Wound Failure in Laparotomy: New insights

__Abstract__ Wound failure is a common complication of abdominal surgery. Its clinical presentation can vary from superficial wound dehiscence to burst abdomen with intraabdominal organs protruding through the wound. In long term, incisiona

Intraperitoneal chemotherapy for peritoneal metastases : an expert opinion

Introduction: The rationale for intraperitoneal (IP) drug delivery for patients with peritoneal metastases (PM) is based on the pharmacokinetic advantage resulting from the peritoneal-plasma barrier, and on the potential to adequately treat small, poorly vascularized PM. Despite a history of more than three decades, many aspects of IP drug delivery remain poorly studied. Areas covered: We outline the anatomy and physiology of the peritoneal cavity, including the pharmacokinetics of IP drug delivery. We discuss transport mechanisms governing tissue penetration of IP chemotherapy, and how these are affected by the biomechanical properties of the tumor stroma. We provide an overview of the current clinical evidence on IP chemotherapy in ovarian, colorectal, and gastric cancer. We discuss the current limitations of IP drug delivery and propose several potential areas of progress. Expert opinion: The potential of IP drug delivery is hampered by off-label use of drugs developed for systemic therapy. The efficacy of IP chemotherapy for PM depends on cancer type, disease extent, and mode of drug delivery. Results from ongoing randomized trials will allow to better delineate the potential of IP chemotherapy. Promising approaches include IP aerosol therapy, prolonged delivery platforms such as gels or biomaterials, and the use of nanomedicine

Patient awareness and symptoms from an incisional hernia

Incisional hernia is a common postoperative complication following open abdominal surgery with incidence varying between 3% and 20%.1 Approximately half of all incisional hernias are diagnosed within 1 year following surgery. In the United Kingdom alone, about 10,000 incisional hernia repairs are performed annually. Incisional hernia repairs are generally elective with emergency repair due to incarceration or strangulation constituting about 15% of repairs.1 Incisional hernia repair is not a low-risk operation and generally has relatively poor results due to chronic postoperative pain and high recurrence rates.2−3 Little has been published on patients' awareness of incisional hernia following open abdominal surgery. Moreover, there are very few publications on indications for incisional hernia repair and on the natural course of such hernias. The literature suggests that symptoms and complaints usually presented by patients include pain, discomfort, cosmetic complaints, skin problems, incarceration, strangulation, functional disability, and pulmonary dysfunction.4−6 The aim of this study was to investigate whether patients were aware that they had a hernia. In addition, we sought to determine symptoms for those who knew that they had an incisional hernia

A qualitative study of the development of a multidisciplinary case conference review methodology to reduce involved margins in pelvic exenteration surgery for recurrent rectal cancer

Aim Pelvic exenteration surgery remains the only curative option for recurrent rectal cancer. Microscopically involved surgical margins (R1) are associated with a higher risk of local recurrence and decreased survival. Our study aimed to develop a post hoc multidisciplinary case conference review and investigate its potential for identifying areas for improvement. Method Results Patients who underwent pelvic exenteration surgery for recurrent rectal cancer with R1 resections at a tertiary referral centre between April 2014 and January 2016 were retrospectively reviewed from a prospectively maintained database. Patients with non-rectal cancers or who underwent palliative surgery were excluded. Cases, imaging and histopathology were evaluated by a dedicated panel including colorectal surgeons, an abdominal radiologist and a gastrointestinal pathologist. R1 resections were reported in 32 of 110 pelvic exenterations. Patients with other tumours were excluded and one patient had a palliative resection. Nine male patients with 11 exenterations were included with a median age of 56 years. All patients had positive soft tissue margins, and one patient also had an involved bony margin. Failures were due to (interdisciplinary) communication problems, specific management of tumour biology (multifocality, spiculated tumours), which can lead to radiological undercalling, and inadequate surgical technical planning. In hindsight, surgery would have been withheld from one patient. Conclusion A retrospective multidisciplinary case evaluation of pelvic exenteration patients with involved surgical margins led to a list of recommendations which included the need to plan for wider surgical soft tissue resections and improvement in interdisciplinary communication. Lessons learned may increase clear margin rates in future resections

Bone Marrow Stem Cell Treatment for Ischemic Heart Disease in Patients with No Option of Revascularization: A Systematic Review and Meta-Analysis

PMCID: PMC3686792This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

A case of split notochord syndrome: a child with a neuroenteric fistula presenting with meningitis

The authors describe a case of split notochord syndrome with a neuroenteric fistula in a newborn presenting with meningitis. Associated anomalies included agenesis of the corpus callosum, short colon, malrotation, epispadias, and an abnormally high bifurcation of the abdominal aorta and inferior vena cava. The embryological mechanisms and etiologic theories are discussed in short

Guiding a new era in pancreatic surgery:Through international collaboration, guidelines, definitions, and optimized outcome

Het huidige proefschrift bevat 13 hoofdstukken, onderverdeeld in 3 delen, waarin het nieuw bewijs levert voor verschillende aspecten van (minimaal invasieve) alvleesklierchirurgie. De meerderheid van deze hoofdstukken zijn gepubliceerd, waaronder een aantal in hoog aangeschreven medische tijdschriften.Het eerste deel geeft een overzicht van de huidige stand van zaken en beschrijft nieuwe richtlijnen voor minimaal invasieve pancreas chirurgie en nieuwe definities voor pancreasstaart resecties. Een toonaangevende publicatie in dit deel is hoofdstuk 2 waarin doormiddel van een grote internationale samenwerking nieuwe richtlijnen zijn vastgesteld voor minimaal invasieve pancreaschirurgie. Het tweede deel richt zich op de implementatie en uitkomsten van robotchirurgie in alvleesklierstaart resecties in Europa en de vergelijking ervan met laparoscopie. Dit deel bevat belangrijke onderzoeken die zijn uitgevoerd in grote patiënt cohorten op Europees niveau, en laat voornamelijk zien dat robotchirurgie veilig en haalbaar is. Het biedt zelfs betere uitkomsten wat betreft conversies en miltbehoud. Tevens is in dit deel de kosteneffectiviteit van minimaal invasieve alvleesklierstaart resectie onderzocht in een gerandomiseerde trial, en laat het zien dat de minimaal invasieve benadering meer kosteneffectief is dan de open benadering. Dit is een erg belangrijke bevinding voor de toekomstige implementatie van minimaal invasieve alvleesklierstaart resectie. Het derde deel focust zich op het verbeteren van uitkomsten na alvleesklierstaartresecties, door te kijken naar de invloed van operatieve drains en neoadjuvante therapie. Een toonaangevende publicatie in dit deel is de gerandomiseerde PANDORINA trial in hoofdstuk 12 die de belangrijke conclusie trekt dat drains achterwege kunnen worden gelaten na alvleesklierstaartresecties , gezien het complicatie percentage niet verschillend is van wanneer er wel een drain wordt geplaatst. Concluderend heeft deze scriptie in belangrijke mate bijgedragen aan de verdere ontwikkeling van minimaal invasieve alvleesklierchirurgie en de optimalisatie van resultaten na distale pancreasresectie op internationaal niveau