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Article: Management of low colorectal anastomotic leak: Preserving the anastomosis.

Blumetti, Jennifer / Abcarian, Herand

World journal of gastrointestinal surgery

2015 Volume 7, Issue 12, Page(s) 378–383

Abstract: Anastomotic leak continues to be a dreaded complication after colorectal surgery, especially in the low colorectal or coloanal anastomosis. However, there has been no consensus on the management of the low colorectal anastomotic leak. Currently operative ...

Abstract	Anastomotic leak continues to be a dreaded complication after colorectal surgery, especially in the low colorectal or coloanal anastomosis. However, there has been no consensus on the management of the low colorectal anastomotic leak. Currently operative procedures are reserved for patients with frank purulent or feculent peritonitis and unstable vital signs, and vary from simple fecal diversion with drainage to resection of the anastomosis and closure of the rectal stump with end colostomy (Hartmann's procedure). However, if the patient is stable, and the leak is identified days or even weeks postoperatively, less aggressive therapeutic measures may result in healing of the leak and salvage of the anastomosis. Advances in diagnosis and treatment of pelvic collections with percutaneous treatments, and newer methods of endoscopic therapies for the acutely leaking anastomosis, such as use of the endosponge, stents or clips, have greatly reduced the need for surgical intervention in selected cases. Diverting ileostomy, if not already in place, may be considered to reduce fecal contamination. For subclinical leaks or those that persist after the initial surgery, endoluminal approaches such as injection of fibrin sealant, use of endoscopic clips, or transanal closure of the very low anastomosis may be utilized. These newer techniques have variable success rates and must be individualized to the patient, with the goal of treatment being restoration of gastrointestinal continuity and healing of the anastomosis. A review of the treatment of low colorectal anastomotic leaks is presented.
Language	English
Publishing date	2015-10-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2573700-4
ISSN	1948-9366
ISSN	1948-9366
DOI	10.4240/wjgs.v7.i12.378
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Article ; Online: Diverticular fistulas to the female reproductive tract: colouterine and colosalpingo-ovarian fistulas.

Blumetti, Jennifer / Harrison, Jacqueline / Abcarian, Herand

The American surgeon

2015 Volume 81, Issue 2, Page(s) E50–1

MeSH term(s)	Adult ; Aged ; Colectomy ; Colonoscopy ; Female ; Fistula/diagnosis ; Fistula/surgery ; Genital Diseases, Female/diagnosis ; Genital Diseases, Female/surgery ; Humans ; Hysterectomy ; Ileostomy ; Intestinal Fistula/diagnosis ; Intestinal Fistula/surgery ; Middle Aged ; Ovariectomy ; Salpingectomy ; Tomography, X-Ray Computed
Language	English
Publishing date	2015-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
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Article ; Online: Epidermoid cancers of the anal canal: current treatment.

Blumetti, Jennifer / Bastawrous, Amir L

Clinics in colon and rectal surgery

2010 Volume 22, Issue 2, Page(s) 77–83

Abstract: Epidermoid carcinoma of the anal canal is an uncommon disease, but has increased in incidence with the HIV epidemic. Prior to the 1970s, treatment consisted of radical surgery with abdominoperineal resection. With the pioneering work of Dr. Norman Nigro, ...

Abstract	Epidermoid carcinoma of the anal canal is an uncommon disease, but has increased in incidence with the HIV epidemic. Prior to the 1970s, treatment consisted of radical surgery with abdominoperineal resection. With the pioneering work of Dr. Norman Nigro, this has shifted to a nonsurgical approach, with primary treatment consisting of multimodality therapy with radiation and chemotherapy. This review provides an overview of the historical, current, and future treatments of epidermoid anal canal malignancies.
Language	English
Publishing date	2010-04-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2048635-2
ISSN	1530-9681 ; 1531-0043
ISSN (online)	1530-9681
ISSN	1531-0043
DOI	10.1055/s-0029-1223838
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Article ; Online: Low diagnostic sensitivity of cystoscopy and cystography of surgically confirmed vesicoenteric fistulae.

Stroie, Florian A / Hasan, Osamah M / Houlihan, Matthew D / McArdle, Brian J / Hollowell, Courtney M P / Blumetti, Jennifer / Vidal, Patricia P / Psutka, Sarah P

International urology and nephrology

2020 Volume 52, Issue 7, Page(s) 1203–1208

Abstract: Purpose: The objective of this study was to assess the accuracy of cystoscopy and cystography, as compared to other diagnostic studies, in identifying vesicoenteric fistulae (VEF) in a contemporary series of patients with surgically confirmed VEF.: ... ...

Abstract	Purpose: The objective of this study was to assess the accuracy of cystoscopy and cystography, as compared to other diagnostic studies, in identifying vesicoenteric fistulae (VEF) in a contemporary series of patients with surgically confirmed VEF. Methods: With institutional review board approval, we performed a single-center retrospective review of surgically confirmed VEF between 2002 and 2018. Demographic data, comorbidities, symptoms, and diagnostic evaluation were reviewed. The sensitivity, specificity, and accuracy of cystoscopy in diagnosis of VEF were compared to cross-sectional imaging. Results: The study cohort consisted of 51 patients with surgically confirmed VEF secondary to diverticular disease. Diagnostic evaluation included cross-sectional imaging with CT (94%), colonoscopy (82%), cystoscopy (75%), cystography (53%), and barium enema (26%). Cystoscopic evaluation definitively demonstrated evidence of VEF in 34% of patients, while 55% of patients had nonspecific urothelial changes on cystoscopy without definitively demonstrating VEF. Comparatively, the sensitivity of VEF was 25% for cystography and 84% for CT. Conclusions: In clinical practice, the diagnostic work-up of VEF is variable. In the modern era of managed care, inclusion of cystoscopy and cystography in the evaluation of VEF does not contribute a substantial additive benefit over standard cross-sectional imaging. Cystoscopy and cystography could potentially be eliminated from the diagnostic evaluation of VEF, in the absence of a concern for malignancy, in an effort to minimize unnecessary invasive testing as well as health care expenditures.
MeSH term(s)	Cystography ; Cystoscopy ; Female ; Humans ; Intestinal Fistula/diagnosis ; Intestinal Fistula/surgery ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Urinary Bladder Fistula/diagnosis ; Urinary Bladder Fistula/surgery
Language	English
Publishing date	2020-02-25
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-020-02409-x
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Article ; Online: Anal Adenocarcinoma: Outcomes in an Uncommon Malignancy.

Bertelson, Noelle / Blumetti, Jennifer / Cintron, Jose / Harrison, Jacquelyn / Chaudhry, Vivek / Abcarian, Herand

The American surgeon

2015 Volume 81, Issue 11, Page(s) 1114–1117

Abstract: Adenocarcinoma is an uncommon malignancy of the anal canal. Although it is recognized as an aggressive disease, optimal management and long-term outcomes are not well established. Patients diagnosed with anal adenocarcinoma were identified from a cancer ... ...

Abstract	Adenocarcinoma is an uncommon malignancy of the anal canal. Although it is recognized as an aggressive disease, optimal management and long-term outcomes are not well established. Patients diagnosed with anal adenocarcinoma were identified from a cancer database. Their charts were reviewed for patient and disease characteristics, management, and outcomes. Eighteen patient charts from 1997 to 2012 were reviewed. Nine patients presented with stage II disease, five with stage III, three with stage IV, and one was inadequately staged before chemoradiation. One patient refused treatment, one patient went straight to abdominoperineal resection, 13 patients underwent initial chemoradiation therapy, and three underwent palliative chemotherapy. Of the 13 patients who received neoadjuvant therapy, eight underwent subsequent radical resection; three progressed during neoadjuvant and became unresectable, one had complete pathologic response and was observed, and one did not complete neoadjuvant and was lost to follow-up. Two patients with stage II disease were disease free over eight years, and one was disease free after 26 months; four patients had persistent or recurrent local disease, and 10 developed metastatic disease. Seven patients died with disease at a median 16 months, and the other seven were alive with disease at a median follow-up of 10 months. Patients with anal adenocarcinoma present at advanced stages, and cure is rare. Although chemoradiation followed by abdominoperineal resection is the most common management strategy, the potential for curative resection and long-term disease free survival is minimal, regardless of stage at presentation.
MeSH term(s)	Adenocarcinoma/surgery ; Adenocarcinoma/therapy ; Anus Neoplasms/surgery ; Anus Neoplasms/therapy ; Chemoradiotherapy, Adjuvant ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome
Language	English
Publishing date	2015-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
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Article: Epidermoid Cancers of the Anal Canal: Current Treatment

Blumetti, Jennifer / Bastawrous, Amir L

Clinics in Colon and Rectal Surgery

2009 Volume 22, Issue 02, Page(s) 77–83

Abstract	Epidermoid carcinoma of the anal canal is an uncommon disease, but has increased in incidence with the HIV epidemic. Prior to the 1970s, treatment consisted of radical surgery with abdominoperineal resection. With the pioneering work of Dr. Norman Nigro, this has shifted to a nonsurgical approach, with primary treatment consisting of multimodality therapy with radiation and chemotherapy. This review provides an overview of the historical, current, and future treatments of epidermoid anal canal malignancies.
Keywords	Anal canal malignancy ; epidermoid carcinoma ; chemoradiation ; Nigro protocol
Language	English
Publishing date	2009-05-01
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2072321-0
ISSN	1530-9681 ; 1531-0043
ISSN (online)	1530-9681
ISSN	1531-0043
DOI	10.1055/s-0029-1223838
Database	Thieme publisher's database

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Article ; Online: No clinical benefit from routine histologic examination of stapler doughnuts at low anterior resection for rectal cancer.

Sugrue, Jeremy / Dagbert, Francois / Park, John / Marecik, Slawomir / Prasad, Leela M / Chaudhry, Vivek / Blumetti, Jennifer / Emmadi, Rajyasree / Mellgren, Anders / Nordenstam, Johan

Surgery

2017 Volume 162, Issue 1, Page(s) 147–151

Abstract: Background: The aim of this study was to evaluate the clinical utility and cost-effectiveness of routine histologic examination of the doughnuts from stapled anastomoses in patients undergoing a low anterior resection for rectal cancer.: Methods: We ... ...

Abstract	Background: The aim of this study was to evaluate the clinical utility and cost-effectiveness of routine histologic examination of the doughnuts from stapled anastomoses in patients undergoing a low anterior resection for rectal cancer. Methods: We performed a retrospective review of 486 patients who underwent a low anterior resection with stapled anastomosis for rectal cancer between 2002 and 2015 at 3 institutions. Pathologic findings in the doughnuts and their impact on patient management were recorded. Tumor characteristics that may influence how often doughnuts were included in the pathology report were analyzed. An approximate cost of histologic examination of doughnuts was also calculated. Results: A total of 412 patients (85%) had doughnuts included in their pathology reports. Two patients had cancer cells in their doughnuts, and both patients had a positive distal margin in their primary tumor specimen; 33 patients had benign findings in their doughnuts. Pathologic examination of the doughnut did not change clinical management in any patient. Patients with rectosigmoid tumors were less likely to have their doughnuts included in the pathology report compared to patients with low tumors (P = .003). Doughnuts were not bundled with the primary tumor specimen in 374 (77%) of our patients; in these patients, pathologic analysis of the doughnut added an additional cost of approximately $643 per specimen. Conclusion: This study demonstrates no clinical benefit in sending anastomotic doughnuts for histopathologic evaluation after performing a low anterior resection with a stapled anastomosis for rectal cancer. Overall cost may be decreased if doughnuts are not analyzed or if they are bundled with the primary tumor specimen.
MeSH term(s)	Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Adenoma/pathology ; Adenoma/surgery ; Aged ; Anastomosis, Surgical ; Cost-Benefit Analysis ; Female ; Humans ; Male ; Middle Aged ; Patient Selection ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Retrospective Studies ; Surgical Stapling/economics ; Treatment Outcome
Language	English
Publishing date	2017-02-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2016.12.035
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Article ; Online: Endoscopic-assisted closure of a chronic colocutaneous fistula.

Prasad, Leela M / deSouza, Ashwin L / Blumetti, Jennifer / Marecik, Slawomir J / Park, John J

Gastrointestinal endoscopy

2010 Volume 72, Issue 3, Page(s) 662–664

MeSH term(s)	Abdominal Abscess/diagnosis ; Abdominal Abscess/surgery ; Aged ; Chronic Disease ; Colectomy ; Colonic Diseases/diagnosis ; Colonic Diseases/surgery ; Cutaneous Fistula/diagnosis ; Cutaneous Fistula/surgery ; Hernia, Ventral/surgery ; Humans ; Intestinal Fistula/diagnosis ; Intestinal Fistula/surgery ; Male ; Postoperative Complications/diagnosis ; Postoperative Complications/surgery ; Reoperation ; Sigmoidoscopy ; Surgical Instruments ; Surgical Mesh ; Tomography, X-Ray Computed
Language	English
Publishing date	2010-09
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	391583-9
ISSN	1097-6779 ; 0016-5107
ISSN (online)	1097-6779
ISSN	0016-5107
DOI	10.1016/j.gie.2009.12.028
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Article ; Online: Causative pathogens, antibiotic sensitivity, resistance patterns, and severity in a contemporary series of Fournier's gangrene.

Bjurlin, Marc A / O'Grady, Thomas / Kim, Dae Y / Divakaruni, Naveen / Drago, Andrew / Blumetti, Jennifer / Hollowell, Courtney M P

Urology

2013 Volume 81, Issue 4, Page(s) 752–758

Abstract: Objective: To identify the causative pathogens and evaluate the antibiotic sensitivity, resistance patterns, and virulence in a contemporary series of patients with Fournier's gangrene.: Materials and methods: The medical records of 41 consecutive ... ...

Abstract	Objective: To identify the causative pathogens and evaluate the antibiotic sensitivity, resistance patterns, and virulence in a contemporary series of patients with Fournier's gangrene. Materials and methods: The medical records of 41 consecutive cases of Fournier's gangrene were evaluated. The patient demographics, causative pathogens, antibiotic sensitivity, and resistance patterns were assessed. The Fournier's gangrene severity index and length of stay were analyzed statistically to determine any differences by causative pathogen. Results: A total of 122 pathogens were cultured. The wound cultures were polymicrobial for 34 patients (83%). Most common pathogens cultured were Bacteroides sp (43.9%), Escherichia coli (36.6%), and Prevotella sp (34.1%). E coli was resistant to fluoroquinolones and trimethoprim/sulfamethoxazole in 13.3%, and 40% of isolates respectively. The wound cultures were monomicrobial for 7 patients (17.0%). A monomicrobial isolate of methicillin-resistant Staphylococcus aureus was cultured that was susceptible to clindamycin and trimethoprim/sulfamethoxazole. Resistance to ampicillin-sulbactam was seen in Providencia sp, Klebsiella sp, E coli, and methicillin-resistant S aureus. Resistance to ceftriaxone and gentamicin was seen in methicillin-resistant S aureus and E coli, respectively. No resistance to clindamycin was demonstrated. No statistically significant difference was detected between the Fournier's gangrene severity index or length of stay and the causative pathogens. Conclusion: Fournier's gangrene remains a community-acquired polymicrobial infection, with anaerobic bacteria as the most common causative pathogens. Candida and methicillin-resistant S aureus are emerging causative pathogens, but methicillin-resistant S aureus remains sensitive to clindamycin and trimethoprim/sulfamethoxazole. Although resistance was demonstrated by some causative pathogens, together, the currently recommended broad-spectrum antibiotics adequately covered all pathogens. Coverage with agents such as fluconazole, vancomycin, or piperacillin-tazobactam is indicated in patients at risk of fungal or hospital-acquired organisms.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Drug Resistance, Bacterial ; Female ; Fournier Gangrene/drug therapy ; Fournier Gangrene/microbiology ; Humans ; Length of Stay ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Severity of Illness Index
Language	English
Publishing date	2013-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	192062-5
ISSN	1527-9995 ; 0090-4295
ISSN (online)	1527-9995
ISSN	0090-4295
DOI	10.1016/j.urology.2012.12.041
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Article ; Online: Management of anastomotic leak: lessons learned from a large colon and rectal surgery training program.

Blumetti, Jennifer / Chaudhry, Vivek / Cintron, Jose R / Park, John J / Marecik, Slawomir / Harrison, Jacqueline L / Prasad, Leela M / Abcarian, Herand

World journal of surgery

2013 Volume 38, Issue 4, Page(s) 985–991

Abstract: Background: Anastomotic leak is a dreaded surgical complication that can lead to significant morbidity and mortality. Despite its prevalence, there is no consensus on the management of anastomotic leak. This study aimed to review the management of ... ...

Abstract	Background: Anastomotic leak is a dreaded surgical complication that can lead to significant morbidity and mortality. Despite its prevalence, there is no consensus on the management of anastomotic leak. This study aimed to review the management of anastomotic leak in the Division of Colon and Rectal Surgery at two institutions. Methods: This is a retrospective review of all anastomotic leaks occurring after surgery in the Division of Colon and Rectal Surgery at two teaching institutions during 1997-2008. Results: Altogether, 103 leaks occurred in 1,707 anastomoses (6 %), with a median time to diagnosis of 20 days (2-1,400 days). The 90-day mortality rate was 3 %. The majority of cases were managed nonoperatively (73 %), and the majority of leaks were from an extraperitoneal anastomosis (67 %). Success (i.e., radiographic demonstration of a healed leak, restored gastrointestinal continuity) occurred in 54 % of operatively managed leaks and 57 % of nonoperatively managed leaks (56 % overall). Operative management differed by leak location. In 91 % of patients with intraperitoneal leaks, the anastomosis was resected. In 76 % of patients with extraperitoneal leaks, diversion and drainage alone was performed without manipulating the anastomosis. Nonoperative management was successful for 57 % of extraperitoneal leaks and 58 % of intraperitoneal leaks. There was no significant difference in the success rates based on type of management (operative/nonoperative) for either extraperitoneal or intraperitoneal leaks. Conclusions: Anastomotic leak continues to result in patient morbidity and mortality. Its diverse presentation requires tailoring management to the patient. Nonoperative and operative treatments are viable options for intraperitoneal and extraperitoneal leaks based on patient presentation.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Anastomotic Leak/diagnosis ; Anastomotic Leak/epidemiology ; Anastomotic Leak/therapy ; Anti-Bacterial Agents/therapeutic use ; Colon/surgery ; Colorectal Surgery/education ; Combined Modality Therapy ; Drainage ; Female ; Follow-Up Studies ; Hospitals, Teaching ; Humans ; Ileostomy ; Illinois ; Incidence ; Male ; Middle Aged ; Rectum/surgery ; Retrospective Studies ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2013-12-05
Publishing country	United States
Document type	Evaluation Study ; Journal Article ; Multicenter Study
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-013-2340-y
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