Economic burden of pelvic sepsis after anastomotic leakage following rectal cancer surgery: a retrospective cost-of-illness analysis
Kiedo WienholtsDavid J. NijssenSarah SharabianyPieter J. TanisMaarten J. PostmaWytze LamérisRoel Hompes
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The microvascular sleeve anastomosis, where one vessel is inserted into the other, was compared with the conventional end to end anastomosis. In an experimental study in rat femoral arteries 42 anastomoses of each kind were examined. Operating time, patency rates, flow rates and strength of the anastomoses were recorded at various postoperative time intervals. It is concluded that the sleeve anastomosis is quicker to perform and that the two types of anastomoses in biomechanical respects are similar. Flow rates are slightly decreased immediately postoperatively in the sleeve anastomosis but this is of a temporary nature.
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The restoration of bowel continuity using multiple classic anastomoses is mostly impossible in unstable critically ill extremely low birth weight neonates. The parameters of healing of approximative anastomoses in which integrity and continuity of bowel is achieved with limited number of stitches were evaluated in an experimental study.Small bowel anastomoses were performed in twenty-two adult male rats. An approximative ileo-ileal anastomosis was performed with five seromuscular-interrupted sutures only; in the control group the anastomosis was performed with the conventional technique of interrupted sutures. The mechanical and biochemical parameters were compared.All anastomoses in both groups healed well without obstruction. The mean operating time needed for an approximative anastomosis was shorter (16 +/- 7.1 min versus 23.6 +/- 6.2 min, p = 0.016). The strength of the approximative anastomoses on the 1st day after surgery was 55 +/- 15 torr; the strength of the conventional anastomoses was 55 +/- 42 torr. The strength of the approximative anastomoses after 7 days was 249 +/- 39 torr; the strength of the conventional anastomoses was 218 +/- 23 torr (p = 0.118). The activity of the collagenolytic enzymes matrix metalloproteinase-2 and matrix metalloproteinase-9 in the anastomotic area was significantly increased compared with the activity in samples of non-operated bowel. There was no significant difference in collagenolytic activity between both types of anastomoses.The approximative anastomosis is a time-saving alternative to conventional anastomoses with a comparable course of anastomotic healing, anastomotic strength, and changes in collagen metabolism.
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In 10 pigs a nonsutured, glued colonic anastomosis was constructed with a modified stapling device without staples and compared with an EEA-stapled anastomosis and a one-layer-sutured anastomosis concerning radiologic appearance, breaking strength, circulation, and collagen concentration.141Ce-labeled microspheres were used for measurements of the anastomotic blood flow before the animals were sacrificed on the 4th postoperative day. The breaking strength was recorded and an anastomotic index calculated. No leakage was found. The anastomotic width did not differ between the groups, but the interindividual variation was more prominent in the sutured group. The handsewn and stapled anastomoses were stronger than the glued anastomosis (P=0.0009 and 0.0054, respectively). There was an increase in the anastomotic circulation in all of the anastomoses, but no differences were seen between groups. The collagen concentration was independent of the technique used.
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Anastomosis of the gastrointestinal tract has been made more secure by the use of the EEA (U. S. Surgical Corp.) stapler. The development of anastomotic strictures after stapling anastomosis is one of the major postoperative complications of this method. This study was done to compare the incidence of anastomotic stricture between stapling anastomosis and layer-to-layer handsewn anastomosis. Twelve dogs were divided into two groups. In each group, two colonic anastomoses were performed. Intestinal contents were not allowed to pass through one of the anastomotic sites created in an isolated segment of the colon, but were allowed to pass through the other site in the remaining colon. By the 28th postoperative day, anastomoses made with the EEA stapler, which had been excluded from contact with feces, had developed significantly more strictures when compared with the other anastomoses (p less than 0.05). The anastomotic strictures were membranous in nature when examined macroscopically and histologically.
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New blood vessels develop as a gastrointestinal anastomosis heals. The morphologic aspects of this neovascularization were studied in 22 dogs, each of which underwent one sutured and one stapled small bowel anastomosis. At intervals ranging from three to 24 days after surgery, the dogs were killed, and the bowel was injected with Batson's compound or india ink. The pattern of vascular growth across the anastomotic site was studied. Both stapled and sutured anastomoses caused an increase in submucosal capillary density at day three compared with control specimens taken from bowel remote from the anastomotic site. This increase was maintained consistently through day 24 in sutured anastomoses but had decreased by day five in stapled anastomoses. Growth of submucosal vessel across the anastomotic site could be demonstrated by day three in sutured and day four in stapled anastomoses. The more vigorous inflammatory response associated with sutured anastomoses may be responsible for more rapid and prominent neovascularization.
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Strength of microvascular anastomoses: Comparison between the unilink anastomotic system and sutures
Abstract The Unilink system, a mechanical anastomotic device, was compared with standard suture techniques in terms of anastomotic strength under conditions of uniaxial loading. Twenty‐five rabbits underwent Unilink and suture anastomosis of both carotid arteries and facial veins. Animals were sacrificed at 1 hour (five animals), 2 weeks (10 animals), and 16 weeks (10 animals), and all vessels were tested by constant loading in a material testing machine. The maximum load required to disrupt the anastomosis as well as the site of vessel failure were recorded. All 100 anastomoses were fully patent as evaluated by clinical testing. At 1 hour and 2 weeks, the Unilink arterial anastomoses were consistently and significantly stronger than the sutured anastomoses. At 16 weeks the sutured arterial anastomoses were significantly stronger than Unilink. The Unilink anastomoses, however, remained approximately 50% stronger than unoperated normal vessels. No statistical differences were observed in the strength of venous anastomoses at any of the intervals tested. There were no statistical differences in the sites of failure of the vessels under loading (i.e., at the anastomosis or proximal or distal to it) between the two techniques.
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Abstract Background: Sepsis was recently redefined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. With this redefinition (Sepsis-3), clinical and microbiological characteristics of patients with sepsis may differ from the patients fulfilling the previous described definition (Sepsis-2). Purpose: To describe differences in clinical and microbiological characteristics of sepsis episodes between Sepsis-3 and Sepsis-2. The secondary aim was to compare blood culture outcomes between episodes fulfilling Sepsis-3 and Sepsis-2 criteria, respectively. Methods: A prospective study design was used to include patients presenting with clinically suspected sepsis in the emergency department. Six blood culture bottles were collected from each patient. Blood cultures were described as having clinically relevant growth, contaminant growth, or no growth. Clinical and laboratory data were collected from medical records and the laboratory information system. Results: The analysis included 549 episodes. There were 387/549 (70.5%) Sepsis-3 and 443/549 (80.7%) Sepsis-2 episodes. In total, 369/549 (67.2%) episodes fulfilled both Sepsis-3 and Sepsis-2 criteria. Blood cultures were positive for clinically relevant growth in 140/387 (36.1%) and 155/443 (35.0%) episodes in Sepsis-3 and Sepsis-2, respectively. Other clinical and microbiological characteristics did not differ between Sepsis-3 and Sepsis-2. Conclusions: A high proportion of patients included through a sepsis alert system fulfilled both Sepsis-3 and Sepsis-2 criteria. The performance of blood cultures in detection of microorganisms was poor and were similar in Sepsis-3 and Sepsis-2 patients.
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Objective To investigate the methods and efficacy of anastomosis between vessels with different diameterby using microvascular anastomotic device.Methods From February 2013 to June 2013,5 patients underwent five free-flap transfered with the use of the microvascular anastomotic device in 12 vessels anastomosis,which included 6 anastomosis with different luminal diameter between donor and recipient vessels.We performed vasoplasity via lateral incision or on the Y-shape branch of small-diameter vessels to enlarge the diameter of anastomotic stoma,then microvascular anastomosis device matched the larger-diameter vessel were used in the anastomosis.Conventional therapy of microvascular anastomosis was performed postoperatively.Results Six anastomoses (4 venous,2 arterial) were performed with the microvascular anastomotic device in anastomotic stoma with different luminal diameter between donor and recipient vessels,with diameter (0.8-1.5)mm in one side and 2.0-3.5 mm in the other side,which had ratio from 1.0 ∶ 1.5-1.0∶ 3.0.The end of small-diameter vessel could be everted over the pins of larger microvascular anastomosis device successfully via vasoplasity.The 2.0-3.5 mm microvascular anastomotic device implant was used in these cases.These anastomoses were successfully completed with microvascular anastomotic device without vessel shedding,blood leak intraoperatively and without vascular crisis postoperatively.The time taken to complete an end-to-end anastomosis with microvascular anastomotic device varied from 3-5 min.The followed-up time ranged from 1-3 months,and flap survival in the 5 patients was 100％.Conclusion It is a simple,fast and effective method to perform microvascular anastomosis using microvascular anastomotic device in anastomotic stoma with different luminal diameter through vasoplasity.
Key words:
Microvascular anastomotic device; Blood vessels; Vasoplasity; Free flap
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