Background Enhanced recovery after surgery (ERAS) protocols are widely employed in colorectal surgery, successful in reducing postoperative morbidities and hospital length of stay (LOS). However, ERAS effects on the inflammatory bowel disease population remain unclear. This study examines the postoperative course of both Crohn’s disease (CD) and colon cancer (CC) patients after elective right hemicolectomies and compares the effectiveness of ERAS protocol. Methods A retrospective analysis was performed on patients with CD and CC undergoing elective right hemicolectomies and ileocecectomies from January 2014 through June 2016 (pre-ERAS) and January 2017 through April 2019 (post-ERAS) from a single tertiary care center. Patient demographics and perioperative variables were examined, including prolonged postoperative ileus (PPOI), hospital LOS, and 30-day readmission. Results 98 CC patients and 91 CD patients met the inclusion criteria. The pre-ERAS CC and post-ERAS CC cohorts were significantly different: post-ERAS had fewer patients with congestive heart failure and chronic obstructive pulmonary disease and had higher albumin levels. The pre-ERAS CC cohort had significantly longer operative durations and higher rates of concomitant procedures than the post-ERAS CC cohort. Both patients with CC and CD had a reduction in LOS with implementation of ERAS, decreasing by 2.24 days ( P = .002) and 1.21 days ( P = .038), respectively. There was a reduction in rates of organ space infections with CD (pre .132, post .00, P = .007). There was a trend towards an increased rate of PPOI with CD (Pre .079, Post .226, P = .062). Discussion The ERAS protocol significantly reduced LOS for both groups, without increasing 30-day readmission rates or other morbidities.

The current management of persistent biliary fistula includes biliary stenting and peritoneal drainage. Endoscopic retrograde cholangiopancreatography (ERCP) is preferred over percutaneous techniques and surgery. However, in patients with modified gastric anatomy, ERCP may not be feasible without added morbidity. We describe a 37-year-old woman with traumatic biliary fistula, large volume choleperitonitis and abdominal compartment syndrome following a motor vehicle collision who was treated with laparoscopic drainage, lavage and biliary drain placement via percutaneous transhepatic cholangiography.

Background: Traditional protocols describe emptying procedures such as pyloroplasty and/or pyloromyotomy after an esophagectomy to improve gastric emptying. Pyloric Botox injections as well as pyloric dilation are safe alternatives that help to unwanted side effects such as. Few studies compare Botox and pyloric dilation specifically. Our study proposes to compare Botox alone with Botox and pyloric dilation.Methods: Data was gathered from one institution from 2010 to 2016. A total of sixty-four patients with esophageal cancer or high-grade dysplasia requiring esophagectomy were included. Patients that did not receive Botox or pyloric dilation were excluded from study. Endoscopic placement of 20 mm CRE TM balloon dilator was inflated to six atmospheres for a duration of 5 minutes. Two hundred units of Botox mixed in 5 cc of normal saline was injected into the pylorus via an extraluminal approach. Chi square and Fisher's exact tests analyzed categorical variables.Results: Sixty-three patients met the inclusion criteria and underwent retrospective chart review. The dual therapy group included 46 (73%) patients. The single therapy group included 17 (27%) of which 14 (22%) received Botox alone and 3 (5%) underwent dilation alone. The average age of patients in this study was 63; 75% of whom were males. The majority (75%) of pathology was adenocarcinoma. Delayed gastric emptying was noted in 9 (20%) in the dual therapy group and 7 (41%) in the single therapy group who underwent Botox only (P=0.08). Anastomotic leak was identified in a total of 4 (6%) patients. In the single therapy group, 1 of 17 patients (6%) experienced an anastomotic leak and three (4%) of the 46 patients in the dual therapy group experienced an anastomotic leak (P=0.8). The median length of stay in the single therapy group was 16 days (range, 2-35 days) compared to 10 days (range, 6-20 days) in the dual therapy group (P=0.034). The single therapy group had 4 patients with a length of stay greater than 21 days (range, 23-35 days) compared to 1 patient in the dual therapy.Conclusions: Adding both Botox and pyloric dilation as a combined procedure may improve patient outcomes after minimally invasive esophagectomy. In some centers intervention with Botox and balloon dilation at the time of esophagectomy may be justified to reduce risks and time associated with traditional procedures. The ease with which these procedures are performed compared to the more traditional pyloromyotomy and pyloroplasty, justifies their use.