Outcome in Patients of Ulcerative Colitis Undergoing Ileal Pouchanal Anastomosis with Comparison of Functional Outcome between Stapler and Hand-Sewn Anastomosis

ntroduction Ulcerative colitis defined as a non-granulomatous idiopathic inflammatory disease which mainly affects the colon and rectum. The disease may arise at any age but most commonly affects the adults between the age group of 30–40 years.1,2. The etiology of the disease is multifactorial, involving genetic predisposition, dysregulated immune responses, epithelial barrier defects and environmental factors. No sex predilection is seen in ulcerative colitis.3,5 The peak age of onset of disease is between 30 to 40 years.4,6 The environmental factors has also been found to play an important role in the etiopathogenesis of ulcerative colitis. Cigarette smoking is one of the major factor associated with ulcerative colitis, non-smokers have a milder disease course and active smokers are less likely to develop ulcerative colitis7 Appendectomy also confers a protective effect against ulcerative colitis, especially in young patients operated for acute appendicitis.8. Classic findings in endoscopy in patients with ulcerative colitis include loss of normal vascular pattern, erythema, erosions, granularity, friability, ulcerations and bleeding9 . The primary aim of medical management is to induce and maintain remission with the long-term goals of improving quality of life and prevent disability. Absolute indications for surgery include uncontrolled hemorrhage, perforation, and colorectal carcinoma or dysplastic lesions not amenable to endoscopic removal.10 Surgery is also indicated in refractory acute severe ulcerative colitis or medically refractory disease. The most commonly performed surgery for ulcerative colitis is restorative proctocolectomy with ileal pouchanal anastomosis (IPAA). An important aspect of the surgery is the use of either sutures or staplers for anastomosis. Two types of ileal pouch-anal anastomosis (IPAA) have been described: a mucosectomy of the rectal stump followed by a hand-sewn ileal pouch-anal anastomosis.11 The alternative technique is to retain the mucosa of the rectal stump and perform a stapled pouch-anal anastomosis.

P575 Kono-S anastomosis reduces post-op intervention after ileocolic resection for Crohn’s disease

Abstract Background Ileocolic resection and anastomosis is the most common intestinal operation for Crohn's disease (CD). However, the choice of anastomosis remains a topic of debate. The SUPRME CD randomized trial demonstrated decreased rates of surgical recurrence after Kono-S anastomosis (KSA). We aimed to compare the long-term recurrence-free survival between KSA and stapled side-to-side (SSTS) anastomosis in a retrospective cohort. We hypothesized that KSA was associated with a lower risk of postoperative recurrence requiring intervention than SSTS. Methods We included consecutive patients from a prospectively maintained database who underwent ileocolic anastomosis for terminal ileal CD between 2020 and 2022. Patients with other types of anastomoses were excluded. The short-term postoperative outcomes and interventions for perianastomotic recurrence were compared between the two groups. Results Overall, 174 patients underwent ileocolic anastomosis: KSA, 83 (47.7%) and SSTS, 91 (52.3%). In the KSA group, compared to SSTS, median BMI was lower (24.3 vs. 26.4 kg/m2, p=0.04), median operative time was longer (186 vs. 146 minutes, p&amp;lt;0.001), and patients were more likely to have mesenteric excision (53% vs. 15.4%, p&amp;lt;0.001). There were no significant differences in the short-term postoperative outcomes. After 12 months, 12 (30%) patients in the KSA group and 14 (35%) in the SSTS group developed endoscopic recurrence with a Rutgeerts score ≥i2 (p = 0.81). Compared with the SSTS group, the KS group received more postoperative biologics (65.1% vs. 39.6%, p=0.001) and more frequent medical therapy for perianastomotic recurrence [18/20, 90%] vs. [15/22, 68%]; p=0.14). On multivariable analysis, the KSA (OR 0.09, 95% CI 0.01-0.95, p=0.05) was associated with a lower risk of perianastomotic recurrence requiring surgical and endoscopic intervention. Conclusion We did not observe any statistically significant differences in overall recurrence-free survival between KSA and SSTS. However, the Kono-S anastomosis was independently associated with a decreased rate of endoscopic or surgical intervention for perianastomotic recurrence.

Evaluation of the type of fetal umblical-portal anastomosis in late-onset fetal growth restriction: A case-control study.

To evaluate the type of umbilical-portal anastomosis in late-onset fetal growth restriction (LO-FGR) and appropriate for gestational age (AGA) fetuses. To investigate the impact of the type of umbilical-portal anastomosis on the adverse outcomes in LO-FGR. This study observed 150 pregnancies with AGA fetuses and 62 pregnancies with fetuses with LO-FGR. In each case, the point of reference for measuring the abdominal circumference was established. The type of umbilical-portal anastomosis was evaluated as T-shaped, X-shaped, and H-shaped according to the shape of main portal vein and portal sinus. Incidences of the type of umbilical-portal anastomosis in AGA and LO-FGR fetuses were evaluated. T-shaped anastomosis was the most common (56.7%) in the AGA group and X-shaped (66.1%) in the LO-FGR group. In LO-FGR, T-shape anastomosis was significantly lower and X-shape anastomosis was significantly higher than AGA (p < 0.001). X-shaped anastomosis was associated with LO-FGR and the RR was 2.3 (95% CI 1.5-3.6; p < 0.001). Incidences of admission to NICU and emergency C/S for fetal distress were higher in fetuses with X -shaped anastomosis in the LO-FGR (p < 0.05). X-shaped umbilical-portal anastomosis have a prognostic significance in LO-FGR fetuses.

Recipient-associated risk factors for post-liver transplantation biliary complications: A cohort study.

Biliary complications (BCs) are a well-documented post-liver transplantation concern with potential implications for patient survival. This study aims at identifying risk factors associated with the development of BCs in recipients after liver transplantation (LT) and exploring strategies for their management. We conducted a retrospective analysis of 1595 adult patients (age > 18 years) who underwent LT surgery between 2019 and 2021. The study assessed the incidence of BCs in this cohort. Of 1595 patients, 178 (11.1%) experienced BCs, while 1417 (88.8%) did not exhibit any signs of such complications. Patients who developed BCs were found to have a significantly lower average age (p < 0.001) and longer cold ischemic times (p < 0.001) compared to those without BCs. Variables such as sex, body mass index (BMI), model for end-stage liver disease (MELD) score, primary diagnosis, type of anastomosis, hepatectomy technique, type of transplanted liver and mortality did not demonstrate statistically significant differences between the two groups (p > 0.05). Univariate logistic regression analysis revealed that a cold ischemic time exceeding 12 hours and duct-to-duct anastomosis were positive predictors for BC development (odds ratios of 6.23 [CI 4.29-9.02] and 1.47 [CI 0.94-2.30], respectively). Conversely, increasing age was associated with a protective effect against BC development, with an odds ratio of 0.64 (CI 0.46-0.89). Our multi-variate analysis identified cold ischemia time (CIT) as the sole significant predictor of post-liver transplantation biliary complications. Additionally, this study observed that advancing patient age had a protective influence in this context. Notably, no significant disparities were detected between hepatectomy techniques and the etiology of liver disease types in the two study groups.

Prognostic factors of postoperative morbidity in surgery for resectable pancreatic cancer. Regional institute of neoplastic diseases 'Dr. Luis Pinillos Ganoza' IREN Norte. 2007-2022.

To determine the prognostic factors associated with postoperative morbidity for resectable pancreatic cancer at the Instituto Regional de Enfermedades Neoplásicas del Norte 'Dr. Luis Pinillos Ganoza' - IREN Norte. 2007-2022. A study was conducted with a case-based (22 patients) and control (14 patients) design nested in a cohort that included 36 patients who underwent proximal duodenopancreatectomy (Whipple) or distal pancreatectomy for pancreatic cancer. In the present study, it was found that the total number of living patients represents 86.1% of the total (36 patients). Of the total population, patients who presented only 1 complication were 13.6% and more than 1 complication were 86.4%. It was also found that the most frequent complication in the general population was gastric emptying syndrome, which was present in 50% of all patients. In the bivariate analysis, a highly significant association was observed between the low prognostic nutritional index (p < 0.001, OD = 20.400, CI = 95%: (3.377-123.245)), the type of pancreatic resection (p < 0.001, OR = 52.500, CI = 95%: (5.174-532.669)) and postoperative morbidity. In contrast, no significant association was found between age ≥65 (p = 0.062), diabetes mellitus (p < 0.908), Wirsung diameter (p < 0.432), hospital stay (p < 0.075) and postoperative morbidity. In the multivariate analysis, serum total bilirubin level ≥20 μmol/L (p = 0.778), use of preoperative biliary drainage (p = 0.176), type of pancreatojejunal anastomosis (p = 0.533) and pancreaticogastric anastomosis (p = 0.504) were not statistically significantly associated with postoperative morbidity. The type of pancreatic resection and the nutritional prognostic index <40.5 are prognostic factors of postoperative morbidity in postoperative patients for resectable pancreatic cancer.

Hypoglossal Nerve Transfer for Facial Nerve Paralysis: A Systematic Review and Meta-Analysis.

Background: Hypoglossal-facial nerve (12-7) anastomosis can restore symmetry and voluntary movement on the face in patients with facial nerve paralysis. Traditional 12-7 transfer includes direct end-to-end nerve anastomosis, sacrificing the entire hypoglossal nerve. Contemporary, end-to-side anastomosis, or split anastomosis techniques limit tongue morbidity by preserving some hypoglossal nerve. Direct outcome comparisons between these techniques are limited. Objective: To compare reported outcomes of facial movement, tongue, speech, and swallow outcomes among the different types of hypoglossal-facial nerve anastomosis schemes. Evidence Review: For this systematic review and meta-analysis, a comprehensive strategy was designed to search PubMed, Scopus, and the Cochrane Database from inception to January 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, reporting guideline yielding 383 results. Any participant who underwent 12-7 transfer using any of the three techniques, with or without an interposition graft, and had documented preoperative and postoperative evaluation of facial nerve function with a validated instrument such as House-Brackmann (HB), was considered for inclusion. Secondary outcomes of synkinesis, tongue atrophy, and speech or swallowing dysfunction were also compared. Forty-nine studies met inclusion criteria, representing data from 961 total patients who underwent 12-7 transfer. Results: The proportion of good HB outcomes (HB I-III) did not differ by anastomosis type: End-to-side and end-to-end anastomosis (73% vs. 59%, p = 0.07), split and end-to-end anastomosis (62% vs. 59%, p = 0.88), and end-to-side anastomosis and split anastomosis (73% vs. 62%, p = 0.46). There was no difference in reported synkinesis rates between the anastomosis types. However, end-to-side anastomosis (z = 6.55, p < 0.01) and split anastomosis (z = 3.58, p < 0.01) developed less tongue atrophy than end-to-end anastomosis. End-to-side anastomosis had less speech/swallowing dysfunction than end-to-end anastomosis (z = 3.21, p < 0.01). Conclusion: End-to-side and split anastomoses result in similar HB facial nerve outcomes as the traditional end-to-end 12-7 anastomosis. End-to-side anastomosis has decreased complications of tongue atrophy and speech/swallow dysfunction compared to end-to-end anastomosis. In addition, split anastomosis has decreased rates of tongue atrophy compared to end-to-end anastomosis.

ARTERIO-VENOUS FISTULA CREATION FOR HEMODIALYSIS. WHAT IS HAPPENING IN BULGARIA?

Purpose. The arterio-venous anastomosis (AVA) continues to be the "gold standard" for vascular access in patients undergoing haemodialysis. This retrospective study aims to analyze the causes that led to End Stage Renal Disease (ESRD), the type of native AVA, their localization, and their patency. Material and Methods. The study included the last 100 consecutive and random AVAs constructed in our clinic. 68 men of average age 62.3 (+/-10.8) years and 32 women of average age 59.9 (+/-15.8) years were operated. The main causes that led to ESRD were: Glomerulonephritis - 33%, Hypertension- 24% and Diabetes- 20%. The overweight patients were 33% and the smokers - 30%. Results. AVA has been successfully constructed in 82% of the patients on the left hand and in 18% on the right hand. A distal latero-terminal radio-cephalic fistula (DLTRC) was constructed on only 8% of the patients. The most common type of anastomosis was an L.T. radio-cephalic in the forearm - 58%, followed by an L.T. brachio-cephalic fistula - 19% and latero-lateral, radio-cephalic in the forearm - 14% of the patients. The early fistula patency was - 80%, one-year cumulative patency was 94%. Conclusion. The analysis of our results shows that the relative share of the overweight and diabetes population is increasing today. In practice, solutions for the construction of primary forearm anastomosis are increasingly common.

Is early CT in cases of elevated postoperative CRP the best option for the diagnosis of colorectal anastomotic leakage?

After colorectal surgery (CRS), the early detection and treatment of anastomotic leakage (AL) is critical. We aimed to evaluate the efficacy of early contrast-enhanced computed tomography (CT) (postoperative day [POD] 2-3) after elective colorectal surgery for the diagnosis of AL for patients with elevated CRP levels at POD 2-3. From 2017 to 2022, all patients who underwent elective CRS with an anastomosis and CRP > 150mg/ml on POD 2-3 underwent enhanced CT during the 24h following the CRP evaluation and were included in this retrospective, single-center study. The primary endpoint was the diagnostic value of the early CT scan for the detection of AL. The secondary endpoints were the diagnostic value of the early CT scan for the detection of grade C AL according to the type of resection and anastomosis and the quality of the opacification. A total of 661 patients underwent elective CRS with anastomosis with an overall AL rate of 7.4%. Among the 661 patients, 141 were finally included in the study. The accuracy of early CT for the diagnosis of AL was 83.7%. For grade C AL, the accuracy was 81.6%. Among patients who had an ileocolic anastomosis, the accuracy was 88.2%, among those who had colorectal or ileorectal anastomosis, the accuracy was 83.0%, and among those who had a coloanal, the accuracy was 66.7%. In cases of good opacification by CT, the accuracy was 84.0%. Early CT does not show perfect accuracy for an early diagnosis of AL.