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Introduction: Gastrointestinal anomalies are structural defects and incomplete or abnormal development of digestive organs can cause blockages, vomiting and problems with bowel movements. Nurses identify problems and implement nursing care for children undergoing gastrointestinal surgeries. The study was aimed at assessing nurses' knowledge and practices towards caring of children undergoing gastrointestinal. Design: A descriptive design was utilized in conducting the study. Settings: This study was conducted at two different settings, surgical departments of a pediatric hospital affiliated to Ain- Shams University Hospitals, and Abou El -Resh EL- Monera hospital affiliated to Cairo University hospital Subjects: Purposive sample composed of all (60) available nurses in the previously mentioned settings. Tools, A questionnaire sheet, and observation checklists. Results: the study results illustrated that, less than two-thirds of the studied nurses had satisfactory total knowledge, while more than two-thirds of them had competent actual total practice regarding care of children undergoing gastrointestinal surgeries. Conclusion: Nurses’ knowledge and practice regarding care of children undergoing gastrointestinal surgeries were satisfactory knowledge and competent practice by more of them half of the nurses. Recommendation: More continuous monitoring of research to assess nurses’ knowledge and practice regarding care of children undergoing gastrointestinal surgeries.

Introduction: A significant proportion of patients undergoing major gastrointestinal operations suffer from malnutrition. Although the benefit of postoperative nutritional support is well established, the effects of energy intake during pre-operative period is less reported. The present study was designed to test the effect of structured pre-operative nutritional therapy on the postoperative recovery of patients undergoing major gastrointestinal operations. Methods: A randomized clinical trial was conducted among 80 patients of the surgical gastroenterology department of a tertiary care center in south India. A simple random sampling method was used. The nutritional status of all participants was assessed by subjective global assessment (SGA). While control group received standard energy intake nutrition, the experimental group received calculated nutrition with an extra 50 g of soy protein for seven days pre operatively. Data were analysed using SPSS version 20. Results: The median day of removal of abdominal drainage tube was 3 (0-5) compared to 5 (2.5-7.5) in the control group. In the intervention group, the median time for the appearance of bowel sounds and starting of enteral feeding was 1.1 (0.5) days and 2 (1-2) days, while in the control group, it was 1.6 (0.9) days, 3 (1-4) days, respectively which was significant at P

Background: Despite of widespread belief, clinical studies and animal experiments have suggested that initiation of early feeding after surgery has many advantages. Present study was planned for comparing outcomes of early and late enteral feeding in patients who were undergoing gastrointestinal surgeries in our settings. This would help the surgeons to select better option for earlier recovery after surgery Objective: To compare the outcome of early versus late enteral feeding in patients undergoing gastrointestinal surgeries. Design: It was a randomized controlled trial. Study Settings: The study was conducted at Department of General Surgery, PIMS Islamabad for a period of six months w.e.f 20-12-2017 to 19-06-2018. Patients and Methods: A total of two hundred (n=200) patients of both gender between age 15-70 years, who had been scheduled for elective or emergency gastrointestinal surgery were enrolled in the study. Patients were randomized early (Group A

Objective The purpose of our study was to evaluate the association between intraoperative hypothermia and AKI in neonates undergoing gastrointestinal surgeries. Study design This retrospective study was conducted for neonates who underwent gastrointestinal surgeries from June 2018 to August 2020. Neonates with a minimum of two documented creatinine values before and after surgical procedures within 48 h were included. According to the mean intraoperative temperature, the eligible neonates were divided into three groups. The primary outcome was the incidence of AKI (as defined by the modified KDIGO criteria). The association between variables and AKI or hospital mortality was also examined. Results A total of 295 neonates fulfilled the eligibility criteria. AKI was more common in patients with lower intraoperative temperature compared to the normothermia group. Intraoperative mean temperature was independently associated with AKI. Patients developing AKI had a higher hospital mortality. AKI and gestational age were independently associated with hospital mortality. Conclusions Inadvertent intraoperative hypothermia was associated with developing postoperative AKI.

BACKGROUND Emergency GI surgeries are the most common surgical procedures done in most of the hospitals and health care centres. These surgeries hold a high risk of mortality and morbidity which can be effectively managed if predicted early. For this, P-POSSUM scoring system has been proved to be highly accurate in an emergency setting. METHODS This study was done in Rajendra Institute of Medical Sciences, Ranchi, over a period of two years, from February 2018 to October 2019. The sample size was 50 which included patients admitted in Emergency Department of RIMS, Ranchi, for emergency GI surgery. Patients with immunocompromised state, diabetes mellitus or of age

The global numbers of robotic gastrointestinal surgeries are increasing. However, the evidence base for robotic gastrointestinal surgery does not yet support its widespread adoption or justify its cost. The reasons for its continued popularity are complex, but a notable driver is the push for innovation — robotic surgery is seen as a compelling solution for delivering on the promise of minimally invasive precision surgery — and a changing commercial landscape delivers the promise of increased affordability. Novel systems will leverage the robot as a data-driven platform, integrating advances in imaging, artificial intelligence and machine learning for decision support. However, if this vision is to be realized, lessons must be heeded from current clinical trials and translational strategies, which have failed to demonstrate patient benefit. In this Perspective, we critically appraise current research to define the principles on which the next generation of gastrointestinal robotics trials should be based. We also discuss the emerging commercial landscape and define existing and new technologies.

Background: Malnutrition is a major health problem, which is common in hospitalized elderly patients and is associated with an increased risk of morbidity and mortality. However, studies on malnutrition and its effect on postoperative pain outcomes in elderly patients have been largely neglected. Here we investigated the relationship between nutritional risk and postoperative pain outcomes in elderly patients.Methods: Between April 1, 2012, and August 31, 2015, 734 elderly patients (≥65 years) who underwent gastrointestinal surgeries were recruited and assigned into two groups according to geriatric nutritional risk index (GNRI). All patients received standard anesthesia procedures and postoperative patient-controlled analgesia for 48 h. The preoperative epidemiology data and postoperative outcome data including pain intensities at rest and movement, the cumulative consumption of analgesics and its common side effects were recorded.Results: The total number of patients with high nutritional risk (GNRI < 92) was 533 out of 734 (72.62%). When compared with low nutritional risk individuals (GNRI ≥ 92), the incidence of inadequate analgesia was significantly higher in elderly patients with GNRI < 92 at different time points. In addition, the cumulative consumption of analgesics was also significantly higher in elderly patients with GNRI < 92 at 0–6 h postoperatively. Through logistic regression analysis, high nutritional risk (OR = 3.113, 95% CI: 1.661–5.834, P < 0.001) and female gender (OR = 0.606, 95% CI: 0.394–0.932, P = 0.023) were identified as significant predictors for postoperative inadequate analgesia. Further sensitivity analyses showed high nutritional risk as a predictor for postoperative inadequate analgesia was more prominent in female patients and early elderly patients. Moreover, 88 was determined as an optimal cut-off value of GNRI for postoperative inadequate analgesia using receiver operating characteristic curve analysis.Conclusion: High nutritional risk is associated with poor postoperative pain outcomes in gastrointestinal elderly patients. Preoperative nutritional evaluation using simple nutritional screening instruments (e.g., GNRI) with the new suggested cut-off value (GNRI = 88) might be included as a standard procedure in routine clinical practice among these patients for postoperative analgesia.

Aim Non‐steroidal anti‐inflammatory drugs (NSAIDs) are commonly used to control postoperative pain; however, their postoperative use has been associated with anastomotic leakage after gastrointestinal surgery. This systematic review and meta‐analysis aimed to determine the correlation between the use of NSAIDs and anastomotic leakage. Methods We conducted a comprehensive electronic literature search up to August 2018 to identify studies comparing anastomotic leakage in patients with and without postoperative NSAID use following gastrointestinal surgery. We then carried out a meta‐analysis using random‐effects models to calculate odds ratios (OR) with 95% confidence intervals (CI). Results Twenty‐four studies were included in this meta‐analysis, including a total of 31 877 patients. Meta‐analysis showed a significant association between NSAID use and anastomotic leakage (OR 1.73; 95% CI = 1.31‐2.29, P, The results of this meta‐analysis indicate that postoperative NSAID use is associated with anastomotic leakage following gastrointestinal surgeries. Although the difference was not significant, selective NSAIDs may be safer than non‐selective NSAIDs.

Surgical site infections are related to a high morbidity, mortality and healthcare costs. Despite ample evidence demonstrating the effectiveness of antimicrobials to prevent surgical site infections, inappropriate timing, antibiotic selection and excessive continuation of antibiotics are common in practice. In this study, we compare the appropriateness of antibiotic prophylaxis in gastrointestinal surgery, before and after an evidence-based guideline implementation. One hundred patients were evaluated in each group. The implementation of the guideline resulted in significant reduction of incorrect use of antibiotics from 55% to 18% (P = 0.002). It also reduced duration of prophylactic antibiotics (43% vs. 23%, P = 0.025). Inappropriate doses diminished but not significantly (8% vs. 5%, P = 0.321). Based on our results, in more than half of of these cases patients received incorrect antibiotic prophylaxis regimens for gastrointestinal surgery in this hospital. Local guideline implementation can result in reduction of antibiotic use, dose and duration errors.

IntroductionThe aim of this study is to compare 90-day mortality and morbidity between open and laparoscopic surgeries performed in one centre since the introduction of ERAS protocols.Material and MethodsAll gastrointestinal surgeries performed between April 2016 and March 2019 at our institution after the introduction of ERAS protocols have been analysed for morbidity and mortality. The analysis was performed in a retrospective manner using data from our prospectively maintained database.ResultsWe performed 245 gastrointestinal and hepatobiliary surgeries between April 2016 and March 2019. The mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. The mean ASA score was 2.4, the mean operative time was 111 minutes and the mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall the 90-day mortality rate was 8.5% and the morbidity rate was around 9.79%. On univariate analysis morbidity was associated with a higher CDC grade of surgeries, a higher ASA grade, longer operating time, the use of more blood products, a longer hospital stay and open surgeries. HPB surgeries and luminal surgeries (non hpb gastrointestinal surgeries) were associated with 90 day post operative morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90-day mortality was predicted by the grade of surgeries, a higher ASA grade, longer operative time, the use of more blood products, open surgeries and emergency surgeries. However on multivariate analysis only the use of more blood products was independently associated with mortalityConclusionThe 90-day mortality and morbidity rates between open and laparoscopic surgeries after the introduction of ERAS protocol were similar.

Background: This study analysed the incidence of surgical site infections in gastrointestinal surgeries and its risk factors. so this study helped us in reducing surgical site infection by avoiding or minimizing that risk factors.Methods: The present study was conducted at general surgery department, SMIMER, Surat. An observational study of 400 cases that have undergone abdominal surgery in SMIMER hospital and were followed up from the day of operation to 30 days after discharge was done.Results: The overall infection rate for a total of the 400 cases was 17.25%. The incidence rate in this study was well within the infection rates of 2.8% to 17% seen in other studies. Different studies from India at different places have shown the SSI (surgical site infection) rate to vary from 6.09% to 38.7%.Conclusions: Our study reveals that though SSIs have been widely studied since a long time, they still remain as one of the most important causes of morbidity and mortality in surgically treated patients.

Background & Objectives: Though abdominal surgery has been practiced for many centuries, the optimal technique for anastomosis of small bowel and large bowel remains controversial. This study was conducted with objective to compare the outcome of stapled and handsewn technique of anastomosis of the lower gastrointestinal tract.Materials & Methods: This prospective study was done in the Department of General Surgery and Surgical Gastroenterology, College of Medical Sciences, Bharatpur in the period between 1st October 2014 to 30th September 2015. A total of 50 patients who underwent resection and anastomosis for various conditions of small bowel and large bowel were alternatively placed in handsewn and stapled group. Both the groups were compared in terms of mean time required to perform the intestinal anastomosis, mean operating time, postoperative complications like anastomotic leak rate and wound infection rate, and the time of postoperative hospital stay.Results: The mean duration to perform the intestinal anastomosis was 32.04±4.51 minutes in the handsewn group and 11.00±1.91 minutes in the stapled group(p0.05). There was no significant difference in the anastomotic leak rate and surgical site infection rate among the two groups.Conclusion: Stapling technique can significantly reduce the time for the anastomotic procedure and also the duration of the operation. However, there was no difference in the rate of anastomotic leak and wound infection between the handsewn and stapled anastomosis. Therefore, stapled anastomosis can be considered a better option over handsewn bowel anastomosis.

Introduction: An anastomosis becomes necessary when a segment of the gastrointestinal tract is resected for benign or malignant disease and gastrointestinal continuity needs to be restored. The two most commonly used anastomotic techniques are handsewn anastomosis and stapled anastomosis.Aim of Study: The aim of my study is to evaluate the outcome of uses of stapler in gastrointestinal surgeries in comparison to conventional hand suture methods.Objectives of the study:•To assess the advantages and disadvantages of stapler use in gastrointestinal surgeries in terms of following:1.Mean operating time.2.Anastomosis Leak.3. Stricture formation.Conclusion: Stapled anastomosis is better in terms of time, complication and cost effective than Handsewen anastomosis.

Introduction: The purpose of nutritional support in the surgical patient is to prevent or reverse the catabolic effects of disease or injury. Protein depletion results in delayed wound healing and many other complications. Serum albumin levels at the time of admission were found to be a very useful predictor of such complications. The ultimate validation for nutritional support in surgical patients should be improvement in clinical outcome and restoration of function. Aim: To find the relationship between serum albumin level

Platelets are small anucleate cytoplasmic cell bodies released by megakaryocytes in response to various physiologic triggers. Traditionally thought to be solely involved in the mechanisms of hemostasis, platelets have gained much attention due to their involvement wound healing, immunomodulation, and antiseptic properties. As the field of surgery continues to evolve so does the need for therapies to aid in treating the increasingly complex patients seen. With over 14 million obstetric, musculoskeletal, and urological and gastrointestinal surgeries performed annually, the healing of surgical wounds continues to be of upmost importance to the surgeon and patient. Platelet-rich plasma, or platelet concentrate, has emerged as a possible adjuvant therapy to aid in the healing of surgical wounds and injuries. In this review, we will discuss the wound healing properties of platelet-rich plasma and various surgical applications.

Laparoscopic surgery has become the standard option for gastrointestinal surgeries. However, laparoscopic procedures require extended training times and are difficult for inexperienced surgeons. Robot-assisted laparoscopic surgery facilitates easy adaptation of laparoscopic procedures, but robotic surgical systems are expensive. In addition, their cost has remained high because there is currently only one manufacturer of commercially available systems. Recently, a new Korean robotic surgical system, Revo-i, has been developed. The aim of this study was to evaluate the feasibility and safety of Revo-i by performing robotic cholecystectomy in a porcine model.After approval by the Institutional Animal Care and Use Committee of Yonsei University Health System, cholecystectomy was performed in four pigs using the Revo-i robotic surgical system. Operative time and perioperative complications were recorded, and all animals were observed for postoperative complications for 2 weeks after surgery RESULTS: Robotic cholecystectomy was completed successfully and without gallbladder perforation in all cases. The mean operative time was 78 ± 12 min, the mean docking time was 4.5 ± 2.52 min, and the mean console time was 49.8 ± 14.17 min. There were no perioperative complications, and none of the animal used for the in vivo models exhibited abnormal behavior during the postoperative observation period.These preliminary results verify the safety and efficacy of robotic cholecystectomy using the Revo-i robotic surgical system. Human trials are slated to begin accordingly.

Surgical site infection (SSI) is a common complication after surgery and is an indicator of quality of care. Risk factors for SSI are studied thoroughly for most types of gastrointestinal surgeries and especially colorectal surgeries, but accumulated data is still lacking for gastric surgeries. We studied the parameters affecting SSI rate after gastric cancer surgery.Consecutive patients, who underwent elective gastric cancer surgery between June and December 2013, were included. Descriptive parameters, laboratory values and past medical histories were recorded prospectively. All patients were followed for 1 month. Recorded parameters were compared between the SSI (+) and SSI (-) groups.Fifty-two patients (mean age: 58.87±9.25 [31-80]; 67% male) were included. SSI incidence was 19%. ASA score ≥3 (p0.001), postoperative weight gain (p0.001), smoking (p=0.014) and body mass index (BMI) ≥30 (p=0.025) were related with a higher SSI incidence. Also patients in the SSI (+) group had a higher preoperative serum C-reactive protein level (p=0.014).We assume that decreasing BMI to30, stopping smoking at least 3 weeks before the operation, and preventing postoperative weight gain by avoiding excessive intravenous hydration will all help decrease SSI rate after gastric surgery.

Wafaa S Hamza,1,2 Mona F Salama,1,3 Samar S Morsi,1,4 Naglaa M Abdo,1,5 Mariam A Al-Fadhli1 1Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait; 2Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt; 3Department of Microbiology and Medical Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 4Department of Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 5Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt Purpose: To measure surgical site infection (SSI) rates among gastrointestinal surgeries and to identify the associated risk factors. Patients and methods: We conducted a multicenter, retrospective, surveillance-based study of adults undergoing gastric, colon, and small bowel (SB) procedures from January to December 2016. Univariate and multivariate analyses were conducted to determine the predictive variables in each surgery. Results: In total, 71 of 2,099 patients developed SSI – 0.8%, 19.8%, and 10.8% following gastric, colon, and SB surgeries, respectively. In gastric surgery, the risk factors identified by univariate analysis were age, duration, wound class, risk index, emergency, and scope use (P

Background We aimed to monitor the microbial load and identify the microorganisms recovered from surgical instruments after clinical use and following manual and automated cleaning. Methods This experimental study was carried out in the Laboratory of Oral Microbiology and Anaerobes at the Federal University of Minas Gerais in Brazil. Microbial samples were taken from 125 surgical instruments used in 25 types of gastrointestinal surgeries. Results The average microbial load was 93.1 CFU/100 mL after clinical use and 41 CFU/100 mL and 8.24 CFU/100 mL on instruments following 2 sequential steps of manual cleaning, respectively, and 75 CFU/100 mL and 16.1 CFU/100 mL on instruments after automated cleaning. Surgical wound classification significantly affected the microbial load recovered on instruments. Coagulase-negative Staphylococcus , Escherichia coli , Pseudomonas spp, Stenotrophomonas maltophilia , and Acinetobacter baumannii complex were recovered. Conclusions The average microbial load observed after the cleaning steps decreased, and the decrease in microbial load was more pronounced using the manual method compared with that observed using the automated method.

Background. Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce the risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing elective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate the impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing elective gastrointestinal surgeries. Methods. This prospective study included consecutive adult patients undergoing elective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham (QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes were grade of complications, 30-day readmission rates, and postoperative care setting. Results. This study included 370 patients, of which 11% (41/370) had eGFR of 2. Patients with eGFR 2 were more likely to have ASA grade 3/4 (p<0.001) and >2 comorbidities (p<0.001). Overall complication rates were 15% (54/370), with no significant difference in overall (p=0.644) and major complication rates (p=0.831) between both groups. In adjusted models, only surgery grade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI: 0.45–1.54; p=0.2). Conclusions. Preoperative eGFR does not appear to impact on postoperative complications in patients undergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics in risk stratification and optimisation of perioperative care of patients.

To optimize means to make something as good as possible. This is the aim of a surgeon when performing any surgical procedure, including all bariatric techniques. Gastrointestinal surgeries are performed either openly or through minimally invasive techniques using regular sutures or mechanical staplers. Mechanical staplers are a mainstay of laparoscopic gastrointestinal surgery, in particular bariatric surgery.

The potential clinical benefits of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have for long been overshadowed by its relatively high morbidity and mortality compared to other surgical procedures. It takes 3–12 months on an average for the quality of life to return to normal. With standardization of indications, better patient selection, development and implementation of perioperative care pathways and institution of formal teaching programs, there has been a reduction in the overall morbidity and mortality from the procedure, and it is now similar to that of other major gastrointestinal surgeries when performed in specialized centres. Morbidity has a negative impact on the overall survival in certain cancers (including colorectal cancer) and can delay the administration of systemic therapy which is equally important in other cancers like ovarian cancer which further emphasizes the importance of patient selection. It may result in a significant additional financial burden where such procedures are not under ‘insurance cover’ and are ‘out-of-pocket’ spending for patients. The 90-day morbidity and mortality capture the overall complication rate more accurately and should be recorded and reported instead of the 30-day morbidity and mortality. Early recognition and management of complications by multidisciplinary teams are needed to ‘rescue’ patients who develop complications.

Bacteremia can be defined as the presence of viable bacteria in the bloodstream. Bacteremia has been documented with surgical (dental and gastrointestinal surgeries) or nonsurgical (endoscopy and endotracheal intubation) interventions. This chapter would examine the bacteremia in common lacrimal surgeries and its implications in surgical preparations and management.

Pro Seal laryngeal mask airway (PLMA) is a new development among supraglottic airway management devices. The modified cuff and drain tube in PLMA makes it a better device over classic Laryngeal mask airway (LMA). This retrospective study was done to know the effectiveness of PLMA in gastrointestinal surgeries. Thirty adult patients of ASA I, II or III who underwent gastrointestinal surgery under general anesthesia with PLMA were reviewed. The following parameters were reviewed: hemodynamic response, ventilatory parameters, ease of gastric tube placement and adverse effects. PLMA was inserted in the first attempt in 28 out of 30 patients. The change in heart rate was 4.9%; mean increase in systolic and diastolic blood pressure after insertion of PLMA was 2% and 1.49% respectively. 100% success was achieved in Ryle’s tube insertion. These parameters are comparatively low when compared with previous studies. This shows PLMA is a less invasive alternative to traditional endotracheal intubation.

A ‘fast-track protocol’ in surgery suggests the application of evidence-based practices to expedite patient recovery. It has shown to reduce hospital stay, hasten recovery as well as facilitate earlier return to work. It has a considerable impact in reducing healthcare costs. The basic tenet is to treat the patient’s disease by minimal disturbance of their physiology. The protocol encompasses pre-operative, intra-operative and post-operative interventions which when carried out together would show maximal benefits. The surgeon is usually the leader of the team managing the patient, but it cannot be over-emphasised that this is a multi-disciplinary team approach. We conducted a prospective interventional study to investigate whether ‘fast-track’ surgery protocols improve patient outcome when compared to traditional peri-operative care followed at our institute. By doing so, we observed that the patients who underwent ‘fast tracking’ required lesser analgesia, had earlier ambulation, earlier return of intestinal motility, were free from tubes, catheters and drains earlier and lastly were discharged earlier. This was achieved without a rise in complications or re-admissions. The results have proved that implementing the fast-track protocol for gastrointestinal surgeries is not only safe and effective, but also improves patient outcome.

Anastomosis in Gastrointestinal surgery is a very commonly performed procedure , since the era of Sushruta, various methods of intestinal anastomosis were followed- recent advancement is the use of stapler as a device for GI anastomosis. Because of the use of staplers technical failures is a rarity, anastomosis is more consistent, and can be used at difficult locations. MATERIALS AND METHODS : A total of 50 cases which met the inclusion and exclusion criteria were included in this hospital based prospective comparative study. The study population included all patients who underwent elective gastrointestinal surgeries . STUDY FACTORS : The subjects were allocated into two groups according to the type of anastomosis, hand sewn and stapler. Both hand sewn and stapled anastomosis were further divided into three sub-groups according to the site of anastomosis viz esophageal, gastrojejunal and colorectal. OUTCOME FACTORS : Anastomotic Integrity, Duration of operation, Return of Bowel activity, Hospital stay. RESULTS: A total of 50 patients with malignant or benign condition of bowel and esophagus, requiring anastomosis were allocated in study group of GI staplers and control group of conventional Hand sewn technique. Out of 50 cases there were 13 esophageal anastomosis, 19 gastrojejunostomies and 18 colorectal anastomosis CONCLUSION: In our present study, we found that stapling technique can significantly reduce the time for anastomotic procedure, less tissue trauma due to less tissue handling, there is early restoration of gastrointestinal function, early resumption of oral feeding and reduced duration of hospital stay which helps ultimately in early return to routine work, importantly staplers can be used at places were hand sewn anastomosis is technically difficult. Technique related complications do not show significant differences which suggests that one can use staplers with same safety and accuracy as sutures

Copper deficiency is an uncommon cause of hematologic abnormalities in children that is often overlooked or misdiagnosed. Although cases have been reported because of malabsorption syndromes or after gastrointestinal surgeries, we report a case of copper deficiency-associated anemia and neutropenia in a child because of dietary restrictions, specifically, transitioning from a formula-based ketogenic diet to a pureed food-based ketogenic diet. On copper supplementation, the patient's anemia and neutropenia resolved. To our knowledge, this report is the first revealing copper deficiency anemia and neutropenia developing because of a ketogenic diet.

【目的】高齢者における消化器手術のリスク評価法としてPOSSUM scoreの有用性について検討した.【方法】1996年から2003年までに全麻下に手術を行った80歳以上の高齢者251例を対象とした.術後合併症のあり群(n=88)となし群(n=163)に分けて,術前因子,血液データ,手術因子, POSSUMの検討を行った.【結果】0.1%以下の有意差が認められた項目は白血球数,緊急手術,腹膜炎,およびPOSSUMのphysiological score (PS), operative severity score (OS), predicted mortality rate, predicted morbidity rateの7項目であった. PS 25点以上をhigh riskとすると,術後合併症発生率はhigh risk groupでは45/64 (70%)であり, low risk group (43/187, 23%)にくらべて有意に高率であった.【結論】高齢者における消化器手術のリスク評価の指標としてPOSSUM scoreは有用である.術前のPSにより術後合併症発生率のhigh risk groupを選定できる.

There has been no report of normal responses of plasma copper and/or ceruloplasmin concentrations after an oral loading dose of unlabeled copper in humans. To establish a normal plasma response curve following an oral dose, we performed a copper-loading test (10 mg elemental copper as copper sulfate) in six healthy adult subjects and monitored plasma copper and ceruloplasmin concentrations for 3.5 h. We found that there were no significant changes in plasma copper and ceruloplasmin concentrations following the oral dose in the subjects. The test was originally intended to evaluate whether there was copper malabsorption in a female patient who developed signs of copper deficiency with her plasma copper levels below 3.0 μmol/l after multiple gastrointestinal surgeries. She did not respond to oral copper sulfate administration but responded to a sublingual application of copper glycinate. These findings suggest that she does not have adequate intestinal copper absorption. In conclusion, the use of unlabeled copper, such as copper sulfate, for an oral loading test, seemingly simple and economical, does not appear to be a suitable means to evaluate copper absorption in humans and is discouraged. In case of copper malabsorption, sublingual administration of copper may be worth trying. J. Trace Elem. Exp. Med. 16: 61–66, 2003. © 2003 Wiley-Liss, Inc.