Background: The main purpose was to assess the efficacy of negative pressure wound therapy (NPWT) for surgical site infection (SSI) in elective open and laparoscopic open-assisted colorectal surgery. The primary end point was to establish SSI within 30 days post-operatively. The secondary aim was hospital stay and to assess SSI predictors in a multivariable analysis. Patients and Methods: A prospective cohort study was undertaken between January 2017 and December 2018 in patients undergoing elective colorectal surgery, both through open and minimally invasive approaches, to whom NPWT or fully occlusive dressing were applied. Baseline data were compared between the two groups and multivariable analysis was performed to identify SSI risk factors. Results: Two hundred patients were included: 100 NPWT patients and 100 closed dressing patients. No differences between the two groups were found. The incidence of SSI in the control dressing group was 19% versus 9% in the NPWT group, which was substantially different (odds ratio [OR] 0.30; 95% confidence interval [CI] 0.11–0.83; p = 0.02). No differences were found in hospital length of stay (12.33 d in NPWT group vs. 12.39 d in the control group; p = 0.82). A body mass index (BMI) of 30–35 (p = 0.04), BMI >35 (p = 0.03), and midline wound (p = 2.68) were found to be predictors of SSI in multivariable analysis. Conclusion: The prophylactic use of NPWT in laparotomy incisions for patients undergoing elective colorectal surgery (both through open and laparoscopic approach) is associated with a reduction in SSI rates.

Duodenal stump fistula (DSF) after gastrectomy has a low incidence but a high morbidity and mortality, and is therefore one of the most aggressive and feared complications of this procedure.We retrospectively evaluated all DSF occurred at our hospital after carrying out a gastrectomy for gastric cancer, between January 1997 and December 2014. We analyzed demographic, oncologic, and surgical variables, and the evolution in terms of morbidity, mortality and hospital stay.In the period covered in this study, we performed 666 gastrectomies and observed DSF in 13 patients (1.95%). In 8 of the 13 patients (61.5%) surgery was the treatment of choice and in 5 cases (38.5%) conservative treatment was carried out. Postoperative mortality associated with DSF was 46.2% (6 cases). In the surgical group, 3 patients developed severe sepsis with multiple organ failure, 2 patients presented a major hematemesis which required endoscopic haemostasis, 1 patient had an evisceration and another presented a subphrenic abscess requiring percutaneous drainage. Six patients (75%) died despite surgery, with 3 deaths in the first 24 hours of postoperative care. The 2 patients who survived after the second surgical procedure had a hospital stay of 45 and 84 days respectively. In the conservative treatment group the cure rate was 100% with no significant complications and an average postoperative hospital stay of 39.5 days (range, 26-65 days).FMD is an unusual complication but it is associated with a high morbidity and mortality. In our experience, conservative management has shown better results compared with surgical treatment.

Although acute anastomotic leakage following low anterior resections occurs at a significant rate (up to 15 % of cases), and represents a major cause of morbidity and mortality, there is no general consensus among surgeons and endoscopists on how best to treat it. In cases of high-flow peritoneal leak, surgery is the only choice; but for low-flow leaks, which lead to abscess formation, there are many different options, including minimally invasive treatment choices such as endoscopic clips (like over-the-scope clips) to close the internal ostium of the fistula, stenting, or the use of tissue glues such as fibrin or cyanoacrylate sealants. Compared with fibrin sealants, cyanoacrylate glues have the advantage of working well in wet environments and also have antibacterial properties, making them useful for contaminated sites. Generally, endoscopic debridement is needed beforehand. Following application of the bioglue, a strong foreign-body reaction sets in, promoting tissue healing, and within 10 – 15 days the bioglue clot falls off [1]. More recent data have shown the safety and efficacy of cyanoacrylate instillation for management of gastrointestinal anastomotic leakage [2] [3], although there are no controlled series with colorectal anastomosis. All authors recommend cyanoacrylate instillation for fistulas with small openings, and advise that repeated instillations may be necessary to ensure fistula obliteration – as also happened in the case we report. It should be noted that it is undesirable to completely fill the cavity with cyanoacrylates, especially in medium-to-large abscesses or long fistula tracts, as this can lead to chronic sinus formation; the recommendation is to seal only the internal ostium of the fistula [1], or to perform combined obliterations using fibrin sealants to fill the cavity and fistula tract and cyanoacrylates to close the internal ostium [2]. In some cases when percutaneous drainage of an abscess is performed with a persistent fistula tract, cyanoacrylates can also be instilled through the catheter to fill the cavity and fistula tract [4] [5], enabling a combined percutaneous – endoscopic approach. We present a case of acute anastomotic leakage following low colorectal anastomosis ([Video 1]) with fully endoscopic management, including confirmation of the diagnosis ([Fig. 1]), closure of the fistula tract with cyanoacrylate bioglue in two consecutive instillations ([Fig. 2], [Fig.3]), and subsequent healing of the anastomosis within 15 days ([Fig. 4]). Video 1 A case of acute anastomotic leakage following low colorectal anastomosis managed endoscopically using cyanoacrylate bioglue to seal the fistula tract. Endoscopy_UCTN_Code_TTT_1AQ_2AG Publication Date: 05 August 2020 (online) © Georg Thieme Verlag KG Stuttgart · New York

Background/Objectives: Anastomotic leakage (AL) is one of the most concerning complications following gastrectomy. The aim of this study was to assess and compare the predictive accuracy of C-reactive protein (CRP), procalcitonin (PCT), the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), fibrinogen, and the mean platelet volume (MPV) in the early diagnosis of post-gastrectomy AL. Methods: A prospective bicentric observational study was conducted including all patients undergoing elective gastrectomy between August 2018 and December 2022. The performance of the selected biomarkers in predicting the existence of AL within the first 7 postoperative days (PODs) was assessed. Results: A total of 107 patients were included for analysis. The incidence of AL was 20.56%, and the median day of diagnosis was on POD5 (interquartile range 4–6). CRP, PCT, the NLR, the PLR, and fibrinogen showed significant associations with the presence of AL (from POD2 for CRP and fibrinogen and from POD3 for PCT, NLR, and PLR). CRP demonstrated a superior predictive accuracy on POD4, with a threshold value of 181.4 mg/L (NPV 99%; AUC 0.87, p < 0.001); PCT demonstrated a superior predictive accuracy on POD7, with a threshold value of 0.13 μg/L (NPV 98%; AUC 0.84, p < 0.001); the NLR showed a superior predictive accuracy on POD6, with a threshold ratio of 6.77 (NPV 95%; AUC 0.86, p < 0.001); the PLR achieved a superior predictive accuracy on POD7, with a ratio of 234 (NPV 98%; AUC 0.71; p = 0.002); and fibrinogen demonstrated a superior predictive accuracy on POD5, with a threshold of 7.344 g/L (NPV 98%; AUC 0.74; p = 0.003). In the comparison of predictive accuracy, CPR, PCT, and the NLR were found to be superior to all other biomarkers. Conclusions: CRP, PCT, and the NLR are biomarkers with a sufficient predictive ability to clinically discard the presence of AL within the first postoperative week.