Reza Fazl Alizadeh

Contemporary management of anastomotic leak after colon surgery: assessing the need for reoperation

BACKGROUND We sought to investigate contemporary management of anastomosis leakage (AL) after colonic anastomosis. METHODS The American College of Surgeons National Surgical Quality Improvement Program database 2012 to 2013 was used to identify patients with AL. Multivariate regression analysis was performed to find predictors of the need for surgical intervention in management of AL. RESULTS A total of 32,280 patients underwent colon resection surgery with 1,240 (3.8%) developing AL. Overall, 43.9% of patients with AL did not require reoperation. Colorectal anastomosis had significantly higher risk of AL compared with ileocolonic anastomosis (adjusted odds ratio [AOR], 1.20; P = .04). However, the rate of need for reoperation was higher for AL in colocolonic anastomosis compared with ileocolonic anastomosis (AOR, 1.48; P = .04). White blood cell count (AOR, 1.07; P < .01), the presence of intra-abdominal infection with leakage (AOR, 1.47; P = .01), and protective stoma (AOR, .43, P = .02) were associated with reoperation after AL. CONCLUSIONS Nonoperative treatment is possible in almost half of the patients with colonic AL. The anatomic location of the anastomosis impacts the risk of AL. Severity of leakage, the presence of a stoma, and general condition of patients determine the need for reoperation.

Association of pre-operative estimated GFR on post-operative pulmonary complications in laparoscopic surgeries

Despite a large body of evidence showing the pandemic of chronic kidney disease, the impact of pre-operative kidney function on the risk of post-operative pulmonary complications (PPCs) is not well known. We used multivariable logistic regression analyses with 3-level hierarchical adjustments to identify the association of pre-operative estimated glomerular filtration rate (eGFR) with PPCs in laparoscopic surgeries. Among 452,213 patients between 2005 and 2013 in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database, a total of 3,727 patients (0.9%) experienced PPCs. We found a gradient association between lower eGFR and higher likelihood of PPCs in the unadjusted model. In the case-mix adjusted model, a reverse-J-shaped association was observed; a small albeit significant association with the highest eGFR category emerged. Further adjustment slightly attenuated these associations, but the PPCs risk in the eGFR groups of <30, 30–60, and ≥120 mL/min/1.73 m2 remained significant: odds ratios (95% confidence intervals) of 1.82 (1.54–2.16), 1.38 (1.24–1.54), and 1.28 (1.07–1.53), respectively (reference: 90–120 mL/min/1.73 m2). Our findings propose a need for careful pre-operative evaluation of cardiovascular and pulmonary functions and post-operative fluid management among patients with not only lower but also very high eGFR.

Venous thromboembolism in common laparoscopic abdominal surgical operations

BACKGROUND Venous thromboembolism (VTE) is potentially a serious postoperative complication. We examined the incidence and outcome of VTE among different laparoscopic abdominal surgical operations for benign diseases. METHODS The National Surgical Quality Improvement Program database was utilized to evaluate all patients with benign disease who underwent laparoscopic abdominal operations including colorectal surgery, bariatric surgery, cholecystectomy, esophageal surgery, abdominal wall hernia repair, and appendectomy from 2005 to 2014. Multivariate logistic regression analysis was performed. RESULTS 750,159 patients were studied and the overall incidence of VTE was 0.32% within 30 days of operation. Colorectal surgery had the highest incidence of VTE (734/65512, 1.12%) with significantly longest length of stay and operative time. Patients who developed VTE had higher mortality and worse outcomes compared to non-VTE patients. CONCLUSIONS Laparoscopic colorectal operations for benign disease is at higher risk for development of VTE compared to other laparoscopic abdominal operations. Further studies should be performed to elucidate the underlying mechanisms for our finding.

An Analysis of Risk Factors, Timing of Complications and Readmission after Pancreaticoduodenectomy

The first successful pancreaticoduodenectomy (PD) was performed and reported by Whipple, Parsons and Mullins in 1935[1]. The authors reported a case series of three patients who underwent a two stage procedure for the treatment of ampullary carcinoma. A one-stage PD was later reported by Trimble in 1941. During the early stages of this procedure, morbidity and mortality were exceedingly high, up to 50% and 30%, respectively [2-4].

Venous thromboembolism in common laparoscopic abdominal surgical operations. - eScholarship

Author(s): Alizadeh, Reza Fazl; Sujatha-Bhaskar, Sarath; Li, Shiri; Stamos, Michael J; Nguyen, Ninh T

Hemorrhoids treatment with transanal hemorrhoidal dearterialization method

RESULTS: There was no mortality within 30 days after surgery. Operation time was 241.66 and 254.84 minutes in EMS group and BS group (p1⁄40.534). In EMS group, open surgery was more frequently performed (67.3% vs 40.0%, p1⁄40.028). There were no differences in length of distal and proximal resection margin (p1⁄40.820 and p1⁄40.620), number of metastatic lymph nodes (p1⁄40.221), flatus passage (p1⁄40.242), diet start (p1⁄40.336), and hospital stay (p1⁄40.444) between the two groups. There was no difference in postoperative morbidity (19.1% vs 24.0%, p1⁄40.762) between the two groups. Mean overall survival (OS) was 86.49 (EMS group) and 115.73 months (BS group), 3-year OS rate was 76.3% (EMS group) and 90.7% (BS group) (p1⁄40.172). Mean disease-free survival (DFS) was 75.87 (EMS group) and 97.82 (BS group), 3-year DFS rate was 77.1% (EMS group) and 76.2% (BS group) (p1⁄40.929).