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PubMed2000

Early feeding after oncological colorectal surgery in Japanese patients.

We aimed to determine the safety and feasibility of an alternative postoperative oral intake protocol for Japanese patients who had had oncological colorectal surgery, with the goal of shortening the length of postoperative stay to the same level as that in Western countries. The subjects of the study were 42 consecutive patients who underwent elective oncological colorectal surgery. Two protocols., Japanese traditional management (TM: n = 20) and alternative management (AM; n = 22), were employed. The two protocols differed in their management of oral intake after surgery. Tolerance of the alternative protocol and the incidence of postoperative complications were determined. The mean length of postoperative stay in the AM and TM groups was 11.5 +/- 1.2 and 24.0 +/- 2.1 days, respectively (P < 0.0001; t-test). Analysis of the patients who underwent open operation also revealed that the length of postoperative stay was less in the AM group than in the TM group (12.3 +/- 1.7 and 24.7 +/- 2.2 days, respectively, P = 0.0003). One patient in the TM group developed small bowel obstruction during the introduction of oral intake. One patient in the AM group also developed small bowel obstruction, after discharge. and was readmitted. Other patients tolerated both the TM and AM protocols. Morbidity in the AM group was 20.0%, and that in the TM group was 30.0% (P = 0.72). The employment of an alternative postoperative oral intake protocol was safe and feasible for Japanese patients. Further investigation is needed to determine the possible benefits, both medical and socioeconomic, of this approach.

Adult↗
PubMed1995

[Orthograde intestinal irrigation or Fordtran solution for bowel preparation in elective colorectal surgery. Prospective outcome study].

In a prospective cohort study, which was carried out at the department for abdominal surgery of the university of Mainz from June to December 1993, two methods of bowel preparation for elective colorectal surgery were compared: oral bowel preparation with Fordtran a new polyethylene glycol solution (63 patients), and whole-gut lavage with Ringer's solution (37 patients). The serum chloride levels and the bodyweight increased significantly more in the whole-gut lavage group. These patients also showed a higher frequency of vomiting during bowel preparation. Neither the bowel cleansing effect nor the postoperative complications differed significantly between the two groups. Owing to these results, the better patient acceptance, and the easier handling and lower costs of PEG solution, we recommend this method of preoperative bowel preparation for elective colorectal surgery.

Adult↗
PubMedDate not supplied

[Results of preoperative preparation with mannitol in colorectal surgery. January-December 1995].

A study on the results obtained in 20 patients selected by the simple randomized method, who were preoperatively prepared for colorectal surgery with the oral administration of manitol and complementary antimicrobial therapeutics at the ASaturnino Lora@ Provincial Teaching Hospital, in Santiago de Cuba, from January to December, 1995, was conducted aimed at evaluating the results attained with the use of manitol in the preoperative preparation for colorectal surgery, determining its complications, analyzing its advantages, and assessing the patient, nurse and surgeon's opinion about the new procedure. The following variables were taken into account: age, preoperative diagnosis and previous operations. The percentage statistical method was used. Most of the patients were elderly, who were able to undergo surgery. There were no complications in connection with the preoperative preparation, which has the following advantages: it is simpler and more efficient that the traditional use of enemas, it is easy to apply, it saves time and resources on reducing the preoperative stay, it is considered as more comfortable for patients and nurses, and it is much more economic and effective, which was proved by surgeons during the operation.

Adult↗
PubMed2003

Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery.

BACKGROUND: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) equations were derived from a heterogeneous general surgical population and have been used successfully as audit tools to provide risk-adjusted operative mortality rates. Their applicability to high-risk emergency colorectal operations has not been established. METHODS: POSSUM variables were recorded for 1017 patients undergoing major elective (n = 804) or emergency (n = 213) colorectal surgery in ten hospitals. Subgroup analysis was performed to investigate the predictive capability of POSSUM and P-POSSUM in emergency and elective surgery and in patients in different age groups. RESULTS: The overall operative mortality rate was 7.5 per cent (POSSUM-estimated mortality rate 8.2 per cent; P-POSSUM-estimated mortality rate 7.1 per cent). In-hospital deaths increased exponentially with age. Both scoring systems overpredicted mortality in young patients and underpredicted mortality in the elderly (P < 0.001). Death was underpredicted by both systems for emergency cases, significantly so at a simulated emergency caseload of 47.9 per cent (P < 0.05). CONCLUSION: There is a lack of calibration of POSSUM and P-POSSUM systems at the extremes of age and high emergency workload. This has important implication in clinical practice, as consultants with a high emergency workload may seem to underperform when these scoring systems are applied. Recalibration or remodelling strategies may facilitate the application of POSSUM-based systems in colorectal surgery.

Adult↗
PubMedDate not supplied

Current status in laparoscopic colorectal surgery.

BACKGROUND: Laparoscopic techniques are being applied with increasing frequency to surgery of both small and large intestines. PURPOSE: This review article was undertaken to analyze the current direction of laparoscopic colorectal surgery. RESULTS: The most feasible procedures are diagnostic laparoscopy, construction of intestinal stomas, rectopexy, and limited resections for benign conditions. Resections for Crohn's disease, especially extensive resections, and colorectal cancer are complex and should be considered investigational. CONCLUSIONS: The role for use of laparoscopic techniques in colorectal surgery will expand greatly in the next several years.

Adenomatous Polyposis Coli↗
PubMed2003

Pharmacokinetics and tissue penetration of pefloxacin plus metronidazole after administration as surgical prophylaxis in colorectal surgery.

The levels of metronidazole and pefloxacin in plasma and tissue penetration of both drugs were studied after prophylactic administration to 7 patients undergoing colorectal surgery. Metronidazole (1,500 mg) and pefloxacin (800 mg) were administered as an intravenous infusion 1 hour before surgery. Mean plasma levels of pefloxacin decreased from 12.92 +/- 4.10 microg/ml at the end of the infusion to 2.18 +/- 1.03 microg/ml at 36 h. These values were above the MIC90 for E. coli (0.125 microg/ml) and E. faecalis (0.5 microg/ml), microorganisms responsible for abdominal infections. Tissue pefloxacin levels were also measured with a range from 0.72 - 7.78 microg/g in subcutaneous cell tissue, from 1.94 - 17.55 microg/g in peritoneum and from 2.76 - 21.99 microg/g in colon wall. Mean plasma concentrations of metronidazole decreased from 39.89 +/- 17.08 microg/ml at the end of the infusion to 2.63 +/- 1.11 microg/ml at 36 h. During this period, concentrations were higher than 2 microg/ml, the MIC90 value for B. fragilis, the anaerobic pathogen more frequently involved in postoperative infections after rectal and colonic surgery. Tissue metronidazole levels ranged from 3.64 - 13.37 microg/g in subcutaneous cell tissue, from 3.26 - 41.66 microg/g in peritoneum and from 6.72 - 43.12 microg/g in colon wall. The AUC/MIC values (efficacy parameter for concentration-dependent killing antibiotics such as pefloxacin and metronidazole) obtained were the following: metronidazole AUC/MIC value for B. fragilis was 173; pefloxacin AUC/MIC values for E. coli and E. faecalis were 941 and 235, respectively. The values of these parameters are higher than the recommended values to ensure efficacy, which means good exposure of the antimicrobials to the microorganisms. In conclusion, the combination of pefloxacin and metronidazole as prophylactic agents to prevent infections in patients undergoing colorectal surgery produce plasma and tissue levels above the MIC values of the main pathogens responsible for this kind of infections.

Adult↗
PubMed1989

Antibiotic prophylaxis in colorectal surgery. Combined doxycycline-tinidazole vs. doxycycline alone.

Single-dose doxycycline was compared with single-dose doxycycline + tinidazole in regard to prevention of septic complications after colorectal surgery, taking into account the type and level of surgery--right or left hemicolectomy, rectal operations and others. The study was performed as a prospective double-blind trial, with randomization in blocks. In colorectal surgery as a whole the combination was found to be more effective than doxycycline alone. When the four surgical blocks were separately considered, however, the difference between the two regimens was found to be mainly due to rectal operations, following which the incidence of abdominal and of perineal wound infections was significantly lower with the combined regimen than with doxycycline alone. The subgroups composed of right-sided or left-sided hemicolectomy or other operations were too small to permit definite conclusions.

Adolescent↗
PubMed1994

Use of laparoscopic techniques in colorectal surgery. Preliminary study.

PURPOSE: This study evaluated the feasibility and safety of laparoscopic bowel surgery performed by colorectal surgeons not previously experienced in laparoscopic biliary or appendiceal surgery. METHODS: Thirty-two patients underwent ileocolic resection/anastomosis (n = 12), loop ileostomy (n = 7), colostomy (n = 4), ileostomy takedown/ileorectal anastomosis (n = 3), subtotal colectomy/ileorectal anastomosis (n = 2), sigmoid resection (n = 2), or other procedures (n = 2). No curative cancer surgery was undertaken. RESULTS: Time to first bowel movement was one to eight (median, four) days. Length of stay ranged from 4 to 11 (median, 6) days. There were no major complications seen in follow-up from 6 to 15 (median, 7) months after surgery. CONCLUSIONS: Large intestinal and distal ileal surgery using laparoscopic techniques, performed by surgeons with training only in laparoscopic intestinal surgery, is feasible and safe. Faster recovery and need for less postoperative analgesia in laparoscopic surgery compared with conventional surgery cannot be surmised from this study. A randomized study design is needed to evaluate many of the differences between conventional and laparoscopic intestinal surgery.

Adolescent↗
PubMed1997

Prevention of wound infection in elective colorectal surgery by local application of a gentamicin-containing collagen sponge.

Preoperative antibiotic prophylaxis is known to significantly reduce the incidence of postoperative wound infection in elective colorectal surgery, and is a recognized part of surgical management. Antibiotics are usually given systemically or orally, or by a combination of the two routes. Local antibiotic delivery to the wound site using an implanted, reabsorbable, gentamicin-containing collagen sponge is a novel concept. We compared postoperative wound infection rates in 221 colorectal surgery patients randomized to receive systemic gentamicin/metronidazole with (Group I, n = 107) or without (Group II, n = 114) the gentamicin-collagen sponge. The two patient groups were identical on the basis of demographics and operations undergone. The postoperative wound infection rate was significantly lower in Group I patients than Group II 5.6% (6/107) and 18.4% (21/ 114), respectively (p < 0.01). The mean duration of hospital stay was 13.8 days in Group I and 16.3 days in Group II, which did not represent a statistically significant difference. The gentamicin collagen sponge was well tolerated and no adverse events were reported that were attributable to its use. This new method for delivering gentamicin directly to the operative site may represent a significant method for reducing postoperative wound infection rates to levels lower than those currently achieved with systemic antibiotics alone.

Administration, Oral↗
PubMed2006

Tissue oxygen saturation during colorectal surgery measured by near-infrared spectroscopy: pilot study to predict anastomotic complications.

INTRODUCTION: We investigated the relation between tissue oxygen saturation measured by near-infrared spectroscopy (NIRS) and anastomotic complications associated with colorectal surgery. METHODS: A series of 20 patients with colorectal cancer underwent radical surgery with enteric anastomosis. Measurements of tissue oxygen saturation (StO2) were performed at both the proximal and distal portions of the anastomotic site; in cases of anterior resection, we measured StO2 only in the proximal portion. RESULTS: Two anastomotic complications (one leakage, one stenosis) occurred in the 20 cases. The StO2 in patients with anastomotic complications was 58.0%, and that in patients without complications was 71.0%. Altogether, 18 patients had StO2 values > 66%, and none of them had anastomotic complications. In contrast, 2 patients had StO2 values < 60%, and both had anastomotic complications. CONCLUSIONS: The StO2 of the anastomotic site can be safely and reliably measured by NIRS during colorectal surgery. Low StO2 on both sides of the anastomosis may indicate an increased risk of anastomotic complications. Further study is needed to determine the cutoff value for StO2 required to prevent serious complications.

Aged↗
PubMed1995

Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial.

INTRODUCTION: The routine use of a nasogastric tube after elective colorectal surgery is no longer mandatory. More recently, early feeding after laparoscopic colectomy has been shown to be safe and well tolerated. Therefore, the aim of our study was to prospectively assess the safety and tolerability of early oral feeding after elective "open" abdominal colorectal operations. MATERIALS AND METHODS: All patients who underwent elective laparotomy with either colon or small bowel resection between November 1992 and April 1994 were prospectively randomized to one of the following two groups: group 1: early oral feeding--all patients received a clear liquid diet on the first postoperative day followed by a regular diet as tolerated; group 2: regular feeding--all patients were treated in the "traditional" way, with feeding only after the resolution of their postoperative ileus. The nasogastric tube was removed from all patients in both groups immediately after surgery. The patients were monitored for vomiting, bowel movements, nasogastric tube reinsertion, time of regular diet consumption, complications, and length of hospitalization. The nasogastric tube was reinserted if two or more episodes of vomiting of more than 100 mL occurred in the absence of bowel movement. Ileus was considered resolved after a bowel movement in the absence of abdominal distention or vomiting. RESULTS: One hundred sixty-one consecutive patients were studied, 80 patients in group 1 (34 males and 46 females, mean age 51 years [range 16-82 years]), and 81 patients in group 2 (43 males and 38 females, mean age 56 years [range 20-90 years]). Sixty-three patients (79%) in the early feeding group tolerated the early feeding schedule and were advanced to regular diet within the next 24 to 48 hours. There were no significant differences between the early and regular feeding groups in the rate of vomiting (21% vs. 14%), nasogastric tube reinsertion (11% vs. 10%), length of ileus (3.8 +/- 0.1 days vs. 4.1 +/- 0.1 days), length of hospitalization (6.2 +/- 0.2 days vs. 6.8 +/- 0.2 days), or overall complications (7.5% vs. 6.1%), respectively, (p = NS for all). However, the patients in the early feeding group tolerated a regular diet significantly earlier than did the patients in the regular feeding group (2.6 +/- 0.1 days vs. 5 +/- 0.1 days; p < 0.001). CONCLUSION: Early oral feeding after elective colorectal surgery is safe and can be tolerated by the majority of patients. Thus, it may become a routine feature of postoperative management in these patients.

Adolescent↗
PubMed2002

Is obesity a high-risk factor for laparoscopic colorectal surgery?

BACKGROUND: The aim of this study was to assess the outcome of laparoscopic colorectal surgery in obese patients and compare it to that of a nonobese group of patients who underwent similar procedures. METHODS: All 162 consecutive patients who underwent an elective laparoscopic or laparoscopic-assisted segmental colorectal resection between August 1991 and December 1997 were evaluated. Body mass index (BMI; kg/m2) was used as an objective index to indicate massive obesity. The parameters analyzed included BMI, age, gender, comorbid conditions, diagnosis, procedure, American Society of Anesthesiologists classification score, operative time, estimated blood loss, transfusion requirements, intraoperative complications, conversion to laparotomy, postoperative complications, length of hospitalization, and mortality. RESULTS: Thirty-one patients (19.1%) were obese (23 males and 8 females). Conversion rates were significantly increased in the obese group (39 vs 13.5%, p = 0.01), with an overall conversion rate of 18%. The postoperative complication rate in the obese group was 78% versus 24% in the nonobese group (p <0.01). Specifically, rates of ileus and wound infections were significantly higher in the obese group [32.3 vs. 7.6% (p <0.01) and 12.9 vs 3.1%. (p = 0.03), respectively]. Furthermore, hospital stay in the obese group was longer (9.5 days) than in the nonobese group (6.9 days, p = 0.02). CONCLUSION: Laparoscopic colorectal segmental resections are feasible in obese patients. However, increased rates of conversion to laparotomy should be anticipated and the risk of postoperative complications is significantly increased, prolonging the length of hospitalization when compared to that of nonobese patients.

Adolescent↗
PubMedDate not supplied

Delayed hypersensitivity skin testing in elective colorectal surgery and relationship to postoperative sepsis.

Delayed hypersensitivity skin testing to five common recall antigens (Varidase, Candida, PPD, Trichophyton, and Mumps) was performed on 50 patients undergoing elective colorectal surgery. Eighteen patients showed an altered response to skin testing (11 relative anergy, seven total anergy) and this group of patients had a significant increase in both total septic complications (p less than 0.001) and major septic complications (p less than 0.05) following operation. Anergy in these patients did not correlate with nutritional status, but it did relate to stage of the tumor in patients with cancer. The low specificity of abnormal delayed hypersensitivity skin testing and its failure to be related to malnutrition limits the practical application of this technique in patients undergoing elective colorectal surgery.

Adult↗
PubMed2001

Training period in laparoscopic colorectal surgery.

BACKGROUND: Thorough training is essential to the success of colorectal laparoscopic surgery (LPS). The aim of this study was to evaluate the results of a 3-month training period in LPS. METHODS: Before beginning the study, the surgical team attended several courses of LPS and spent a long time working at a large animal facility to perfect laparoscopic techniques. Twenty-six consecutive patients underwent LPS in a 3-month training period. Controls (n = 26) who underwent open colorectal surgery (LPT) were selected to match the LPS patients for age, gender, primary disease, type of surgery, comorbidity, and nutritional status. RESULTS: Conversion to open surgery was necessary in one patient (3.8%). The operative time was 1 h longer for LPS than LPT (p < 0.001). The mean number of lymph nodes harvested was 17 in LPS and 18 in LPT (p = 0.76). The first flatus (p < 0.02) and bowel movement (p < 0.002) occurred earlier in the LPS group. The postoperative infection rate was 11.5% for LPS and 19.2% for LPT (p = 0.33). Two anastomotic leaks occurred in each group. The mean postoperative hospital stay was 9.6 days (standard deviation [SD], 2.6) for LPS and 11.0 days (SD, 5.2) for LPT (p = 0.68). Recovery of postoperative physical performance and social life occurred earlier in the LPS than the LPT group (p < 0.001). At 1-year follow-up, no difference was found in terms of cancer recurrence or long-term complications. CONCLUSION: Oncologic results and postoperative morbidity were comparable for LPS and LPT. LPS allows a faster postoperative recovery.

Adolescent↗
PubMed1981

[Urinary enzyme excretion after prophylactic antibiotic therapy in patients following colorectal surgery (author's transl)].

The urinary excretion of N-acetyl-beta-glucosaminade (NAG) and alanine aminopeptidase (AAP) was measured as an indicator for nephrotoxicity to neomycin and gentamycin in patients after colorectal surgery. We found that the continuous determination of urinary enzymes is a good indicator for the degree of kidney damage. The dose dependence of nephrotoxicity was influenced by the severity of colorectal surgery. The simple method of urinary enzyme determination seems to be a very valuable test to detect parenchymal damage of the kidney after prophylactic antibiotic therapy.

Acetylglucosaminidase↗
PubMed2001

Impact of oral antimicrobial prophylaxis on surgical site infection and methicillin-resistant Staphylococcus aureus infection after elective colorectal surgery. Results of a prospective randomized trial.

The impact of oral antimicrobial prophylaxis on the surgical site infection and methicillin-resistant Staphylococcus aureus (MRSA) infection after elective colorectal surgery was evaluated by a prospective randomized single-blind study. The patients were randomly allocated to receive either mechanical bowel cleansing with polyethylene glycol alone (group 1) or mechanical cleansing plus oral antimicrobial prophylaxis with kanamycin and erythromycin for 2 days prior to surgery (group 2). In both groups, cefotiam was intravenously given twice a day for 3 days. A total of 143 patients (71 for group 1 and 72 for group 2) were eligible. The incidence of a surgical site infection was 23.9% in group 1 and 11.1% in group 2 (P = 0.04). The incidence of MRSA infection including at surgical and remote sites was 11.1% in group 1 and 5.6% in group 2 (P = 0.19). A multivariate logistic regression analysis showed that the risk of surgical site infection was influenced by the choice of the chemical bowel preparation (P = 0.03) and blood loss (P < 0.01), while an MRSA infection was predominantly influenced by blood loss (P < 0.01) followed by coexisting underlying diseases (P = 0.07). These results suggest that preoperative antimicrobial prophylaxis would be useful for reducing the incidence of a surgical site infection without increasing the risk of an MRSA infection following elective colorectal surgery.

Adult↗
PubMedDate not supplied

[Infectious chemoprophylaxis in colorectal surgery. A multicenter study of imipenem-cilastatin vs. cefuroxime and metronidazole or cefotetan].

The authors report the results of a multicentric clinical study on prevention of surgical infections in colorectal surgery by chemo-antibiotic prophylaxis. This trial was carried on to evaluate the effect of imipenem-cilastatin (1 g i.v. just before operation and 1 g i.v. 3 hours from surgical procedure) vs. cefuroxime + metronidazole (1.5 g + 0.25 g i.v.) or cefotetan (1 g i.v.) given with the same modalities. In 48 patients undergoing colorectal resection (47 with malignant neoplastic disease) 24 were treated with imipenem, 18 with cefuroxime and 6 with cefotetan. In group A (imipenem-cilastatin) the infection rate was 4.2% (1/24 cases), in group B (cefuroxime + metronidazole or cefotetan) postoperative infections were registered in 4 out of 24 cases (16.6%). This study documented the good results of systemic chemoprophylaxis and the great efficacy of imipenem-cilastatin in colorectal surgery.

Cefotetan↗
PubMed1994

The application of laparoscopy in colorectal surgery: a preliminary report of twelve cases.

BACKGROUND: With the development of video camera imaging system and the improvement of laparoscopic manipulation instruments, laparoscopic surgery has become applicable to many abdominal surgeries. Having completed the feasibility studies of animal model over 10 dogs, we began to apply this new technique in the field of colorectal surgery. METHODS: From March to July 1993, 12 cases of large bowel resection were performed with laparoscopy. Operations performed included seven cases of laparoscopy-assisted right colectomy (LARC), three cases of laparoscopic abdominal-perineal resection (LAPR), one case of laparoscopic low anterior resection (LLAR) and one case of laparoscopy-assisted subtotal colectomy. Five cases received operation due to diverticular disease, three due to rectal carcinoma, three due to broad villous adenoma and one due to lipoma over ileocecal region. RESULTS: The average operation time for LARC was 4 hours and 50 minutes, and for LAPR was 6 hours and 35 minutes. Operation time required decreased substantially as the number of laparoscopic surgery performed increased. The average post-operative length of stay was 5.5 days for LARC and 11.5 days for LAPR. Most of the patient started diet intake on the third day after surgery. There was no major complication. Only two cases developed minor complications of subcutaneous hematoma over trocar insertion site and minor wound infection. CONCLUSIONS: Laparoscopic technique can feasibly be employed in certain cases of colorectal surgery, although it is rather complicated and requires longer learning curve than other laparoscopic procedures. Therefore, surgeons should take it most caution while carrying out this procedure. Experimental trials over animal model is also highly recommended before clinical practice.

Adult↗