A T Drain Approach Treating Anastomotic Leaks After Gastrointestinal Surgery
Ontology highlight
ABSTRACT:
DISEASE(S): Diverticulitis,Colorectal Cancer,Anastomotic Leak
PROVIDER: 2307451 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:Interventions: Measure amylase levels in drain fluid daily after low colorectal anastomoses as an early indicator of anastomotic leak.
- a small sample of drain fluid will be collected daily while pelvic drain is in situ during hospital admission following colorectal surgery and samples will be sent to the local pathology service for measurement of amylase
- the amylase levels in drain fluid at each collection while the drain is in-situ will be collected and correlated to the clinical course
- clinical course following surgery will be observed during admission (and data collected after patient has been discharged, retrospective data collection).
- Follow up consultation at 6 weeks following surgery
Primary outcome(s): Daily amylase levels in the drain fluid post-operatively. The measurement of amylase in drain fluid is measured and reported by local pathology service.[Day 1, Day 2, Day 3, Day 4 and Day 5, post operatively, or until pelvic drain is removed. ]
Study Design: Purpose: Screening;Duration: Longitudinal;Selection: Defined population;Timing: Both
| 2471651 | ecrin-mdr-crc
Project description:Background: Clinical failure of arteriovenous fistulae (AVF) is frequently due to juxta-anastomotic neointimal hyperplasia (JANIH). Although the mouse AVF model recapitulates human AVF maturation, previous studies focused on the outflow vein distal to the anastomosis. We hypothesized that the juxta-anastomotic area (JAA) has increased NIH compared to the outflow vein. Method: AVF were created in C57BL/6 mice without or with chronic kidney disease (CKD). Temporal and spatial changes of the JAA were examined using histology and immunofluorescence. Computational techniques were used to model the AVF. RNA-seq and bioinformatic analyses were performed to compare the JAA with the outflow vein. The jugular vein to carotid artery AVF model was created in Wistar rats. Result: The neointima in the JAA shows increased volume compared to the outflow vein. Computational modeling shows increased volume of disturbed flow at the JAA compared to the outflow vein. Endothelial cells are immediately lost from the wall contralateral to the fistula exit, followed by thrombus formation and JANIH. Gene Ontology (GO) enrichment analysis of the 1862 differentially expressed genes (DEG) between the JANIH and the outflow vein identified 525 overexpressed genes. The rat jugular vein to carotid artery AVF showed changes similar to the mouse AVF. Conclusion: Disturbed flow through the JAA correlates with rapid endothelial cell loss, thrombus formation, and JANIH; late endothelialization of the JAA channel correlates with late AVF patency. Early thrombus formation in the JAA may influence later development of JANIH.
2023-12-08 | GSE249267 | GEO
Project description:Assessing the value of a citizen science approach for ctenophore identification
| PRJEB48037 | ENA
Project description:Interventions: Patients who undergo low anterior resection without a diverting loop ileostomy and have a rectal tube and pelvic drain will be invited to participate.
Only participants who are included in the study (by providing written consent) will receive Gastrografin flushes of rectal tube four times per day (QID), to replace saline flushes QID.
At Day 1, Day 2, Day 3, Day 4, Day 5 (or until rectal tubes is in situ) after surgery:
Participants will receive rectal tube flushing with 30 ml Gastrografin (25% v/v in saline) 4 times per day (QID). At 06:30am and 16:30pm, a 20 ml sample of drain fluid will be collected and stored until all samples during hospital admission are collected (for measurement of Gastrografin by DECT and ICPMS). Also, a sample from the rectal tube will be collected on Day 1 after surgery to confirm the presence of luminal Gastrografin. Patients will be observed during the hopital admission following surgery.
The presence of Gastrografin will be measured in each sample by DECT and ICPMS.
The clinical course post surgery will be monitored in all participants and the group will be catagorised into patients that DO NOT experience an anastomotic leak following surgery and patients that DO experience an anastomotic leak following surgery.
Primary outcome(s): Level of Gastrografin in drain fluid will be measured by DECT and ICP-MS[Day 1, 2, 3, 4, 5 or until rectal tube is in situ];Anastomotic leak after surgery by clinical assessment and CT (as per standard care)[Day 1, 2, 3, 4, 5 post surgery]
Study Design: Purpose: Diagnosis; Allocation: Non-randomised trial
| 2470927 | ecrin-mdr-crc
Project description:In colorectal surgery about 30% of postoperative mortality is attributed to anastomotic leak, whit an incidence range between 1.8% and 15.9%. Preventing the anastomotic leak can therefore bring benefits to the patient and the health system. To date we have technologically advanced suturizers and the correct realization (well-vascularized margins, not in tension, etc.) remains crucial to prevent anastomotic dehiscence. Experimental results demonstrate that modified cyanacrylate is a suitable potential "reinforcement" on intestinal anastomoses (manual or linear intra-corporeal). Applied after mechanical anastomosis, it polymerizes in a short time, closing the spaces of the suture line between one point and the other, expressing an adhesive, hemostatic and sealing action on the tissues, also creating an effective antiseptic barrier towards of the most common infectious or pathogenic agents.
| 2261859 | ecrin-mdr-crc
Project description:OBJECTIVE:Although major anastomotic bleeding after lower gastrointestinal surgery is considered rare, it can be life-threatening if not properly managed. The objective of this study was to assess the incidence of postoperative lower gastrointestinal intraluminal bleeding and to identify its potential risk factors. This retrospective cohort study used data from charts of 314 patients who underwent digestive surgery of the colon or small intestine. Details are reported for their sociodemographic data, surgical approach, comorbidities, timing and presentation of intraluminal bleeding events, bleeding diagnosis, treatment strategies, hospital length of stay, and clinical complications. RESULTS:A total of 7 patients (2.3%) experienced intraluminal bleeding in the postoperative period. The average length of hospital stay before discharge was 12 days (median?=?13 days). Patients with intraluminal bleeding had a significantly higher percentage of coronary artery diseases compared to patients without intraluminal bleeding (P value?=?.04), as well as having a cancer diagnosis (P value?=?.02). The clinical complications that were more likely in patients with intraluminal bleeding included requiring blood transfusions (P value?=?.01), reduction in hemoglobin (P value?=?.001), cardiac ischemia (P value?=?.02), and atrial fibrillations (P value?=?.02).
| S-EPMC6607592 | biostudies-literature
Project description:Background and study aims A variety of endoscopic techniques are currently available for treatment of upper gastrointestinal (UGI) anastomotic leaks; however, no definite consensus exists on the most appropriate therapeutic approach. Our aim was to explore current management of UGI anastomotic leaks. Methods A survey questionnaire was distributed among international expert therapeutic endoscopists regarding management of UGI anastomotic leaks. Results A total of 44 % of 163 surveys were returned; 69 % were from gastroenterologists and 56 % had > 10 years of experience. A third of respondents treat between 10 and 19 patients annually. Fifty-six percent use fully-covered self-expandable metal stents as their usual first option; 80% use techniques to minimize migration; 4 weeks was the most common reported stent dwell time. Sixty percent perform epithelial ablation prior to over-the-scope-clip placement or suturing. Regarding endoscopic vacuum therapy (EVT), 56 % perform balloon dilation and intracavitary EVT in patients with large cavities but small leak defects. Regarding endoscopic septotomy, 56 % consider a minimal interval of 4 weeks from surgery and 90 % consider the need to perform further sessions. Regarding endoscopic internal drainage (EID), placement of two stents and shorter stents is preferred. Persistent inflammation with clinical sepsis was the definition most commonly reported for endoscopic failure. EVT/stent placement and EVT/EID were the therapeutic options most often chosen in patients with previous oncologic surgery and previous bariatric surgery, respectively. Conclusions There is a wide variation in the management of patients with UGI anastomotic leaks. Future prospective studies are needed to move from an expert- to evidence- and personalization-based care.
| S-EPMC6877414 | biostudies-literature
Project description:In colorectal surgery, anastomotic leak and its septic consequences still remain as the most concerning complications resulting in substantial morbidity and mortality. A common determining factor for assessing the viability of a bowel anastomosis is adequate arterial perfusion to ensure sufficient local tissue oxygenation. Intraoperative near-infrared fluorescence (INIF) imaging using indocyanine green (ICG) dye is a novel technique which allows the surgeon to choose the point of transection at an optimally perfused area before creating a bowel anastomosis. Recently, the INIF imaging system has been installed on the robotic systems and this helps identify intravascular NIF signals in real time.
Although reports from several case series and retrospective cohorts have described the feasibility and safety of this imaging system during robotic colorectal surgery, to date, no studies have addressed more systematically the outcomes of this technique in robotic surgery. Considering the limitations of these reports, investigators aim to conduct a prospective randomized trial to compare robotic procedures with or without INIF imaging in patients undergoing colorectal surgery.
| 2201839 | ecrin-mdr-crc