Adhesion-related readmissions after open and laparoscopic surgery: a retrospective cohort study (SCAR update)

Krielen, Pepijn; Stommel, Martijn W J; Pargmae, Pille; Bouvy, Nicole D.; Bakkum, Erica A.; Ellis, Harold; Parker, Michael; Griffiths, Ewen; Goor, Harry van; Broek, Richard P. G. ten

doi:10.1016/s0140-6736(19)32636-4

Cited by 142 publications

(119 citation statements)

References 20 publications

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“…Of note, we found that adhesions were mild and further radical D2 lymph node dissection was easily feasible, which we attributed to the initial laparoscopy. These results were consistent with a recent meta‐analysis and systematic review of the long‐term outcomes of laparoscopic surgery 16 …”

Section: Discussionsupporting

confidence: 92%

“…These results were consistent with a recent meta-analysis and systematic review of the long-term outcomes of laparoscopic surgery. 16 Self-expanding metal stents are associated with low morbidity and mortality, with a potentially earlier improvement of oral intake compared to gastrojejunostomy. [17][18][19] However, this procedure can lead to a high rate of re-interventions because of tumor overgrowth or ingrowth, stent migration, or angulation.…”

Section: Postoperative Complicationmentioning

confidence: 99%

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Staged laparoscopic management of locally advanced gastric cancer with outlet obstruction

Zang

Hao

et al. 2021

Journal of Surgical Oncology

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Background: The prognosis of patients with locally advanced gastric cancer with outlet obstruction is poor. Gastrectomy with curative intent is often initially impossible or difficult.Objective: We report our experience of curative distal gastrectomy after laparoscopic gastrojejunostomy and fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy to examine the feasibility and safety of this modified strategy for locally advanced gastric cancer with outlet obstruction, initially deemed unresectable.Methods: Between October 2017 and June 2019, 15 patients diagnosed with locally advanced gastric cancer with outlet obstruction sequentially underwent gastrojejunostomy, received four cycles of FLOT chemotherapy, and underwent laparoscopic distal gastrectomy with curative intent (R0 resection + D2 lymphadenectomy). Clinical data were retrospectively collected and analyzed. Results: R0 resection was possible in 12/15 patients, laparoscopically in 11, and one conversion to laparotomy was necessary. There was no perioperative mortality in the 12 patients. Pathologic evaluation of the resected specimens revealed that complete tumor grade regression 1a (TRG1a), TRG1b, TRG2, and TRG3 occurred in 3, 2, 4, and 3 patients, respectively. Conclusion:This case series showed that curative surgical resection was feasible as a staged approach for patients with locally advanced gastric cancer with outlet obstruction, after initial staged gastrojejunostomy and chemotherapy.

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Section: Discussionsupporting

confidence: 92%

Section: Postoperative Complicationmentioning

confidence: 99%

Staged laparoscopic management of locally advanced gastric cancer with outlet obstruction

Zang

Hao

et al. 2021

Journal of Surgical Oncology

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“…Moreover, patients in the experimental group received laparoscopic surgery less frequently, compared to those in the control group (74.6% vs. 87.7%). The surgical approach may influence the development of postoperative abdominal adhesions [ 32 ]. However, studies comparing the adhesion risk in laparoscopy versus that in laparotomy have given mixed results [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Thermo-Sensitive Sol–Gel Anti-Adhesion Agent after Gynecologic Surgery

Kim

Lee

Seol

et al. 2020

JCM

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Postoperative abdominal adhesions can lead to several adverse consequences such as pelvic pain, bowel obstruction, and infertility. We aimed to explore the anti-adhesion efficacy and safety of a thermo-sensitive sol–gel agent in patients who receive abdominopelvic surgery for benign gynecologic disease. This study was a randomized, controlled, single-blind clinical trial of women undergoing benign gynecologic surgery between January 2017 and December 2017. The patients were randomly assigned to three groups with a 1:1:1 ratio: experimental group (received the thermo-sensitive sol–gel agent), control group (untreated), and comparator group (received 4% icodextrin). Patients were followed for 4 weeks postoperatively, and efficacy was evaluated by performing the visceral slide test to identify adhesion formation. In total, 183 patients were enrolled in the study, and 178 (97.3%) completed the trial. The incidence rate of abdominal adhesion formation was significantly lower in the experimental group than in the control group (7.9% vs. 21.1%, p = 0.040); however, it was similar between the experimental and comparator groups (7.9% vs. 13.8%. p = 0.299). At 4 weeks, no differences in adhesion-related symptoms were observed between the experimental and control groups. Adverse events were mostly mild and did not differ significantly among the three groups (p = 0.375). In conclusion, use of a thermo-sensitive sol–gel agent was safe and effective to prevent abdominal adhesions after benign gynecologic surgeries.

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“…The incidence of small bowel obstruction due to peritoneal adhesions after abdominal surgery is 2.1%-4.6% [74,75]. In the era of laparoscopy, the incidence of postoperative adhesions and the rate of re-admissions directly related to adhesions have been significantly reduced after colorectal surgery [76,77]. However, postoperative adhesions still represent a significant burden and a cause for increased costs [77].…”

Section: Postoperative Adhesionsmentioning

confidence: 99%

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

et al. 2021

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Background The gut microbiota (GM) has been proposed as one of the main determinants of colorectal surgery complications and theorized as the “missing factor” that could explain still poorly understood complications. Herein, we investigate this theory and report the current evidence on the role of the GM in colorectal surgery. Methods We first present the findings associating the role of the GM with the physiological response to surgery. Second, the change in GM composition during and after surgery and its association with colorectal surgery complications (ileus, adhesions, surgical-site infections, anastomotic leak, and diversion colitis) are reviewed. Finally, we present the findings linking GM science to the application of the enhanced recovery after surgery (ERAS) protocol, for the use of oral antibiotics with mechanical bowel preparation and for the administration of probiotics/synbiotics. Results According to preclinical and translational evidence, the GM is capable of influencing colorectal surgery outcomes. Clinical evidence supports the application of an ERAS protocol and the preoperative administration of multistrain probiotics/synbiotics. GM manipulation with oral antibiotics with mechanical bowel preparation still has uncertain benefits in right-sided colic resection but is very promising for left-sided colic resection. Conclusions The GM may be a determinant of colorectal surgery outcomes. There is an emerging need to implement translational research on the topic. Future clinical studies should clarify the composition of preoperative and postoperative GM and the impact of the GM on different colorectal surgery complications and should assess the validity of GM-targeted measures in effectively reducing complications for all colorectal surgery locations.

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Adhesion-related readmissions after open and laparoscopic surgery: a retrospective cohort study (SCAR update)

Cited by 142 publications

References 20 publications

Staged laparoscopic management of locally advanced gastric cancer with outlet obstruction

Staged laparoscopic management of locally advanced gastric cancer with outlet obstruction

A Randomized Controlled Trial of Thermo-Sensitive Sol–Gel Anti-Adhesion Agent after Gynecologic Surgery

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

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