Impact of prior abdominal surgery on postoperative prolonged ileus after ileostomy repair

SummaryBackground and aimsPostoperative ileus (POI) is one of the most common reasons for sustained hospital stays after ileostomy repair. Although many factors have been investigated as POI risk factors, the investigation of the impact of prior abdominal surgery (PAS) before rectal cancer surgery has been limited. This study aimed to identify the impact of PAS as a risk factor for POI after ileostomy repair.Material and methodsA total of 220 consecutive patients with rectal cancer who underwent ileostomy repair were enrolled. The patients were divided into PAS-positive and PAS-negative groups according to the history of PAS before rectal cancer surgery. Univariate and multivariate analyses were performed to identify the clinicopathological factors associated with POI.ResultsThe PAS-positive group had a longer operation time (111 min vs. 93.4 min, p=0.029) and a greater length of hospital stay (10 days vs. 7.8 days, p=0.003) compared with the PAS-negative group. POI was more frequent in the PAS-positive group (23.1% vs. 6.2%, p=0.011). The POI rate in the entire cohort was 8.1%. The repair method (stapled side-to-side vs. hand-sewn end-to-end, odds ratio OR=3.6, 95% confidence interval CI=1.2–11.1, p=0.022) and PAS (odds ratio=4.0, 95% confidence interval=1.2–12.8, p=0.017) were significant predictors of POI in the multivariate analysis.ConclusionsThis study suggests that PAS before rectal cancer surgery is associated with POI after ileostomy repair

Development of a Rating System for Digestive System Impairments: Korean Academy of Medical Sciences Guideline

A systematic and effective welfare system for people with digestive system impairments is required. In Korea, an objective and scientific rating guideline does not exist to judge the digestive system impairments. Whether the impairments exist or not and the degree of it need to be examined. Thus, with these considerations we need a scientific rating guideline for digestive system impairments to fit our cultural and social background. In 2007, a research team, for the development of rating impairment guidelines, was organized under the supervision of Korean Academy of Medical Sciences. The rating guidelines for digestive system impairments was classified into upper and lower gastrointestinal tracts impairments and liver impairment. We developed objective rating guidelines for the upper gastrointestinal tract, the impairment generated after surgery for the stomach, duodenum, esophagus, and for the lower gastrointestinal tract, the impairment generated after construction and surgery for colon, rectum, anus, and intestinal stomas. We tried to make the rating impairment guidelines to include science, objectivity, convenience, rationality, and actuality. We especially emphasized objectivity as the most important value. We worked to make it easy and convenient to use for both the subjects who received the impairment ratings and the doctors who will give the ratings

Worse outcome of debridement, antibiotics, and implant retention in acute hematogenous infections than in postsurgical infections after total knee arthroplasty: a multicenter study

Background : We sought to determine (1) the success rate of debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI) of the knee in patients with acute postsurgical infection and in those with acute hematogenous infection via a multicenter study, (2) the factors related to the failure of DAIR for overall acute PJI and acute hematogenous PJI via subgroup analysis, and (3) whether the PJI recurrence patterns differed between the two groups over time after DAIR. Methods : This retrospective multicenter study included 101 acute knee PJI. Acute postsurgical PJI was defined as PJI diagnosed < 3 months following initial knee arthroplasty surgery. DAIR was performed for 34 cases of acute postsurgical PJIs (postsurgical group) and 67 cases of acute hematogenous PJIs (hematogenous group). The success rates between groups were compared, and factors related to DAIR failure were analyzed. Results : The overall success rate of DAIR was 77%. The success rate tended to be higher in the postsurgical group than in the hematogenous group (p = 0.060). However, there was no significant factor related to DAIR failure in the subgroup analysis of acute hematogenous PJIs. In the postsurgical group, the recurrence of PJI occurred until 3 months, whereas in the hematogenous group, recurrence occurred for up to 2 years. Conclusions : The failure rate tended to be higher in the acute hematogenous PJI group than in the acute postsurgical PJI group. Since acute hematogenous infections may recur for a longer period than postsurgical infections, careful follow-up is required after DAIR

Genetic, management, and nutritional factors affecting intramuscular fat deposition in beef cattle — A review

Intramuscular fat (IMF) content in skeletal muscle including the longissimus dorsi muscle (LM), also known as marbling fat, is one of the most important factors determining beef quality in several countries including Korea, Japan, Australia, and the United States. Genetics and breed, management, and nutrition affect IMF deposition. Japanese Black cattle breed has the highest IMF content in the world, and Korean cattle (also called Hanwoo) the second highest. Here, we review results of research on genetic factors (breed and sex differences and heritability) that affect IMF deposition. Cattle management factors are also important for IMF deposition. Castration of bulls increases IMF deposition in most cattle breeds. The effects of several management factors, including weaning age, castration, slaughter weight and age, and environmental conditions on IMF deposition are also reviewed. Nutritional factors, including fat metabolism, digestion and absorption of feed, glucose/starch availability, and vitamin A, D, and C levels are important for IMF deposition. Manipulating IMF deposition through developmental programming via metabolic imprinting is a recently proposed nutritional method to change potential IMF deposition during the fetal and neonatal periods in rodents and domestic animals. Application of fetal nutritional programming to increase IMF deposition of progeny in later life is reviewed. The coordination of several factors affects IMF deposition. Thus, a combination of several strategies may be needed to manipulate IMF deposition, depending on the consumer’s beef preference. In particular, stage-specific feeding programs with concentrate-based diets developed by Japan and Korea are described in this article

Impact of prior abdominal surgery on postoperative prolonged ileus after ileostomy repair

Background and aims: Postoperative ileus (POI) is one of the most common reasons for sustained hospital stays after ileostomy repair. Although many factors have been investigated as POI risk factors, the investigation of the impact of prior abdominal surgery (PAS) before rectal cancer surgery has been limited. This study aimed to identify the impact of PAS as a risk factor for POI after ileostomy repair. Material and methods: A total of 220 consecutive patients with rectal cancer who underwent ileostomy repair were enrolled. The patients were divided into PAS-positive and PAS-negative groups according to the history of PAS before rectal cancer surgery. Univariate and multivariate analyses were performed to identify the clinicopathological factors associated with POI. Results: The PAS-positive group had a longer operation time (111 min vs. 93.4 min, p=0.029) and a greater length of hospital stay (10 days vs. 7.8 days, p=0.003) compared with the PAS-negative group. POI was more frequent in the PAS-positive group (23.1% vs. 6.2%, p=0.011). The POI rate in the entire cohort was 8.1%. The repair method (stapled side-to-side vs. hand-sewn end-to-end, odds ratio OR=3.6, 95% confidence interval CI=1.2–11.1, p=0.022) and PAS (odds ratio=4.0, 95% confidence interval=1.2–12.8, p=0.017) were significant predictors of POI in the multivariate analysis. Conclusions: This study suggests that PAS before rectal cancer surgery is associated with POI after ileostomy repair

Different clinical features according to the anastomotic leakage subtypes after rectal cancer surgeries: contained vs. free leakages.

BackgroundAnastomotic leakage can be classified by free and contained leakage according to clinical manifestations. The risk factors and their comparison between these leakage subtypes are uncertain. This study aims to evaluate anastomotic leakage patterns and to compare clinical features between free and contained leakages after low anterior resection for rectal cancer.Materials and methodsBetween January 2005 and December 2012, a total of 2035 consecutive patients who underwent low anterior resection for primary rectal cancer were evaluated retrospectively at two-tertiary referral centers. The primary end points of this study were to assess detailed clinical features among leakage subtypes. The secondary end point was to compare risk factors between free and contained leakages.ResultsPatients were subdivided into a no leakage group (n = 1890), free leakage group (n = 73), and contained leakage group (n = 72). Free leakage occurred more frequently in laparoscopic and robotic surgeries than open surgery (p = 0.015). On the other hand, contained leakage was developed in a higher rate of patients who received preoperative chemoradiotherapy (pConclusionsContained leakage in rectal cancer surgery showed different clinical manifestations and risk factors compared to free leakage. It is necessary to pay more attention to patients with particular risk factors for anastomotic leakage subtypes