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Background Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has diverse clinical manifestations and the optimal treatment strategy is unknown. The aim of this study was to assess the efficacy of treatment strategies for different manifestations of anastomotic leak after oesophagectomy. Methods A retrospective cohort study was performed in 71 centres worldwide and included patients with anastomotic leak after oesophagectomy (2011–2019). Different primary treatment strategies were compared for three different anastomotic leak manifestations: interventional versus supportive-only treatment for local manifestations (that is no intrathoracic collections; well perfused conduit); drainage and defect closure versus drainage only for intrathoracic manifestations; and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis. The primary outcome was 90-day mortality. Propensity score matching was performed to adjust for confounders. Results Of 1508 patients with anastomotic leak, 28.2 per cent (425 patients) had local manifestations, 36.3 per cent (548 patients) had intrathoracic manifestations, 9.6 per cent (145 patients) had conduit ischaemia/necrosis, 17.5 per cent (264 patients) were allocated after multiple imputation, and 8.4 per cent (126 patients) were excluded. After propensity score matching, no statistically significant differences in 90-day mortality were found regarding interventional versus supportive-only treatment for local manifestations (risk difference 3.2 per cent, 95 per cent c.i. −1.8 to 8.2 per cent), drainage and defect closure versus drainage only for intrathoracic manifestations (risk difference 5.8 per cent, 95 per cent c.i. −1.2 to 12.8 per cent), and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis (risk difference 0.1 per cent, 95 per cent c.i. −21.4 to 1.6 per cent). In general, less morbidity was found after less extensive primary treatment strategies. Conclusion Less extensive primary treatment of anastomotic leak was associated with less morbidity. A less extensive primary treatment approach may potentially be considered for anastomotic leak. Future studies are needed to confirm current findings and guide optimal treatment of anastomotic leak after oesophagectomy.

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Objective: To determine the incidence of complications [Surgical site infection (SSI), intra-abdominal abscess (IAA),stump leak] related to stump ligation with manual loop of sliding extracorporeal suture knot in LA.Methods: This cohort study was conducted on patients who underwent laparoscopic appendectomy from June2014 to November 2020 performed by the same surgeon with almost similar technique. Stump was ligated withmanual loops, applied by the surgeon or trainee or both (one by surgeon and other by trainee). SSI and IAA wereclassified according to Centers for Disease Control and Prevention (CDC) criteria.Results: Total 120 patients were included with median (Interquartile range, IQR) age of 24 (19-35) years and malepredominance i.e. 81 (67.5%). Median (IQR) for the duration of symptoms, time from presentation to surgery andduration of surgery was 2(1-4) days, 10 (4-15) hours and 60 (44-70) minutes, respectively. SSI was documented in9(7.5%) patients, managed by wound hygiene and antibiotics. IAA was observed in one(0.8%) patient who requiredreadmission for antibiotics and radiology guided drain placement. No stump leak was observed.Conclusion: Manual endo-loop is a safe, reliable and cost effective technique for stump ligation in LA, and can safelybe incorporated into teaching of surgical trainees.Keywords: Surgical Site Infection, Intra Abdominal Abscess, Endoloop, Stump leak, Clips, Stapler.

Burns carries a high risk of mortality and morbidity. This with increased chances of drug-resistant infections makes the management complicated. Hence this study was conducted to find out the prevalence of multi-drug resistant organisms (MDRO) in burns patients admitted to the intensive care unit at a tertiary care hospital. A 2-year retrospective study was conducted where burn patients reporting MDRO were included. Statistical analysis was performed using SPSS version 26 where a p-value <0.05 was considered statistically significant. Out of 97 patients, tissue cultures of 65 patients revealed the presence of MDRO in 27 (27.8%) patients. A male predominance (17, 63.0%) was noted with a mean age of 29.0-year-old. Fire burn (15, 55.6%) was reported to be the most common cause of burn with an average of 29.9% of Total Body Surface Area (TBSA) involved. MDR Pseudomonas aeruginosa was the commonest organism reported in 12 (44%) patients. The average length of stay (LOS) was noted to be 11.3 days with a mortality rate of 48.1% (Overall, in all MDRO’S infections). Patients who reported MDRO showed a tendency for longer hospitalization with a higher risk of mortality as the TBSA increased. However, in presence of other factors in burns like higher TBSA, inhalation injury and lack of advanced skin substitute these mortality figures, and their association can be debated. Lastly, the implementation of control measures, as basic as hand hygiene, should be partaken to reduce the burden of MDR infections.