Vicryl® intestinal anastomosis

Reported are 305 patients undergoing 327 intestinal anastomoses with polyglactin 910 (Vicryl^®, Ethicon) suture. The technique of one-layer interrupted absorbable suture anastomosis is discussed. A leak rate of 0.6 percent is recorded and indicates this method is acceptable.     

Anemia following Roux-en-Y gastric bypass for morbid obesity; a 5-year follow-up study

Objectives: Patients are at risk of anemia post Roux-en-Y gastric bypass (RYGB). We sought to determine the prevalence of anemia and related nutritional deficiencies 5 years after RYGB and to evaluate adherence to nutritional supplements with iron, vitamin B12, and folate.

Material and methods: Patients operated with RYGB 2004–2006 were eligible for evaluation. Blood samples were collected and use of nutritional supplements was recorded preoperatively, and at outpatients’ consultations 1, 2, and 5 years postoperatively. Of 203 patients operated, 184 (91%) completed the 5 year follow-up and were included in the study. Of these, 97% had valid measurements of hemoglobin both at baseline and after 5 years.

Results: During the 5 years after RYGB, the prevalence of anemia increased from 4% preoperatively to 24% in females, and from 0% to 7% in males. Ferritin levels decreased gradually in both genders. Iron deficiency increased from 6% preoperatively to 42% at 5 years in females, and from 0% to 9% in males. Vitamin B12 deficiency was not altered while folate deficiency decreased from 10% preoperatively to 1% at 5 years. Five years after surgery 25% reported the use of supplements with iron, while 83% used vitamin B12 and 65% used multivitamins with folate.

Conclusions: We observed a long-term increase in anemia and iron deficiency after RYGB in both genders, but most pronounced in women. Our postoperative protocol for prevention of vitamin B12 and folate deficiencies appear acceptable. Iron status and iron supplementation seems to need stronger emphasis during follow-up after RYGB.     

Preoperative and postoperative evaluation by manometric study of the anal sphincter after coloanal anastomosis for carcinoma

The purpose of the present study was to pre- and postoperatively evaluate the anal sphincter after coloanal anastomosis in 20 patients with carcinoma of the rectum at 5.5 to 8 cm from the anal verge. The 20 patients matched age and sex with the controlled subjects. Of the 20 patients, 17 with normal preoperative manometric studies when compared with control subjects underwent a coloanal anastomosis as described by Castrini, and three patients with preoperative incontinence underwent abdominoperineal resection. Manometric studies preoperatively, and postoperatively at three and 12 months, indicated a statistically significant decrease in squeezing pressure, and rectal compliance at three months that almost normalized by 12 months. The rectal compliance correlated with the number of bowel movements per day at three months (four to five per day) and at 12 months (two to three per day). The rectoanal reflex and length of pressure zone have remained unchanged. Results seem to indicate that anal continence can be preserved after coloanal anastomosis.     

改良动静脉内瘘成形术120例临床疗效分析

目的：报道应用改良连续缝合加褥式缝合血管进行血液透析内瘘术的临床效果。方法：选取120例需行血液透析患者男55例,女65例,年龄24岁～75岁,行前臂标准位桡动脉头静脉侧端改良连续缝合加褥式缝合内瘘术,通过临床及超声随访验证。结果：手术成功率达99％,内瘘长期有效率达98．2％。结论：应用改良连续缝合加褥式缝合血管行内瘘术能够收到良好的临床效果。     

Mr lymphangiography: How i do it

Lymphedema is a chronic progressive edematous disease that in the United States is most commonly related to malignancy and its treatment. Lymphaticovenular anastomosis is a recently introduced microsurgical treatment option for lymphedema that requires the identification and mapping of individual lymphatic channels. While nuclear medicine lymphoscintigraphy has been the primary imaging modality performed to evaluate suspected lymphedema, lymphoscintigraphy does not provide the spatial information necessary for presurgical planning. High‐resolution dynamic 3D magnetic resonance imaging (MRI) can noninvasively image abnormal lymphatic channels to both diagnose lymphedema and depict the location and number of individual lymphatic channels for surgical planning. MR lymphangiography can be performed at 1.5T or 3.0T using multichannel phased array surface coils. The main components of the exam are a heavily T₂‐weighted 3D sequence to define the severity and extent of edema, a high‐resolution dynamic 3D gradient echo imaging after intracutaneous contrast injection to visualize lymphatic channels, and a delayed 3D gradient echo sequence after intravenous contrast to define veins. This article reviews the pathophysiology and microsurgical treatment of lymphedema, presents the imaging protocol used at our institution, and describes exam interpretation and the image postprocessing performed for surgical planning. J. MAGN. RESON. IMAGING 2015;42:1465–1477.     

Predictors of 30-day follow-up visit completion after primary bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry

BackgroundAdherence to follow-up visits is often unsatisfactory after bariatric surgery.ObjectivesTo identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion.SettingMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015–2018).MethodsPatients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy were included in this analysis. Data were analyzed using weighted logistic regression. Subanalyses included stratification of the sample by sex and age (<45, 45–60, and >60 years).ResultsPatients (n = 566,774) were predominantly female (79.6%), White (72.4%), non-Hispanic (77.9%), and middle-aged (44.5 ± 11.9 years), with a mean BMI of 45.3 ± 7.8 kg/m². More than 95% of patients completed the 30-day visits. In the whole-sample analysis, older age (odds ratio [OR], 1.02) and the presence of non–insulin-dependent diabetes (OR, 1.04), hypertension (OR, 1.03), hyperlipidemia (OR, 1.10), obstructive sleep apnea (OR, 1.15), and gastroesophageal reflux disease (OR, 1.16) were positive predictors of the 30-day visit completion (P_s < .01). Conversely, sleeve gastrectomy procedure (OR, .86), Black race (OR, .87), Hispanic ethnicity (OR, .94), and the presence of insulin-dependent diabetes (OR, .96) and smoking (OR, .83) were negative predictors (P_s < .01). Several differences emerged in subanalyses. For example, in sex stratification, Hispanic ethnicity lost its significance in men. In age stratification, BMI and male sex emerged as positive predictors in the age groups of <45 and 45–60 years, respectively.ConclusionAlthough challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.