Collagenase-producing bacteria are common in anastomotic leakage after colorectal surgery: a systematic review.

PURPOSE: Some gut bacteria can produce enzymes (collagenases) that can break down collagen in the intestinal wall. This could be a part of the pathophysiology of anastomotic leakage (AL). This systematic review aimed to investigate if such bacteria were present more frequently in AL patients versus non-AL patients following colorectal surgery. METHODS: This systematic review was reported according to the PRISMA and AMSTAR guidelines. Before the literature search, a study protocol was registered at PROSPERO (CRD42022363454). We searched PubMed, EMBASE, Google Scholar, and Cochrane CENTRAL on April 9th, 2023, for randomized and observational human studies of AL following colorectal surgery with information on gastrointestinal bacteria. The primary outcome was bacteria with the potential to produce collagenase. The risk of bias was assessed with the Newcastle-Ottawa Scale, as all studies were observational. RESULTS: We included 15 studies, with a total of 52,945 patients, of which 1,747 had AL, and bacteriological information from feces, mucosa, the resected specimen, or drain fluid was presented. In 10 of the 15 studies, one or more collagenase-producing bacteria were identified in the patients with AL. Neither the bacteria nor the collagenase production were quantified in any of the studies. The studies varied greatly in terms of sample material, analytical method, and time of collection. Studies using DNA sequencing methods did not report findings of collagenase-producing bacteria. CONCLUSION: Collagenase-producing bacteria are more common in patients with AL following colorectal surgery than in patients without AL, but the significance is unclear. From the current studies, it is not possible to determine the pathogenicity of the individual gut bacteria.

Limited value of preoperative neutrophil-to-lymphocyte ratio to predict post-operative outcomes after major emergency abdominal surgery.

INTRODUCTION Major emergency abdominal surgery results in a high risk of morbidity and mortality. Preoperative neutrophil-to-lymphocyte ratio (NLR) has been proposed as a predictor of post-operative outcomes in elective surgery. The aim of the present study was to examine whether preoperative NLR was associated with post-operative morbidity and mortality after major emergency abdominal surgery. METHODS We conducted a retrospective cohort study of patients undergoing major emergency abdominal surgery in two university hospitals in Denmark between 2010 and 2016. Associations between preoperative NLR and 30-day post-operative complications and mortality were established through multivariate logistic regression and receiver-operating characteristics (ROC) analysis. RESULTS A total of 570 patients were included in the study. The overall 30-day mortality was 9.3% and 59.3% had post-operative complications. The median preoperative NLR was 8.6 (interquartile range: 4.8-14.7). Although NLR was higher in the group of patients who had complications or died after surgery, a multivariate analysis showed that the NLR was not associated with 30-day post-operative complications (odds ratio (OR) = 1.01 (95% confidence interval (CI): 0.99-1.02); p = 0.424) or mortality (OR = 0.99 (95% CI: 0.97-1.02); p = 0.57). The ROC analysis showed an area under the curve of 0.55 and 0.60 for 30-day post-operative complications and mortality, respectively. CONCLUSIONS Preoperative NLR was not associated with 30-day post-operative complications and mortality in patients undergoing major emergency abdominal surgery. FUNDING none. TRIAL REGISTRATION not relevant.

[Plasmapheresis in the treatment of acute pancreatitis associated with severe hypertriglyceridaemia].

Acute pancreatitis can be caused by hypertriglyceridaemia. The treatment includes lowering of the blood triglyceride levels. We present a case of a 40-year-old woman who was admitted in this condition. She was treated with plasmapheresis, which led to a rapid decline of the blood triglyceride levels. The national Danish guidelines on treatment of acute pancreatitis do not mention plasmapheresis as a method of lowering elevated triglyceride levels. We suggest that the guidelines should be revised with attention to this treatment option.

[Ectopic epipidymis can be misinterpreted as an inguinal hernia]. / Ektopisk bitestikel kan tolkes som fastsiddende ingvinalhernie.

Inguinal hernia is a common condition. In rare cases, an ectopic placed organ can be misinterpreted as an inguinal hernia. We present a case of an 18-year-old male who had an inguinal herniotomy, but instead of a hernia an ectopic placed epididymis was found. The epididymis was resected and the patient was discharged on the first post-operative day. A post-operative ultrasonography showed two normally sized and placed epididymides in the scrotum. This case report discusses other common findings during inguinal herniotomy.

No Circadian Variation in Surgeons' Ability to Diagnose Acute Appendicitis.

OBJECTIVE: To examine if there were circadian variations in surgeons' ability to diagnose acute appendicitis. DESIGN: Retrospective database study of all patients admitted to an acute surgical procedure under the potential diagnosis of acute appendicitis in a 4-year period. The day was divided into 2 time intervals, day to evening hours (08:00-23:59) and night hours (00:00-07:59). Relevant data regarding the admission and surgical procedures were categorized into these 2 time intervals. SETTING: Department of Surgery at a Danish university hospital in Copenhagen. PARTICIPANTS: A total of 2366 patients were included. There were no age limitations or selection in sex. RESULTS: There was no significant difference in the ability to diagnose appendicitis in day-evening hours vs night hours (p = 0.391), nor was any significant difference found on weekdays (Monday-Thursday) vs weekends (Friday-Sunday) (p = 0.278). There were no differences in duration of the procedures, rate of conversion, or severity of postoperative surgical complications between the 2 groups. More patients underwent diagnostic imaging during day to evening hours compared with night hours (308 vs 46; p = 0.014). The use of imaging had no effect on the ability to diagnose appendicitis. Male sex showed a higher probability of the diagnosis being appendicitis compared with other or no pathology (odds ratio: 3.094; p < 0.001). Age between 40 and 80 years was significantly associated with a higher probability of the diagnosis being appendicitis compared with other or no pathology. The negative appendectomy rate was 10.5%. CONCLUSION: We found no difference in the surgeons' ability to diagnose acute appendicitis during night hours compared with day to evening hours.