International Surgery Volume 106: Issue 2

It is important to again indicate who we, as Fellows in the International College of Surgeons (ICS), are and our identity. We are a global legal federation of locally incorporated surgical organizations in countries around the world. The International College of Surgeons has Fellow members in over 100 countries. The ICS is apolitical with a long inclusive history dating to 1935, 87 years of being open to all nationalities, races, and creeds. The International College of Surgeons is in official relations with the World Health Organization (WHO) as a Non-State Actor (NSA).

International Surgery is the Official Journal of

Objective

The objective of this study was to determine the causes of postoperative complications associated with subcutaneous central venous ports.

Summary of Background Data

Central venous ports were subcutaneously implanted in 523 patients between January 2005 and December 2013.

Methods

The purpose of port implantation was administration of chemotherapy in 439 patients and home central venous nutrition in 84 patients. The underlying disease was malignant in 481 patients and benign in 42.

Results

The median follow-up was 12 months (range, 1–99 months), and postoperative complications developed in 69 patients (13%). Infection occurred in 40 patients (7.6%) and catheter pinch-off in 11 patients (3%). Significant risk factors for infection were nutritional port placement (P < 0.001) and use of a femoral vein approach (P = 0.001). A left subclavian approach was a significant risk factor for catheter pinch-off (P = 0.003).

Conclusions

Postoperative complications, mainly infections and catheter pinch-off, developed in 13% of the patients. As for measures against complications, a femoral vein approach should be avoided to prevent infection. Moreover, because ports for parenteral nutrition require multiple punctures, methods to reduce the number of punctures and techniques for disinfection and management should be reevaluated. To prevent catheter pinch-off, an internal jugular vein approach should be used instead of a left subclavian approach.

Introduction

Laparoscopic reconstruction after left colectomy is mostly performed with functional end-to-end anastomosis through about 5–7 cm sized incision. However, this procedure poses some problems, including increased intestinal mobilization range and parietal destruction, insufficient blood flow to the intestinal tract due to arterial arch malformation, and dominant artery dissection. In this paper, we present a case of descending colon cancer for which totally laparoscopic surgery and intracorporeal anastomosis could be performed safely with preoperative simulation and intraoperative navigation.

Case presentation

A 34-year-old male was complaint fecal occult blood positive and a colonoscopy was performed. The patient was diagnosed with descending colon cancer cT2N0N0 Stage I. Preoperative CT angiography findings showed that the inferior mesenteric artery (IMA) branched into the left colic artery (LCA) and the sigmoid arteries (S1, S2) in order and showed LCA and S1 as the dominant arteries, and a totally laparoscopic descending colectomy (D2 dissection and S2 artery preserving) was scheduled. At his operation, for investigate blood flow of anastomotic region, ICG was used. After an intravenous injection of ICG, blood flow was evaluated and intestinal dissection was performed at the scheduled dissection line. Intracorporeal anastomosis was then performed using the overlap method and a linear stapler.

Conclusion

Although the intracorporeal anastomosis procedure has a high degree of difficulty, the use of preoperative simulation and intraoperative navigation may reduce the surgeon's intraoperative stress and enable safe and accurate intestinal dissection and anastomosis in the totally laparoscopic surgery.

Objective

This study aimed to determine if induction of sodium picosulfate and magnesium citrate (SPMC) preparation leads to adequate surgery for left-sided colorectal cancer (CRC).

Summary of Background Data

Adequate bowel cleansing is vital for safe and accurate colorectal surgery. Ingestion of laxatives for bowel cleansing may be associated with a broad spectrum of adverse effects during surgical intervention.

Methods

A single-center prospective study was conducted with hospitalized patients scheduled operation for left-sided CRC. All enrolled patients were instructed to consume normal diet until before preparation. Twenty-seven patients underwent preoperative SPMC preparation.

Results

The primary endpoint of this study was the 30-day postoperative morbidity rate, which was 23%, and no postoperative complication was higher than Clavien-Dindo grade 3. The primary anastomosis rate was 100%, and there was no anastomotic leakage. The colonic cleansing grades were 1 or 2 according to the bowel preparation scale for surgical assessment in 89% of the patients. The acceptability of the cleansing procedure by the patients assessed by a questionnaire was 85%, and the acceptability of the SPMC preparation by the medical staff was 93%. The surgical procedures included 18 laparoscopies, 6 robotic surgeries, and 3 laparotomies. The median operation time was 165 minutes, and the median blood loss was <50 cc. The median sodium serum concentration was significantly decreased after surgery.

Conclusion

Ingestion of an SPMC preparation as a cleansing procedure was judged to be adequate for curative surgery in patients with left-sided colorectal cancer.

Inadequacy of anterior-only fixation for reducible three-column injury of the subaxial cervical spine: case report

Yu-ying WuM.D.,

Po-Yuan ChenM.D.,

Kang LuPhD., and

I-Fan LinM.D.

Editorial Letter for International Surgery Issue 106 (2Q, 2022)

Complications After Implantation of Subcutaneous Central Venous Ports: Focus on Infection and Catheter Pinch-off

Objective

Summary of Background Data

Methods

Results

Conclusions

Totally Laparoscopic Left Colectomy With Preoperative Simulation Using 3D CT Angiography and Intraoperative Navigation Using the Indocyanine Green (ICG) Fluorescence Method

Introduction

Case presentation

Conclusion

Preoperative Oral-Bowel Preparation Using Sodium Picosulfate and Magnesium Citrate Combination Powder for Left-Sided Colorectal Cancer: A Prospective Study

Objective

Summary of Background Data

Methods

Results

Conclusion

Patient-Controlled Intravenous Analgesia With Tramadol and Lornoxicam After Thoracotomy: A Comparison With Patient-Controlled Epidural Analgesia

Objective

Summary of background data

Methods

Results

Conclusions

Application of ica D, agr, mec A, and mre B Gene Testing in Early Diagnosis of Periprosthetic Joint Infection

Objective

Methods

Results

Conclusion

Learning Curve of Resident Surgeons for Open Mesh Repair of Inguinal Hernia

Objective

Methods

Results

Conclusion

Inadequacy of anterior-only fixation for reducible three-column injury of the subaxial cervical spine: case report

Lasers for Pulmonary Resections

miR-135a promotes tumor invasion by targeting BACH1 and GATA3 in gastric cancer

Treatment of Intertrochanteric Fractures in the Elderly with Minimally Invasive DAA for Hip Arthroplasty

Comparison of clinical outcomes between percutaneous transhepatic biliary drainage with local lithotripsy and ERCP alone for treating intrahepatic bile duct stones