Journal of the American College of Surgeons
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Anastomotic leakage is a frequent and life-threatening complication after colorectal surgery. Early recognition of anastomotic leakage is critical to reduce mortality. Because early clinical and radiologic signs of anastomotic leakage are often nonspecific, there is an urgent need for accurate biomarkers. Markers of inflammation and gut damage might be suitable, as these are hallmarks of anastomotic leakage. ⋯ Preoperative intestinal fatty acid binding protein measurement can be used for anastomotic leakage risk assessment. In addition, the combination of C-reactive protein and calprotectin has high diagnostic accuracy. Implementation of these markers in daily practice deserves additional investigation.
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Refinements in donor management have resulted in increased numbers and quality of grafts after neurologic death. We hypothesize that the increased use of hormone replacement therapy (HRT) has been accompanied by improved outcomes over time. ⋯ The marked increase in the use of HRT in the management of brain-dead donors has been accompanied by increased organ availability overall. Potential mechanisms might include successful conversion of previously unacceptable donors and improved recovery in certain subsets of donors.
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Traditional open necrosectomy for pancreatic necrosis is associated with significant morbidity and mortality. Although minimally invasive techniques have been described and offer some promise, each has considerable limitations. This study assesses the safety and effectiveness of laparoscopic transgastric necrosectomy (LTN), a novel technique for the management of necrotizing pancreatitis. ⋯ Laparoscopic transgastric necrosectomy is a novel, minimally invasive technique for the management of pancreatic necrosis that allows for debridement in a single operation. When feasible, LTN can reduce the morbidity associated with traditional open necrosectomy and avoid the limitations of other minimally invasive approaches.
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Comparative Study Observational Study
Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays.
Efficiency in the operating room has become a topic of great interest. This study aimed to quantify the percent use of instruments among common instrument trays across 4 busy surgical services: Otolaryngology, Plastic Surgery, Bariatric Surgery, and Neurosurgery. We further aimed to calculate the costs associated with tray and instrument sterilization, as well as the implications of missing or damaged instruments. ⋯ Our study demonstrates that the percent use of instruments across surgical specialties and multiple tray types is low. Attention to tray composition may result in immediate and significant cost savings.