• Humans
• Male
• Female
• Retrospective Studies
• Middle Aged
• Enhanced Recovery After Surgery
• Postoperative Hemorrhage/epidemiology
• Length of Stay/statistics & numerical data
• Aged
• Ketorolac/therapeutic use
• Celecoxib/therapeutic use
• Incidence
• Colorectal Surgery/methods
• Colorectal Surgery/adverse effects
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Cyclooxygenase 2 Inhibitors/therapeutic use
• Elective Surgical Procedures/adverse effects
• Elective Surgical Procedures/methods
• Patient Readmission/statistics & numerical data
• Blood Transfusion/statistics & numerical data
• Clinical Protocols
• Anastomosis, Surgical/methods
• Anastomosis, Surgical/adverse effects
• Perioperative Care/methods

• accelerated recovery
• colorectal surgery
• enhanced recovery after surgery (eras)
• pain management
• postoperative care
• postoperative complications

• Crohn’s disease
• IBD
• Mycobacterium paratuberculosis
• antibiotics
• bacteria
• microbiome
• mycobacteria
• surgery

• colorectal surgery
• electronic medical record
• enhanced recovery after surgery
• patient outcomes
• resident education
• surgical resident

• Humans
• Internship and Residency
• Colorectal Surgery
• Prospective Studies
• Digestive System Surgical Procedures
• Perioperative Care
• Length of Stay
• Postoperative Complications
• Retrospective Studies

• Anastomotic leakage
• Colorectal neoplasms
• Colorectal surgery
• Non-steroidal anti-inflammatory drugs

• Adult
• Humans
• Anastomotic Leak/epidemiology
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Anastomosis, Surgical
• Retrospective Studies
• Colorectal Neoplasms/surgery
• Risk Factors

• 6-paradol (PubChem CID: 94378)
• 6-shogaol (PubChem CID: 5281794)
• Aloe-emodin (PubChem CID: 10207)
• Capsaicin (PubChem CID: 1548943)
• Cinnamaldehyde (PubChem CID: 637511)
• Corydaline (PubChem CID: 101301)
• Emodin (PubChem CID: 3220)
• Geniposide (PubChem CID: 107848)
• Ginsenoside Rb1 (PubChem CID: 9898279)
• Ginsenoside Rf (PubChem CID: 441922)
• Hesperidin (PubChem CID: 10621)
• Honokiol (PubChem CID: 72303)
• Hydroxy-α- sanshool (PubChem CID: 53429684)
• Hydroxy-β-sanshool (PubChem CID: 10220912)
• Jatrorrhizine (PubChem CID: 72323)
• Luteolin (PubChem CID: 5280445)
• Magnolol (PubChem CID: 72300)
• Mangiferin (PubChem CID: 5281647)
• Naringenin (PubChem CID: 439246)
• Natural herbal medicines
• Postoperative ileus
• TRPA1
• TRPV1
• γ-sanshool (PubChem CID: 6440615)

• Humans
• TRPA1 Cation Channel
• Plants, Medicinal
• Ileus/drug therapy
• Pain
• Plant Extracts
• TRPV Cation Channels/physiology

• Mesenteric traction syndrome
• Non-steroidal anti-inflammatory drugs
• Patients’ outcome
• Postoperative leakage or bleeding

• Humans
• Flurbiprofen/administration & dosage
• Flurbiprofen/adverse effects
• Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
• Pain, Postoperative/drug therapy
• Retrospective Studies
• Postoperative Hemorrhage/chemically induced
• Incidence
• Postoperative Complications
• Abdomen/surgery
• Laparoscopy

• Monitoring
• Postoperative care
• Roux-en-Y gastric bypass
• Safety net
• Same-day discharge

• Humans
• Gastric Bypass/adverse effects
• Gastric Bypass/methods
• Nausea/surgery
• Obesity, Morbid/surgery
• Observational Studies as Topic
• Patient Discharge
• Postoperative Care
• Postoperative Complications/epidemiology
• Retrospective Studies
• Vomiting

• Humans
• Adult
• Lidocaine
• Pain Management
• Colorectal Surgery
• Randomized Controlled Trials as Topic
• Administration, Intravenous
• Pain, Postoperative/diagnosis
• Pain, Postoperative/etiology
• Pain, Postoperative/prevention & control
• Analgesia
• Analgesics

• Colorectal surgery
• ERAS
• Enhanced recovery

• Humans
• Colon
• Digestive System Surgical Procedures
• Endoscopy
• Rectum
• Surgeons
• United States

• Humans
• United States
• Rectum
• Colon/surgery
• Digestive System Surgical Procedures
• Surgeons

• Anastomotic leakage
• Colorectal surgery
• Complications
• Rectal neoplasms
• Water-soluble enema

Flurbiprofen has been one of the most commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) in China and other Asian countries for perioperative multimodal analgesia in recent years, yet its association with anastomotic leakage in gastrointestinal anastomoses is unknown. The current study was designed to investigate whether short-term administration of flurbiprofen would increase the risk of anastomotic leakage in patients undergoing gastrointestinal surgery for cancer resection.

A total of 3653 patients (2487 (66.1%) men) undergoing elective operation for gastrointestinal cancer between 18 July 2017 and 30 Oct 2020 were included. The median age was 61 years (interquartile range 53–67 years). The exposure was the short-term postoperative use of flurbiprofen (defined as flurbiprofen treatment within the first week after surgery). The primary outcome was the frequency of clinical anastomotic leakage.

Of 3653 patients with available data who were included in the final analysis, 2282 received flurbiprofen administration, and 1371 did not. Anastomotic leakage was not significantly increased among the patients receiving flurbiprofen compared with those who did not (1.62% v 1.46%; P=0.70). In-hospital mortality was comparable between the two groups (0.04% v 0.07%; P=0.72). After adjusted analysis, male sex (OR 3.51, 95% CI 1.80–6.85), ASA score of 3–4 (OR 2.69, 95% CI 1.62–4.48), and intraoperative infusion (OR 2.24, 95% CI 1.19–4.21) were identified as risk factors for anastomotic leakage.

Postoperative short-term use of flurbiprofen did not increase the risk of anastomotic leakage in gastrointestinal anastomoses.

• Anastomotic leakage
• Flurbiprofen
• Gastrointestinal surgery
• Nonsteroidal anti-inflammatory drugs

• Anastomosis leakage
• COX-2 selective
• NSAIDs
• Post-operative complications

This meta-analysis aimed to evaluate whether ketorolac administration is associated with an increased anastomotic leak rate after colorectal surgery.

The literature was searched using the Web of Science, Embase, and PubMed databases, and the search ended on May 31, 2020. The Newcastle–Ottawa Scale was used to assess methodological quality. Statistical heterogeneity was assessed using the Chi-square Q test and I² statistics. Subgroup analysis was performed, and Egger's test was used to assess publication bias.

This meta-analysis included seven studies with 400,822 patients. Our results demonstrated that ketorolac administration after surgery increases the risk of anastomotic leak [OR = 1.41, 95% CI: 0.81–2.49, Z = 1.21, P = 0.23]. Low heterogeneity was observed across these studies (I² = 0%, P = 0.51). The results of subgroup analysis showed that the use of ketorolac in case–control and retrospective cohort studies significantly increased the risk of anastomotic leak (P < 0.05). Furthermore, the subgroup analysis revealed that ketorolac use increased anastomotic leak rate in patients in the United States and Canada, and ketorolac plus morphine use did not increase anastomotic leak rate in Taiwanese patients (P < 0.05). No significant publication bias was observed (P = 0.126). Moreover, the analysis of risk factors related to anastomotic leak rate indicated that the total use of ketorolac did not increase the risk of anastomotic leak similar to the control group (P > 0.05).

The meta-analysis indicates that the use of ketorolac increases the risk of anastomotic leak after colorectal surgery.

PROSPERO, identifier CRD42020195724.

Driven by the increasing concern about the risk of diclofenac (DCF) residues as water pollutants in the aqueous environment and the growing need for its trace determination, a simple but sensitive electrochemical aptasensor for the trace detection of DCF was developed. To construct the aptasensor, the amine-terminated DCF aptamer was covalently immobilized on the surface of the carboxylic acid–functionalized multi-walled carbon nanotube (f-MWCNT)–modified glassy carbon electrode (GCE) through EDC/NHS chemistry. The f-MWCNTs provide a reliable matrix for aptamer immobilization with high grafting density, while the aptamer serves as a biorecognition probe for DCF. The obtained aptasensor was incubated with DCF solutions at different concentrations and was then investigated by electrochemical impedance spectroscopy (EIS). It displays two linear ranges of concentration for DCF detection, from 250 fM to 1pM and from 1 pM to 500 nM with an extremely low detection limit of 162 fM. Also, the developed biosensor shows great reproducibility, acceptable stability, and reliable selectivity. Therefore, it offers a simple but effective aptasensor construction strategy for trace detection of DCF and is anticipated to show great potential for environmental applications.

• gastrointestinal
• inflammation
• postoperative ileus
• surgery

• ERAS
• enhanced recovery after surgery
• multimodal analgesia
• opioid-sparing analgesia
• pain management
• postsurgical pain

• funding

Anastomotic leakage is a potentially severe complication occurring after colorectal surgery and can lead to increased morbidity and mortality, permanent stoma formation, and cancer recurrence. Multiple risk factors for anastomotic leak have been identified, and these can allow for better prevention and an earlier diagnosis of this significant complication. There are nonmodifiable factors such as male gender, comorbidities and distance of tumor from anal verge, and modifiable risk factors, including smoking and alcohol consumption, obesity, preoperative radiotherapy and preoperative use of steroids or non-steroidal anti-inflammatory drugs. Perioperative blood transfusion was shown to be an important risk factor for anastomotic failure. Recent studies on the laparoscopic approach in colorectal surgery found no statistical difference in anastomotic leakage rate compared with open surgery. A diverting stoma at the time of primary surgery does not appear to reduce the leak rate but may reduce its clinical consequences and the need for additional surgery if anastomotic leakage does occur. It is still debatable if preoperative bowel preparation should be used, especially for left colon and rectal resections, but studies have shown similar incidence of postoperative leak rate.

• anastomotic fistula
• anastomotic leakage
• colorectal cancer
• colorectal surgery
• risk factors

• Enhanced recovery after surgery (ERAS)
• Enhanced recovery protocols (ERP)
• Fast-track surgery

• Clinical Protocols/standards
• Enhanced Recovery After Surgery/standards
• Humans
• Pain, Postoperative/drug therapy
• Pain, Postoperative/therapy
• Patient Care Bundles/economics
• Patient Care Bundles/standards
• Perioperative Care/economics
• Perioperative Care/standards
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Postoperative Complications/therapy

• Anastomotic leak (AL)
• Colorectal cancer
• General surgery
• Non-steroidal anti-inflammatory drugs (NSAIDs)

• ileus
• intestinal nervous system
• postoperative

• Anastomotic insufficiency
• Colon
• Dehiscence
• Leak
• Rectum
• Vital sign

• Colonic surgery
• Compliance
• Enhanced recovery program
• Rectal surgery

• Colon
• Digestive System Surgical Procedures
• Humans
• Length of Stay
• Perioperative Care
• Rectum/surgery
• Retrospective Studies

• analgesic requirement
• anesthesia
• surgery
• vitamin C

• Analgesics/therapeutic use
• Analgesics, Opioid/therapeutic use
• Ascorbic Acid/therapeutic use
• Dietary Supplements
• Humans
• Pain, Postoperative/drug therapy
• Perioperative Period
• Postoperative Nausea and Vomiting/prevention & control
• Randomized Controlled Trials as Topic
• Risk Assessment

• Anaesthesia
• Analgesia
• ERAS
• Surgery
• Urology

• 5-HT3
• ERAS paradigms
• Enhanced Recovery after Surgery
• antiemetic
• colorectal surgery
• corticosteroids
• dexamethasone
• goal-directed fluid therapy
• guidelines
• multimodal analgesia
• ondansetron
• opioid-sparing
• postoperative gastrointestinal dysfunction
• postoperative nausea and vomiting
• preoperative carbohydrate loading
• preoperative fasting
• prophylaxis
• surgery

• Anastomotic leak
• Colorectal cancer
• Non-steroidal anti-inflammatory drugs
• Risk factors

• Acute kidney injury
• Anastomotic leak
• Colorectal surgery
• Enhanced recovery
• Postoperative complications
• Urinary retention

• Acute Kidney Injury/etiology
• Anastomotic Leak/chemically induced
• Anastomotic Leak/etiology
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Colon/surgery
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/methods
• Enhanced Recovery After Surgery
• Humans
• Postoperative Complications/etiology
• Rectum/surgery
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Urinary Catheterization/adverse effects
• Urinary Catheterization/methods
• Urinary Retention/etiology

• Anastomotic leakage
• Colorectal surgery
• Meta-analysis
• Vascular calcification

• Anastomotic healing
• Colorectal anastomotic leak
• Etiopathogenesis
• Inflammation
• Leakage
• Local recurrence
• Microbiome

The tissue inflammatory response can influence the outcome of anastomotic healing. Anastomotic leakage represents a dreadful complication after gastrointestinal surgery, in particular sepsis and intra-abdominal infections impair the restorative process of colic anastomoses. It has been debated whether the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is a risk factor for dehiscence, since many patients receive NSAIDs in the early postoperative period. Our aim was, for the first time, to analyze the morpho-functional effects of postoperative administration of two commonly used NSAIDs, Diclofenac and Ketorolac, on the healing process of colo-colic anastomoses constructed under condition of fecal peritonitis in a rat model. Sixty adult male rats underwent two surgical procedures: peritonitis induction and colo-colic anastomosis, and were divided into three groups: 20 rats received saline; 20 rats 4 mg/kg Diclofenac and 20 rats 5 mg/kg Ketorolac. We assessed anastomosis strength, morphological features of tissue wound healing, immunohistochemical metalloproteinase 9 (MMP9) expression and collagen deposition and content by Sirius red staining and hydroxyproline level. We found no significant difference in bursting pressure, collagen content and organization and morphological features between the groups, except a significantly reduced presence of inflammatory cells and MMP9 expression in the groups treated with NSAIDs. Our findings showed that Diclofenac and Ketorolac administration did not affect post-surgical healing and did not increase the leakage risk of colo-colic anastomoses during peritonitis.

• anastomotic leakage
• cyclooxygenase inhibitor
• gastrointestinal surgery
• meta‐analysis
• non‐steroidal anti‐inflammatory drugs

Opioid administration in postoperative patients has contributed to the opioid crisis by increasing the load of opioids available in the community. Implementation of evidence-based practices is key to optimizing the use of opioids for acute pain control. This study aims to characterize the administration and prescribing practices after emergency laparoscopic general surgery procedures with the goal of identifying areas for improvement.

A retrospective chart review of 200 patients undergoing emergency laparoscopic appendectomies and cholecystectomies was conducted for a 2-year period at a single institution. Eligible patients were opioid-naïve adults admitted through the emergency department. Opioid administration and discharge prescriptions were converted to oral morphine equivalents (OME), and analyzed and compared with published literature and local guidelines.

Opioid analgesia was provided as needed to 69% of patients in hospital with average dosing of 26.7 OME/day; comparatively, 99.5% of patients received prescriptions for opioids on discharge at an average dosing of 61.7 OME/day. The average dosing in the discharge prescriptions was not correlated with in-hospital needs (Pearson=−0.04; p=0.56); and higher narcotic doses were associated with combination opioid prescriptions compared with separate opioid prescriptions (73.8 (1.90) vs. 50.1 (1.90) OME/day; p<0.01). This difference was driven by the combination medication, Percocet.

In the immediate postoperative period, most patients were managed in hospital with opioid analgesia dosages that fell within guidelines. Nearly all patients were provided with prescriptions for opioids on discharge, these prescriptions both exceeded local guidelines and were not correlated with in-hospital narcotic needs or pain scores.

Level 3 retrospective cohort study.

• acute care surgery
• appendectomy
• cholecystectomy
• opioids

• Bariatric surgery
• Enhanced recovery
• Fast track
• Roux-en-Y gastric bypass
• Sleeve gastrectomy

• ERAS
• colorectal surgery
• multimodal analgesia
• pain management

• collaborative
• colon and rectal surgery
• outcomes
• quality improvement

Acute normovolemic hemodilution (ANH) is an autologous transfusion method, using blood collected during surgery, to reduce the need for allogeneic blood transfusion. ANH is controversial because it may lead to various complications. Among the possible complications, anastomotic leakage is one that would have a significant effect on the operation outcome. However, the relationship between ANH and anastomotic site healing requires additional research. Therefore, we conducted this prospective study of ANH, comparing it with standard intraoperative management, undergoing gastric anastomosis in rats.

Sixteen Sprague-Dawley rats were randomly assigned to three groups: group A, surgery with ANH; group N, surgery with standard intraoperative management; and group C, sham surgery with standard intraoperative management. ANH was performed in group A animals by, removing 5.8–6.6 mL of blood and replacing it with 3 times as much crystalloid. All rats were enthanized on postoperative day 6, and histopathologic analyses were performed.

The mean hematocrit values, after hemodilution were 22.0% (range, 18.0%–29.0%), group A; 33.0% (29.0%–35.0%), group N; and 32.5% (29.0%–34.0%), group C. There were significant differences between groups A and N (P = 0.019, P = 0.009, P = 0.004, P = 0.039, and P = 0.027), and between groups N and C (P = 0.006, P = 0.027, P = 0.04, P = 0.008, and P = 0.009) with respect to inflammatory cell numbers, neovascularization, fibroblast numbers, edema and necrosis, respectively; there were no differences between groups A and N.

In rat model, anastomotic complications did not increase in the ANH group, compared with the standard intraoperative management group.

• Anastomotic leak
• Experimental animal model
• Hemodilution

Hypoalbuminemia is associated with inflammation. Despite being addressed repeatedly in the literature, there is still confusion regarding its pathogenesis and clinical significance. Inflammation increases capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin. The half‐life of albumin has been shown to shorten, decreasing total albumin mass. These 2 factors lead to hypoalbuminemia despite increased fractional synthesis rates in plasma. Hypoalbuminemia, therefore, results from and reflects the inflammatory state, which interferes with adequate responses to events like surgery or chemotherapy, and is associated with poor quality of life and reduced longevity. Increasing or decreasing serum albumin levels are adequate indicators, respectively, of improvement or deterioration of the clinical state. In the interstitium, albumin acts as the main extracellular scavenger, antioxidative agent, and as supplier of amino acids for cell and matrix synthesis. Albumin infusion has not been shown to diminish fluid requirements, infection rates, and mortality in the intensive care unit, which may imply that there is no body deficit or that the quality of albumin “from the shelf” is unsuitable to play scavenging and antioxidative roles. Management of hypoalbuminaemia should be based on correcting the causes of ongoing inflammation rather than infusion of albumin. After the age of 30 years, muscle mass and function slowly decrease, but this loss is accelerated by comorbidity and associated with decreasing serum albumin levels. Nutrition support cannot fully prevent, but slows down, this chain of events, especially when combined with physical exercise.

• albumin infusion
• albumin mass
• albumin scavenger
• capillary permeability
• fractional synthesis rate albumin
• growth
• hypoalbuminemia
• immune response
• inflammation
• interstitial space
• pregnancy
• puberty
• serum albumin binding protein
• serum albumin indicator of inflammatory activity
• serum albumin risk factor
• vascular endothelial growth factor

Diclofenac increases the risk of anastomotic leakage, but the underlying mechanism is unknown. As diclofenac is excreted largely as biliary metabolites, the aim of this study was to determine the effect of these metabolites on intestinal anastomoses.

This was a randomized controlled blinded experiment using 210 male Wistar rats to assess the effect of ‘diclofenac bile’ on the anastomotic complication score, leak rate and anastomotic strength following oral and parenteral administration of diclofenac. Bile duct and duodenal catheterization techniques were used for diversion and replacement of bile, and biliary diclofenac metabolites were determined.

Replacement of control bile with diclofenac bile resulted in higher anastomotic complication scores (P = 0·006) and leakage in five of 18 animals, compared with one of 18 controls (P = 0·089). In turn, following oral diclofenac administration, replacement of diclofenac bile with control bile reduced anastomotic complications (P = 0·016). The leak rate was seven of 15 versus 13 of 17 without replacement (P = 0·127). After intramuscular administration of diclofenac, the reduction in anastomotic complications was not significant when bile was replaced with control bile (P = 0·283), but it was significant when bile was drained without replacement (P = 0·025). Diclofenac metabolites in bile peaked within 2 h after administration. Administration of diclofenac bile resulted in nearly undetectable plasma levels of diclofenac (mean(s.d.) 0·01(0·01) μg/ml) after 120 min. Following oral diclofenac, bile replacement with control bile did not affect the plasma concentration of diclofenac (0·12(0·08) μg/ml versus 0·10(0·05) μg/ml with diclofenac bile; P = 0·869).

Altered bile composition as a result of diclofenac administration increases the ileal anastomotic complication rate in rats.

• Anti-inflammatory
• colorectal surgery
• postoperative ileus

• Anastomotic leak
• Anti-inflammatory agents,
• Epidemiology
• Esophageal neoplasms
• Nonsteroidal