H. Hande Aydinli

Troponin elevation after colorectal surgery: Significance and management

Objective: The aim of this study is to identify the association between early postoperative troponin elevations and outcomes after major colorectal surgery. Background: Myocardial infarction is the leading cause of death after noncardiac surgery. Most postoperative myocardial infarctions are clinically silent, and asymptomatic troponin elevations have the same early mortality as symptomatic infarctions. Methods: Patients over the age of 45, undergoing major colorectal surgery from March 2015 to January 2016, were identified. Plasma troponin T concentrations were prospectively collected within 24 and 48 hours after surgery. Characteristics, evaluations, management, and outcomes of patients with elevated troponin concentrations were analyzed. Mortality within the follow-up period was the primary end point. Results: A total of 1020 patients were screened with postoperative troponin concentrations. Fifty patients had troponin concentrations >0.01 ng/mL. Patients rarely (16%) had ischemic symptoms. Cardiology was consulted for 23 patients and started on medical therapy. Seventeen of these patients were alive at follow-up. Ten patients (20%) with troponin concentrations >0.01 ng/mL died within the follow-up period, 7 of which had concentrations ≥0.03 ng/mL. Conclusions: Most postoperative myocardial injury is asymptomatic and may only be detected by routine troponin screening. Elevated troponin concentrations after colorectal surgery may facilitate identifying patients at postoperative risk and prompt appropriate testing. Early intervention in select patients may lead to potential reduction of mortality after major colorectal surgery.

The usefulness of the H-pouch configuration in salvage surgery for failed ileal pouches

Abdominal salvage surgery for a failed ileal pouch–anal anastomosis (5) is safe and feasible in experienced hands. When salvaging an ileal pouch or creating a new J, S or W pouch may not be feasible, construction of an H‐pouch may be the final option. This study reports a single colorectal surgeons experience on H‐pouch anal anastomosis in patients referred with a failed ileal pouch.

Robotic Ileocolic Resection with Intracorporeal Anastomosis for Complex Crohn's Disease

A robotic approach to colorectal surgery offers similar morbidity and mortality to conventional laparoscopy. As surgeons have gained more experience, and the da Vinci Xi® has enabled multiquadrant surgery, a robotic platform has been used for increasingly complex procedures such as resections for Crohns disease(CD). Three-dimensional, high-definition visualization, increased dexterity, availability of the wristed instruments, and use of simultaneous energy devices provide additional technical benefits in the management of CD with robotic platform. This article is protected by copyright. All rights reserved.

Conventional vs Single Port Approaches to Laparoscopic Colectomy

Multiple multicentered randomized clinical trials confirming the safety, efficacy and benefits of laparoscopy have arguably made minimally invasive surgery the new standard of care for colon resection. Both European and American multicenter randomized clinical trials (RTC) demonstrate improved short-term and comparable long-term outcomes with laparoscopic versus open colon resection [1–7].

Minimally invasive approach to complicated Crohn's disease in four different cases - a video vignette

Dear Sir, Morgagni hernia is a rare diaphragmatic defect that results from a congenital failure of the pars sternalis to fuse with the costal arches [1]. Many authors advocate surgical repair for this type of hernia, even if it is asymptomatic [2]. The video vignette (Video S1) presents the laparoscopic repair of a Morgagni hernia. A 32-year-old male patient presented with a 2-month history of dyspnoea and abdominal discomfort. The patient had no previous history of operations or major trauma. CT scan revealed a large Morgagni hernia containing omental fat. A laparoscopic repair was performed. The patient was placed in the reverse Trendelenburg position under general anaesthesia and three trocars were used. The hernia content was easily reduced with gentle traction. The hernia sac was dissected free with mostly blunt dissection and resected. The suture of the free edge of the diaphragm to the anterior abdominal wall was performed using non-absorbable mattress sutures. A synthetic mesh was sutured and tacked in place to strengthen the repair. The postoperative course was uneventful and the patient was discharged on the fifth postoperative day. Follow-up CT scan showed no hernia recurrence and the patient remains symptom-free 5 years after the surgery. Laparoscopic repair of Morgagni hernias offers the diagnostic and therapeutic advantages of a minimally invasive approach.

Surgical management of complex fistulizing Crohn's disease - a video vignette.

anorectal junction and a J-ileal-pouch, with each limb measuring 15–20 cm, was created extracorporeally. An intracorporeal anastomosis was created, which was covered by a diverting loop ileostomy. The patient recovered without any complication and at 3 months, as a third stage of the RPC, the ileostomy was closed and recovery was uneventful. Single-port laparoscopic RPC with IPAA through the LLQ ileostomy site is technically feasible and safe.

Minimally invasive management of colonoscopic perforation during polypectomy – a video vignette

The incidence of perforation during diagnostic colonoscopy is about 0.4%, with an increase of up to 0.8% when polypectomy is undertaken.1 Perforation often requires an emergency laparotomy. Minimally invasive surgery is now routine for elective colorectal surgery, but its place in the emergency setting often depends on the preference of the individual surgeon and is not well defined.2,3 This article is protected by copyright. All rights reserved.

Laparoscopic ileocolic resection with intracorporeal anastomosis for fistulizing Crohn's disease using a reduced port technique - a video vignette.

Initially laparoscopic surgery for Crohns disease was not attempted especially in cases with extensive inflammation, thickened mesentery and adhesions. With the benefit of laparoscopy and greater surgical experience, the laparoscopic approach has been increasingly used for fistulising Crohns disease. This article is protected by copyright. All rights reserved.