Achieving a negative resection through a pelvic exenteration for a recurrent or an advanced pelvic malignancy offers the potential for cure. Exenterative surgical units have expanded the boundaries and redefined what constitutes resectable disease through improved surgical technique. In selected cases, contiguous tumor involvement of the aortoiliac axis requires en bloc resection and subsequent vessel reconstruction. However, vascular reconstruction can be challenging in a contaminated field during an extended radical resection.
 
  The aim of this Technical Note is to describe a novel method in the management of patients with recurrent or advanced pelvic malignancy involving the aortoiliac axis by performing preemptive femoral-femoral arterial and venous crossover grafts, with adjunctive arteriovenous loop fistula formation before undergoing an extended radical pelvic resection 4 weeks later.
 
  Four patients have undergone preemptive femoral-femoral arterial and venous crossover grafts at our institution (meuring that the grafts are patent before embarking on major intra-abdominal surgery.
  Most preventive ileostomy following colorectal surgery requires a closure procedure. The intervals between primary surgery and ileostomy closure remain controversial.
 
  This study aimed to compare early versus late closure of preventive ileostomy following colorectal surgery.
 
  A systematic literature search was performed in conference papers, MEDLINE, EMBASE, the Cochrane Library, and the Clinicaltrials.gov database.
 
  Randomized clinical trials published through October 2019 comparing early versus late closure of ileostomy following colorectal surgery were selected.
 
  Morbidity, leak of the primary anastomosis, reoperation, surgical site infection, small-bowel obstruction/postoperative ileus, total operative time, and postoperative length of hospital stay were measured. Results were synthesized using meta-analysis and were rated as firm or weak evidence by trial sequential analysis.
 
  A total of 6 randomized controlled trials were included. Firm evidence from trial sequential analysis demonstrated that th989.
 In selected patients, early closure of ileostomy after colorectal surgery can be considered, with a lower incidence of postoperative small-bowel obstruction/postoperative ileus and less total operative time, but a relatively high surgical site infection rate. PROSPERO registration number CRD42020160989.
  The Bundled Payments for Care Improvement initiative links payments for service beneficiaries during an episode of care (limited to 90 days from index surgery discharge).
 
  The purpose of this study was to identify drivers of costs/payments for the major bowel Bundled Payments for Care Improvement initiative.
 
  Discharges from the Medicare Standard Analytic Files of hospitals participating in the major bowel bundle of the Bundled Payments for Care Improvement initiative were analyzed.
 
  The study was conducted at 4 tertiary care centers.
 
  All patients in diagnostic related groups of 329, 330, or 331 treated at eligible facilities between September 1, 2012, and September 30, 2014, were included.
 
  We calculated all costs/payments for the bundled period, that is, 3 days before surgery, the index hospitalization including surgery, and the 90-day postoperative period. We then determined costs for laparoscopic versus open procedures using International Classification of Diseases, Ninth Revision, procedure codesn más efectivos para reducir los costos de los GRD de menor complejidad, mientras que los esfuerzos para impactar la readmisión y la utilización del servicio posterior al alta serían más impactantes para los GRD de mayor complejidad. See Video Abstract at http//links.lww.com/DCR/B420.
  Closer scrutiny of prescription patterns following surgery could contribute to the national effort to combat the opioid epidemic.
 
  This study aimed to define opioid consumption patterns following anorectal operations for development of an institutional prescribing guideline.
 
  This was a retrospective cohort study.
 
  The study was conducted at a single tertiary care center.
 
  Patients undergoing outpatient anorectal surgery between July 2018 and January 2019 were included.
 
  The study measured prescription and consumption quantities measured as equianalgesic oxycodone 5-mg pills.
 
  There were 174 operations categorized into 4 operation categories 72 hemorrhoid excisions, 55 fistulas-in-ano operations, 8 anal condyloma fulgurations, and 39 miscellaneous operations (14 sphincterotomies, 16 anal biopsies/skin tag excisions, and 9 transanal rectal lesion excisions). Prescription quantity was varied (range, 3-80 equianalgesic oxycodone 5-mg pills). Overall, 39% of patients consumed no pills, 18% consumed all, a uso observados en este estudio, se deben realizar estudios prospectivos para optimizar la prescripción de opioides. Consulte Video Resumen en http//links.lww.com/DCR/B374.
  The architecture of perirectal fasciae is complex as mirrored by different anatomical concepts.
 
  This study aimed to perform a comprehensive visualization of perirectal fasciae to facilitate strategies of rectal surgery such as total mesorectal excision, intersphincteric resection, and transanal total mesorectal excision.
 
  Macroscopic dissection and histologic studies of perirectal fasciae and autonomic pelvic nerves were performed.
 
  This study was conducted in a university laboratory of macroscopic and microscopic anatomy.
 
  Thirteen (5 female) pelvic specimens were obtained from body donors (67-92 years of age).
 
  The primary outcomes measured were the photodocumentation of perirectal fasciae, spaces and fusion zones, and histologic and immunohistochemical analysis of key structures.
 
  The retrorectal space is a mesofascial interface between the mesorectal fascia and the parietal pelvic fascia. The parietal pelvic fascia is composed of 2 lamellae ensheathing the autonomic pelvic nerves. The outer lamelctosacro. La fascia pélvica parietal se une con los músculos rectal pubococcígeo y longitudinal en la unión anorrectal. Anterolateralmente, los haces neurovasculares están estrechamente relacionados con esta zona de fusión fascial y el tabique rectogenital.Debido al aumento de la edad de los donantes de cuerpos, los hallazgos pueden estar sujetos a procesos degenerativos relacionados con la edad.Las dos láminas de la fascia pélvica parietal y las zonas de fusión fascial son estructuras claves de la anatomía perirrectal. Para la preservación del nervio autónomo de nervios pélvicos autonómicos, el reconocimiento de la lámina interna de la fascia pélvica parietal es importante.  https://www.selleckchem.com/products/ulonivirine.html  Para evitar la perforación rectal inadvertida o la disección presacra accidental, el ligamento rectosacro debe ser identificado y seccionado para una movilización rectal completa. Consulte Video Resumen en http//links.lww.com/DCR/B389.