1
|
Bracale U, Iacone B, Tedesco A, Gargiulo A, Di Nuzzo MM, Sannino D, Tramontano S, Corcione F. The use of mixed reality in the preoperative planning of colorectal surgery: Preliminary experience with a narrative review. Cir Esp 2024:S2173-5077(24)00037-1. [PMID: 38307256 DOI: 10.1016/j.cireng.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/14/2024] [Indexed: 02/04/2024]
Abstract
New advanced technologies have recently been developed and preliminarily applied to surgery, including virtual reality (VR), augmented reality (AR) and mixed reality (MR). We retrospectively review all colorectal cases in which we used holographic 3D reconstruction from February 2020 to December 2022. This innovative approach was used to identify vascular anomalies, pinpoint tumor locations, evaluate infiltration into neighboring organs and devise surgical plans for both training and educating trainee assistants. We have also provided a state-of-the-art analysis, briefly highlighting what has been stated by the scientific literature to date. VR facilitates training and anatomical assessments, while AR enhances training and laparoscopic performance evaluations. MR, powered by HoloLens, enriches anatomic recognition, navigation, and visualization. Successful implementation was observed in 10 colorectal cancer cases, showcasing the effectiveness of MR in improving preoperative planning and its intraoperative application. This technology holds significant promise for advancing colorectal surgery by elevating safety and reliability standards.
Collapse
Affiliation(s)
- Umberto Bracale
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Biancamaria Iacone
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy.
| | - Anna Tedesco
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Antonio Gargiulo
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | | | - Daniele Sannino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Salvatore Tramontano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| |
Collapse
|
2
|
Silva ACV, Tumelero TJ, Yamamoto DR, Truppel SK, da Silva GS, Ribeiro LBM, Zacharias P, Olandoski M, Magro DO, Vieira MC, Kotze PG. Biological therapy, surgery, and hospitalization rates for inflammatory bowel disease: An observational Latin American comparative study between adults and pediatric patients. Gastroenterol Hepatol 2023:S0210-5705(23)00452-1. [PMID: 37890582 DOI: 10.1016/j.gastrohep.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE Compare the proportions of use of biological therapy, surgeries, and hospitalizations between adults and pediatric inflammatory bowel disease (IBD)-Crohn's disease (CD) and ulcerative colitis (UC)-patients. PATIENTS AND METHODS Observational, retrospective, and multicenter study. Data were collected from all consecutive IBD patients seen as outpatients or admitted to hospital, during 2015-2021, in two IBD tertiary centers in a South Brazilian capital. Patients with unclassified colitis diagnosis were excluded from this study. Patients were classified as having CD or UC and sub-categorized as adult or pediatric according to age. Data were analyzed using frequency, proportion, Fisher's exact test, and Chi-square test. RESULTS A total of 829 patients were included: 509 with CD (378 adults/131 pediatric) and 320 with UC (225/95). Among patients with CD, no differences were observed for proportions of use of biological therapy (80.2% in pediatric vs. 73.3% in adults; P=0.129), surgery (46.6% vs. 50.8%; P=0.419), or hospitalization (64.9% vs. 56.9%; P=0.122). In UC, significant differences were observed for biological therapy (40.0% vs. 28.0%; P=0.048) and hospitalization (47.4% vs. 24.0%; P<0.001). No significant difference was observed in surgery rates (17.9% vs. 12.4%; P=0.219). CONCLUSIONS Biological therapy and incidence of hospitalization were greater among pediatric patients with UC, compared with adults; no difference was observed in the need for abdominal surgery. In CD, no significant difference was observed in the three main outcomes between the age groups.
Collapse
Affiliation(s)
| | - Tainá Júlia Tumelero
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | | | | | | | | | - Patricia Zacharias
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Marcia Olandoski
- Biostatistics, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | | | - Mário César Vieira
- Pediatric Gastroenterology Unit, Pequeno Príncipe Hospital, Curitiba, Brazil
| | - Paulo Gustavo Kotze
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| |
Collapse
|
3
|
Morais de Babo NM, Filipe Lima Barbosa C, Almeida Ferreira AL, Silva LI. ERAS programme in a Portuguese tertiary hospital: An audit of the first six months of implementation in elective colorectal surgery. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:247-258. [PMID: 36940854 DOI: 10.1016/j.redare.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/01/2022] [Indexed: 03/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES Enhanced Recovery After Surgery (ERAS) is a multimodal strategy designed to optimize postoperative recovery and reduce morbidity, length of hospital stay, and care costs. The aim of this study was to evaluate compliance and clinical outcomes 6 months of implementation of the program in scheduled colorectal surgery in a tertiary hospital. MATERIAL AND METHODS Data from 209 patients who underwent elective colorectal surgery were analysed. The first 102 patients (pre-ERAS group) who underwent surgery between January and May 2018, before the implementation of the program, were compared with the 107 patients treated between May and October 2019, after ERAS implementation. The main outcomes were patient education and counselling, use of intravenous fluids, early mobilization, incidence of postoperative nausea and vomiting, return of bowel function, length of stay, complications, mortality, and overall compliance. RESULTS The ERAS program was associated with a significant increase in patient education and counselling (p<0.001) and with a significant reduction in intra- and postoperative IV fluid administration (p=0.007 and p<0.001, respectively) and postoperative nausea or vomiting (17.6% vs 5.0%, p=0.007). Time to recovery of activities of daily living (5.29 vs 2.85 days; p<0.001), time to solid oral intake (6.21 vs 4.35 days; p<0.001), time to first flatus (2.41 vs 1.51 days; p<0.001) and defecation (3.35 vs 1.66 days; p<0.001) decreased with ERAS. There were no statistically significant differences in length of stay, complications, and mortality. CONCLUSION This study showed that the ERAS program improved perioperative outcomes and postoperative recovery in patients undergoing colorectal surgery in our hospital.
Collapse
Affiliation(s)
- Nuno Miguel Morais de Babo
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal.
| | - Catarina Filipe Lima Barbosa
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | | |
Collapse
|
4
|
Tueme-de la Peña D, Salgado-Gamboa EA, Ortiz de Elguea-Lizárraga JI, Zambrano Lara M, Rangel-Ríos HA, Chapa-Lobo AF, Salgado-Cruz LE. Indocyanine green fluorescence angiography in colorectal surgery: A retrospective case-control analysis in Mexico. Rev Gastroenterol Mex (Engl Ed) 2023:S2255-534X(23)00022-1. [PMID: 36890063 DOI: 10.1016/j.rgmxen.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/09/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION AND AIMS An anastomotic leak is one of the most dreaded complications in colorectal surgery because it increases postoperative morbidity and mortality. The aim of the present study was to identify whether indocyanine green fluorescence angiography (ICGFA) reduced the anastomotic dehiscence rate in colorectal surgery. MATERIAL AND METHODS A retrospective study on patients that underwent colorectal surgery with colonic resection or low anterior resection and primary anastomosis, within the time frame of January 2019 and September 2021, was conducted. The patients were divided into the case group, in which ICGFA was performed for the intraoperative evaluation of blood perfusion at the anastomosis site, and the control group, in which ICGFA was not utilized. RESULTS A total of 168 medical records were reviewed, resulting in 83 cases and 85 controls. Inadequate perfusion that required changing the surgical site of the anastomosis was identified in 4.8% of the case group (n = 4). A trend toward reducing the leak rate with ICGFA was identified (6% [n = 5] in the cases vs 7.1% in the controls [n = 6] [p = 0.999]). The patients that underwent anastomosis site change due to inadequate perfusion had a 0% leak rate. CONCLUSIONS ICGFA as a method to evaluate intraoperative blood perfusion showed a trend toward reducing the incidence of anastomotic leak in colorectal surgery.
Collapse
Affiliation(s)
- D Tueme-de la Peña
- Hospital Christus Muguerza Alta Especialidad - UDEM, Monterrey, Nuevo León, Mexico
| | - E A Salgado-Gamboa
- Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, Mexico
| | | | - M Zambrano Lara
- Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
| | - H A Rangel-Ríos
- Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, Mexico
| | - A F Chapa-Lobo
- Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, Mexico
| | - L E Salgado-Cruz
- Hospital Christus Muguerza Alta Especialidad - UDEM, Monterrey, Nuevo León, Mexico; Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, Mexico; Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico.
| |
Collapse
|
5
|
Garcia-Granero A, Jerí Mc-Farlane S, Gamundí Cuesta M, González-Argente FX. Application of 3D-reconstruction and artificial intelligence for complete mesocolic excision and D3 lymphadenectomy in colon cancer. Cir Esp 2023; 101:359-368. [PMID: 36709852 DOI: 10.1016/j.cireng.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/29/2022] [Indexed: 01/28/2023]
Abstract
Mathematical algorithms 3D-reconstruction techniques and artificial intelligence are a current line of innovation in colorectal surgical oncology. The objective of this study is to show the initial experience of a 3D image processing and reconstruction system to perform complete mesocolic excision and D3-lymphadenectomy in colon cancer. It is applied to a splenic flexure neoplasm and in a right colon cancer with suspected retroperitoneal infiltration. 3D image processing and reconstruction was employed to delimit 10 cm proximal and distal intestinal margins to the tumor and define its corresponding vascularization. In right colon cancer it showed position and exact dimensions of D3-lymphadenectomy area and possible retroperitoneal fascia infiltration. 3D image processing and reconstruction allows to obtain valuable information from computerized tomography scan. It could be employed during surgical strategy planification to improve oncological results and reduce intraoperative complications.
Collapse
Affiliation(s)
- Alvaro Garcia-Granero
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma, Illes Balears, Spain; Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma, Illes Balears, Spain; Unidad de Reconstrucción-3D y Centro de Simulación, Hospital Universitario Son Espases, Palma, Illes Balears, Spain; Profesor Departamento de Anatomía y Embriología Humana, Universidad de Islas Baleares, Palma, Illes Balears, Spain; Coordinador Unidad de Anatomía Quirúrgica Aplicada, Universidad de Valencia, Valencia, Spain.
| | - Sebastían Jerí Mc-Farlane
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma, Illes Balears, Spain
| | - Margarita Gamundí Cuesta
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma, Illes Balears, Spain
| | - Francesc Xavier González-Argente
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma, Illes Balears, Spain
| |
Collapse
|
6
|
Garcia-Perez E, Aguirre-Larracoechea U, Portugal-Porras V, Azpiazu-Landa N, Telletxea-Benguria S. Frailty assessment has come to stay: Retrospective analysis pilot study of two frailty scales in oncological older patients undergoing colorectal surgery. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:1-9. [PMID: 36682609 DOI: 10.1016/j.redare.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/24/2021] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Colorectal cancer is a disease of the elderly and its main treatment is surgery. Frailty, a clinical syndrome of decreased reserve, increases with age and has been recognized as a predictive factor for postoperative mortality. Our primary objective was to assess the association between two frailty scores and mortality within the first year after surgery, by retrospectively linking frailty scores to mortality data and comparing the strength of their association with mortality to that of the ASA Classification. The frailty scales used were: the Modified Frailty Index (MFI) and, the Risk Analysis Index-A (RAI-A) and the G8 screening test (G8). As secondary objectives, we assessed the relationship of the frailty scales with morbidity and compared all the scales with the ASA. MATERIAL AND METHODS We retrospectively studied 172 patients aged 65 years and older who underwent laparoscopic colorectal surgery for cancer between January 2017 and June 2018, following them up for 1year after surgery. RESULTS Both morbidity and mortality were significantly associated with all frailty scale scores (p<.001). The more frailty, the greater probability of prolonged hospital stay, complications, readmissions and emergency department visits. Using each scale, patients were categorized into two groups (frail and non-frail patients). The C-indexes for 1-year mortality with the RAI-A and, MFI and G8 were 0.89 and, 0.86 and 0.86 respectively. On the other hand, ASA status is not strongly associated with mortality, with a C-index of .63. DISCUSSION Frailty scores should begin to influence medical and surgical strategies and further research is needed to develop guidelines for interventions in geriatric patients.
Collapse
Affiliation(s)
- E Garcia-Perez
- Department of Anaesthesiology and Intensive Care, Galdakao-Usánsolo Hospital, Galdakao, Spain.
| | - U Aguirre-Larracoechea
- Research Unit, REDISSEC, Health Services Research on Chronic Patients Network, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - V Portugal-Porras
- General Surgery Department, Medicine and Surgery Faculty, Basque Country University, Galdakao-Usánsolo Hospital, Galdakao, Spain
| | - N Azpiazu-Landa
- Department of Anaesthesiology and Intensive Care, Galdakao-Usánsolo Hospital, Galdakao, Spain
| | - S Telletxea-Benguria
- Department of Anesthesiology and Intensive Care, Galdakao-Usánsolo Hospital, Galdakao, Spain
| |
Collapse
|
7
|
Aguirre-Allende I, Enríquez-Navascués JM, Elorza G, Etxart A, Echeveste A, Borda-Arrizabalaga N, Placer C, Saralegui Y. Care burden and outcome of the surgical management of ulcerative colitis: A retrospective analysis of the last 20 years in a tertiary hospital in Spain. Cir Esp 2023; 101:12-19. [PMID: 36635025 DOI: 10.1016/j.cireng.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/03/2021] [Indexed: 01/12/2023]
Abstract
AIM To analyze the surgical burden of UC care in the last two decades, analyzing the characteristics of the patients, surgical indications along with the short and long-term results. METHOD Single-center retrospective cohort analysis of UC patients undergoing abdominal and anorectal surgery between January 2000 and December 2020. The care burden, clinical data and results were analyzed according to distribution by decades. RESULTS 128 patients, 37% female, underwent 376 surgical interventions (296 intestinal procedures and 80 anorectal). Mean follow-up for the cohort was 106±64 months. Timing from diagnosis to first surgery was under 5 years in 53.3%. In the second decade of the study there were fewer operated patients (73 vs. 48) as well as the total number of interventions per patient (2.7 vs. 2.0). The proportion between elective and urgent surgery was reversed in the second decade, observing an increase in laparoscopic surgery (70% vs. 8%) together with a decrease in major postoperative morbidity (Clavien-Dindo≥IIIa) (20% vs 8.4%). 80 patients underwent a restorative proctocolectomy, with a failure of 5% at 1 year but 23.7% in the long term. 37 patients required anorectal surgery, of which 26 (71%) were serial interventions, most due to septic complications of the pouches. CONCLUSIONS The number of colectomies and interventions per patient decreased in the last decade, while there were improvements in morbidity and surgical approach. The need for sequential surgeries and long-term active instrumental surveillance for possible functional deterioration constitutes a significant clinical burden.
Collapse
Affiliation(s)
- Ignacio Aguirre-Allende
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Jose M Enríquez-Navascués
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain.
| | - Garazi Elorza
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Ane Etxart
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Ainhoa Echeveste
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Nerea Borda-Arrizabalaga
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Carlos Placer
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Yolanda Saralegui
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| |
Collapse
|
8
|
Morales-Conde S, Licardie E, Alarcón I, Balla A. Indocyanine green (ICG) fluorescence guide for the use and indications in general surgery: recommendations based on the descriptive review of the literature and the analysis of experience. Cir Esp 2022; 100:534-554. [PMID: 35700889 DOI: 10.1016/j.cireng.2022.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/26/2021] [Indexed: 06/15/2023]
Abstract
Indocyanine Green is a fluorescent substance visible in near-infrared light. It is useful for the identification of anatomical structures (biliary tract, ureters, parathyroid, thoracic duct), the tissues vascularization (anastomosis in colorectal, esophageal, gastric, bariatric surgery, for plasties and flaps in abdominal wall surgery, liver resection, in strangulated hernias and in intestinal ischemia), for tumor identification (liver, pancreas, adrenal glands, implants of peritoneal carcinomatosis, retroperitoneal tumors and lymphomas) and sentinel node identification and lymphatic mapping in malignant tumors (stomach, breast, colon, rectum, esophagus and skin cancer). The evidence is very encouraging, although standardization of its use and randomized studies with higher number of patients are required to obtain definitive conclusions on its use in general surgery. The aim of this literature review is to provide a guide for the use of ICG fluorescence in general surgery procedures.
Collapse
Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain; Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Eugenio Licardie
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain.
| | - Andrea Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain; UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Civitavecchia, Rome, Italy.
| |
Collapse
|
9
|
Bustamante Recuenco C, Alonso-Lambertí Rizo L, Salazar Carrasco A, Valle Rubio A, Cendrero Martín M, Jiménez Carneros V, Ramos Rodríguez JL, Jiménez Miramón FJ. Resident training in colorectal laparoscopic surgery: A retrospective morbidity, mortality and survival analysis of 408 cases in our environment. Cir Esp 2022; 100:555-561. [PMID: 35697242 DOI: 10.1016/j.cireng.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/14/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Colorectal cancer has a growing incidence in our society. However, the performance of laparoscopic interventions in this field is still not included in the National Training Program. Given the lack of references, our objective was to analyze the resident's participation in laparoscopic colorectal surgery and its possible effect on morbidity and mortality and oncological prognosis. METHODS A retrospective longitudinal single-center study that included all laparoscopic colorectal surgical procedures performed by residents (R group) and by attending surgeons (A group) between 01/01/2009 and 12/31/2017, maintaining follow-up until 12/31/2018. Postoperative morbidity and mortality, overall survival (OS) and disease- free survival (DFS), as well as their relationship with the resident involvement as first surgeon were analyzed. RESULTS 408 patients were analyzed, of which 138 (33.8%) were operated by a supervised resident and 270 (66.2%) by the attending surgeon. No differences were detected in the rate of postoperative complications between both groups (OR: 1.536; 95% CI: 0.947-2.409; p = 0.081). Furthermore, resident participation had no influence on tumor recurrence rate (R Group: 14.2% vs. A Group: 16.9%; p = 0.588) or on overall (p = 0.562) or disease-free survival (p = 0.305). CONCLUSION Resident involvement in laparoscopic colorectal surgery had no influence on morbidity and mortality or oncological prognosis in our center. Conducting prospective studies in this regard will provide greater knowledge, enabling a progressive improvement of the training program.
Collapse
Affiliation(s)
| | | | | | - Ainhoa Valle Rubio
- FEA Cirugía General y del Aparato Digestivo, Hospital Universitario de Getafe, Madrid, Spain
| | - Manuel Cendrero Martín
- FEA Cirugía General y del Aparato Digestivo, Hospital Nuestra Señora de los Sonsoles, Ávila, Spain
| | | | | | | |
Collapse
|
10
|
López-Rojo I, Alonso O, Ortega-Pérez G, Galipienzo-Garcia J, González-Moreno S. Prioritization, patient selection, and multimodal perioperative management of colorectal cancer facing health-care system saturation. CIR CIR 2021; 89:755-762. [PMID: 34851582 DOI: 10.24875/ciru.20000990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim is to analyze the usefulness of pre-operative COVID-19 screening to detect asymptomatic patients, the capability of our patient selection algorithm to detect patients with more advanced tumors and the results of colorectal cancer surgery managed with a multimodal approach. We propose the use of a preoperative patient selection algorithm to prioritize the surgical treatment of patients with worse oncological prognosis and lower perioperative risk in situations of health system saturation. MATERIAL AND METHODS Prospective descriptive study including 71 patients operated on for colorectal cancer during COVID-19's high incidence period. A division was made into two periods of time that were later compared with the aim of assessing whether the scale used identified those patients with lower surgical risk and higher oncological priority for their priority scheduling. RESULTS Post-operative severe acute respiratory syndrome coronavirus 2 infection occurred in one patient (1.4%). Pre-operative polymerase chain reaction detected one asymptomatic patient (3%). Tumor stage was ≥ IIIA in 39% and node positive in 39% of patients in the first period, while 26% and 21% in the second period, respectively (p = 0.320; p = 0.179), without increasing the surgical stay or complications. Median hospital stay was 5 days. Grades III and IV morbidity were 4.4% and 1.4%. CONCLUSION The use of an algorithm and Patient Selection Scale can detect patients with more advanced tumors to be operated before. Multimodal management/ERAS have a role in achieving short stay and low morbidity.
Collapse
Affiliation(s)
| | - Oscar Alonso
- Surgical Oncology Service, Anderson Cancer Center
| | | | | | | |
Collapse
|
11
|
Ortiz de Elguea-Lizárraga JI, Riojas-Garza A, Chapa-Lobo AF, Rangel-Ríos HA, García-García AL, Quevedo-Fernández E, Salgado-Cruz LE. Indocyanine green fluorescence angiography in colorrectal surgery. First case series in Mexico. Rev Gastroenterol Mex (Engl Ed) 2021; 87:29-34. [PMID: 34656502 DOI: 10.1016/j.rgmxen.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND AIM Anastomosis leak occurs in 1-19% of colorrectal surgeries. Our objective was to present the first Mexican case series on colorrectal surgery using indocyanine green fluorescence angiography to evaluate perfusion prior to carrying out the anastomosis. MATERIALS AND METHODS A retrospective, analytic, descriptive study was conducted. We studied the case records of consecutive patients that underwent colorrectal surgery with indocyanine green angiography performed by the same group of colorrectal surgeons. RESULTS Twenty-one case records were reviewed. Eleven (52.3%) of the patients were women, mean patient age was 57 years (38-82), and mean body mass index was 25 kg/m2 (17-34). Fifteen (71.4%) patients were diagnosed with malignant disease. Indocyanine green angiography changed our therapeutic decision in three (14.2%) patients. Two colorrectal anastomoses (14.2%) were performed at fewer than 5 cm from the anal verge and 13 (61.9%) were performed at more than 5 cm from the anal verge. Three of the anastomoses were ileocolic (14.2%), two were coloanal (9.5%), and one was ileoanal (4.7%). There were six (28.5%) complications, no cases of anastomotic leak, and no complications associated with the use of indocyanine green. The mortality rate was 0%. CONCLUSION The present case series is the first on colorrectal surgery conducted in Mexico using indocyanine green fluorescence angiography, with excellent results.
Collapse
Affiliation(s)
| | - A Riojas-Garza
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Nuevo León, Mexico
| | - A F Chapa-Lobo
- Coloncare, Hospital Ángeles Valle Oriente, Nuevo León, Mexico
| | - H A Rangel-Ríos
- Coloncare, Hospital Ángeles Valle Oriente, Nuevo León, Mexico
| | - A L García-García
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Nuevo León, Mexico
| | - E Quevedo-Fernández
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Nuevo León, Mexico
| | - L E Salgado-Cruz
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Nuevo León, Mexico; Coloncare, Hospital Ángeles Valle Oriente, Nuevo León, Mexico.
| |
Collapse
|
12
|
Aguirre-Allende I, Enríquez-Navascués JM, Elorza G, Etxart A, Echeveste A, Borda-Arrizabalaga N, Placer C, Saralegui Y. Care burden and outcome of the surgical management of ulcerative colitis: A retrospective analysis of the last 20 years in a tertiary hospital in Spain. Cir Esp 2021; 101:S0009-739X(21)00259-1. [PMID: 34509292 DOI: 10.1016/j.ciresp.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
AIM To analyze the surgical burden of UC care in the last two decades, analyzing the characteristics of the patients, surgical indications along with the short and long-term results. METHOD Single-center retrospective cohort analysis of UC patients undergoing abdominal and anorectal surgery between January 2000 and December 2020. The care burden, clinical data and results were analyzed according to distribution by decades. RESULTS 128 patients, 37% female, underwent 376 surgical interventions (296 intestinal procedures and 80 anorectal). Mean follow-up for the cohort was 106±64 months. Timing from diagnosis to first surgery was under 5 years in 53.3%. In the second decade of the study there were fewer operated patients (73 vs. 48) as well as the total number of interventions per patient (2.7 vs. 2.0). The proportion between elective and urgent surgery was reversed in the second decade, observing an increase in laparoscopic surgery (70% vs. 8%) together with a decrease in major postoperative morbidity (Clavien-Dindo≥IIIa) (20% vs 8.4%). 80 patients underwent a restorative proctocolectomy, with a failure of 5% at 1 year but 23.7% in the long term. 37 patients required anorectal surgery, of which 26 (71%) were serial interventions, most due to septic complications of the pouches. CONCLUSIONS The number of colectomies and interventions per patient decreased in the last decade, while there were improvements in morbidity and surgical approach. The need for sequential surgeries and long-term active instrumental surveillance for possible functional deterioration constitutes a significant clinical burden.
Collapse
Affiliation(s)
- Ignacio Aguirre-Allende
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Jose M Enríquez-Navascués
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain.
| | - Garazi Elorza
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Ane Etxart
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Ainhoa Echeveste
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Nerea Borda-Arrizabalaga
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Carlos Placer
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Yolanda Saralegui
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| |
Collapse
|
13
|
Ripollés-Melchor J, Fernández Dorado F, Rubio Aguilera AI, Criado Camargo A, Chico García M, Abad-Motos A, Abad-Gurumeta A. Association between preoperative baseline pulse pressure and estimated pulse wave velocity and acute renal failure and mortality following colorectal surgery. A single-centre observational study. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:S0034-9356(21)00103-1. [PMID: 34289958 DOI: 10.1016/j.redar.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 01/26/2021] [Accepted: 02/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Elevated pulse wave velocity is a haemodynamic parameter considered to be a risk factor for the development of cardiovascular alterations, while pulse pressure is a predictor of cardiovascular complications and development of acute renal failure after both cardiac and non-cardiac surgery. Our objective was to determine whether baseline pulse pressure and estimated pulse wave velocity are associated with renal failure and 30-day mortality following colorectal surgery. METHODS Retrospective observational study. A total of 816 adult patients undergoing elective colorectal surgery were evaluated by performing multivariable logistic regression analysis to determine whether baseline pulse pressure and estimated pulse wave velocity were independently associated with complications, specifically renal failure and 30-day postoperative mortality, and whether pulse pressure and estimated pulse wave velocity thresholds correlated with outcomes. RESULTS Baseline pulse pressure was 56.00mmHg (45.00;68.00) and estimated pulse wave velocity was 13.16m/s (10.76;14.85). Baseline pulse pressure was not associated with acute renal failure or mortality in the univariate model. Baseline estimated pulse wave velocity was not associated with complications, acute renal failure, or mortality. An estimated pulse wave velocity of 13.78m/s significantly predicted acute renal failure (AUC 0.654 [0.588-0.720]) and mortality (AUC 0.698 [0.600-0.796]). CONCLUSIONS Neither pulse pressure nor preoperative baseline estimated pulse wave velocity were associated with acute renal failure or postoperative mortality. The preoperative estimated pulse wave velocity threshold of 13.78m/s predicted an increased risk of acute renal failure and postoperative mortality.
Collapse
Affiliation(s)
- J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM). Grupo Español de Rehabilitación Multimodal (GERM), Madrid, España.
| | | | | | | | | | - A Abad-Motos
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM). Grupo Español de Rehabilitación Multimodal (GERM), Madrid, España
| | - A Abad-Gurumeta
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Spanish Perioperative Audit and Research Network (REDGERM). Grupo Español de Rehabilitación Multimodal (GERM), Madrid, España
| |
Collapse
|
14
|
Bustamante Recuenco C, Alonso-Lambertí Rizo L, Salazar Carrasco A, Valle Rubio A, Cendrero Martín M, Jiménez Carneros V, Ramos Rodríguez JL, Jiménez Miramón FJ. Resident training in colorectal laparoscopic surgery: A retrospective morbidity, mortality and survival analysis of 408 cases in our environment. Cir Esp 2021; 100:S0009-739X(21)00162-7. [PMID: 34059314 DOI: 10.1016/j.ciresp.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Colorectal cancer has a growing incidence in our society. However, the performance of laparoscopic interventions in this field is still not included in the National Training Program. Given the lack of references, our objective was to analyze the resident's participation in laparoscopic colorectal surgery and its possible effect on morbidity and mortality and oncological prognosis. METHODS A retrospective longitudinal single-center study that included all laparoscopic colorectal surgical procedures performed by residents (R group) and by attending surgeons (A group) between 01/01/2009 and 12/31/2017, maintaining follow-up until 12/31/2018. Postoperative morbidity and mortality, overall survival (OS) and disease-free survival (DFS), as well as their relationship with the resident involvement as first surgeon were analyzed. RESULTS 408 patients were analyzed, of which 138 (33.8%) were operated by a supervised resident and 270 (66.2%) by the attending surgeon. No differences were detected in the rate of postoperative complications between both groups (OR: 1.536; 95% CI: 0.947-2.409; p=0.081). Furthermore, resident participation had no influence on tumor recurrence rate (R Group: 14.2% vs. A Group: 16.9%; p=0.588) or on overall (p = 0.562) or disease-free survival (p = 0.305). CONCLUSION Resident involvement in laparoscopic colorectal surgery had no influence on morbidity and mortality or oncological prognosis in our center. Conducting prospective studies in this regard will provide greater knowledge, enabling a progressive improvement of the training program.
Collapse
Affiliation(s)
| | | | | | - Ainhoa Valle Rubio
- FEA Cirugía General y del Aparato digestivo, Hospital Universitario de Getafe, Madrid, España
| | - Manuel Cendrero Martín
- FEA Cirugía General y del Aparato digestivo, Hospital Nuestra Señora de los Sonsoles, Ávila, España
| | | | | | | |
Collapse
|
15
|
Páramo-Zunzunegui J, Alonso-García M, Rodríguez-Villar D, Drewniak-Jakubowska J, Calvo-Espino P, Cuberes-Montserrat R, Rodríguez-Caravaca G, Durán-Poveda M. Incidence of surgical infection and risk factors in colorectal surgery - A prospective cohort study. CIR CIR 2021; 89:156-162. [PMID: 33784283 DOI: 10.24875/ciru.20000205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective was to measure the incidence of surgical site infection (SSI) and identify risk factors, in patients undergoing elective surgery of the colon and rectum. MATERIALS AND METHODS A prospective cohort study was performed from January 2017 to December 2018. RESULTS A total of 130 patients were studied. The cumulative incidence of SSI was 12.3%. The 56.25% were superficial wound infections and the 31.25%, organ-space infection. The risk factors significantly associated with SSI were the non-administration of pre-operative oral nutrition, diabetes mellitus, heart disease, symptomatic state at the diagnosis of colorectal cancer (CRC), and ≥ 2 altered nutritional biochemical parameters at diagnosis. After multivariate , risk factors associated with SSI were: non-administration of preoperative enteral nutrition (odds ratio [OR] = 0.27; 95% confidence interval [CI]: 0.07-1.0), DM (OR = 3.0; 95% CI: 0.9-9.9), the heart disease (OR = 4.6; 95% CI: 1.1-18.6), and laparoscopic surgery (OR = 0.28; 95% CI: 0.08-0.97). The average stay was higher in patients with a diagnosis of SSI (11.9 vs. 9.2 days). CONCLUSIONS Independent risk factors for SSI in CRC were the non-administration of pre-operative enteral nutrition, the existence of heart disease, and open surgery.
Collapse
Affiliation(s)
- Javier Páramo-Zunzunegui
- Department of General and Digestive System Surgery, Hospital Universitario de Móstoles.,International Doctoral Program, Universidad Rey Juan Carlos
| | | | | | | | - Pablo Calvo-Espino
- Department of General and Digestive System Surgery, Hospital Universitario de Móstoles
| | | | - Gil Rodríguez-Caravaca
- Preventive Medicine Unit, Hospital Universitario Fundación Alcorcón.,Department of Preventive Medicine and Public Health, Faculty of Health Science, Universidad Rey Juan Carlos
| | - Manuel Durán-Poveda
- Department of General and Digestive System Surgery, Hospital Universitario Rey Juan Carlos. Madrid, Spain
| |
Collapse
|
16
|
Ortiz de Elguea-Lizárraga JI, Riojas-Garza A, Chapa-Lobo AF, Rangel-Ríos HA, García-García AL, Quevedo-Fernández E, Salgado-Cruz LE. Indocyanine green fluorescence angiography in colorrectal surgery. First case series in Mexico. Rev Gastroenterol Mex (Engl Ed) 2020; 87:S0375-0906(20)30135-X. [PMID: 33388212 DOI: 10.1016/j.rgmx.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/09/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIM Anastomotic leak occurs in 1-19% of colorrectal surgeries. Our objective was to present the first Mexican case series on colorrectal surgery using indocyanine green fluorescence angiography to evaluate perfusion prior to carrying out the anastomosis. MATERIALS AND METHODS A retrospective, analytic, descriptive study was conducted. We studied the case records of consecutive patients that underwent colorrectal surgery with indocyanine green angiography performed by the same group of colorrectal surgeons. RESULTS Twenty-one case records were reviewed. Eleven (52.3%) of the patients were women, mean patient age was 57 years (38-82), and mean body mass index was 25 kg/m2 (17-34). Fifteen (71.4%) patients were diagnosed with malignant disease. Indocyanine green angiography changed our therapeutic decision in three (14.2%) patients. Two colorrectal anastomoses (14.2%) were performed at fewer than 5 cm from the anal verge and 13 (61.9%) were performed at more than 5 cm from the anal verge. Three of the anastomoses were ileocolic (14.2%), two were coloanal (9.5%), and one was ileoanal (4.7%). There were six (28.5%) complications, no cases of anastomotic leak, and no complications associated with the use of indocyanine green. The mortality rate was 0%. CONCLUSION The present case series is the first on colorrectal surgery conducted in Mexico using indocyanine green fluorescence angiography, with excellent results.
Collapse
Affiliation(s)
| | - A Riojas-Garza
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Nuevo León, México
| | - A F Chapa-Lobo
- Coloncare, Hospital Ángeles Valle Oriente , Nuevo León,México
| | - H A Rangel-Ríos
- Coloncare, Hospital Ángeles Valle Oriente , Nuevo León,México
| | - A L García-García
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Nuevo León, México
| | - E Quevedo-Fernández
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Nuevo León, México
| | - L E Salgado-Cruz
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Nuevo León, México; Coloncare, Hospital Ángeles Valle Oriente , Nuevo León,México.
| |
Collapse
|
17
|
Sentí S, Gené C, Troya J, Pacho C, Nuñez R, Parrales M, Jimenez I, Fernandez-Llamazares J, Julian JF, Parés D. Comprehensive geriatric assessment: Influence on clinical results after colorectal surgery in advanced age patients. Gastroenterol Hepatol 2020; 44:472-480. [PMID: 33199132 DOI: 10.1016/j.gastrohep.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/08/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The objective of this work was to analyse the postoperative clinical results of patients surgically treated for colorectal cancer in relation to the results of the preoperative comprehensive geriatric evaluation. METHODS Observational study in which postoperative morbidity and mortality at 30 and 90 days were analysed in a cohort of patients surgically treated for colorectal cancer according to age groups: group 1) between 75 and 79 years old; group 2) between 80 and 84 years old, and group 3) ≥85 years old. In addition to the anaesthetic risk assessment, patients were assessed with the Karnofsky, Barthel and Pfeiffer indexes. Mortality at 30 and 90 days after surgery was analysed in relation to the results of the comprehensive evaluation. RESULTS A total of 227 patients with colorectal cancer were included in the study period: 91 in group 1, 89 in group 2 and 47 in group 3. There were statistically significant differences in mortality at 30 days (p=0,029) but not at 90 days after surgery, according to age groups. Mortality at 90 days was significantly higher in patients with worse scores on the Karnofsky and Barthel scales. CONCLUSIONS Comprehensive geriatric assessment using different scales is a good tool to assess postoperative mortality in the mid-term postoperative period.
Collapse
Affiliation(s)
- Sara Sentí
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Germans Trias y Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | - Clara Gené
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Germans Trias y Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | - José Troya
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Germans Trias y Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | - Cristina Pacho
- Unidad de Geriatría de Agudos, Servicio Medicina Interna, Hospital Germans Trias y Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | - Raquel Nuñez
- Unidad de Geriatría de Agudos, Servicio Medicina Interna, Hospital Germans Trias y Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | - Mauricio Parrales
- Servicio de Cirugía General y Digestiva, Hospital Germans Trias y Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | - Irene Jimenez
- Unidad de Atención al Ciudadano, Hospital Germans Trias y Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | - Jaume Fernandez-Llamazares
- Servicio de Cirugía General y Digestiva, Hospital Germans Trias y Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | - Joan-Francesc Julian
- Servicio de Cirugía General y Digestiva, Hospital Germans Trias y Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | - David Parés
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Germans Trias y Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, España.
| |
Collapse
|
18
|
Barbero M, García J, Alonso I, Alonso L, San Antonio-San Román B, Molnar V, León C, Cea M. ERAS protocol compliance impact on functional recovery in colorectal surgery. Cir Esp 2020; 99:108-114. [PMID: 32564875 DOI: 10.1016/j.ciresp.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Compliance to ERAS protocols is a process quality measure that is associated to better outcomes. The main objective of this study is to analyze the association between protocol compliance, surgical stress and functional recovery. The secondary objective is to identify independent factors associated to functional recovery. METHODS A prospective observational single-centre study was performed. Patients who had scheduled colorectal surgery within an ERAS program from January 2017 to June 2018 were included. We analysed the relationship between protocol compliance percentage and surgical stress (defined by C reactive protein [CRP] blood levels on postoperative 3rd day), and functional recovery (defined by the proportion of patients who meet the discharge criteria on the 5th PO day or before). Multivariate analysis was performed to asses independent factor associated to functional recovery. RESULTS 313 were included. For every additional percentage point of compliance to the protocol 3rd day C reactive protein plasmatic level decreases 1,46 mg/dL and increases 7% the probability to meet the discharge criteria (p < 0.001 both). Independent factors associated to functional recovery were ASA III-IV (OR 0.26; 0.14-0.48), surgical CR-POSSUM score (OR 0.68; 0.57-0.83), early mobilization (OR 4.22; 1.43-12.4) and removal of urinary catheter (OR 3.35; 1.79-6.27), p < 0,001 each of them. CONCLUSION Better compliance to ERAS protocol in colorectal surgery decreases surgical stress and accelerates functional recovery.
Collapse
Affiliation(s)
- Macarena Barbero
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España.
| | - Javier García
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España; Instituto de Investigación Sanitaria, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Isabel Alonso
- Servicio de Cirugía General, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Laura Alonso
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Belén San Antonio-San Román
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Viktoria Molnar
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Carmen León
- Servicio de Cirugía General, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Matías Cea
- Servicio de Cirugía General, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| |
Collapse
|
19
|
Barbero-Mielgo M, García-Fernández J, Alonso-Menarguez B, Román BSA, Molnar V, Gilsanz-Rodríguez F. [Is postoperative acute pain control in colorectal surgery better within an enhanced recovery after surgery program (ERAS)?]. J Healthc Qual Res 2020; 35:65-72. [PMID: 32234289 DOI: 10.1016/j.jhqr.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/19/2020] [Accepted: 03/04/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE A good acute pain control is necessary to achieve the main objective of Enhanced recovery After Surgery (ERAS) programs and accelerate recovery. The study objective is to evaluate postoperative (PO) acute pain, PO opioid consumption, and its association with functional recovery, after implementing a colorectal surgery ERAS program. An analysis was made as regards drugs adverse effects. METHODS Observational cohort study on scheduled colorectal Surgery: one prospective cohort subjected to the ERAS care program, and one retrospective cohort that received traditional non-standardised care. A record was made of mean pain intensity (measured by a visual analogue scale, which classifies pain intensity from 0 to 10, from lower to higher intensity), as well as the amount of opioid consumption on the day of surgery and on the first three postoperative days, and drugs adverse effects. An analysis was made of the association between PO opioid consumption and ERAS program, and between PO opioid consumption and functional recovery. RESULTS The study included a total of 410 patients (313 in the ERAS group and 97 in the control group). In the ERAS group, it was observed that the mean visual analogue scale was less than 2, with a smaller amount of PO opioid consumption, on each single day and the accumulated amount of the four days (4 [0-24] vs. 0 [0-4], P<.001). PO opioid consumption was associated with functional recovery (OR 0.97 [95% CI; 0.96-0.99], P=.011). No drugs adverse effects were observed. CONCLUSIONS After implementing a colorectal Surgery ERAS program, good pain control was achieved, as well as a reduction in PO opioid consumption, which is associated with functional recovery. No drugs adverse effects were observed.
Collapse
|
20
|
Rivera Domínguez A, de Araujo Martins-Romeo D, Ruiz García T, García de la Oliva A, Cueto Álvarez L. Urgent Multidetector Computed Tomography in Colon Cancer: Postsurgical Changes and Early Complications. Radiologia (Engl Ed) 2019; 61:286-96. [PMID: 31010689 DOI: 10.1016/j.rx.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/20/2019] [Accepted: 02/24/2019] [Indexed: 11/20/2022]
Abstract
Complications after surgery for colorectal cancer are common in emergency departments. Multidetector computed tomography plays a fundamental role in the follow-up of patients after surgery, because it enables the detection of relapse and complications. Radiologists need to be familiar with different surgical techniques and the normal postsurgical changes so that we can differentiate them from potential complications and relapse. This article reviews the multidetector computed tomography findings that can be considered normal after surgical intervention for colorectal cancer as well as the most common early complications seen in postsurgical colorectal cancer patients presenting at emergency departments.
Collapse
|
21
|
Resalt-Pereira M, Muñoz JL, Miranda E, Cuquerella V, Pérez A. Goal-directed fluid therapy on laparoscopic colorectal surgery within enhanced recovery after surgery program. ACTA ACUST UNITED AC 2019; 66:259-266. [PMID: 30862401 DOI: 10.1016/j.redar.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Enhanced recovery after surgery protocols (ERAS) are used in peri-operative care to reduce the stress response to surgical aggression. As fluid overload has been associated with increased morbidity and delayed hospital discharge, a major aspect of this is fluid management. Intra-operative goal-directed fluid protocols have been shown to reduce post-operative complications, particularly in high risk patients.?. OBJECTIVE To compare 2fluid therapy models (zero-balance versus goal-directed fluid therapy) in patients who were scheduled for laparoscopic colorectal surgery within an ERAS program, recording the rate of complications such as surgical site infection, ileus, post-operative náusea and vomiting, and variability of the estimated glomerular filtration rate (eGFR). MATERIALS AND METHODS An observational, retrospective study was conducted including adults who were scheduled for elective laparoscopic colorectal surgery within an ERAS program, and to investigate the postoperative complication rate. RESULTS A total of 128 patients were included in this study; 43 (33.6%) in the zero-balance group and 85 (66.4%) in the goal-directed fluid therapy group. The total fluids administered was lower in the goal-directed fluid therapy group, as well as the incidence of post-operative complications (surgical site infection, anastomotic leak, ileus, and postoperative náusea and vomiting). No significant differences were found for length of stay, intra-operative urine output, and variability of the eGFR.?. CONCLUSION The results of this study show that by using a goal-directed fluid therapy algorithm, the total amount of fluids administered can be reduced, as well as obtaining a lower incidence of post-operative complications.
Collapse
Affiliation(s)
- M Resalt-Pereira
- Departamento de Anestesiología, Reanimación y Terapéutica de Dolor, Hospital General Universitario de Elche, Camí de l'Almazara 11, CP 03203 Elche, Alicante, España.
| | - J L Muñoz
- Departamento de Anestesiología, Reanimación y Terapéutica de Dolor, Hospital General Universitario de Elche, Camí de l'Almazara 11, CP 03203 Elche, Alicante, España
| | - E Miranda
- Departamento de Anestesiología, Reanimación y Terapéutica de Dolor, Hospital General Universitario de Elche, Camí de l'Almazara 11, CP 03203 Elche, Alicante, España
| | - V Cuquerella
- Departamento de Anestesiología, Reanimación y Terapéutica de Dolor, Hospital General Universitario de Elche, Camí de l'Almazara 11, CP 03203 Elche, Alicante, España
| | - A Pérez
- Departamento de Anestesiología, Reanimación y Terapéutica de Dolor, Hospital General Universitario de Elche, Camí de l'Almazara 11, CP 03203 Elche, Alicante, España
| |
Collapse
|
22
|
Badia JM, Arroyo-García N. Mechanical bowel preparation and oral antibiotic prophylaxis in colorectal surgery: Analysis of evidence and narrative review. Cir Esp 2019; 96:317-325. [PMID: 29773260 DOI: 10.1016/j.ciresp.2018.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 01/03/2023]
Abstract
The role of oral antibiotic prophylaxis and mechanical bowel preparation in colorectal surgery remains controversial. The lack of efficacy of mechanical preparation to improve infection rates, its adverse effects, and multimodal rehabilitation programs have led to a decline in its use. This review aims to evaluate current evidence on antegrade colonic cleansing combined with oral antibiotics for the prevention of surgical site infections. In experimental studies, oral antibiotics decrease the bacterial inoculum, both in the bowel lumen and surgical field. Clinical studies have shown a reduction in infection rates when oral antibiotic prophylaxis is combined with mechanical preparation. Oral antibiotics alone seem to be effective in reducing infection in observational studies, but their effect is inferior to the combined preparation. In conclusion, the combination of oral antibiotics and mechanical preparation should be considered the gold standard for the prophylaxis of postoperative infections in colorectal surgery.
Collapse
Affiliation(s)
- Josep M Badia
- Servicio de Cirugía General, Hospital General de Granollers , Granollers, España; Universitat Internacional de Catalunya , Barcelona, España.
| | - Nares Arroyo-García
- Servicio de Cirugía General, Hospital General de Granollers , Granollers, España
| |
Collapse
|
23
|
Guevara-Morales GR, Regalado-Torres MA, Cantarell-Castillo E, Castro-Salas R, Maldonado-Barrón R, Castellanos-Juárez JC. [Utilidad de la proteína C reactiva en el diagnóstico oportuno de fuga de anastomosis en cirugía colorrectal]. CIR CIR 2018; 86:432-436. [PMID: 30226485 DOI: 10.24875/ciru.18000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introducción La fuga de anastomosis (FA) en cirugía colorrectal es una complicación temida por el incremento de la morbimortalidad. La tasa de FA se reporta desde el 1 hasta el 25%. Realizar el diagnóstico de forma temprana es difícil. Objetivo Determinar el rendimiento diagnóstico de la proteína C reactiva (PCR) en una cohorte de pacientes sometidos a cirugía colorrectal electiva con anastomosis. Método Se realizó un estudio prospectivo, comparativo, en 138 pacientes sometidos a cirugía colorrectal con anastomosis de forma electiva, analizando los valores séricos de la PCR los días 1, 3, 5 y 7 del posoperatorio, así como los de leucocitos y otros datos de sepsis abdominal. Resultados La tasa de FA fue del 6.5%, y los valores de la PCR fueron significativamente más altos en el grupo de pacientes con FA en el tercer día del posoperatorio. Con un punto de corte de 18.5 mg/dl en el tercer día del posoperatorio se obtuvo una sensibilidad del 81%, una especificidad del 91%, un valor predictivo positivo del 45% y un valor predictivo negativo del 98%. Conclusión La medición de la PCR en el tercer día del posoperatorio en pacientes sometidos a cirugía colorrectal electiva con anastomosis primaria o secundaria permite identificar las complicaciones sépticas, incluida la FA. Introduction The anastomotic leakage (AL) in colorectal surgery is a complication feared by the increase in morbidity and mortality. The rate of AF is reported from 1 to 25%. Making the diagnosis early is difficult. Objective To determine the diagnostic performance of the C reactive protein (CRP) in a cohort of patients undergoing elective colorectal surgery with anastomosis. Method A prospective, comparative study was conducted in 138 patients undergoing elective anastomosis with colorectal surgery, analyzing the serum values of CRP on postoperative days 1, 3, 5 and 7, as well as leukocytes and other abdominal sepsis data. Results The AL rate was 6.5%, the CRP values were significantly higher in the group of patients with AF on the 3rd postoperative day; with a cut-off point of 18.5 mg/dl on the third postoperative day, it obtained sensitivity 81%, specificity 91%, positive predictive value 45%, negative predictive value 98%. Conclusion Measurement of CRP on the third postoperative day in patients undergoing elective colorectal surgery with primary or secondary anastomosis allows the identification of septic complications including leakage of anastomosis.
Collapse
Affiliation(s)
- Guillermo R Guevara-Morales
- Departamento de Cirugía General, Hospital Regional de Veracruz del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Veracruz, Veracruz, México
| | - Marco A Regalado-Torres
- Departamento de Cirugía General, Hospital Regional de Veracruz del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Veracruz, Veracruz, México
| | - Eduardo Cantarell-Castillo
- Departamento de Cirugía General, Hospital Regional de Veracruz del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Veracruz, Veracruz, México
| | - Ricardo Castro-Salas
- Servicio de Cirugía Oncológica, Hospital Regional de Veracruz del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Veracruz, Veracruz, México
| | - Rebeca Maldonado-Barrón
- Servicio de Coloproctología, Hospital Regional de Veracruz del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Veracruz, Veracruz, México
| | - Juan C Castellanos-Juárez
- Servicio de Coloproctología, Hospital Regional de Veracruz del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Veracruz, Veracruz, México
| |
Collapse
|
24
|
Hoyuela C, Juvany M, Trias M, Ardid J, Martrat A. Incisional hernia prevention using a cyanoacrilate-fixed retrofascial mesh. Cir Esp 2017; 96:35-40. [PMID: 29249278 DOI: 10.1016/j.ciresp.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 10/24/2017] [Accepted: 10/28/2017] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The rate of incisional hernia in high-risk patients (obesity, cancer, etc.) is high, even in laparoscopic surgery. The aim of this study is to evaluate the safety of the use of cyanoacrylate fixed prophylactic meshes in the assistance incision in overweight or obese patients undergoing laparoscopic colorectal surgery. METHODS A prospective, non-randomized cohort study of patients undergoing elective laparoscopic resection for colorectal cancer between January 2013 and March 2016 was performed. Those with a body mass index greater than 25kg / m2 were evaluated to implant a prophylactic meshes fixed with cyanoacrylate (Histoacryl®) as reinforcement of the assistance incision. RESULTS 52 patients were analyzed (mean body mass index: 28.4±2kg / m 2). Prophylactic meshes was implanted in 15 patients. The time to put the mesh in place was always less than 5minutes. There was no significant difference in wound infection rate (12% vs. 10%). No mesh had to be explanted. Although the mean follow-up was shorter (14.1±4 vs. 22.3±9 months), there were no incisional hernia in the mesh group. On the other hand, in the non-mesh group, 1 acute evisceration (2.7%) and 4 incisional hernia of the assistance incision were observed (10.8%). There were no significant differences between groups regarding trocar incisional hernia (6.6 vs. 5.4%). CONCLUSIONS The implantation of a reinforcement prophylactic mesh in overweight or obese patients undergoing laparoscopic colorectal surgery is safe and seems to reduce the short-term rate of incisional hernia. Fixation with cyanoacrylate is a rapid method that facilitates the procedure without additional complications.
Collapse
Affiliation(s)
- Carlos Hoyuela
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Montserrat Juvany
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Trias
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jordi Ardid
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Antoni Martrat
- Servicio de Cirugía Digestiva, Hospital Platón Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| |
Collapse
|
25
|
Argudo N, Iskra MP, Pera M, Sancho JJ, Grande L, López-Cano M, Pereira JA. The use of an algorithm for prophylactic mesh use in high risk patients reduces the incidence of incisional hernia following laparotomy for colorectal cancer resection. Cir Esp 2017; 95:222-8. [PMID: 28400141 DOI: 10.1016/j.ciresp.2017.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/10/2017] [Accepted: 03/26/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Incisional hernia (IH) after colorectal surgery is highly prevalent. The objective of this study is to assess the utility of an algorithm to decide on mesh augmentation after a midline laparotomy for colorectal resection to prevent IH in high-risk patients. METHODS A prospective study was conducted including all patients undergoing a midline laparotomy for colorectal resection between January 2011 and June 2014, after the implementation of a decision algorithm for prophylactic mesh augmentation in selected high-risk patients. Intention-to-treat analyses were conducted between patients in which the algorithm was correctly applied and those in which it was not. RESULTS From the 235 patients analysed, the algorithm was followed in 166 patients, the resting 69 cases were used as a control group. From an initial adherence to the algorithm of 40% in the first semester, a 90.3% adherence was achieved in the seventh semester. The incidence of IH decreased as the adherence to the algorithm increased (from 28 to 0%) with a time-related correlation (R2=0.781). A statistically significant reduction in IH incidence was demonstrated in high-risk groups in which the algorithm was correctly applied (10,2 vs. 46,3%; p=0,0001; OR: 7,58;95%; CI: 3,8-15). Survival analysis showed that the differences remained constant during follow-up. CONCLUSION The implementation of the algorithm reduces the incidence of IH in high-risk patients. The adherence to the algorithm also correlates with a decrease in the incidence of IH.
Collapse
|
26
|
Correa-Rovelo JM, Villanueva-López GC, Medina-Santillan R, Carrillo-Esper R, Díaz-Girón-Gidi A. [Intestinal obstruction secondary to postoperative adhesion formation in abdominal surgery. Review]. CIR CIR 2015; 83:345-51. [PMID: 26116038 DOI: 10.1016/j.circir.2015.05.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/03/2014] [Indexed: 01/09/2023]
Abstract
The development of intestinal obstruction after upper and lower abdominal surgery is part of the daily life of each every surgeon. Despite this, there are very few good quality studies that allow enable assessment of the frequency of intestinal obstruction to be assessed, even although postoperative adhesions are the cause of considerable direct and indirect morbidity and its prevention can be considered a public health problem. And yet, in Mexico, at this time, there is no validated recommendation validated on the prevention of adhesions, or more particularly, in connection with the use of a variety of anti-adhesion commercial products which have been marketed for at least a decade. Intraperitoneal adhesions develop between surfaces without peritoneum of the abdominal organs, mesentery, and abdominal wall. The most common site of adhesions is between the greater omentum and anterior abdominal wall previous. Despite the frequency of adhesions and their direct and indirect consequences, just there is only one published a recommendation (from gynaecological literature), regarding peritoneal adhesion prevention. As regards of colorectal surgery, performed more than 250,000 colorectal resections are performed annually in the United States, and from 24% to 35% of them will develop a complication. The clinical and economic financial burden of these complications is enormous, and surgeries colorectal surgery been specifically highlighted as a potential point prevention point of surgical morbidity.
Collapse
Affiliation(s)
| | | | - Roberto Medina-Santillan
- Departamento de Investigación y Posgrado, Escuela Superior de Medicina IPN, México, D.F., México
| | - Raúl Carrillo-Esper
- Unidad de Cuidados Intensivos, Hospital y Fundación Clinica Médica Sur, México, D.F., México
| | - Alejandro Díaz-Girón-Gidi
- Residente de Cirugía Genral, Facultad Mexicana de Medicina, Universidad La Salle, México, D.F., México
| |
Collapse
|
27
|
Colsa Gutiérrez P, Viadero Cervera R, Morales-García D, Ingelmo Setién A. Intraoperative peripheral nerve injury in colorectal surgery. An update. Cir Esp 2015; 94:125-36. [PMID: 26008880 DOI: 10.1016/j.ciresp.2015.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 02/04/2015] [Accepted: 03/08/2015] [Indexed: 12/15/2022]
Abstract
Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury.
Collapse
Affiliation(s)
- Pablo Colsa Gutiérrez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana , Torrelavega, Cantabria, España.
| | | | - Dieter Morales-García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Alfredo Ingelmo Setién
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana , Torrelavega, Cantabria, España
| |
Collapse
|