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Article ; Online: Contemporary management of diverticulitis.

Portolese, Austin C / Jeganathan, Nimalan A

Surgery open science

2024 Volume 19, Page(s) 24–27

Abstract: The treatment of diverticulitis is experiencing a shift in management due to a number of large scale clinical trials. For instance, clinicians are beginning to recognize that avoidance of antibiotics in uncomplicated diverticulitis is not associated with ...

Abstract	The treatment of diverticulitis is experiencing a shift in management due to a number of large scale clinical trials. For instance, clinicians are beginning to recognize that avoidance of antibiotics in uncomplicated diverticulitis is not associated with worse outcomes. Additionally, while the decision to proceed with elective surgical resection for recurrent uncomplicated disease is less conclusive and favors a patient-centric approach, complicated disease with a large abscess denotes more aggressive disease and would likely benefit from elective surgical resection. Lastly, in patient with acutely perforated diverticulitis who require urgent surgical intervention, laparoscopic lavage is generally not recommended due to high re-intervention rates and the preferred surgical procedure is primary anastomosis with or without diversion due to high morbidity and low rates of Hartmann reversal.
Language	English
Publishing date	2024-02-20
Publishing country	United States
Document type	Journal Article
ISSN	2589-8450
ISSN (online)	2589-8450
DOI	10.1016/j.sopen.2024.02.001
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Article: Necrotizing Soft Tissue Infections of the Perineum.

Kline, Bryan P / Jeganathan, Nimalan A

Clinics in colon and rectal surgery

2022 Volume 35, Issue 3, Page(s) 237–243

Abstract: Necrotizing soft tissue infections of the perineum are rapidly progressing infections associated with significant morbidity and mortality. Prompt diagnosis and management with early surgical debridement is necessary to improve survival from this deadly ... ...

Abstract	Necrotizing soft tissue infections of the perineum are rapidly progressing infections associated with significant morbidity and mortality. Prompt diagnosis and management with early surgical debridement is necessary to improve survival from this deadly disease. Repeat debridements are not uncommon. Important adjuncts to surgery include broad-spectrum antibiotics and management in an intensive care unit, as patients frequently develop multisystem organ failure. Once the acute phase is managed, fecal diversion with either an ostomy or fecal management catheter can be considered to decrease soiling of the wound and facilitate healing. Long-term management requires meticulous wound care, often with the assistance of negative pressure wound therapy. Patients may ultimately require skin grafts or tissue flaps for soft tissue coverage following extensive surgical debridements.
Language	English
Publishing date	2022-02-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2048635-2
ISSN	1531-0043
ISSN	1531-0043
DOI	10.1055/s-0041-1740102
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Article: Necrotizing Soft Tissue Infections of the Perineum

Kline, Bryan P. / Jeganathan, Nimalan A.

Clinics in Colon and Rectal Surgery

(Uncommon Colorectal Challenges)

2022 Volume 35, Issue 03, Page(s) 237–243

Series title	Uncommon Colorectal Challenges
Abstract	Necrotizing soft tissue infections of the perineum are rapidly progressing infections associated with significant morbidity and mortality. Prompt diagnosis and management with early surgical debridement is necessary to improve survival from this deadly disease. Repeat debridements are not uncommon. Important adjuncts to surgery include broad-spectrum antibiotics and management in an intensive care unit, as patients frequently develop multisystem organ failure. Once the acute phase is managed, fecal diversion with either an ostomy or fecal management catheter can be considered to decrease soiling of the wound and facilitate healing. Long-term management requires meticulous wound care, often with the assistance of negative pressure wound therapy. Patients may ultimately require skin grafts or tissue flaps for soft tissue coverage following extensive surgical debridements.
Keywords	necrotizing soft tissue infection ; Fournier's gangrene ; surgical debridement
Language	English
Publishing date	2022-02-09
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2048635-2
ISSN	1530-9681 ; 1531-0043
ISSN (online)	1530-9681
ISSN	1531-0043
DOI	10.1055/s-0041-1740102
Database	Thieme publisher's database

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Article: Intraoperative Techniques for Gaining Ileoanal Pouch Reach.

Mankarious, Marc M / Deutsch, Michael J / Jeganathan, Nimalan A

Clinics in colon and rectal surgery

2022 Volume 35, Issue 6, Page(s) 458–462

Abstract: Ileal pouch-anal anastomosis allows for reestablishing gastrointestinal continuity in patients after proctocolectomy. The technical elements of pouch creation and gaining reach into the pelvis are demanding and require a variety of surgical maneuvers to ... ...

Abstract	Ileal pouch-anal anastomosis allows for reestablishing gastrointestinal continuity in patients after proctocolectomy. The technical elements of pouch creation and gaining reach into the pelvis are demanding and require a variety of surgical maneuvers to achieve a tension-free anastomosis. We present a brief review of the literature discussing various approaches aimed at improving ileal pouch reach into the low pelvis. Although these techniques are used with different frequencies, they serve as important adjuncts to the gastrointestinal surgeons' armamentarium.
Language	English
Publishing date	2022-11-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2048635-2
ISSN	1531-0043
ISSN	1531-0043
DOI	10.1055/s-0042-1758136
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Article: Meckel's Diverticulum Charading as Crohn's Disease: A Single-Institution Case Series.

Eng, Nina L / Kulaylat, Audrey / Jeganathan, Nimalan A / Scow, Jeffery S / Deutsch, Michael

Cureus

2023 Volume 15, Issue 4, Page(s) e38191

Abstract: Meckel's diverticulum is the most common gastrointestinal congenital anomaly and may present with lower gastrointestinal bleeding, abdominal pain, and nausea. Imaging and endoscopic findings can be similar to those of Crohn's disease, including ... ...

Abstract	Meckel's diverticulum is the most common gastrointestinal congenital anomaly and may present with lower gastrointestinal bleeding, abdominal pain, and nausea. Imaging and endoscopic findings can be similar to those of Crohn's disease, including transmural inflammation, stricturing, and superficial ulceration frequently in the distal ileum. Here, we present a case series of three patients who were initially diagnosed with Crohn's disease and ultimately found to have Meckel's diverticulum alone on final pathology. This single-institution case series, the largest in the literature, highlights the importance of maintaining a high index of suspicion for Meckel's diverticulum, especially in the absence of microscopic evidence of inflammatory bowel disease.
Language	English
Publishing date	2023-04-27
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.38191
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Article ; Online: Is the writing on the wall? The relationship between the number of disease-modifying anti-inflammatory bowel disease drugs used and the risk of surgical resection.

Mankarious, Marc M / Greene, Alicia C / Schaefer, Eric W / Clarke, Kofi / Kulaylat, Afif N / Jeganathan, Nimalan A / Deutsch, Michael J / Kulaylat, Audrey S

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

2024

Abstract: Background: Disease-modifying anti-inflammatory bowel disease drugs (DMAIDs) revolutionized the management of ulcerative colitis (UC). This study assessed the relationship between the number and timing of drugs used to treat UC and the risk of colectomy ...

Abstract	Background: Disease-modifying anti-inflammatory bowel disease drugs (DMAIDs) revolutionized the management of ulcerative colitis (UC). This study assessed the relationship between the number and timing of drugs used to treat UC and the risk of colectomy and postoperative complications. Methods: This was a retrospective review of adult patients with UC treated with disease-modifying drugs between 2005 and 2020 in the MarketScan database. Landmark and time-varying regression analyses were used to analyze risk of surgical resection. Multivariable Cox regression analysis was used to determine risk of postoperative complications, emergency room visits, and readmissions. Results: A total of 12,193 patients with UC and treated with disease-modifying drugs were identified. With a median follow-up time of 1.7 years, 23.8% used >1 drug, and 8.3% of patients required surgical resection. In landmark analyses, using 2 and ≥3 drugs before the landmark date was associated with higher incidence of surgery for each landmark than 1 drug. Multivariable Cox regression showed hazard ratio (95% CIs) of 4.22 (3.59-4.97), 11.7 (9.01-15.3), and 22.9 (15.0-34.9) for using 2, 3, and ≥4 drugs, respectively, compared with using 1 DMAID. That risk was constant overtime. The number of drugs used preoperatively was not associated with an increased postoperative risk of any complication, emergency room visits, or readmission. Conclusion: The use of multiple disease-modifying drugs in UC is associated with an increased risk of surgical resection with each additional drug. This provides important prognostic data and highlights the importance of patient counseling with minimal concern regarding risk of postoperative morbidity for additional drugs.
Language	English
Publishing date	2024-03-13
Publishing country	Netherlands
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	10.1016/j.gassur.2024.03.011
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Zs.A 5207: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 354: Show issues

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Article: Intraoperative Techniques for Gaining Ileoanal Pouch Reach

Mankarious, Marc M. / Deutsch, Michael J. / Jeganathan, Nimalan A.

Clinics in Colon and Rectal Surgery

(Surgical Treatment of Mucosal Ulcerative Colitis)

2022 Volume 35, Issue 06, Page(s) 458–462

Series title	Surgical Treatment of Mucosal Ulcerative Colitis
Abstract	Ileal pouch-anal anastomosis allows for reestablishing gastrointestinal continuity in patients after proctocolectomy. The technical elements of pouch creation and gaining reach into the pelvis are demanding and require a variety of surgical maneuvers to achieve a tension-free anastomosis. We present a brief review of the literature discussing various approaches aimed at improving ileal pouch reach into the low pelvis. Although these techniques are used with different frequencies, they serve as important adjuncts to the gastrointestinal surgeons' armamentarium.
Keywords	ileal pouch anal anastomosis/IPAA ; J-pouch ; mesenteric lengthening ; pouch reach
Language	English
Publishing date	2022-11-01
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2048635-2
ISSN	1530-9681 ; 1531-0043
ISSN (online)	1530-9681
ISSN	1531-0043
DOI	10.1055/s-0042-1758136
Database	Thieme publisher's database

In stock of ZB MED Cologne/Königswinter

Zs.A 3931: Show issues

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Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

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Article: A Case Report of Necrotizing Neutrophilic Dermatosis: A Sheep in Wolf's Clothing.

Ackerman, Devon / Phan, Chandat / Kuroki, Marcos / Helm, Matthew / Jeganathan, Nimalan A

Cureus

2022 Volume 14, Issue 7, Page(s) e26498

Abstract: Neutrophilic dermatosis (ND) is a category of diseases characterized by trauma-induced, autoinflammatory cutaneous eruption. Comorbid systemic disease is common with a predilection for malignancy, inflammatory bowel disease, and rheumatologic disease. ... ...

Abstract	Neutrophilic dermatosis (ND) is a category of diseases characterized by trauma-induced, autoinflammatory cutaneous eruption. Comorbid systemic disease is common with a predilection for malignancy, inflammatory bowel disease, and rheumatologic disease. Rarely, it can manifest with aseptic shock, an entity referred to as necrotizing neutrophilic dermatosis (NND). NND may occur in the postoperative setting and is often misdiagnosed as a necrotizing soft tissue infection. Unfortunately, the treatment for a necrotizing soft tissue infection, namely, wide debridement, is often detrimental in the setting of NND. We present the case of a woman with underlying myelodysplastic syndrome who developed episodic postoperative hemodynamic collapse followed by delayed necrotic peristomal ulceration following colonic diversion for complicated diverticulitis. Infectious workup and operative re-exploration were unrevealing. Pathologic assessment of affected skin tissue showed changes consistent with ND, ultimately leading to the diagnosis of NND. Her clinical course dramatically improved with the initiation of immunosuppressive therapy. The mimicry of NND to a potentially lethal necrotizing soft-tissue infection creates a grave diagnostic dilemma in the postoperative period. A general lack of knowledge of NND among non-dermatologic specialists produces an opportunity for misdiagnosis and inappropriate surgical interventions, namely, serial debridement. Several clinical cues may aid in the earlier recognition of NND. The cornerstone of treatment involves systemic corticosteroid therapy with adjunctive therapy for refractory cases. NND must be considered in the differential diagnosis of necrotizing soft tissue infection as early recognition may result in the avoidance of deleterious surgical interventions.
Language	English
Publishing date	2022-07-01
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.26498
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Article ; Online: Changing disposition patterns in the era of COVID-19 after colon resections: A National Surgical Quality Improvement Program colectomy study.

Mankarious, Marc M / Portolese, Austin C / Kazzaz, Sarah A / Deutsch, Michael J / Jeganathan, Nimalan A / Scow, Jeffrey S / Kulaylat, Audrey S

Surgery

2023 Volume 174, Issue 2, Page(s) 203–208

Abstract: Background: The COVID-19 pandemic severely impacted post-hospitalization care facilities in the United States and hindered their ability to accept new patients for various reasons. This study aimed to assess the impact of the pandemic on discharge ... ...

Abstract	Background: The COVID-19 pandemic severely impacted post-hospitalization care facilities in the United States and hindered their ability to accept new patients for various reasons. This study aimed to assess the impact of the pandemic on discharge disposition after colon surgery and associated postoperative outcomes. Methods: A retrospective cohort study was performed using the National Surgical Quality Improvement Participant Use File and targeted colectomy. Patients were divided into the following 2 cohorts: (1) pre-pandemic (2017-2019) and (2) pandemic (2020). The primary outcomes included discharge disposition-post-hospitalization facility versus home. The secondary outcomes were rates of 30-day readmissions and other postoperative outcomes. The multivariable analysis assessed for confounders and effect modification on discharge to home. Results: Discharge to posthospitalization facilities decreased by 30% in 2020 compared to 2017 to 2019 (7% vs 10%, P < .001). This occurred despite an increase in emergency cases (15% vs 13%, P < .001) and open surgical approach (32% vs 31%, P < .001) in 2020. Multivariable analysis revealed that patients in 2020 had 38% lower odds of going to post-hospitalization facilities (odds ratio 0.62, P < .001) after adjusting for surgical indications and underlying comorbidities. This decrease in patients going to a post-hospitalization facility was not associated with an increased length of stay or an increase in 30-day readmissions or postoperative complications. Conclusion: During the pandemic, patients undergoing colonic resection were less likely to be discharged to a post-hospitalization facility. This shift was not associated with an increase in 30-day complications. This should prompt further research to assess the reproducibility of these associations, especially in a setting without a global pandemic.
MeSH term(s)	Humans ; United States/epidemiology ; Retrospective Studies ; Quality Improvement ; Pandemics ; Reproducibility of Results ; COVID-19/epidemiology ; COVID-19/complications ; Colectomy/adverse effects ; Colon/surgery ; Patient Discharge ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Patient Readmission
Language	English
Publishing date	2023-04-19
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.2023.04.008
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Article ; Online: Neoadjuvant chemotherapy does not increase risk for anastomotic leak for simultaneous resection of primary colon cancer with synchronous liver metastasis: A NSQIP-colectomy analysis.

Mankarious, Marc M / Portolese, Austin C / Hoskins, Meloria A / Deutsch, Michael J / Jeganathan, Nimalan A / Scow, Jeffrey S / Kulaylat, Audrey S

Journal of surgical oncology

2023 Volume 128, Issue 1, Page(s) 58–65

Abstract: Background and objectives: In patients with colon cancer with synchronous liver metastasis, treatment algorithms are complex and often require multidisciplinary evaluation. Neoadjuvant therapy is frequently utilized, but there is an unclear relationship ...

Abstract	Background and objectives: In patients with colon cancer with synchronous liver metastasis, treatment algorithms are complex and often require multidisciplinary evaluation. Neoadjuvant therapy is frequently utilized, but there is an unclear relationship with postoperative outcomes in patients with simultaneous resection. Methods: This is a retrospective cohort study from the National Surgical Quality Improvement Program and Targeted Colectomy databases. All patients with stage IV colon cancer undergoing simultaneous colectomy with synchronous liver metastasis resection or ablation between 2015 and 2019 were identified and categorized into subgroups based on receipt of neoadjuvant chemotherapy. Multivariable logistic regression was utilized to assess for risk factors of anastomotic leaks and serious postoperative complications. Results: We identified 1006 patients who underwent simultaneous colectomy and liver operations. Of those, 418 (41.6%) received neoadjuvant chemotherapy within 90 days of surgery, while 588 (58.4%) had simultaneous upfront surgery. On multivariable logistic regression, neoadjuvant therapy was not associated with postoperative anastomotic leaks (odds ratio [OR]: 1.30; p = 0.39) or serious complications (OR: 1.04; p = 0.82). Conclusion: Neoadjuvant therapy does not increase postoperative complications in simultaneous colon and liver resections. These results may alleviate concerns regarding postoperative morbidity in the decision-making process of administering neoadjuvant therapy.
MeSH term(s)	Humans ; Anastomotic Leak/etiology ; Neoadjuvant Therapy/adverse effects ; Retrospective Studies ; Colectomy/adverse effects ; Colectomy/methods ; Colonic Neoplasms/drug therapy ; Colonic Neoplasms/surgery ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Liver Neoplasms/drug therapy ; Liver Neoplasms/surgery
Language	English
Publishing date	2023-03-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	82063-5
ISSN	1096-9098 ; 0022-4790
ISSN (online)	1096-9098
ISSN	0022-4790
DOI	10.1002/jso.27242
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