Aim This subgroup analysis of a prospective multicentre cohort study aims to compare postoperativ... more Aim This subgroup analysis of a prospective multicentre cohort study aims to compare postoperative morbidity between transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME). The study was designed as a subgroup analysis of a prospective multicentre cohort study. Patients undergoing TaTME or LaTME for rectal cancer were selected. All patients were followed up until the first visit to the outpatient clinic after hospital discharge. Postoperative complications were classified according to the Clavien-Dindo classification and the comprehensive complication index (CCI). Propensity score matching was performed. Results In total, 220 patients were selected from the overall prospective multicentre cohort study. After propensity score matching, 48 patients from each group were compared. The median tumour height for TaTME was 10.0 cm (6.0-10.8) and for LaTME was 9.5 cm (7.0-12.0) (P = 0.459). The duration of surgery and anaesthesia were both significantly longer for TaTME (221 vs 180 min, P < 0.001, and 264 vs 217 min, P < 0.001). TaTME was not converted to laparotomy whilst surgery in five patients undergoing LaTME was converted to laparotomy (0.0% vs 10.4%, P = 0.056). No statistically significant differences were observed for Clavien-Dindo classification, CCI, readmissions, reoperations and mortality. The study showed that TaTME is a safe and feasible approach for rectal cancer resection. This new technique obtained similar postoperative morbidity to LaTME.
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
BACKGROUND: Anastomotic leakage (AL) is the most feared complication of colorectal surgery. Ather... more BACKGROUND: Anastomotic leakage (AL) is the most feared complication of colorectal surgery. Atherosclerosis is suggested to have a detrimental effect on anastomotic healing. This study aimed to analyze the calcium score, a measure for atherosclerosis, as a risk factor for AL. STUDY DESIGN: The calcium scores of colorectal patients operated on in 2 Dutch university medical centers were determined using a computed tomography scan and calcium scoring software. The aorta, common iliac arteries, internal and external iliac arteries were studied. Additionally, patient-and operation-related factors were scored. RESULTS: A total of 122 patients were included. In patients with AL, calcium scores were significantly higher in the left common iliac artery (561.4 vs 156.0, P ϭ .028), right common iliac artery (542.0 vs 144.4, P ϭ .041), both common iliac arteries together (1,103.3 vs 301.9, P ϭ .046), and the left internal iliac artery (716.3 vs 35.3, P ϭ .044). CONCLUSIONS: Patients with higher calcium scores in the iliacal arteries have an increased leakage risk.
Background. Anastomotic leakage is the major complication after colorectal surgery. To date, anim... more Background. Anastomotic leakage is the major complication after colorectal surgery. To date, animal experiments concerning colorectal anastomosis focus on anastomotic healing instead of anastomotic leakage. This study aims to develop a new experimental model for colorectal anastomotic leakage. Methods. A control group, receiving an anastomosis with 12 interrupted sutures, was compared to a group receiving an anastomosis with 6 interrupted sutures. When the leakage rate was observed to be too low, the number of sutures was decreased stepwise, to 5 or less. Each group contained 9 ''C57Bl6-mice''. After 7 d the Anastomotic Bursting Pressure (ABP) was determined. Results. In the first experiment, one mouse (11.1%) in the case group and none in the control group developed leakage. Average ABP was 152,2 mmHg in the control group and 138,8 mmHg in the case group (P [ 0,111). In the second experiment, case group receiving an anastomosis with 5 sutures, 4 mice (44.4%) in the case group developed leakage. This experiment was repeated twice resulting in leakage rates of 33.3% and 44.4%. The average overall ABP in the case group was 142,7 mmHg vs. 179,9 mmHg (P [ 0,022) in the control group. The mice without leakage showed a stabilization of average weight loss around day 2 and 3 and a decrease afterwards. The mice with leakage showed a decrease only after day 5. The difference in wellness-scores between the groups with-and without leakage was 2 points, increasing during follow-up. Conclusions. The model of anastomotic leakage caused by creating an anastomosis with 5 interrupted sutures is feasible. Weight loss and wellness-scores are good predictors of leakage.
Colorectal anastomotic leakage (AL) is a severe complication leading to severe infection, sepsis ... more Colorectal anastomotic leakage (AL) is a severe complication leading to severe infection, sepsis and sometimes death. At present the diagnosis is made clinically, usually at 6-8 days after surgery. An objective biomarker reflecting the intra-abdominal milieu surrounding the anastomosis would be a useful additional diagnostic tool to make the diagnosis of AL before its clinical presentation. This review aims to assess the current status of the search for such a biomarker in peritoneal fluid. A literature search was carried out, using MEDLINE, PubMed and the Cochrane library, for all publications concerning human peritoneal fluid in relation to postoperative complications in general, and, more specific, anastomotic leakage after colorectal surgery. Analysis of several immune parameters, tissue repair parameters, parameters for ischaemia and microbiological composition of peritoneal fluid show that these can be determined reliably in the fluid, albeit with a large variance. Furthermore the data show that changes in concentration of these parameters precede AL and other postoperative complications by several days. The results of the review demonstrate that it is possible to distinguish between patients with and without AL by measuring biomarkers in fluid from the peritoneal drain. Prospective studies with larger numbers of patients should, however, be performed and additional biomarkers should be studied to explore the full diagnostic potential of this approach.
Then we have applied Multidimensional Prognostic Index (MPI), developed on mortality risk, findin... more Then we have applied Multidimensional Prognostic Index (MPI), developed on mortality risk, finding that cancer patients have a lower risk in comparison to non cancer patients. Conclusion: VES-13 criteria and Multidimensional Prognostic Index are shown sensitive to recognize and to discriminate frail patients with or without cancer. We have found that comorbidity and functional status are independent in cancer patients. Cancer patients are less frail showing best scores, with a statistically significant lower mortality risk than non cancer patients.
Background No real consensus regarding the definition of dumping syndrome (DS) seems to exist and... more Background No real consensus regarding the definition of dumping syndrome (DS) seems to exist and few subtyping is used in clinical practice. Knowledge is needed for correct design of trials and establishment of uniform treatment strategies. The aim of this study is to explore the distribution of clinical characteristics related to the subtypes of DS. Methods A comprehensive search was performed in Cochrane, Google Scholar, PubMed, and ResearchGate. Data were collected on the definition and diagnostics of DS used in each study. Results Twenty-seven clinical trials were included. Seventeen articles clearly provided a definition of DS and ten of these differentiated between early and late DS. Diagnose of DS was based on clinical symptoms (24 articles), hemodynamic parameters (e.g., tachycardia, hypotension; 9 articles), and biochemical analysis (e.g., blood sugar level; 12 articles). Questionnaires were used in 13 articles. A total of 67 different symptoms were correlated with dumping syndrome. Two symptoms were exclusively correlated with early and nine with late DS. Nine articles differentiated between early and late dumping based on timing since the last meal. Hypoglycemia was correlated with late DS in ten articles. Conclusions This study reveals a vast heterogeneity in the definition and clinical characteristics of DS after RYGB. We feel that a standardized definition is required to provide a firm parameter in the evaluation and setup of clinical trials. A better understanding and description of the definition and diagnostic criteria of DS after RYGB is crucial to improve scientific reporting.
Background Due to the SARS-COV 2 pandemic related restrictions the 2020 Belgian Surgical Week (BS... more Background Due to the SARS-COV 2 pandemic related restrictions the 2020 Belgian Surgical Week (BSW) was organized as a virtual congress, being the first surgical, virtual congress in Belgium. Since this was a new experience and probably not the last, we aim to share our experience to assist other professionals in organizing their virtual event. Methods The "BSW-light" was organized by the RBSS in collaboration with a Professional Congress Organizer (PCO), which is described in detail. Analytical data of the Conclusion Although the "BSW-light" proved to be successful, a preference to meet in real live remained. However, given its potential, we should keep an open mind towards integrating the advantages of a virtual meeting into a live event.
Background The protective ostomy is the current standard of care to protect a low colorectal anas... more Background The protective ostomy is the current standard of care to protect a low colorectal anastomosis from leakage, but exposes patients to complications requiring an alternative strategy. The Colovac+ is a vacuum-based intraluminal bypass device designed to shield the anastomosis from fecal content, preventing the clinical outcomes of anastomotic leakage. The objective of this study was to evaluate the preliminary efficacy, safety, and technical feasibility of the Colovac+ in a porcine model. Methods: Twelve pigs received a colorectal anastomosis with Colovac+ implantation. The device was left in situ for 10 days and then retrieved endoscopically. Six pigs were to be sacrificed immediately after device retrieval and the other 6 were to be sacrificed on day 38. Clinical, endoscopic, and histopathological examinations were performed to evaluate the following endpoints: prevention of contact between the anastomosis and fecal content, device migration, feasibility of the implantation and retrieval procedure, collateral damage to the colonic wall, colon healing after device retrieval, and systemic toxicity related to the device. Results: Eleven pigs completed the study. One pig died prematurely due to a surgical complication unrelated to the device (bladder damage with uroperitoneum). There was no evidence of contact between the anastomosis and fecal content, none of the pigs developed symptomatic anastomotic leakage, there were no significant device migrations, and there was no evidence of systemic toxicity. Colovac+ implantation was easily performed in all cases except 1 (due to an inappropriate lubricant). Colovac+ retrieval was achieved successfully in all cases. Postretrieval examinations on day 10 revealed ulcerations at the anchoring site in 4 cases indicating mechanical damage caused by the stent. However, in the recovery group, no ulcerations were observed on day 38, and the colonic wall had properly healed in all animals. Conclusions: The Colovac+ is a technically feasible, safe, and efficient device for the protection of a colorectal anastomosis in a porcine model. The device holds promise for clinical use and warrants further research.
Background: An internal abdominal hernia is defined as the protrusion of a viscus through a mesen... more Background: An internal abdominal hernia is defined as the protrusion of a viscus through a mesenteric or peritoneal aperture within the peritoneal cavity. A less common type of internal herniation is a small bowel herniation through a defect in the falciform ligament of the liver. This defect can be congenital or iatrogenic after penetration of the falciform ligament with a trocar during laparoscopic surgery. Methods: We present a case report illustrating an internal herniation through an iatrogenic defect in the falciform ligament of the liver. Results: A 78-year-old man comes to the emergency department with severe abdominal pain for several hours. Laparoscopic exploration shows a small bowel herniation through an iatrogenic defect of the falciform ligament after laparoscopic cholecystectomy. Reduction of the internal herniation is performed. Due to subsequently small bowel necrosis, a small bowel resection with primary anastomosis has to be performed too. Conclusion: Small bowel herniation through an iatrogenic defect in the falciform ligament is very rare. However, it can lead to severe complications such as small bowel necrosis. To prevent internal herniation, we strongly suggest immediate repair or division of the falciform ligament when an iatrogenic defect is created during laparoscopic procedures.
Purpose With current diagnostic methods, the majority of patients with symptomatic colorectal ana... more Purpose With current diagnostic methods, the majority of patients with symptomatic colorectal anastomotic leakage (CAL) is identified approximately 1 week after operation. The aim of this study is to determine whether real-time polymerase chain reaction (RT-PCR) for detection of Escherichia coli and Enterococcus faecalis on drain fluid can serve as a screening test for CAL in the early postoperative phase. Methods All patients included in this multicenter prospective observational study underwent left-sided colorectal resection for both malignant and benign diseases with construction of an anastomosis. In all patients, an intra-abdominal drain was placed during operation. During the first five postoperative days, drain fluid was processed for RT-PCR. The quantitative results of the RT-PCR on days 2 to 5 were compared to the results of day 1 in order to detect concentration changes. Results In total, 243 patients, with both benign and malignant diseases, were included of whom 19 (7.8 %) developed symptomatic CAL. An increase in E. coli concentration was found in significantly more patients with CAL on day 4 and 5 [p = 0.0004; diagnostic odds ratio (DOR) 7.9]. For E. faecalis, this result was found for days 2, 3, and 4 (p <0.003) with highest DOR on day 3 (31.6). Sensitivity and negative predictive values were 92.9 and 98.7 %, respectively, virtually ruling out CAL in case of negative test results on the third postoperative day. Conclusion Quantitative PCR for E. faecalis performed on drain fluid may be an objective, affordable and fast screening tool for symptomatic colorectal anastomotic leakage.
Abstract Objective: We would like to present a patient with a history of ulcerative colitis suffe... more Abstract Objective: We would like to present a patient with a history of ulcerative colitis suffering from a synchronous rectal and prostate cancer treated with a laparoscopic total proctocolectomy (with TaTME) and Retzius sparing RARP simultaneously. Methods: Retzius sparing RARP with bilateral lymph node harvesting was performed first. Afterwards, TaTME was commenced with the placement of a Lonestar® retractor and GelPort®. Anterior dissection was troubled unexpectedly by outspoken fibrosis. For that reason, it was completed laparoscopically. We then continued with the laparoscopic total proctocolectomy. Last, a transanal circular stapled ileoanal anastomosis was created and a derivating ileostomy was installed. Results: Postoperative proctoscopy showed a patent ileoanal anastomosis. After removal of the Foley catheter on day 21, the patient was immediately continent. Prostate specimen revealed a pT2cN1M0 transmural invasive adenocarcinoma with a Gleason score of 7 (3 + 4). Pathology analysis of the rectum revealed a stage IIIc transmural invasive moderately differentiated rectal adenocarcinoma (pT3N2bM0) with free margins. He was referred for adjuvant chemotherapy. Conclusions: In this case, the combination of TaTME and Retzius sparing RARP for synchronous rectal and prostate cancer was feasible and safe. We suggest performing the anterior TaTME dissection last, due to disturbing blood flow into the operating field after prostatectomy.
Many patients still die every year as a result of anastomotic leakage after surgery. The medical ... more Many patients still die every year as a result of anastomotic leakage after surgery. The medical world needs an objective aid to detect leakage during surgery and during the critical recovery period. We propose a miniature measurement system to detect adequate tissue oxygenation pre-and postoperatively (continuously for 7 days) on the colon. The sensor chip should include an oxygen-saturation sensor,
Introduction : Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures ... more Introduction : Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal. Both conservative and invasive treatment options are diverse and guidance to their implementation is lacking. Methods : A Delphi consensus process was used to review current literature and draft relevant statements. These were reconciliated until sufficient agreement was reached. The grade of evidence was determined. These guidelines were based on the published literature up to June 2020. Results : Hemorrhoids are normal structures within the anorectal region. When they become engorged or slide down the anal canal, symptoms can arise. Every treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations. For low-grade hemorrhoids, conservative treatment should consist of fiber supplements and can include a short course of venotropics. Instrumental treatment can be added case by case : infrared coagulation or rubber band ligation when prolapse is more prominent. For prolapsing hemorrhoids, surgery can be indicated for refractory cases. Conventional hemorrhoidectomy is the most efficacious intervention for all grades of hemorrhoids and is the only choice for non-reducible prolapsing hemorrhoids. Conclusions : The current guidelines for the management of hemorrhoidal disease include recommendations for the clinical evaluation of hemorrhoidal disorders, and their conservative, instrumental and surgical management. (Acta gastroenterol. belg., 2021, 84, 101-120).
Background and objectives: A semi-quantitative Real-Time PCR strategy was developed to identify i... more Background and objectives: A semi-quantitative Real-Time PCR strategy was developed to identify indicator organisms for an indication on anastomotic leakage in peritoneal drainage fluid, Escherichia coli and Enterococcus faecalis. Materials and Methods: The analytical performance of the amplification method was validated with 10 culture-positive and 7 culture negative peritoneal drain fluid samples, obtained from 9 different patients with a colorectal anastomosis. Results: Real-Time PCR results were fully concordant with the microbiological culture results. However, among the culture negative samples, four false-positive RT-PCR results were found. All false-positives originated from a single patient with a surgical site infection. This may indicate an elevated sensitivity of the RT-PCR method. Conclusion: The results showed that the semi-quantitative RT-PCR method has the clear potential to be useful as a powerful tool in early detection of anastomotic leakage.
Aim This subgroup analysis of a prospective multicentre cohort study aims to compare postoperativ... more Aim This subgroup analysis of a prospective multicentre cohort study aims to compare postoperative morbidity between transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME). The study was designed as a subgroup analysis of a prospective multicentre cohort study. Patients undergoing TaTME or LaTME for rectal cancer were selected. All patients were followed up until the first visit to the outpatient clinic after hospital discharge. Postoperative complications were classified according to the Clavien-Dindo classification and the comprehensive complication index (CCI). Propensity score matching was performed. Results In total, 220 patients were selected from the overall prospective multicentre cohort study. After propensity score matching, 48 patients from each group were compared. The median tumour height for TaTME was 10.0 cm (6.0-10.8) and for LaTME was 9.5 cm (7.0-12.0) (P = 0.459). The duration of surgery and anaesthesia were both significantly longer for TaTME (221 vs 180 min, P < 0.001, and 264 vs 217 min, P < 0.001). TaTME was not converted to laparotomy whilst surgery in five patients undergoing LaTME was converted to laparotomy (0.0% vs 10.4%, P = 0.056). No statistically significant differences were observed for Clavien-Dindo classification, CCI, readmissions, reoperations and mortality. The study showed that TaTME is a safe and feasible approach for rectal cancer resection. This new technique obtained similar postoperative morbidity to LaTME.
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
BACKGROUND: Anastomotic leakage (AL) is the most feared complication of colorectal surgery. Ather... more BACKGROUND: Anastomotic leakage (AL) is the most feared complication of colorectal surgery. Atherosclerosis is suggested to have a detrimental effect on anastomotic healing. This study aimed to analyze the calcium score, a measure for atherosclerosis, as a risk factor for AL. STUDY DESIGN: The calcium scores of colorectal patients operated on in 2 Dutch university medical centers were determined using a computed tomography scan and calcium scoring software. The aorta, common iliac arteries, internal and external iliac arteries were studied. Additionally, patient-and operation-related factors were scored. RESULTS: A total of 122 patients were included. In patients with AL, calcium scores were significantly higher in the left common iliac artery (561.4 vs 156.0, P ϭ .028), right common iliac artery (542.0 vs 144.4, P ϭ .041), both common iliac arteries together (1,103.3 vs 301.9, P ϭ .046), and the left internal iliac artery (716.3 vs 35.3, P ϭ .044). CONCLUSIONS: Patients with higher calcium scores in the iliacal arteries have an increased leakage risk.
Background. Anastomotic leakage is the major complication after colorectal surgery. To date, anim... more Background. Anastomotic leakage is the major complication after colorectal surgery. To date, animal experiments concerning colorectal anastomosis focus on anastomotic healing instead of anastomotic leakage. This study aims to develop a new experimental model for colorectal anastomotic leakage. Methods. A control group, receiving an anastomosis with 12 interrupted sutures, was compared to a group receiving an anastomosis with 6 interrupted sutures. When the leakage rate was observed to be too low, the number of sutures was decreased stepwise, to 5 or less. Each group contained 9 ''C57Bl6-mice''. After 7 d the Anastomotic Bursting Pressure (ABP) was determined. Results. In the first experiment, one mouse (11.1%) in the case group and none in the control group developed leakage. Average ABP was 152,2 mmHg in the control group and 138,8 mmHg in the case group (P [ 0,111). In the second experiment, case group receiving an anastomosis with 5 sutures, 4 mice (44.4%) in the case group developed leakage. This experiment was repeated twice resulting in leakage rates of 33.3% and 44.4%. The average overall ABP in the case group was 142,7 mmHg vs. 179,9 mmHg (P [ 0,022) in the control group. The mice without leakage showed a stabilization of average weight loss around day 2 and 3 and a decrease afterwards. The mice with leakage showed a decrease only after day 5. The difference in wellness-scores between the groups with-and without leakage was 2 points, increasing during follow-up. Conclusions. The model of anastomotic leakage caused by creating an anastomosis with 5 interrupted sutures is feasible. Weight loss and wellness-scores are good predictors of leakage.
Colorectal anastomotic leakage (AL) is a severe complication leading to severe infection, sepsis ... more Colorectal anastomotic leakage (AL) is a severe complication leading to severe infection, sepsis and sometimes death. At present the diagnosis is made clinically, usually at 6-8 days after surgery. An objective biomarker reflecting the intra-abdominal milieu surrounding the anastomosis would be a useful additional diagnostic tool to make the diagnosis of AL before its clinical presentation. This review aims to assess the current status of the search for such a biomarker in peritoneal fluid. A literature search was carried out, using MEDLINE, PubMed and the Cochrane library, for all publications concerning human peritoneal fluid in relation to postoperative complications in general, and, more specific, anastomotic leakage after colorectal surgery. Analysis of several immune parameters, tissue repair parameters, parameters for ischaemia and microbiological composition of peritoneal fluid show that these can be determined reliably in the fluid, albeit with a large variance. Furthermore the data show that changes in concentration of these parameters precede AL and other postoperative complications by several days. The results of the review demonstrate that it is possible to distinguish between patients with and without AL by measuring biomarkers in fluid from the peritoneal drain. Prospective studies with larger numbers of patients should, however, be performed and additional biomarkers should be studied to explore the full diagnostic potential of this approach.
Then we have applied Multidimensional Prognostic Index (MPI), developed on mortality risk, findin... more Then we have applied Multidimensional Prognostic Index (MPI), developed on mortality risk, finding that cancer patients have a lower risk in comparison to non cancer patients. Conclusion: VES-13 criteria and Multidimensional Prognostic Index are shown sensitive to recognize and to discriminate frail patients with or without cancer. We have found that comorbidity and functional status are independent in cancer patients. Cancer patients are less frail showing best scores, with a statistically significant lower mortality risk than non cancer patients.
Background No real consensus regarding the definition of dumping syndrome (DS) seems to exist and... more Background No real consensus regarding the definition of dumping syndrome (DS) seems to exist and few subtyping is used in clinical practice. Knowledge is needed for correct design of trials and establishment of uniform treatment strategies. The aim of this study is to explore the distribution of clinical characteristics related to the subtypes of DS. Methods A comprehensive search was performed in Cochrane, Google Scholar, PubMed, and ResearchGate. Data were collected on the definition and diagnostics of DS used in each study. Results Twenty-seven clinical trials were included. Seventeen articles clearly provided a definition of DS and ten of these differentiated between early and late DS. Diagnose of DS was based on clinical symptoms (24 articles), hemodynamic parameters (e.g., tachycardia, hypotension; 9 articles), and biochemical analysis (e.g., blood sugar level; 12 articles). Questionnaires were used in 13 articles. A total of 67 different symptoms were correlated with dumping syndrome. Two symptoms were exclusively correlated with early and nine with late DS. Nine articles differentiated between early and late dumping based on timing since the last meal. Hypoglycemia was correlated with late DS in ten articles. Conclusions This study reveals a vast heterogeneity in the definition and clinical characteristics of DS after RYGB. We feel that a standardized definition is required to provide a firm parameter in the evaluation and setup of clinical trials. A better understanding and description of the definition and diagnostic criteria of DS after RYGB is crucial to improve scientific reporting.
Background Due to the SARS-COV 2 pandemic related restrictions the 2020 Belgian Surgical Week (BS... more Background Due to the SARS-COV 2 pandemic related restrictions the 2020 Belgian Surgical Week (BSW) was organized as a virtual congress, being the first surgical, virtual congress in Belgium. Since this was a new experience and probably not the last, we aim to share our experience to assist other professionals in organizing their virtual event. Methods The "BSW-light" was organized by the RBSS in collaboration with a Professional Congress Organizer (PCO), which is described in detail. Analytical data of the Conclusion Although the "BSW-light" proved to be successful, a preference to meet in real live remained. However, given its potential, we should keep an open mind towards integrating the advantages of a virtual meeting into a live event.
Background The protective ostomy is the current standard of care to protect a low colorectal anas... more Background The protective ostomy is the current standard of care to protect a low colorectal anastomosis from leakage, but exposes patients to complications requiring an alternative strategy. The Colovac+ is a vacuum-based intraluminal bypass device designed to shield the anastomosis from fecal content, preventing the clinical outcomes of anastomotic leakage. The objective of this study was to evaluate the preliminary efficacy, safety, and technical feasibility of the Colovac+ in a porcine model. Methods: Twelve pigs received a colorectal anastomosis with Colovac+ implantation. The device was left in situ for 10 days and then retrieved endoscopically. Six pigs were to be sacrificed immediately after device retrieval and the other 6 were to be sacrificed on day 38. Clinical, endoscopic, and histopathological examinations were performed to evaluate the following endpoints: prevention of contact between the anastomosis and fecal content, device migration, feasibility of the implantation and retrieval procedure, collateral damage to the colonic wall, colon healing after device retrieval, and systemic toxicity related to the device. Results: Eleven pigs completed the study. One pig died prematurely due to a surgical complication unrelated to the device (bladder damage with uroperitoneum). There was no evidence of contact between the anastomosis and fecal content, none of the pigs developed symptomatic anastomotic leakage, there were no significant device migrations, and there was no evidence of systemic toxicity. Colovac+ implantation was easily performed in all cases except 1 (due to an inappropriate lubricant). Colovac+ retrieval was achieved successfully in all cases. Postretrieval examinations on day 10 revealed ulcerations at the anchoring site in 4 cases indicating mechanical damage caused by the stent. However, in the recovery group, no ulcerations were observed on day 38, and the colonic wall had properly healed in all animals. Conclusions: The Colovac+ is a technically feasible, safe, and efficient device for the protection of a colorectal anastomosis in a porcine model. The device holds promise for clinical use and warrants further research.
Background: An internal abdominal hernia is defined as the protrusion of a viscus through a mesen... more Background: An internal abdominal hernia is defined as the protrusion of a viscus through a mesenteric or peritoneal aperture within the peritoneal cavity. A less common type of internal herniation is a small bowel herniation through a defect in the falciform ligament of the liver. This defect can be congenital or iatrogenic after penetration of the falciform ligament with a trocar during laparoscopic surgery. Methods: We present a case report illustrating an internal herniation through an iatrogenic defect in the falciform ligament of the liver. Results: A 78-year-old man comes to the emergency department with severe abdominal pain for several hours. Laparoscopic exploration shows a small bowel herniation through an iatrogenic defect of the falciform ligament after laparoscopic cholecystectomy. Reduction of the internal herniation is performed. Due to subsequently small bowel necrosis, a small bowel resection with primary anastomosis has to be performed too. Conclusion: Small bowel herniation through an iatrogenic defect in the falciform ligament is very rare. However, it can lead to severe complications such as small bowel necrosis. To prevent internal herniation, we strongly suggest immediate repair or division of the falciform ligament when an iatrogenic defect is created during laparoscopic procedures.
Purpose With current diagnostic methods, the majority of patients with symptomatic colorectal ana... more Purpose With current diagnostic methods, the majority of patients with symptomatic colorectal anastomotic leakage (CAL) is identified approximately 1 week after operation. The aim of this study is to determine whether real-time polymerase chain reaction (RT-PCR) for detection of Escherichia coli and Enterococcus faecalis on drain fluid can serve as a screening test for CAL in the early postoperative phase. Methods All patients included in this multicenter prospective observational study underwent left-sided colorectal resection for both malignant and benign diseases with construction of an anastomosis. In all patients, an intra-abdominal drain was placed during operation. During the first five postoperative days, drain fluid was processed for RT-PCR. The quantitative results of the RT-PCR on days 2 to 5 were compared to the results of day 1 in order to detect concentration changes. Results In total, 243 patients, with both benign and malignant diseases, were included of whom 19 (7.8 %) developed symptomatic CAL. An increase in E. coli concentration was found in significantly more patients with CAL on day 4 and 5 [p = 0.0004; diagnostic odds ratio (DOR) 7.9]. For E. faecalis, this result was found for days 2, 3, and 4 (p <0.003) with highest DOR on day 3 (31.6). Sensitivity and negative predictive values were 92.9 and 98.7 %, respectively, virtually ruling out CAL in case of negative test results on the third postoperative day. Conclusion Quantitative PCR for E. faecalis performed on drain fluid may be an objective, affordable and fast screening tool for symptomatic colorectal anastomotic leakage.
Abstract Objective: We would like to present a patient with a history of ulcerative colitis suffe... more Abstract Objective: We would like to present a patient with a history of ulcerative colitis suffering from a synchronous rectal and prostate cancer treated with a laparoscopic total proctocolectomy (with TaTME) and Retzius sparing RARP simultaneously. Methods: Retzius sparing RARP with bilateral lymph node harvesting was performed first. Afterwards, TaTME was commenced with the placement of a Lonestar® retractor and GelPort®. Anterior dissection was troubled unexpectedly by outspoken fibrosis. For that reason, it was completed laparoscopically. We then continued with the laparoscopic total proctocolectomy. Last, a transanal circular stapled ileoanal anastomosis was created and a derivating ileostomy was installed. Results: Postoperative proctoscopy showed a patent ileoanal anastomosis. After removal of the Foley catheter on day 21, the patient was immediately continent. Prostate specimen revealed a pT2cN1M0 transmural invasive adenocarcinoma with a Gleason score of 7 (3 + 4). Pathology analysis of the rectum revealed a stage IIIc transmural invasive moderately differentiated rectal adenocarcinoma (pT3N2bM0) with free margins. He was referred for adjuvant chemotherapy. Conclusions: In this case, the combination of TaTME and Retzius sparing RARP for synchronous rectal and prostate cancer was feasible and safe. We suggest performing the anterior TaTME dissection last, due to disturbing blood flow into the operating field after prostatectomy.
Many patients still die every year as a result of anastomotic leakage after surgery. The medical ... more Many patients still die every year as a result of anastomotic leakage after surgery. The medical world needs an objective aid to detect leakage during surgery and during the critical recovery period. We propose a miniature measurement system to detect adequate tissue oxygenation pre-and postoperatively (continuously for 7 days) on the colon. The sensor chip should include an oxygen-saturation sensor,
Introduction : Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures ... more Introduction : Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal. Both conservative and invasive treatment options are diverse and guidance to their implementation is lacking. Methods : A Delphi consensus process was used to review current literature and draft relevant statements. These were reconciliated until sufficient agreement was reached. The grade of evidence was determined. These guidelines were based on the published literature up to June 2020. Results : Hemorrhoids are normal structures within the anorectal region. When they become engorged or slide down the anal canal, symptoms can arise. Every treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations. For low-grade hemorrhoids, conservative treatment should consist of fiber supplements and can include a short course of venotropics. Instrumental treatment can be added case by case : infrared coagulation or rubber band ligation when prolapse is more prominent. For prolapsing hemorrhoids, surgery can be indicated for refractory cases. Conventional hemorrhoidectomy is the most efficacious intervention for all grades of hemorrhoids and is the only choice for non-reducible prolapsing hemorrhoids. Conclusions : The current guidelines for the management of hemorrhoidal disease include recommendations for the clinical evaluation of hemorrhoidal disorders, and their conservative, instrumental and surgical management. (Acta gastroenterol. belg., 2021, 84, 101-120).
Background and objectives: A semi-quantitative Real-Time PCR strategy was developed to identify i... more Background and objectives: A semi-quantitative Real-Time PCR strategy was developed to identify indicator organisms for an indication on anastomotic leakage in peritoneal drainage fluid, Escherichia coli and Enterococcus faecalis. Materials and Methods: The analytical performance of the amplification method was validated with 10 culture-positive and 7 culture negative peritoneal drain fluid samples, obtained from 9 different patients with a colorectal anastomosis. Results: Real-Time PCR results were fully concordant with the microbiological culture results. However, among the culture negative samples, four false-positive RT-PCR results were found. All false-positives originated from a single patient with a surgical site infection. This may indicate an elevated sensitivity of the RT-PCR method. Conclusion: The results showed that the semi-quantitative RT-PCR method has the clear potential to be useful as a powerful tool in early detection of anastomotic leakage.
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Papers by Niels Komen