ID;decision;title;abstract
3;maybe;Perioperative selective decontamination of the digestive tract and standard antibiotic prophylaxis versus standard antibiotic prophylaxis alone in elective colorectal cancer patients.;INTRODUCTION: Infectious complications and especially anastomotic leakage (AL) severely impede the recuperation of patients following colorectal cancer (CRC) surgery. When the normal gut barrier fails, as in AL, pathogenic microorganisms can enter the circulation and may cause severe sepsis which is associated with substantial mortality. Moreover, AL has a negative impact on the CRC prognosis. Selective decontamination of the digestive tract (SDD) employs oral nonabsorbable antibiotics to eradicate pathogenic microorganisms before elective tumour resection. METHODS: In this multicentre randomised clinical trial, perioperative SDD in addition to standard antibiotic prophylaxis is compared with standard antibiotic prophylaxis alone in patients with CRC who undergo elective surgical resection with a curative intent. The SDD regimen consists of colistin, tobramycin and amphotericin B. The primary objectives of this randomised clinical trial are to evaluate if perioperative SDD reduces the incidence of clinical AL and its septic consequences as well as other infectious complications. A main secondary objective is improvement of the cancer-free survival. A total of 762 patients will be included in total for sufficient power. CONCLUSION: It is hypothesised that SDD will reduce clinical AL thereby reducing the morbidity and the mortality in CRC patients. FUNDING: The trial is investigator-initiated, investigator-driven and supported by the Dutch Digestive Foundation (WO 11-06) and the private Posthumus Meyes Fund. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov: NCT01740947.
4;include;Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery (SELECT trial).;"BACKGROUND: Infectious complications and anastomotic leakage affect approximately 30 per cent of patients after colorectal cancer surgery. The aim of this multicentre randomized trial was to investigate whether selective decontamination of the digestive tract (SDD) reduces these complications of elective colorectal cancer surgery. METHODS: The effectiveness of SDD was evaluated in a multicentre, open-label RCT in six centres in the Netherlands. Patients with colorectal cancer scheduled for elective curative surgery with a primary anastomosis were eligible. Oral colistin, tobramycin and amphotericin B were administered to patients in the SDD group to decontaminate the digestive tract. Both treatment and control group received intravenous cefazolin and metronidazole for perioperative prophylaxis. Mechanical bowel preparation was given for left-sided colectomies, sigmoid and anterior resections. Anastomotic leakage was the primary outcome; infectious complications and mortality were secondary outcomes. RESULTS: The outcomes for 228 patients randomized to the SDD group and 227 randomized to the control group were analysed. The trial was stopped after interim analysis demonstrated that superiority was no longer attainable. Effective SDD was confirmed by interspace DNA profiling analysis of rectal swabs. Anastomotic leakage was observed in 14 patients (6·1 per cent) in the SDD group and in 22 patients (9·7 per cent) in the control group (odds ratio (OR) 0·61, 95 per cent c.i. 0·30 to 1·22). Fewer patients in the SDD group had one or more infectious complications than patients in the control group (14·9 versus 26·9 per cent respectively; OR 0·48, 0·30 to 0·76). Multivariable analysis indicated that SDD reduced the rate of infectious complications (OR 0·47, 0·29 to 0·76). CONCLUSION: SDD reduces infectious complications after colorectal cancer resection but did not significantly reduce anastomotic leakage in this trial. Registration number: NCT01740947 ( https://www.clinicaltrials.gov)"
27;maybe;Prophylactic antibiotics in bowel surgery.;NA
38;maybe;One-day bowel preparation in children with colostomy using normal saline.;"BACKGROUND: Colonic and colorectal surgery frequently requires bowel preparation. This is an evaluation of the use of normal saline for one-day bowel preparation in children with colostomy. PATIENTS AND METHODS: A prospective study of 55 children with colostomy who had one-day bowel preparation for colonic and colorectal surgical procedures in a 3-year period. The information, along with clinical data was recorded on a structured proforma. Data were analysed using SPSS version 11.0. RESULTS: There were 33 boys and 22 girls. The median age was 4 years (range, one month - 13 years). The primary diagnosis were as follows: Anorectal malformation, 24 (44%); Hirschsprung`s disease, 24 (44%); Faecal incontinence- post-abdominoperineal pull-through, 2 (4%); Penetrating rectal injury, 1 (2%); others, 4(8%). Intraoperative bowel luminal fluid cleanliness was assessed as clear in 36 (62%) and contaminated in 21 (38%). Overall, postoperatively, superficial surgical site infection occurred in 6 (10.9%) patients (2 had clean intraoperative colonic fluid, 5.9%. CONCLUSION: One-day bowel preparation using normal saline is effective and safe in children with colostomy."
42;maybe;The comparison of saline enema and bisacodyl in rectal preparation before anorectal surgery.;BACKGROUND: Given the limited data on the need of mechanical bowel preparation application before anorectal surgeries and the preferred method for bowel preparation, we aimed to compare saline enema and bisacodyl in rectal preparation before anorectal surgery. MATERIALS AND METHODS: This is a randomized clinical trial study. Seventy-nine hospitalized patients for anorectal surgery (hemorrhoid, fissure, and fistula) were recruited by convenient sampling and then randomly allocated to receive 500 cc Saline by rectal enema or six bisacodyl tablets (Sobhan company) beginning from a day before the operation in order to prepare the bowel. After surgery, surgeons' satisfaction of the surgery and patients' satisfaction of the preparation process were evaluated in the ward using Likert score by a nurse blind to the study. Also, the patients were interviewed for pain after the first defecation, using numeric rating scale based on a 0-10 scores. All patients were actively followed-up after discharge for 1 mo concerning postoperative complications. The obtained data were analyzed by SPSS software (version 16), Mann-Whitney, chi-squared, and Fisher exact tests at the significant level of P < 0/0.5. RESULTS: A total of 79 patients participated in the study, 38 received 500-cc saline by rectal enema and 41 bisacodyl tablets. No significant differences were observed between the two groups in most variables except for pain after the first defecation (P = 0.032). CONCLUSIONS: According to the results, the bisacodyl approach results in less pain in the first postoperative defecation and fewer complications than the rectal enema. Thus, bisacodyl can be suggested as a superior counterpart for enema.
43;maybe;Topical ampicillin against wound infection after colorectal surgery.;NA
55;maybe;Time of administration of a single dose of oral levofloxacin and its effect in infectious complications from transrectal prostate biopsy.;OBJECTIVE: To evaluate the efficacy of two prophylactic schemes for prostate biopsy using a single dose of oral levofloxacin given either before, or immediately after transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: A total of 300 men formed two groups of 150 patients each: the first group received one dose of 500 mg of levofloxacin 30 min to an hour before, and the second group the same antibiotic immediately after prostate biopsy. No pre-biopsy enema was used. Side effects after prostate biopsy were recorded, and the two groups were compared. RESULTS: Only one patient from the first group developed a urinary tract infection after biopsy. A mean number of more than 10 cores per patient were taken. Haematuria was the most common complaint, followed by haemospermia. Haematuria and rectal bleeding were more common in patients where more than 8 cores were taken from the prostate (P = 0.005 and P = 0.017, respectively). Prostate cancer was detected in 34.3% of patients in total. CONCLUSION: The use of a single dose of 500 mg levofloxacin given immediately after prostate biopsy proved to be quite effective for the prevention of infectious complications, even in the setting of an extensive biopsy protocol.
62;maybe;[The necessity of mechanical bowel preparation in colo-rectal surgery].;NA
66;maybe;Do Preoperative Oral Antibiotics Decrease the Incidence of Surgical Site Infection After Segmental Colectomy Without a Mechanical Bowel Prep?;NA
105;maybe;Colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis. A prospective trial of optimal antibiotic management.;The ideal prophylactic antibiotic regimen has not been established for patients undergoing colectomy, mucosal proctectomy, and endorectal ileoanal anastomosis, a prolonged operation frequently accompanied by abdominal and pelvic contamination and associated with an infection rate up to 20%. The aim of this study was to evaluate, in a prospective, randomized, double-blind fashion, the efficacy of a short perioperative course compared to an extended postoperative course of intravenous antibiotics (cefoxitin) in patients undergoing colectomy with ileoanal anastomosis. Forty patients with ulcerative colitis or familial polyposis coli received a mechanical and oral antibiotic bowel preparation and a standard three-dose perioperative course of intravenous cefoxitin. Patients then were randomized to receive intravenous cefoxitin, 1 g every 6 hours, or placebo for 5 days. No differences in overall postoperative morbidity were observed and neither group developed intra-abdominal, pelvic, or wound infections. It is concluded that a standard three-dose perioperative course of intravenous antibiotics provides adequate prophylaxis in the prevention of infectious complications in patients undergoing colectomy, mucosal proctectomy, and ileoanal anastomosis.
107;include;Primary colorectal anastomosis, no preparation, no stoma needed.;"Background: Mechanical bowel preparation was regarded for a long time as a vital prerequisite for successful colorectal surgery; this is now being questioned. The distressful effect of bowel preparation, alongside the safety of primary colorectal anastomosis in emergency cases, has led to a considerable change in the surgical protocol, making primary repair and anastomosis after colon resection safer without bowel preparation, and the role of colostomy has changed from mandatory to optional. Aim: To assess whether colorectal surgery can be performed safely without mechanical bowel preparation or colostomy. Method: A series of 130 patients, who underwent elective and emergency colorectal surgery, were followed prospectively over a three‐year period in Al Bashir Teaching Hospital, Amman, Jordan. The patients were randomized into two groups. In one group (preparation group) 66 elective patients were selected from the outpatient department; the bowel was prepared using Fortran's solution. In the second group (non‐preparation group), 64 patients were selected from the emergency and outpatient departments, no bowel preparation was used. Colostomy was omitted in both groups. The main outcomes regarding operative time, hospital stay, rate of postoperative wound infection, anastomotic leak and intra‐abdominal abscess were compared between the two groups. Results: Malignancy was the most prevalent pathology in both the preparation and non‐preparation groups, 75.7% and 62.5% respectively, while benign diseases were present in up to 24.2% of the preparation group and in 1.5% of the non‐preparation group. Anastomosis was ileo‐colic in 33.3% and 37.5%, colo‐colic or colo‐rectal in 66.6% and 62.5% of the preparation and non‐preparation groups respectively. There was no significant statistical difference in the overall postoperative complication rates between the two groups, 16.6% in the preparation group and 14% in the non‐preparation group. Postoperative wound infection, wound dehiscence, intra‐abdominal abscess and anastomotic leak occurred in 9.09%, 1.5%, 1.5% and 4.5% in the preparation group, as compared to 7.8%, 3.1%, 0% and 3.1% in the non‐preparation group respectively. The mortality rate was nil in both groups. Conclusion: Resection of colorectal pathology followed by primary anastomosis, without stoma, can be performed safely with the omission of preoperative mechanical bowel preparation."
122;maybe;An Open-Label Prospective Randomized Controlled Trial of Mechanical Bowel Preparation vs Nonmechanical Bowel Preparation in Elective Colorectal Surgery: Personal Experience.;Over the last two decades, preoperative mechanical bowel preparation for elective colorectal surgery has been criticized. Yet, many surgeons are still in favor of its use simply because of the belief that it achieves better clearance of the colonic fecal load. The objective of this study is to compare the outcome with regard to patient compliance and postoperative complications following elective colorectal surgery between two groups of patients, one with bowel prepared mechanically and the other by nonmechanical means. This open-label prospective randomized controlled trial was conducted in a high-volume tertiary government referral hospital of Kolkata over a period of 3 years. It included 71 patients, divided into two groups, admitted for elective colorectal resection procedures in one surgical unit. Both methods of bowel preparation were equally well tolerated, and there was no statistically significant difference in the incidence of postoperative complications or mortality between the two groups.
126;include;Systemic prophylaxis with metronidazole (Flagyl) in elective surgery of the colon and rectum.;The effect of metronidazole prophylaxis in elective colonic and rectal surgery was studied in a prospective double-blind trial in which metronidazole was compared with a placebo. Fifty-six patients were included in the study, and the patients were randomly allocated to the two groups. Twenty-five patients received 2 gm of metronidazole the day before operation and 1.2 gm as a single daily dose for 5 days after operation. Twenty-one patients were given placebos in the same dosage. Before operation all patients were prepared with mechanical evacuation of the bowel. A significantly lower frequency of wound spesis, intraabdominal complications, and septicemia was found in the metronidazole group as compared to the placebo group. The incidence was 4.0% and 36%, respectively. Following protectomy, infection in the perineal area occurred in 33% and 43% of the respective groups. In the metronidazole-treated patients, however, this was the only complication, whereas 50% of the patients in the placebo group developed intraabdominal complications as well. After operation anaerobic bacteria were isolated from 8% of the patients who received prophylactic metronidazole. In the control group 67% of the patients had a positive postoperative anaerobic culture. Bacteroides fragilis was isolated from 13 of 14 patients with postoperative infection in the placebo group. B. fragilis was not isolated from any of the metronidazole-treated patients. The study indicates that anaerobic bacteria are the major contributors to would infection following colonic and rectal surgery and that metronidazole prophylaxis greatly reduces the frequency of postoperative infection.
148;maybe;The effect of metronidazole on the incidence of postoperative wound infection in elective colon surgery.;A prospective randomized clinical trial assessing the relative effectiveness of erythromycin-neomycin and metronidazole-neomycin as a preoperative bowel preparation was carried out. Bacteriologic studies of feces and colon content revealed no significant difference in the reduction of aerobic bacteria between the two groups. There was, however, a significantly greater reduction in anaerobic bacteria in the feces and colon contents of patients receiving metronidazole. Wound infection rate was 25% in the erythromycin group, and organisms recovered from the wound in all cases were fecal in nature. Two wound infections occurred in the metronidazole group (5%) and in both cases the organisms recovered were staphylococci of presumed skin origin. These studies suggest that anaerobic bacteria are the major contributors to wound infection after colon surgery and that their specific reduction is associated with a lower incidence of wound infection.
161;maybe;Anastomotic dehiscence in colorectal surgery: is bowel preparation still relevant ?;"The belief that mechanical bowel preparation prior to colon and rectal surgery reduces the risk of anastomotic dehiscence is now being disputed. We performed a prospective study over a 3 year period to examine this issue. All patients undergoing an eledtive colon or rectal resection and primary anastomosis were randomised to bowel preparation (BP) or no bowel preparation (NBP) prior to surgery. The BP group were restricted to fluids, light diet and a morning and evening dose of Picolax (Ferring AB, Sweden) on the day before surgery. Normal diet was continued in the NBP group until the night before surgery, otherwise perioperative management and surgical technique were identical in both groups. Age and Dukes staging were similar in the BP (n=87) and NBP (n=116) groups. Indications for surgery were carcinoma (n=141) diverticular disease (n=22), inflammatory bowel disease (n=28) and miscellaneous (n=12). Operations performed were; right hemicolectomies (15 BP/37NBP), left colonic resections (16/24), anterior resections (48/44), and total colectomies (8/11). There were 8 clinical anastomitic leaks, 3 in each anterior resection group, and one in each group after a total colectomy. The 2 deaths were both in the BP group; one was secondary to anastomotic leakage. These data indicate that bowel preparation does not reduce the incidence of anastomotic dehiscence in colorectal surgery."
162;maybe;Requirement for bowel preparation in colorectal surgery.;To determine whether mechanical bowel preparation influences the incidence of anastomotic dehiscence following colorectal surgery, 186 patients undergoing elective left colonic or rectal resection were randomized before surgery to bowel preparation (n = 89) or no bowel preparation (n = 97). Surgical technique was standardized and no patient had a defunctioning colostomy. Seventeen patients were excluded (seven with preparation, ten without). Indications for surgery in the remaining 169 patients were carcinoma (133 patients), diverticular disease (26), inflammatory bowel disease (six) and miscellaneous conditions (four). Operations performed were left colonic resection or reversal of Hartmann's procedure (26 with preparation, 28 without) and anterior resection (56 versus 59). The overall morbidity rate (18 per cent) was similar in the two groups. All seven clinical anastomotic leaks occurred after low anterior resection, in three of the 39 patients who had undergone bowel preparation and four of the 36 who had not (P > 0.9). Two deaths occurred, both of patients who had received bowel preparation, one being secondary to anastomotic leakage. Bowel preparation does not influence outcome after elective colorectal surgery.
187;maybe;Role of oral antibiotics for prophylaxis against surgical site infections after elective colorectal surgery.;Over the past few decades, surgeons have made many attempts to reduce the incidence of surgical site infections (SSI) after elective colorectal surgery. Routine faecal diversion is no longer practiced in elective colonic surgery and mechanical bowel preparation is on the verge of being eliminated altogether. Intravenous antibiotics have become the standard of care as prophylaxis against SSI for elective colorectal operations. However, the role of oral antibiotics is still being debated. We review the available data evaluating the role of oral antibiotics as prophylaxis for SSI in colorectal surgery.
207;maybe;Dexmedetomidine improves gastrointestinal motility after laparoscopic resection of colorectal cancer: a randomized clinical trial.;BACKGROUND: To investigate the effects of intraoperative application of dexmedetomidine (Dex) on early gastrointestinal motility after laparoscopic resection of colorectal cancer. METHODS: In this prospective, randomized double‐blind investigation, 60 patients who underwent laparoscopic resection of colorectal cancer were randomly allocated to receive Dex (DEX group, n = 30) or saline (CON group, n = 30). In the DEX group, Dex was loaded (1 μg/kg) before anesthesia induction and was infused (0.3 μg/kg/h) during surgery. Time to postoperative first flatus (FFL) and first feces (FFE), and time to regular diet were recorded. Serum diamine oxidase (DAO) activity and intestinal fatty acid‐binding protein (I‐FABP) were detected. RESULTS: Both the time to the FFL (44.41 ± 4.51 hours vs 61.03 ± 5.16 hours, P = 0.02) and the time to the FFE (60.67 ± 4.94 hours vs 82.50 ± 6.88 hours, P = 0.014) were significantly shorter in the DEX group than the CON group. Furthermore, the time to regular diet of the DEX group was shorter than that of the CON group (76.15 ± 4.11 hours vs 91.50 ± 5.70 hours, P = 0.037). Both DAO and I‐FABP increased significantly from beginning of surgery to postoperative day 1 in the CON group (2.49 ± 0.41 ng/mL vs 4.48 ± 0.94 ng/mL for DAO, P = 0.028, 1.32 ± 0.09 ng/mL vs 2.17 ± 0.12 ng/mL for I‐FABP, P = 0.045, respectively), whereas no significant change was observed in the DEX group. Furthermore, patients in the DEX group had stable hemodynamics and shorter hospital stay than those in the CON group. CONCLUSION: Dex administration intraoperatively benefits recovery of gastrointestinal motility function after laparoscopic resection of colorectal cancer with stable hemodynamics during surgery though further studies are needed to explore the mechanisms of Dex on gastrointestinal motility.
228;include;Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double-blind clinical study.;"The effectiveness of short-term, low-dose, preoperative oral administration of neomycin and erythromycin base combined with vigorous purgation in reducing the incidence of wound infections and other septic complications of elective colon and rectal operations has been studied in a prospective, randomized, double-blind, clinical trial. One hundred and sixteen patients completed the study; all received mechanical preparation; 56 received neomycin-erythromycin base while 60 received an identical appearing placebo. The two patient groups were comparable in age distribution, clinical diagnoses, associated systemic diseases, types of operation performed and similar clinical features. The overall rate of directly related septic complications was 43 per cent in the placebo group and 9% in the group receiving neomycin and erythromycin base. The wound infection rates were 35% in placebo and 9% in antibiotic treated patients. Oral administration of neomycin and erythromycin base together with vigorous mechanical cleansing reduces the risk of septic complications after elective colo-rectal operations."
233;maybe;Impact of mechanical bowel preparation on survival after colonic cancer resection.;BACKGROUND: A randomized study in 1999-2005 of mechanical bowel preparation (MBP) preceding colonic resection found no decrease in postoperative complications. The aim of the present study was to evaluate the long-term effect of MBP regarding cancer recurrence and survival after colonic resections. METHODS: The cohort of patients with colonic cancer in the MBP study was followed up for 10 years. Data were collected from registers run by the National Board of Health and Welfare. Register data were validated against information in patient charts. Cox proportional hazards model was used for multivariable analysis of factors predictive of cancer-specific survival. RESULTS: Register analysis showed significantly fewer recurrences, and better cancer-specific and overall survival in the MBP group. After validation, 839 of 1343 patients remained for analysis (448 MBP, 391 no MBP). Eighty (17·9 per cent) of 448 patients in the MBP group and 88 (22·5 per cent) of 391 in the no-MBP group developed a cancer recurrence (P = 0·093). The 10-year cancer-specific survival rate was 84·1 per cent in the MBP group and 78·0 per cent in the no-MBP group (P = 0·019). Overall survival rates were 58·8 and 56·0 per cent respectively (P = 0·186). CONCLUSION: Patients receiving MBP before elective colonic cancer surgery had significantly better cancer-specific survival after 10 years.
236;maybe;Bowel preparation for colorectal operations.;NA
255;include;Role of oral antibiotics in reducing the chance of infection after operations for cancer of the rectum.;INTERVENTION: Intervention1: Oral antibiotic bowel preparation: All the patients in this arm in addition to the bowel preparation solution ( 45 ml of Exelyte bowel preparation solution ( monobasic sodium phosphate dihydrate 24.417 g, disodium hydrogen orthophosphate dihydrate 5.439 g) to be consumed at 8 am and 4 pm ), will also receive 3 tablets each of, 1 gm of Erythromycin Estolate and 400 mg of Metronidazole in the package, to be taken at 1pm, 2pm and 11 pm, on the day prior to surgery Control Intervention1: Mechanical Bowel preparation : Exelyte: 2 bottles of 45 ml of Exelyte bowel preparation solution ( monobasic sodium phosphate dihydrate 24.417 g, disodium hydrogen orthophosphate dihydrate 5.439 g) to be consumed at 8 am and 4 pm on the day prior to surgery. CONDITION: Patients with rectal cancer PRIMARY OUTCOME: . To evaluate and assess the superiority of oral antibiotic bowel preparation in reducing incidence of surgical site infections in patients undergoing elective resection for rectal cancer in comparison to only mechanical bowel preparation at a tertiary care center in India.‐‐‐‐‐‐Timepoint: 30 days from the day of surgery SECONDARY OUTCOME: To assess the impact of antibiotic bowel preparation on post‐operative length of hospital stay‐‐‐‐‐‐Timepoint: 30 days from the day of surgery To assess the impact of antibiotic bowel preparation on post‐operative morbidity.‐‐‐‐‐‐Timepoint: 30 days from the day of surgery INCLUSION CRITERIA: All patients with rectal/ rectosigmoid cancer ( based on MRI imaging ), planned for surgical resection
332;maybe;In Patients Undergoing Colorectal Resection, Can Preoperative Antibiotics Combined With Mechanical Bowel Preparation Compared With Mechanical Bowel Preparation Only Significantly Reduce Surgical Site Infection?;NA
343;include;Mechanical bowel preparation before colorectal surgery: is it necessary?;"Introduction: Anastomotic leakage is one of the most important complications after the colorectal anastomosis. The aim of this study was to investigate the differences of the postoperative complications between the groups of mechanical bowel prep and non‐prep. Objectives: The presence of bowel contents during surgery has been related to anastomotic leakage, but the belief that mechanical bowel preparation (MBP) is an efficient agent against leakage and infectious complications. On the other hand, according to recent studies, MBP was abandoned before the colorectal surgery. The aim of this study was to investigate the differences of the postoperative complications between the groups of mechanical bowel prep and non‐prep. Materiel/Patients and Methods: The study includes 54 patients who had elective colorectal resection between 2008, and 2011. Emergency operations were not included. Almost all low anterior resections were covered by a loop ileostomy. The patients were randomly assigned to the 2 study groups (MBP or non‐MBP) according to identification numbers. All patients were treated with intravenous and oral antibiotics prior to surgery. The patients in the MBP group received Fleet Phospho Soda (2.4 g of monobasic sodium phosphate and 0.9 g of dibasic sodium phosphate) for bowel preparation. Independent samples t test was used to compare various parameters between the 2 groups, such as mean age, hospital stay, and time to first defecation; Fisher exact test was used to calculate the differences in various complications such as surgical site infections between the 2 groups. Results: A total of 54 patients participated in the study, 30 without MBP and 24 with MBP. The 2 groups were similar in age, sex, and type of surgical procedure. All of the patients underwent surgery owing to colorectal cancer. The hospitalization period was similar in the MBP group as compared with the non‐MBP group(p > 0.05). The time until the first bowel movement was also similar between the 2 groups mean +/‐ SD; 2.2 +/‐ 1.3 days in the non‐MBP group as compared with a mean +/‐ SD of 2.7 +/‐ 1.1 days in the MBP group (p > 0.05). One patient (1.8%) died in the postoperative course owing to multiple organ dysfunctionsyndrome. Six patients (20.0%) of the non‐MBP group suffered from postoperative complications as compared with 5 patients (20.8%) of the MBP group. Conclusion: It was concluded that elective colorectal surgery without MBP is safe and associated with reduced postoperative morbidity."
358;maybe;anesthetic strategy for control of postoperative pain for laparoscopic colectomy.;"INTERVENTION: Pharmaceutical Form: Solution for injection INN or Proposed INN: Ropivacaine Concentration unit: mg/ml milligram(s)/millilitre Concentration number: 10‐ Pharmaceutical form of the placebo: Solution for injection Route of administration of the placebo: Intraperitoneal use Pharmaceutical Form: Solution for injection INN or Proposed INN: Morphine Concentration unit: mg/ml milligram(s)/millilitre Concentration number: 10‐ Pharmaceutical Form: Solution for injection INN or Proposed INN: Ketoprofen Concentration unit: mg/ml milligram(s)/millilitre Concentration number: 10‐ Pharmaceutical Form: Solution for injection INN or Proposed INN: Paracetamol Concentration unit: mg/ml milligram(s)/millilitre Concentration number: 10‐ CONDITION: Elective Laparoscopic colectomy ; MedDRA version: 14.1 Level: LLT Classification code 10017633 Term: Gallbladder inflammation System Organ Class: 10019805 ‐ Hepatobiliary disorders Therapeutic area: Analytical, Diagnostic and Therapeutic Techniques and Equipment [E] ‐ Anesthesia and Analgesia [E03] PRIMARY OUTCOME: Main Objective: Assess if Ropivacaine nebulization (150 mg) produces better postoperative pain control than Saline nebulization (15 ml) after laparoscopic colectomy. Primary end point(s): Postoperative Pain Secondary Objective: Analgesic consumption during the first 72 hours after surgery; Time to unassisted walking; Incidence of adverse events; Return to active bowel function. Timepoint(s) of evaluation of this end point: 72 hours SECONDARY OUTCOME: Secondary end point(s): Consumption of analgesics and the total dose of analgesics in any assessment by the awakening in the recovery room and the ward will be calculated using the medical record. At each evaluation will also measure the proportion of patients requiring no morphine or requiring rescue dose. Time to unassisted ambulation time unassisted ambulation is defined as the time in hours between the discharge from the recovery room and when the patient is able to walk to the door of his room and go to bed without assistance. Resumption of intestinal function. The return of bowel function will be evaluated by two parameters: time of the first air passage and intestinal bowel movement the first time. The patient will be informed about the importance of notifying the first air passage and the first bowel movements. All hospital morbidity or complications associated with, or adverse effects associated with the intervention study, the surgery will be evaluated using the folder ol'anestesia cynical by the day of discharge from hospital wing. Timepoint(s) of evaluation of this end point: 72 hours INCLUSION CRITERIA: Females and Males 18‐80 years old; ASA Score I – III; A patient with severe systemic disease; Patients scheduled for laparoscopic colectomy; Diagnosis of colon cancer; patients free from pain in preoperative period; Patients who do not use opioids analgesic drugs before surgery; Patients without cognitive impairment or mental retardation; Patients who have given a written informed consent Are the trial subjects under 18? no Number of subjects for this age range: 0 F.1.2 Adults (18‐64 years) yes F.1.2.1 Number of subjects for this age range 80 F.1.3 Elderly (>=65 years) yes F.1.3.1 Number of subjects for this age range 50"
371;maybe;The prophylactic use of antibiotics in surgery for colonic carcinoma.;NA
410;maybe;Oral antibiotics to prevent surgical site infections following colon surgery.;NA
413;maybe;The prevention of surgical site infection in elective colon surgery.;Infections at the surgical site continue to occur in as many as 20% of elective colon resection cases. Methods to reduce these infections are inconsistently applied. Surgical site infection (SSI) is the result of multiple interactive variables including the inoculum of bacteria that contaminate the site, the virulence of the contaminating microbes, and the local environment at the surgical site. These variables that promote infection are potentially offset by the effectiveness of the host defense. Reduction in the inoculum of bacteria is achieved by appropriate surgical site preparation, systemic preventive antibiotics, and use of mechanical bowel preparation in conjunction with the oral antibiotic bowel preparation. Intraoperative reduction of hematoma, necrotic tissue, foreign bodies, and tissue dead space will reduce infections. Enhancement of the host may be achieved by perioperative supplemental oxygenation, maintenance of normothermia, and glycemic control. These methods require additional research to identify optimum application. Uniform application of currently understood methods and continued research into new methods to reduce microbial contamination and enhancement of host responsiveness can lead to better outcomes.
424;maybe;Re-emphasis of priorities in surgical antibiotic prophylaxis.;The results of two prospective, randomized trials, comparing single dose piperacillin with multidose cefoxitin prophylaxis in elective surgical procedures of the gastrointestinal tract were combined to examine some basic aspects of clinically, applied antibiotic prophylaxis. As there was no difference in the efficacy of prophylaxis between the groups, data from both centers and both drug groups were combined for analysis. Patients whose ages were greater than 40 years, the presence of cancer and the administration of an antibiotic for longer than 60 minutes preoperatively were associated with a higher rate of infectious complications. Duration of operation was also related to subsequent infection, ranging from 6 per cent in procedures lasting less than two hours to 27 per cent in operations lasting more than four hours. There was a greater failure of prophylaxis in patients undergoing rectal procedures, with a 29 per cent rate of infectious complications compared with 14 per cent in patients undergoing operations upon the colon. This difference was present even when duration of operation was taken into account.
458;include;Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery;NA
464;include;Operations on the colon. The role of antibiotics in preoperative preparation.;A study was carried out on 183 patients in an attempt to evaluate the role of antibiotics in the preoperative preparation of the colon.Kanamycin, neomycin and a placebo were administered in a double-blind fashion during a 72-hour period preceding operation. In addition, mechanical cleansing of the bowel was done in all cases. Considering only the criteria of mortality and the incidence of postoperative wound and peritoneal infections in this preliminary report there was no apparent significant difference between patients receiving antibiotics and those receiving a placebo.
499;maybe;[Preoperative prophylactic antibiotics reduce septic complications of colorectal operations (authors' translation)].;On the preoperative day before colorectal operations (n = 36), 3 g neomycine and 3 g erythromycine were administered as oral prophylactic antibiotics. No antibiotics were administered to the controls (n = 24). The number of postoperative septic complications was reduced after preoperative prophylactic antibiotics. There were two abscesses of the abdominal wound, one fecal fistula, and two anastomotic disruptions in the control group but only two abscesses of the abdominal wound in the antibiotic group. No toxic effects were observed during this trial.
505;maybe;Failure of antimicrobial prophylaxis with cefoxitin, or metronidazole and gentamicin in colorectal surgery. Is mannitol to blame?;NA
514;include;Oral and Parenteral Versus Parenteral Antibiotic Prophylaxis in Elective Laparoscopic Colorectal Surgery (JMTO PREV 07-01): A Phase 3, Multicenter, Open-label, Randomized Trial.;"OBJECTIVE: To confirm the efficacy of oral and parenteral antibiotic prophylaxis (ABX) in the elective laparoscopic colorectal surgery. BACKGROUND: There is no evidence for the establishment of an optimal ABX regimen for laparoscopic colorectal surgery, which has become an important choice for the colorectal cancer patients. METHODS: The colorectal cancer patients scheduled to undergo laparoscopic surgery were eligible for this multicenter, open-label, randomized trial. They were randomized to receive either oral and parenteral prophylaxis (1 g cefmetazole before and every 3 h during the surgery plus 1 g oral kanamycin and 750 mg metronidazole twice on the day before the surgery; Oral-IV group) or parenteral prophylaxis alone (the same IV regimen; IV group). The primary endpoint was the incidence of surgical site infections (SSIs). Secondary endpoints were the incidence rates of Clostridium difficile colitis, other infections, and postoperative noninfectious complications, as well as the frequency of isolating specific organisms. RESULTS: Between November 2007 and December 2012, 579 patients (289 in the Oral-IV group and 290 in IV group) were evaluated for this study. The incidence of SSIs was 7.26% (21/289) in the Oral-IV group and 12.8% (37/290) in the IV group with an odds ratio of 0.536 (95% CI, 0.305-0.940; P = 0.028). The 2 groups had similar incidence rates of C difficile colitis (1/289 vs 3/290), other infections (6/289 vs 5/290), and postoperative noninfectious complications (11/289 vs 12/290). CONCLUSIONS: Our oral-parenteral ABX regimen significantly reduced the risk of SSIs following elective laparoscopic colorectal surgery."
534;maybe;[Modern mechanical antibiotic preparation in colorectal operations. Results of a prospective study].;A prospective clinical study was made to compare the effectiveness of a short-term oral antibiotic prophylaxis (neomycin) and a longacting oral-parenteral aerobically and anaerobically effective combination (neomycin, metronidazol, chloramphenicol) on the incidence of wound infections. All patients had orthograde lavage as a mechanical bowel preparation. Preoperative administration of the antibiotic combination before lavage could not reduce the relative aerobic bacterial count of the faeces. The incidence of wound infections was nearly identical with 4/89 in the neomycin group and 5/114 in the combination group. In the neomycin group there occurred 2/44 anastomotic dehiscences, but none in the combination group (0/65). Lethal complications were significantly higher in the neomycin group (7/89 to 2/114), whereas nonlethal complications were not significantly higher in the combination group. These data suggest that long-term, oral-parenteral prophylaxis with an antibiotic combination was not superior to a short-term, sole neomycin prophylaxis applied after orthograde lavage. Cleansing the bowel as completely as possible is a fundamental prerequisite for an effective antibiotic prophylaxis.
537;include;Orally Administered Trimethoprim-Sulfamethoxazole and Metronidazole as Infection Prophylaxis in Elective Colorectal Surgery.;BACKGROUND: This randomized clinical trial evaluated orally administered trimethoprim-sulfamethoxazole and metronidazole (TSM) in elective colorectal surgery as prophylactic for post-operative surgical site infections (SSI). METHODS: Patients undergoing elective colorectal resection were evaluated for inclusion. Randomized subjects received either orally administered TSM or intravenously administered cefuroxime and metronidazole (control group, CXM). The primary endpoint was the rate of SSI. RESULTS: A total of 1073 subjects were randomized to either control (540) or TSM (533). 486 patients in the TSM group and 499 in the control group were followed-up with after 4 weeks. Thirty-seven (3.8%) patients were afflicted by SSI at discharge from hospital and 69 (7.0%) at follow-up four weeks after surgery. After four weeks, the rate of incisional SSI was 7.0% in the TSM group and 3.6% in the control group (p=0.022). For organ/space SSI and the other complications monitored in the study, no differences were observed between the groups. CONCLUSION: Orally administered TSM as prophylaxis before elective colorectal surgery results in a low rate of organ/space SSI but an increased rate of incisional SSI compared with intravenously administered cefuroxime and metronidazole. Thus, when considering orally administered TSM, because of environmental concerns or for economic reasons, the slightly increased infection rate has to be kept in mind.
548;include;Randomized Controlled Trial on the Necessity of Chemical Cleaning as Preoperative Preparation for Colorectal Cancer Surgery.;The use of preoperative oral antibiotics for the preparation of elective colorectal surgery remains controversial. We examined the necessity of chemical preparation using oral antibiotics compared with mechanical preparation, to achieve the further reduction of infection rates in colorectal resection. Consecutive 91 patients were included in this prospective clinical trial of colon preparation. 45 patients received mechanical preparation alone with the polyethylene glycol lavage solution (group A), while 46 patients received mechanical preparation and chemical bowel preparation with 1.5g Kanamycin for 3 days orally before surgery (group B). Cefotiam hydrochloride was administered for 3 consecutive days after surgery in both groups. Specimens for culture were obtained pre‐, intra‐ and post‐operatively. In the specimens of intraoperative colonic mucosal swabs, Escherichia coli (E. coli) was significantly less cultured in group B than in group A. Postoperative diarrhea was observed in 7 patients of group A (15.5 %) and in 20 patients of group B (43.5%) (p < 0.05). The surgical site infection (SSI) rate was 20.0% in group A and 36.9% in group B (p = 0.1041). Although there was no significant difference, SSI rate tended to be higher in group B than in group A. In conclusion, chemical preparation with oral intake of 1,500 mg Kanamycin for 3 days before surgery did not add any advantages to mechanical preparation and is considered unnecessary to perform colorectal surgery.
551;maybe;Preoperative bowel conditioning with synbiotics for elective colorectal surgery.;Rationale: Preoperative mechanical bowel cleaning for colorectal surgery is a routine procedure. Synbiotics (probiotics plus prebiotics) are known for their beneficial effects on gut immune function and maintanance of gut barrier. The main purpose of this study was to replace mechanical bowel cleaning with synbiotics or prebiotics and to asses the systemic inflammatory response and clinical outcome in patients undergoing colorectal surgery. Methods: A prospective double‐blind randomized placebocontrolled trial was conducted in 68 patients. 20 patients recieved synbiotics with no preoperative mechanical bowel cleaning, the second group of 28 patients prebiotics and heat‐deactivated probiotics and no preoperative mechanical bowel cleaning, and the third (control) group of 20 patients only mechanical bowel cleaning prior to the operation. Results: Significantly higher values of interleukin 6 (IL‐6) were detected 72 h after the operation in the synbiotic group (p = 0.02), as well as an increase of fibrinogen at 24 h postoperatively (p = 0.03). The group recieving only prebiotcs regained bowel movements earlier after the operation as the other two groups (p = 0.03). There were no differences in postoperative complications between the groups. Mean hospital stay was 9.2 days in the prebiotic group, 9.5 days in the control group, and 10.95 days in the synbiotic group. Conclusion: Preoperative administration of prebiotics in elective colorectal surgery appears to have the same protective effect in preventing a postoperative inflammatory response as mechanical bowel cleaning. It seems that only preoperative feeding of the patient own intestinal flora and preserving it with no mechanichal cleaning benifits the patient before elective colorectal surgery. Further prospective studies are needed to verify the effects of synbiotics.
593;maybe;The use of prophylactic antibiotics in colorectal surgery: a prospective trial.;The aim ofthis study was to examine the use of prophylactic co-trimoxazole or piperacillin in large bowl surgery. 102 patients undergoing open large bowel surgery were randomised prospectively into three groups. Golytely bowel preparation was identical in each group. Telfa wicks were inserted between each skin suture, irrigated daily with saline and removed 7 days post-operatively in al petaients. Antibiotics was given with the pre-medication and at 8 and 16 hours postoperatively. Control patients received no antibiotics. The overall abdominal wound infection rate was 9.8%. The wound infection and complication rates were similar in all dub-groups. The prophylactic use of co-trimoxazole or piperacillin in this study did not allect patients outcome in any way.
607;include;A prospective, randomized, double-blind study of 10% mannitol mechanical bowel preparation combined with oral neomycin and short-term, perioperative, intravenous Flagyl as prophylaxis in elective colorectal resections.;The effect of 1-day mechanical bowel preparation with 10% mannitol combined with oral neomycin and short-term perioperative intravenous Flagyl (group I) was studied in a prospective, randomized, double-blind study and was compared with oral neomycin and an intravenous placebo (Group II). Thirty-one patients were evaluated in group I (Flagyl), and there was a 0% septic complication rate. Thirty-seven patients were in the neomycin placebo group (group II), which had a septic complication rate of 22%. The difference between the two groups was statistically significant. No complications were observed from either the 10% mannitol solution or the intravenous Flagyl at either clinical, hematologic, or biochemical assessment. The study indicates that 1-day mechanical bowel preparation with 10% mannitol combined with oral neomycin and short-term, perioperative, intravenous Flagyl is a safe, effective, and inexpensive method for significantly reducing the septic complications of elective colorectal surgical resections.
619;maybe;A double-blind, randomized study of three antimicrobial regimens in the prevention of infections after elective colorectal surgery.;"The objective of this study was to assess the prophylactic efficacy of cefoxitin, ceftizoxime, and metronidazole-gentamicin in colorectal surgery. A double-blind, randomized prospective clinical trial design was used in a Canadian tertiary care teaching hospital. Patients were randomized to one of three treatment groups and received three doses of a study drug (30 min preoperative and 2 postoperative doses at 12 and 24 h). Cefoxitin and ceftizoxime were given as 1000-mg doses. Metronidazole-gentamicin was given as 500 mg of metronidazole plus 120 mg of gentamicin in a minibag. High-risk patients (bowel ischemia, diabetic, current steroid use, etc.) received 10 postoperative doses. Patients with infections, prior antibiotics, or study drug allergies were excluded. Over 30 months, 153 patients were enrolled. Thirty-one patients were excluded for protocol violations. Of the 122 evaluable patients (38 ceftizoxime, 45 metronidazole-gentamicin, 39 cefoxitin), there was no difference across groups regarding sex, age, weight, preoperative Apache II score, and prior history of bowel surgery. Groups were equivalent regarding surgeon, nursing unit, high-risk status (six ceftizoxime, seven metronidazole-gentamicin, seven cefoxitin), bowel preparation, and procedure (including blood loss, drains, organ injury, intraoperative complications). Clinically significant infection requiring systemic antibiotics (7-day hospital and 30-day follow-up) was identified in 0% of ceftizoxime, 15% of metronidazole-gentamicin, and 26% of cefoxitin receiving patients (p = 0.005). Mean ASEPSIS scores for each group were 2.3 (range 0-15) for ceftizoxime, 9.2 (range 0-45) for metronidazole-gentamicin, and 10.4 (range 0-75) for cefoxitin (p = 0.01). Ceftizoxime patients tended to have a shorter total hospital stay (12.2 days versus 19.7 days for cefoxitin versus 13.9 days for metronidazole-gentamicin; p = 0.04), although the procedure to discharge interval was not significantly different (p = 0.09). There was no difference in clinical outcome according to risk status. Anaerobic bacteria were observed more commonly in the ceftizoxime and cefoxitin groups, whereas enteric Gram-negative aerobes were observed most often in the metronidazole-gentamicin group. The study regimens were generally well tolerated. Drug costs were equivalent between ceftizoxime and cefoxitin and lowest with the metronidazole-gentamicin regimen. Ceftizoxime appears to be more effective for the prevention of infection in colorectal surgery than either cefoxitin or metronidazole-gentamicin in the dosage regimens studied."
629;maybe;Cefotaxime single-dose surgical prophylaxis in a prepaid group practice. Comparisons with other cephalosporins and ticarcillin/clavulanic acid.;The prophylactic efficacy of a single 1g dose of cefotaxime for a wide variety of clean and clean-contaminated surgical procedures was studied in a large prepaid medical practice setting. Regimens were evaluated in 3 successive prospective, randomised comparative trials involving 1950 evaluable patients between November 1983 and March 1986. Single-dose cefotaxime was initially compared with standard multiple-dose regimens of cephazolin and cefoxitin, and subsequently used as the control regimen for comparisons with single-dose cefoperazone and ticarcillin/clavulanic acid. Patients were observed for the development of wound infection, non-wound morbidity, and adverse reactions. The single-dose prophylaxis regimens resulted in fewer surgical wound infections (p less than 0.05) compared with multi-dose prophylaxis if colorectal procedures were excluded from the analyses. The limited effectiveness of single-dose prophylaxis in colorectal surgery occurred despite the co-administration of erythromycin and neomycin. More than half the infections in all groups were discovered after hospital discharge and were inconsequential. Organisms isolated from the various infections generally remained susceptible to the administered antimicrobial agents. Adverse reactions occurred significantly (p less than 0.001) less often in the patients receiving single-dose prophylaxis. Non-wound morbidity was comparable in all trial groups. The costs associated with single-dose regimens were much lower than those of the FDA-approved multiple-dose regimens. These data confirm that single-dose, broad spectrum beta-lactam agents such as cefotaxime provide safe, effective and economical prophylaxis for a wide variety of surgical procedures.
648;maybe;[Preparation of the colon for elective surgery].;"Mechanical bowel preparation and antibiotic therapy have been conclusive to decrease morbi-mortality in elective colon surgery. Two methods were compared: the traditional laxative and three days solution enemas method, and the 3-6 hours total intestinal irrigation method. We evaluated the patient's acceptance, intraoperative bowel preparation, and postoperative. We included 31 patients distributed in both groups and with similar procedures. Our results showed up 80% effectiveness in colon cleaning on both methods; 100% patients accepted the irrigation method which had 6.6% postoperative mobility, the enemas method had 18.7%. Therefore, we concluded that total intestinal irrigation method is quick, safe and effective in elective colon surgery."
654;maybe;Cefoxitin versus erythromycin, neomycin, and cefazolin in colorectal operations. Importance of the duration of the surgical procedure.;Perioperative parenteral cefoxitin was compared with oral erythromycin, neomycin and parenteral cefazolin in a prospective, double‐blind, randomized evaluation of 119 patients undergoing colorectal operations. Patients receiving cefoxitin had a higher wound infection rate than patients receiving erythromycin‐neomycin‐cefazolin (12.5% v 3.2%, respectively, p = .06). A direct correlation existed between the duration of the operation and the infection rate. Cefoxitin prophylaxis was as effective as erythromycin‐neomycin‐cefazolin in patients undergoing surgical procedures of 4 hours or less (infection rates of 4.8% and 4.0%, respectively). However, for surgical procedures lasting more than 4 hours, 5 of 14 patients (37.5%) receiving cefoxitin developed a wound infection v 0 of 13 patients receiving erythromycin‐neomycin‐cefazolin (p < .05). It is speculative as to whether frequent two‐gram doses of cefoxitin given during the operation would provide prophylaxis equivalent to erythromycin‐neomycin‐cefazolin.
657;maybe;Aggressive bowel preparation does not enhance bacterial translocation, provided the mucosal barrier is not disrupted: a prospective, randomized study.;"PURPOSE: Prospective, randomized studies have shown that bowel preparation may adversely affect infectious complications following colonic resections. However, very little is known about the effects of bacterial translocation on these infectious complications. The aim of this prospective, randomized study was to assess the effects of bowel preparation on bacterial translocation. METHODS: A total of 82 consecutive patients undergoing elective abdominal operations were randomly assigned to four groups: control (I; n = 20), mechanical (II; n = 21), mechanical plus oral metronidazole (III; n = 20), and polyethylene glycol preparation (IV; n = 21). Patients with intra-abdominal infection, those receiving preoperative antibiotics for any reason, and those having lower gastrointestinal tract disease were excluded from the study. Peritoneal swab, ileocecal and pericolic mesenteric lymph nodes, liver wedge biopsy, portal venous blood, and peripheral blood samples were taken for culture. Patients were followed up for postoperative infectious complications. Groups were matched according to age, gender, body surface area, and Acute Physiology and Chronic Health Evaluation II scores. RESULTS: Bacterial translocation was identified by a positive culture in one patient in Group I, two in Group II, one in Group III, and three in Group IV, respectively. Differences in number of positive cultures among the groups were not statistically significant. Nine patients had major infectious complications. Only two had bacterial translocation, and the same micro-organisms grew in both patients, in one at the wound site and in the other at the cyst abscess. CONCLUSION: This study demonstrated that mechanical bowel preparation does not enhance the spontaneous occurrence of bacterial translocation in patients without any clinical signs of lower gastrointestinal tract disease."
673;maybe;Bowel preparation for elective colon and rectal surgery.;Bowel preparation is an integral component of elective colorectal surgery. However, minimal data exist to support this practice. Evidence favoring and opposing bowel preparation is presented and reviewed. The role of oral and antibiotic therapy is similarly examined. Finally, the evolution of bowel preparation and modern methods of preparation are discussed.
686;include;Mechanical bowel preparation in elective colorectal surgery.;Objectives: To assess the effects of preoperative mechanical bowel preparation (MBP) on postoperative complications and recovery in elective colorectal surgery. Material and Methods: Prospective study carried out in the Surgical Department of Hayatabad Medical Complex on patients with American Society of Anaesthesiologist (ASA) grade < III, undergoing elective bowel resection and primary anastomosis for colorectal pathology. Post operative anastomotic leak, re‐operation rate and mortality within a 30 day period were determined as the primary end points while the secondary endpoints were wound infections, abscesses, cardiovascular complications and hospital stay. Results: A total of 102 patients were randomized into two groups. Half of these (MBP‐Gp1) received mechanical bowel preparation prior to surgery and the other half (No MBP‐Gp2) did not have any bowel preparation. No significant difference was observed between the two groups in relation to the primary and secondary endpoints with the rate of anastomotic leak recorded as 11.76% and 7.84%, re‐operation rate 9.8% and 5.88%, mortality 1.96% and 1.96%, cardiovascular complications 19.61% and 11.76%, wound infection 23.5% and 15.69% and deep abscess 7.84% and 3.92% respectively. Post‐operative hospital stay was 10.27 d in Gp1 and 10.02 d in group 2, the difference being statistically insignificant. Conclusions: Mechanical bowel preparation offers no benefit in terms of anastomotic leak rate, infective and other complications in patients undergoing elective colorectal procedures.
689;maybe;A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer.;"OBJECTIVE: A prospective randomized controlled trial (RCT) of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. AIMS: This study evaluates the use of a multimodal package in colorectal cancer surgery in the context of an RCT. METHODS: Patients for elective resection for colorectal cancer were offered trial entry. Participants were stratified by sex and requirement for a total mesorectal excision and centrally randomized. Multimodal patients received intravenous fluid restriction, unrestricted oral intake with prokinetic agents, early ambulation, and fixed regimen epidural analgesia. Control patients received intravenous fluids to prevent oliguria, restricted oral intake until return of bowel motility, and weaning regimen epidural analgesia. Adherence to both regimens was reinforced using a daily checklist and protocol guidance sheets. Discharge decision was made using pre-agreed criteria. The primary endpoint was postoperative stay, and achievement of independence milestones. Secondary endpoints were postoperative complications, readmission rates, and mortality. Analysis was by intention to treat. RESULTS: Seventy patients were recruited. Approximately one fourth underwent TME. Median ages were similar (69.3 vs. 73.0 years). The median stay was significantly reduced in the multimodal group (5 vs. 7 days; P < 0.001, Mann-Whitney U test). Patients in the control arm were 2.5 times as likely to require a postoperative stay of more than 5 days. Patients in the multimodal group had less cardiorespiratory and anastomotic complications but more readmissions. There were 2 deaths, both controls. CONCLUSIONS: This RCT provides level 1b evidence that a multimodal management protocol can significantly reduce postoperative stay following colorectal cancer surgery. Morbidity and mortality are not increased."
707;maybe;Oral prophylaxis with neomycin and erythromycin in colorectal surgery. More proof for efficacy than failure.;In an open, prospective, and randomized investigation on the prophylactic efficacy of peroral neomycin sulfate-erythromycin base vs intravenous ceftriaxone-metronidazole preparation in colorectal surgery, no significantly diverging results between regimens were recorded (1/27 [3.7%] and 2/27 [7.4%] wound infections, respectively). Commentary is made about the diverging results from earlier studies on antimicrobial prophylaxis and on the multifactorial causality of surgical infection. We believe that variables such as physical condition of the patients, virulence and local resistance patterns of bacteria, and technical skill of the surgeons are far more important in regard to the postoperative outcome concerning septic complications than is the choice of proper antibiotics. Thus, to determine the efficacy of antimicrobial prophylaxis, we call for larger investigations in the future, preferably double-blind, where it is possible to better control and diminish the influence of determinants other than the antibiotics being compared.
710;maybe;[IMPACT OF PREOPERATIVE BOWEL PREPARATION ON PREVENTION OF SURGICAL SITE INFECTION].;Preoperative preparation of the bowel includes two methods, mechanical bowel preparation (MBP) to remove gross feces and oral antibiotic bowel preparation (OABP) to reduce the colonic bacterial load. MBP and OABP have been performed since the 1940s to 1950s. MBP is routinely performed to reduce the morbidity and mortality of elective colorectal surgery and has been a surgical dogma since the early 1970s. However, numerous prospective, randomized, controlled trials and meta-analyses have questioned the need for MBP in elective colorectal surgery, and a meta-analysis showed that significantly more anastomotic leaks were found after MBP. OABP decreases postoperative infectious complications considerably, although the results differ with the type of antibiotic used. Recently, several large retrospective studies have demonstrated that MBP plus OABP is associated with reduced postoperative infectious complications including surgical site infection rates after elective colorectal surgery. Further prospective, randomized trials of MBP and OABP alone and in combination should be conducted.
1;exclude;Postoperative pneumatosis intestinalis in infants does not automatically preclude enteral feeding.;BACKGROUND: A degree of feed intolerance after neonatal abdominal surgery is common but in an otherwise well baby enteral feeding usually is continued at the highest tolerated level. However, the presence of rectal bleeding, pneumatosis intestinalis, or portal vein gas seen on plain abdominal x-rays suggest the possibility of postoperative necrotising enterocolitis. When this happens feedings usually are stopped for 7 to 10 days, and intravenous antibiotics and total parental nutrition are commenced. METHODS: The authors report 12 episodes of rectal bleeding and 11 episodes of pneumatosis intestinalis in 3 infants who previously had undergone neonatal abdominal surgery for intestinal malformations. In 7 of these episodes, feedings were neither stopped nor were antibiotics given. At the time of these 7 episodes, the infants were more than 3 kg in weight, had no significant cardiac or respiratory pathology, were all clinically stable, had no evidence of peritonitis, had no thrombocytopenia, and were greater than 37 weeks postconception. RESULTS: The 3 infants were monitored closely. There were no early or late problems observed attributable to this management. CONCLUSION: Carefully selected clinically stable patients that have postoperative pneumatosis intestinalis or exhibit rectal bleeding may be successfully managed by reduced enteral feedings with no antibiotics. J Pediatr Surg 36:1820-1823.
2;exclude;Selective decontamination of the digestive tract in gastrointestinal surgery: useful in infection prevention? A systematic review.;INTRODUCTION: Gastrointestinal surgery is associated with a high incidence of infectious complications. Selective decontamination of the digestive tract is an antimicrobial prophylaxis regimen that aims to eradicate gastrointestinal carriage of potentially pathogenic microorganisms and represents an adjunct to regular prophylaxis in surgery. MATERIAL AND METHODS: Relevant studies were identified using bibliographic searches of MEDLINE, EMBASE, and the Cochrane database (period from 1970 to November 1, 2012). Only studies investigating selective decontamination of the digestive tract in gastrointestinal surgery were included. RESULTS: Two randomized clinical trials and one retrospective case-control trial showed significant benefit in terms of infectious complications and anastomotic leakage in colorectal surgery. Two randomized controlled trials in esophageal surgery and two randomized clinical trials in gastric surgery reported lower levels of infectious complications. CONCLUSION: Selective decontamination of the digestive tract reduces infections following esophageal, gastric, and colorectal surgeries and also appears to have beneficial effects on anastomotic leakage in colorectal surgery. We believe these results provide the basis for a large multicenter prospective study to investigate the role of selective decontamination of the digestive tract in colorectal surgery.
5;exclude;IMPACT OF BOWEL PREPARATION ON SURGICAL SITE INFECTION, ILEUS, ANASTOMOTIC LEAK, MAJOR MORBIDITY AND MORTALITY AFTER ELECTIVE COLORECTAL SURGERY: AN ACS-NSQIP ANALYSIS BY COARSENED EXACT MATCHING.;NA
6;exclude;Preoperative radiotherapy and curative surgery for the management of localised rectal carcinoma.;- Background This is an update of the original review published in 2007. Carcinoma of the rectum is a common malignancy, especially in high income countries. Local recurrence may occur after surgery alone. Preoperative radiotherapy (PRT) has the potential
7;exclude;[Bacteriological data concerning the utilisation of antibiotics in the preparation of colo-rectal surgery (author's transl)].;NA
8;exclude;[The miniinvasive colon decompression by the tumor obstruction].;NA
9;exclude;Parastomal Hernia Prevention Trial.;"INTERVENTION: Mesh Intervention Procedure: Subjects in this arm of the study will have mesh permanently implanted at the stoma site at the time of their surgery. The procedure duration will differ between patients depending on the circumstances of, and indications for, the surgery. The stoma formation will be performed as follows: 1. Dissect away a section of peritoneum and posterior rectus sheath on the side of the colostomy from the posterior aspect of the rectus abdominus muscle with the centre of the superior‐inferior aspect of this area at the level of the marked colostomy trephine site. 2. Place a piece of 15cm x 15cm mesh in the space. 3. Secure the lateral corners of the mesh to the lateral abdominal wall musculature with a permanent suture. 4. Make the trephine at the marked site using a circular skin incision and deepen through abdominal wall fat to the fascia. Make a cruciate incision in the anterior rectus sheath, split the rectus abdominus muscle longitudinally. 5. Cut a circle in the centre of the mesh and the peritoneum of a size just adequate to allow easy passage of the colon through the mesh and then the abdominal wall. 6. Deliver the colon through the trephine site to the skin. 7. Close fascia. 8. Irrigate wound. 9. Close the midline wound skin. 10. Apply a dressing to the midline wound. 11. Mature the colostomy using dissolvable sutures. 12. Apply the colostomy bag. CONDITION: Parastomal Hernia Permanant colostomy PRIMARY OUTCOME: The formation of clinically‐apparent parastomal herniae. ; Assessment: ; Clinical assessment of stoma site. The formation of radiologically‐apparent parastomal herniae. ; Assessment: ; CT scan of abdomen SECONDARY OUTCOME: All cause mortality ; Assessment: ; 1. Medical record review Complications, including stomal stricture, stoma dehiscence, wound dehiscence, stomal fistula, small bowel obstruction, wound infection, pelvic abscess, or incisional hernia. ; Assessment: ; 1. Clinical assessment ; 2. X‐ray(where necessary to confirm diagnosis) ; 3. Blood tests (where necessary to confirm diagnosis) Duration of hospital length of stay. ; Assessment: ; Number of days from time of surgery until discharge from hospital. Duration of operating time. ; Assessments: ; 1. Duration between knife‐to‐skin and last suture. ; 2. Duration between commencing stoma formation and attachment of colostomy bag. New or recurrent malignancy. ; Assessment: ; 1. Clinical assessment ; 2. CT scan (where necessary to confirm diagnosis) ; 3. Blood tests (where necessary to confirm diagnosis) Re‐operation. ; Assessment: ; 1. Medical record review Readmission to hospital. ; Assessment: ; 1. Medical record review INCLUSION CRITERIA: Subjects requiring elective admission for an open colon or colorectal resection to include the formation of a permanent end colostomy. The procedures will include the following: a. Abdomino‐perineal resection of the rectum; b. Rectosigmoidectomy (Hartmann’s procedure); or c. Formation of end colostomy for incontinence."
10;exclude;Efficacy of enteral nutrition in adult Ileal Crohn's disease- the RICE study.;"INTERVENTION: Randomized Ileal Crohn’s disease study of exclusive Enteral Nutrition (RICE) is a randomised controlled study for the treatment of ileal Crohn’s disease (CD) randomising EEN versus standard therapy in a single‐blinded trial design. In Phase 1 of the study consenting patients with either severe Crohn's disease or symptomatic terminal ileal strictures/ perforation requiring surgical resection are randomised to receive EEN using polymeric formula versus calorie‐matched standard of care diet for 6 weeks (in the subgroup of patients requiring surgery this will be taken in the 6 weeks immediately pre‐surgery). In phase 2, patients that required surgery will undergo post‐operative re‐randomization to determine the effects of 6 months of partial enteral nutrition (PEN) on the prevention of post‐operative CD. Other post‐operative patients who will have resection of the terminal ileum may be recruited directly into phase 2 of the study without having participated in phase 1. In phase 1 of the study, participants will consume EEN in the form of Nestle Modulen, prescribed by a dietician to meet all their nutritional requirements. The aim is to achieve compliance for >80% of consumed calories in the form of Nestle Modulen, which will be monitored through use of food diaries and regular follow up. In Phase 2 of the study Nestle Modulen will be consumed for about 50‐60% of normal daily calorie intake and again adherence will be monitored through the use of a food diary. CONDITION: Crohn's disease PRIMARY OUTCOME: Primary end point for phase 1 of the study is both clinical remission (defined as CDAI less than or equal to 150) and MRI remission (defined as increase in the terminal ileum cross‐sectional lumen area by at least 100% as assessed on MRE by a central blinded GI radiologist), following 6 weeks of EEN versus standard of care calorie‐matched diet for Crohn’s disease patients presenting with a severe disease flare or prior to planned surgical resection of the terminal ileum. Patients need to be both in clinical remission and MR remission in order to score the primary outcome. Primary end point for phase 2 of the study is endoscopic disease recurrence rate following 6 months of PEN versus standard of care calorie‐matched diet, post planned surgical resection of the terminal ileum. Endoscopic recurrence is defined as post‐resection Rutgeerts score equal to or greater than i2 at the anasthemosis site, assessed by the unblended onsite endoscopist and a blinded centralised endoscopist, the final result being reached via consensus following an over the phone discussion. SECONDARY OUTCOME: Comparison of microbiome at 6 months post terminal ileal resection, as measured via DNA pyrosequencing, RNA pyrosequencing and metabolomics with mass spectrometry, between subjects randomised to 6 months of postoperative partial enteral nutrition versus standard of care calorie‐matched diet (Phase 2). Comparison of microbiome following 6 weeks , as assessed via DNA pyrosequencing, RNA pyrosequencing and metabolomics with mass spectrometry on feacal specimens, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Comparison of tissue inflammation, fibrosis, mucosal immunology, regulatory T cell profile and tissue proteomics of terminal ileal resection specimens between subjects randomised to 6 weeks of preoperative EEN versus standard of care calorie‐matched diet (Phase 1, surgical subgroup). This is a histopathological/ molecular qualitative comparison. Hospital readmission rate within 30 days following discharge post terminal ileal resection, between subjects randomised to 6 weeks of preoperative EEN versus standard of care calorie‐matched diet. Outcome will be assessed via both patient questionnaire (designed specifically for this study) and review of the medical records. Mean BMI increase at week 6 between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). BMI will be calculated from height and weigh obtained from stadiometer and digital scale respectively. Mean Body weight increase at week 6 between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Assessed using a digital scale Mean Crohn’s Disease Activity Index (CDAI) score at 6 months postoperative, between subjects randomised to 6 months of post‐operative PEN versus standard of care calorie‐matched diet (Phase 2) Mean Crohn’s Disease Activity Index (CDAI) score at 6 weeks, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Mean daily dose of steroids, thiopurines, methotrexate, 5‐aminosalicylates and Non‐steroidal anti‐inflammatory drugs (NSAIDs) between subjects randomised to 6 months of post‐operative EEN versus standard of care calorie‐matched diet (Phase 2). Outcome will be assessed via a questionnaire (designed specifically for this study) at weeks 0, 2, 4 and 6. Based on this information an average daily dose of each medication used for the entire 6 week period of phase 1 will be calculated for each participant. Mean daily dose of steroids, thiopurines, methotrexate, 5‐aminosalicylates and Non‐steroidal anti‐inflammatory drugs (NSAIDs) between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Outcome will be assessed via a questionnaire (designed specifically for this study) at weeks 0, 2, 4 and 6. Based on this information an average daily dose of each medication used for the entire 6 week period of phase 1 will be calculated for each participant. Mean decrease in CRP at week 6, as compared to level at week 0, between subjects randomised to 6‐8 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Assessed using a blood test Mean decrease in faecal calprotectin at 6 weeks as compared to level at screening visit, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Mean decrease in white cell count (WCC) at week 6, as compared to level at week 0, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Assessed using a blood test Mean hospital stay following terminal ileum resection between subjects randomised to 6 weeks of preoperative EEN versus standard of care calorie‐matched diet. Outcome will be assessed via review of the medical records. Mean IBD Questionaire (IBDQ) score aat 6 weeks, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Mean IBD Questionaire (IBDQ) score at 6 months postoperative, between subjects randomised to 6 months of post‐operative PEN versus standard of care calorie‐matched diet (Phase 2) Mean IBD‐disability index score at 6 months postoperative, between subjects randomised to 6 months of post‐operative PEN versus standard of care calorie‐matched diet (Phase 2) Mean IBD‐disability index score at 6 weeks, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Mean increase in albumin at week 6, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Assessed via blood test. Mean increase in ferritin at week 6, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Assessed via a blood test. Mean increase in grip strength at week 6, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Assessed using a Hand Dynamometer. Mean increase in haemoglobin at week 6, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Assessed via a blood test. Mean increase in muscle ultrasound density at week 6, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Assessed by a competent dietitian using an ultrasound machine. Mean increase in prealbumin at week 6, between subjects randomised to 6 weeks of EEN v rsus standard of care calorie‐matched diet (Phase 1). Assessed via blood test. Mean increase in serum zinc at week 6, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Assessed via a blood test. Mean intestinal permeability (TEER) of terminal ileal resection specimen between subjects randomised to 6 weeks of preoperative EEN versus standard of care calorie‐matched diet (Phase 1, surgical subgroup). Mean length of intra‐operative bowel resected between subjects randomised to 6 weeks of preoperative EEN versus standard of care calorie‐matched diet. Length of resected specimens will be measured post resection by the surgeon. Mean Patient Reported Outcome‐ 2 (PRO2) score at 6 months postoperative, between subjects randomised to 6 months of post‐operative PEN versus standard of care calorie‐matched diet (Phase 2) Mean Patient Reported Outcome‐ 2 (PRO2) score at 6 weeks, between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Mean total cost of care between subjects randomised to 6 months of post‐operative partial enteral nutrition versus standard of care calorie‐matched diet (Phase 2). Total cost of care will be estimated via a questionnaire (designed specifically for this study) administered to the patient at month 6. Mean total cost of care between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). Total cost of care will be estimated via a questionnaire (designed specifically for this study) administered to the patient at week 6. Proportion achieving steroid‐free remission at 6 months following surgical resection of the terminal ileum, between subjects randomised to 6 months of post‐operative PEN versus standard of care calorie‐matched diet (Phase 2). Outcome assessed via both review of the medical records and patient questionnaire (designed specifically for this study). ; Proportion of subjects adhering to prescribed diet between subjects randomised to 6 months of post‐operative PEN versus standard of care calorie‐matched diet (Phase 2). All subjects will keep a food diary that will be reviewed by the study dietitian on a weekly basis. Proportion of subjects adhering to prescribed diet between subjects randomised to 6 weeks of EEN versus standard of care calorie‐matched diet (Phase 1). All subjects will keep a food diary that will be reviewed by the study dietitian on a weekly basis. Proportion of subjects having peri‐operative complications, including intra‐abdominal sepsis and anastomotic leak within the first 30 days post operation, between subjects randomised to 6 weeks of preoperative EEN versus standard of care calorie‐matched diet. Outcome will be assessed via review of the medical records. ; Proportion of subjects presenting with bowel obstruction during 6 weeks of EEN versus standard of care calorie‐matched diet prior to planned surgical resection of the terminal ileum. This outcome will be assessed by regular weekly review of the patient and history taking, either face to face or over the phone as per the visit schedule. Proportion of subjects randomised to 6 weeks of EEN requiring step down diet or nasogastric/ nasojejunal feeding (Phase 1). Outcome will be assessed via review of the medical records. Proportion of subjects undergoing planned primary anastomosis versus end‐ileostomy following the 6 weeks of EEN versus standard of care calorie‐matched diet. Outcome will be assessed via review of the medical records. Proportion rescued from surgery between subjects randomised to 6 weeks of preoperative EEN versus standard of care calorie‐matched diet. During the 6 week review participants will be asked to indicate weather a decision has been by them and their surgeon to cancel their semi‐elective terminal ileal resection, and the reason for this decision (eg symptom improvement to extent that surgery not required, currently unfit for surgery etc). Samples taken at week 0 will be stored for future analysis to try to uncover predictive markers for response to therapy. Following samples will be stored: plasma for proteomic and serological markers, eluted DNA for genomic biomarkers, and colonic mucosal tissue biopsies for tissue metabolomics and magnetic resonance spectroscopy. INCLUSION CRITERIA: Participant must meet all of the inclusion criteria below at time of enrolment to be eligible to participate in phase 1 of the study 1. Crohn’s disease involving the terminal ileum, established diagnosis >6 months 2. Aged 18 – 70 inclusive 3. Ileal complicated Crohn’s disease requiring laparoscopic / open ileal (or small bowel segmental) resection, OR severe ileal Crohn’s disease Participant must meet all of the inclusion criteria below at time of surgery to be eligible to participate in phase 2 of the study: 1. Crohn’s disease involving the terminal ileum, established diagnosis >6 months 2. Aged 18 – 70 inclusive 3. Ileal complicated Crohn’s disease undergoing laparoscopic / open ileal (or small bowel segmental) resection 4. Terminal ileum can be reached by colonoscopy."
11;exclude;Efficacy trial of a novel stoma-output recycling device.;"INTERVENTION: This randomized controlled trial will investigate the efficacy and safety a novel stoma output recycling pump for patients undergoing elective reversal of their loop ileostomy. The device is a centrifugal pump (impeller) housed within a stoma appliance and connected to an enteral feeding tube placed inside the distal limb. The pump is activated on‐demand (as individually indicated by a specific patient's daily output volume) to achieve bolus refeeding, using a battery‐powered driver with 5 speed settings. The correct speed setting is determined by the viscosity of the patient's chyme. The device will be used in patients who are at least 2 weeks post‐loop ileostomy formation, have confirmation of adequate downstream anastomosis healing via radiological investigation, and are at least 2 weeks away from having their ileostomy reversed. Patients are fitted with this device in the outpatient clinic by a study investigator (who will be either a surgical registrar/consultant or stoma nurse) after enrolment, are carefully educated on how to use it, undergo a trial run with plain water in the stoma bag, and then are sent home with an information sheet and contact details of the study team if any issues arise. The device will be used during the waiting period for ileostomy reversal (weeks to months) with the frequency of use determined by the individual patient's stoma output per day. The per‐protocol population will include all those allocated to using the device and have used it continuously daily for a minimum period of 2 weeks directly prior to the surgery date. The intention to treat population will include all those allocated to using the device and have used it at least once. Strategies to encourage adherence: The research team will be in regular contact with the patient to assess and encourage device usage. Patients will also self‐report device use in standardised logbook diaries. CONDITION: Oral and Gastrointestinal ‐ Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon Patients with defunctioning loop ileostomy; ; Patients with defunctioning loop ileostomy PRIMARY OUTCOME: Length of hospital stay (days) after reversal of loop ileostomy as measured by simple calculation of the number of full days spent in hospital between date of discharge and date of admission collected from patient's medical records[Date of discharge ] SECONDARY OUTCOME: Change in renal function (eGFR) [eGFR blood test measured at discharge after ileostomy formation and measured in pre‐admission prior to ileostomy reversal ] Complications/difficulties or issues related to device usage, e.g. pump failure, catheter tube dislodgement as assessed by patient reporting the issue to the study investigator. Data is also collected from the patient's logbook. [From day of enrolment until ileostomy reversal ] Comprehensive Complications Index (CCI) ‐ a validated instrument measuring the sum of all complications weighted by severity as classified by Clavien‐Dindo grading system[At time of discharge and repeated at 30 days post‐surgery] Costs of inpatient care as assessed by the local district health board data analyst information regarding the individual patient's hospital stay [From day of enrolment until 30 days post‐surgery ] Duration of each device usage as assessed by the logbook questionnaire completed by the patient. The questionnaire has been specifically designed for this study. [From enrolment to day of ileostomy reversal ] Frequency of device usage per day as assessed by the daily logbook questionnaires completed by the patient. The questionnaire has been specifically designed for this study. [From day of enrolment until ileostomy reversal] Histology characteristics of the mucosal biopsies from the distal ileal limb and rectum/neorectum (from a subset of 16 patients, 8 in each arm) [Day of ileostomy reversal ] Incidence and grade of chemotherapy‐induced diarrhoea as assessed by inspecting oncology outpatient clinic letters and/or inpatient admission notes[From time of enro ment to completion of chemotherapy (if applicable) ] Incidence of adverse events/complications following ileostomy reversal, e.g. bleeding, infections, anastomosis leak (classified by Clavien‐Dindo grading system) as assessed by review of clinical records and patient reporting. [From ileostomy reversal until 30 days post‐surgery ] Incidence of device cessation due to intolerance or other reasons as assessed by patient reporting to the study investigator. Data will also be collected from the patient's logbook. [From day of enrolment until ileostomy reversal ] Incidence of hospital re‐admissions for stoma‐related issues, such as dehydration as assessed by both inspection of electronic clinical records and from patient reporting to the study investigator[From day of enrolment until ileostomy reversal] Incidence of outpatient or GP visits for stoma‐related complications, e.g. dehydration as assessed by self‐reporting from the patient recorded in their daily logbook. [From day of enrolment until ileostomy reversal ] Low Anterior Resection Syndrome (LARS) Symptom scores[Measured at 30 days, 3 months, 6 months, 1 year and 3 years post‐surgery] Manometry motility characteristics of the distal limb as measured by a high‐resolution manometry catheter (in fasting and fed states) (from a subset of 12 patients, 6 in each arm)[Prior to ileostomy reversal after a minimum of 2 weeks of stoma‐output recycling ] Net stoma losses per day (mls) as calculated by multiplying the average number of times the patient reports emptying their stoma bag per day by the average volume of each stoma bag emptying. Data will be collected from patient's daily logbook. [From day of enrolment until ileostomy reversal ] Number of stoma bags used as assessed by the patient keeping a tally of the total number of stoma bag changes during the pre‐operative period. This data will be collected from the patient's logbook. [From day of enrolment until ileostomy reversal ] Pre‐operative quality of life as measured by the EQ‐5D‐5L and Ostomy Adjustment Scale questionnaires[At enrolment and repeated within 1 week prior to ileostomy reversal] Qualitative performance of device usage as assessed by the logbook questionnaire completed by the patient and via a survey performed at the end of the recycling period. The questionnaire has been specifically designed for this study. [From enrolment to day of ileostomy reversal ] Recovery of bowel function post‐surgery as measured by time to GI2, i.e. time to tolerance of oral diet and passage of stool. (hours). This will be assessed via a brief clinical review in the morning by a study investigator and a brief questionnaire completed by the patient in the evening. The questionnaire has been specifically designed for this study. [From day 1 post‐ileostomy reversal until endpoint met] The incidence of dose reduction or modification of chemotherapy regimens as assessed by inspecting oncology clinic letters and/or inpatient admission notes [From time of enrolment to completion of chemotherapy (if applicable) ] Use of medications to slow down stoma‐output as assessed by asking the patient if they needed to restart any of their previous stoma‐output reducing medications. Data will be collected from the daily logbook. [From time of enrolment until ileostomy reversal ] INCLUSION CRITERIA: â€¢ Defunctioning loop ileostomy created during colorectal/gynaecological resection surgery at least 2 weeks prior to enrolment into the study in the Auckland District Health Board catchment area â€¢ Age > or = 18 years â€¢ Anastomotic leak excluded (via gastrograffin study/ CT with rectal contrast/ endoscopy) â€¢ Distal limb of ileostomy can be intubated by a minimum 24Fr feeding tube (dilatation of stoma orifice strictures is allowable) â€¢ Able to demonstrate they are able to independently manage their stoma or have a consistent daily caregiver available who can support regular stoma management â€¢ Able to understand risks and benefits of participating in the study â€¢ Able to provide infor ed consent"
12;exclude;Limited Routine Total Parenteral Nutrition versus oral diet progression post Whipple procedure to assess affect on patient functionality.;"INTERVENTION: All patients will follow the RPA Whippleâ€™s protocol for oral diet progression. Oral diet: NBM day 0‐1, Clear Fluid diet day 2‐4, Full Fluid diet day 3‐5, Post Gastrectomy diet day >4. Where clear diet is clear liquids only, full fluid diet is opaque liquids only and post gastrectomy diet is a diet and meal frequency appropriate for patients in the early post‐operative phase after a gastrectomy or oesophagogastrectomy, and to minimise risk of dumping syndrome or oesophageal blockage (as per NSW Agency of Clinical Innovation diet specifications] . The intervention group (n = 10) patients will be placed on TPN within 24hrs post pancreaticoduodenectomy with oral diet progression. TPN will be calculated to meet patientâ€™s estimated nutritional requirements using Schofield Equation. TPN will be titrated to goal rate using existing practice as per hospital policy â€œParental Nutrition (ICU patients)â€?.TPN will be given via pre‐existing central line inserted pre‐op. IV fluids given to intervention arm as per RPA Hospital Pancreaticoduodenectomy Checklist [IVT Day 0 post‐operatively use Hartmanâ€™s Solution. Chart rate at 150mls/hour and on the ward if a fluid bolus is required, the preference is to use 100mls 20% Albumin] Diet progression: Day 0‐1: NBM + TPN goal rate Day 2‐4: Clear Fluid diet + TPN goal rate Day 3‐5: Full Fluid diet + TPN half goal rate Day > 4: Post Gastrectomy diet + TPN half goal rate or ceased In addition to the above as deeded appropriate by the medical team, the patients may receive: IV fluids to meet hydration needs, oral nutritional supplements as appropriate (if oral intake is inadequate to meet estimated nutritional requirements alone). The number of days from initial surgery to when the TPN is ceased will be recorded. Measurement data will be stored via a secure method within REDCap. The pre‐operative and intra‐operative data is already collected by the Hospital Upper Gastrointestinal Outcomes database CONDITION: Cancer ‐ Bowel ‐ Small bowel (duodenum and ileum) Cancer ‐ Pancreatic Oral and Gastrointestinal ‐ Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon pancreatic cancer;pancreatitis;Cancer: Bowel ‐ small bowel (duodenum and ileum); ; pancreatic cancer ; pancreatitis ; Cancer: Bowel ‐ small bowel (duodenum and ileum) PRIMARY OUTCOME: The primary aim of this study is to determine the feasibility of providing total parenteral nutrition meeting estimated nutritional requirements versus standard diet progression post pancreaticoduodenectomy. [Composite primary outcome: The retention rate will be defined as the percentage of individuals who completed the intervention. This will be determined post discharge of the patient from Royal Prince Alfred Hospital.; Adherence will be defined as the percentage of TPN goal rate reached. Adherence will be calculated at day 4 post randomisation, and will be determined by number of patients in the intervention group who had reached goal rate TPN and the number of days at goal rate.; The goal rate of TPN will be determined in ICU and will be calculated using Schofield Equation specific for the individuals age and gender, with activity factor of 1.0‐1.1 and injury factor of 1.2‐1.25 and estimated protein requirements using protein targets of 1.2‐1.5g/kgBW/day as per ESPEN guideline on clinical nutrition in the intensive care unit. ] SECONDARY OUTCOME: Composite secondary outcome ; Complication rates: will be defined as the total number of complications post‐operatively and calculated based on drain/serum Amylase levels[Serum amylase will be assessed on day 3 and day 5 post randomisation and final assessment of complication rates will occur on day of discharge. ] Handgrip strength; will be assessed using a dynamometer[Will be assessed at baseline, day 3, day 7 and one month post randomisation ] Length of hospital stay[Will be assessed by the duration of inpatient hospital stay with the day of surgery considered as day 0 until the day of d scharged using data linkage to medical records. ] Nutritional status: will be defined using Subjective Global Assessment [Will be assessed day one and one month post randomisation ] Quality of life; assessed using questionnaire [EQ‐5D‐5L][Will be assessed at baseline, day 3, day 7 and one month post randomisation ] Total estimate nutritional requirements provided; will be assessed using food diary and / or calculation of provision of total parenteral nutrition provided. [Will be assessed at baseline, day 3 and day 7 post randomisation ] INCLUSION CRITERIA: ‐ Patients undergoing intended curative pancreaticoduodenectomy at RPAH, inclusive of other extended surgical procedures. ‐ Ability to provide written consent ‐ Between 18‐99 years of age"
13;exclude;[Conventional large intestine preparation with laxatives and enemas].;NA
14;exclude;Left-sided transmesocolic herniation of small bowel in an otherwise unaffected abdomen.;Transmesocolic hernia is an uncommon type of internal hernia with incidence ranging from approximately 5-10%. To the best of our knowledge, this is the first reported case of a transmesocolic hernia through a gap within the descending mesocolon presenting clinically as an intestinal obstruction. A 75-year-old man was admitted with clinical features of intestinal obstruction. An abdominal X-ray showed multiple small bowel loops with air fluid levels. Contrast-enhanced CT of the abdomen revealed small bowel obstruction not only on the right, but also on the left side of the collapsed descending colon. Emergency surgery was performed. Strangulated bowel loops with gangrenous changes were resected and double-barrel ileostomy was carried out. The postoperative period was uneventful. Restoration of bowel was performed after 6 weeks. Preoperative diagnosis of bowel obstruction caused by a transmesocolic hernia remains difficult despite the currently available imaging techniques. Prompt surgery can prevent serious complications such as peritonitis and sepsis.
15;exclude;The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review.;"BACKGROUND: The gut microbiota (GM) has been proposed as one of the main determinants of colorectal surgery complications and theorized as the ""missing factor"" that could explain still poorly understood complications. Herein, we investigate this theory and report the current evidence on the role of the GM in colorectal surgery. METHODS: We first present the findings associating the role of the GM with the physiological response to surgery. Second, the change in GM composition during and after surgery and its association with colorectal surgery complications (ileus, adhesions, surgical-site infections, anastomotic leak, and diversion colitis) are reviewed. Finally, we present the findings linking GM science to the application of the enhanced recovery after surgery (ERAS) protocol, for the use of oral antibiotics with mechanical bowel preparation and for the administration of probiotics/synbiotics. RESULTS: According to preclinical and translational evidence, the GM is capable of influencing colorectal surgery outcomes. Clinical evidence supports the application of an ERAS protocol and the preoperative administration of multistrain probiotics/synbiotics. GM manipulation with oral antibiotics with mechanical bowel preparation still has uncertain benefits in right-sided colic resection but is very promising for left-sided colic resection. CONCLUSIONS: The GM may be a determinant of colorectal surgery outcomes. There is an emerging need to implement translational research on the topic. Future clinical studies should clarify the composition of preoperative and postoperative GM and the impact of the GM on different colorectal surgery complications and should assess the validity of GM-targeted measures in effectively reducing complications for all colorectal surgery locations."
16;exclude;Intestinal perforation due to fecal impaction after renal transplantation.;Three renal allograft recipients suffered major intestinal complications shortly after the operation. Identification of diverticular disease, adequate preoperative bowel preparation, avoidance of excessive amounts of non-absorbable antacids, early ambulation, and periodic laxatives and stool softeners can prevent these complications. Surgical management includes careful inspection for additional perforations, resection and colostomy, and continuous peritoneal lavage.
17;exclude;A meta-analysis of randomized, controlled trials on the role of combined oral and intravenous antibiotics in the prevention of surgical site infections after colorectal surgery.;NA
18;exclude;Mesenteric Ischemia Caused by Heparin-induced Thrombocytopenia: A Case Report.;"Deep venous thrombosis (DVT) prophylaxis is the current standard of care in trauma patients. While most of the anticoagulation complications are obvious and can be promptly identified, heparin-induced thrombocytopenia (HIT) requires a high index of suspicion for early diagnosis to prevent a potentially fatal outcome. A 39-year-old female presented to our emergency room after sustaining a gunshot wound to her left flank and pelvis requiring a sigmoid colon and left fallopian tube and ovary resection with colostomy diversion. The patient did well in her early postoperative period; however, her condition rapidly deteriorated after that as a result of mesenteric ischemia caused by heparin-induced thrombocytopenia. After multiple visits to the operating room, the patient ended up with short bowel syndrome, necessitating a referral to a bowel transplant center. Our aim is to increase awareness of this potentially lethal complication with a mortality rate up to 30% of patients."
19;exclude;Effect of Mosapride on Postoperative Ileus in Patients Undergoing Colorectal Surgery:;NA
20;exclude;The role of cryosurgery of the prostate for nonsurgical candidates.;"INTRODUCTION: Technological advancements have reduced the morbidity associated with cryosurgery, leading to an increased interest in this modality for the treatment of organ-confined prostate cancer. In this study, we critically examine the current role of cryoablation of the prostate to better understand how to counsel patients regarding this treatment option. METHODS: A database was compiled over a 3-year period (2008-2011) of 30 patients who underwent cryoablation for organ-confined prostate cancer. Indications for cryosurgery included primary treatment, focal treatment (institutional review board-approved prospective study), and salvage cryotherapy for radiation failure. The primary outcomes were biochemical response via prostate-specific antigen (PSA) measurement and morbidity associated with cryoablation. Cryotherapy failure was defined as an increasing postcryotherapy PSA level ≥ 2 ng/mL above the post-treatment nadir, a positive prostate biopsy, or radiographic evidence of metastatic disease. RESULTS: Of the 30 patients who underwent cryoablation from 2008 to 2011, 26 patients had complete follow-up data for analysis. Of these patients, 17 (65.38%) had total gland cryotherapy, 5 (19.23%) had salvage cryotherapy for radiation failure, and 4 (15.38%) had focal cryotherapy. The mean patient age was 68 years (54-89); median preoperative PSA was 5.5 ng/mL (1.7-15.9); median prostate volume was 35 mL (15-54); mean Gleason score was 7; and the median PSA at study conclusion was 0.7 (0.02-3.4) ng/mL. Of the 17 patients who had total prostate cryotherapy, 11 (64.7%) had significant factors precluding primary treatment by a surgical and/or radiation approach, including neurological disorders (2), morbid obesity (1), rectal cancer treated with radiation (1), kidney/pancreas transplant (2), ileoanal pouch secondary to inflammatory bowel disease (IBD) (1), renal failure (1), and age (3). There were no intra- or postoperative complications. After a median follow-up of 18 months (1-40), none of the patients with multiple comorbidities had biochemical failures. Two patients from the salvage group experienced treatment failure requiring androgen deprivation therapy. CONCLUSIONS: This critical analysis of a single-surgeon experience at a large academic prostate cancer program revealed that the contemporary role of cryosurgery is, in select patients with comorbidities, preventing surgical and/or radiation therapy. Additionally, cryosurgery has a role in treating radiation failures. Further studies are necessary to investigate focal cryotherapy as an option for primary treatment, but our preliminary results are promising, without any biochemical failures in our focal therapy cohort."
21;exclude;Large bowel obstruction as a consequence of transverse colon volvulus: A case report.;"INTRODUCTION: Transverse colon volvulus incidence is comparatively rare when compared to cecal and sigmoid volvulus. Its diagnosis is still challenging for the surgeon. Delay in the diagnosis of this condition carries high morbidity and mortality rates. AIM: To report a rare case of transverse colon volvulus in a young adult male that presented as large bowel obstruction and was operated upon in the General Surgery department in the Jordanian Royal Medical Services (JRMS), Amman, Jordan. PRESENTATION OF CASE: An 18-year-old male presented with severe generalized abdominal pain of 12-h-duration, associated with significant abdominal distention and constipation of one-day duration. His abdominal examination revealed a massively distended, tender abdomen; however, there were no signs of peritonitis. Abdominal radiographs showed a massively dilated large bowel. He underwent exploratory laparotomy that revealed the diagnosis of transverse colon volvulus. His condition was managed operatively with transverse colectomy with a primary anastomosis. The patient had a satisfactory postoperative recovery. DISCUSSION: Only 3-5% of all cases of intestinal obstruction are caused by colonic volvulus. Transverse colon is involved in 2-4% of them. The diagnosis of transverse colon volvulus can be delayed and difficult because it does not have the same classically recognizable radiographic features as cecal and sigmoid volvulus. CONCLUSION: Transverse colon volvulus is a rare entity. A swift suspicion of diagnosis is key to preventing severe outcomes. It can result in bowel perforation and fecal peritonitis. The definitive diagnosis is frequently made intraoperatively. Early surgical intervention is essential for better outcome and avoiding complications."
22;exclude;Post-esophagectomy pseudomembranous inflammation of the interposed colon.;BACKGROUND: Pseudomembranous colitis (PMC) usually is caused by antibiotic-related changes in colonic anaerobic microflora, leading to Clostridium difficile overgrowth and overproduction of toxins. We present the first reported case of PMC affecting the intrathoracic, interposed colon of an esophagectomy patient in the absence of inflammation of the in situ colon. METHODS: Case report and review of pertinent English-language literature. CASE REPORT: A 47 year-old male developed Clostridium difficile-related colitis after in Ivor-Lewis esophagectomy for carcinoma of the esophagus, and rendered asymptomatic after 10 days of therapy with oral vancomycin. Postoperatively, the patient developed a broncho-esophageal fistula, and was reconstructed with a two-stage colonic esophageal colonic interposition three months after the fistula was closed surgically. On postoperative day nine, the patient developed symptomatic PMC of the interposed colon segment, whereas the in situ colon was spared. Therapy with oral vancomycin for three weeks eradicated the infection. CONCLUSIONS: Pseudomembranous colitismay develop in the interposed colon after a esophageal colonic interposition, even absent inflammation of the in situ colon. Previous infection with C. difficile may have increased the risk in this patient.
23;exclude;How Should the Low Anterior Resection Syndrome Score Be Interpreted?;"BACKGROUND: Bowel dysfunction after low anterior resection is often assessed by determining the low anterior resection syndrome score. What is unknown, however, is whether this syndrome is already present in the general population and which nonsurgical factors are associated. OBJECTIVE: The purpose of this study was to determine the prevalence of minor and major low anterior resection syndrome in the general Dutch population and which other factors are associated with this syndrome. DESIGN: This was a cross-sectional study. SETTINGS: The study was conducted within the general Dutch population. PATIENTS: The Groningen Defecation and Fecal Continence Questionnaire was distributed among a general Dutch population-based sample (N = 1259). MAIN OUTCOME MEASURES: Minor and major low anterior resection syndrome were classified according to the scores obtained. RESULTS: The median, overall score was 16 (range, 0-42). Minor low anterior resection syndrome was more prevalent than the major form (24.3% vs 12.2%; p < 0.001). Bowel disorders, including fecal incontinence, constipation, and irritable bowel syndrome were associated with the syndrome, whereas sex, age, BMI, and vaginal delivery were not. Remarkably, patients with diabetes mellitus were significantly more prone to experience minor or major low anterior resection syndrome. The ORs were 2.8 (95% CI, 1.8-4.4) and 3.7 (95% CI, 2.2-6.2). LIMITATIONS: We selected frequent comorbidities and other patient-related factors that possibly influence the syndrome. Additional important factors do exist and require future research. CONCLUSIONS: Minor and major low anterior resection syndrome occur in a large portion of the general Dutch population and even in a healthy subgroup. This implies that the low anterior resection syndrome score can only be used to interpret the functional result of the low anterior resection provided that a baseline measurement of each individual is available. Furthermore, because people with low anterior resection syndrome often experience constipation and/or fecal incontinence, direct examination and diagnosis of these conditions might be a more efficient approach to treating patient bowel dysfunctions. See Video Abstract at http://links.lww.com/DCR/B110. ¿CÓMO DEBE INTERPRETARSE LA PUNTUACIÓN DEL SÍNDROME DE RESECCIÓN ANTERIOR BAJA?: La disfunción intestinal después de la resección anterior baja a menudo se evalúa determinando la puntuación del síndrome de resección anterior baja. Sin embargo, lo que se desconoce es si este síndrome ya está presente en la población general y qué factores no quirúrgicos están asociados.Determinar la prevalencia del síndrome de resección anterior baja menor y mayor en la población holandesa general y qué otros factores están asociados con este síndrome.Estudio transversal.Población holandesa general.El cuestionario de defecación y continencia fecal de Groningen se distribuyó entre una muestra general de población holandesa (N = 1259).El síndrome de resección anterior baja menor y mayor se clasificó de acuerdo con las puntuaciones obtenidas.La mediana de la puntuación general fue de 16.0 (rango 0-42). El síndrome de resección anterior baja menor fue más frecuente que la forma principal (24.3% versus 12.2%, (P <0.001). Los trastornos intestinales, incluyendo incontinencia fecal, estreñimiento y síndrome del intestino irritable se asociaron con el síndrome, mientras que el sexo, la edad y el cuerpo el índice de masa y el parto vaginal no lo hicieron. Notablemente, los pacientes con diabetes mellitus fueron significativamente más propensos a experimentar el síndrome de resección anterior baja menor o mayor. Las razones de probabilidad fueron 2.8 (IC 95%, 1.8-4.4) y 3.7 (IC 95%, 2.2 -6.2), respectivamente.Se seleccionaron las comorbilidades frecuentes y otros factores relacionados con el paciente que posiblemente influyen en el síndrome. Existen otros factores importantes que requieren investigación en el futuro.El síndrome de resección anterior baja menor y mayor ocurre en una gran parte de la población holandesa general e incluso en un subgrupo sano. Esto implica que la puntuación del síndrome de resección anterior baja solo se puede utilizar para interpretar el resultado funcional de la resección anterior baja, siempre que esté disponible una medición inicial de cada individuo. Además, dado que las personas con síndrome de resección anterior baja a menudo experimentan estreñimiento y/o incontinencia fecal, el examen directo y el diagnóstico de estas afecciones pueden ser un enfoque más eficiente para tratar las disfunciones intestinales de los pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B110."
24;exclude;Endoscopic repair of a large colonoscopic perforation with clips.;We report a patient with a large colonic perforation that occurred in a screening colonoscopy, successfully repaired with endoclips, although the safety and efficacy of this approach is not entirely established. Endoscopic clip placement can be used to treat iatrogenic colonic perforation, when the defect is readily recognized and is easily accessible for closure, and the bowel preparation is excellent.
25;exclude;Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer.;BACKGROUND: The main aim of this study was to compare short‐term results and long‐term outcomes of patients who underwent intraoperative colonic lavage (IOCL) with primary anastomosis with those who had stent placement prior to scheduled surgery for obstructive left‐sided colonic cancer (OLCC). METHODS: We conducted a prospective, controlled, randomized study of patients diagnosed with OLCC. Patients were divided into two groups: stent and deferred surgery (group 1) and emergency IOCL (group 2). Demographic variables, risk prediction models, postoperative morbidity and mortality, staging, complications due to stent placement, surgical time, clinical follow‐up, health costs, and follow‐up of survival were recorded. RESULTS: Twenty‐eight patients (15 group 1 and 13 group 1) were enrolled. The study was suspended upon detecting excess morbidity in group 2. The two groups were homogeneous in clinical and demographic terms. Overall morbidity in group 1 was 2/15 (13.3%) compared with 7/13 (53.8%) in group 2 (p = 0.042). None of the 15 patients in group 1 presented anastomotic dehiscence compared with 4/13 (30.7%) in group 2 (p = 0.035). Surgical site infection was detected in 2 (13.3%) patients in group 1 and in 6 (46.1%) in group 2 (p = 0.096). Postoperative stay was 8 days (IQR 3, group 1) and 10 days (IQR 10, group 2) (p = 0.05). The mean follow‐up period was 37.6 months (SD = 16.08) with no differences in survival between the groups. CONCLUSION: In our setting, the use of a stent and scheduled surgery is safer than IOCL and is associated with lower morbidity, shorter hospital stay, and equally good long‐term survival.
26;exclude;Complications of ileal pouch anal anastomosis.;"Ileal pouch anal anastomosis (IPAA) is associated with complications in a significant number of patients, including ileal-anal separation, anal stricture, pouchitis, pelvic sepsis, and small bowel obstruction. In most cases, these complications may be successfully treated using either medical or surgical therapy and do not result in long-term pouch dysfunction. Important preventative measures include accrual of experience or creation of a team with experienced surgical leadership and scrupulous selection of patients who have no features of Crohn's disease. Despite these precautions, 5% to 15% of patients will develop chronic pouch dysfunction and pouch failure requiring diversion with or without excision of the pouch. Medical measures, such as antibiotics, immunomodulators, and biologic agents, and surgical measures such as advancement flap anoplasty may be attempted to salvage pouch function and are successful in more than 50% of cases. Indeterminate colitis does not preclude IPAA; however, Crohn's colitis is absolute contraindication for same. Patients who require colectomy and are suspected for any reason to have CD may undergo ileorectal anastomosis with preservation of anorectal continence and excellent functional results."
28;exclude;Dipeptide Alanyl Glutamine and Postoperative Insulin Resistance in Colon Carcinoma Patients:;NA
29;exclude;Esco trial: colonic stent versus emergency surgery in malignant colonic occlusion, an interim report.;"Introduction: Emergency surgery for acute colonic obstruction is burdened by a significantly higher rate of complications. The clinical employment of self‐expandable metal stents today represents a valid alternative. Materials and Methods: Patients with acute left‐sided colonic cancer obstruction are randomly assigned to one of the two treatment groups: A) emergency positioning of a stent followed by elective surgery (laparoscopic or open); B) emergency surgery. Primary endpoint is the incidence of postoperative complications at 2 months. Secondary endpoints are postoperative mortality, success percentage of stent positioning and percentage of complications related to stent positioning, hospital stay, QoL, quantity of life, cost differences, oncological results. Results: Since March 2008, 48 patients have been included: 22 in group A and 26 in group B. The morbidity rate is nil. The stents were positioned successfully in all but 3 (13.6%) cases: in 2 the positioning was technically impossible, in 1 the patient had no restoration of bowel function. In all cases, emergency surgery was successfully performed. Conclusion: Expected results consist in a reduction of postoperative complications and hospital stay in patients submitted to stent positioning without worsening of the evolution of the neoplastic illness. The available interim data don't permit to draw any conclusion yet."
30;exclude;Role of endoscopy in predicting the disease course in inflammatory bowel disease.;Endoscopy provides a direct evaluation of mucosal lesions in inflammatory bowel disease (IBD), permitting the description of elementary lesions, their surface extent and severity. The severity of mucosal lesions directly reflects disease activity and may help to identify an aggressive behavior of the disease. Several studies have recently pointed out the potential role of endoscopy in the prediction of IBD outcome. Indeed, severe endoscopic lesions in Crohn's disease (CD) patients, defined by deep and extensive ulcerations on at least one part of the colon, are associated with an increased risk of penetrating complication and surgery. Severe endoscopic lesions during severe attacks of ulcerative colitis (UC) are associated with an increased risk of colectomy in the short and long term. Severity of postoperative recurrence in CD may help to predict the risk of clinical relapse and need for further surgery. Achievement of mucosal healing, which can be obtained by administration of several types of drugs, is associated with a better outcome, less surgery and hospitalization. This review focuses on the assessment of endoscopic severity in CD and UC and on the impact of endoscopic severity on disease outcome. More specifically, we discuss how endoscopy can be used at different stages of IBD to predict the disease course and/or to adapt treatment strategies.
31;exclude;Outcome of loop versus divided colostomy in the management of anorectal malformations.;"Anorectal Malformations/*surgery; Appetite Depressants; Colon, Descending/surgery; Colon, Sigmoid/surgery; Colon, Transverse/surgery; Colostomy/adverse effects/*methods; Female; Humans; Infant; Infant, Newborn; Male; Operative Time; Postoperative Complications/etiology; Retrospective Studies; Skin/injuries; Treatment Outcome; Wounds and Injuries/etiology"
32;exclude;Transanal Reinforcement of Low Rectal Anastomosis in Rectal Cancer Surgery:;NA
33;exclude;Does a more extensive mucosal excision prevent haemorrhoidal recurrence after stapled haemorrhoidopexy? Long-term outcome of a randomized controlled trial.;AIM: The study aimed in a multicentric randomized controlled trial to define the role of a more extensive mucosal resection on recurrence of mucosal prolapse in patients with Stage III haemorrhoids undergoing stapled haemorrhoidopexy. METHOD: In all, 135 patients were randomized to treatment with a PPH-01/03 (Ethicon EndoSurgery) or an EEA (Covidien) stapler. They were reviewed after a minimum follow-up of 4 years to determine the rate of recurrent mucosal prolapse and general condition (wellness evaluation score). Postoperative bowel dysfunction was assessed using the Rome III criteria. RESULTS: Eighty-seven (65%) of the 135 patients (48 in the EEA stapler group and 37 in the PPH group) were available for long-term follow-up. The two groups were comparable for age, gender and duration of follow-up (mean 49.3 ± 5.4 months and 49.0 ± 5.3 months respectively). In the EEA group, 11 (23%) patients had some degree of recurrent prolapse compared with 12 (32%) in the PPH group (P = 0.409). Persistence of anal bleeding was significantly higher in the PPH group (P = 0.04) while the postoperative Haemorrhoid Symptom Score was significantly better in the EEA group (1.73 ± 1.65 vs 3.17 ± 1.94, P < 0.001). The wellness evaluation score was significantly better in the EEA group (1.2 ± 1.27 vs 0.6 ± 1.0, P = 0.028). Furthermore, 7 (15%) of the patients in the EEA group complained of some evacuation disturbance compared with 13 (36%) in the PPH group (P = 0.021). CONCLUSION: The study failed to demonstrate any significant difference in the long-term recurrence rate of Stage III haemorrhoids using EEA or PPH. Nevertheless, use of the larger volume EEA provides better symptom resolution compared with PPH.
34;exclude;Protective effect of adipose tissue-derived mesenchymal stromal cells in an experimental model of high-risk colonic anastomosis.;BACKGROUND: Dehiscence of intestinal anastomosis results in high morbidity and mortality. The aim of this study was to investigate the effects of locally administered adipose tissue-derived mesenchymal stromal cells in a model of high-risk colonic anastomosis in rats. METHODS: Seven days after induction of colitis with 2,4,6-trinitrobenzene sulfonic acid, Wistar rats were submitted to a transection of the descending colon followed by end-to-end anastomosis and were then treated with 2×10(6) adipose tissue-derived mesenchymal stromal cells (from the preperitoneal fat) or an acellular culture solution instilled onto the surface of the anastomosis. At day 14, after macroscopic survey of the abdominal cavity, the anastomotic area was submitted to histologic and immunohistochemical analysis, evaluation of myeloperoxidase activity, fibrosis, epithelial integrity, NF-κ B activation, expression of inflammatory cytokines, and extracellular matrix-related genes. RESULTS: Anastomotic leakage and mortality associated with high-risk anastomosis decreased with treatment with adipose tissue-derived mesenchymal stromal cells (P < .03). Application of adipose tissue-derived mesenchymal stromal cells resulted in lower histologic scores (P = .011), decreased deposition of collagen fibers (P = .003), preservation of goblet cells (P = .033), decreased myeloperoxidase activity (P = .012), decreased accumulation of CD4+ T-cells (P = .014) and macrophages (P = .011) in the lamina propria, a decrease in the number of apoptotic cells (P = .008), and the activation of NF-κ B (P = .036). Overexpression of IL-17, TNF-α , IFN-γ, and metalloproteinases in the acellular culture solution-treated, high-risk anastomosis group decreased (P < .05) to near normal values with adipose tissue-derived mesenchymal stromal cells treatment. CONCLUSION: Improvements in outcomes of a high-risk colonic anastomosis with adipose tissue-derived mesenchymal stromal cells therapy reflect the immunomodulatory activity and healing effect of these cells, even after just topical administration and reinforces their use in future translational research.
35;exclude;Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy.;"BACKGROUND: Temporary faecal diversion is recommended with a low colorectal, coloanal or ileoanal anastomosis (LA). This randomized study evaluated early (EC; 8 days) versus late (LC; 2 months) closure of the temporary stoma. METHODS: Patients undergoing rectal resection with LA were eligible to participate. If there was no radiological sign of anastomotic leakage after 7 days, patients were randomized to EC or LC. The primary endpoints were postoperative morbidity and mortality 90 days after the initial resection. RESULTS: Some 186 patients were analysed. There were no deaths within 90 days and overall morbidity rates were similar in the EC and LC groups (31 versus 38 per cent respectively; P = 0.254). Overall surgical complication (both 15 per cent; P = 1.000) and reoperation (both 8 per cent; P = 1.000) rates were similar, but wound complications were more frequent after EC (19 versus 5 per cent; P = 0.007). Small bowel obstruction (3 versus 16 per cent; P = 0.002) and medical complications (5 versus 15 per cent; P = 0.021) were more common with LC. Median (range) hospital stay was reduced by EC (16 (6‐59) versus 18 (9‐262) days; P = 0.013). CONCLUSION: Early stoma closure is feasible in selected patients, with reduced hospital stay, bowel obstruction and medical complications, but a higher wound complication rate. Registration number: NCT00428636 (http://www.clinicaltrials.gov)."
36;exclude;Total abdominal colectomy has a similar short-term outcome profile regardless of indication: data from the National Surgical Quality Improvement Program.;"The purpose of this study was to evaluate the 30-day postoperative complications rate in patients undergoing elective total abdominal colectomy (TAC) for chronic constipation, neoplastic disorders, and inflammatory bowel disease (IBD) using the American College of Surgeons National Quality Improvement Database (ACS-NSQIP). The 2007 ACS-NSQIP sample was used to identify the Current Procedural Terminology codes for TAC and International Classification of Diseases, 9th Revision codes for chronic constipation, neoplasia, and IBD. Preoperative and intraoperative variables and postoperative complications were compared among the three diagnosis groups. Wilcoxon rank sum and Fisher exact tests were used for analysis. P < 0.05 was considered significant. Seven hundred forty-four patients were identified; chronic constipation was found in 107 (14.4%) patients, neoplasia in 312 (42.3%), and IBD in 322 (43.3%). Patients with constipation were predominantly females (85.2%). The neoplastic group was older and had greater body mass index when compared with the other groups. Patients with IBD presented greater use of steroids, lower albumin and hematocrit levels, and higher morbidity probability. Constipated patients had more neurologic and renal complications when compared with the IBD group (P = 0.01). None of the other categories of complications were statistically different among the diagnosis groups. With the exception of urinary tract infection being higher in the constipation patients compared with IBD (10 vs 4%, P = 0.03), there were no statistically significant differences among the other short-term specific complications. The 30-day complication rate after TAC is similar for chronic constipation, neoplasia, and IBD."
37;exclude;Let sleeping dogs lie: role of the omentum in the ileal pouch-anal anastomosis procedure.;"A surgical aphorism has long held that the omentum is the ""watchdog of the abdomen."" However, detractors believe that leaving the omentum behind after colectomy precipitates later small bowel obstruction. A retrospective comparison was made between a group of 406 patients (Group I) having omentectomy with proctocolectomy and ileoanal anastomosis and a group of 239 patients (Group II) having a similar procedure without omentectomy. Follow-up in this series of 645 patients was 4.3 +/- 2.1 years (mean +/- SEM). No difference was present in the rate of partial small bowel obstruction or complete small bowel obstruction between Group I patients (32 percent partial, 12 percent complete) and Group II patients (29 percent partial, 12 percent complete; P greater than 0.1). However, a better outcome with regard to postoperative sepsis and sepsis requiring operation was apparent in Group II patients retaining the omentum (4 percent and 3 percent, respectively) than in Group I patients (10 percent and 8 percent, respectively), in whom the omentum was removed (P less than 0.01). As this experience would support, we urge surgeons to ""let sleeping dogs lie"" and, when possible, retain the omentum when performing colectomy or proctocolectomy."
39;exclude;[Orthograde intestinal irrigation].;NA
40;exclude;Surgical Management of Crohn Disease in Children: Guidelines From the Paediatric IBD Porto Group of ESPGHAN.;The incidence of Crohn disease (CD) has been increasing and surgery needs to be contemplated in a substantial number of cases. The relevant advent of biological treatment has changed but not eliminated the need for surgery in many patients. Despite previous publications on the indications for surgery in CD, there was a need for a comprehensive review of existing evidence on the role of elective surgery and options in pediatric patients affected with CD. We present an expert opinion and critical review of the literature to provide evidence-based guidance to manage these patients. Indications, surgical options, risk factors, and medications in pre- and perioperative period are reviewed in the light of available evidence. Risks and benefits of surgical options are addressed. An algorithm is proposed for the management of postsurgery monitoring, timing for follow-up endoscopy, and treatment options.
41;exclude;[Role of nutritional support in the treatment of enteric fistulas].;"Enteric fistulas are nowadays considered an important therapeutic challenge. Artificial, total parenteral and enteral nutrition have allowed an improvement in the healing of these fistulas and a lower incidence of mortality. Fourteen patients with enteric fistulas (10 men, 4 women; mean age: 64.4 years; range: 20-80 years) were observed. The fistula was located in the large bowel in 11 patients, in the ileum in 2, and in the jejunum in 1. Thirteen patients received enteral nutrition. The patient with the jejunal fistula received total parenteral nutrition for 30 days and then enteral nutrition. The fistulas were successfully treated in 11 patients. One patients underwent surgery after 6 weeks of treatment with enteral nutrition because of lack of improvement of the symptomatology. In two patients, with advanced cancer of the colon and stomach, respectively, only a reduction of the fistula output was achieved. Nutritional support in the treatment of enteric fistulas is an effective procedure widely utilised to restore adequate nutritional status and bowel rest, which are two important targets for achieving fistula closure. Nutritional support is also useful in the management of patients undergoing surgery in order to reduce the postoperative complication rate."
44;exclude;Use of preoperative bowel preparation in elective colorectal surgery in Denmark remains high.;INTRODUCTION: Previous studies have shown that preoperative bowel preparation does not influence the frequency of postoperative complications after elective open colonic resections. The Danish Colorectal Cancer Group (DCCG) recommends that mechanical bowel preparation (MBP) should be omitted prior to elective colonic resections. Several surveys show that most surgeons use MBP before colorectal surgery. The aim of this survey was to investigate the use of preoperative bowel preparation in elective colonic and rectal resections in Denmark. MATERIAL AND METHODS: The survey was conducted in 2009. A questionnaire on the use of preoperative bowel preparation in elective colonic and rectal resections performed in 2008 was sent to all the departments of surgery that perform colorectal surgery in Denmark. RESULTS: 34% of the patients received bowel preparation before open colonic resection compared with 81% before open rectal resection. Overall, the frequency of bowel preparation was significantly higher in laparoscopic (63%) than in open surgery (50%). CONCLUSION: MBP before elective open colonic resections remains widely used despite the national DCCG guideline. MBP before laparoscopic colorectal resections was more frequently used than before open colorectal resections as MBP before rectal resections was more frequently used than before colonic resections. The need for preoperative bowel preparation in these procedures has yet to be determined. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.
45;exclude;A cost-effectiveness evaluation of 3 antimicrobial regimens for the prevention of infective complications after abdominal surgery.;OBJECTIVE: To measure the cost and effectiveness of 3 established antimicrobial regimens for the prevention of infective complications after abdominal surgery. DESIGN: A prospective randomized trial was performed involving a total of 1070 patients undergoing abdominal surgery. SETTING AND PATIENTS: All patients having upper gastrointestinal tract, colorectal, appendiceal, or biliary surgery at a major teaching hospital in Melbourne, Australia, were considered for entry into the study. INTERVENTIONS: Patients were randomized prior to surgery to receive a single dose of cefotaxime sodium (1 g), ticarcillin plus clavulanic acid (3.1 g), or ceftriaxone sodium, (1 g). All drugs were given intravenously at the start of anesthesia. MAIN OUTCOME MEASURES: Rates of major wound infections, minor wound infections, other wound problems, and other infective complications. The acquisition and administrative costs of the drugs used and the costs of the infective complications were measured. RESULTS: A Total of 1070 patients were entered into the study. Major wound infections occurred in 21 patients (2.0%). Twenty-five patients (2.3%) developed a minor wound infection. Other infective complications developed in 107 patients. There were significantly fewer minor wound infections in the ceftriaxone-treated group as compared with the other 2 groups. There was no differences in the frequency of major wound infections, other wound problems, or other infective complications. The acquisition costs of cefotaxime and ticarcillin plus clavulanic acid were less than those of ceftriaxone. The estimated cost of treating the infective complications in the group of patients who received ticarcillin plus clavulanic acid ($128,039) was greater than the cost associated with the groups being treated with cefotaxime ($91,243) or ceftriaxone ($96,095). CONCLUSIONS: The study indicates that each of the 3 regimens was associated with highly satisfactory control of postoperative infective complications after abdominal surgery. On the basis of the estimated costs of infective complications, cefotaxime and ceftriaxone appear equally effective for the prevention of infective complications after abdominal surgery. Acquisition costs for cefotaxime were lower and it is recommended as the preferred agent on this basis.
46;exclude;[What can we do when a esophagocoloplasty fails?].;BACKGROUND: Postoperative complications of esophageal replacement are potentially severe, and they can even make impossible the digestive continuity. However, several surgical options have been used for such situations. The aim of the study is to assess the early and late results in patients who have been managed or referred to our department for this problem. PATIENTS AND METHODS: We reviewed 8 patients operated between 1975 and 2005, four of them were referred from other hospitals. The ranging in age was from 4 months and 23 years at the moment of the first colonic replacement, and who required a second plasty because of intra or postoperative complications. The esophagocoloplasty was retrosternal in 6 cases and transhiatal in 2, with a left colon graft in 6, ileocolonic in I and right colon in the last one. The initial diagnosis was traqueoesophageal fistula in 6 (type III in 3, type I in 2 and IV in 1), caustic injury in 1 and herpetic esophagitis in 1. Complications requiring reoperation were stricture of the cervical esophagococolic anastomosis because of postoperative dehiscence (n=4), perioperative deficient graft vascularisation (n=2), graft necrosis (n= 1) and symptomatic gastric-colic reflux (n=l). RESULTS: The deficient graft irrigation was detected and managed during the surgical procedure in 2 cases, left colonic graft was remplaced by a gastric tube and the right colon, respectively, with excellent results. Repeated endoscopic dilatations (n=4) as well as surgical revision with resection and reanastomosis of the stenotic segment (n=2), did not suffice in children with severe strictures (100%). A second plasty was tried in 2 patients: a failed microsurgical sigmoid graft in one of them, and a presternal esophagocoloplasty with a left colonic graft in the other one. It was impossible to perform a new plasty in two chidren, because of the severe mediastinal fibrosis. One patient was referred with severe gastro-colic reflux and the cologastric anastomosis and the gastrostomy were refashioned. Another patient with graft necrosis required total resection of the coloplasty and a new esophagostomy and gastrostomy. 50% of the patients recovered digestive continuity, and nowadays three of them eat normally. The fourth one died after several years because of an Guillain Barr├® syndrome. Four patients are still waiting for future attempts of esophageal substitution. CONCLUSIONS: There are surgical options to reestablish the digestive continuity whenever the initial esophageal replacement fails. Severe postoperative strictures do not dissapear with endoscopic dilatations or stenotic resection and reanastomosis, but they usually require a new graft in another less injured place. Poor vascularisation of the graft can be prevented, giving the best solution for each patient, and at minimal suspicion of ischemia, consider another plasty or access during the operation.
47;exclude;Review: bowel preparation before elective colorectal surgery increases anastomotic leakage more than no preparation.;NA
48;exclude;Preoperative radiotherapy and extracellular matrix remodeling in rectal mucosa and tumour matrix metalloproteinases and plasminogen components.;BACKGROUND. Preoperative radiotherapy reduces recurrence but increases postoperative morbidity. The aim of this study was to explore the effect of radiotherapy in rectal mucosa and rectal tumour extracellular matrix (ECM) by studying enzymes and growth factors involved in ECM remodeling. MATERIALS AND METHODS. Twenty patients with short-term preoperative radiotherapy and 12 control patients without radiotherapy were studied. Biopsies from rectal mucosa and tumour were collected prior to radiotherapy and at surgery. Tissue MMP-1, -2, -9, TIMP-1, uPA, PAI-1, TGF-beta1 and calprotectin were determined by ELISA. Biopsies from irradiated and non-irradiated peritoneal areas were also analysed. RESULTS. Radiotherapy increased the tissue levels of MMP-2 and PAI-1 in both the rectal mucosa and tumours while calprotectin and uPA showed an increase only in the mucosa after irradiation. The increase of calprotectin was due to an influx of inflammatory cells as revealed by immunohistochemistry. Prior to irradiation, the tumour tissues had increased levels of MMP-1, -2, -9, total TGF-beta1, uPA, PAI-1 and calprotectin compared to mucosa, while TIMP-1 and the active TGF-beta1 fraction showed no statistical difference. CONCLUSIONS. This study indicates a radiation-induced effect on selected ECM remodeling proteases. This reaction may be responsible for early and late morbidity. Interference of this response might reduce these consequences.
49;exclude;Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis: the First Results From the Randomized Controlled Trial DILALA.;Objective: To evaluate short‐term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial. Background: Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and stoma (Hartmann procedure) with considerable postoperative morbidity and mortality. Laparoscopic lavage has been suggested as a less invasive surgical treatment. Methods: Laparoscopic lavage was compared with colon resection and stoma in a randomized controlled multicenter trial, DILALA (ISRCTN82208287). Initial diagnostic laparoscopy showing Hinchey III was followed by randomization. Clinical data was collected up to 12 weeks postoperatively. Results: Eighty‐three patients were randomized, out of whom 39 patients in laparoscopic lavage and 36 patients in the Hartmann procedure groups were available for analysis. Morbidity and mortality after laparoscopic lavage did not differ when compared with the Hartmann procedure. Laparoscopic lavage resulted in shorter operating time, shorter time in the recovery unit, and shorter hospital stay. Conclusions: In this trial, laparoscopic lavage as treatment for patients with perforated diverticulitis Hinchey III was feasible and safe in the short‐term.
50;exclude;[Anti-edema activity of injectable Venoruton in abdominal surgery].;"The anti-oedema activity of an injectable drug (HR; active principle: 0-(beta-hydroxyethyl)-rutoside) was assessed in 60 gastric extrahepatic bile duct, and large intestine surgery patients (30 being used as controls). Gastroscopy (with biopsy), gastroduodenoscopy, colonoscopy (with biopsy) and radiological examination were usually performed on the 5th and 10th post-operative days. The drug showed significant therapeutic effects: rapid resolution of oedema, especially at the sutures, leading to early cicatrisation, canalisation and the prevention of dehiscence. Finally, duration of hospitalisation was less than in the untreated cases. The gastroscopic, radiographic and biopsy findings are considered to have shown clear evidence of the drug's action against oedema formation."
51;exclude;Acute pseudo-obstruction of the colon (Ogilvie's syndrome) following open heart surgery.;The acute pseudo-obstruction of the colon or Ogilvie's syndrome is a rare surgical complication with an unknown pathogenesis. It is characterized by a distention of the large bowel without distal mechanical obstruction and a normal motility of the small bowel. The cause may be a postoperative imbalance between the sympathic and parasympathic innervation of the distal colon. In about one third of the cases a spontaneous perforation of the cecum develops, with a mortality of up to 50 per cent. We report the 5th case after cardiovascular surgery in the literature overall and the first in which conservative therapy successfully prevented perforation and laparotomy. An overview of the etiology, diagnosis, and treatment of this complication is given.
52;exclude;High Variability in Nosocomial Clostridium difficile Infection Rates Across Hospitals After Colorectal Resection.;BACKGROUND: Hospital-acquired Clostridium difficile infection is associated with adverse patient outcomes and high medical costs. The incidence and severity of C. difficile has been rising in both medical and surgical patients. OBJECTIVE: Our aim was to assess risk factors and variation associated with the development of nosocomial C. difficile colitis among patients undergoing colorectal resection. DESIGN: This was a retrospective cohort study. SETTINGS: The study included segmental colectomy and proctectomy cases in New York State from 2005 to 2013. PATIENTS: The study cohort included 150,878 colorectal resections. Patients with a documented previous history of C. difficile infection or residence outside of New York State were excluded. MAIN OUTCOME MEASURES: A diagnosis of C. difficile colitis either during the index hospital stay or on readmission within 30 days was the main measure. RESULTS: C. difficile colitis occurred in 3323 patients (2.2%). Unadjusted C. difficile colitis rates ranged from 0% to 11.3% among surgeons and 0% to 6.8% among hospitals. After controlling for patient, surgeon, and hospital characteristics using mixed-effects multivariable analysis, significant unexplained variation in C. difficile rates remained present across hospitals but not surgeons. Patient factors explained only 24% of the total hospital-level variation, and known surgeon and hospital-level characteristics explained an additional 8% of the total hospital-level variation. Therefore, ≈70% of the hospital variation in C. difficile infection rates remained unexplained by captured patient, surgeon, and hospital factors. Furthermore, there was an ≈5-fold difference in adjusted C. difficile rates across hospitals. LIMITATIONS: A limited set of hospital and surgeon characteristics was available. CONCLUSIONS: Colorectal surgery patients appear to be at high risk for C. difficile infection, and alarming variation in nosocomial C. difficile infection rates currently exists among hospitals after colorectal resection. Given the high morbidity and cost associated with C. difficile colitis, adopting institutional quality improvement programs and maintaining strict prevention strategies are of the utmost importance.
53;exclude;Full mucosal proctectomy initiated below the dentate line may prevent the development of a perianal fistula after ileal pouch-anal anastomosis for ulcerative colitis.;BACKGROUND: Long-term functional results of ileal pouch-anal anastomosis (IPAA) with mucosal proctectomy (MP) for ulcerative colitis (UC) are satisfactory but may be compromised by perianal fistulae. METHODS: We analyzed the effect of the level of MP (above or below the dentate line) on the risk of perianal fistulae in 151 patients undergoing IPAA for UC. RESULTS: A postoperative perianal fistula occurred in 12 patients (10 with MP from the level above the dentate line and 2 below). Patients developing perianal fistulae after IPAA were significantly younger at IPAA (23 vs. 32 years, p = 0.015). Age <25 years at UC onset (hazard ratio, HR, 3.5, p = 0.041), age <30 years at IPAA (HR 4.3, p = 0.015) and MP above the dentate line (HR 4.7, p = 0.010) were significant risk factors for perianal fistulae after IPAA. Multivariate analysis showed that age <30 years at IPAA (HR 4.4, p = 0.018) and MP above the dentate line (HR 6.0, p = 0.012) were significant risk factors. CONCLUSION: IPAA with MP below the dentate line for UC might reduce the risk of postoperative perianal fistulae.
54;exclude;Effect of preadmission bowel preparation on outcomes of elective colorectal procedures in young children.;"BACKGROUND: The utility of mechanical bowel preparation (MBP) to minimize infectious complications in elective colorectal surgery is contentious. Though data is scarce in children, adult studies suggest a benefit to MBP when administered with oral antibiotics (OAB). METHODS: After IRB approval, the Pediatric Health Information System (PHIS) was queried for young children undergoing elective colon surgery from 2011 to 2014. Patients were divided into: no bowel preparation (Group 1), MBP (Group 2), and MBP plus OAB (Group 3). Statistical significance was determined using univariate and multivariate analysis with GEE models accounting for clustering by hospital. RESULTS: One thousand five hundred eighty-one patients met study criteria: 63.7% in Group 1, 27.1% in Group 2, and 9.2% in Group 3. Surgical complication rate was higher in Group 1 (23.3%) compared to Groups 2 and 3 (14.2% and 15.5%; P<0.001). However, median length of stay was shorter in Group 1 (4, IQR 4days) compared to Group 2 (5, IQR 3) and Group 3 (6, IQR 3) (P<0.001). 30-day readmission rates were similar. In multivariate analysis compared to patients in Group 1, the odds of surgical complications were 0.72 (95% CI 0.40-1.29, P=0.28) with MBP alone (Group 2), 1.79 (95% CI 1.28-2.52, P=0.0008) with MBP+OAB (Group 3), and 1.13 (95% CI 0.81-1.58, P=0.46) for the aggregate Group 2 plus 3. CONCLUSION: Utilization of bowel preparation in children is variable across children's hospitals nationally, and the benefit is unclear. Given the discrepancy with adult literature, a three-armed pediatric-specific randomized controlled trial is warranted. LEVEL OF EVIDENCE: Level III treatment study - retrospective comparative study."
56;exclude;Prospective phase-II-study evaluating postoperative radiotherapy of cervical and endometrial cancer patients using protons - the APROVE-trial.;Background: The prognosis for patients with cervical or endometrial cancer has improved over the last decades. Thus, reducing therapy‐related toxicity and impact on quality of life have become more and more important. With the development of new radiotherapy techniques like IMRT (Intensity‐modulated radiotherapy) the incidence of acute and chronic toxicities has already been reduced. Nevertheless, rates of complications requiring medical treatment range from 0.7‐8% according to literature. 7.7% of patients develop severe complications after 5years with an increasing risk for complications of 0.3%/year. Particularly, the volume of the small and large bowel receiving low doses (15Gy) has been shown to be a predictive factor for the development of higher bowel toxicity. With the introduction of proton therapy into clinical practice, there are new opportunities for optimization of organ at risk‐sparing thus possibly reducing toxicity. Methods/design: The APROVE study is a prospective single‐center one‐arm phase‐II‐study. Patients with cervical or endometrial cancer after surgical resection who have an indication for postoperative pelvic radiotherapy will be treated with proton therapy instead of the commonly used photon radiation. A total of 25 patients will be included in this trial. Patients will receive a dose of 45‐50.4 GyE in 1.8 GyE fractions 5‐6 times per week using active raster‐scanning pencil beam proton radiation. Platinum‐based chemotherapy can be administered if indicated. For treatment planning, rectum, sigma, large and small bowel, bladder and femoral heads are defined as organs at risk. The CTV is defined according to the RTOG consensus guidelines. Discussion: The primary endpoint of the study is the evaluation of safety and treatment tolerability of pelvic radiation using protons defined as the lack of any CTC AE Grade 3 or 4 toxicity. Secondary endpoints are clinical symptoms and toxicity, quality of life and progression‐free survival. The aim is to explore the potential of proton therapy as a new method for adjuvant pelvic radiotherapy to decrease the dose to the bowel, rectum and bladder thus reducing acute and chronic toxicity and improving quality of life. Trial registration: Registered at https://clinicaltrials.gov , ClinicalTrials.gov Identifier: NCT03184350 , registered 09 June 2017, enrolment of the first participant 19 June 2017. Copyright © 2017 The Author(s)
57;exclude;Single-dose amoxycillin-clavulanic acid vs. cefotetan for prophylaxis in elective colorectal surgery: a multicentre, prospective, randomized study. The PRODIGE Group.;A prospective, multicentre, randomized trial was carried out in 19 hospitals in order to compare the efficacy of amoxycillin-clavulanic acid with cefotetan as antibiotic prophylaxis in patients undergoing elective colorectal surgery. Since the main purpose of the study was to demonstrate equivalence between the two regimens, the protocol planned the inclusion of 200 patients. Eligible patients were randomly assigned to receive either amoxycillin-clavulanic acid (2.2 g) or cefotetan (2 g) in a single infusion on the induction of anaesthesia. Failure of prophylaxis was defined as occurrence of infection of intestinal origin, either minor (wound cellulitis) or major (abscess, peritonitis, septicaemia) within the 30-day postoperative period. Among 221 randomized patients, 208 (105 amoxycillin-clavulanic acid, 103 cefotetan) aged 66 +/- 12 years (mean +/- SD) were evaluated while 13 were withdrawn. Colorectal cancer was the indication for surgery in 73% of cases. Eleven (10 +/- 6%, 95% confidence interval) and 13 (13 +/- 7%) failures were observed in the amoxycillin-clavulanic acid and cefotetan groups (P = 0.63 chi-square test) respectively. Most infections occurred before the 10th postoperative day (8% failures at this time, estimated by the Kaplan-Meier method). The results of the trial demonstrate that amoxycillin-clavulanic acid and cefotetan have similar efficacy when used for prophylaxis of infection after elective colorectal surgery.
