Carol-ann Vasilevsky | McGill University (original) (raw)

Papers by Carol-ann Vasilevsky

Canadian Journal of Surgery, 2015

Canadian assoCiation of BariatriC PhysiCians and surgeons assoCiation Canadienne des médeCins et ... more Canadian assoCiation of BariatriC PhysiCians and surgeons assoCiation Canadienne des médeCins et Chirurgiens Bariatriques 02 The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks. P

Springer eBooks, Dec 25, 2018

This chapter will cover cryptoglandular anorectal abscess and fistula-in-ano, necrotizing periana... more This chapter will cover cryptoglandular anorectal abscess and fistula-in-ano, necrotizing perianal infection, anoperineal infection in neutropenic patients, and fistulizing perianal Crohn’s disease. The topics rectovaginal fistula and perianal Crohn’s disease are covered in separate chapters of this text.

Springer eBooks, Nov 8, 2013

Gastroenterology, May 1, 2019

British Journal of Surgery, Dec 1, 2020

The objective of this study was to describe conditional recurrence‐free survival (RFS) of patient... more The objective of this study was to describe conditional recurrence‐free survival (RFS) of patients after an index episode of diverticulitis managed without surgery, and to estimate the difference in conditional RFS for diverticulitis according to specific risk factors.

Diseases of The Colon & Rectum, Feb 1, 2016

BACKGROUND: the management of acute diverticulitis in immunosuppressed patients is increasingly d... more BACKGROUND: the management of acute diverticulitis in immunosuppressed patients is increasingly debated. the appropriate timing and type of operation remains controversial. OBJECTIVE: this study examines the impact of immunosuppression on mortality and morbidity following colectomies for diverticulitis in the emergency and elective settings. DESIGN SETTINGS: With the use of the american College of surgeons national surgical Quality improvement Program database, the outcomes of immunosuppressed compared with immunocompetent patients who underwent colectomy for acute diverticulitis were compared. PATIENTS: the multi-institutional database was queried for patients who underwent colectomy for acute diverticulitis from 2005 to 2012. MAIN OUTCOMES MEASURES: the impact of immunosuppression on mortality, major morbidity, organ space infection, infectious complications, and wound dehiscence was assessed. RESULTS: of 26,987 patients, 1332 were immunosuppressed and 25,655 were immunocompetent; 4271 patients had emergency (596 immunosuppressed and 3675 immunocompetent) and 22,716 patients had elective (736 immunosuppressed and 21,980 immunocompetent) colectomies for diverticulitis. in both groups, mortality and major morbidity were significantly higher in the emergency (immunosuppressed 16% and 45%, immunocompetent 4% and 28%) compared with the elective setting (immunosuppressed 2% and 25%, immunocompetent 0.4% and 12%), p < 0.001. on multivariate regression for the emergency setting, immunosuppression significantly increased mortality (oR, 1.79; 95% Ci, 1.17-2.75) and did not significantly increase morbidity. on multivariate regression for the elective setting, mortality was similar in immunosuppressed and immunocompetent groups; however, major morbidity (oR, 1.46; 95% Ci, 1.17-1.83) and wound dehiscence (oR, 2.69; 95% Ci, 1.63-4.42) were significantly increased in immunosuppressed compared with immunocompetent patients. LIMITATIONS: the retrospective design and standardized outcomes are based on heterogeneous data. CONCLUSIONS: emergency colectomy for diverticulitis is associated with higher mortality in immunosuppressed than in immunocompetent patients, whereas elective colectomy is associated with comparable mortality. in the elective setting, immunosuppressed compared with immunocompetent patients are at increased risk of major morbidity and wound dehiscence.

Informa Healthcare eBooks, May 14, 2003

Journal of The American College of Surgeons, Nov 1, 2021

PubMed, Apr 1, 2001

Objective: To describe the etiology and clinical course of acute colitis occurring after flexible... more Objective: To describe the etiology and clinical course of acute colitis occurring after flexible endoscopy. Design: Chart review. Setting: A university teaching hospital. Patients: Eight patients who sought assessment of potential colonic disease. Intervention: Colonoscopy in 5 patients and flexible sigmoidoscopy in 3 patients. The indication for endoscopy was screening in 5 patients, cancer surveillance in 2 patients and preoperative evaluation of colon carcinoma in 1 patient. Outcome measures: The relation of presenting symptoms to glutaraldehyde exposure, the response to therapy and the need for further therapy. Results: All patients had abdominal pain, mucus diarrhea and rectal bleeding within 48 hours after endoscopy. Most patients reported that the symptoms started within 12 hours of the procedure. All patients were confirmed by sigmoidoscopy to have colitis within 72 hours of the first endoscopic procedure. One patient required hospitalization. In the first 7 patients several stool cultures were negative for Clostridium difficile using the cytotoxin assay by the cell culture method. Four patients had negative cultures for Yersinia, Salmonella and Shigella spp. Three patients were treated with metronidazole initially. Two patients underwent endoscopic biopsy and examination of the biopsy specimen showed fibrinoleukocytic exudate and ischemic type injury. One patient underwent the scheduled sigmoid resection within 48 hours of endoscopy for a Dukes' stage B adenocarcinoma. Concomitant acute ischemic colitis limited to the mucosa and submucosa was noted in the resected specimen. Symptoms resolved in all patients and follow-up endoscopy revealed normal mucosa. Conclusion: The entity of glutaraldehyde-induced colitis should be recognized and special attention should be given during instrument cleansing to minimize the risk of its development.

Diseases of The Colon & Rectum, Sep 1, 1988

To determine if subtotal colectomy constitutes a valuable alternative in the treatment of patient... more To determine if subtotal colectomy constitutes a valuable alternative in the treatment of patients with chronic constipation, a retrospective review of 52 consecutive patients who underwent subtotal colectomy between January 1980 and August 1985 was undertaken. Forty-six patients underwent ileodistal sigmoidostomy while five patients underwent ileoproctostomy and five with concomitant rectal prolapse underwent simultaneous proctopexy. A mortality rate of 3.8 percent and morbidity rate of 60 percent were encountered. The most frequently occurring complication was small-bowel obstruction, which occurred in 36 percent, and necessitated laparotomy in 66 percent. Additional procedures were necessary in five patients because of newly discovered rectal prolapse (two patients), rectocele (one patient), unrelieved constipation (one patient), and incapacitating incontinence (one patient). Follow-up data available in 94 percent (mean, 46 months) disclosed that patients had an average of 2.8 bowel movements per day without the use of laxatives (89 percent) or ~nemas (80 percent). Overall, 79 percent were satisfied with the final outcome. It is concluded that subtotal colectomy constitutes a viable option in the treatment of chronic constipation. However, the significant morbidity and mortality associated with the procedure dictate the need for careful patient selection on the basis of appropriate physiologic testing.

Springer eBooks, Nov 21, 2021

Springer eBooks, 2011

Anorectal abscess and fistula-in-ano represent different stages of anorectal suppuration. The abs... more Anorectal abscess and fistula-in-ano represent different stages of anorectal suppuration. The abscess is the acute inflammatory event. Ducts from anal glands empty into the anal crypts at the level of the dentate line. Anal glands penetrate into deeper tissue: 80 % submucosal, 8 % internal sphincter, 8 % conjoined longitudinal muscle, 2 % intersphincteric space, and 1 % penetrate the internal sphincter. Understanding the potential anorectal spaces (Table 13.1) is essential for successful treatment of anorectal suppuration. Table 13.2 lists the etiologies of anorectal abscesses. 90 % are from nonspecific cryptoglandular suppuration. Abscesses result from obstruction of the anal glands (Park’s cryptoglandular theory published in 1961).

The American Journal of Clinical Nutrition, 1986

Nutritional status and skeletal muscle function were studied in 20 CAPD patients (12 men and eigh... more Nutritional status and skeletal muscle function were studied in 20 CAPD patients (12 men and eight women) who were randomly selected among a total population of 95 CAPD patients. Their ages ranged from 29 to 74 years-mean 59-and they underwent CAPD for a period of one to 180 (mean 62.2 ± 53.3) weeks. Nutritional assessment included mea

Diseases of The Colon & Rectum, Apr 1, 1985

Journal of Gastrointestinal Surgery, Sep 27, 2018

Background There is ongoing debate regarding the benefits of minimally invasive techniques for re... more Background There is ongoing debate regarding the benefits of minimally invasive techniques for rectal cancer surgery. The aim of this study was to compare pathologic outcomes of patients who underwent rectal cancer resection by open surgery, laparoscopy, and robotic surgery using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) proctectomy-targeted database. Methods All patients from the 2016 ACS-NSQIP proctectomy-targeted database who underwent elective proctectomy for rectal cancer were identified. Patients were divided into three groups based on initial operative approach: open surgery, laparoscopy, and robotic surgery. Pathologic and 30-day clinical outcomes were then compared between the groups. A propensity score analysis was performed to control for confounders, and adjusted odds ratios for pathologic outcomes were reported. Results A total of 578 patients were included-211 (36.5%) in the open group, 213 (36.9%) in the laparoscopic group, and 154 (26.6%) in the robotic group. Conversion to open surgery was more common among laparoscopic cases compared to robotic cases (15.0% vs. 6.5%, respectively; p = 0.011). Positive circumferential resection margin (CRM) was observed in 4.7%, 3.8%, and 5.2% (p = 0.79) of open, laparoscopic, and robotic resections, respectively. Propensity score adjusted odds ratios for positive CRM (open surgery as a reference group) were 0.70 (0.26-1.85, p = 0.47) for laparoscopy and 1.03 (0.39-2.70, p = 0.96) for robotic surgery. Conclusions The use of minimally invasive surgical techniques for rectal cancer surgery does not appear to confer worse pathologic outcomes.

PubMed, Oct 1, 1999

Objective: To determine the rate of complications of ileoanal pouch anastomosis, their treatment ... more Objective: To determine the rate of complications of ileoanal pouch anastomosis, their treatment and their influence on a successful outcome. Design: A computerized database and chart review. Setting: Three academic tertiary care health centres. Patients: All 239 patients admitted for surgery between 1981 and 1994 with a diagnosis of ulcerative colitis and familial adenomatosis coli. Interventions: Sphincter-saving total proctocolectomy and construction of either S-type of J-type ileoanal reservoir. Outcome measures: Indications, early and late complications, incidence of pouch excision. Results: Of the 239 patients, 228 (95.4%) were operated on for ulcerative colitis and 11 (4.6%) for familial polyposis coli. One patient in each group was found to have a carcinoma not previously diagnosed. Twenty-eight patients had poor results: in 17 (7.1%) the ileostomy was never closed or was re-established because of pelvic sepsis or complex fistulas, sclerosing cholangitis or severe diarrhea; 11 (4.6%) patients required excision of the pouch because of anal stenosis, perirectal abscess-fistula or rectovaginal fistula. Three patients died--of suicide, and complications of liver transplantation and HIV infection. Thus, 208 patients maintained a functioning pouch. The early complication rate (within 30 days of operation) was 57.7% (138 patients) and the late complication rate was 52.3% (125 patients). Pouchitis alone did not lead to failure or pouch excision. Emptying difficulties in 25 patients with anal stenosis were helped in 2 by resorting to intermittent catheterization. Patients with indeterminate colitis had a higher rate of anorectal septic complications, and all patients having Crohn's disease after pouch construction had complicated courses. Conclusions: The complication rate associated with ileoanal pouch anastomosis continues to be relatively high despite increasing experience with this technique. Overall, however, a satisfactory outcome was obtained in 87% of patients.

Journal of Gastrointestinal Surgery, Jun 3, 2020

Background The purpose of this study was to develop and validate a prediction model and clinical ... more Background The purpose of this study was to develop and validate a prediction model and clinical risk score for Intensive Care Resource Utilization after colon cancer surgery. Methods Adult (≥ 18 years old) patients from the 2012 to 2018 ACS-NSQIP colectomy-targeted database who underwent elective colon cancer surgery were identified. A prediction model for 30-day postoperative Intensive Care Resource Utilization was developed and transformed into a clinical risk score based on the regression coefficients. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit test. The model was validated in a separate test set of similar patients. Results In total, 54,893 patients underwent an elective colon cancer resection, of which 1224 (2.2%) required postoperative Intensive Care Resource Utilization. The final prediction model retained six variables: age (≥ 70;

Surgical Clinics of North America, Jun 1, 1984

The use of staples for bowel anastomoses as described by Ravitch and Steichen has markedly facili... more The use of staples for bowel anastomoses as described by Ravitch and Steichen has markedly facilitated these operations. These authors have carefully detailed the technique of creating an end-to-end inverting anastomosis of the gastrointestinal tract. 33 The introduction of the EEA stapler has extended the limits of low anterior resection by enabling surgeons to perform a highly reliable anastomosis at a lower level than was technically possible with a traditional hand-sewn anastomosis. Over the last several years, numerous publications have described individual experience with the circular stapling device.

Diseases of The Colon & Rectum, Jul 1, 2022

BACKGROUND: Colorectal cancer is increasing in young adults. Our understanding of the adenoma-car... more BACKGROUND: Colorectal cancer is increasing in young adults. Our understanding of the adenoma-carcinoma sequence in young patients aged <50 years is lacking. The yield obtained by lowering the age of screening colonoscopy remains unclear. OBJECTIVE: The goal of this study was to understand the burden and histology of colorectal polyps in young adults and to explore predictors of adenoma detection in this population. DESIGN: This is a retrospective cohort study. SETTING: Colonoscopies were performed at a single university-affiliated tertiary care center. PATIENTS: This study included adults aged <50 years who underwent a colonoscopy between 2014 and 2019. Patients with inflammatory bowel disease and genetic disorders were excluded. MAIN OUTCOME MEASURES: Adenoma detection rates were analyzed according to age. Predictors of adenoma detection were investigated by multiple logistic regression. RESULTS: A total of 4475 patients were analyzed. The mean age was 40.2 ± 8.0 years, 56.4% were female, and the mean BMI was 26.3 ± 5.5 kg/m2. A family history of colorectal cancer was reported in 23.8% of patients. The overall polyp and adenoma detection rates were 22% and 14%. The majority of polyps were adenomatous (58.9% of all polypectomies) and located in the left colon or rectum (61.4%). The detection rates of adenomas, advanced neoplasias, and adenocarcinomas were highest in patients aged 45 to 49 (19.3%, 4.8%, and 1.3%). On multivariate analysis, variables independently associated with adenoma detection included age (OR 1.08, 95% CI, 1.06-1.1), female sex (OR 1.80, 95% CI, 1.44-2.27), BMI (OR 1.01, 95% CI, 1.01-1.05), and having undergone a diagnostic colonoscopy (OR 1.81, 95% CI, 1.44-2.29). On subgroup analysis of patients aged 45 to 49, the same variables remained associated with adenoma detection except for age. LIMITATIONS: The study was limited due to the retrospective nature with heterogenous data. CONCLUSIONS: Adenoma detection in young adults aged 45 to 49 approaches the current adenoma detection of older adults. Predictors of adenoma detection in these young adults are female gender and BMI, which may help guide colorectal cancer screening guidelines in the future. See Video at http://links.lww.com/DCR/B843. COMPRENDER DE LA CARGA DE LOS ADENOMAS COLORRECTALES EN PACIENTES <50 aÑOS: UN ESTUDIO DE COHORTE RETROSPECTIVO DE UN SOLO CENTRO ANTECEDENTES: El cáncer colorrectal está aumentando en adultos jóvenes. No se conoce la secuencia adenoma-carcinoma en pacientes jóvenes <50 años. El rendimiento obtenido al reducir la edad de la colonoscopia de detección sigue sin estar claro. OBJETIVO: Comprender la carga y la histología de los pólipos colorrectales en adultos jóvenes y explorar los predictores de detección de adenomas en esta población. DISEÑO: Estudio de cohorte retrospectivo. AJUSTE: Las colonoscopias se realizaron en un único centro de atención terciario afiliado a la universidad. PACIENTES: Adultos jóvenes <50 años que se sometieron a una colonoscopia entre 2014-2019. Se excluyeron los pacientes con enfermedad inflamatoria intestinal y trastornos genéticos. PRINCIPALES MEDIDAS DE RESULTADO: Se analizaron las tasas de detección de adenomas según la edad. Los predictores de la detección de adenomas se investigaron mediante regresión logística múltiple. RESULTADOS: Se analizaron 4475 pacientes. La edad media fue de 40,2 ± 8,0 años, el 56,4% eran mujeres y el IMC medio fue de 26,3 ± 5,5 kg / m2. Se informó de antecedentes familiares de cáncer colorrectal en el 23,8% de los pacientes. Las tasas generales de detección de pólipos y adenomas fueron del 22% y el 14%, respectivamente. La mayoría de los pólipos eran adenomatosos (58,9% de todas las polipectomías) y estaban localizados en colon izquierdo o recto (61,4%). Las tasas de detección de adenomas, neoplasias avanzadas y adenocarcinomas fueron más altas en pacientes de 45 a 49 años (19,3%, 4,8% y 1,3%, respectivamente). En el análisis multivariado, las variables asociadas de forma independiente con la detección de adenomas incluyeron: edad (OR 1.08; IC del 95%: 1,06-1,1), sexo femenino (OR 1,80; IC del 95%: 1,44-2,27), IMC (OR 1,01; IC del 95%: 1,01-1,05)) y haber sido sometido a una colonoscopia diagnóstica (OR 1,81; IC 95% 1,44-2,29). En el análisis de subgrupos de pacientes de 45 a 49 años, las mismas variables permanecieron asociadas con la detección de adenomas, excepto la edad. LIMITACIONES: Carácter retrospectivo con datos heterogéneos. CONCLUSIONES: La detección de adenomas en adultos jóvenes de 45 a 49 años se acerca a la detección actual de adenomas en adultos mayores. Los predictores de la detección de adenomas en estos adultos jóvenes son el sexo femenino y el IMC, que pueden ayudar a guiar las pautas de detección del cáncer colorrectal en el futuro. Consulte Video Resumen en http://links.lww.com/DCR/B843. (Traducción—Dr. Hagerman)