In biomedical applications, bioadhesives have become a game-changer, offering novel approaches to tissue engineering, surgical adhesion, and wound healing. This comprehensive review paper provides a thorough analysis of bioadhesives and their categorization according to application site and crosslinking process, bonding efficacy, and mechanical characteristics. The use of bioadhesives to stop bleeding and seal leaks is also covered in the review. The article delves into the various crosslinking techniques used in bioadhesives, including chemical, physical, and hybrid approaches. It emphasizes on how these mechanisms control the adhesive's elasticity, durability, and structural integrity. In addition, the review looks at the mechanical strength of bioadhesives, taking important characteristics like shear strength, toughness, elasticity, and tensile strength into account. It is highlighted how important bioadhesives are to the life sciences because they drive innovation and interdisciplinary cooperation, address present healthcare issues, and create new avenues for therapeutic development. The paper also explores some vital characteristics of bioadhesives that, when strategically combined with one another, improve their efficacy and usefulness in a variety of surgical and medical applications. The analysis concludes by examining nature-inspired adhesives, including those based on geckos, mussels, and tannic acid, and their unique bonding mechanisms and potential for use in advanced biomedical applications.

Over 300,000 colorectal surgeries are performed annually in the U.S. with up to 10% complicated by anastomotic leaks, which cause significant morbidity and mortality. Despite its significant association with anastomotic leaks, tension is predominantly assessed intraoperatively using subjective metrics. This study aims to assess the feasibility of a novel objective method to assess mechanical tension in ex vivo porcine colons.

This research was conducted using the da Vinci Research Kit (dVRK). First, a machine learning algorithm based on a long short-term memory neural network was developed to estimate the pulling forces on robotic arms of dVRK. Next, two robotic arms were used to apply upward forces to five ex vivo porcine colon segments. A force sensor was placed underneath the colons to measure ground-truth forces, which were compared to estimated forces calculated by the machine learning algorithm. Root mean square error and Spearman's Correlation were calculated to evaluate force estimation accuracy and correlation between measured and estimated forces, respectively.

Measured forces ranged from 0 to 17.2 N for an average experiment duration of two minutes. The algorithm's force estimates closely tracked the ground-truth sensor measurements with an accuracy of up to 88% and an average accuracy of 74% across all experiments. The estimated and measured forces showed a very strong correlation, with no Spearman's Correlation less than 0.80 across all experiments.

This study proposes a machine learning algorithm that estimates colonic tension with a close approximation to ground-truth data from a force sensor. This is the first study to objectively measure tissue tension (and report it in Newtons) using a robot. Our method can be adapted to measure tension on multiple types of tissue and can help prevent surgical complications and mortality.

Creating a "tension-free anastomosis" is a fundamental principle in safe bowel surgery. This review aims to summarize the current literature regarding the measurement and impact of tension on bowel anastomoses.

This scoping review was conducted using a systematic literature search in the PubMed, SCOPUS, and EMBASE databases. Data were synthesized in tables and summarized paragraphically, with studies assessed using the Newcastle-Ottawa scale.

Out of the 350 studies identified in the initial literature review, 25 were included in this study. Several studies indicated that anastomotic leak and tension are strongly associated, with the presence of tension making leaks up to 10 times more likely. However, no objective and clinically available methods exist to measure tension on bowel anastomosis in humans. Freedom from tension has traditionally been measured via surrogate measures of adequate bowel mobilization and subjective assessment by operating surgeons. Animal and cadaveric studies have been the frontier for objective measurement of wall tension. These studies use tensiometers to measure tension and automated machines or pulley and ratcheting systems to increase tension at specified intervals. However, these methods are universally destructive due to their design of measuring maximal tensile load and are not readily adaptable to the operating room.

The current literature does not address the objective measurement of bowel tension in live human subjects. Given the importance of tension, developing an objective, safe, intraoperative method to measure bowel wall tension would be a valuable surgical tool.

Anastomotic leak after colorectal resection is associated with morbidity, mortality, and poor bowel function. Minimal data exist on the relationship between anastomotic technique, intraoperative leak test, and subsequent clinical leak, particularly on the utility of performing end-to-end anastomosis (EEA) vs non-EEA (NEEA) to avoid postoperative leaks. This study aimed to analyze potential associations between anastomotic construction, intraoperative anastomotic assessments, and clinical leak.

This was a retrospective cohort study comparing anastomotic techniques used in patients with colorectal cancer who underwent left-sided colorectal resections with colorectal or coloanal anastomoses at a tertiary care center. The outcomes were rates of intraoperative air leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analyses were performed to evaluate the potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak.

Among 844 patients, 27 (3.2%) had intraoperative leak, 6 (0.7%) had incomplete donuts, and 27 (3.2%) experienced clinical leak. Of note, 500 patients (59.2%) had EEAs, and 344 patients (40.7%) had NEEAs. There were no significant differences in demographics or comorbidities between groups (P >.05) or rates of incomplete donuts (P =.07). EEA was associated with significantly more intraoperative air leaks than NEEA on univariate analysis (4.9% vs 1.2%, respectively; P =.005) and multivariate analysis (odds ratio [OR], 3.6; 95% CI, 1.01-12.50; P =.049). There was no difference in postoperative clinical leak between the groups on univariate analysis (3.0% in EEA vs 3.5% in NEEA; P =.69) or multivariate analysis (OR, 0.97; 95% CI, 0.40-2.34; P =.94).

EEA is associated with higher rates of intraoperative air leak than NEEA, even after adjusting for potential confounders.

Anorectal malformations (ARM) are rare congenital anomalies with an overall prevalence of 3.32 per 10,000 pregnancies. ARM describe a spectrum of anomalies of the anus and rectum ranging from a minimally displaced anal canal to a complete fusion of the anorectum, vagina and urethra with hypoplastic sphincter and pelvic floor muscle. Aberrant septation of the hindgut with anomalous cloacal membrane during weeks 6 to 9 of gestation form the developmental basis for a spectrum of anomalies defined as ARM. Although underlying specific syndromes and occasional familiar occurrence suggest genetic aetiology, most ARM are non-syndromic and their causal genetic mechanisms and non-genetic insults remain unclear. ARM is a clinical diagnosis, generally made early after birth via careful inspection of the perineum. Prenatal detection remains rare, and modern technical developments have added little to prenatal diagnostics. ARM is corrected surgically. Since its introduction in 1982, posterior sagittal anorectoplasty is the most common surgery for ARM reconstruction. Subsequent surgical adaptations focus on minimizing iatrogenic operative injury by limiting surgical invasiveness. They include laparoscopic procedures and shortening of incisions with confined dissection in open surgery. Although outcomes in patients with ARM have evolved throughout the past decades, there is urgent need for further improvements both in functional outcomes and quality of life. The importance of psychosocial experiences of affected patients is increasingly recognized. Continued research is necessary to improve prenatal detection, to elucidate genetic and epigenetic alterations and to refine optimal surgical procedures.

A leakage of a colorectal anastomosis represents a severe complication in visceral surgery. An anastomotic insufficiency (AI) is a potentially life-threatening complication for patients that carries a high risk of subsequent complications and long-term stoma care. Numerous factors influence the risk of AI. Knowing and being able to estimate these factors are essential for successful treatment in colorectal surgery as they help determine the surgical strategy. The recognition of an AI can be challenging for practitioners due to the variability in the clinical presentation. If the presence of AI is suspected appropriate diagnostic measures must therefore be taken. If an AI has occurred a colorectal specialist should definitely be involved in the treatment as this can significantly reduce further complications and the rate of permanent stomas.

Some observational data have suggested that anastomotic leak may be reduced with triple-row staple technology compared to double-row staple technology. We aimed to investigate this further by performing a systematic review comparing double- and triple-row staple technology for colorectal anastomoses.

This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to November 2023. Articles were eligible for inclusion if they were comparing double-row staple and triple-row staple technology for left-sided colo-colic, colorectal, or coloanal anastomosis. The main outcomes included anastomotic leak, anastomotic hemorrhage, 30-day mortality, and reoperation. Meta-analyses with inverse variance random effects were performed. Certainty of evidence was assessed with Grading of Recommendations, Assessment, Development, and Evaluations.

After reviewing 340 relevant citations, 6 retrospective cohort studies met inclusion. Overall, 19,372 patients (mean age: 60.2 years, 52.7% female sex) had anastomoses with double-row staple technology, and 2,298 patients (mean age: 61.3 years, 50.3% female sex) with triple-row staple technology. Most operations were anterior resections (double-row: 55.3%; triple-row: 43.6%). Across all included studies, the risk of anastomotic leak was reduced with triple-row staple technology (6.3% vs 7.5%, risk ratio 0.54, 95% confidence interval 0.31-0.94, P = .03, I2=75%). There were no significant differences in anastomotic hemorrhage (risk ratio 0.47, 95% confidence interval 0.15-1.49, P = .20, I2 = 57%), 30-day mortality (risk ratio 0.66, 95% confidence interval 0.17-2.55, P = .55, I2 = 0%), or reoperation (risk ratio 1.05, 95% confidence interval 0.42-2.64, P = .91, I2 = 56%).

Triple-row staple technology may reduce the risk of anastomotic leak in left-sided colorectal anastomoses.

Anastomotic leaks remain one of the most dreaded complications in gastrointestinal surgery causing significant morbidity, that negatively affect the patients' quality of life. Experimental studies play an important role in understanding the pathophysiological background of anastomotic healing and there are still many fields that require further investigation. Knowledge drawn from these studies can lead to interventions or techniques that can reduce the risk of anastomotic leak in patients with high-risk features. Despite the advances in experimental protocols and techniques, designing a high-quality study is still challenging for the investigators as there is a plethora of different models used.

To review current state of the art for experimental protocols in high-risk anastomosis in rats.

This systematic review was performed according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. To identify eligible studies, a comprehensive literature search was performed in the electronic databases PubMed (MEDLINE) and Scopus, covering the period from conception until 18 October 2023.

From our search strategy 102 studies were included and were categorized based on the mechanism used to create a high-risk anastomosis. Methods of assessing anastomotic healing were extracted and were individually appraised.

Anastomotic healing studies have evolved over the last decades, but the findings are yet to be translated into human studies. There is a need for high-quality, well-designed studies that will help to the better understanding of the pathophysiology of anastomotic healing and the effects of various interventions.

The anastomotic leak (AL) is one of the most feared complications of colorectal surgery, since it is associated with a high rate of morbidity, mortality, length of hospital stay and cost of care. Our aim was to determine the risk factors associated with anastomosis leak in colorectal cancer patients who underwent surgical resection with anastomosis.

A multicentre observational, analytical, retrospective and case-control study was carried out. For each case, two controls were included from three national hospitals from Lima, Peru during the period 2021-2022. To determine the degree of association, multivariate logistic regression model was carried out.

A total of 360 patients were included, 120 from each hospital. The mean age of the population was 68.03 ± 14.21 years old. The majority were 65 years old or older (66.1%), 52.8% were female, and 63.3% had clinical stage III. The 40% of the patients had albumin levels lower than 3.5 g/dL. Regarding the surgery, 96.4% were elective, 68.9% underwent open approach, and 80.8% had an operative time of more than 180 minutes. Most of them had right colon cancer (50.8%). In the multivariate analysis, a significant association was found with the age variable (OR = 2.48; 95%CI:1.24-4.97), clinical tumour level (OR = 2.71; 95%CI:1.34-5.48), American Society of Anesthesiologists (ASA) Score (OR = 3.23; 95%CI:1.10-9.50), preoperative serum albumin (OR = 22.2; 95%CI:11.5-42.9).

The most important independent risk factors associated with AL among patients with colorectal cancer were pre-operative such as lower preoperative serum albumin levels, followed by a higher ASA Score, clinical-stage III-IV, and an age ≥65 years old.

Three types of circular staplers can be used to perform a colorectal anastomosis: two-row (MCS), three-row (TRCS) and powered (PCS) devices. The objective of this meta-analysis has been to provide the existing evidence on which of these circular staplers would have a lower risk of presenting a leak (AL) and/or anastomotic bleeding (AB).

An in-depth search was carried out in the electronic bibliographic databases Embase, PubMed and SCOPUS. Observational studies were included, since randomized clinical trials comparing circular staplers were not found.

In the case of AL, seven studies met the inclusion criteria in the PCS group and four in the TRCS group. In the case of AB, only four studies could be included in the analysis in the PCS group. The AL OR reported for PCS was 0.402 (95%-confidence interval (95%-CI): 0.266-0.608) and for AB: 0.2 (95% CI: 0.08-0.52). The OR obtained for AL in TRCS was 0.446 (95%-CI: 0.217 to 0.916). Risk difference for AL in PCS was - 0.06 (95% CI: - 0.07 to - 0.04) and in TRCS was - 0.04 (95%-CI: - 0.08 to - 0.01). Subgroup analysis did not report significant differences between groups. On the other hand, the AB OR obtained for PCS was 0.2 (95% CI: 0.08-0.52). In this case, no significant differences were observed in subgroup analysis.

PCS presented a significantly lower risk of leakage and anastomotic bleeding while TRCS only demonstrated a risk reduction in AL. Risk difference of AL was superior in the PCS than in TRCS.

Reports on combined resection for synchronous lung lesions and esophageal cancer (CRLE) cases are rare and mostly individual cases. Furthermore, the feasibility of CRLE has always been a controversial topic. In the current study, the authors retrospectively analyzed the feasibility of CRLE and established an individualized prediction model for esophageal anastomotic leaks after CRLE by performing a multicenter retrospective study.

Patients who underwent esophagectomy between January 2009 and June 2021 were extracted from a four-center prospectively maintained database, and those with CRLE at the same setting were matched in a 1:2 propensity score-matched (PSM) ratio to esophagectomy alone (EA) patients. A nomogram was then established based on the variables involved in multivariate logistic regression analysis. Internal validation of the nomogram was conducted utilizing Bootstrap resampling. Decision and clinical impact curve analysis were computed to assess the practical clinical utility of the nomogram. A prognosis analysis for CRLE and EA patients by Kaplan-Meier curves was conducted.

Of the 7152 esophagectomies, 216 cases of CRLE were eligible, and 1:2 ratio propensity score-matched EA patients were matched. The incidence of anastomotic leaks following CRLE increased significantly ( P =0.035). The results of the multivariate analysis indicated the leaks varied according to the type of lung resection (anatomic>wedge resection, P =0.016) and site of resected lobe (upper>middle/low lobe; P =0.027), and a nomogram was established to predict the occurrence of leaks accurately (area under the curve=0.786). Although no statistically significant difference in overall survival (OS) was observed in the CRLE group ( P =0.070), a trend toward lower survival rates was noted. Further analysis revealed that combined upper lobe anatomic resection was significantly associated with reduced OS ( P =0.027).

Our study confirms that CRLE is feasible but comes with a significantly increased risk of anastomotic leaks and a concerning trend of reduced survival, particularly when upper lobe anatomic resections are performed. These findings highlight the need for careful patient selection and surgical planning when considering CRLE.

An anastomotic leak is an unpredictable postoperative complication during recovery from colorectal surgery that may require a re-operation. Potentially pathogenic bacteria like Pseudomonas (and Enterococcus) contribute to the pathogenesis of an anastomotic leak through their capacity to degrade collagen and to activate tissue matrix metalloprotease-9 in host intestinal tissues. The microbiome, therefore, is the key to preventing an anastomotic leak after colorectal surgery. The aim of this trial was to investigate whether perioperative selective decontamination with a new mixture of locally acting antibiotics specially designed against Pseudomonas aeruginosa and Enterococcus faecalis can reduce or even stop early symptomatic leakage.

All hospitalized patients in our University Clinic undergoing colorectal surgery with a left-sided anastomosis were included as two groups; patients in the intervention group received polymyxin B, gentamicin and vancomycin every six hours for five postoperative days and those in the control group did not receive such an intervention. An anastomotic leak was defined as a clinically obvious defect of the intestinal wall integrity at the colorectal anastomosis site (including suture) that leads to a communication between the intra- and extraluminal compartments, requiring a re-do surgery within seven postoperative days.

Between February 2017 and May 2023, a total of 301 patients (median age of 63 years) were analyzed. An anastomotic leak was observed in 11 patients in the control group (n = 152), but in no patients in the intervention group (n = 149); this difference was highly significant.

The antibiotic mixture (with polymyxin B, gentamicin and vancomycin) used for local decontamination in our study stopped the occurrence of anastomotic leaks completely. According to the definition of anastomotic leak, no further surgery was required after local perioperative decontamination.

Surgeons often have strong opinions about how to perform colorectal anastomoses with little data to support variations in technique. The aim of this study was to determine if location of the end-to-end (EEA) stapler spike relative to the rectal transection line is associated with anastomotic integrity.

This study was a retrospective analysis of a quality collaborative database at a quaternary centre and regional hospitals. Patients with any left-sided colon resection with double-stapled anastomosis were included (December 2019 to August 2022). Our primary endpoint was a composite outcome including positive air insufflation test, incomplete anastomotic donut, or thin/eccentric donut. Our secondary endpoint was clinical leak.

Overall, 633 patients were included and stratified by location of the stapler spike relative to the rectal transection line. Of note, 86 patients had an end-colon to anterior rectum ("reverse Baker") anastomosis with no crossing staple lines. The rates of the composite endpoint based on position of the stapler spike were 12.4% (anterior), 8.1% (through), 12.8% (posterior), 5.1% (corner), and 2.3% for the "reverse Baker" (p = 0.03). The overall rate of clinical leak was 3.8% and there were no differences between methods. In a multivariate analysis, the "reverse Baker" anastomosis was associated with decreased odds of poor anastomotic integrity when compared to anastomoses with crossing staple lines (OR 0.20, 95% CI: 0.05-0.87, p = 0.03).

For anastomoses with crossing staple lines, the position of the stapler spike relative to the rectal staple line is not associated with differences in anastomotic integrity. In contrast, anastomoses with no crossing staple lines resulted in significantly lower rates of poor anastomotic integrity, but no difference in clinical leaks.

There are several anastomotic techniques available to facilitate restorative rectal cancer surgery after total mesorectal excision (TME), including double-stapled anastomosis (DST) and handsewn coloanal anastomosis (CAA). However, to date no one technique is superior with regard to anastomotic leakage (AL) or functional outcomes. Transanal transection single-stapled anastomosis (TTSS) aims to overcome some of the technical challenges and offer comparable clinical and functional outcomes to traditional anastomotic techniques. The aim of this study was to explore the role of TTSS in modern rectal cancer surgery and to provide comparative clinical and functional outcome data with DST and CAA.

A prospective cohort study was undertaken to assess the safety and clinical and patient-reported outcomes associated with the TTSS procedure. All patients undergoing sphincter-preserving surgery for rectal cancer with an anastomosis performed within 6 cm of the anal verge between January 2016 and April 2021 were prospectively enrolled into this study. Clinical and patient-reported outcome data, including low anterior resection syndrome (LARS) assessment, were collected. The primary endpoint was anastomotic leakage within 30 days.

A total of 275 patients participated in this study, with 70 (25%) patients undergoing a TTSS, 110 (40%) undergoing a DST and 95 (35%) undergoing a CAA. Patients undergoing a CAA had more distal tumours than those having a TTSS or DST, with a median tumour height of 5, 7 and 9 cm (p < 0.001), respectively. We observed a statistically significant reduction in AL in the TTSS group compared with the DST group, with rates of 8.6% versus 20.9% (p = 0.028). There was no difference in LARS scores between patients undergoing TTSS and DST (p = 0.228), while patients with a CAA had worse LARS scores than TTSS patients (p = 0.002).

TTSS is a technically safe and feasible anastomotic technique in rectal cancer surgery as an alternative to DST and CAA. Its advantages over DST are a reduced AL rate and, over CAA, improved function. It should therefore be considered as an alternative technique to improve clinical and patient-reported outcomes in restorative rectal cancer surgery.

The risk factors for anastomotic leak (AL) after resection and primary anastomosis for traumatic bucket handle injury (BHI) have not been previously defined. This multicenter study was conducted to address this knowledge gap.

This is a multicenter retrospective study on small intestine and colonic BHIs from blunt trauma between 2010 and 2021. Baseline patient characteristics, risk factors, presence of shock and transfusion, operative details, and clinical outcomes were compared using R.

Data on 395 subjects were submitted by 12 trauma centers, of whom 33 (8.1%) patients developed AL. Baseline details were similar, except for a higher proportion of patients in the AL group who had medical comorbidities such as diabetes, hypertension, and obesity (60.6% vs. 37.3%, p=0.015). AL had higher rates of surgical site infections (13.4% vs. 5.3%, p=0.004) and organ space infections (65.2% vs. 11.7%, p<0.001), along with higher readmission and reoperation rates (48.4% vs. 9.1%, p<0.001, and 39.4% vs. 11.6%, p<0.001, respectively). There was no difference in intensive care unit length of stay or mortality (p>0.05). More patients with AL were discharged with an ostomy (69.7% vs. 7.3%, p<0.001), and the mean duration until ostomy reversal was 5.85±3 months (range 2-12.4 months). The risk of AL significantly increased when the initial operation was a damage control procedure, after adjusting for age, sex, injury severity, presence of one or more comorbidities, shock, transfusion of >6 units of packed red blood cells, and site of injury (adjusted RR=2.32 (1.13, 5.17)), none of which were independent risk factors in themselves.

Damage control surgery performed as the initial operation appears to double the risk of AL after intestinal BHI, even after controlling for other markers of injury severity.

III.

Several malignant and benign indications may necessitate bowel resection. Despite the emergence of newer techniques, the hand-sewn technique remains popular for the reestablishment of intestinal continuity after resection. This method can achieve anastomosis in one or two layers. Some studies have suggested that the single-layer technique has several potential benefits compared to its rivals while simultaneously maintaining a comparable efficacy and safety profile. Previous reviews have failed to recommend either of these methods over the other due to a lack of high-quality evidence. This review aims to establish which technique provides the best outcomes by reviewing recent relevant trials and comparing both methods. We conducted a systematic review of randomized controlled trials (RCTs) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A database search of PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) ultimately returned nine randomized trials published between 2003 and 2023 comparing single-layer intestinal anastomosis (SLIA) and double-layer intestinal anastomosis (DLIA) that fit the inclusion criteria. Overall, results show a dearth of robust trials, and the included studies displayed variable eligibility criteria and materials used for anastomosis. The available evidence, however, does suggest that neither technique is inferior in terms of preventing post-operative complications, but SLIA is less expensive and quicker to perform. The evidence is, however, limited, and further high-quality research is needed.

Rigid proctosigmoidoscopy (RP) and flexible sigmoidoscopy (FS) are two modalities commonly used for intraoperative evaluation of colorectal anastomoses. This study seeks to determine whether there is an association between the endoscopic modality used to evaluate colorectal anastomoses and the rate of anastomotic leak (AL), organ space infection, and overall infectious complication.

The 2012-2018 American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing colorectal anastomoses. Anastomotic evaluation method (RP versus FS) was identified by Current Procedural Terminologycoding and used for group classification. Outcomes measured included AL, organ space infections, and overall infection. Multivariable logistic regression analysis for predicting AL was performed.

We identified 7100 patients who underwent a colorectal anastomosis with intraoperative endoscopic evaluation. RP was utilized in 3397 (47.8%) and FS in 3703 (52.2%) patients. RP was used more commonly in diverticulitis (44.5% versus 36.2%, P < 0.01), while FS was used more frequently in malignancy (47.5% versus 36.7%, P < 0.01). Anastomotic evaluation with FS was associated with lower rates of organ space infection (3.8% versus 4.8%, P = 0.025) and AL (2.9% versus 3.8%, P = 0.028) compared to RP. On multivariate logistic regression modeling, anastomotic evaluation with RP was associated with a higher risk of AL (odds ratio 1.403, 95% CI 1.028-1.916, P = 0.033) compared to FS.

Compared to FS, rigid proctosigmoidoscopic evaluation of a colorectal anastomosis was associated with an increased rate of AL and organ space infection.

Indocyanine green (ICG) is a water-soluble fluorescent dye that is minimally toxic and widely used in gastrointestinal surgery. ICG facilitates anatomical identification of structures (e.g., ureters), assessment of lymph nodes, biliary mapping, organ perfusion and anastomosis assessment, and aids in determining the adequacy of oncological margins. In addition, ICG can be conjugated to artificially created antibodies for tumour markers, such as carcinoembryonic antigen for colorectal, breast, lung, and gastric cancer, prostate-specific antigen for prostate cancer, and cancer antigen 125 for ovarian cancer. Although ICG has shown promising results, the optimization of patient factors, dye factors, equipment, and the method of assessing fluorescence intensity could further enhance its utility. This review summarizes the clinical application of ICG in gastrointestinal surgery and discusses the emergence of novel dyes such as ZW-800 and VM678 that have demonstrated appropriate pharmacokinetic properties and improved target-to-background ratios in animal studies. With the emergence of robotic technology and the increasing reporting of ICG utility, a comprehensive review of clinical application of ICG in gastrointestinal surgery is timely and this review serves that aim.

The use of sutures to strengthen the anastomosis after rectal cancer surgery to reduce the possibility of anastomotic leakage has been debated. The aim of this systematic review and meta-analysis was to investigate the influence of intraoperative anastomotic reinforcing sutures on anastomotic leakage of double-stapling anastomosis for laparoscopic rectal cancer surgery.

A systematic search of PubMed, Embase, Web of Science, and Cochrane databases was performed to identify literature examining anastomotic leak as the primary outcome to compare studies of laparoscopic surgery for rectal cancer using the double-stapling anastomosis technique with or without intraoperative anastomotic reinforcement with sutures.

A total of 1122 rectal cancer patients from 5 nonrandomized studies were included in the research. In the combined trial, intraoperative anastomotic reinforcement sutures significantly reduced the incidence of anastomotic leakage in patients who underwent laparoscopic rectal cancer surgery (OR, 0.32; 95% CI, 0.19-0.55; p < 0.0001). With or without intraoperative anastomotic reinforcing sutures, the incidence of postoperative reoperation for anastomotic leak did not differ substantially (OR, 0.32; 95% CI, 0.08-1.21, p = 0.09). Moreover, the surgery was prolonged due to anastomotic reinforcement with sutures (OR, 6.64; 95% CI, - 6.18 to 19.47, p = 0.31).

Intraoperative anastomotic reinforcement with sutures may be associated with a lower incidence of anastomotic leakage. The amount of research evidence is limited because most of the studies analyzed did not include patients with factors such as neoadjuvant therapy or prophylactic stomas. Therefore, additional multicenter randomized controlled studies with larger size samples are needed to support the validity of the approach.

Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to analyze the effect of a three-row circular stapler on anastomotic leakage and related morbidity after left-sided colorectal resections.

A circular stapled anastomosis was performed in 4255 (50.9%) out of 8359 patients enrolled in two prospective multicenter studies in Italy, and, after exclusion criteria to reduce heterogeneity, 2799 (65.8%) cases were retrospectively analyzed through a 1:1 propensity score-matching model including 20 covariates relative to patient characteristics, to surgery and to perioperative management. Two well-balanced groups of 425 patients each were obtained: group (A) - true population of interest, anastomosis performed with a three-row circular stapler; group (B) - control population, anastomosis performed with a two-row circular stapler. The target of inferences was the average treatment effect in the treated (ATT). The primary endpoints were overall and major anastomotic leakage and overall anastomotic bleeding; the secondary endpoints were overall and major morbidity and mortality rates. The results of multiple logistic regression analyses for the outcomes, including the 20 covariates selected for matching, were presented as odds ratios (OR) and 95% confidence intervals (95% CI).

Group A versus group B showed a significantly lower risk of overall anastomotic leakage (2.1 vs. 6.1%; OR 0.33; 95% CI 0.15-0.73; P =0.006), major anastomotic leakage (2.1 vs. 5.2%; OR 0.39; 95% CI 0.17-0.87; P =0.022), and major morbidity (3.5 vs. 6.6% events; OR 0.47; 95% CI 0.24-0.91; P =0.026).

The use of three-row circular staplers independently reduced the risk of anastomotic leakage and related morbidity after left-sided colorectal resection. Twenty-five patients were required to avoid one leakage.

Technological advancements in minimally invasive surgery have led to significant improvements in patient outcomes. One such technology is surgical stapling, which has evolved into a key component of many operating rooms by facilitating ease and efficacy in resection and repair of diseased or otherwise compromised tissue. Despite such advancements, adverse post-operative outcomes such as anastomotic leak remain a persistent problem in surgical stapling and its correlates (i.e., hand-sewing), most notably in low colorectal or coloanal procedures. Many factors may drive anastomotic leaks, including tissue perfusion, microbiome composition, and patient factors such as pre-existing disease. Surgical intervention induces complex acute and chronic changes to the mechanical environment of the tissue; however, roles of mechanical forces in post-operative healing remain poorly characterized. It is well known that cells sense and respond to their local mechanical environment and that dysfunction of this "mechanosensing" phenomenon contributes to a myriad of diseases. Mechanosensing has been investigated in wound healing contexts such as dermal incisional and excisional wounds and development of pressure ulcers; however, reports investigating roles of mechanical forces in adverse post-operative gastrointestinal wound healing are lacking. To understand this relationship well, it is critical to understand: 1) the intraoperative material responses of tissue to surgical intervention, and 2) the post-operative mechanobiological response of the tissue to surgically imposed forces. In this review, we summarize the state of the field in each of these contexts while highlighting areas of opportunity for discovery and innovation which can positively impact patient outcomes in minimally invasive surgery.

Prebiotics, probiotics, and synbiotics have received increasing attention over the years for their beneficial impact on the gut microbiome and for their systemic anti-inflammatory effects. They have also been shown to improve surgical outcomes. Here, we review the inflammatory effects of surgery as well as the data which suggests a benefit of prebiotics, probiotics, and synbiotics taken in the perioperative period.

Synbiotics and fermented foods may have an even greater anti-inflammatory effect than probiotics or prebiotics alone. Recent data suggest that the anti-inflammatory effects and microbiome changes brought on by prebiotics, probiotics, and synbiotics have the potential to improve surgical outcomes. We highlight the potential to alter systemic inflammation, surgical and hospital-acquired infections, colorectal cancer formation, recurrence, and anastomotic leak. Synbiotics could also impact metabolic syndrome. Prebiotics, probiotics, and especially synbiotics may be extremely beneficial when taken in the perioperative period. Even short-term gut microbiome pre-habilitation could alter surgical outcomes significantly.

Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging. Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies, making tissue bridging challenging.

This study proposes a tissue adhesive in the form of adhesive cryogel particles (ACPs) made from chitosan, acrylic acid, 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) and N-hydroxysuccinimide (NHS). The adhesion performance was examined by the 180-degree peel test to a collection of tissues including porcine heart, intestine, liver, muscle, and stomach. Cytotoxicity of ACPs was evaluated by cell proliferation of human normal liver cells (LO2) and human intestinal epithelial cells (Caco-2). The degree of inflammation and biodegradability were examined in dorsal subcutaneous rat models. The ability of ACPs to bridge irregular tissue defects was assessed using porcine heart, liver, and kidney as the ex vivo models. Furthermore, a model of repairing liver rupture in rats and an intestinal anastomosis in rabbits were established to verify the effectiveness, biocompatibility, and applicability in clinical surgery.

ACPs are applicable to confined and irregular tissue defects, such as deep herringbone grooves in the parenchyma organs and annular sections in the cavernous organs. ACPs formed tough adhesion between tissues [(670.9 ± 50.1) J/m² for the heart, (607.6 ± 30.0) J/m² for the intestine, (473.7 ± 37.0) J/m² for the liver, (186.1 ± 13.3) J/m² for muscle, and (579.3 ± 32.3) J/m² for the stomach]. ACPs showed considerable cytocompatibility in vitro study, with a high level of cell viability for 3 d [(98.8 ± 1.2) % for LO2 and (98.3 ± 1.6) % for Caco-2]. It has comparable inflammation repair in a ruptured rat liver (P = 0.58 compared with suture closure), the same with intestinal anastomosis in rabbits (P = 0.40 compared with suture anastomosis). Additionally, ACPs-based intestinal anastomosis (less than 30 s) was remarkably faster than the conventional suturing process (more than 10 min). When ACPs degrade after surgery, the tissues heal across the adhesion interface.

ACPs are promising as the adhesive for clinical operations and battlefield rescue, with the capability to bridge irregular tissue defects rapidly.

To optimize the efficiency of ileocolic anastomosis following right hemicolectomy, several variations of the surgical technique have been tested. These include performing the anastomosis intra- or extracorporeally or performing a stapled or hand-sewn anastomosis. Among the least studied is the configuration of the two stumps (i.e., isoperistaltic or antiperistaltic) in the case of a side-to-side anastomosis. The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature. High-quality literature is scarce, with only three studies directly comparing the two alternatives, and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage, stenosis, or bleeding. However, there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis. Finally, existing data do not identify a certain anastomotic configuration (i.e., isoperistaltic or antiperistaltic) as superior over the other. Thus, the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.

A bioadhesive triboelectric nanogenerator (BA-TENG), as a first-aid rescue for instant and robust wound sealing and ultrasound-driven accelerated wound healing, is designed. This BA-TENG is fabricated with biocompatible materials, and integrates a flexible TENG as the top layer and bioadhesive as the bottom layer, resulting in effective electricity supply and strong sutureless sealing capability on wet tissues. When driven by ultrasound, the BA-TENG can produce a stable voltage of 1.50 V and current of 24.20 µA underwater. The ex vivo porcine colon organ models show that the BA-TENG seals defects instantly (≈5 s) with high interfacial toughness (≈150 J m^-2 ), while the rat bleeding liver incision model confirms that the BA-TENG performs rapid wound closure and hemostasis, reducing the blood loss by about 82%. When applied in living rats, the BA-TENG not only seals skin injuries immediately but also produces a strong electric field (E-field) of about 0.86 kV m^-1 stimulated by ultrasound to accelerate skin wound healing significantly. The in vitro studies confirm that these effects are attributed to the E-field-accelerated cell migration and proliferation. In addition, these TENG adhesives can be applied to not only wound treatment, nerve stimulation and regeneration, and charging batteries in implanted devices.

Postoperative complications after a colonic and rectal surgery are of significant concern to the surgical community. Although there are different techniques to perform anastomosis (i.e., handsewn, stapled, or compression), there is still no consensus on which technique provides the least number of postoperative problems. The objective of this study is to compare the different anastomotic techniques regarding the occurrence or duration of postoperative outcomes such as anastomotic dehiscence, mortality, reoperation, bleeding and stricture (as primary outcomes), and wound infection, intra-abdominal abscess, duration of surgery, and hospital stay (as secondary outcomes).

Clinical trials published between January 1, 2010, and December 31, 2021, reporting anastomotic complications with any of the anastomotic technique were identified using the MEDLINE database. Only articles that clearly defined the anastomotic technique used, and report at least two of the outcomes defined were included.

This meta-analysis included 16 studies whose differences were related to the need of reoperation (p < 0.01) and the duration of surgery (p = 0.02), while for the anastomotic dehiscence, mortality, bleeding, stricture, wound infection, intra-abdominal abscess, and hospital stay, no significant differences were found. Compression anastomosis reported the lowest reoperation rate (3.64%) and the handsewn anastomosis the highest (9.49%). Despite this, more time to perform the surgery was required in compression anastomosis (183.47 min), with the handsewn being the fastest technique (139.92 min).

The evidence found was not sufficient to demonstrate which technique is most suitable to perform colonic and rectal anastomosis, since the postoperative complications were similar between the handsewn, stapled, or compression techniques.

This study investigates the nanoindentation technique to elucidate the quasi-static and dynamic stress response at the wounded and sutured tissue interface. In vitro modeling and wound healing analysis enable an understanding of sutured tissue interface integrity, modulus, and stability using an artificial abdominal wall model. Sutured tissues with simple interrupted suturing (SIS) demonstrated a 35-40% higher modulus than simple continuous suturing (SCS). High-density suturing with a suture space of 2.5 mm exhibited a 2-fold higher modulus than low-density suturing with a suture space of 5 mm. The elastic modulus of the sutured pad immersed in deionized water was ∼70-95% of the dry condition. The dynamic stress data indicate that long-term body motions-triggered stress instability at the wound interface was affected by suturing style and density. The pivotal factors determining wound healing are quasi-static and dynamic modulus at the sutured interface, which is intimately associated with patient pain, wound complications, healing speed, and blood flow. The proposed method and data are an original approach to addressing wound healing, contributing to patient well-being and identifying, interpreting, and breaking the drawn-out debates in the suturing field.

Anastomotic leakage is a life-threatening complication. Improvement of the anastomosis technique is needed, especially in patients with an inflamed edematous intestine. The aim of our study was to evaluate the safety and efficacy of an asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis in pediatric patients.

A total of 23 patients underwent intestinal anastomosis at the Department of Pediatric Surgery of Binzhou Medical University Hospital. Demographic characteristics, laboratory parameters, anastomosis time, duration of nasogastric tube placement, day of first postoperative bowel movement, complications, and length of hospital stay were statistically analyzed. The follow-up was conducted for 3-6 months after discharge.

Patients were divided into two groups: the single-layer asymmetric figure-of-eight suture technique (group 1) and the traditional suture technique (group 2). Body mass index in group 1 was lower than in group 2 (14.43 ± 3.23 vs. 19.38 ± 6.74; P = 0.036). The mean intestine anastomosis time in group 1 (18.83 ± 0.83 min) was less than that in group 2 (22.70 ± 4.11 min; P = 0.005). Patients in group 1 had an earlier first postoperative bowel movement (2.17 ± 0.72 vs. 2.80 ± 0.42; P = 0.023). The duration of nasogastric tube placement in group 1 was shorter than that in group 2 (4.12 ± 1.42 vs. 5.60 ± 1.57; P = 0.043). There was no significant difference in laboratory variables, complication occurrence, and length of hospital stay between the two groups.

The asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis was feasible and effective. More studies are needed to compare the novel technique with the traditional single-layer suture.

Assessing performance automatically in a virtual reality trainer or from recorded videos is advantageous but needs validated objective metrics. The purpose of this study is to obtain expert consensus and validate task-specific metrics developed for assessing performance in double-layered end-to-end anastomosis.

Subjects were recruited into expert (PGY 4-5, colorectal surgery residents, and attendings) and novice (PGY 1-3) groups. Weighted average scores of experts for each metric item, completion time, and the total scores computed using global and task-specific metrics were computed for assessment.

A total of 43 expert surgeons rated our task-specific metric items with weighted averages ranging from 3.33 to 4.5 on a 5-point Likert scale. A total of 20 subjects (10 novices and 10 experts) participated in validation study. The novice group completed the task significantly more slowly than the experienced group (37.67 ± 7.09 vs 25.47 ± 7.82 min, p = 0.001). In addition, both the global rating scale (23.47 ± 4.28 vs 28.3 ± 3.85, p = 0.016) and the task-specific metrics showed a significant difference in performance between the two groups (38.77 ± 2.83 vs 42.58 ± 4.56 p = 0.027) following partial least-squares (PLS) regression. Furthermore, PLS regression showed that only two metric items (Stay suture tension and Tool handling) could reliably differentiate the performance between the groups (20.41 ± 2.42 vs 24.28 ± 4.09 vs, p = 0.037).

Our study shows that our task-specific metrics have significant discriminant validity and can be used to evaluate the technical skills for this procedure.

A surgeon must possess the knowledge and technical skill to obtain length following a left-sided colorectal resection to perform a tension free anastomosis. The distal target organ - either rectum or anus - is fixed in location, and therefore requires surgeons to acquire mastery of proximal mobilization of the colonic conduit. Generally, splenic flexure mobilization (SFM) provides adequate length. Surgeons benefit from clearer understanding of the multiple steps involved in SFM as a result of improved visualization and demonstration of the relevant anatomy - adjacent organs and the attachments, embryologic planes, and mesenteric structures. Much may be attributed to laparoscopic and robotic platforms which provided improved exposure and as a result, development or refinement of novel approaches for SFM with potential advantages. Complete mobilization draws upon the sum or combination of the varied approaches to accomplish the goal. However, in the situation where extended resection is necessary or in the case of re-operative surgery sacrificing either more proximal or distal large intestine often occurs, the transverse colon or even the ascending colon represents the proximal conduit for anastomosis. This challenging situation requires familiarity with special maneuvers to achieve colorectal or coloanal anastomosis using these more proximal conduits. In such instances, operative techniques such as either ileal mesenteric window with retroileal anastomosis or de-rotation of the right colon (Deloyer's procedure) enable the intestinal surgeon to construct such anastomoses and thereby avoid stoma creation or loss of additional large intestine.

Surgical staplers and clip appliers are commonly used and have a potential to malfunction, which may result in serious injury or death. These events are self-reported to the Food and Drug Administration and compiled in the Food and Drug Administration's Manufacturer and User Facility Device Experience database. This study characterizes mortality related to surgical stapler and clip applier failure reported in the Food and Drug Administration's Manufacturer and User Facility Device Experience database.

The Food and Drug Administration's Manufacturer and User Facility Device Experience database was reviewed between 1992 and 2016 for medical device reports related to surgical staplers and clip appliers filed under the following product codes: GAG, FZP, GDO, GDW, KOG, and GCJ. Adverse events including death and the type of device failure were reviewed. Temporal trends in reported deaths related to device failure were analyzed and the Healthcare Cost and Utilization Project database was used to adjust for annual surgical case volume using linear regression analysis.

A total of 75,415 malfunctions, 21,115 injuries, and 676 deaths were associated with the use of surgical stapler and clip applier devices. Most deaths occurred postoperatively (N = 516, 76.3%) and were due to infection/sepsis (N = 89, 17.2%) or vascular injuries (N = 110, 21.3%). Intraoperative mortality (N = 79, 11.7%) was primarily due to vascular injuries (N = 73, 92.4%). Device failures resulting in death were noted both intraoperatively (N = 268, 39.6%) and postoperatively (N = 325, 48.1%). In post hoc root cause analysis, a surgical stapler and clip applier device problem was the most common attributed cause of death (N = 238, 65.4%). In the linear regression analysis, there was a significant increase in the mortality from device failure in the study period after adjusting for annual surgical volume (P < .01).

Mortality related to the use of surgical staplers and clip appliers is increasing. Most deaths occurred postoperatively, and an increased awareness of potential life-threatening complications is warranted when these devices are used.

Ileocolic anastomoses are commonly performed by surgeons in both open and minimally invasive settings and can be created by using many different techniques and configurations. Here the authors review both current literature and the author's preference for creation of ileocolic anastomoses in the setting of malignancy, inflammatory bowel disease, and colonic inertia. The authors also review evidence surrounding adjuncts to creation of anastomoses such as use of indocyanine green and closing mesenteric defects. While many techniques of anastomotic creation have adapted with new evidence and technologies, several key principles still provide the foundation for current practice.

Colorectal anastomosis is a sophisticated problem that demands an elaborate discussion and an elegant solution. "Those who forget the past are condemned to repeat it." George Santayana, Life of Reason , 1905.

Task-specific metrics facilitate the assessment of surgeon performance. This 3-phased study was designed to (1) develop task-specific metrics for stapled small bowel anastomosis, (2) obtain expert consensus on the appropriateness of the developed metrics, and (3) establish its discriminant validity.

In Phase I, a hierarchical task analysis was used to develop the metrics. In Phase II, a survey of expert colorectal surgeons established the importance of the developed metrics. In Phase III, to establish discriminant validity, surgical trainees and surgeons, divided into novice and experienced groups, constructed a side-to-side anastomosis on porcine small bowel using a linear cutting stapler. The participants' performances were videotaped and rated by 2 independent observers. Partial least squares regression was used to compute the weights for the task-specific metrics to obtain weighted total score.

In Phase II, a total of 45 colorectal surgeons were surveyed: 28 with more than 15 years, 13 with 5 to 15 years, and 4 with less than 5 years of experience. The consensus was obtained on all the task-specific metrics in the more experienced groups. In Phase III, 20 subjects participated equally in both groups. The experienced group performed better than the novice group regardless of the rating scale used: global rating scale (p = 0.009) and the task-specific metrics (p = 0.012). After partial least squares regression, the weighted task-specific metric score continued to show that the experienced group performed better (p < 0.001).

Task-specific metric items were developed based on expert consensus and showed good discriminant validity compared with a global rating scale between experienced and novice operators. These items can be used for evaluating technical skills in a stapled small bowel anastomosis model.

Adequate endoscopic scoring in Crohn's disease (CD) is crucial, as dictates the need for initiating postoperative medical therapy and is utilized as outcome parameter in clinical trials. We aimed to observe anastomotic wound healing in relation to endoscopic scoring of both inverted and everted stapled lines in side-to-side anastomoses.

Two prospective patient cohorts were included: ileocolic resection (ICR) for CD, and right-sided colon resection for colorectal cancer (CRC). Videos taken during colonoscopy six months postoperatively were evaluated. The SES-CD and modified Rutgeerts score were determined. Primary outcome was the presence of ulcerations in CD patients on both the inverted and everted stapled lines. Secondary outcomes were the presence of anastomotic ulcerations in CRC patients and the number of cases having ulcerations exclusively at the inverted stapled line.

Of the 82 patients included in the CD cohort, ulcerations were present in 63/82 (76·8%) at the inverted- versus 1/71 (1·4%) at the everted stapled line. Likewise in the CRC cohort, ulcerations were present in 4/6 (67·7%) at the inverted versus 0/6 (0%) at the everted stapled line. 27% of the 63 patients in the CD cohort had ulcerations exclusively on the inverted stapled line.

Inverted stapled lines heal with ulcerations, whereas the everted stapled line heal without any ulcerations, both in CD and non-CD patients. The abnormalities at the inverted stapled line might interfere with endoscopic scoring of recurrence, with potentially an impact on patients' quality of life and on health-care costs if postoperative treatment is initiated incorrectly.

For patients who have undergone colorectal surgery, anastomotic leakage is a serious and challenging complication with a variable rate ranging between 1.8% and 19.2%. Postoperative anastomotic leaks after colorectal surgery can have severe consequences for patients, particularly ones who present with few or no symptoms. Computed tomography and/or water-soluble contrast enema (WSE) are the most frequently utilized imaging methods to identify and diagnose anastomotic leaks early. WSE is a safe and complication-free procedure that allows to identify the presence of otherwise unrecognized anastomotic leaks, both in asymptomatic and symptomatic patients. Fluoroscopic rectal examination using a water-soluble contrast agent for postoperative patients is never an easy examination to perform since it requires careful preparation, skill, and knowledge. Four morphological types of anastomotic dispersion have been described: "saccular type", "horny type", "serpentine type" and "dendritic type". Among 4 types of leakage, dendritic and serpentine types are more frequently followed by clinical symptoms and none of the dendritic type resolves spontaneously. On the other hand, the saccular and horny types have a better prognosis after healing of the loss and subsequent restoration of the ostomy as they consist of a cavity that provides a sort of physical barrier to the spread of inflammation. The aim of this pictorial essay was to illustrate the spectrum of imaging findings of morphological types of radiologic leakages on WCE in patients with colorectal surgical anastomosis. We have also tried to provide tips and tools to enable identification of radiological leakages on retrograde WCE, particularly of the smallest leaks which can be more easily missed.

Background: Complications in colon surgery can have severe health consequences, while at the same time, they are associated with increased costs. An anastomotic leak (AL) is associated with significantly increased costs compared to cases without. The aim of our analysis was to evaluate, which individual processes and patient-unrelated factors influencing the treatment process of colon surgery are responsible for the financial burden in patients with AL. Methods: Data from 263 patients who underwent colon surgery in Wetzikon hospital between January 2018 and December 2020 and was analyzed. In these 263 cases, 12 anastomotic leaks occurred and were compared with 36 cases without AL using a Propensity Score Matching (PSM). The covariates for the PSM have been Age, Sex, and Type of Surgery (t value: −3.26, p-value: 0.001). Results: A total of 48 surgeries were broken down in terms of costs and profitability. This reflected a mean deficit of −37,527 CHF per case (range from −130.05 to +755 CHF) for patients with AL, whereas a mean profit of 1590 CHF per case (range from −24.37 to +12.65 CHF) for those without AL (p < 0.001). Thus, the difference in profit showed a factor of 24.6 with an overall significant negative outcome for the occurrence of AL. The main cost contributing factors were the length of hospital stay (~p < 0.05) and length of intensive care (p < 0.05), whereas neither surgical operation time and anesthesia time nor surgical access, insurance status, indication or type of operation had a significant influence on the net revenue. Conclusion: AL after colon surgery leads to a significant deficit regarding the net revenue. Regarding process optimization, our analysis identified several sectors of non-patient-related, yet cost-influencing variables that should be addressed in future evaluations and optimization of the colon surgery treatment processes.

Anastomotic leakage (AL) after colorectal surgery is a serious complication. This study aimed to evaluate the effectiveness of the EEA™ circular stapler, a new triple-row circular stapler (TCS), relative to a conventional, double-row circular stapler (DCS). A total of 285 patients who underwent anastomosis with the double stapling technique at the Tokyo Medical University Hospital between 2017 and 2021 were included in this nonrandomized clinical trial with historical controls using a propensity score (PS) analysis. The primary endpoint was the risk of AL. We performed a 1:2 PS matching analysis. Before case matching, AL occurred in 15 (7.4%) and 2 (2.4%) patients in the DCS and TCS groups, respectively, with no significant difference (P = .17). After case matching, AL occurred in 13 patients (11.6%) and 1 patient (1.8%) in the DCS and TCS groups, respectively, revealing a significant difference (P = .04). Cox models were created by applying PS to adjust for group differences via regression adjustment. Odds ratios for AL in the DCS group versus the TCS group were 0.31 (95% confidence interval [CI]: 0.07-1.38) in the entire cohort, 0.15 (95% CI: 0.02-0.64) in the regression adjustment cohort, and 0.14 (95% CI: 0.02-1.09) in the 1:2 PS-matched cohort. PS analysis of clinical data suggested that the use of TCS contributes to a reduced risk of AL after colorectal anastomosis CTwith the double stapling technique.

Hand-sewn and stapled intestinal anastomoses are both daily performed routine procedures by surgeons. Yet, differences in micro perfusion of these two surgical techniques and their impact on surgical outcomes are still insufficiently understood. Only recently, hyperspectral imaging (HSI) has been established as a non-invasive, contact-free, real-time assessment tool for tissue oxygenation and micro-perfusion. Hence, objective of this study was HSI assessment of different intestinal anastomotic techniques and analysis of patients' clinical outcome.

Forty-six consecutive patients with an ileal-ileal anastomoses were included in our study; 21 side-to-side stapled and 25 end-to-end hand-sewn. Based on adsorption and reflectance of the analyzed tissue, chemical color imaging indicates oxygen saturation (StO2), tissue perfusion (near-infrared perfusion index [NIR]), organ hemoglobin index (OHI), and tissue water index (TWI).

StO2 as well as NIR of the region of interest (ROI) was significantly higher in stapled anastomoses as compared to hand-sewn ileal-ileal anastomoses (StO2 0.79 (0.74-0.81) vs. 0.66 (0.62-0.70); p<0.001 NIR 0.83 (0.70-0.86) vs. 0.70 (0.63-0.76); p=0.01). In both groups, neither anastomotic leakage nor abdominal septic complications nor patient death did occur.

Intraoperative HSI assessment is able to detect significant differences in tissue oxygenation and NIR of hand-sewn and stapled intestinal anastomoses. Long-term clinical consequences resulting from the reduced tissue oxygenation and tissue perfusion in hand-sewn anastomoses need to be evaluated in larger clinical trials, as patients may benefit from further refined surgical techniques.