Home About us Contact
|
Home About us Contact | ||
|
|
||
Colorectal Resection (colorectal + resection)
Selected AbstractsBowel resection for severe endometriosis: An Australian series of 177 casesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Hannah J. WILLS Background: Colorectal resection for severe endometriosis has been increasingly described in the literature over the last 20 years. Aims: To describe the experiences of three gynaecological surgeons who perform radical surgery for colorectal endometriosis. Methods: The records of three surgeons were reviewed. Relevant information was extracted and complied into a database. Results: One hundred and seventy-seven women were identified as having undergone surgery between February 1997 and October 2007. The primary reason for presentation was pain in the majority of women (79%). Eighty-one segmental resections were performed, 71 disc excisions, ten appendicectomies and multiple procedures in ten women. The majority of procedures (81.4%) were performed laparoscopically. Histology confirmed the presence of disease in 98.3% of cases. A further 124 procedures to remove other sites of endometriosis were conducted, along with an additional 44 procedures not primarily for endometriosis. A total of 16 unintended events occurred. Conclusions: Our study adds to the growing body of literature describing colorectal resection for severe endometriosis. Overall, the surgery appeared to be well tolerated, demonstrating the role for this surgery. [source] Combined first-stage hepatectomy and colorectal resection in a two-stage hepatectomy strategy for bilobar synchronous liver metastases,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2010M. Karoui Background: This study assessed the feasibility and outcomes of combined colorectal and hepatic resection as the first step of two-stage hepatectomy in patients with bilobar synchronous colorectal liver metastases. Methods: All patients with bilobar synchronous colorectal liver metastases who were considered for two-stage hepatectomy, combining resection of the primary tumour with the first stage of hepatectomy, between 2000 and 2008 were selected from a prospectively collected database at two institutions. Data were analysed retrospectively on an intention-to-treat basis. Results: Thirty-three patients were studied. Twenty patients received neoadjuvant chemotherapy. Combined colorectal resection and clearance of left-sided liver metastases was the first-stage procedure in all but one patient, in whom right clearance was performed. In 17 patients right portal vein ligation was undertaken at the same time. No patient died. Two patients had anastomotic leakage. Interval chemotherapy was given to 25 patients, five of whom also had percutaneous portal vein embolization. Twenty-five patients had the second-stage hepatectomy, but not eight patients with disease progression. There was one postoperative death after the second stage, and eight patients experienced morbidity. Median follow-up from the first stage was 28·7 months. Overall and disease-free survival rates for patients who completed the procedure were 80 and 44 per cent respectively at 3 years, and 48 and 22 per cent at 5 years. Conclusion: In patients with bilobar synchronous colorectal liver metastases who are candidates for two-stage hepatectomy, combined resection of the primary tumour and first-stage hepatectomy reduces the number of procedures, optimizes chemotherapy administration and may improve outcome. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Laparoscopic reintervention for anastomotic leakage after primary laparoscopic colorectal surgery,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2007J. Wind Background: Anastomotic leakage is associated with high morbidity and mortality rates. The aim of this study was to assess the potential benefits of a laparoscopic reintervention for anastomotic leakage after primary laparoscopic surgery. Methods: Between January 2003 and January 2006, ten patients who had laparoscopic colorectal resection and later developed anastomotic leakage had a laparoscopic reintervention. A second group included 15 patients who had relaparotomy after primary open surgery. Results: Patient characteristics were comparable in the two groups. The median time from first operation to reintervention was 6 days in both groups. There were no conversions. The intensive care stay was shorter in the laparoscopic group (1 versus 3 days; P = 0·002). Resumption of a normal diet (median 3 versus 6 days; P = 0·031) and first stoma output (2 versus 3 days; P = 0·041) occurred earlier in the laparoscopic group. The postoperative 30-day morbidity rate was lower (four of ten patients versus 12 of 15; P = 0·087) and hospital stay was shorter (median 9 versus 13 days; P = 0·058) in the laparoscopic group. No patient developed incisional hernia in the laparoscopic group compared with five of 15 in the open group (P = 0·061). Conclusion: These data suggest that laparoscopic reintervention for anastomotic leakage after primary laparoscopic surgery is associated with less morbidity, faster recovery and fewer abdominal wall complications than relaparotomy. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] A protocol is not enough to implement an enhanced recovery programme for colorectal resection,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2007J. Maessen Background: Single-centre studies have suggested that enhanced recovery can be achieved with multimodal perioperative care protocols. This international observational study evaluated the implementation of an enhanced recovery programme in five European centres and examined the determinants affecting recovery and length of hospital stay. Methods: Four hundred and twenty-five consecutive patients undergoing elective open colorectal resection above the peritoneal reflection between January 2001 and January 2004 were enrolled in a protocol that defined multiple perioperative care elements. One centre had been developing multimodal perioperative care for 10 years, whereas the other four had previously undertaken traditional care. Results: The case mix was similar between centres. Protocol compliance before and during the surgical procedure was high, but it was low in the immediate postoperative phase. Patients fulfilled predetermined recovery criteria a median of 3 days after operation but were actually discharged a median of 5 days after surgery. Delay in discharge and the development of major complications prolonged length of stay. Previous experience with fast-track surgery was associated with a shorter hospital stay. Conclusion: Functional recovery in 3 days after colorectal resection could be achieved in daily practice. A protocol is not enough to enable discharge of patients on the day of functional recovery; more experience and better organization of care may be required. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Trends towards increased use of the laparoscopic approach in colorectal surgeryCOLORECTAL DISEASE, Issue 10 2010J. Lengyel Abstract Aim, The aim of the study was to identify the trend towards laparoscopic resection in the practice of one surgeon and to determine whether the default approach to all colorectal procedures could be by means of minimally invasive techniques with an associated low rate of conversion. Method, A prospective database of primary colorectal resections under the care of one colorectal surgeon collected between July 2003 and December 2008 was analysed to determine the trend in the use of the laparoscopic approach and the rate of conversion of an intention-to-treat policy for laparoscopic procedures. Patients with recurrent rectal or colonic malignancy were excluded from the study. Results, A total of 598 patients underwent elective colorectal resection of which 371 (62%) were carried out laparoscopically with a rate of conversion of 3.2%. The proportion of all colorectal resections that were undertaken laparoscopically in the first 1 year was 26% (22/85) (no conversions). This proportion rose to 100% (127/127) in the fifth year of the study of which 4.0% were converted. The introduction of more complex procedures did not have an adverse effect on the trend towards more laparoscopic resections The commencement of a laparoscopic colorectal fellowship in 2006 was associated with a marked increase in the number of laparoscopic cases. Conclusion, A conscious decision to make the laparoscopic approach the default for all colorectal resections can be achieved safely with a low conversion rate. This can be achieved within the context of training a ,novice' laparoscopic colorectal surgeon. [source] Preoperative conditioning with oral carbohydrate loading and oral nutritional supplements can be combined with mechanical bowel preparation prior to elective colorectal resectionCOLORECTAL DISEASE, Issue 9 2008P. O. Hendry Abstract Objective, Preoperative conditioning with oral fluid and carbohydrate (CHO) loading allows the patient to undergo surgery in the fed state and is associated with reduced postoperative insulin resistance. Further benefit may accrue from oral nutritional supplements (ONS) to counteract the fasting associated with mechanical bowel preparation (MBP). In this study we assess the ability to prescribe, dispense and have patients comply with a protocol combining preoperative ONS and CHO/fluid loading during MBP. Method, One hundred and forty-seven patients undergoing elective left colonic or rectal resection were recruited to an Enhanced Recovery after Surgery (ERAS) programme. All patients were prescribed MBP (2 sachets Picolax). On the daytime prior to surgery, eligible patients were prescribed 2 × 200 ml of ONS (Fortijuice®, Nutricia) and in the evening 800 ml oral CHO/fluid loading (Preop®, Nutricia,). Patients were prescribed a further 400 ml of oral/CHO/fluid on the morning of surgery 2 h prior to induction of anaesthesia. Protocol compliance was audited prospectively. Results, One hundred and forty-seven patients received MBP. Twenty-three patients were ineligible for oral CHO/fluid loading [diabetes (n = 22), allergy to lemon flavoured drinks (n = 1)]. Fourteen patients did not receive the preoperative CHO drinks due to failure to prescribe (n = 8) or dispense (n = 6). One hundred and ten patients were dispensed the combined ONS and CHO/fluid loading regimen, compliance rates were 83% with ONS, 80% with CHO/fluid loading and 74% with both. Conclusion, Approximately 74% of patients undergoing MBP can comply with preoperative conditioning with ONS and CHO/fluid loading. Prescription and dispensing requires close attention to detail. [source] The influence of an Enhanced Recovery Programme on clinical outcomes, costs and quality of life after surgery for colorectal cancerCOLORECTAL DISEASE, Issue 6 2006P. M. King Objective, Optimizing peri-operative care using an enhanced recovery programme improves short-term outcomes following colonic resection. This study compared a prospective group of patients undergoing resection of colorectal cancer within an enhanced recovery programme, with a prospectively studied historic cohort receiving conventional care. Patients and methods, Sixty patients underwent elective resection within an enhanced recovery programme (ERP). This incorporated pre-operative counselling, epidural analgesia, early feeding and mobilization. Clinical outcomes were compared with 86 prospectively studied historic control patients receiving conventional care (CC). All patients completed EORTC QLQ-C30, QLQ-CR38 and health economics questionnaires up to three months after surgery. Results, Baseline clinical data were similar in both groups. Postoperative hospital stay was significantly reduced in the ERP, with patients staying 49% as long as those in the CC group including convalescent hospital stay (95% CI 39% to 61%P < 0.001). There were no differences in the number of complications, readmissions or re-operations. There were no significant differences in quality of life or health economic outcomes. Conclusion, Patients undergoing colorectal resection within an ERP stay in hospital half as long as those receiving conventional care, with no increased morbidity, deterioration in quality of life or increased cost. [source] Postoperative arrhythmias in colorectal surgical patients: incidence and clinical correlatesCOLORECTAL DISEASE, Issue 3 2006S. R. Walsh Abstract Objective, To determine the incidence and clinical correlates of postoperative cardiac arrhythmias in patients undergoing elective large bowel resection. Methods, Fifty-one consecutive patients undergoing elective open colorectal resection were recruited for this prospective observational study. Participating patients underwent daily three-lead electrocardiograms postoperatively. Data regarding potential risk factors for arrhythmias were recorded. Post-operative complications were recorded. Results, Thirteen (26%) patients developed a postoperative arrhythmia, most commonly atrial fibrillation. Significant univariate correlates with postoperative arrhythmias were: age (P < 0.01), hypertension (P < 0.01), pre-operative serum potassium levels (P < 0.01), postoperative pulmonary oedema (P = 0.03), postoperative serum potassium (P = 0.03) and sodium (P < 0.01). Arrhythmia patients were more likely to have other complications (P = 0.02). Thirty-one percent of arrhythmia patients had underlying sepsis compared with 18% of controls (P = 0.38). Conclusion, Arrhythmias are common following elective large bowel resection. They occur in older patients and are associated with the development of other complications. [source] The benefit of geriatric intervention in surgery,increased throughput does not necessarily need more bedsCOLORECTAL DISEASE, Issue 6 2000R. B. Dunn Objective Three years ago a consultant geriatrician began regular visits to the coloproctology and general surgery wards of an acute Trust every weekday, to assist staff with the medical management, rehabilitation and discharge planning of patients aged 65 years and above. The length of stay of these patients in the first 10 months of the appointment was compared with younger concurrent controls and with historical controls in the preceding 10 months. Results The mean length of stay for the 4146 patients aged 16 years and above in a 10-month intervention period was 1.3 days shorter (95% confidence interval (CI) 0.86,1.74 days) than for the 4002 patients in the 10-month control period. This pattern was consistent across all ages and types of surgery, including major colorectal resection. Conclusion There was an important benefit to the availability of coloproctology and general surgical beds in this acute Trust. More efficient rehabilitation of elderly patients reduces ,bed blockage' post-operatively, and allows more effective use of available resources. Co-ordination of the geriatric service with the specialized stoma support service allows earlier discharge of the elderly, and their relocation to appropriate premises where long-term changes in bowel habit and problems with stoma care can be managed away from the acute surgical unit. [source] Trends towards increased use of the laparoscopic approach in colorectal surgeryCOLORECTAL DISEASE, Issue 10 2010J. Lengyel Abstract Aim, The aim of the study was to identify the trend towards laparoscopic resection in the practice of one surgeon and to determine whether the default approach to all colorectal procedures could be by means of minimally invasive techniques with an associated low rate of conversion. Method, A prospective database of primary colorectal resections under the care of one colorectal surgeon collected between July 2003 and December 2008 was analysed to determine the trend in the use of the laparoscopic approach and the rate of conversion of an intention-to-treat policy for laparoscopic procedures. Patients with recurrent rectal or colonic malignancy were excluded from the study. Results, A total of 598 patients underwent elective colorectal resection of which 371 (62%) were carried out laparoscopically with a rate of conversion of 3.2%. The proportion of all colorectal resections that were undertaken laparoscopically in the first 1 year was 26% (22/85) (no conversions). This proportion rose to 100% (127/127) in the fifth year of the study of which 4.0% were converted. The introduction of more complex procedures did not have an adverse effect on the trend towards more laparoscopic resections The commencement of a laparoscopic colorectal fellowship in 2006 was associated with a marked increase in the number of laparoscopic cases. Conclusion, A conscious decision to make the laparoscopic approach the default for all colorectal resections can be achieved safely with a low conversion rate. This can be achieved within the context of training a ,novice' laparoscopic colorectal surgeon. [source] The uptake of laparoscopic colorectal surgery in Great Britain and Ireland: a questionnaire survey of consultant members of the ACPGBICOLORECTAL DISEASE, Issue 3 2009K. E. Schwab Abstract Objective, The National Institute for Clinical Excellence (NICE) has recommended laparoscopic resection as an alternative to open surgery for patients with colorectal cancer. The aim of this study was to evaluate the current uptake of laparoscopic colorectal surgery in Great Britain and Ireland. Method, A questionnaire was distributed to members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) regarding their current surgical practice. Results were analysed individually, by region, and nationwide. Results, Information was received on 436 consultants (in 155 replies), of whom 233 (53%) perform laparoscopic colorectal procedures. During the previous year, 25% of colorectal resections were performed laparoscopically by the respondents. However, of those surgeons who were performing laparoscopic resections, only 30% performed more than half of all their resections laparoscopically. Right hemicolectomy, left-sided resections, and rectopexy were the most frequently performed laparoscopic resections. There was an even distribution throughout the country of consultants performing laparoscopic resections (regional IQR 48,60%). The main reason for consultants not performing laparoscopic procedures was a lack of training or funding. Conclusion, Laparoscopic colorectal surgery is being performed by more than half (53%) of colorectal consultants nationwide, although only a quarter of all procedures are being undertaken laparoscopically. [source] Laparoscopic colectomy is cheaper than conventional open resectionCOLORECTAL DISEASE, Issue 9 2007P. F. Ridgway Abstract Objective, International randomized trials have endorsed the routine use of laparoscopic techniques in colorectal surgery. The authors hypothesize that the overall care pathway in minimal access resection was cheaper than conventional open resection. Method, This was a case-matched study of consecutive patients undergoing laparoscopic resection between July 2005 and February 2006. Intraoperative (costs, duration, incision length) and postoperative [morbidity, length of stay (LOS), readmission] parameters were examined. Institutional retrospective open controls and national validated figures were used for costings. Results, Thirty-five laparoscopic and 53 open resections were evaluated. Median LOS was 5 days in the laparoscopic group vs 12 in the open group (P = 0.001). There were two conversions (5.7%) and two readmissions. Mean operative cost of laparoscopic resection was ,1557.08, therefore 2.4 bed days need to be saved to recoup the increased cost compared with open resection. The actual median save is 7 days (P = 0.031). A mean of ,4591.38 and 7 bed days per case is saved by performing the resection laparoscopically. Subgroup analysis of laparoscopic resections clearly demonstrates similar trends. Conclusion, The institutional saving is over ,150 000 and 245 bed days during the study period. Despite higher operative spending, laparoscopic colorectal resections are significantly cheaper than conventional open resections. [source] Pre-operative mechanical bowel cleansing or not? an updated meta-analysisCOLORECTAL DISEASE, Issue 4 2005P. Wille-Jørgensen Abstract Objectives, Pre-operative mechanical bowel preparation has been considered an efficient regimen against leakage and infectious complications, after colorectal resections. This dogma is based only on observational data and experts' opinions. The aim of this study was to evaluate the efficacy and safety of prophylactic pre-operative mechanical bowel preparation before elective colorectal surgery. Methods, EMBASE, LILACS, MEDLINE and The Cochrane Library and abstracts from major gastroenterological congresses were searched. No language restrictions were applied. The selection criterion used was randomised clinical trials (RCT) comparing any kind of mechanical bowel preparation with no preparation in patients submitted to elective colorectal surgery and where anastomotic leakage, mortality, and wound infection were outcome measurements. Data were independently extracted by the reviewers and cross-checked. The methodological quality of each trial was assessed by the same reviewers. For meta-analysis the Peto-Odds ratio was used. Results, Of 1592 patients (9 RCTs), 789 were allocated to mechanical bowel preparation (Group A) and 803 to no preparation (Group B) before elective colorectal surgery. Anastomotic leakage developed in 48 (6%) of 772 patients in A compared with 25 (3.2%) of 777 patients in B; Peto OR 2.03, 95% (CI: 1.28,3.26; P = 0.003). Wound infection occurred in 59 (7.4%) of 791 patients in A and in 43 (5.4%) of 803 patients in B; Peto OR 1.46, 95% (CI: 0.97,2.18; P = 0.07); Five (1%) of 509 patients died in group in A compared with 3 (0.61%) of 516 patients in group B; Peto OR 1.72, 95% (CI: 0.43,6.95; nonsignificant). Conclusion, There is no evidence that patients benefit from mechanical bowel preparation. On the contrary taking colorectal surgery as a whole, pre-operative bowel cleansing leads to a higher rate of anastomotic leakage. The dogma that mechanical bowel preparation is necessary before elective colorectal surgery has to be reconsidered. [source] | ||||||||||