Enhanced Recovery after Surgery

Enhanced recovery after surgery (ERAS) protocols are specialized perioperative care guidelines. The protocol was first published in 2005. Since then, it has been associated with improved perioperative outcomes. This multimodal peri-operative protocols standardize the perioperative care to minimize the surgical stress response and post-operative pain, reduce complications, improve post-operative outcomes, expedite recovery and decrease the length of hospital stay. It initially started with colorectal surgery, but now it is used in hepatobiliary, upper gastrointestinal system, urology, gynecology, vascular surgery, bariatric, and non-gastro intestinal specialties. Its role is well established in elective surgery. Now there are enough evidence suggesting its role in emergency surgeries as well. There are 24 elements of the ERAS bundle. However, only some critical elements of the ERAS bundle are feasible to be used in emergency surgery. Postoperative pain management is one of the significant elements in the ERAS bundle. Multimodal analgesia is the optimal modality for pain control. It facilitates early ambulation and rehabilitation. Current evidence recommends the ERAS protocol. However, each item within the protocol constantly changes over time, depending upon the evidence

Bowel Preparation before Elective Colorectal Surgery: Its Current Role

Bowel preparation for elective colorectal surgery has been performed for decades with the assumption to decrease infectious complications and anastomotic leaks. Nevertheless, the scientific basis of the same is still debatable. Various methods of bowel preparation are mechanical bowel preparation (MBP) with or without prophylactic oral antibiotics (POA), preoperative POA alone without MBP, and preoperative enema alone without MBP and POA. However, there is no consensus on the optimal type of bowel preparation. The available agents for MBP are polyethylene glycol (PEG) and sodium phosphate (NaP) or picosulphate. The most common prophylactic oral antibiotic regimen used in preoperative bowel preparation is Neomycin and Metronidazole a day before surgery, although the microbiological basis of this is unverified. Most studies around the beginning of this century indicate inadequate evidence for using MBP for colorectal surgery to suggest harm caused by the process and accordingly advise against it. However, several retrospective studies and meta-analyses, which were done after 2014, arguably demonstrate that preoperative MBP and POA reduce the postoperative surgical site infection rate. However, as per the current evidence, it can be suggested that MBP and preoperative POA can be safely included in the preoperative preparation of elective colorectal surgery

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Pełen przegląd literatury dotyczącej pierwotnej gruźlicy pęcherzyka żółciowego

Gruźlica (tuberculosis) jest chorobą zakaźną obejmującą wiele narządów. Postać brzuszna może dotyczyć przewodu pokarmowego, węzłów chłonnych, narządów miąższowych oraz otrzewnej. Pęcherzyk żółciowy rzadko stanowi pierwotne ognisko zakażenia w obrębie jamy brzusznej. Opierając się na szerokim przeglądzie literatury, stwierdziliśmy, że obecne doniesienia dotyczące gruźlicy pęcherzyka żółciowego ograniczają się do opisów przypadków. Wcześniej nigdy nie przeprowadzono przeglądu literatury dotyczącej tej rzadkiej choroby. Gruźlica pęcherzyka żółciowego jest trudna do rozpoznania w okresie przedoperacyjnym. Sporadycznie uwzględnia się ją w diagnostyce różnicowej częstszych chorób, takich jak kamica żółciowa czy rak pęcherzyka żółciowego. Typowy obraz patologiczny resekowanych tkanek pomaga postawić właściwe rozpoznanie. Poddawanie każdego materiału ocenie histopatologicznej i zastosowanie leczenia zachowawczego daje szansę wyleczenia. W niniejszym przeglądzie literatury autorzy starają się przedstawić aktualny stan wiedzy na temat tej jednostki chorobowej

Kompleksowe omówienie pierwotnego zapalenia gruźliczego pęcherzyka żółciowego

Gruźlica (TB) jest chorobą zakaźną, która może wpływać na każdy z narządów w organizmie człowieka. Gruźlica brzuszna może przyjąć formę zapalenia żołądkowo-jelitowego, zapalenia węzłów chłonnych, zapalenia trzewnej lub otrzewnowej. Woreczek żółciowy (GB) rzadko jest głównym narządem objętym gruźlicą brzuszną. Obszerna literatura badawcza dotycząca gruźlicy pęcherzyka żółciowego ogranicza się do pojedynczych opisów przypadków. Do tej pory brakuje omówienia tej rzadkiej patologii jamy brzusznej. Gruźlica GB jest trudna do zdiagnozowania przedoperacyjnie. Stanowi bowiem rzadkie przypadki pomiędzy bardziej powszechnymi patologiami pęcherzyka żółciowego: kamicą żółciową lub nowotworem pęcherzyka żółciowego. Typowa histopatologia wyciętego fragmentu pomaga w postawieniu tej nietypowej diagnozy. Poddanie każdej próbki badaniu histopatologicznemu, po którym następuje terapia, daje szansę na wyleczenie. W niniejszej pracy autorzy podjęli próbę zapewnienia wglądu w omawianą jednostkę chorobową

A comprehensive review on Primary gallbladder tuberculosis

Tuberculosis (TB) is an infectious disease that can affect any organ system of the body. Abdominal TB can be gastrointestinal, lymph nodal, visceral or peritoneal. The gallbladder (GB) is rarely involved in abdominal TB as a primary organ. Extensive research literature on gallbladder TB is limited to case reports. There has been no review on this rare abdominal pathology. GB tuberculosis is a difficult diagnosis preoperatively. It is a rare differential among the more common gallbladder pathologies such as cholelithiasis, or a gallbladder malignancy. Typical histopathology of the resected specimen helps to establish this rare diagnosis. Subjecting every specimen to histopathological examination followed by medical treatment offers the chance of cure. Through this review, the authors attempt to provide an insight into this disease entity

A comprehensive review of primary gall bladder tuberculosis

Tuberculosis (TB) is an infectious disease that can involve any organ system of the body. Abdominal TB can be gastrointestinal, lymph-nodal, visceral or peritoneal. Gall bladder (GB) is rarely involved as a primary organ in abdominal TB. On extensive research, the literature on gall bladder TB is limited to case reports. There has been no review on this rare abdominal pathology. The GB tuberculosis is difficult to diagnose preoperatively. It is a rare differential among the more common gall bladder pathologies like cholelithiasis, or a gall bladder malignancy. Standard histopathology of a resected specimen helps in this rare diagnosis. Subjecting every specimen to histopathological examination followed by medical treatment offers a chance to cure. Through this review the authors have tried to provide an insight into this entity