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Yeganeh Z, Rahimi M, Kopatsis AP, Kopatis K, Kopatsis A. Outcome of Prophylactic Postoperative Negative Pressure Wound Treatment in Colorectal Cancer Patients. Am Surg 2022:31348221091936. [PMID: 35451887 DOI: 10.1177/00031348221091936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Wound infection is a common cause of morbidity in colorectal surgery. We speculated that a prophylactic Negative Pressure Wound Treatment (NPWT) is associated with less postoperative wound complications for colorectal cancer patients who undergo a colectomy. METHODS Multivariate analysis was used to investigate the association between NPWT and wound complications for patients with colorectal cancer who underwent a colectomy using data from the National Surgical Quality Improvement Program (NSQIP) database during the 2013 - 2019 period. RESULTS We investigated 96 105 patients who underwent colectomy for colorectal cancer during 2013-2019 within the database. Negative Pressure Wound Treatment was utilized for 270 patients following the principal procedure (.3%). Patients who had NPWT had dirtier wounds, less bowel preparation, more extensive surgery (total colectomy vs partial colectomy), higher stoma creation, and more non-elective operations. Multiple factors were associated with postoperative wound complications such as smoking Adjusted Odd Ratio (AOR:1.27, P < .01), chronic steroid use (AOR: 1.30, P < .01), obesity (AOR: 1.54, P < .01), and serum albumin level less than 3.5 g/dL (AOR: 1.29, P < .01). Overall, there was no significant decrease in wound complications using NPWT (AOR: .66, P = .14). However, a sub-group of patients who underwent emergent/urgent operation had a significant lower risk of wound complications using NPWT (AOR: .3, CI: .09-.99, P = .04). CONCLUSION Prophylactic NPWT is associated with a decrease in wound complications of patients who underwent an emergent/urgent colectomy for colorectal cancer. However, we could not find any significant decrease in wound complications for elective colorectal procedures for colorectal cancer. Further clinical trials are needed to confirm these study results.
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Affiliation(s)
- Zhobin Yeganeh
- Department of Surgery, 24669NYC Health and Hospitals-Elmhurst, Elmhurst, NY, USA
| | - Murwarid Rahimi
- Department of Surgery, 24669NYC Health and Hospitals-Elmhurst, Elmhurst, NY, USA
| | - Anthony P Kopatsis
- Department of Surgery, 24669NYC Health and Hospitals-Elmhurst, Elmhurst, NY, USA
| | - Katherine Kopatis
- Department of Surgery, 24669NYC Health and Hospitals-Elmhurst, Elmhurst, NY, USA
| | - Anthony Kopatsis
- Department of Surgery, 24669NYC Health and Hospitals-Elmhurst, Elmhurst, NY, USA
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Fuschillo G, Pellino G. Chronic Perineal Sinus After Proctectomy for Crohn's Disease: Risk Reduction Strategies and Management. Dis Colon Rectum 2022; 65:468-471. [PMID: 35067504 DOI: 10.1097/dcr.0000000000002413] [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] [Indexed: 02/08/2023]
Affiliation(s)
- Giacomo Fuschillo
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli," Naples, Italy
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Zaheer Ahmad N, Abbas MH, Al-Naimi NMAB, Parvaiz A. Meta-analysis of biological mesh reconstruction versus primary perineal closure after abdominoperineal excision of rectal cancer. Int J Colorectal Dis 2021; 36:477-492. [PMID: 33392663 DOI: 10.1007/s00384-020-03827-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Extralevator abdominoperineal excision (ELAPE) of rectal cancer has been proposed to achieve better oncological outcomes. The resultant wide perineal wound, however, presents a challenge for primary closure and subsequent wound healing. This meta-analysis compared the outcomes of primary perineal closure with those of biological mesh reconstruction. METHODS The Medline and Embase search was performed for the publications comparing primary perineal closure to biological mesh reconstruction. Early perineal wound complications (seroma, infection, dehiscence) and late perineal wound complications (perineal hernia, chronic pain, and chronic sinus) were analyzed as primary endpoints. Intraoperative blood loss, operation time, and hospital stay were compared as secondary endpoints. RESULTS There was no significant difference in the overall early wound complications after primary closure or biological mesh reconstruction (odds ratio (OR) of 0.575 with 95% confidence interval (CI) of 0.241 to 1.373 and a P value of 0.213). The incidence of perineal hernia after 1 year was significantly high after primary closure of the perineal wounds (OR of 0.400 with 95% CI of 0.240 to 0.665 and a P value of 0.001). No significant differences were observed among other early and late perineal wound complications. The operation time and hospital stay were shorter after primary perineal closure (p 0.001). CONCLUSION A lower incidence of perineal hernia and comparable early perineal wound complications after biological mesh reconstruction show a relative superiority over primary closure. More randomized studies are required before a routine biological mesh reconstruction can be recommended for closure of perineal wounds after ELAPE.
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Affiliation(s)
- Nasir Zaheer Ahmad
- Department of Surgery, University Hospital Limerick, St Nessan's Rd, Dooradoyle, Co., Limerick, V94 F858, Republic of Ireland.
| | - Muhammad Hasan Abbas
- Department of Surgery, Russells Hall Hospital NHS Trust, Pensnett Rd, West Midlands, Dudley, DY1 2HQ, UK
| | | | - Amjad Parvaiz
- Faculty of Health Sciences, University of Portsmouth, Portsmouth, UK.,Colorectal Department, Poole NHS Trust Poole UK, Poole, UK
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Gologorsky R, Arora S, Dua A. Negative-Pressure Wound Therapy to Reduce Wound Complications after Abdominoperineal Resection. Perm J 2020; 24:19.173. [PMID: 32069209 DOI: 10.7812/tpp/19.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Abdominoperineal resection is associated with a high rate of wound complications. A high degree of wound tension, a common contributor to wound breakdown and complications, may be mitigated by incisional negative-pressure wound therapy (NPWT). Although NPWT has been shown to reduce complications associated with open and complex wounds, there is a paucity of data regarding its prophylactic use for incisional wounds. OBJECTIVE To determine the effect of NPWT use on surgical wound complications of abdominoperineal resection for malignancy. METHODS We performed a systematic review by querying the PubMed database for studies from 1990 to 2019 and included English-language studies that used incisional NPWT for closed wounds from abdominoperineal resection in malignancy cases. RESULTS Five studies with a total of 76 patients were included. Their findings showed reduced rates of surgical site complications with the use of incisional NPWT. Another 2 studies describing the use of prophylactic NPWT to expedite secondary closure of the surgical wound followed by incisional wound therapy were separately categorized and included 8 patients, none of whom experienced wound wound complications. DISCUSSION Additional, prospective research is needed to confirm the benefit of prophylactic incisional NPWT.
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Affiliation(s)
- Rebecca Gologorsky
- Department of Surgery, University of California San Francisco-East Bay, Oakland
| | | | - Anahita Dua
- Department of Surgery, Massachusetts General Hospital, Boston
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Lightner AL, Dattani S, Dozois EJ, Moncrief SB, Pemberton JH, Mathis KL. Pouch excision: indications and outcomes. Colorectal Dis 2017; 19:912-916. [PMID: 28387059 DOI: 10.1111/codi.13673] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/09/2017] [Indexed: 12/13/2022]
Abstract
AIM Restorative proctocolectomy with ileal-pouch anal anastomosis is the procedure of choice for ulcerative colitis. Unfortunately, up to 10% of pouches will fail, requiring either reconstruction or excision. While several series have reported on the aetiology of pouch failure, no study to date has focused on the postoperative complications associated with pouch excision. METHODS Patients who had excision of ileoanal reservoir with ileostomy (CPT code 45136) were included. Data abstracted included preoperative, operative and postoperative variables. A Kaplan-Meier curve of pouch survival was performed. RESULTS In all, 147 patients met the inclusion criteria for the study. The median age of patients was 47 years (73 women), and 132 had a diagnosis of ulcerative colitis at the time of colectomy. The most common indications for pouch excision were sepsis (n = 46; 31%) and Crohn's disease (n = 37; 25%). 84 (57%) patients experienced short-term (< 30 days) postoperative complications, the most common of which was a surgical site infection (n = 32; 21%); 55 (37%) patients had long-term complications (> 30 days) postoperatively, the most common of which was a return to the operating room (n = 19; 13%) largely for perineal wounds. Thirty-day mortality was zero. 4.8%, 47.6%, 65.3% and 84.4% of patients had undergone pouch excision by 1, 5, 10 and 20 years from the time of pouch construction, respectively. CONCLUSIONS Pouch excision has a high rate of both short- and long-term postoperative complications. Patients should be appropriately counselled to set expectations accordingly. In view of these findings we suggest that this operation should ideally be performed at a high volume centre with the availability of a multidisciplinary surgical team.
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Affiliation(s)
- A L Lightner
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - S Dattani
- Division of General Surgery, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - E J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - S B Moncrief
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - J H Pemberton
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - K L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Walma MS, Burbach JPM, Verheijen PM, Pronk A, van Grevenstein WMU. Vacuum-assisted closure therapy for infected perineal wounds after abdominoperineal resection. A retrospective cohort study. Int J Surg 2015; 26:18-24. [PMID: 26718610 DOI: 10.1016/j.ijsu.2015.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/18/2015] [Accepted: 12/01/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Perineal wound complications are a main problem after abdominoperineal resection (APR). There is little evidence concerning perineal wound management. This study describes and evaluates the role of vacuum-assisted closure (VAC) therapy in wound management strategies of perineal wound infections after APR. METHODS Patients undergoing APR for malignant disease between January 2007 and January 2013 were identified retrospectively. Data regarding occurrence and management of perineal wound complications were collected. Perineal wound infections were classified into minor or major complications and time to wound healing was measured. Time to wound healing was compared between patients receiving routine care or with additional VAC therapy. RESULTS Of 171 included patients, 76 (44.4%) had minor and 36 (21.1%) major perineal wound infections. Management of major infected perineal wounds consisted of drainage (n = 16), debridement (n = 4), drainage combined with debridement (n = 4), VAC therapy alone (n = 5), or VAC therapy combined with other treatments (n = 7). Median duration of perineal wound healing in major infected wounds was 141 days (range 17-739). Median time to wound healing was not different in patients treated with (172 days, range 23-368) or without VAC therapy (131 days, range 17-739). DISCUSSION AND CONCLUSION In this study, VAC therapy did not shorten time to wound healing. However, prospective studies are required to investigate the role of VAC therapy in management of infected perineal wounds after APR. Up to then, wound management will remain to be based on clinical perception and 'gut-feeling'.
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Affiliation(s)
- M S Walma
- Department of Surgery, University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - J P M Burbach
- Department of Surgery, University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P M Verheijen
- Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - W M U van Grevenstein
- Department of Surgery, University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Use of Vacuum-assisted closure in management of open abdominal wound with multiple enterocutaneous fistulae during chemotherapy: A case report. Int J Surg Case Rep 2015; 17:112-6. [PMID: 26599504 PMCID: PMC4701801 DOI: 10.1016/j.ijscr.2015.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/28/2015] [Accepted: 11/04/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Vacuum-assisted closure (VAC) is useful for treating complex wounds because it promotes granulation. In the present report, a successful case of VAC used for an open abdominal wound with enterocutaneous fistulae after multiple intestinal perforations during chemotherapy is described. PRESENTATION OF CASE A 73-year-old man was admitted to our hospital with severe abdominal pain. He underwent surgical resection for ascending colon cancer 4 years ago and was administered chemotherapy with bevacizumab for recurrence. Physical examination and computed tomography revealed perforation of the intestine, and an emergency operation was performed. Following this procedure, other intestinal perforations occurred, resulting in an open abdominal wound at postoperative day (POD) 10. To isolate enteric contents and promote granulation, VAC was applied to the abdominal wound with enterocutaneous fistulae. Oral intake started at POD 21 and the wound size became smaller. Further, an ostomy bag was directly attached to the most oral perforation site. The patient recovered from life-threatening events without severe infection and was transferred to another hospital close to his home at POD 180. DISCUSSION Gastrointestinal perforation is known to be one of the fatal adverse events of bevacizumab. In this case four gastrointestinal perforations were observed. Isolation of enteric contents is important to heal the wound and VAC is an effective therapy for the management of open abdominal wounds even with enterocutaneous fistulae. CONCLUSION Innovative VAC use for the management of open abdominal wounds can improve the nutritional status and overall wound healing of the patient.
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