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At least 325 records · Page 18Linked to original sources
PubMed2006

Resection of isolated pelvic recurrences after colorectal surgery: long-term results and predictors of improved clinical outcome.

BACKGROUND: Recurrence in the pelvis after resection of a rectal or rectosigmoid cancer presents a dilemma. Resection offers the only reasonable probability for cure, but at the cost of marked perioperative morbidity and potential mortality. Clinical decision making remains difficult. METHODS: Patients who underwent resection with curative intent for isolated pelvic recurrences after curative colorectal surgery from 1988 through 2003 were reviewed retrospectively. Clinical and pathological factors, salvage operations, and complications were recorded. The primary measured outcome was overall survival. Univariate and multivariate analyses were conducted to identify prognostic factors of improved outcome. RESULTS: Ninety patients underwent an attempt at curative resection of a pelvic recurrence; median follow-up was 31 months. Complications occurred in 53% of patients. Operative mortality occurred in 4 (4.4%) of 90 patients. Median overall survival was 38 months, and estimated 5-year survival was 40%. A total of 51 of 86 patients had known recurrences (15 local, 16 distant, 20 both). Multivariate analysis revealed that preoperative carcinoembryonic antigen level and final margin status were statistically significant predictors of outcome. CONCLUSIONS: The resection of pelvic recurrences after colorectal surgery for cancer can be performed with low mortality and good long-term outcome; however, morbidity from such procedures is high. Low preoperative carcinoembryonic antigen and negative margin of resection predict improved survival.

Adult↗
PubMed1984

Comparison of systemic prophylaxis with metronidazole/placebo and metronidazole/fosfomycin in colorectal surgery. A clinical study demonstrating the need for additional anti-aerobic prophylactic cover.

The aim of this randomized double-blind study comparing the efficacy of two prophylactic regimens, metronidazole/placebo (n = 23) and metronidazole/fosfomycin (n = 26) was two-fold. First, to evaluate the need for anti-aerobic cover in addition to short-term systemic administration of metronidazole against anaerobes in colorectal surgery. Secondly, to explore the prophylactic effect of fosfomycin on aerobes of intestinal origin. An unacceptably high rate of surgical sepsis (16.3%) forced premature conclusion of the study after 49 patients had entered it. All surgical and remote infections occurred in the metronidazole/placebo group and were caused solely by aerobes. Anaerobic sepsis was not seen at all and the surgical infection rate was 34.8%. No septic complications occurred in the 26 patients (0%) receiving metronidazole/fosfomycin (p less than 0.01). Thus the study demonstrated both the need to administer an effective anti-aerobic agent in addition to metronidazole in colorectal surgery and the efficacy of fosfomycin in preventing aerobic sepsis of intestinal origin. Adverse reactions to the two drugs were not observed and resistance did not occur.

Adult↗
PubMed1997

Early postoperative feeding after elective colorectal surgery.

BACKGROUND: Several investigators have demonstrated that routine nasogastric decompression after abdominal surgery is unnecessary and can be safely eliminated, and 1 recent study demonstrated the safety of early oral feedings. OBJECTIVE: To test the hypothesis that successful early feeding would lead to a shorter duration of hospitalization and, therefore, would be more cost-effective. PATIENTS: Fifty-eight patients with elective colorectal surgery. METHODS: Patients were prospectively randomized to 1 of 2 postoperative treatment arms: early feeding (EF group, n = 29) and traditional feeding (TF group, n = 29). All patients in the EF group began a liquid diet on the first postoperative day and were advanced to a regular diet when they consumed 1000 mL in 24 hours. All patients in the TF group began a liquid diet after resolution of the postoperative ileus and were advanced to a regular diet after consuming 1000 mL in 24 hours. Patients were dismissed after tolerating two thirds of the regular diet. Both groups had intraoperative orogastric tubes that were removed at the end of surgery. Nasogastric tubes were inserted for persistent postoperative vomiting. RESULTS: No significant differences were noted in age, types of procedures, or in prior abdominal surgery in either group. No significant differences were seen in rates of nausea (55% in EF vs 50% in TF group) or vomiting (48% in EF vs 33% in TF group). One patient in the EF group had aspiration pneumonia, and anastomotic leak resulted in sepsis and eventual death of 1 patient in the TF group. No significant difference was observed in length of hospital stay between the 2 groups (mean +/- SD, 7.2 +/- 3.3 days in EF vs 8.1 +/- 2.3 days in TF group). CONCLUSIONS: Early oral feeding after elective colorectal surgery is safe. Most of the patients tolerated EF; however, there was no significant difference in duration of hospitalization in these patients.

Adult↗
PubMed1993

Imipenem prophylaxis in elective colorectal surgery.

In a randomized controlled study of 411 patients undergoing elective colorectal surgery, the efficacy and safety of two different regimens of imipenem were compared with those of a control regimen of cefuroxime plus metronidazole. Surgical infections occurred in 92 (26.4 per cent) of 349 evaluable patients. There were no major differences between the three treatment groups. It is concluded that imipenem is as effective as cefuroxime plus metronidazole in the prevention of sepsis after elective colorectal procedures.

Aged↗
PubMedDate not supplied

Prophylactic antibiotics for elective colorectal surgery or operation for obstruction of the small bowel: a comparison of cefonicid and cefoxitin.

Elective colorectal surgery carries a rate of septic complications of up to 35% in patients not receiving prophylaxis. This can be reduced to 5% in patients receiving appropriate prophylactic agents. The safety and efficacy of cefonicid, a new cephalosporin with a half-life of 4-5 hr, were compared with those of cefoxitin for prophylaxis in patients undergoing elective colorectal procedures or surgery for obstruction of the small bowel. Fifty-seven assessable patients were randomly assigned in a double-blind fashion to therapy with 1 g of cefonicid intravenously (iv) or intramuscularly (im) 1 hr before surgery only or 2 g of cefoxitin iv or im 1 hr before surgery and 2 g every 6 hr for 24 hr. Groups were comparable in terms of underlying diseases. Samples for blood culture were obtained immediately before and after surgery and at 8:00 A.M. on the first and second postoperative days. No blood cultures were positive. Two of 30 patients receiving cefonicid developed wound infections (6%). Two of 27 patients receiving cefoxitin developed wound infections, and one developed an intraabdominal abscess (11%). No significant adverse effects were noted. The results suggest cefonicid may be an effective prophylactic antibiotic for bowel surgery. Most importantly, cefonicid offers the advantages associated with the administration of a single daily dosage, among which are reduction of pharmacy costs and the freeing of nursing hours for patient care.

Adult↗
PubMed1983

A comparison of intravenous cefoxitin and a combination of gentamicin and metronidazole as prophylaxis in colorectal surgery.

In a prospective randomized clinical trial, 103 patients undergoing elective colorectal surgery received either cefoxitin or a combination of metronidazole and gentamicin. Six of 52 patients in the cefoxitin group (11.5 per cent) and six of 48 patients in the metronidazole/gentamicin group (12.5 per cent) developed serious wound infections. Two patients (3.8 per cent) in the cefoxitin group and one patient (2.1 per cent) in the metronidazole/gentamicin group developed deep sepsis. These results suggest that cefoxitin is as effective as the combination of metronidazole and gentamicin for prophylaxis against serious postoperative septic complications.

Aged↗
PubMed1985

Comparison of two systemic antibiotics for the prevention of complications in elective colorectal surgery.

In a prospective randomized trial on 77 patients undergoing elective colorectal surgery, cefoxitin and cephalothin were given as systemic antibiotic prophylaxis. Postoperative sepsis occurred in 2/40 (5%) of those given cefoxitin compared to 9/37 (24.3%) of those given cephalothin. The reduction in the infection rate in the group treated by cefoxitin was statistically significant (p less than 0.02). Specific drug toxicity was not evidenced except for transient skin rashes in two patients of both groups.

Aged↗
PubMed1997

Laparoscopic colorectal surgery and cancer.

Review article of the actual level of knowledge about laparoscopic colorectal surgery and laparoscopic-assisted procedures. At present time laparoscopy for the cure of colorectal neoplasia should only be performed within prospective randomized trials. In the meantime it is perfectly appropriate to perform laparoscopy for palliation of metastatic disease. Patients with benign colorectal neoplasms can achieve better outcome if treated by laparoscopy rather than laparotomy. Other areas in which laparoscopy may be useful include enterolysis and possibly, treatment of rectal prolapse. Laparoscopy can be appropriately applied for the treatment of terminal ileal Crohn's disease, sigmoid diverticulitis, reversal of Hartmann's pouches and the construction of stomas.

Aged↗
PubMed2002

Acute normovolaemic haemodilution in colorectal surgery.

AIMS: Blood transfusions are often given to surgical patients. This study was designed to assess whether acute normovolaemic haemodilution (ANH) reduces exposure to allogeneic blood, affects clinical outcome and hospital stay, and is feasible in colorectal surgery. METHODS: All ASA 1 and 11 patients undergoing colectomies performed between 1997 and 1999 were identified retrospectively from our colorectal cancer database to ascertain our current peri and postoperative transfusion practice. Twenty-six selected patients subsequently underwent ANH during colectomy surgery. The number of patients and units transfused were identified. RESULTS: One hundred and twenty-three of 317 (39%) patients identified from our colorectal cancer database were transfused a total of 328 units (median 2, range 1-7). Of the 26 patients undergoing ANH, 4 (15%) were transfused a total of 13 units (median 3, range 2-5). The reduction in number of patients transfused was statistically significant (P=0.017). ANH increased anaesthetic time by a median of 19 min. There were no complications associated with ANH and the median hospital stay was 9 days (range 6-13). CONCLUSIONS: In this pilot study of selected patients, ANH is a feasible and effective method of reducing allogeneic blood exposure in major colorectal surgery. A prospective randomised controlled trial is now urgently required.

Adult↗
PubMed2002

Use of intrathecal morphine for postoperative pain relief after elective laparoscopic colorectal surgery.

Laparoscopic surgery has become popular in recent years, but few studies have addressed analgesia for this type of surgery. We conducted a prospective double-blind randomised trial on 36 cases of laparoscopic colorectal surgery to determine the influence of intrathecal morphine on postoperative pain relief. All patients received a subarachnoid block with local anaesthetic in addition to general anaesthesia. One group also received intrathecal morphine. A patient-controlled analgesic (PCA) device was prescribed for pain control postoperatively and the visual analogue score (VAS) was used for pain assessment. The group who received intrathecal morphine used significantly less morphine. There were no adverse cardiovascular effects of the combined anaesthetic technique. Nausea and vomiting remained the main side-effect of intrathecal morphine but this was easily treated with anti-emetics.

Adult↗
PubMed1992

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.

Adult↗
PubMed2000

Fluid collections detected by ultrasound following uncomplicated colorectal surgery.

The aim of the study was to assess the incidence and site of intraperitoneal fluid collections following uncomplicated colorectal surgery and to identify factors relating to the presence of such collections. 38 patients (22 males) with a mean age of 67 years (range 38-85 years) undergoing uncomplicated colorectal procedures were studied prospectively. Patients underwent abdominal and pelvic ultrasound on Day 3 and Day 7 following surgery. The number, site and volume of collections were recorded. Ultrasound-detected fluid collections were present in 26% on Day 3 and 25% on Day 7 following laparotomy. The presence of a collection was not related to the amount of residual volume after peritoneal lavage with normal saline prior to operative closure, to intraoperative blood loss or to the presence of drains. The right upper quadrant was the commonest site of intraperitoneal collections. In the absence of additional clinical signs, the presence of such collections is not an indication for intervention.

Adult↗
PubMedDate not supplied

Preoperative cell-mediated immunity and duration of antibiotic prophylaxis in relation to postopertive infectious complications. A controlled trial in biliary, gastroduodenal and colorectal surgery.

In a prospective controlled trial, 750 patients undergoing elective biliary, gastric or colorectal surgery were randomized to receive short-term or long-term antibiotic prophylaxis--cefotaxime for biliary or gastric, and gentamicin/metronidazole for colorectal operations. In all patients, delayed cutaneous hypersensitivity was preoperatively assessed by simultaneous application of seven standardized recall antigens. Positive reaction was defined as mean diameter greater than or equal to 2 mm, anergy as no positive reaction to any antigen, and a 'score' as the sum (in mm) of all the mean diameters of positive reactions. There was no significant difference in septic complication or mortality rates following short-term vs. long-term prophylaxis. Anergy was found in 21 patients (2.8%), while 63 (8.4%) scored 2-4 and 666 (88.8%) greater than or equal to 5. The incidence of postoperative infectious complications was 25% in the patients with score less than 5 and 10% in those scoring greater than or equal to 5, and the corresponding mortality was 14.3 and 2.1% (both p less than 0.001). In the group with preoperative scores less than 5, the duration of antibiotic prophylaxis influenced neither postopertive infectious complications nor mortality.

Adult↗
PubMed2005

[A serious complication in colorectal surgery: anastomotic leakage. Our experience].

Anastomotic leakage is a severe complication in colorectal surgery with a lot of generic and specific risk factors. There are still controversies about the possibility to prevent it or to limit its severity with the use of faecal diversions. We report our experience on 189 patients operated in five years on colon-rectum, in election and emergency, with manual or mechanical anastomoses in the last 20 cm from the anal verge. We have had 21 anastomotic leakages (11%), symptomatic in 10 cases (5.5%), and 5 deaths (2.6%), 3 directly correlated to the leakage. In the patients (n 98) with loop-ileostomy there wasn't anastomotic leakages reduction, but only of clinical impact. We prefer loop-ileostomy in cases of extraperitoneal anastomoses, always in emergency and in anastomoses at risk.

Adult↗
PubMed1990

Single dose cefotaxime plus metronidazole versus three dose cefuroxime plus metronidazole as prophylaxis against wound infection in colorectal surgery: multicentre prospective randomised study.

OBJECTIVE: To establish whether a single preoperative dose of cefotaxime plus metronidazole was as effective as a standard three dose regimen of cefuroxime plus metronidazole in preventing wound infection after colorectal surgery. DESIGN: Prospective randomised allocation to one of two prophylactic antibiotic regimens in a parallel group trial. Group sequential analyses of each 250 patients were performed. SETTING: 14 District general and teaching hospitals. PATIENTS: 1018 Adults having colorectal operations were randomised, of whom 943 were evaluated. Demographic features, conditions requiring surgery, and operative procedures were similar in the two groups. Most patients had surgery for carcinoma of the colon or rectum. INTERVENTIONS: Group 1 received cefotaxime 1 g intravenously plus metronidazole 500 mg intravenously preoperatively. Group 2 received cefuroxime 1.5 g intravenously plus metronidazole 500 mg intravenously preoperatively, followed by cefuroxime 750 mg intravenously plus metronidazole 500 mg intravenously eight hours and 16 hours postoperatively. MAIN OUTCOME MEASURES: Development of surgical wound infection (as evidenced by the presence of pus), death, or discharge from hospital. RESULTS: Wound condition was scored on a five point scale on alternate days until discharge or for up to 20 days postoperatively. Wound infection rates were: group 1, 32/453 (7.1%; 95% confidence interval 4.7% to 9.4%); group 2, 33/454 (7.3%; 95% confidence interval 4.9% to 9.6%). Death rates (group 1: 26/470 (5.5%); group 2: 31/471 (6.6%], the incidence of postoperative complications, the median duration of hospital stay (12 days), and antibiotic tolerance were all similar in the two groups. Pooled data from groups 1 and 2 showed that wound infections were more frequent when minor faecal contamination had occurred at operation and when the duration of operation exceeded 90 minutes (greater than 90 min 11.2% of cases; less than 90 min 4.8%) and were associated with an extended hospital stay. CONCLUSIONS: A single preoperative dose of cefotaxime plus metronidazole is an efficacious as a three dose regimen of cefuroxime plus metronidazole in preventing wound infection after colorectal surgery and has practical advantages in eliminating the need for postoperative antibiotics.

Adolescent↗
PubMed1990

[Mechanical staplers in colorectal surgery: cost-benefit ratio].

The cost/benefit ratio of stapled anastomoses in colorectal surgery has been retrospectively evaluated on the basis of a 8 year experience taking into account the overall costs in surgery as well as short term and long term benefits. With this aim, our experience was divided in two periods: 1st period: November 1970-January 1981: 598 hand sutures; 2nd period: February 1981-December 1988: 787 stapled sutures. Mechanical suturing was found to be superior based on the following: a) the average postoperative hospital stay decreased from 20.2 days to 14.7 days; b) temporary stomas decreased from 62.2 to 25.1%; c) abdominoperineal resection for rectal cancer decreased from 60.7 to 41.6%.

Anastomosis, Surgical↗
PubMed1982

Whole-gut irrigation as a preparation for colorectal surgery.

Whole-gut irrigation was used to prepare 43 patients for colorectal surgery. Antibiotics were used pre-operatively in the first group and added to the irrigation fluid in the second. The condition of the bowel lumen was regarded as perfect or good in 87,2% of cases, and the total sepsis rate was 15,4%. The results are regarded as a significant improvement on conventional methods of bowel preparation.

Adolescent↗