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Preventive strategies for anastomotic leakage after colorectal resections: A review

World Journal of Meta-Analysis 2019年第8期7卷 389-398页

作者： Mostafa Shalaby waleed thabet Mosaad Morshed Mohamed Farid Pierpaolo Sileri Department of General Surgery Mansoura University Hospitals Mansoura University Dakahliya Mansoura 35516 Egypt Department of General Surgery UOC C Policlinico Tor Vergata Hospital University of Rome Tor Vergata Rome 00133 Italy

Anastomosis is a crucial step in radical cancer surgery. Despite being a daily practice in gastrointestinal surgery, anastomotic leakage (AL) stands as a frequent postoperative complication. Because of increased morbidity, mortality, combined with longer hospital stay, the rate of re-intervention, and poor oncological outcomes, AL is considered the most feared and life-threatening complication after colorectal resections. Furthermore, poor functional outcomes with a higher rate of a permeant stoma in 56% of patients this could negatively affect the patient’s quality of life. This a narrative review which will cover intraoperative anastomotic integrity assessment and preventive measures in order to reduce AL. Although the most important prerequisites for the creation of anastomosis is well-perfused and tension-free anastomosis, surgeons have proposed several preventive measures, which were assumed to reduce the incidence of AL, including antibiotic prophylaxis, intraoperative air leak test, omental pedicle flap, defunctioning stoma, pelvic drain insertion, stapled anastomosis, and general surgical technique. However, lack of clear evidence of which preventive measures is superior over the other combined with the fact that the decision remains based on the surgeon’s choice. Despite the advances in surgical techniques, AL remains a serious health problem associated with increased morbidity, mortality with additional cost. Many preventative measures were employed with no clear evidence supporting the superiority of stapled anastomosis over hand-Sewn anastomosis, coating of the anastomosis, or pelvic drain. Defunctioning stoma, when justified it could decrease the leakage-related complications and the incidence of reoperation. MBP combined with oral antibiotics still recommended.

关键词： Anastomotic leakage Colorectal Resection Anastomosis Cancer Anastomotic disruption

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Efficacy and safety of botulinum toxin in treatment of anismus: A systematic review

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2016年第3期7卷 453-462页

作者： Sameh Hany Emile Hossam Ayman Elfeki Hosam Ghazy Elbanna Mohamed Youssef waleed thabet Tito M Abd El-Hamed Basem Said Ahmed Lotfy General Surgery Department Colorectal Surgery Unit Mansoura Faculty of Medicine Mansoura University

AIM: To evaluate the efficacy and safety of botulinum toxin type A(BTX-A) in the management of patients with anismus. METHODS: An organized search of published literature was conducted using electronic databases including: Pub Med/MEDLINE, and Cochrane Central Register of Control ed Trials, also an internet-based search using "Google Scholar" service was conducted. Both comparative and observational studies were included. We excluded irrelevant articles, editorials, case reports, reviews, and meta-analyses. The studies that followed the patients less than 6 mo were excluded. Variables collected were demographic data of the patients, technique of BTX-A injection and number of sessions, short-term and longterm clinical improvement, post-injection changes in electromyography(EMG), defecography, manometry, and balloon expulsion test, and complications recorded after BTX-A ***: Seven studies comprising 189 patients were included in the review. The median age of the patients was 41.2 years and female-to-male ratio was 1.3:1. The median dose of BTX-A injected per procedure was 100 IU(range, 20-100 IU). Lateral injection was done in five trails and combined lateral and posterior injections in two trials. Three studies used endorectal ultrasonographyguided technique, one study used EMG-guided technique,whereas the remaining three studies used manual palpation with the index finger. The median percentage of patients who reported initial improvement of symptoms was 77.4%(range 37.5%-86.7%), this percentage declined to a median of 46%(range 25%-100%) at 4 mo after injection of BTX-A. Rates of improvement evaluated by balloon expulsion test, EMG, and defecography ranged between(37.5%-80%),(54%-86.7%), and(25%-86.6%), respectively. Fourteen(7.4%) patients developed complications after injection of BTX-A. Complication rates across the studies ranged from 0% to 22.6%. CONCLUSION: Initial satisfactory improvement of symptoms after BTX-A injection remarkably deteriorate

关键词： Botulinum toxin Botulinum toxin type A Botox Anismus Puborectalis syndrome Efficacy

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Place of upper endoscopy before and after bariatric surgery: A multicenter experience with 3219 patients

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World Journal of Gastrointestinal Endoscopy 2016年第10期8卷 409-417页

作者： Mohamed E Abd Ellatif Haitham Alfalah Walid A Asker Ayman E El Nakeeb Alaa Magdy waleed thabet Mohamed A Ghaith Emad Abdallah Rania Shahin Asharf Shoma Ibraheim E Dawoud Ashraf Abbas Asaad F Salama Maged Ali Gamal Department of Surgery Mansoura University Hospital Consultant of Bariatric Surgery King Saud Medial City (KSMS) Gastroenterology Surgical Center Mansoura University Department of Anesthesia Mansoura University Hospital Department of Clinical Pathology Benha University Hospital Department of Surgery Jahra Hospital

AIM: To study the preoperative and postoperative role of upper esophagogastroduodenoscopy(EGD) in morbidly obese patients. METHODS: This is a multicenter retrospective study by reviewing the database of patients who underwent bariatric surgery(laparoscopic sleeve gastrectomy, laparoscopic Roux en Y gastric bypass, or laparoscopic minigastric bypass) in the period between 2001 June and 2015 August(Jahra Hospital-Kuwait, Hafr Elbatin Hospital and King Saud Medical City-KSA, and Mansoura University Hospital- Egypt). Patients with age 18-65 years, body mass index(BMI) > 40, or > 35 with comorbidities after failure of many dietetic regimen and acceptable levels of surgical risk were included in the study after having an informed signed consent. We retrospectively reviewed the medical charts of all morbidly obese patients. The patients' preoperative data included clinical history including upper digestive symptoms and preoperative full workup including EGD. Only patients whose charts revealed weather they were symptomatic or not were studied. We categorized patients accordingly into two groups; with(group A) or without(group B) upper digestive symptoms. The endoscopic findings were categorized into 4 groups based on predetermined criteria. The medical record of patients who developed stricture, leak or bleeding after bariatric surgery was reviewed. Logestic regression analysis was used to identify preoperative predictors that might be associated with abnormal endoscopic findings. RESULTS: Three thousand, two hundred and nineteen patients in the study period underwent bariatric surgery(75% LSG, 10% LRYDB, and 15% MGB). Mean BMI was 43 ± 13, mean age 37 ± 9 years, 79% were female. Twenty eight percent had presented with upper digestive symptoms(group A). EGD was considered normal in 2414(75%) patients(9% group A vs 66% group B, P = 0.001). The abnormal endoscopic findings were found high in those patients with upper digestive symptoms. Abnormal findings(one or more) were fo

关键词： Morbid obesity Obesity surgery Endoscopy Complications Dilation Stenting

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