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Chen CC, Chang KT, Lee YW, Chen JS, Wei PL, Chang CL, Huang YJ. Effectiveness of pudendal nerve block in the management of acute post-haemorrhoidectomy pain in Asian individuals using inverse probability of treatment weighting (IPTW). Asian J Surg 2024:S1015-9584(24)01643-9. [PMID: 39191591 DOI: 10.1016/j.asjsur.2024.07.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/21/2024] [Accepted: 07/22/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Inadequate management of acute post-haemorrhoidectomy pain is a major concern. Optimal pain management is necessary to reduce acute postoperative pain and improve care quality. Therefore, we investigated the efficacy of postoperative pudendal nerve block (PNB) in reducing acute post-haemorrhoidectomy pain in Asian individuals. METHODS This retrospective cohort study analysed 108 adult patients with grade 3 haemorrhoids. Patients with anorectal cancer were excluded from this study. Among the 108 patients, 79 and 29 received spinal anaesthesia (SA) with PNB (SAPNB) and SA alone, respectively. Propensity score matching and inverse probability of treatment weighting were performed to adjust for the effects of confounders. RESULTS Patients receiving SAPNB had significantly lower postoperative pain scores 6, 12, and 18 h after haemorrhoidectomy but significantly higher postoperative pain scores 24 and 48 h after haemorrhoidectomy than did patients receiving SA alone. PNB, older age, female sex, reduced operation time, and absence of cardiovascular disease reduced the risk of moderate to severe postoperative pain. Only the addition of PNB was consistently associated with a reduced risk of moderate to severe pain 6, 12, and 18 h after haemorrhoidectomy. Patients receiving SAPNB had significantly lower risks of perianal swelling and urinary retention but a significantly higher risk of nausea than did those receiving SA alone. The two groups exhibited similarity in their rates of postoperative readmission because of poor pain management and their lengths of stay upon readmission. CONCLUSION The addition of PNB to SA may effectively reduce acute post-haemorrhoidectomy pain.
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Affiliation(s)
- Chang-Cyuan Chen
- Department of Medical Education, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Kuei-Ting Chang
- Department of Medical Education, Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Yuan-Wen Lee
- Department of Anaesthesiology, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Juan-Syun Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Po-Li Wei
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan; Cancer Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Translational Laboratory, Department of Medical Research, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taipei City, Taiwan
| | - Chia-Li Chang
- Data Analyst, Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, Taipei City, Taiwan
| | - Yan-Jiun Huang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan.
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Yano T, Kabata D, Kimura S. Pain at the First Post-hemorrhoidectomy Defecation Is Associated with Stool Form. J Anus Rectum Colon 2022; 6:168-173. [PMID: 35979270 PMCID: PMC9328793 DOI: 10.23922/jarc.2021-052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: Methods: Results: Conclusions: Trial registration:
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Affiliation(s)
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine
| | - Seiichi Kimura
- Department of Medical Statistics, Osaka City University Graduate School of Medicine
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Papadomanolakis-Pakis N, Uhrbrand P, Haroutounian S, Nikolajsen L. Prognostic prediction models for chronic postsurgical pain in adults: a systematic review. Pain 2021; 162:2644-2657. [PMID: 34652320 DOI: 10.1097/j.pain.0000000000002261] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/02/2021] [Indexed: 12/23/2022]
Abstract
ABSTRACT Chronic postsurgical pain (CPSP) affects an estimated 10% to 50% of adults depending on the type of surgical procedure. Clinical prediction models can help clinicians target preventive strategies towards patients at high risk for CPSP. Therefore, the objective of this systematic review was to identify and describe existing prediction models for CPSP in adults. A systematic search was performed in MEDLINE, Embase, PsychINFO, and the Cochrane Database of Systematic Reviews in March 2020 for English peer-reviewed studies that used data collected between 2000 and 2020. Studies that developed, validated, or updated a prediction model in adult patients who underwent any surgical procedure were included. Two reviewers independently screened titles, abstracts, and full texts for eligibility; extracted data; and assessed risk of bias using the Prediction model Risk of Bias Assessment Tool. The search identified 2037 records; 28 articles were reviewed in full text. Fifteen studies reporting on 19 prediction models were included; all were at high risk of bias. Model discrimination, measured by the area under receiver operating curves or c-statistic, ranged from 0.690 to 0.816. The most common predictors identified in final prediction models included preoperative pain in the surgical area, preoperative pain in other areas, age, sex or gender, and acute postsurgical pain. Clinical prediction models may support prevention and management of CPSP, but existing models are at high risk of bias that affects their reliability to inform practice and generalizability to wider populations. Adherence to standardized guidelines for clinical prediction model development is necessary to derive a prediction model of value to clinicians.
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Affiliation(s)
| | - Peter Uhrbrand
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Lone Nikolajsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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Yano T. Is There a Relationship Between Stool Consistency and Pain at First Defecation After Limited Half Hemorrhoidectomy? A Pilot Study. Ann Coloproctol 2020; 37:306-310. [PMID: 32972107 PMCID: PMC8566150 DOI: 10.3393/ac.2020.08.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/10/2020] [Indexed: 10/27/2022] Open
Abstract
PURPOSE While the first defecation pain is a problem following hemorrhoidectomy, it is unknown whether the stool consistency has an influence on pain. This pilot study aimed to investigate whether the intensity of defecation pain varied according to stool consistency. METHODS This prospective cohort study evaluated patients who underwent hemorrhoidectomy in combination with injection sclerotherapy for grade III or IV hemorrhoids. The pain intensity and stool form during the first postoperative defecation were self-recorded by the patients using a visual analogue scale (score of 0-10) and Bristol Stool Form Scale, respectively. The patients were classified into 3 groups according to stool consistency, and the intensity of defecation pain was compared among the groups using analysis of variance. RESULTS A total of 61 patients were eligible for this study and were classified into the hard stool (n=15), normal stool (n=21), and soft stool groups (n=25). No significant intergroup differences were identified in the intensity of pain at defecation (P=0.29). CONCLUSION This pilot study demonstrated that there were no clear differences in pain intensity during the first defecation after surgery among the 3 groups with different levels of stool consistency.
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Abstract
Experimental and clinical acute pain research in relation to biological sex and genetics started in the 1980s. Research methods became more powerful and sensitive with the advancement in affordable gene sequencing methods and high-throughput genetic assays. Decades of research has identified several potential pharmaceutical targets, providing insights into future research direction, and understanding of acute pain and opioid analgesic effects in the clinical setting. However, there is insufficient evidence to make generalized recommendations for using genetic tests for clinical practice of acute pain management.
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Affiliation(s)
- Albert Hyukjae Kwon
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room H3580, Stanford, CA 94305, USA
| | - Pamela Flood
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room H3580, Stanford, CA 94305, USA.
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Solorio-López S, Palomares-Chacón UR, Guerrero-Tarín JE, González-Ojeda A, Cortés-Lares JA, Rendón-Félix J, García-Rentería J, Chávez-Tostado M, Cuesta-Márquez LA, Salazar-Parra M, Fuentes Orozco C. Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 107:681-5. [PMID: 26541658 DOI: 10.17235/reed.2015.3926/2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Hemorrhoidal disease occurs in 50% of people aged > 40 years and is the most common reason for anorectal surgery. Pain is the main complication. Multiple topical and systemic drugs have been investigated for pain control, but there is no ideal treatment. Metronidazole has been shown to decrease postoperative pain but is not used widely. OBJECTIVE To evaluate the effect of oral metronidazole versus placebo and to assess postoperative pain following hemorrhoidectomy. MATERIAL AND METHODS Controlled clinical trial in adult patients who underwent elective hemorrhoidectomy for grade III/IV hemorrhoids. Patients were assigned to receive metronidazole (500 mg q8 h orally; study group, SG) or placebo (control group, CG) for 7 days after surgery. Pain was assessed using a visual analog scale after surgery. Analgesic administration (time and use of analgesics) and resumption of daily life activities were also assessed. RESULTS Forty-four patients were included, 22 in each group. Postoperative pain differed significantly between the SG and CG at 6 h (3.86 ± 0.56, 6.64 ± 1.49), 12 h (5.59 ± 1.33, 8.82 ± 0.79), 24 h (6.86 ± 1.49, 9.73 ± 0.45), day 4 (5.32 ± 2.10, 9.50 ± 0.59), day 7 (3.14 ± 1.03, 7.36 ± 1.39), and day 14 (2.14 ± 0.46, 5.45 ± 1.29). The first analgesia dose was required at 21.27 ± 5.47 h in the CG and 7.09 ± 2.36 h in the SG (p < 0.05), the time of analgesic use was 6.86 ± 1.61 days in the CG and 13.09 ± 2.48 days in the SG (p < 0.05), and resumption of daily activities occurred at 7.59 ± 1.56 days in the CG and 14.73 ± 3.76 days in the SG (p < 0.05). CONCLUSION Oral administration of metronidazole is effective in pain management after hemorrhoidectomy.
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Affiliation(s)
- Sergio Solorio-López
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México
| | | | | | - Alejandro González-Ojeda
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México
| | - José Antonio Cortés-Lares
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México
| | - Jorge Rendón-Félix
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México
| | - Jesús García-Rentería
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México
| | - Mariana Chávez-Tostado
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México
| | | | - Marcela Salazar-Parra
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México
| | - Clotilde Fuentes Orozco
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, CMNO-IMSS, México
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Hidalgo Grau LA, Ruiz Edo N, Llorca Cardeñosa S, Heredia Budó A, Estrada Ferrer Ó, Del Bas Rubia M, García Torralbo EM, Suñol Sala X. Circular mucosal anopexy: Experience and technical considerations. Cir Esp 2016; 94:287-93. [PMID: 26997121 DOI: 10.1016/j.ciresp.2015.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 11/12/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Circular mucosal anopexy (CMA) achieves a more comfortable postoperative period than resective techniques. But complications and recurrences are not infrequent. This study aims to evaluate of the efficacy of CMA in the treatment of hemorrhoids and rectal mucosal prolapse (RMP). METHOD From 1999 to 2011, 613 patients underwent surgery for either hemorrhoids or RMP in our hospital. CMA was performed in 327 patients. Gender distribution was 196 male and 131 female. Hemorrhoidal grades were distributed as follows: 28 patients had RMP, 46 2nd grade, 146 3rd grade and 107 4th grade. Major ambulatory surgery (MAS) was performed in 79.9%. Recurrence of hemorrhoids was studied and groups of recurrence and no-recurrence were compared. Postoperative pain was evaluated by Visual Analogical Scale (VAS) as well as early complications. RESULTS A total of 31 patients needed reoperation (5 RMP, 2 with 2nd grade, 17 with 3rd grade,/with 4th grade). No statistically significant differences were found between the non-recurrent group and the recurrent group with regards to gender, surgical time or hemorrhoidal grade, but there were differences related to age. In the VAS, 81.3% of patients expressed a postoperative pain ≤ 2 at the first week. Five patients needed reoperation for early postoperative bleeding. Six patients needed admission for postoperative pain. CONCLUSIONS Recurrence rate is higher in CMA than in resective techniques. CMA is a useful technique for the treatment of hemorrhoids in MAS. Pain and the rate of complications are both low.
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Affiliation(s)
- Luis Antonio Hidalgo Grau
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Neus Ruiz Edo
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España.
| | - Sara Llorca Cardeñosa
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Adolfo Heredia Budó
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Óscar Estrada Ferrer
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Marta Del Bas Rubia
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Eva María García Torralbo
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Xavier Suñol Sala
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
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Santangelo G, Pellino G, De Falco N, Colella G, D'Amato S, Maglione MG, De Luca R, Canonico S, De Falco M. Prevalence, diagnosis and management of ectopic thyroid glands. Int J Surg 2015; 28 Suppl 1:S1-6. [PMID: 26708843 DOI: 10.1016/j.ijsu.2015.12.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 04/25/2015] [Accepted: 05/10/2015] [Indexed: 12/13/2022]
Abstract
Ectopic thyroid tissue (ETT) is an uncommon entity that may be found anywhere along the line of the obliterated thyroglossal duct, usually from the tongue to the diaphragm. We performed a retrospective analysis of patients undergoing surgical treatment for thyroid disease between January 2000 and December 2013, seeking for ETT All patients with prior neck surgery or trauma were excluded. The clinic-pathologic features, prevalence and diagnosis of the lesions were collected and analyzed. Out of 3092 included patients, 28 ETT were identified (0.9%). The anatomical site of ETT was as follows: lateral cervical in 6 (21.4%), along the thyroglossal duct in 6 (21.4%), mediastinal in 5 (17.9%), lingual in 5 (17.9%), sublingual in 3 (10.7%), and submandibular in 3 (10.7%). Histopathology revealed 27 benign lesions and 1 (3.6%) papillary carcinoma. ETT is found in less than 1% of patients receiving thyroid surgery. Diagnosis of ETT requires clinical imaging. Surgery is a prudent choice due to the potential of malignant evolution of ETT.
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Affiliation(s)
- Giuseppe Santangelo
- Fifth Division of General Surgery and Special Surgical Techniques, Second University of Naples, Naples, Italy; Division of General and Geriatric Surgery, Second University of Naples, Italy.
| | - Gianluca Pellino
- Division of General and Geriatric Surgery, Second University of Naples, Italy.
| | - Nadia De Falco
- Fifth Division of General Surgery and Special Surgical Techniques, Second University of Naples, Naples, Italy; Division of General and Geriatric Surgery, Second University of Naples, Italy.
| | - Giuseppe Colella
- Department of the Head and Neck Surgery, Second University of Naples, Naples, Italy.
| | - Salvatore D'Amato
- Department of the Head and Neck Surgery, Second University of Naples, Naples, Italy.
| | - M Grazia Maglione
- Department of the Head and Neck Surgery, Second University of Naples, Naples, Italy.
| | - Roberto De Luca
- Department of the Head and Neck Surgery, Second University of Naples, Naples, Italy.
| | - Silvestro Canonico
- Division of General and Geriatric Surgery, Second University of Naples, Italy.
| | - Massimo De Falco
- Fifth Division of General Surgery and Special Surgical Techniques, Second University of Naples, Naples, Italy; Division of General and Geriatric Surgery, Second University of Naples, Italy.
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Pellino IM, Pellino G. Consequences of defensive medicine, second victims, and clinical-judicial syndrome on surgeons’ medical practice and on health service. Updates Surg 2015; 67:331-7. [DOI: 10.1007/s13304-015-0338-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 11/14/2015] [Indexed: 02/07/2023]
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Pellino G, Sciaudone G, Caprio F, Candilio G, De Fatico GS, Reginelli A, Canonico S, Selvaggi F. Hormonal contraceptives and venous thromboembolism: Are inflammatory bowel disease patients at increased risk? A retrospective study on a prospective database. Ann Med Surg (Lond) 2015; 4:462-6. [PMID: 26779335 PMCID: PMC4685236 DOI: 10.1016/j.amsu.2015.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 09/14/2015] [Accepted: 10/31/2015] [Indexed: 12/15/2022] Open
Abstract
Recent studies showed an increased risk of venous thromboembolism (VTE) in patients receiving oral hormonal contraceptives. Inflammatory bowel diseases (IBD) often affect young patients and represent a pro-coagulant condition. This could result from active inflammation, but a potential role for genetic and molecular factors has been suggested. Hormonal contraceptives have also been associated with increased risk of VTE and the risk may be greater in IBD patients that already are in a pro-coagulant status, but no definitive data are available in this population. The purpose of our study was to seek for differences of the risk of VTE in IBD patients receiving hormonal contraceptives compared with controls. This is a retrospective study. We interrogated a prospectively maintained database of IBD patients observed at our outpatient clinic between 2000 and 2014. All female patients managed conservatively, with no active disease, who were taking oral hormone contraceptives in the study period, were included. Patients observed for other-than-IBD conditions at our Unit and at the Unit of Gynaecology and Obstetrics, receiving contraceptives, served as controls (ratio 1:2). Patients with cancer, those receiving hormonal therapy, and those with known genetic predisposition to VTE were excluded. We included 146 six IBD patients and 290 controls. One patient in each group developed VTE. Overall, the incidence of VTE associated with oral contraceptives was 0.5%. IBD was associated with increased risk of VTE (OR 1.9, 95% CI 0.12–32.12, p > 0.99). Active smokers since 10 years (17.2%) had higher risks of VTE (OR 8.6, 95% CI 1.16–19.25, p = 0.03). Our data show that patients with IBD in remission are not at higher risk of VTE due to oral oestrogen-containing contraceptives compared with non-IBD controls. Smokers are at increased risk, irrespective of the baseline disease. Contraceptives do not increase the risk of VTE in IBD patients in remission. Irrespective of baseline disease, smoking is associated with VTE. IBD patients receiving contraceptives should be encouraged to quit smoking.
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Affiliation(s)
- Gianluca Pellino
- Unit of Colorectal Surgery, Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy
| | - Guido Sciaudone
- Unit of Colorectal Surgery, Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy
| | - Francesca Caprio
- Department of The Woman, The Child and General and Specialized Surgery, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy
| | - Giuseppe Candilio
- Unit of Colorectal Surgery, Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy
| | - G Serena De Fatico
- Unit of Colorectal Surgery, Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy
| | - Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy
| | - Silvestro Canonico
- Unit of General and Geriatric Surgery, Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy
| | - Francesco Selvaggi
- Unit of Colorectal Surgery, Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy
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Pellino G, Selvaggi F. In reply to Tin et al. Int J Colorectal Dis 2015; 30:1437. [PMID: 25598046 DOI: 10.1007/s00384-015-2127-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Gianluca Pellino
- Unit of General Surgery, Second University of Naples, Via F. Giordani, 42, 80122, Naples, Italy
| | - Francesco Selvaggi
- Unit of General Surgery, Second University of Naples, Via F. Giordani, 42, 80122, Naples, Italy.
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13
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Pellino G, Sciaudone G, Selvaggi F, Canonico S. Prophylactic negative pressure wound therapy in colorectal surgery. Effects on surgical site events: current status and call to action. Updates Surg 2015; 67:235-45. [PMID: 25921360 DOI: 10.1007/s13304-015-0298-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/13/2015] [Indexed: 12/12/2022]
Abstract
Surgical site events, including surgical site infections (SSI), represent a major problem in general surgery. SSI are responsible of nuisance for patients, and can lead to important complications and disability, often needing prolonged postoperative stay with specific treatment and recovery in Intensive Care Units. These justify the higher costs due to SSI. Despite the growing body of evidence concerning SSI in general surgery, literature dealing with SSI after colorectal surgery is scarce, reflecting in suboptimal perception of such a relevant issue by colorectal surgeons and health authorities in Italy, though colorectal surgery is associated with higher rates of SSI. The best strategy for reducing the impact of SSI on costs of care and patients quality of life would be the development of a preventive bundle, similar to that adopted in the US through the colorectal section of the National Surgery Quality Improvement Project of the American College of Surgeons (ACS-NSQIP). This policy has been showed to significantly reduce the rates of SSI. In this scenario, incisional negative pressure wound therapy (NPWT) is likely to play a pivotal role. We herein reviewed the literature to report on the current status of preventive NPWT on surgical wounds of patients undergoing colorectal procedures with primary wound closure, suggesting evidence-based measures to reduce the impact of SSI, and to contain the costs associated with conventional NPWT devices by means of newer available technologies. Some explicative real life cases are presented.
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Affiliation(s)
- Gianluca Pellino
- Unit of General Surgery, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy,
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15
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Pellino G, Petronella P, Selvaggi F. Gradual staple line disruption presenting with subtle multidiverticular pocket syndrome after STARR. Updates Surg 2014; 66:291-2. [DOI: 10.1007/s13304-014-0274-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 12/11/2022]
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