Prophylactic Ureteral Stent Placement vs No Ureteral Stent Placement During Open Colectomy

Abstract

rate increased after RYGB to 28% at 1 year (21 patients), 31% at 5 years (23 patients), and 47% at 10 years (35 patients) (Figure 1).At 10 years after RYGB, the anemia rate in the cohort without bariatric specialist follow-up (n = 58) increased to 33 patients (57%), from 13 (22%) before surgery (P < .001). The rate of anemia in the cohort with bariatric specialist follow-up (n = 16) did not increase significantly after 10 years (3 [19%] vs 2 [13%]; P = .07) (Figure 2). Compared with patients with bariatric specialist follow-up, patients without bariatric specialist follow-up had significantly higher odds of anemia at 10 years (odds ratio, 6.1; 95% CI, 1.4-27.6; P = .02) after adjusting for preoperative anemia.Discussion | Long-term complications of RYGB, such as anemia, may go unrecognized by nonbariatric specialists. Causes include iron, vitamin B 12 , and folate deficiency; less common causes include copper, vitamin A, and selenium deficiency and bleeding marginal ulcers. We found high anemia rates 10 years after RYGB; these rates may reflect a mixed vitamin and mineral deficiency, because patients had normocytic anemia. Our study suggests that follow-up with bariatric specialists more than 5 years after surgery, rather than with specialists with no bariatric expertise, can decrease long-term anemia risk. This finding may demonstrate the bariatric specialist's specific understanding of the long-term risk for nutritional deficiency after RYGB and the importance of vitamin and mineral supplementation. All patients receiving iron supplements who still had anemia at 10 years were in the group without bariatric specialist follow-up (n = 11), a finding suggesting an inappropriate choice of treatment or inadequate follow-up. No similar effect of follow-up was observed for other long-term outcomes, such as excess weight loss and medication requirements.This study emphasizes the importance of long-term specialty-specific follow-up for bariatric surgery. The major limitation of this study was the size of the cohort with bariatric specialist follow-up, which may be too small to identify a significant difference in the 10-year anemia rates compared with preoperative rates. Nonetheless, the significant difference observed in the cohort without bariatric specialist follow-up suggests an opportunity for an intervention to improve follow-up and decrease anemia rates and other long-term complications. Long-term follow-up should be an integral part of bariatric programs, and additional studies are needed to identify potential barriers to successful follow-up. In the VA population, such barriers include distance from a bariatric center and lower socioeconomic status. We implemented a hub-andspoke model for bariatric care, including health care specialist education, in which the bariatric team communicates regularly with the patient's primary care clinician before and after surgery. 6 This model may prove to be an effective tool to overcome such barriers and improve outcomes.

Intraureteral indocyanine green augments ureteral identification and avoidance during complex robotic‐assisted colorectal surgery

“…In addition, we noted very low rates of new-onset urinary symptoms, which included a 6% incidence of haematuria, urinary tract infection and acute kidney injury. While direct comparison with externalized ureteral stenting without a control group is limited, these numbers compare favourably with historically reported incidence of haematuria (14%), urinary tract infection (17%) and acute kidney injury (33%) for traditional stents and haematuria (98%), renal insufficiency (6%) and postoperative urinary retention (4%) for lighted stents [13,14,21,22]. Our low procedural morbidity and complication rate with intraureteral ICG is consistent with reports from other studies [17][18][19]…”

“…Following institutional review board approval, adult patients who would benefit from adjunctive ureteral identification and avoidance during robotic-assisted colorectal surgery between September In addition, postoperative incidence of acute kidney injury (defined as an increase in creatinine greater than or equal to 1.5 times the baseline value) and urinary tract infection was evaluated. [13,14]. Externalized ureteral stent placement can be associated with more serious complications, including transient ureteral obstruction following stent removal (2%) and ureteral injury (0.12%) [12].…”

Does prophylactic ureteric stenting at the time of colorectal surgery reduce the risk of ureteric injury? A systematic review and meta‐analysis

“…Overall, 66 articles underwent full‐text review (Appendix ). We identified nine retrospective cohort studies suitable for inclusion published between 1994 and 2019 and evaluating 98 507 patients (Table 2) [2,4,5,13‐18]. No randomized controlled trials were identified.…”

Indocyanine green fluorescence-guided laparoscopic colorectal cancer surgery with prophylactic retrograde transileal conduit ureteral catheter placement after previous total cystectomy: a case report

“…Postoperative removal of the catheter was also easily possible at the bedside. We believe that complications, such as urinary tract infection, dysuria, and hematuria associated with ureteral catheter placement [ 17 ], can be avoided by removing the catheter early after surgery.…”