Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

The use of the first industrial X-ray CT scanner increases the lumber recovery value: case study on visually strength-graded Douglas-fir timber

Key message: Industrial computed tomography scanning of logs provides detailed information on timber quality prior to sawing. A sawing simulation—considering log rotation angle and knot size accuracy—revealed an average value increase of up to 20% for the best angle compared to the conventional horns-up position. Context: Computed tomography (CT) scanning has the potential to improve the value of products sawn from logs and meets the increasing demands of the wood industry for detailed information on log quality prior to processing. Aims: In a validation step, automated measurements of knot cluster variable DAB (DIN 4074-1:2012-06) using CT were compared with manual measurements. In a second optimization step, the hypothesis that the value of the sawn products is increased by sawing at the best rotation angle as opposed to the horns-up position was tested. Methods: A sample of 36 Douglas-fir logs were scanned in an industrial CT scanner, and sawn into boards. Knots on the boards were manually measured, and compared with the corresponding knots on virtual boards created from the CT data. The error of the DAB was measured by comparing CT data to manual measurements. An optimized sawing simulation was performed, using the measured DAB error to account for CT measurement errors, as well as a rotational error to account for errors in the log turning equipment. Using the results of the sawing simulation, Monte Carlo simulations were performed to show the potential and benefit of an industrial CT scanner. Results: The three largest DABs measured by the CT showed good correlation to the measurements on the manual boards. The simulation revealed an average increase of value from 4 to 20% compared to the conventional horns-up position depending on the relative price differences between the strength grades. Conclusion: By using a CT scanner to optimize sawing, sawmill owners can process logs in a better way to produce final products with increased added value

Surgical injury of the facial nerve. Anatomy, semeiology and study of nervous function [LESIONI CHIRURGICHE DEL NERVO FACCIALE: ANATOMIA, SEMEIOLOGIA E STUDIO DELLA FUNZIONE NERVOSA]

The extracranial part of the facial nerve is a frequent seat of lesions, which can be either congenital, or traumatic, or surgical, or neoplastic. The authors review the semeiology of the lesion and discuss the techniques for the preservation of facial nerve function

Surgical injury of the facial nerve. Anatomy, semeiology and study of nervous function [LESIONI CHIRURGICHE DEL NERVO FACCIALE: ANATOMIA, SEMEIOLOGIA E STUDIO DELLA FUNZIONE NERVOSA]

The extracranial part of the facial nerve is a frequent seat of lesions, which can be either congenital, or traumatic, or surgical, or neoplastic. The authors review the semeiology of the lesion and discuss the techniques for the preservation of facial nerve function

[The optimal implantation of the peritoneal-jugular shunt with LeVeen valve]

The authors underline the efficacy of peritoneovenous shunting with LeVeen's valve in the treatment of refractory ascites in cirrhotic patients. Selection and appropriate preoperative management of patients are essential to assure good immediate and long-term results