The Role of Ileostomy in the Prevention and Treatment of Anastomotic Leakage after Elective Rectal Cancer Surgery - A Retrospective Analysis of Specific Risk Factors, Outcomes, and Complications.

Background: The objective of this paper is to highlight the role and place of ileostomy from the perspective of the risk of anastomotic leakage (AL). Materials and method: This was a retrospective study of 74 (46.54%) low and ultra-low anterior resections from 159 cases of rectal cancer operated on in a seven-year interval (2015 - 2021). The cases were divided into two groups: Group A with protective ileostomy (47 cases = 63.51%) and Group B without protective ileostomy (27 cases = 35.49%). Results: The type of anastomosis was low colorectal for 15 cases and ileorectal for two cases, both in Group A, with either mechanical or manual sutures. Continuous loop ileostomy was the only fecal diversion procedure used for protection. The ileostomy-specific complications recorded in Group A were peristomal skin lesions (8 cases), early peristomal hernia (2 cases), and severe dehydration with acute renal-insufficency (7 cases). The closure of the ileostomy was performed in 42 cases (89.36%), with the time between the primary operation and the closure being 4.28 months on average, with limits between 12 days and 10 months. AL treatment was conservative in 13 (76.47%) cases and surgical in four cases, with the types of operations performed at reintervention being take-down of the anastomosis + left terminal colostomy + ileostomy closure in three cases (2 in Group A and 1 in Group B) and terminal ileostomy in one case in Group A. Conclusions: To reduce its specific complications, ileostomy should be performed in well-selected patients. Those with risk factors for leakage include males, the elderly, and those having important comorbidities, neoadjuvant chemoradiotherapy, low tumors below 5 cm from the anal verge, or complete circumferential stenosis and peritumoral inflammatory infiltrate.

Management of Anastomotic Leakage after Low Anterior Rectal Resections with Total Mesorectal Excision - A Retrospective Study.

Background: This study sought to investigate the diagnostic procedures, treatment modalities, and consequences of anastomotic leakage (AL) in low anterior resection rectal cancer patients. Methods: A retrospective analysis was conducted on 186 patients consecutively admitted and treated in the 1st Department of Surgery in Craiova, between January 2018 and June 2022, all of whom had undergone surgical interventions for adenocarcinoma of the rectum. Among this cohort, 106 patients who had undergone scheduled low and ultralow anterior rectal resections with total mesorectal excision were selected for further analysis. Twenty-four patients were diagnosed with postoperative AL and underwent diverse management strategies based on the severity of their condition. Results: The study revealed an incidence of 22.6% for postoperative AL, with all of them being classified as grade B and C, according to the 2010 International Study Group of Rectal Cancer Classification, which were associated with significant morbidity and mortality. Notably, patients exhibited various comorbidities, including obesity, arterial hypertension, type 2 diabetes mellitus, and kidney failure. The management approach depended on the severity of the clinical presentation and the availability of treatment options. Early diagnosis and conservative management constituted the initial therapeutic strategy for grade B AL, with surgical reintervention or transanal vacuum therapy being used in grade C AL. Conclusions: The incidence and mortality associated with AF following low anterior resections were notably elevated. Grade B AL were successfully managed through conservative treatment, whereas grade C AL required either surgical reintervention for drainage or diversion procedures, or transanal vacuum therapy.

Preoperative Immunocyte-Derived Ratios Predict Postoperative Recovery of Gastrointestinal Motility after Colorectal Cancer Surgery.

The aim of this study was to assess the role of immunocyte-derived ratios (IDRs), such as the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), as markers for the postoperative recovery of gastrointestinal function following colorectal cancer surgery. A retrospective analysis was conducted on a consecutive cohort of 260 patients who underwent radical colorectal cancer surgery within the timeframe spanning from January 2016 to December 2022. Data concerning the postoperative recovery of gastrointestinal function included the I-FEED score, time to pass flatus, toleration for liquids in the first 48 h, and the need for nasogastric tube reinsertion in the immediate postoperative period. A special emphasis was allocated towards the examination of IDRs and their interrelation with the postoperative gastrointestinal functional parameters. The I-FEED score exhibited a positive correlation with the NLR, SII, and PLR. The univariate analysis indicated that all IDRs, multiorgan resection, hemoglobin and protein levels, regional nodal extent of the tumor (N), and obesity significantly affected nasogastric tube reinsertion. The multivariate analysis showed that the SII and N1 stages were risk factors for nasogastric tube reinsertion after colorectal cancer surgery. The SII and multiorgan resection were the only classifiers that remained significant in the multivariable analysis for the toleration for liquids. In summation, certain preoperative IDRs, such as the SII, PLR, and NLR, may hold potential as predictive determinants for postoperative gastrointestinal functional recovery following colorectal cancer surgery.

Uncovering the Impact of Lymphadenectomy in Advanced Gastric Cancer: A Comprehensive Review.

Gastric cancer is a significant health concern worldwide, and lymphadenectomy plays a crucial role in its treatment. However, there is ongoing debate regarding the optimal approach-D1 or D2 lymphadenectomy. This paper aims to synthesize the available evidence by conducting a comprehensive literature review and comparing the advantages and disadvantages of both techniques. The analysis includes studies, clinical trials, and systematic reviews that assess survival outcomes, morbidity, and quality of life. The selected studies revealed different outcomes associated with D1 and D2 lymphadenectomy, including lymph node harvest, disease control, recurrence rates, and overall survival. Postoperative complications also varied between the two techniques. These findings highlight the complex considerations involved in selecting the most suitable lymphadenectomy approach for individual patients. Therefore, the decision requires an individualized assessment that considers the potential benefits and risks of D1 and D2 techniques. A collaborative approach involving interdisciplinary teams is crucial for developing personalized treatment plans that optimize both oncological outcomes and postoperative quality of life.

Lichtenstein Repair in Inguinal Hernia- A Retrospective Study on the Impact of In-Hospital Costs of Diabetes Mellitus.

INTRODUCTION: Inguinal hernia is one of the most common conditions in surgical departments and diabetes is known to have a significant impact on both patients' health and healthcare system. The current study aims to evaluate extensively the differences in costs for different subgroups of diabetic patients undergoing inguinal hernia repair in a tertiary care medical center in South-West Romania. MATERIAL AND METHODS: A total number of 195 patients underwent hernia repair for primary or recurrent inguinal hernia between 2015 and 2020 and were included in the analysis. The group was divided into diabetic/non-diabetic patients and each of these subgroups was studied separately according to the presence or absence of comorbidities, sex and place of origin. RESULTS: Statistically significant differences were found in the division of the age group, highlighting the fact that in diabetic patients the average age was around 74.76 years, unlike those without diabetes in which the average age was approximately 61.31 years. Another statistically significant difference was observed in the classification by hospitalization days of the group of patients with incarcerated inguinal hernia, in a sense that diabetic patients required a prolonged hospitalization by 1.5 days as opposed to non-diabetics. CONCLUSIONS: The costs of hospitalization for diabetic patients undergoing hernia repair surgery were marginally higher than in non-diabetic patients, but no statistical difference could be observed between any of the costs subsets in the two patients groups.

Nonoperative Treatment of Abdominal Trauma Involving Liver and Spleen.

Introduction: The management of this type of trauma has evolved considerably, especially with the introduction of interventional radiology (angiography, splenic artery embolization - SAE) but also the concept of non-operative treatment (NOT), defined as a follow-up of injuries, without surgery. Material and Method: We have established a strategy for dealing with cases of abdominal trauma with injuries by non-operative treatment (NOT). We applied NOT to 13 patients in 50 (26%), of which 8 were patients with spleen injuries and 5 were patients with liver damage. Most of the lesions were grade II (8 cases), 2 cases were grade I and 3 cases were grade III. Results: There was only one case dealt by NOT, in which surgery was performed 48 hours after admission. In two patients with extravasation of the contrast agent on CT and angiography, angioembolization of the splenic artery was performed, with good results. Control CT was performed at a period that varied between 24 hours and 5 days after admission. The average period of hospitalization of patients approached by NOT was 6,6 days. Conclusions: Contrast-enhanced CT examination remains the basis for NOT initiation, providing the necessary data on the degree of liver or splenic lesion, the size of blood collections and extravasation of the contrast substance but is also the essential imaging exploration in assessing NOT efficacy. Angioembolization can be successfully performed in cases where CT examination and angiography show contrast extravasation. There was only one case included in the NOT, which was operated laparoscopically, but most authors emphasize that this should not be considered a failure of the method.

Analysis of Some Behavioral Risk Factors in Relation to Acute Coronary Events.

The association of acute coronary events and behavioral risk factors is already known. Of these, smoking and alcohol consumption are the behavioral risk factors with the most intense impact in the occurrence of these events. The correct knowledge of the dynamics and their involvement in the evolution of acute coronary events remains of overwhelming importance in the light of current data. To achieve the purpose of this study data from three family medicine practices from the period November 2018 to May 2019 were corroborated. Anonymous questionnaires were applyed to the subjects. For this study, questions related to the habit of smoking and consuming alcohol were selected. The study aimed to analyze the associative relationships between acute coronary events and two of the most common behavioral risk factors, smoking and alcohol consumption. The highest prevalence of acute coronary events was observed in current smokers and in former smokers. The period of exposure to smoking showed that this is one of the variables most strongly associated with an increased risk of acute coronary events. Moderate consumption of wine or beer seems to have a weak association with acute coronary events, even weaker than those who do not consume at all suggesting a protective effect.

Indication of total parathyroidectomy for an Epstein syndrome patient with end-stage renal disease.

Epstein syndrome is an extremely rare genetic disorder characterized by the association of nephritis, deafness and megathrombocytopenia. We present the case of a 21-year-old patient diagnosed with Epstein syndrome and hyperparathyroidism secondary to chronic kidney disease. The main particularity of this case resides in the association between megathrombocytopenia and secondary hyperparathyroidism requiring surgery, which could lead to a series of concerns regarding the intra- and postoperative hemorrhagic risk of the procedure. Nevertheless, both the surgical procedure and the postoperative recovery were uneventful, suggesting that the lower threshold for preoperative thrombocyte count in megathrombocytopenia should be specifically considered on an individual case analysis.