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  1. Article ; Online: Robotic modified Sugarbaker technique for parastomal hernia repair: a standardized approach.

    Ferrari, Davide / Violante, Tommaso / Gomaa, Ibrahim A / Cima, Robert R

    Updates in surgery

    2024  

    Abstract: Parastomal hernia (PSH) is a prevalent long-term morbidity associated with stoma construction, and the optimal operative management remains uncertain. This study addresses the need for a standardized approach to symptomatic PSH repair, focusing on the ... ...

    Abstract Parastomal hernia (PSH) is a prevalent long-term morbidity associated with stoma construction, and the optimal operative management remains uncertain. This study addresses the need for a standardized approach to symptomatic PSH repair, focusing on the robotic-assisted modified Sugarbaker technique with composite permanent mesh. The study, conducted in a high-volume colon and rectal surgery referral practice, outlines a systematic approach to patient selection, surgical procedures, and postoperative care. Preoperative evaluations include detailed medical and surgical histories, impact assessments of PSH, and oncological history reviews. The surgical technique involves the Da Vinci Xi™ robotic platform for adhesiolysis, hernia content reduction, stoma revision if needed, narrowing of the enlarged stoma trephine, lateralization of the stoma limb of bowel, and securing the mesh to the abdominal wall. Outcomes are reported for 102 patients undergoing robotic parastomal hernia repair from January 2021 to July 2023. Conversion to open surgery occurred in only one case (0.9%). Postoperative complications affected 39.2% of patients, with ileus being the most frequent (24.5%). Recurrence was observed in 5.8% of cases during an average follow-up of 10 months. In conclusion, parastomal hernia, a common complication post-stoma creation, demands surgical intervention. The robotic-assisted modified Sugarbaker repair technique, as outlined in this paper, offers promising results in terms of feasibility and outcomes.
    Language English
    Publishing date 2024-04-04
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-024-01813-7
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  2. Article ; Online: Robotic-assisted parastomal hernia repair using the Sugarbaker technique.

    Cardenas Lara, Francisco J / Cima, Robert R

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2023  Volume 25, Issue 12, Page(s) 2460–2461

    MeSH term(s) Humans ; Herniorrhaphy/methods ; Robotic Surgical Procedures ; Surgical Stomas/adverse effects ; Hernia, Ventral/surgery ; Surgical Mesh/adverse effects ; Incisional Hernia/etiology ; Incisional Hernia/surgery ; Laparoscopy/methods
    Language English
    Publishing date 2023-10-23
    Publishing country England
    Document type Letter
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16779
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    Zs.A 5799: Show issues Location:
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  3. Article ; Online: A historical perspective on the problem of the retained surgical sponge: Have we really come that far?

    Cima, Robert R / Newman, James S

    Surgery

    2021  Volume 170, Issue 1, Page(s) 146–152

    Abstract: Retained surgical items, particularly surgical sponges, are a considered a "never event." Unfortunately, they continued to be reported despite significant efforts to reduce them. Our goal was to identify some of the earliest reports of surgical items, ... ...

    Abstract Retained surgical items, particularly surgical sponges, are a considered a "never event." Unfortunately, they continued to be reported despite significant efforts to reduce them. Our goal was to identify some of the earliest reports of surgical items, particularly surgical sponges, to see how it was presented in the literature as well as any insights into contributing factors and processes to mitigate the event. We progress forward in time to look at how this issue has been addresses or changed as we enter the 21st century. After this review, it appears that our advances are not as significant as those efforts proposed over 100 years ago. We view this as a call to action for significant change in our operative safety processes and to incorporate available technology.
    MeSH term(s) Foreign Bodies/complications ; Foreign Bodies/history ; History, 19th Century ; History, 20th Century ; History, 21st Century ; Humans ; Malpractice/history ; Malpractice/legislation & jurisprudence ; Medical Errors/history ; Medical Errors/prevention & control ; Medical Errors/statistics & numerical data ; Practice Guidelines as Topic ; Surgical Sponges/adverse effects ; Surgical Sponges/history ; Surgical Sponges/statistics & numerical data
    Language English
    Publishing date 2021-02-26
    Publishing country United States
    Document type Historical Article ; Journal Article
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2021.01.035
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    Uk I Zs.129: Show issues Location:
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  4. Article ; Online: Postoperative Venous Thromboembolism in Colon and Rectal Cancer: Do Tumor Location and Operation Matter?

    McKenna, Nicholas P / Bews, Katherine A / Behm, Kevin T / Habermann, Elizabeth B / Cima, Robert R

    Journal of the American College of Surgeons

    2023  Volume 236, Issue 4, Page(s) 658–665

    Abstract: Background: Existing venous thromboembolism (VTE) risk scores help identify patients at increased risk of postoperative VTE who warrant extended prophylaxis in the first 30 days. However, these methods do not address factors unique to colorectal surgery, ...

    Abstract Background: Existing venous thromboembolism (VTE) risk scores help identify patients at increased risk of postoperative VTE who warrant extended prophylaxis in the first 30 days. However, these methods do not address factors unique to colorectal surgery, wherein the tumor location and operation performed vary widely. VTE risk may extend past 30 days. Therefore, we aimed to determine the roles of tumor location and operation in VTE development and evaluate VTE incidence through 90 days postoperatively.
    Study design: Adult patients undergoing surgery for colorectal cancer between January 1, 2005, and December 31, 2021, at a single institution were identified. Patients were then stratified by cancer location and by operative extent. VTEs were identified using diagnosis codes in the electronic medical record and consisted of extremity deep venous thromboses, portomesenteric venous thromboses, and pulmonary emboli.
    Results: A total of 6,844 operations were identified (72% segmental colectomy, 22% proctectomy, 6% total (procto)colectomy), and tumor location was most commonly in the ascending colon (32%), followed by the rectum (31%), with other locations less common (sigmoid 16%, rectosigmoid junction 9%, transverse colon 7%, descending colon 5%). The cumulative incidence of any VTE was 3.1% at 90 days with a relatively steady increase across the entire 90-day interval. Extremity deep venous thromboses were the most common VTE type, accounting for 37% of events, and pulmonary emboli and portomesenteric venous thromboses made up 33% and 30% of events, respectively. More distal tumor locations and more anatomically extensive operations had higher VTE rates.
    Conclusions: When considering extended VTE prophylaxis after colorectal surgery, clinicians should account for the operation performed and the location of the tumor. Further study is necessary to determine the optimal length of VTE prophylaxis in high-risk individuals.
    MeSH term(s) Adult ; Humans ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Venous Thrombosis/epidemiology ; Venous Thrombosis/etiology ; Venous Thrombosis/prevention & control ; Colon ; Pulmonary Embolism/epidemiology ; Pulmonary Embolism/etiology ; Pulmonary Embolism/prevention & control ; Colectomy/adverse effects ; Rectal Neoplasms/complications ; Rectal Neoplasms/surgery ; Risk Factors ; Incidence
    Language English
    Publishing date 2023-01-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1097/XCS.0000000000000537
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  5. Article ; Online: Timing and Location of Venous Thromboembolisms After Surgery for Inflammatory Bowel Disease.

    McKenna, Nicholas P / Bews, Katherine A / Behm, Kevin T / Mathis, Kellie L / Cima, Robert R / Habermann, Elizabeth B

    The Journal of surgical research

    2024  Volume 296, Page(s) 563–570

    Abstract: Introduction: Patients with inflammatory bowel disease are reported to be at elevated risk for postoperative venous thromboembolism (VTE). The rate and location of these VTE complications is unclear.: Methods: Patients with ulcerative colitis (UC) or ...

    Abstract Introduction: Patients with inflammatory bowel disease are reported to be at elevated risk for postoperative venous thromboembolism (VTE). The rate and location of these VTE complications is unclear.
    Methods: Patients with ulcerative colitis (UC) or Crohn's disease (CD) undergoing intestinal operations between January 2006 and March 2021 were identified from the medical record at a single institution. The overall incidence of VTEs and their anatomic location were determined to 90 days postoperatively.
    Results: In 2716 operations in patients with UC, VTE prevalence was 1.95% at 1-30 days, 0.74% at 31-60 days, and 0.48% at 90 days (P < 0.0001). Seventy two percent of VTEs within the first 30 days were in the portomesenteric system, and this remained the location for the majority of VTE events at 31-60 and 61-90 days postoperatively. In the first 30 days, proctectomies had the highest incidence of VTEs (2.5%) in patients with UC. In 2921 operations in patients with CD, VTE prevalence was 1.43%, 0.55%, and 0.41% at 1-30 days, 31-60 days, and 61-90 days, respectively (P < 0.0001). Portomesenteric VTEs accounted for 31% of all VTEs within 30 days postoperatively. In the first 30 days, total abdominal colectomies had the highest incidence of VTEs (2.5%) in patients with CD.
    Conclusions: The majority of VTEs within 90 days of surgery for UC and Crohn's are diagnosed within the first 30 days. The risk of a VTE varies by the extent of the operation performed, with portomesenteric VTE representing a substantial proportion of events.
    MeSH term(s) Humans ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Inflammatory Bowel Diseases/surgery ; Inflammatory Bowel Diseases/complications ; Venous Thrombosis/etiology ; Colitis, Ulcerative/surgery ; Colitis, Ulcerative/complications ; Crohn Disease/complications ; Crohn Disease/surgery ; Colectomy/adverse effects ; Incidence ; Risk Factors
    Language English
    Publishing date 2024-02-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2024.01.033
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    Zs.A 178: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  6. Article ; Online: Validation of a left-sided colectomy anastomotic leak risk score and assessment of diversion practices.

    McKenna, Nicholas P / Bews, Katherine A / Cima, Robert R / Crowson, Cynthia S / Habermann, Elizabeth B

    American journal of surgery

    2022  Volume 224, Issue 3, Page(s) 971–978

    Abstract: Background: A left-sided anastomotic leak risk score was previously developed and internally but not externally validated.: Methods: Left-sided colectomy anastomotic leak risk scores were calculated for patients within the ACS NSQIP Colectomy ... ...

    Abstract Background: A left-sided anastomotic leak risk score was previously developed and internally but not externally validated.
    Methods: Left-sided colectomy anastomotic leak risk scores were calculated for patients within the ACS NSQIP Colectomy Targeted PUF from 2017 to 2018 and institutional NSQIP databases at three hospitals from 2011 to 2019. The calibration and discrimination of the risk score was assessed.
    Results: A total of 21,116 patients (ACS NSQIP) and 485 patients (institutional NSQIP) were identified. Anastomotic leak rate was 2.8% and 2.9% respectively. C-statistic in the ACS NSQIP cohort was 0.61 and 0.64 in the institutional cohort compared to 0.66 in the original development cohort. Strong visual correspondence existed between predicted and observed anastomotic leak rates in the ACS NSQIP cohort.
    Conclusions: The left-sided anastomotic leak risk score was validated in two new populations. Use of the score would aid in the decision of when to perform a diverting stoma.
    MeSH term(s) Anastomotic Leak ; Colectomy ; Databases, Factual ; Humans ; Retrospective Studies ; Risk Factors ; Surgical Stomas
    Language English
    Publishing date 2022-04-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2022.04.018
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  7. Article ; Online: Bowel Dysfunction after Low Anterior Resection for Colorectal Cancer: A Frequent Late Effect of Surgery Infrequently Treated.

    McKenna, Nicholas P / Bews, Katherine A / Yost, Kathleen J / Cima, Robert R / Habermann, Elizabeth B

    Journal of the American College of Surgeons

    2022  Volume 234, Issue 4, Page(s) 529–537

    Abstract: Background: The development of major low anterior resection syndrome (LARS) after low anterior resection is severely detrimental to quality of life, yet awareness of it by clinicians and patients and the frequency of treatment of LARS is unclear.: ... ...

    Abstract Background: The development of major low anterior resection syndrome (LARS) after low anterior resection is severely detrimental to quality of life, yet awareness of it by clinicians and patients and the frequency of treatment of LARS is unclear.
    Study design: Patients who underwent low anterior resection for sigmoid or rectal cancer at a tertiary center between 2007 and 2017 (n = 798) were surveyed in 2019 to assess LARS symptoms and report medications or treatment received for LARS. LARS scores were calculated (score range 0-42) and normalized to published data on LARS prevalence in the general population in Europe, stratified by age (<50 or ≥50) and sex.
    Results: Of the 594 patients (74%) who returned the survey, 255 (43%) were identified as having major LARS (LARS score ≥30). This prevalence was significantly higher than published normative data from Denmark and Amsterdam when stratified by age greater than or less than 50 and sex. Patients with major LARS infrequently reported current use of first-line therapies (antidiarrheal medications 32%, fiber supplements 16%, and both 13%). Only 3% reported receiving second-line therapy of transanal irrigations and/or pelvic floor rehabilitation, and only 1% had undergone third-line therapy of sacral nerve stimulator implantation.
    Conclusion: Major LARS is common yet seemingly underrecognized by clinicians because less than half of patients are on first-line therapy and practically none are on second- and third-line therapies. Long-term follow-up of patients after low anterior resection, improved preoperative and postoperative education, and continued symptom assessment is necessary to improve treatment of major LARS.
    MeSH term(s) Gastrointestinal Diseases ; Humans ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Proctectomy/adverse effects ; Quality of Life ; Rectal Diseases ; Rectal Neoplasms/surgery ; Syndrome
    Language English
    Publishing date 2022-03-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1097/XCS.0000000000000085
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  8. Article ; Online: Is there Clinical Value to Routine Postoperative Day 1 Labs after Proctectomy?

    McKenna, Nicholas P / Glasgow, Amy E / Behm, Kevin T / Habermann, Elizabeth B / Cima, Robert R

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

    2021  Volume 25, Issue 11, Page(s) 2961–2962

    MeSH term(s) Colitis, Ulcerative ; Crohn Disease ; Humans ; Proctectomy/adverse effects
    Language English
    Publishing date 2021-05-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2012365-6
    ISSN 1873-4626 ; 1934-3213 ; 1091-255X
    ISSN (online) 1873-4626 ; 1934-3213
    ISSN 1091-255X
    DOI 10.1007/s11605-021-05027-9
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    Zs.A 5207: Show issues Location:
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  9. Article ; Online: Timing and indications for colectomy in chronic ulcerative colitis: Surgical consideration.

    Cima, Robert R

    Digestive diseases (Basel, Switzerland)

    2010  Volume 28, Issue 3, Page(s) 501–507

    Abstract: Total proctocolectomy (TPC) cures a patient of the intestinal manifestation of chronic ulcerative colitis. The timing of surgery during the illness will influence the choice of operation, the frequency of post-operative complications, and the long-term ... ...

    Abstract Total proctocolectomy (TPC) cures a patient of the intestinal manifestation of chronic ulcerative colitis. The timing of surgery during the illness will influence the choice of operation, the frequency of post-operative complications, and the long-term functional outcomes. Surgery is divided into emergency, urgent, and elective procedures. Emergency cases are performed for complications of fulminant colitis: hemorrhage, perforation, toxic megacolon or sepsis. A subtotal colectomy (STC) with a Brooke ileostomy (BI) is the procedure of choice. STC removes the bulk of the disease, allows the patient's health to be restored, medication to be withdrawn, and permits a future restorative operation. Urgent operations occur in hospitalized patients with continued symptoms after seven days of maximal medical therapy. Once again the preferred operation is a STC-BI. Indications for elective colectomy include: persistent symptoms despite maximal medical therapy, medication side-effects, persistent chronic disease state, dysplasia/malignancy. Elective surgical options include TPC-BI, TPC with ileal-pouch anal anastomosis (IPAA), or STC-BI. The choice of operation is based upon patient preference and preoperative physiologic and functional status. Factors associated with increased post-operative complications are weight loss >10%, multiple preoperative blood transfusions, albumin <3.0 gm/dl, and degree of immuno-suppression. In high-risk patients, STC-BI should be performed. IPAA can be performed later after the patient's health is restored. In conclusion, numerous factors affect the timing and choice of operation in patients with CUC. Avoiding complications in IPAA patients is essential as they negatively impact the long-term function and durability of the IPAA.
    MeSH term(s) Anastomosis, Surgical ; Chronic Disease ; Colectomy/methods ; Colitis, Ulcerative/surgery ; Colonic Pouches ; Humans ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2010
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 632798-9
    ISSN 1421-9875 ; 0257-2753
    ISSN (online) 1421-9875
    ISSN 0257-2753
    DOI 10.1159/000320409
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  10. Article ; Online: Wrong-site craniotomy.

    Cima, Robert R

    Journal of neurosurgery

    2010  Volume 113, Issue 3, Page(s) 458–9; discussion 459–60

    MeSH term(s) Communication ; Craniotomy ; Functional Laterality ; Humans ; Medical Errors/prevention & control ; Medical Errors/trends ; Review Literature as Topic
    Language English
    Publishing date 2010-09
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/2009.10.JNS091399
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