Sami A. Chadi

Emerging Trends in the Etiology, Prevention, and Treatment of Gastrointestinal Anastomotic Leakage

Anastomotic leaks represent one of the most alarming complications following any gastrointestinal anastomosis due to the substantial effects on post-operative morbidity and mortality of the patient with long-lasting effects on the functional and oncologic outcomes. There is a lack of consensus related to the definition of an anastomotic leak, with a variety of options for prevention and management. A number of patient-related and technical risk factors have been found to be associated with the development of an anastomotic leak and have inspired the development of various preventative measures and technologies. The International Multispecialty Anastomotic Leak Global Improvement Exchange group was convened to establish a consensus on the definition of an anastomotic leak as well as to discuss the various diagnostic, preventative, and management measures currently available.

Survival following salvage abdominoperineal resection for persistent and recurrent squamous cell carcinoma of the anus: do these disease categories affect survival?

This study aimed to investigate the results of salvage abdominoperineal excision (APR) in patients with persistent or recurrent squamous cell carcinoma of the anus (SCCA).

Faecal incontinence in patients with a sphincter defect: comparison of sphincteroplasty and sacral nerve stimulation

Sphincteroplasty (SP) is used to treat faecal incontinence (FI) in patients with a sphincter defect. Although sacral nerve stimulation (SNS) is used in patients, its outcome in patients with a sphincter defect has not been definitively evaluated. We compared the results of SP and SNS for FI associated with a sphincter defect.

The impact of surgeon laparoscopic training and case volume of laparoscopic surgery on conversion during elective laparoscopic colorectal surgery.

The study aimed to determine whether laparoscopic volume and type of training influence conversion during elective laparoscopic colorectal surgery.

Hepatic microvascular changes in rat abdominal compartment syndrome

BACKGROUND Abdominal compartment syndrome (ACS) is associated with an increased rate of multiple organ dysfunction and is an independent marker for mortality. Our objective was to develop an animal model to study the mechanisms of tissue and microvascular injury associated with ACS at the microscopic level. MATERIALS AND METHODS ACS was established in rats with CO₂ insufflation at 20 mm Hg for 2 h, with an abdominal cast. Sinusoidal perfusion, inflammatory response, and cell death were quantified in exteriorized livers. Respiratory and renal dysfunction were assessed biochemically and morphologically. Myeloperoxidase levels, a marker of neutrophil activation, were measured in the liver, lung, and small intestine. RESULTS Continuously perfused sinusoids were significantly lower in the ACS group (81.4 ± 2.2% versus 99.6% ± 0.50), with an increase in nonperfused and intermittently perfused sinusoids (P < 0.05). Hepatocellular death and the number of activated leukocytes in postsinusoidal venules showed 7- and 18-fold increases, respectively, in the ACS group (P < 0.05). A significant increase in blood urea nitrogen levels in experimental rats was also observed. Myeloperoxidase levels were found to be 8-fold higher in lungs of ACS rats relative to control (P < 0.05), as well as statistically significant increase in the pCO₂ and decrease in pH of ACS rats. CONCLUSIONS We have successfully developed a model of ACS with documented evidence of renal and respiratory dysfunction. In addition, we have microscopy-confirmed evidence of early inflammatory changes and perfusion deficits in the liver with a concomitant increase in cell death in the ACS group.

Sacral neuromodulation for the treatment of faecal incontinence following proctectomy.

This study assessed the effectiveness of sacral neuromodulation (SNM) for faecal incontinence (FI) following proctectomy with colorectal or coloanal anastomosis.

Surgeon perspectives on the use and effects of neoadjuvant chemoradiation in the treatment of rectal cancer: a comprehensive review of the literature

BackgroundDespite screening initiatives, rectal cancer remains one of the most prevalent malignancies diagnosed in patients worldwide with a high mortality. The introduction of neoadjuvant therapy has resulted in a paradigm shift in the treatment and outcomes of rectal cancer. Surgeons play an intricate role in the pre-operative, operative, and post-operative management of these patients.PurposeThe purpose of this comprehensive literature review was to summarize the evolution of the use chemotherapy and radiation and the process of differentiation into specific neoadjuvant chemoradiation protocols in the treatment of locally advanced rectal cancer. This will provide a concise summary for practicing surgeons of the current evidence for neoadjuvant chemoradiation as well as the various implications of therapy on operative outcomes.ConclusionThe initial benefit of adjuvant therapy in the treatment of rectal cancer patients became evident with prospective studies demonstrating improvements in various oncologic survival outcomes. Due to the improved compliance and reduced toxicity, as well as the potential for tumor down-staging and sphincter preservation, neoadjuvant approaches became the preferred method of administering chemotherapy and radiation. Furthermore, a subgroup of patients has been shown to present with complete clinical response to neoadjuvant therapy. This has resulted in the development of the non-operative “watch and wait” approach, which has initiated discussions on changing the interval from the completion of neoadjuvant therapy to surgical resection. The continued development of the multidisciplinary approach will only further improve our ability to provide patients with the best possible oncologic outcomes.

896 The Clinical Utility of Over the Scope Clip in the Treatment of Gastrointestinal Defects

Background The over-the-scope clip (OTSC) is a novel endoscopic tool that enables non-surgical management of gastrointestinal (GI) defects. The aim of this study was to report our experience with OTSC for patients with GI defects.

PTU-169 Comparison between sphincteroplasty and sacral nerve stimulation for treat-ment of anal incontinence patients with sphincter injuries

Introduction This study aimed to compare outcomes of patients with anal sphincter defects treated by sacral nerve stimulation (SNS) or sphincteroplasty (SP). Method After IRB approval, patients treated for FI with a sphincter defect were identified from a prospective database; treatment groups were matched and stratified by SNS or SP. Primary outcome was change in Wexner FI Score (FIS). Demographic variables, past medical history and complication rates were also reviewed. Sphincter defects were assessed by endoanal ultrasound and ranged from 45°–180°. Continuous variables were compared with independent t-tests or Mann-Whitney U tests based on evidence of Gaussian distribution. Categorical variables were compared with Chi-squared analyses. Paired within group analyses were performed with paired t-tests and Wilcoxon signed-rank test. In order to perform a paired assessment of the role of each intervention in affecting the FIS, an Analysis of Covariance (ANCOVA) was performed. Results 26 female patients were included, 13 each underwent sphincteroplasty or SNS. The groups were similar with regards to age (62.2 vs 57.2 years, p = 0.16), BMI (26.2 vs 26.5, p = 0.33), initial FIS (15.9 vs 16.8, p = 0.39) and follow-up (14 vs 10 months, p = 0.72). The groups were similar for >1 vaginal delivery or rates of urinary incontinence (p = 1.00 and p = 0.62, respectively). Early postoperative complications included 1 patient in each group with wound infection. Within group analyses revealed a significant improvement of FIS in SNS patients (15.9 to 8.4; p = 0.003) but not observed in the SP group (16.9 to 12.9; p = 0.078). Between groups, a trend towards lower FIS was seen in the SNS group as compared to SP but was not significant (8.4 vs 12.9; p = 0.06). ANCOVA analysis did reveal either procedure as superior in reducing FIS. Conclusion This study demonstrates that within each group SNS is effective at reducing FI in patients with a sphincter defect. Larger sample sizes will be required to better compare the difference in scores and assess for superiority between procedures. Disclosure of interest None Declared.

PTU-165 Outcomes of re-implantation of sacral neurostimulation for faecal incon-tinence are similar to those of first time implants

Introduction There is a paucity of data related to the outcome of sacral neurostimulation (SNS) device re-implantation for faecal incontinence (FI). This study aimed to determine the outcomes of re-implantation of SNS for FI. Method An IRB approved retrospective review of prospectively collected data of patients with FI receiving SNS was performed. Demographic variables, co-morbidities, operative details, reportable events, and functional outcomes were analysed. Continuous variables were assessed for Gaussian distribution. Non-parametric variables were compared with the Mann-Whitney test, and normally distributed variables were compared with an independent samples t-test. In assessing the role of each intervention in decreasing FI score (FIS) comparatively, an analysis of covariance was performed (ANCOVA). Results 115 patients (mean age 58.5 ± 15 years, 98 females) had implantation of SNS device from 2010–2014. 13% (15/115) underwent lead re-implantation. Implanted and re-implanted groups had similar demographics, co-morbidities, complication, and explantation rates. Operative time was significantly higher in the re-implanted group (first implanted 56.7 ± 17 min; re-implanted 70.1 ± 33 min; p = 0.01). Most common reason for re-implantation was lead-related in 33% (5/15). Loss of efficacy was identified in 20% (3/15) as was lack of efficacy 20% (3/15). Infection was observed in 20% (3/15) of patients, all of whom failed antibiotic therapy and were explanted. A significant decrease in FIS was seen in patients with a first time implantation (median FIS 16 to 7; p < 0.001), and re-implanted patients (median FIS 18 to 12.5; p = 0.036). There was an identifiable difference in preoperative FIS between groups (median FIS implanted 16, re-implanted 18; p = 0.036). ANCOVA analysis did not reveal superiority of either procedure in decreasing FIS (p = 0.284). Conclusion Reimplantation of SNS is feasible and has similar outcomes as first time implantation. Failure and explantation of SNS should not preclude subsequent reimplantation. Disclosure of interest None Declared.