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Consensus on the definition of colorectal anastomotic leakage: A modified Delphi study

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World Journal of Gastroenterology 2020年第23期26卷 3293-3303页

作者： Claire pm van Helsdingen Audrey CHM Jongen Wouter J de Jonge Nicole D Bouvy joep pm derikx Department of Pediatric Surgery Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam and Vrije Universiteit AmsterdamAmsterdam 1105 AZNetherlands Tytgat Institute for Liver and Intestinal Research Amsterdam UMCUniversity of AmsterdamAmsterdam 1105 BKNetherlands Department of Surgery Maastricht University Medical CenterMaastricht 6202 AZNetherlands Department of General VisceralThoracic and Vascular SurgeryUniversity Hospital BonnBonn 53127Germany

BACKGROUND Despite the emerging knowledge about colorectal anastomotic leakage(CAL)through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the wide variety of definitions used in literature, comparison of study outcomes and quality of care is *** To reach consensus on the definition of CAL using a modified Delphi *** The RAND/UCLA appropriateness method was used. The expert panel consisted of international colorectal surgeons and researchers who had published three or more articles about CAL. The consensus process consisted of two online distributed questionnaires and a third round with a recommendation. In the questionnaires participants were asked to rate the appropriateness of statements using a 1-9 Likert scale. Consensus was defined as a panel median between 1-3 or 7-9 without disagreement. In the final round a recommendation was formed regarding the definition of CAL and the expert panel was asked if they agreed or ***-three authors participated in the first round and twenty-one finished the second round. After two rounds consensus was reached on 37 items(80%) in nine different categories. The International Study Group of Rectal Cancer definition is the most frequently advised general definition by our panel. Consensus was reached regarding the clinical symptoms of CAL, which serum markers contributes to the suspicion of CAL, which radiological and perioperative findings should be considered as CAL, which grading system is appropriate and if there should be a range of postoperative days in the definition. Eventually, 19 experts completed all three rounds of which 16(84%) agreed with our final recommendations for the definition of *** A consensus-based recommendation for the definition of CAL was formed using our modified Delphi method that can be widely incorporated in the field.

关键词： Anastomotic leak Consensus Colorectal surgery Postoperative complication Morbidity Colorectal anastomosis Definition

Botulinum toxin injections after surgery for Hirschsprung disease:Systematic review and meta-analysis

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World Journal of Gastroenterology 2019年第25期25卷 3268-3280页

作者： Danielle Roorda Zarah AM Abeln Jaap Oosterlaan Lodewijk WE van Heurn joep pm derikx Department of Pediatric Surgery Emma Children’s HospitalAmsterdam UMCUniversity of Amsterdam and Vrije Universiteit AmsterdamAmsterdam Reproduction and DevelopmentAmsterdam 1105 AZNetherlands Department of Pediatrics Emma Children’s HospitalAmsterdam UMCUniversity of AmsterdamEmma Neuroscience GroupAmsterdam Reproduction and DevelopmentAmsterdam 1105 AZNetherlands Department of Pediatric Surgery Emma Children’s HospitalAmsterdam UMCUniversity of Amsterdam and Vrije Universiteit AmsterdamAmsterdam Gastroenterology and MetabolismAmsterdam 1105 AZNetherlands

BACKGROUND A large proportion of patients with Hirschsprung disease experience persistent obstructive symptoms after corrective *** obstructive symptoms may result in faecal stasis that can develop into Hirschsprung-associated enterocolitis,a potential life-threatening *** treatment to improve faecal passage is internal anal sphincter relaxation using botulinum toxin *** To give an overview of all empirical evidence on the effectiveness of botulinum toxin injections in patients with Hirschsprung *** A systematic review and meta-analysis was done by searching PubMed,EMBASE and the Cochrane Library,using entry terms related to:(1)Hirschsprung disease;and(2)Botulinum toxin injections.14 studies representing 278 patients met eligibility *** that were extracted were proportion of patients with improvement of obstructive symptoms or less enterocolitis after injection,proportion of patients with adverse effects and data on type botulinum toxin,mean dose,average age at first injection and patients with associated ***-effects meta-analysis was used to aggregate effects and random-effects meta-regression was used to test for possible confounding *** Botulinum toxin injections are effective in treating obstructive symptoms in on average 66%of patients[event rate(ER)=0.66,P=0.004,I2=49.5,n=278 patients].Type of botulinum toxin,average dose,average age at first injections and proportion of patients with associated syndromes were not predictive for this *** 7 duration of improvement after one botulinum toxin injections was 6.4 mo and patients needed on average 2.6 *** was a significant higher response rate within one month after botulinum toxin injections compared to more than one month after Botulinum toxin injections(ER=0.79,vs ER=0.46,Q=19.37,P<0.001).Botulinum toxin injections were not effective in treating enterocolitis(ER 0.58,P=0.65,I2=71.0,n=52 patients).There wer

关键词： Hirschsprung disease Botulinum toxin Internal anal sphincter Obstructive symptoms Enterocolitis Adverse effects

Improving the outcomes in oncological colorectal surgery

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World Journal of Gastroenterology 2014年第35期20卷 12445-12457页

作者： Jeroen LA van Vugt Kostan W Reisinger joep pm derikx Djamila Boerma Jan HMB Stoot Department of Surgery St Antonius Hospital Department of Surgery Maastricht University Medical Center and Nutrim School for NutritionToxicology and MetabolismMaastricht University Department of Surgery Orbis Medical Center Department of Surgery Atrium Medical Center

During the last several decades,colorectal cancer surgery has experienced some major perioperative *** risk-assessment of nutrition,frailty,and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy,contributed to improved postoperative *** recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient *** an initially indecisive start due to uncertainty about oncological safety,the most significant improvement in intraoperative care was the introduction of *** surgery for colon and rectal cancer is associated with better short-term outcomes,whereas long-term outcomes regarding survival and recurrence rates are ***,long-term results in rectal surgery remain to be *** recognition of anastomotic leakage remains a challenge,though multiple improvements have allowed better management of this complication.

关键词： Laparoscopic surgery Colorectal surgery Anastomotic leakage Frailty Nutritional status Sarcopenia Enhanced recovery after surgery Audits

Human small intestine is capable of restoring barrier function after short ischemic periods

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World Journal of Gastroenterology 2017年第48期23卷 8452-8464页

作者： Dirk HSM Schellekens Inca HR Hundscheid Claire AJI Leenarts joep Grootjans Kaatje Lenaerts Wim A Buurman Cornelis HC Dejong joep pm derikx Department of Surgery Maastricht University Medical Center NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht University Department of Gastroenterology Academic Medical Center MHeNs School of Mental Health and Neuroscience Maastricht University Medical Center Pediatric Surgical Center of Amsterdam Emma Children’s Hospital Academic Medical Center and VU University Medical Center

AIM To assess intestinal barrier function during human intestinal ischemia and reperfusion(IR).METHODS In a human experimental model,6 cm of jejunum was selectively exposed to 30 min of ischemia(I) followed by 30 and 120 min of reperfusion(R). A sham procedure was also performed. Blood and tissue was sampled at all-time points. Functional barrier function was assessed using dual-sugar absorption tests with lactulose(L) and rhamnose(R). Plasma concentrations of citrulline,an amino acid described as marker for enterocyte function were measured as marker of metabolic enterocytes restoration. Damage to the epithelial lining was assessed by immunohistochemistry for tight junctions( TJs),by plasma marker for enterocytes damage(I-FABP) and analyzed by electron microscopy(EM) using lanthanum nitrate as an electrondense *** Plasma L/R ratio's were significantly increased after 30 min of ischemia(30 I) followed by 30 min of reperfusion(30 R) compared to control(0.75 ± 0.10 vs 0.20 ± 0.09,P < 0.05). At 120 min of reperfusion(120 R),ratio's normalized(0.17 ± 0.06) and were not significantly different from control. Plasma levels of I-FABP correlated with plasma L/R ratios measured at the same time points(correlation: 0.467,P < 0.01). TJs staining shows distortion of staining at 30 I. An intact lining of TJs was again observed at 30 I120 R. Electron microscopy analysis revealed disrupted TJs after 30 I with paracellular leakage of lanthanum nitrate,which restored after 30 I120 R. Furthermore,citrulline concentrations closely paralleled the histological perturbations during intestinal *** This study directly correlates histological data with intestinal permeability tests,revealing that the human gut has the ability of to withstand short episodes of ischemia,with morphological and functional recovery of the intestinal barrier within 120 min of reperfusion.

关键词： Intestinal ischemia-reperfusion Intestinal barrier function Intestinal permeability Human Dualsugar absorption test Tight Junctions Citrulline

Generic and disease-specific health-related quality of life in patients with Hirschsprung disease:A systematic review and meta-analysis

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World Journal of Gastroenterology 2022年第13期28卷 1362-1376页

作者： Veerle Huizer Naveen Wijekoon Daniëlle Roorda Jaap Oosterlaan Marc A Benninga LW Ernest van Heurn Shaman Rajindrajith joep pm derikx Department of Pediatric Surgery Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam and Vrije Universiteit AmsterdamAmsterdam Reproduction and DevelopmentAmsterdam 1105 AZNetherlands Department of Surgery University of Colombo and Department of Paediatric SurgeryLady Ridgeway Hospital for ChildrenColombo 00800Sri Lanka Department of Pediatrics Emma Children's HospitalAmsterdam UMCUniversity of AmsterdamEmma Neuroscience GroupAmsterdam Reproduction and DevelopmentAmsterdam 1105 AZNetherlands Department of Pediatrics Lady Ridgeway Hospital for ChildrenColombo 00800Sri Lanka

BACKGROUND Patients with Hirschsprung disease(HD)are at risk of persistent constipation,fecal incontinence or recurrent enterocolitis after surgical treatment,which in turn may impact physical and psychosocial *** health-related quality of life(HRQoL)and disease-specific health-related quality of life are relevant outcome measures to assess the impact of HD on the QoL of these *** To summarize all available evidence on HRQoL of patients with HD after surgery and the impact of possible moderating *** Pubmed,Web of Sciences,Psyc Info and Embase were searched with search terms related to’Hirschsprung disease’,’Pediatrics’and’Quality of life’.Mean and standard deviation of generic HRQoL overall and domain scores were extracted from each study,as well as data describing potential factors associated with *** effect models were used for meta-analytic aggregation of generic HRQoL ***-regression was used to assess the relationship between patient and clinical characteristics and generic ***-specific HRQoL outcomes of patients with HD were systematically *** Seventeen articles were included in the systematic review(n=1137 patients)and 15 in the quantitative meta-analysis(n=1024 patients).Four studies reported disease-specific ***’s age ranged between 0 and 21 ***-analytic aggregation showed a nonsignificantly impaired generic HRQoL(d=-0.168[95%CI:-0.481;0.145],P=0.293,I^(2)=94.9)in patients with HD compared to healthy ***(d=-0.042[95%CI:-0.419;0.335],P=0.829,I^(2)=95.1),psychosocial(d=-0.159[95%CI:-0.458;0.141],P=0.299,I^(2)=93.6)and social HRQoL(d=-0.092[95%CI:-0.642;0.457],P=0.742,I^(2)=92.3)were also not significantly lower compared to healthy *** was no relation between health-related outcomes and the sex of the patients and whether generic HRQoL was measured by parental proxy or ***-specific complaints of patients with HD impaired physical

关键词： Hirschsprung disease Health-related quality of life Meta-analysis Systematic review Pediatrics

Non-invasive markers of gut wall integrity in health and disease

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World Journal of Gastroenterology 2010年第42期16卷 5272-5279页

作者： joep pm derikx Misha DP Luyer Erik Heineman Wim A Buurman Department of Surgery University Hospital Maastricht & Nutrition and Toxicology Research InstituteMaastricht UniversityMaastricht6200 MDThe Netherlands Department of Surgery Orbis Medical Centre Sittard6162 BGThe Netherlands Department of Surgery University Medical Centre Groningen9713 GZThe Netherlands

The intestinal mucosa is responsible for the absorption of nutrients from the lumen and for the separation of the potentially toxic luminal content(external environment) from the host(internal environment).Disruption of this delicate balance at the mucosal interface is the basis for numerous(intestinal) *** animal studies have shown that gut wall integrity loss is involved in the development of various inflammatory syndromes,including post-operative or post-traumatic systemic inflammatory response syndrome,sepsis,and multiple organ *** of gut wall integrity in clinical practice is still a challenge,as it is difficult to evaluate the condition of the gut non-invasively with currently available diagnostic ***,non-invasive,rapid diagnostic means to assess intestinal condition are needed to evaluate the effects of treatment of intestinal *** review provides a survey of non-invasive tests and newly identified markers that can be used to assess gut wall integrity.

关键词： Intestinal damage Markers Human Gut wall integrity

Should primary anastomosis be considered more?A retrospective analysis of anastomotic complications in young children

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World Journal of Pediatric Surgery 2023年第4期6卷 224-230页

作者： Laurens D.Eeftinck Schattenkerk Gijsbert D.Musters Wouter J.de Jonge L.W.(Ernest)van Heurn joep pm derikx Department of Pediatric Surgery Emma Children’s HospitalAmsterdam UMCUniversity of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands Tytgat Institute for Liver and Intestinal Research Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands Department of General VisceralThoracic and Vascular SurgeryUniversity Hospital BonnBonnGermany

Objective Little is known about intestinal anastomotic leakage and stenosis in young children(≤3 years of age).The purpose of this study is to answer the following questions:(1)what is the incidence of anastomotic stenosis and leakage in infants?(2)which surgical diseases entail the highest incidence of anastomotic stenosis and leakage?(3)what are perioperative factors associated with anastomotic stenosis and leakage?Methods Patients who underwent an intestinal anastomosis during primary abdominal surgery in our tertiary referral centre between 1998 and 2018 were retrospectively *** general incidence and incidence per disease of anastomotic complications were *** risk factors(location and type of anastomosis,mode of suturing,and suture resorption time)were evaluated by multivariate Cox regression for anastomotic *** and American Society of Anaesthesiology(ASA)score of≥Ⅲwere evaluated byχ^(2)test for anastomotic *** In total,477 patients underwent an *** most prominent diseases are intestinal atresia(30%),Hirschsprung’s disease(29%),and necrotizing enterocolitis(14%).Anastomotic stenosis developed in 7%(34/468)of the patients with highest occurrence in necrotizing enterocolitis(14%,9/65).Colonic anastomosis was associated with an increased risk of anastomotic stenosis(hazard ratio(HR)=3.6,95%CI 1.8 to 7.5).No technical features(type of anastomosis,suture resorption time and mode of suturing)were significantly associated with stenosis *** leakage developed in 5%(22/477)of the patients,with the highest occurrence in patients with intestinal atresia(6%,9/143).An ASA score of≥Ⅲ(p=0.03)and male gender(p=0.03)were significantly associated with anastomotic *** Both anastomotic stenosis and leakage are major surgical *** more patient specific factors can result in better treatment selection,which should not solely be based on the type of disease.

关键词： anastomosis anastomotic complications

Non-invasive assessment of barrier integrity and function of the human gut

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World Journal of Gastrointestinal Surgery 2010年第3期2卷 61-69页

作者： joep Grootjans Geertje Thuijls Froukje Verdam joep pm derikx Kaatje Lenaerts Wim A Buurman Department of Surgery Maastricht University Medical Center & NUTRIM School for NutritionToxicology and MetabolismUniversiteitssingel 506229 ERMaastrichtThe Netherlands

Over the past decades evidence has been accumulating that intestinal barrier integrity loss plays a key role in the development and perpetuation of a variety of disease states including inflammatory bowel disease and celiac disease,and is a key player in the onset of sepsis and multiple organ failure in situations of intestinal hypoperfusion,including trauma and major *** into gut barrier integrity and function loss is important to improve our knowledge on disease etiology and pathophysiology and contributes to early detection and/or secondary prevention of disease.A variety of tests have been developed to assess intestinal epithelial cell damage,intestinal tight junction status and consequences of intestinal barrier integrity loss,*** intestinal *** review discusses currently available methods for evaluating loss of human intestinal barrier integrity and function.

关键词： Intestinal integrity Intestinal barrier func- tion Intestinal permeability Markers