Role of Gut Microbiome and Enteric Bacteria in Gallbladder Cancer

Gallbladder cancer (GBC) is associated with a sinister prognosis, a short survival time, and early metastasis to distant sites. Chronic inflammation of the gallbladder due to gallstone disease and biliary bacteria remain key factors in the pathogenesis of GBC. The association of chronic bacterial infections with the development of GBC has provided a new perspective on the causation of GBC. A strong link between chronic Salmonella infection and enterohepatic strains of Helicobacter species with GBC has been suggested. It is believed that many other enteric bacterial strains, predominantly the Enterobacteriaceae species, are associated with the development of GBC. However, the available literature mainly comprises observational studies and small meta-analyses necessitating the requirement of a higher level of evidence. This chapter discusses the role of the gut microbiome, dysbiosis and its association with carcinogenesis, and the organisms associated with the causation of GBC

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

Telesurgery and Robotics: Current Status and Future Perspectives

The concept of telehealth has revolutionized the healthcare delivery system. Based on this concept, telesurgery has emerged as a promising and feasible option, providing surgical care to remotely located patients. This has become possible by advancements in the robotic system combined with the cutting-edge technology of telecommunication. Since the ability to perform telepresence surgery was hypothesized, consistent development and research in this novel area have led to the beginning of telesurgical care, which can fulfill the demand for surgical care in remote locations. In addition to the benefits of robotic-assisted minimally invasive surgery, telesurgery eliminates geographical barriers, which helps patients have better access to quality surgical care. It may reduce the overall financial burden by eliminating the travel expense of the patients, providing expertise through the telepresence of experienced surgeons, and reducing the operating room personnel. The telesurgical approach is also being utilized for telementoring, i.e., real-time guidance and technical assistance in surgical procedures by highly skilled surgeons. Despite the numerous technological improvements in telesurgery, its widespread implementation in clinical setting still lags, mandating the identification of the offending factors that limit its clinical translation

Gut Microbiome and Crohn’s Disease: An Enigmatic Crosstalk

Crohn’s disease (CD) is a chronic, recurrent, immune-mediated inflammatory bowel disease that demonstrates a spectrum of intestinal and extra-intestinal manifestations. The pathogenesis of CD is multifactorial and involves a complex interplay between environmental and microbiological factors in a genetically susceptible host. There is robust evidence suggesting the role of gut microbial dysbiosis in the development as well as exacerbation of CD by immune dysregulation and alteration in the immune microbiota crosstalk. Patients with CD show reduced commensal microbial diversity, along with increased numbers of pathogenic Enterobacteriaceae and Proteobacteriaceae. Faecalibacterium prausnitzii, an anti-inflammatory molecule-producing bacteria, is also seen in reduced numbers in patients with CD and is associated with an increased risk of recurrence. There has been a paradigm shift in the management of patients of CD, from controlling symptoms to controlling inflammation and promoting mucosal healing. Current treatment strategies aim to replace, remove, reset, or redesign the gut microbiota for the therapeutic benefits of patients with CD. These include microbial restoration therapies such as dietary modification, the use of pre-, pro-, and postbiotics, and fecal microbiota transfer (FMT). This chapter focuses on the role of gut microbiota in the pathophysiology of CD and the emerging concepts in microbial therapeutics

How e-Health Has Influenced Patient Care and Medical Education: Lessons Learned from the COVID-19 Pandemic

The concept of e-Health involves the application of information and communication technologies from off-site locations to various domains of healthcare ranging from patient care, public health, and administration to health education. It refers to health informatics, telemedicine, electronic health records, and clinical decision support systems. The e-health initiatives aim to improve health outcomes in terms of quality, access, affordability, and efficient monitoring. The application of e-health interventions has particularly expanded in recent times because of the restrictions imposed by the pandemic. It has been proven to be nearly as effective as in-person care along with high patient and provider satisfaction and at decreased costs. We present our experience from the use of various e-health interventions during the COVID-19 pandemic along with a review of related literature. This ranged from Internet-based services, interactive TV or Polycom’s, kiosks, online monitoring of patient’s vital signs, and remote consultations with experts. Our success and experience with various e-health interventions during the pandemic allow us to provide a more hybrid form of healthcare in the future both for patient care and medical education and training

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 SCARE Statement: Consensus-based surgical case report guidelines

AbstractIntroductionCase reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines.MethodsThe CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group.ResultsIn round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7–9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist.ConclusionWe present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports

The SCARE Statement: Consensus-based surgical case report guidelines

Introduction: Case reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines.Methods: The CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group.Results: In round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7–9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist.Conclusion: We present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports.</p