Aim: Anastomotic leak (AL) is the most important complication of intestinal surgery with an anastomosis. Whilst a number of studies have defined risk factors for AL, frustratingly, low-risk patients still develop AL. Studies have looked at drain fluid analysis for detection of AL, but these findings have failed to translate into routine clinical practice. This umbrella systematic review aims to provide an overview of the promising candidate biomarkers (BMs) that show potential to translate into clinical practice.
Methods: A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane, KSR Evidence and the Epistemonikos databases on the 14 April 2021. Only systematic reviews of cohort or controlled studies measuring drain fluid biomarkers in humans were included. The methodological quality of the reviews was assessed using the AMSTAR 2 instrument. Clinical trial registries were searched for trials actively investigating drain fluid BMs. Candidate BMs were classified, and threshold values investigated.
Results: Nine systematic reviews, published between 2007 and 2020, met the inclusion criteria, and contained a total of 36 cohort studies. A total of 38 different BMs were studied. The most promising category of drain fluid BM was the extravasated intra-luminal substances (EILS) and five registered trials of these BMs were found. Two of nine reviews were of moderate quality.
Conclusions: The majority of BMs show inconsistent threshold values and are in the experimental stage. A number are not readily available for adoption into routine clinical practice. Most do not state a cut-off value to be considered as diagnostic.
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http://dx.doi.org/10.1111/codi.15844 | DOI Listing |
Medicina (Kaunas)
January 2025
Department of Advanced Since and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery, Luigi Vanvitelli University of Campania, 80138 Naples, Italy.
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View Article and Find Full Text PDFLaryngoscope
January 2025
Department of Otolaryngology- Head & Neck Surgery, University of Western Ontario, London, Ontario, Canada.
Background: Endoscopic techniques allow for improved visualization and tumor debulking of pituitary adenomas. More thorough tumor resection, however, can be associated with higher rates of CSF leaks. We set out to determine if CSF leaks influenced patient perceived quality of life outcomes.
View Article and Find Full Text PDFAim: To assess the changes of intracranial pressure waveforms (ICPW) acquired noninvasively in a set of acute hydrocephalus patients prior to and posterior to interventions.
Material And Methods: Patients with clinical and radiological diagnoses of hydrocephalus were evaluated for alterations in ICPW by means of a system that detects cranial micro expansions just before and immediately after interventions. The system quantified the difference between ICPW peaks (P1 and P2), providing the P2/P1 ratio.
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View Article and Find Full Text PDFJ Neurosurg Case Lessons
January 2025
Department of Neurological Surgery, Cooper University Health Care, Camden, New Jersey.
Background: External ventricular drains (EVDs) provide an invaluable diagnostic method for accessing cerebrospinal fluid and therapeutically treating elevated intracranial pressure. Although complications including hemorrhage and infection have been well documented, the formation of iatrogenic pseudoaneurysms following EVD placement has rarely been reported. The authors present a case of this exceedingly rare complication of iatrogenic pseudoaneurysm formation following EVD placement.
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