Risk Factors for Anastomotic Leak, Consideration for Proximal Diversion, and Appropriate Use of Drains.

Anastomotic leaks are a major source of morbidity after colorectal surgery. There is a myriad of risk factors that may contribute to anastomotic leaks. These risk factors can be categorized as modifiable, nonmodifiable, and intraoperative factors.

Surgical Residents' Perspective on Informed Consent-How Does It Compare With Attending Surgeons?

Background: The informed consent discussion (ICD) is a compulsory element of clinical practice. Surgical residents are often tasked with obtaining informed consent, but formal instruction is not included in standard curricula. This study aims to examine attitudes of surgeons and residents concerning ICD.

Exophytic condyloma: are they as benign as we think?

Aim: As the understanding of anal dysplasia continues to develop, controversy remains regarding treatment of these lesions. The purpose of this study was to evaluate lesion type (flat vs exophytic) and the association between morphology and dysplasia.

Methods: This was a single-centre retrospective analysis of a prospectively collected pathological database of patients > 17 years old who underwent operative excision/biopsies for presumed anal condyloma or dysplasia from 2009 to 2018.

It Takes a Village: The First 100 Patients Seen in a Multidisciplinary Pelvic Floor Clinic.

Objective: This study aimed to assess the characteristics of patients assessed and treated at a multidisciplinary pelvic floor program that includes representatives from multiple specialties. Our goal is to describe the process from triaging patients to the actual collaborative delivery of care. This study examines the factors contributing to the success of our multidisciplinary clinic as evidenced by its ongoing viability.

Value of an interactive phone application in an established enhanced recovery program.

Purpose: An interactive mobile phone application was added to an established Enhanced Recovery After Surgery (ERAS) program to determine the impact on ERAS compliance as well as clinical outcomes.

Methods: We identified patients undergoing elective colorectal surgery enrolled in our ERAS program from February 2017 to July 2018. Patients enrolled in a phone application were compared with those not enrolled in terms of age, sex, diagnosis, operative approach, bowel preparation, oral intake and solid food intake, ERAS pathway adherence, and clinical outcomes.

Early feeding in colorectal surgery patients: safe and cost effective.

Purpose: Enhanced recovery after surgery (ERAS) pathways has demonstrated improved outcomes in colorectal surgery. An important component of ERAS is early oral intake. The aim of this study is to determine the impact of early oral intake in patients following colorectal surgery.

A national analysis of operative treatment of adult patients with Hirschsprung's disease.

Purpose: Hirschsprung's disease is primarily a disease of infancy, but in rare cases, adults with this condition require surgery. The aim of this study is to identify the types of operations and postoperative outcomes in adults with Hirschsprung's disease on a national level.

Methods: The National Surgical Quality Improvement Program database was used to perform a retrospective review of all adult patients diagnosed with Hirschsprung's disease.

Four Synchronous Primary Malignancies of the Breast, Lung, Colon and Esophagus.

The literature contains few reports of patients with four more or more synchronous primary malignancies. We report the case of a 74-year-old woman who presented with synchronous primary malignant neoplasms of the breast (metaplastic carcinoma), lung (squamous cell carcinoma), esophagus (adenocarcinoma), and colon (adenocarcinoma). She was treated with multimodality therapy and demonstrated a favorable response at early follow-up.

Cleft lift procedure for pilonidal disease: technique and perioperative management.

Pilonidal disease is a common condition affecting young patients. It is often disruptive to their lifestyle due to recurrent abscesses or chronic wound drainage. The most common surgical treatment, "cystectomy," removes useful tissue unnecessarily and does not address the etiology of the condition.

Radiographic staging practices of newly diagnosed colorectal cancer vary according to medical specialty.

Background: Since 2008, multiple guidelines have endorsed incorporation of chest CT in the radiographic staging assessment of newly diagnosed colorectal cancer (CRC). Radiographic staging practices performed after CRC is detected have not been studied.

Objective: To evaluate radiographic staging practices for newly diagnosed CRC between gastroenterologists versus non-gastroenterologists.

Outcomes of discharge after elective laparoscopic colorectal surgery with transversus abdominis plane blocks and enhanced recovery pathway.

Background: Enhanced recovery pathways (ERP) have been well shown to permit early recovery and discharge. The addition of a transversus abdominis plane (TAP) block to a standard pathway may improve these outcomes. We evaluated the addition of a TAP block to an established ERP.

Laparoscopic-guided transversus abdominis plane block for colorectal surgery.

The transversus abdominis plane block has been used as a component of postoperative analgesia after hysterectomy and open abdominal surgery. This block involves the injection of anesthetic between the internal oblique and transversus abdominis muscles. We demonstrate an improved method by the use of laparoscopic guidance for transversus abdominis plane blocks.

Transversus abdominis plane blocks and enhanced recovery pathways: making the 23-h hospital stay a realistic goal after laparoscopic colorectal surgery.

Background: Although enhanced recovery pathways (ERPs) may permit early recovery and discharge after laparoscopic colorectal surgery (LC), most publications report that the mean hospital stay is 4 and 6 days. This study evaluates the addition of a transversus abdominis plane (TAP) block to the standard ERP.

Methods: In this study, 35 consecutive elective patients received a TAP block at the end of LC.

Fast track colorectal surgery.

A "fast track" colon surgery program is the global package of perioperative care encompassing preoperative, operative, and postoperative techniques, which in aggregate result in fewer complications, a reduction in cost, less postoperative pain, a reduction in the hospital length of stay, and quicker return to work and normal activities. Results of fast track programs have shown significant advantages; however, strong evidence is forthcoming. Implementation of a fast track program requires a significant commitment and a multidisciplinary approach.

Benefits of laparoscopic peritoneal lavage for complicated sigmoid diverticulitis.

Background: The traditional therapy for perforated sigmoid diverticulitis with peritonitis is emergency colectomy usually with colostomy. We report laparoscopic exploration with peritoneal lavage as an alternative in seven patients who required emergency surgery for diverticulitis.

Methods: Six patients presented with diffuse peritonitis and one with a failure of percutaneous therapy.

Tuberculous fistulae in ano: a case report and literature review.

Tuberculosis can present anywhere in the gastrointestinal tract; however, anorectal tuberculosis has been reported rarely. We present a case report of tuberculous fistulae in ano and review the extrapulmonary manifestations of tuberculosis.

Hemostasis in the absence of clotting factors.

Background: This study tests whether the hemostatic action of poly-N-acetyl glucosamine (p-GlcNAc) fiber material involves vasoconstrictor release leading to closure of an aortic laceration.

Methods: A 22-gauge cannula was inserted into an infrarenal aortic segment of a rat. Surrounding ligatures were tied, and the aorta was flushed with 60 mL of saline from a reservoir held at 80 cm.

Comparison of the effects of a 50% exchange-transfusion with albumin, hetastarch, and modified hemoglobin solutions.

We compared the hemodynamic effects of replacing 50% of the blood volume of anesthetized rats with an equal volume of five solutions: human serum albumin (HSA), hetastarch, unmodified hemoglobin, diaspirin-crosslinked hemoglobin, and o-raffinose-crosslinked hemgolobin. Control rats were exchange-transfused with their own blood. HSA and hetastarch caused a severe reduction in systemic vascular resistance (SVR), hypotension, and acute renal failure immediately after the exchange-transfusion.

Sialyl Lewis(x) hybridized complement receptor type 1 moderates acid aspiration injury.

The potentially enhanced anti-inflammatory effects of the sialyl Lewis(x) (sLe(x))-decorated version of soluble complement receptor type 1 (sCR1) in moderating acid aspiration injury are examined. HCl was instilled in tracheostomy tubes placed in mice, and extravasation of (125)I-labeled albumin in bronchoalveolar lavage (BAL) fluid was used to calculate the vascular permeability index (PI). Neutrophil counts in BAL fluid and immunohistochemistry were performed.

Mast cells mediate complement activation after acid aspiration.

A significant role for the alternative complement pathway in acid aspiration has been demonstrated by the observation that C3 but not C4 genetic knockout mice are protected from permeability edema. Using mast cell-deficient mice (W/Wv), we tested the hypothesis that mast cells mediate complement activation after acid aspiration. Tracheostomy tubes were placed in anesthetized mice and 2 mL/kg 0.

Recombinant soluble P-selectin glycoprotein ligand 1 moderates local and remote injuries following experimental lower-torso ischaemia.

Background: A central role for the polymorphonuclear leucocyte (PMN) in skeletal muscle ischaemia-reperfusion has been demonstrated by the observation that PMN depletion reduced local and remote pulmonary vascular permeability. This study investigated the role of recombinant soluble P-selectin glycoprotein ligand-immunoglobulin fusion protein (rPSGL-Ig), a P- and E-selectin antagonist, in moderating injury.

Methods: Mice underwent 2 h of hindlimb ischaemia and 3 h of reperfusion.

Moderation of skeletal muscle reperfusion injury by a sLe(x)-glycosylated complement inhibitory protein.

The role of the sialyl Lewis(x) (sLe(x))-decorated version of soluble complement receptor type 1 (sCR1) in moderating skeletal muscle reperfusion injury, by antagonizing neutrophil endothelial selectin interaction and complement activation, is examined. Mice underwent 2 h of hindlimb ischemia and 3 h of reperfusion. Permeability index (PI) was assessed by extravasation of 125I-labeled albumin.

Endothelial selectin blockade attenuates lung permeability of experimental acid aspiration.

Background: A central role for the polymorphonuclear leukocyte (PMN) in experimental acid aspiration has been demonstrated by the observation that PMN depletion reduced pulmonary vascular permeability. This study investigates the role of recombinant soluble P-selectin glycoprotein ligand-immunoglobulin fusion protein (rPSGL-Ig), a P- and E-selectin antagonist in moderating acid aspiration lung injury.

Methods: Tracheostomy tubes were placed in male C57BL/6 mice and 0.