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Dalmau M, Marti-Gallostra M, Pellino G, Espin-Basany E, Armengol M. The colon does not reach! A technical note with tricks to avoid colorectal anastomoses under tension. Colorectal Dis 2024; 26:564-569. [PMID: 38263581 DOI: 10.1111/codi.16865] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
AIM We describe two options for colorectal anastomosis suitable in cases when the colon would reach the pelvis under tension. METHOD Deloyers procedure and the retro-ileal colorectal anastomosis are presented, focusing on practical tips and tricks to perform them. Insights on patients who underwent the procedures are provided to demonstrate the advantages and feasibility of the techniques. RESULTS Each step of both techniques is detailed. Ten patients underwent Deloyers procedure and nine underwent retro-ileal anastomosis at our unit. A minimally invasive approach was attempted in 13 patients, of whom five required conversion to open surgery due to the technical complexity of the abdominal procedure. Colorectal anastomosis was successfully performed in all patients. There were no major intra-operative complications, although five patients had postoperative complications requiring further treatment. CONCLUSIONS Both techniques are effective in patients at risk of receiving a colorectal anastomosis under tension, and a minimally invasive approach can be used. However, owing to the complexity of surgery in this group of patients, the perioperative morbidity is not negligible. Careful postoperative management is advisable, and patients should be informed of the risks. In expert hands, the outcomes are acceptable, avoiding an ileorectal anastomosis and its constraints.
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Affiliation(s)
- Mar Dalmau
- Colorectal Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Marc Marti-Gallostra
- Colorectal Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Gianluca Pellino
- Colorectal Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Eloy Espin-Basany
- Colorectal Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Manuel Armengol
- Colorectal Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
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Gómez Ruiz M, Espin-Basany E, Spinelli A, Cagigas Fernández C, Bollo Rodriguez J, Enriquez Navascués JM, Rautio T, Tiskus M. Author response to: Comment on: Early outcomes from the Minimally Invasive Right Colectomy Anastomosis study (MIRCAST). Br J Surg 2024; 111:znad444. [PMID: 38298068 DOI: 10.1093/bjs/znad444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/12/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Marcos Gómez Ruiz
- Grupo de Investigación e Innovación en Cirugía, IDIVAL, Colorectal Surgery Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | | | - Carmen Cagigas Fernández
- Grupo de Investigación e Innovación en Cirugía, IDIVAL, Colorectal Surgery Unit, Marqués de Valdecilla University Hospital, Santander, Spain
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Ali D, Mohsin H, Afzal MF, Batool S, Suleman A, Khalid J, Zafar M, Dilawar M, Janjua MH, Sarwar MZ, Naqi SA, Akbar A, Afzal A, Anwar J, Gondal KM, Shaukat M, Waheed M, Sohail M, Mukhtiar N, Ammar AS, Hussain A, Khan AN, Sarwar A, Khan I, Khattak S, Oqaili B, Saada B, Zatari D, Jubran F, Hamdan F, Emar M, Alawi R, Jacome G, Insturain I, Arauz J, Hurtado M, Beron RI, Castaño R, Cao VHB, Kwiatkowski A, Dobkowski G, Bartosiak K, Walędziak M, Możański M, Zadrożna M, Kowalewski P, Fiedziuk A, Wątroba A, Los A, Sitarska M, Rząca M, Zawadzki M, Czarnecki R, Tavares C, Santos F, Borges F, Real JC, Lima MJ, Carlos S, Pereira V, Pacheco A, Gomes G, Pimenta J, Elisiario L, Jervis M, Gonçalves V, Pedro V, Jordão D, Neves FR, Conceição L, Ângelo MD, Marques P, Saraiva RP, Caroço TV, Windels A, Machado A, Ribeiro C, Velez C, Oliveira J, Melo MR, Lima R, Pires A, Lareiro C, Martins R, Revez T, Martins A, Cardoso D, Alegre I, Estevão P, Andrade D, Gomes DC, Duarte MJ, Custódio P, Nemésio RA, Rodrigues S, Correia A, Domingos H, Herrando I, Azevedo J, Fernandez L, Azevedo P, Vieira P, Torre A, Amado A, Paiva M, Saraiva R, Costa S, Mendes T, Queirós T, Silva A, Faustino A, Freitas A, Mendes J, Amaral L, Quintanilha R, Silva R, Coelho AM, Ribeiro A, Pinto C, Ribeiro N, Reis R, Costa S, Fernandes V, Sanches A, Amorim E, Miguel I, Rachadell J, Sanches M, Oliveira S, Baptista V, Roxo A, Devesa H, Teslyak O, Barradas R, Marques S, Martins S, Pepino S, Silva A, Deus AC, Ferreira A, Marinho D, Sousa D, Martins MJ, Matias N, Pinto A, Correia D, Amado F, Cordeiro L, Morales M, Lamas M, Marçal S, Rodrigues AI, Santos A, Marçal A, Oliveira A, Gomes C, Ferreira C, Marques R, Chitul A, Alexandrescu C, Bezede C, Cristian D, Mandi D, Grama F, Ungureanu R, Stoica B, Diaconescu C, Ciubotaru C, Tanase I, Grintescu I, Negoita VM, Calin C, Simeanu C, Ciotarla DC, Caltea M, Mirica RM, Luca A, Pasca A, Vlad C, Bonci EA, Stefanescu I, Achimas-Cadariu PA, Gata VA, Capusan A, Petrisor C, Dindelegan G, Seicean R, Scurtu R, Bintintan V, Fagarasan V, Ionescu C, Crisan D, Zanc L, Ene-Cocis MV, Muresan MS, Mihalcea SM, Dudric V, Musina AM, Ristescu AI, Roata CE, Moglan M, Dimofte MG, Lunca S, Iacob S, Dychko A, Litvin A, Kapustina A, Provozina A, Anokhin E, Zabiyaka M, Shin A, Djumabayev K, Kuznetsova M, Gordeyev S, Kochkina S, Mamedli Z, Markaryan D, Galliamov E, Semina E, Agapov M, Malahov P, Garmanova T, Kakotkin V, Zaycev A, Sumbaev A, Bedzhanyan A, Orman E, Petrenko K, Bredikhin M, Frolova Y, Tulina I, Bashilkina O, Tsarkov P, Rodimov S, Stamov V, Balaban V, Alexnder A, Yanishev A, Rogozhev D, Yakunina N, Chubukova N, Nugmanov R, Karachun A, Petrov A, Domanskiy A, Panaiotti L, Smolina M, Sapronova T, Pelipas Y, Zagaynov E, Khrykov G, Davidovskaja L, Burlov N, Mankevich N, Tverdohlebova T, Bogatikov A, Lodygin AV, Krasnoselsky C, Vasiukova ES, Kopteyev NR, Ovchinnikov T, Kashchenko VA, Novikova A, Terentyeva E, Kuleshov O, Pavlov R, Koshel A, Kostromitsky D, Drozdov E, Klokov S, Camacho A, Khan FN, Bandar MA, Shamim R, Chowdhury S, Kovacevic B, Krdzic I, Zdravkovic M, Kenic M, Milentijevic M, Petkovic N, Radulovic R, Ngu J, Teo NZ, Singh PA, Ong SY, Li S, en Siew B, Chee C, Koh JJM, Lee KY, Tan KK, Wong SC, Loh W, Pujol AF, Rubio JC, Farrés LP, Vendrell LL, Del Olmo MIU, Pedregosa AB, Galmes C, Luckute D, Casanova D, Artigot M, Guedes X, Olivella Y, Sarda MS, Toscano MJ, Damieta MP, Pera M, Gonçalvez SA, Galvez ST, Ruiz SS, Espin-Basany E, Marinello F, Villarino-Villa L, Heras MVL, Martin-Sanchez R, Mata RM, Blanco-Colino R, Otero A, de Lacy AM, Sanahuja JM, Bravo R, Ferraz T, Gonzabay V, Gonzalez F, Menendez P, Del Castillo VCG, Lopez-Pelaez VM, Silva ÁS, Lillo-García C, Tauler EM, Manresa MCE, Pérez SL, Llopis SQ, Rubio AV, Castillo ER, Miramón FJJ, Rodriguez JLR, Rizo-Lamberti LA, Garrido PG, Carneros VJ, Alfonso BA, Sierra BG, Amador CG, Gomendio MDP, Palomino MVR, de La Plaza Llamas R, Cafranga EG, Ramos JLE, Estudillo MC, Pérez RE, Pernas RM, de Lebrusant Fernández S, Bautista WMS, Llamazares AL, Valbuena AL, Moran LA, Alvarez LJ, Raposo LG, Ceron SF, Calvo AC, Valcárcel CR, Peña JP, Gómez LMJ, Díez MC, Lindenbaum PD, Mata SK, Ruiz-De-La-Hermosa A, Abad-Motos A, Toribio-Combarro B, Ripollés-Melchor J, Fuenmayor-Valera ML, Ortega-Domene P, Loscos A, Del Pueblo CS, Dziakova J, Mugüerza JM, Carlin PS, Anula R, Mouvet Y, Forero-Torres A, Andrés BDS, Marcos CM, Rubio I, Pascual I, Yague J, Alcolea NG, Alonso A, Diéguez B, Ibañez I, Pérez JL, Losada M, García-Conde M, Hernández M, Blazquez-Martin A, Vera-Mansilla C, Mendoza-Moreno F, Hernandez-Salvan J, Diez-Alonso M, Hernandez-Juara P, Barrena-Blazquez S, Minaya-Bravo AM, Galván-Pérez A, Miguel-Méndez CS, Gonzalez-Gonzalez E, Alvarez-Díez M, García-Ureña MÁ, Llorente-Moreno M, Ruiz-Lozano C, Colás-Ruiz E, Pérez-Calvo J, Gomila-Sanso JA, Álvarez-Llano L, Serrano-Fuentes SC, Soto-Montesinos C, Dedeu-Bastardas I, Perez-Reche I, Labró-Ciurans M, Pardo-López S, Pérez EG, Fernández IO, Canals LO, Espino PC, Ruano PG, Ricardo V, Ros EP, Manuel EM, Buleje JAB, Prats MMC, Baños PAP, González PM, Celdrán RG, Pellicer-Franco EM, Valero-Navarro G, Vicente-Villena JP, Martinez-Mercader MM, Baeza-Murcia M, Mengual-Ballester M, Soria-Aledo V, Fernández-Martínez D, Varela-Rodríguez L, Garcia-Flórez LJ, Fernández-Hevia M, Gonzalez-Diaz MJ, Fernández-Arias S, Puertas CP, de San Pío Carvajal E, Cebolla ES, Brainsa E, Bayo JMM, Castro MC, Blanco RR, Gutierrez E, Pinto FL, Alegre JM, Flores N, ÓSullivan SN, Fernández BF, Alonso JE, Conde JGA, Ropero NM, Bayón RÁ, Dominguez SH, Ramirez S, Martin de Pablos A, Perez-Sanchez A, Cano-Matias A, Del-Rio-Lafuente FJ, Caballero-Delgado J, Valdes-Hernandez J, Gomez-Rosado JC, Martinez C, Cholewa H, Sancho-Muriel J, Alberola MJ, Navasquillo M, Primo V, Moreno V, Espí-Macías A, Moro-Valdezate D, Carrascosa-Morales I, Martín-Arévalo J, Soro-Domingo M, García-Botello S, Pla-Marti V, Abellán AM, Pérez CM, Cortés GFV, Blasco LF, Chornet MR, Martín RS, Diego ARD, Vázquez-Fernández A, Pascual A, de Andrés-Asenjo B, Beltrán de Heredia J, Ruiz-Soriano M, Rodríguez-Jiménez R, Iribarren EM, Rodríguez EVF, Del Carmen Casas García M, García-Señoráns MP, Valderrama ÓC, Rodríguez PF, Santos RS, Currás RP, Vigorita V, Roche CG, Delgado E, Lafuente F, Gascon I, Saudi S, Fraj V, Wickramasinghe D, de Zoysa I, Samarasekera N, Wickramarathne R, Dassanayake V, Balathayalan Y, de Silva D, Perera M, Pulleperuma S, Jayasekara S, Wijenayake W, Gunetilleke B, Abeysinghe N, Chandrasinghe P, Kumarage S, Abdalradiy AG, Widatalla ABH, Ahmed AY, Mohamed HA, Hamid HKS, Ali MH, Eldin SJ, Agger E, Jutesten H, Lindgren J, Lepsenyi M, Azhar N, Hansdotter P, Ekepil A, Lindén Å, Brandström G, Smedberg J, Schiffer E, Ris F, Longchamp G, Meyer J, Dupret L, Galetti K, Regusci L, Grischott M, Malugani M, Mouhandes AEF, Danial AK, Khayat M, Sbahi MHE, Marawy MK, Abdullah MA, Douba Z, Mansour A, Niazi A, Hamza A, Mohamad AH, Awead M, Mohammad S, Salloum S, Jabar AA, Zazo A, Shebli B, Ayoub K, Younes L, Bannoud MH, Zazo R, Saad A, Hamdan A, Wakkaf H, Adra L, Souliman M, Anton M, Hannouf S, Li KL, Cheng KI, Ji SJ, Hsieh YC, Parlak EA, Demir M, Kara U, Peker YS, Yiğit D, Unal N, Iflazoğlu N, Yalkin Ö, Topal S, Gulcu B, Ozturk E, Gümbelek G, Terkanlıoğlu S, Koklucan A, Ince G, Sen M, Isik O, Kural S, Akesen S, Yilmazlar T, Sungurtekin H, Sungurtekin U, Vural U, Ozgen U, Isik A, Onk D, Kurnaz E, Ozker TS, Ipek A, Ferlengez A, Erturk C, Tatar C, Sevik H, Akay O, Sensoy O, Hayirlioglu MB, Aktas S, Ozben V, Aliyeva Z, Mutlu AU, Gökay BV, Saraçoğlu C, Aytaç E, Gülmez M, Işık MÜ, Hacim A, Akbas A, Soyhan F, Turgut MA, Demirgan S, Meric S, Altinel Y, Baris B, Akova E, Kahraman E, Kucuk HF, Saracoglu KT, Kaya S, Lel S, Gurbulak EK, Caz E, Kostek M, Mihmanli M, Yazici P, Oba S, Kırkan EF, Ulgur HS, Kalın M, Dinkci MD, Duzgun O, Ozturk S, Zengin AK, Aşkar A, Şanlı AN, Erginöz E, Özçelik MF, Ergün S, Uludağ SS, Kara D, Yılmaz G, Sarıcı IŞ, Kara Y, Incesu A, Arican C, Atici SD, Kaya T, Gezer T, Kirmizi Y, Aydin G, Namdaroglu O, Adakaya S, Canda AE, Ozzeybek D, Coskun N, Sokmen S, Ozkardesler S, Bisgin T, Miftari A, Caliskan C, Akgun E, Avseren G, Deniz N, Yoldas T, Güreşin A, Zayakov G, Pösteki G, Utkan NZ, Tatar OC, Akçay Ö, Güler SA, Mantoğlu B, Demirel E, Akın E, Gonullu E, Altintoprak F, Palabıyık O, Bayhan Z, Ciftci AB, Colak E, Aybar E, Celik HK, Eraslan H, Yemez K, Ozbilgin SS, Senol S, Gultekin FA, Piskin O, Guler O, Karadere Y, Kakeeto A, Oguttu B, Sikakulya FK, Lule H, Rybachuk A, Shudrak A, Beznosenko A, Lisnyy I, Rozhkova V, Zvirych V, Alawlaqi D, El Jamali F, Balooshi IA, Ahmed M, Albers M, Ali NA, Church R, Dudas G, Wells J, Pavlova M, Sebastiani S, Paterson C, Kaushal M, Patel P, Panchal S, Handa S, Tezas S, Zaidi SN, Raj G, Wright J, Hallam S, Karandikar S, Gates Z, Marshall A, Thompson A, Tennakoon A, Rao M, Callan R, Tufail S, Rajendran G, Polisetty K, Husain N, Clarke N, Naranayanasamy S, Hallett A, Lorejo E, Ward N, Antakia R, Xanthis A, Simillis C, Tweedle E, Panagiotopoulou I, Grimes L, Mounstephen L, Bocancia R, Carden C, Lynch J, Noveros MS, Shaalan R, Khalil T, Marshall W, Hodge K, Balfour J, Mcintosh K, Buijs L, Yule M, Vaughan-Shaw PG, Smith S, Anderson T, Mcdermott FD, Daniels IR, Tapp J, Smart N, Rajaretnam N, Bethune R, Clark T, Delimpalta C, Liao C, Banham G, Induruwage L, Velchuru V, Lawrence A, Rahman A, Bennett J, Badawi M, Harshen R, Bhargava A, Gorrela K, Jumah M, Hanson M, Arya S, Atendido T, Shrestha A, Cook E, Rakhimov I, Collins J, Alamin N, Vigneswaran N, Basnyat P, Shamardal A, Chacko A, Wanshantha D, Bisheet G, Ebdewi H, Abdellatif M, Adu-Poku P, Tore A, Adams F, Allen K, Ahmed K, Kulkarni N, Chitnis A, Patel H, Magsino J, Sarodaya V, Minicozzi A, Dempsy C, Ahmed H, Jayasinghe JD, Okail MH, Thaha M, Hallworth S, Parmar C, Chua L, Pizanias M, Samin R, Young T, Sagar J, Yorkmui L, Cirocchi N, Ahmed S, Barreda SC, Kudchadkar S, Baker A, Jayasankar B, Jackson J, Abdelsaid K, Hassan M, Shetty S, Coldwell C, Davies E, Nader H, Raistrick M, Ryska O, Hawkin P, Raymond T, Witjes C, Van de Steen K, Crabtree N, Boyce S, Somera W, Woodward A, Ryan K, Kassai M, Aleem M, Ghosh A, Rixson D, Lewis E, Lynch N, Shovelton C, Zywicka E, Guest F, Barton J, Purnell R, Bamford R, Teare T, Adams B, Chmielewski G, Smith L, Connolly L, Niblett R, Singh A, Halliwell G, Paraoan M, Doree N, Asaad P, Kilbride C, Carpenter H, Wilson J, Fletcher J, Vijayagopal KA, Abbakar M, Zaimis T, Walsh A, Kubisz-Pudelko A, Nono J, Pippard L, Chowdhary M, Dalton R, Moussa T, Dominguez F, Solla G, Curbelo J, Laurini M, Viola M, Brito N, Al-Alnsi A, Al-Naggar H, Saryah L, Al-Shehari M, Alsayadi R, Al-Hutheifi R, Shream S, Saeed S, Spurring EM. Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries. Br J Surg 2024; 111:znad370. [PMID: 38029386 PMCID: PMC10771257 DOI: 10.1093/bjs/znad370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. METHODS The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. RESULTS A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). CONCLUSION Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).
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Ocaña J, García-Pérez JC, Fernández-Martínez D, Aguirre I, Pascual I, Lora P, Espin-Basany E, Labalde-Martínez M, León C, Pastor-Peinado P, López-Domínguez C, Muñoz-Plaza N, Valle A, Dujovne P, Alías D, Pérez-Santiago L, Correa A, Carmona M, Fernández-Cebrián JM, Die J. Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group. Colorectal Dis 2024; 26:120-129. [PMID: 38010046 DOI: 10.1111/codi.16810] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/27/2023] [Accepted: 09/22/2023] [Indexed: 11/29/2023]
Abstract
AIM Management of diverticulitis with abscess formation in immunosuppressed patients (IMS) remains unclear. The main objective of the study was to assess short- and long-term outcomes between IMS and immunocompetent patients (IC). The secondary aim was to identify risk factors for emergency surgery. METHODS A nationwide retrospective cohort study was performed at 29 Spanish referral centres between 2015-2019 including consecutive patients with first episode of diverticulitis classified as modified Hinchey Ib or II. IMS included immunosuppressive therapy, biologic therapy, malignant neoplasm with active chemotherapy and chronic steroid therapy. A multivariate analysis was performed to identify independent risk factors to emergency surgery in IMS. RESULTS A total of 1395 patients were included; 118 IMS and 1277 IC. There were no significant differences in emergency surgery between IMS and IC (19.5% and 13.5%, p = 0.075) but IMS was associated with higher mortality (15.1% vs. 0.6%, p < 0.001). Similar recurrent episodes were found between IMS and IC (28% vs. 28.2%, p = 0.963). Following multivariate analysis, immunosuppressive treatment, p = 0.002; OR: 3.35 (1.57-7.15), free gas bubbles, p < 0.001; OR: 2.91 (2.01-4.21), Hinchey II, p = 0.002; OR: 1.88 (1.26-2.83), use of morphine, p < 0.001; OR: 3.08 (1.98-4.80), abscess size ≥5 cm, p = 0.001; OR: 1.97 (1.33-2.93) and leucocytosis at third day, p < 0.001; OR: 1.001 (1.001-1.002) were independently associated with emergency surgery in IMS. CONCLUSION Nonoperative management in IMS has been shown to be safe with similar treatment failure than IC. IMS presented higher mortality in emergency surgery and similar rate of recurrent diverticulitis than IC. Identifying risk factors to emergency surgery may anticipate emergency surgery.
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Affiliation(s)
- Juan Ocaña
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Carlos García-Pérez
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Ignacio Aguirre
- Colorectal Surgery Unit, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Isabel Pascual
- Colorectal Division, Hospital Universitario La Paz, Madrid, Spain
| | - Paola Lora
- Colorectal Division, Hospital Univseristario Cabueñes, Gijón, Spain
| | - Eloy Espin-Basany
- Department of Colorectal Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Carmen León
- Division of Coloproctology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Paula Pastor-Peinado
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Nerea Muñoz-Plaza
- Division of Coloproctology, Hospital Universitario Burgos, Burgos, Spain
| | - Ainhoa Valle
- Division of Coloproctology, Hospital Universitario de Getafe, Getafe, Spain
| | - Paula Dujovne
- Division of Coloproctology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - David Alías
- Unit of Coloproctology, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | | | - Alba Correa
- Unit of Coloproctology, Hospital Universitario La Princesa, Madrid, Spain
| | - María Carmona
- Division of Coloproctology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - José María Fernández-Cebrián
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Die
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Espin-Basany E. President's report, European Society of Coloproctology. Colorectal Dis 2023; 25:1755-1759. [PMID: 37665022 DOI: 10.1111/codi.16743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Eloy Espin-Basany
- Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
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Gómez Ruiz M, Espin-Basany E, Spinelli A, Cagigas Fernández C, Bollo Rodriguez J, María Enriquez Navascués J, Rautio T, Tiskus M. Early outcomes from the Minimally Invasive Right Colectomy Anastomosis study (MIRCAST). Br J Surg 2023; 110:1153-1160. [PMID: 37289913 PMCID: PMC10416692 DOI: 10.1093/bjs/znad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/20/2023] [Accepted: 02/26/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The impact of method of anastomosis and minimally invasive surgical technique on surgical and clinical outcomes after right hemicolectomy is uncertain. The aim of the MIRCAST study was to compare intracorporeal and extracorporeal anastomosis (ICA and ECA respectively), each using either a laparoscopic approach or robot-assisted surgery during right hemicolectomies for benign or malignant tumours. METHODS This was an international, multicentre, prospective, observational, monitored, non-randomized, parallel, four-cohort study (laparoscopic ECA; laparoscopic ICA; robot-assisted ECA; robot-assisted ICA). High-volume surgeons (at least 30 minimally invasive right colectomy procedures/year) from 59 hospitals across 12 European countries treated patients over a 3-year interval The primary composite endpoint was 30-day success, defined by two measures of efficacy-absence of surgical wound infection and of any major complication within the first 30 days after surgery. Secondary outcomes were: overall complications, conversion rate, duration of operation, and number of lymph nodes harvested. Propensity score analysis was used for comparison of ICA with ECA, and robot-assisted surgery with laparoscopy. RESULTS Some 1320 patients were included in an intention-to-treat analysis (laparoscopic ECA, 555; laparoscopic ICA, 356; robot-assisted ECA, 88; robot-assisted ICA, 321). No differences in the co-primary endpoint at 30 days after surgery were observed between cohorts (7.2 and 7.6 per cent in ECA and ICA groups respectively; 7.8 and 6.6 per cent in laparoscopic and robot-assisted groups). Lower overall complication rates were observed after ICA, specifically less ileus, and nausea and vomiting after robot-assisted procedures. CONCLUSION No difference in the composite outcome of surgical wound infections and severe postoperative complications was found between intracorporeal versus extracorporeal anastomosis or laparoscopy versus robot-assisted surgery.
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Affiliation(s)
- Marcos Gómez Ruiz
- Grupo de Investigación e Innovación en Cirugía, IDIVAL, Colorectal Surgery Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Carmen Cagigas Fernández
- Grupo de Investigación e Innovación en Cirugía, IDIVAL, Colorectal Surgery Unit, Marqués de Valdecilla University Hospital, Santander, Spain
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Trenti L, Biondo S, Espin-Basany E, Barrios O, Sanchez-Garcia JL, Landaluce-Olavarria A, Bermejo-Marcos E, Garcia-Martinez MT, Alias Jimenez D, Jimenez F, Alonso A, Manso MB, Kreisler E. Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Vessel-Sealing Device Hemorrhoidectomy for Grade III to IV Hemorrhoids: Long-term Outcomes From the THDLIGA Randomized Controlled Trial. Dis Colon Rectum 2023; 66:e818-e825. [PMID: 35239526 DOI: 10.1097/dcr.0000000000002272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Both transanal hemorrhoidal dearterialization and vessel-sealing device hemorrhoidectomy are safe for grade III to IV hemorrhoid treatment. Whether one of them is superior regarding long-term results remains unclear. OBJECTIVE To compare long-term results after transanal hemorrhoidal dearterialization and vessel-sealing device hemorrhoidectomy. DESIGN Multicenter randomized controlled trial. SETTINGS This study was conducted at 6 centers. PATIENTS Patients ≥18 years of age with grade III to IV hemorrhoids were included in the study. INTERVENTIONS Patients were randomly assigned to transanal hemorrhoidal dearterialization (n = 39) or vessel-sealing device hemorrhoidectomy (n = 41). MAIN OUTCOME MEASURES The primary outcome was hemorrhoid symptom recurrence assessed by a specific questionnaire 2 years postoperatively. Secondary outcomes included long-term complications, reoperations, fecal continence, and patient satisfaction and quality of life. RESULTS Five of the 80 patients included in the study were lost to follow-up. Thirty-six patients randomly assigned to transanal hemorrhoidal dearterialization and 39 patients randomly assigned to vessel-sealing device hemorrhoidectomy were included in the long-term analysis. The differences between mean baseline and mean 2-year score in the 2 groups were similar (-11.0, SD 3.8 vs -12.5, SD 3.6; p = 0.080). Three patients in the transanal hemorrhoidal dearterialization group underwent supplementary procedures for hemorrhoid symptoms, compared with none in the vessel-sealing device hemorrhoidectomy group ( p = 0.106). Four patients in the vessel-sealing hemorrhoidectomy group and none in the transanal hemorrhoidal dearterialization group experienced chronic opened wound ( p = 0.116). LIMITATIONS Lack of stratification for hemorrhoid grade and power calculation based on the main outcome trial but not on the end point of this long-term study. CONCLUSIONS Transanal hemorrhoidal dearterialization with mucopexy is associated with hemorrhoid symptom recurrence similar to vessel-sealing device hemorrhoidectomy at 2 years. See Video Abstract at http://links.lww.com/DCR/B933 . REGISTRATION Clinicaltrials.gov ; ID: NCT02654249. DESARTERIALIZACIN HEMORROIDAL TRANSANAL CON MUCOPEXIA VERSUS HEMORROIDECTOMA CON DISPOSITIVO DE SELLADO DE VASOS PARA HEMORROIDES DE GRADO IIIIV RESULTADOS A LARGO PLAZO DEL ENSAYO CLNICO ALEATORIZADO THDLIGARCT ANTECEDENTES:Tanto la desarterialización hemorroidal transanal como la hemorroidectomía con dispositivo de sellado de vasos son seguras y bien toleradas para el tratamiento de las hemorroides de grado III-IV. La primera se asocia con una necesidad más breve de analgesia posoperatoria que la hemorroidectomía con dispositivo de sellado de vasos. No está claro si uno de ellos es superior con respecto a los resultados a largo plazo.OBJETIVO:El objetivo fue comparar los resultados a largo plazo después de la desarterialización hemorroidal transanal y la hemorroidectomía con dispositivo de sellado de vasos.DISEÑO:Se realizó un ensayo clínico aleatorizado multicéntrico.AJUSTE:Este estudio se realizó en 6 centros.PACIENTES:Se incluyeron en el estudio pacientes de ≥18 años con hemorroides de grado III-IV.INTERVENCIONES:Los pacientes fueron asignados al azar a desarterialización hemorroidal transanal (n = 39) o hemorroidectomía con dispositivo de sellado de vasos (n = 41).PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la recurrencia de los síntomas de hemorroides evaluada mediante un cuestionario específico 2 años después de la operación. Los resultados secundarios incluyeron complicaciones a largo plazo, reoperaciones, continencia fecal, satisfacción del paciente y calidad de vida.RESULTADOS:Cinco de los 80 pacientes incluidos en el estudio se perdieron durante el seguimiento. En el análisis a largo plazo se incluyeron 36 pacientes aleatorizados a desarterialización hemorroidal transanal y 39 aleatorizados a hemorroidectomía con dispositivo de sellado de vasos. Las diferencias entre la puntuación inicial media y la puntuación media a los 2 años en los dos grupos fueron similares (-11,0, DE 3,8 frente a -12,5, DE 3,6; p = 0,080). Tres pacientes en el grupo de desarterialización hemorroidal transanal se sometieron a procedimientos complementarios por síntomas de hemorroides, en comparación con ninguno en el grupo de hemorroidectomía con dispositivo de sellado de vasos (p = 0,106). Cuatro pacientes en el grupo de hemorroidectomía con sellado de vasos y ninguno en el grupo de desarterialización hemorroidal transanal experimentaron herida abierta crónica (p = 0,116). No se encontraron diferencias en cuanto a continencia fecal (p = 0,657), satisfacción del paciente (p = 0,483) y calidad de vida.LIMITACIONES:No hay estratificación para el grado de hemorroides ni el cálculo del poder basado en el resultado principal del ensayo, pero no en el criterio de valoración de este estudio a largo plazo.CONCLUSIONES:La desarterialización hemorroidal transanal con mucopexia se asocia con una recurrencia de síntomas de hemorroides similar a la hemorroidectomía con dispositivo de sellado de vasos a los dos años. See Video Abstract at http://links.lww.com/DCR/B933 . (Traducción- Dr. Francisco M. Abarca-Rendon )REGISTRO DE PRUEBA:Clinicaltrials.gov (NCT02654249).
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Affiliation(s)
- Loris Trenti
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Sebastiano Biondo
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Eloy Espin-Basany
- Colorectal Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital Barcelona, Barcelona, Spain
| | - Oriana Barrios
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Jose L Sanchez-Garcia
- Colorectal Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital Barcelona, Barcelona, Spain
| | | | | | | | - David Alias Jimenez
- Department of Surgery, Rey Juan Carlos University Hospital, Móstoles, Madrid, Spain
| | - Fernando Jimenez
- Department of Surgery, Galdakao Usansolo Hospital, Vizcaya, Spain
| | - Adolfo Alonso
- Department of Surgery, La Princesa University Hospital, Madrid, Spain
| | - Maria B Manso
- Department of Surgery, Rey Juan Carlos University Hospital, Móstoles, Madrid, Spain
| | - Esther Kreisler
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
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8
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Simoncini T, Panattoni A, Aktas M, Ampe J, Betschart C, Bloemendaal ALA, Buse S, Campagna G, Caretto M, Cervigni M, Consten ECJ, Davila HH, Dubuisson J, Espin-Basany E, Fabiani B, Faucheron JL, Giannini A, Gurland B, Hahnloser D, Joukhadar R, Mannella P, Mereu L, Martellucci J, Meurette G, Montt Guevara MM, Ratto C, O'Reilly BA, Reisenauer C, Russo E, Schraffordt Koops S, Siddiqi S, Sturiale A, Naldini G. Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users. Surg Endosc 2023:10.1007/s00464-023-10001-4. [PMID: 36952046 PMCID: PMC10035464 DOI: 10.1007/s00464-023-10001-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/25/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Robotic surgery has gained popularity for the reconstruction of pelvic floor defects. Nonetheless, there is no evidence that robot-assisted reconstructive surgery is either appropriate or superior to standard laparoscopy for the performance of pelvic floor reconstructive procedures or that it is sustainable. The aim of this project was to address the proper role of robotic pelvic floor reconstructive procedures using expert opinion. METHODS We set up an international, multidisciplinary group of 26 experts to participate in a Delphi process on robotics as applied to pelvic floor reconstructive surgery. The group comprised urogynecologists, urologists, and colorectal surgeons with long-term experience in the performance of pelvic floor reconstructive procedures and with the use of the robot, who were identified primarily based on peer-reviewed publications. Two rounds of the Delphi process were conducted. The first included 63 statements pertaining to surgeons' characteristics, general questions, indications, surgical technique, and future-oriented questions. A second round including 20 statements was used to reassess those statements where borderline agreement was obtained during the first round. The final step consisted of a face-to-face meeting with all participants to present and discuss the results of the analysis. RESULTS The 26 experts agreed that robotics is a suitable indication for pelvic floor reconstructive surgery because of the significant technical advantages that it confers relative to standard laparoscopy. Experts considered these advantages particularly important for the execution of complex reconstructive procedures, although the benefits can be found also during less challenging cases. The experts considered the robot safe and effective for pelvic floor reconstruction and generally thought that the additional costs are offset by the increased surgical efficacy. CONCLUSION Robotics is a suitable choice for pelvic reconstruction, but this Delphi initiative calls for more research to objectively assess the specific settings where robotic surgery would provide the most benefit.
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Affiliation(s)
- Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Andrea Panattoni
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mustafa Aktas
- Division of Obstetrics and Gynecology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jozef Ampe
- Department of Urology, AZ Sint-Jan Bruges Hospitals, Brugge, Belgium
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Stephan Buse
- Department of Urology and Urologic Oncology, Alfried Krupp Hospital, Essen, Germany
| | - Giuseppe Campagna
- Division of Urogynecology and Pelvic Floor Reconstructive Surgery, Department of Women and Child Health, University Hospital A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Marta Caretto
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mauro Cervigni
- Department of Urology, La Sapienza University-Polo Pontino ICOT, Latina, Italy
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort and Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Hugo H Davila
- Cleveland Clinic Indian River Hospital, Florida State University, College of Medicine, Tallahassee, FL, USA
| | - Jean Dubuisson
- Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Eloy Espin-Basany
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Bernardina Fabiani
- Proctology and Pelvic Floor Clinical Center, Cisanello University Hospital, Pisa, Italy
| | - Jean-Luc Faucheron
- Colorectal Surgery Unit, Visceral Surgery and Acute Care Surgery Department, Grenoble Alps University Hospital, Grenoble, France
| | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Brooke Gurland
- Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Dieter Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Ralf Joukhadar
- Department of Obstetrics and Gynecology, University of Wuerzburg, Würzburg, Germany
| | - Paolo Mannella
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liliana Mereu
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy
| | - Jacopo Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - Guillaume Meurette
- Digestive and Endocrine Surgery Clinic, IMAD, CHU de Nantes, Hôtel Dieu, Nantes Cedex, France
| | - Maria Magdalena Montt Guevara
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carlo Ratto
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barry A O'Reilly
- Department of Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland
| | - Christl Reisenauer
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Tuebingen, Germany
| | - Eleonora Russo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Alessandro Sturiale
- Proctology and Pelvic Floor Clinical Center, Cisanello University Hospital, Pisa, Italy
| | - Gabriele Naldini
- Proctology and Pelvic Floor Clinical Center, Cisanello University Hospital, Pisa, Italy
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9
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Celentano V, Adamina M, Spinelli A, Fleshner P, Pellino G, Mineccia M, Selvaggi F, Svrcek M, Tozer P, Espin-Basany E, Hancock L, Faiz O, Coffey CJ, Sampietro G. SupportiNg operAtive Photographic documentation in ileocolonic CROHN's disease surgery: The SNAPCROHN study. Colorectal Dis 2023; 25:282-288. [PMID: 36109836 DOI: 10.1111/codi.16342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/14/2022] [Accepted: 09/06/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are reported variations in the intraoperative management of Crohn's disease. This consensus statement aimed to develop a standardised protocol for photographic documentation of intraoperative findings and critical procedural steps in ileocolonic Crohn's disease surgery. METHODS Colorectal surgeons with a specialist interest in minimally invasive surgery and inflammatory bowel disease were invited as committee members to develop a survey on the use of photo-documentation in Crohn's disease surgery. A 15 item survey was developed on ethical considerations and applications of photo-documentation in audit and quality control, research, and training. RESULTS There was strong agreement on the potential application of intraoperative photo-documentation in Crohn's disease for training, research, quality control and tertiary referrals. Reviewers agreed that intraoperative staging required photo-documentation of strictures, skip lesions, perforations, fat wrapping and mesenteric disease. The necessary steps to be photo-documented were very specific to Crohn's disease surgery, such as views of anastomosis and strictureplasties, and extent of resection(s). CONCLUSIONS Our consensus statement identified several items for appropriate intraoperative photo-documentation in Crohn's disease surgery, to be used as an adjunct to accurate annotation of intraoperative findings and procedures.
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Affiliation(s)
- Valerio Celentano
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Michel Adamina
- Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Phillip Fleshner
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Universita' degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Michela Mineccia
- Division of General and Oncologic Surgery, Mauriziano Hospital, Turin, Italy
| | - Francesco Selvaggi
- Department of Advanced Medical and Surgical Sciences, Universita' degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Magali Svrcek
- Department of Pathology, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Phil Tozer
- Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK
| | - Eloy Espin-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Hancock
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Omar Faiz
- Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK
| | - Calvin J Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Gianluca Sampietro
- Università degli Studi di Milano, Milan, Italy.,Division of General and HPB Surgery, Rho Memorial Hospital, Milan, Italy
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10
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Balla A, Saraceno F, Rullo M, Morales-Conde S, Targarona Soler EM, Di Saverio S, Guerrieri M, Lepiane P, Di Lorenzo N, Adamina M, Alarcón I, Arezzo A, Bollo Rodriguez J, Boni L, Biondo S, Carrano FM, Chand M, Jenkins JT, Davies J, Delgado Rivilla S, Delrio P, Elmore U, Espin-Basany E, Fichera A, Flor Lorente B, Francis N, Gómez Ruiz M, Hahnloser D, Licardie E, Martinez C, Ortenzi M, Panis Y, Pastor Idoate C, Paganini AM, Pera M, Perinotti R, Popowich DA, Rockall T, Rosati R, Sartori A, Scoglio D, Shalaby M, Simó Fernández V, Smart NJ, Spinelli A, Sylla P, Tanis PJ, Valdes-Hernandez J, Wexner SD, Sileri P. Protective ileostomy creation after anterior resection of the rectum: Shared decision-making or still subjective? Colorectal Dis 2022; 25:647-659. [PMID: 36527323 DOI: 10.1111/codi.16454] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/21/2022] [Accepted: 10/26/2022] [Indexed: 12/30/2022]
Abstract
AIM The choice of whether to perform protective ileostomy (PI) after anterior resection (AR) is mainly guided by risk factors (RFs) responsible for the development of anastomotic leakage (AL). However, clear guidelines about PI creation are still lacking in the literature and this is often decided according to the surgeon's preferences, experiences or feelings. This qualitative study aims to investigate, by an open-ended question survey, the individual surgeon's decision-making process regarding PI creation after elective AR. METHOD Fifty four colorectal surgeons took part in an electronic survey to answer the questions and describe what usually led their decision to perform PI. A content analysis was used to code the answers. To classify answers, five dichotomous categories (In favour/Against PI, Listed/Unlisted RFs, Typical/Atypical, Emotions/Non-emotions, Personal experience/No personal experience) have been developed. RESULTS Overall, 76% of surgeons were in favour of PI creation and 88% considered listed RFs in the question of whether to perform PI. Atypical answers were reported in 10% of cases. Emotions and personal experience influenced surgeons' decision-making process in 22% and 49% of cases, respectively. The most frequently considered RFs were the distance of the anastomosis from the anal verge (96%), neoadjuvant chemoradiotherapy (88%), a positive intraoperative leak test (65%), blood loss (37%) and immunosuppression therapy (35%). CONCLUSION The indications to perform PI following rectal cancer surgery lack standardization and evidence-based guidelines are required to inform practice. Until then, expert opinion can be helpful to assist the decision-making process in patients who have undergone AR for adenocarcinoma.
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Affiliation(s)
- Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital 'San Paolo', Civitavecchia, Rome, Italy
| | - Federica Saraceno
- UOC of General and Minimally Invasive Surgery, Hospital 'San Paolo', Civitavecchia, Rome, Italy.,Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Marika Rullo
- Department of Social, Political and Cognitive Sciences, University of Siena, Siena, Italy
| | - 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
| | - Eduardo M Targarona Soler
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Salomone Di Saverio
- ASUR Marche 5, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital 'San Paolo', Civitavecchia, Rome, Italy
| | - Nicola Di Lorenzo
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Michel Adamina
- Department of Surgery, Kantonsspital Winterthur and Faculty of Medicine, University of Basel, Basel, Switzerland
| | - 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
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Jesus Bollo Rodriguez
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | | | - Francesco Maria Carrano
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Manish Chand
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - John T Jenkins
- Department of Colorectal Surgery, North West London NHS Trust, St Mark's Hospital, London, UK
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK.,University of Cambridge, Cambridge, UK
| | | | - Paolo Delrio
- Colorectal Surgical Oncology, Istituto Nazionale Dei Tumori, IRCCS Fondazione Pascale, Napoli, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Eloy Espin-Basany
- Colorectal Surgery Unit, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Alessandro Fichera
- Division of Colorectal Surgery, Department of Surgery, Baylor University Medical Center, Texas, Dallas, USA
| | - Blas Flor Lorente
- Digestive Surgery Department, 'La Fe' University Hospital, Valencia, Spain
| | - Nader Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK
| | - Marcos Gómez Ruiz
- Colorectal Surgery Unit, Hospital Universitario Marques de Valdecilla, Santander, Spain.,Valdecilla Biomedical Research Institute, IDIVAL, Santander, Spain
| | | | - Eugenio Licardie
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain
| | - Carmen Martinez
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Yves Panis
- Department of Colorectal Surgery, Hôpital Beaujon, Clichy, France
| | - Carlos Pastor Idoate
- Division of Colorectal Surgery, Department of General Surgery, University Clinic of Navarre, Madrid, Spain
| | - Alessandro M Paganini
- Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy
| | - Miguel Pera
- Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Roberto Perinotti
- Department of General Surgery, SS Colo-Rectal and Proctological Surgery, Biella Hospital, Ponderano, Biella, Italy
| | | | - Timothy Rockall
- General Surgery at Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Alberto Sartori
- Department of General and Emergency Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Daniele Scoglio
- Department of General Surgery, AULSS 4 Veneto Orientale, San Donà di Piave General Hospital, San Donà di Piave, Italy
| | - Mostafa Shalaby
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
| | | | | | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Rozzano, Milan, Italy
| | | | - Pieter J Tanis
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Javier Valdes-Hernandez
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Sevilla, Spain
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Florida, Weston, USA
| | - Pierpaolo Sileri
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
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11
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Manchon-Walsh P, de Lacy FB, Pera M, Espin-Basany E, Targarona EM, Biondo S, Aliste Sanchez L, Pallarès N, Tebé C, Pata F, Lacy AM, Guarga A, Borràs JM. Reply. Dis Colon Rectum 2022; 65:e1080-e1081. [PMID: 36102843 DOI: 10.1097/dcr.0000000000002603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Paula Manchon-Walsh
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l'Hospitalet, Barcelona, Spain, Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - F Borja de Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic, IDIBAPS, Biomedical Research Centre (CIBERehd), Esther Koplowitz Centre, University of Barcelona, Carrer Villaroel, Barcelona, Spain
| | - Miguel Pera
- Colorectal Surgery Unit, Department of Surgery, Hospital del Mar (IMIM), Barcelona, Spain
| | - Eloy Espin-Basany
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Pº de la Vall d'Hebron, Barcelona, Spain
| | - Eduardo M Targarona
- Surgery Unit, Hospital de la Santa Creu i Sant Pau, C/de Sant Quintí, Barcelona, Spain
| | - Sebastiano Biondo
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, L'Hospitalet de Llobregat, Barcelona, Spain, Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, C/Feixa Llarga, s/n, Barcelona, Spain
| | - Luisa Aliste Sanchez
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain, Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n,, Barcelona, Spain
| | - Natalia Pallarès
- Statistics Advisory Service, Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, L'Hospitalet de Llobregat, Barcelona, Spain, Basic Clinical Practice Department, University of Barcelona, C/Feixa Llarga, s/n, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebé
- Statistics Advisory Service, Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesco Pata
- General Surgery Unit, Nicola Giannettasio Hospital, Via Ippocrate, Corigliano-Rossano, Italy, La Sapienza University, Roma, Italy
| | - Antonio M Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic, IDIBAPS, Biomedical Research Centre (CIBERehd,), Esther Koplowitz Centre, University of Barcelona, Carrer Villaroel, Barcelona, Spain
| | - Alex Guarga
- Health Service Procurement and Assessment, Catalonian Health Service (CatSalut), Travessera de les Corts, Barcelona, Spain
| | - Josep M Borràs
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Biomedical Research Institute of Bellvitge (IDIBELL), Barcelona, Spain
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12
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Sensi B, Khan J, Warusavitarne J, Nardi A, Spinelli A, Zaghiyan K, Panis Y, Sampietro G, Fichera A, Garcia-Granero E, Espin-Basany E, Konishi T, Siragusa L, Stefan S, Bellato V, Carvello M, Adams E, Frontali A, Artigue M, Frasson M, Marti-Gallostra M, Pellino G, Sica GS. Long-term Oncological Outcome of Segmental Versus Extended Colectomy for Colorectal Cancer in Crohn's Disease: Results from an International Multicentre Study. J Crohns Colitis 2022; 16:954-962. [PMID: 34897426 DOI: 10.1093/ecco-jcc/jjab215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/11/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Crohn's disease increases colorectal cancer risk, with high prevalence of synchronous and metachronous cancers. Current guidelines for colorectal cancer in Crohn's disease recommend pan-proctocolectomy. The aim of this study was to evaluate oncological outcomes of a less invasive surgical approach. METHODS This was a retrospective database analysis of Crohn's disease patients with colorectal cancer undergoing surgery at selected European and US tertiary centres. Outcomes of segmental colectomy were compared with those of extended colectomy, total colectomy, and pan-proctocolectomy. Primary outcome was progression-free survival. Secondary outcomes included overall survival, synchronous and metachronous colorectal cancer, and major postoperative complications. RESULTS Ninety-nine patients were included: 66 patients underwent segmental colectomy and 33 extended colectomy. Segmental colectomy patients were older [p = 0.0429], had less extensive colitis [p = 0.0002] and no preoperatively identified synchronous lesions [p = 0.0109].Median follow-up was 43 [31-62] months. There was no difference in unadjusted progression-free survival [p = 0.2570] or in overall survival [p = 0.4191] between segmental and extended colectomy. Multivariate analysis adjusting for age, sex, ASA score, and AJCC staging, confirmed no difference for progression-free survival (hazard ratio [HR] 1.00, p = 0.9993) or overall survival [HR 0.77, p = 0.6654]. Synchronous and metachronous cancers incidence was 9% and 1.5%, respectively. Perioperative mortality was nil and major complications were comparable [7.58% vs 6.06%, p = 0.9998]. CONCLUSIONS Segmental colectomy seems to offer similar long-term outcomes to more extensive surgery. Incidence of synchronous and metachronous cancers appears much lower than previously described. Further prospective studies are warranted to confirm these results.
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Affiliation(s)
- Bruno Sensi
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
| | - Jim Khan
- Portsmouth Hospital, NHS trust, Surgery, Portsmouth, UK
| | | | - Alessandra Nardi
- University of Rome Tor Vergata, Department of Mathematics, Rome, Italy
| | | | | | - Yves Panis
- Beaujon Hospital, Colorectal Surgery, Paris, France
| | | | | | | | | | | | - Leandro Siragusa
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
| | - Samuel Stefan
- Portsmouth Hospital, NHS trust, Surgery, Portsmouth, UK
| | | | | | - Evan Adams
- Cedars Sinai Hospital, Surgery, Los Angeles, CA, USA
| | | | | | | | | | - Gianluca Pellino
- Hospital Universitario Val d'Hebron, Surgery, Barcelona, Spain.,Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples,Italy
| | - Giuseppe S Sica
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
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13
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Sensi B, Khan J, Warusavitarne J, Nardi A, Spinelli A, Zaghiyan K, Panis Y, Sampietro G, Fichera A, Garcia-Granero E, Espin-Basany E, Konishi T, Siragusa L, Stefan S, Bellato V, Carvello M, Adams E, Frontali A, Artigue M, Frasson M, Marti-Gallostra M, Pellino G, Sica GS. Corrigendum to: Long-term Oncological Outcome of Segmental Versus Extended Colectomy for Colorectal Cancer in Crohn's Disease: Results from an International Multicentre Study. J Crohns Colitis 2022; 16:1009. [PMID: 35171229 DOI: 10.1093/ecco-jcc/jjac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Bruno Sensi
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
| | - Jim Khan
- Portsmouth Hospital, NHS trust, Surgery, Portsmouth, UK
| | | | - Alessandra Nardi
- University of Rome Tor Vergata, Department of Mathematics, Rome, Italy
| | | | | | - Yves Panis
- Beaujon Hospital, Colorectal Surgery, Paris, France
| | | | | | | | | | | | - Leandro Siragusa
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
| | - Samuel Stefan
- Portsmouth Hospital, NHS trust, Surgery, Portsmouth, UK
| | | | | | - Evan Adams
- Cedars Sinai Hospital, Surgery, Los Angeles, CA, USA
| | | | | | | | | | - Gianluca Pellino
- Hospital Universitario Val d'Hebron, Surgery, Barcelona, Spain.,Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe S Sica
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
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14
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Badia JM, Amillo Zaragüeta M, Rubio-Pérez I, Espin-Basany E, González Sánchez C, Balibrea JM. What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations. Cir Esp 2022; 100:392-403. [PMID: 35283055 DOI: 10.1016/j.cireng.2022.03.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 06/14/2023]
Abstract
Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3 surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed.
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Affiliation(s)
- Josep M Badia
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Granollers, Spain.
| | - Mireia Amillo Zaragüeta
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Granollers, Spain
| | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario la Paz, Madrid, Spain
| | - Eloy Espin-Basany
- Servicio de Cirugía General, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | | | - José M Balibrea
- Servicio de Cirugía General, Hospital Clínic de Barcelona, Barcelona, Spain
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15
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Celentano V, Tekkis P, Nordenvall C, Mills S, Spinelli A, Smart N, Selvaggi F, Warren O, Espin-Basany E, Kontovounisios C, Pellino G, Warusavitarne J, Hancock L, Myrelid P, Remzi F. Standardization of ileoanal J-pouch surgery technique: Quality assessment of minimally invasive ileoanal J-pouch surgery videos. Surgery 2022; 172:53-59. [PMID: 34980484 DOI: 10.1016/j.surg.2021.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ileal pouch anal anastomosis is a complex procedure associated with significant morbidity, with several complications after ileal pouch anal anastomosis surgery leading to pouch failure. The aim of the study is to evaluate the heterogeneity surrounding the technique of ileoanal J-pouch surgery by assessing the safety and quality of published online peer-reviewed surgical videos. METHODS Ileal pouch anal anastomosis videos published on peer-reviewed surgical journals and video channels were edited and anonymized to demonstrate specific steps of the surgical procedure: mobilization and division of the rectum, formation of the ileoanal J-pouch reservoir, anastomosis, and lengthening techniques. The anonymized videos were presented to a group of reviewers with expertise in ileal pouch anal anastomosis blinded to the names and affiliations of the surgeons performing the procedure. Primary outcome was the rate of interobserver variability in the assessment of specific technical steps of the ileal pouch anal anastomosis surgery procedure. Secondary outcome was the appropriateness of the use of surgical videos review as an assessment tool for ileal pouch anal anastomosis surgery, measured as rate of reviewers being unable to answer for poor video quality. RESULTS In total, 29 video fragments were distributed, and 13 assessors completed a 60-item survey, organized in 7 major domains. The survey completion rate was 93.4%. Out of a total 729 answers, in 23 (3.2%) the reviewers indicated they were unable to comment due to poor video image, and in 48 (6.5%) were unable to comment due to the particular step not being shown in the procedure. The proportion of assessors rating rectal mobilization technically appropriate ranged from 30.7% to 92.3% and from 7.7% to 69.2% for safety. The level of rectal division was considered appropriate in 0 to 53.8% of the videos, whereas the stapling technique used for rectal division was appropriate in 0 to 70% of the videos. CONCLUSION Our study assessed published peer-reviewed videos on ileal pouch anal anastomosis surgery and reported heterogeneity in the safety of the demonstrated techniques. Blind assessment of published peer-reviewed ileal pouch anal anastomosis videos reported a high rate of unsafe or inappropriate technique for rectal mobilization and transection in the reviewed videos, with fair interobserver agreement among reviewers. There is a need for consensus on what is considered safe and appropriate in ileal pouch anal anastomosis surgery. Peer review of ileal pouch anal anastomosis surgery videos could facilitate training and accreditation in this complex procedure.
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Affiliation(s)
- Valerio Celentano
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK.
| | - Paris Tekkis
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Sarah Mills
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Antonino Spinelli
- Humanitas Clinical and Research Center IRCCS, Division of Colon and Rectal Surgery, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Neil Smart
- Exeter Health Services, Research Unit, Royal Devon & Exeter Hospital, UK
| | - Francesco Selvaggi
- Department of Advanced Medical and Surgical Sciences, Universita' degli Studi della Campania "Luigi Vanvitelli," Naples, Italy
| | - Oliver Warren
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Eloy Espin-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Christos Kontovounisios
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Universita' degli Studi della Campania "Luigi Vanvitelli," Naples, Italy; Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Laura Hancock
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Par Myrelid
- Division of Surgery, Department of Biomedical and Clinical Sciences, Faulty of Health Sciences, Linköping University, Sweden; Department of Surgery, County Council of Östergötland Linköping, Sweden
| | - Feza Remzi
- Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY; NYU Grossman School of Medicine, New York, NY
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de’Angelis N, Micelli Lupinacci R, Abdalla S, Genova P, Beliard A, Cotte E, Denost Q, Goasguen N, Lakkis Z, Lelong B, Manceau G, Meurette G, Perrenot C, Pezet D, Rouanet P, Valverde A, Pessaux P, Azagra S, Mege D, Di Saverio S, de Chaisemartin C, Espin-Basany E, Gaujoux S, Gómez-Ruiz M, Gronnier C, Karoui M, Spinoglio G. Robotic-assisted right colectomy. Official expert recommendations delivered under the aegis of the French Association of Surgery (AFC). J Visc Surg 2022; 159:212-221. [DOI: 10.1016/j.jviscsurg.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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de’Angelis N, Khan J, Marchegiani F, Bianchi G, Aisoni F, Alberti D, Ansaloni L, Biffl W, Chiara O, Ceccarelli G, Coccolini F, Cicuttin E, D’Hondt M, Di Saverio S, Diana M, De Simone B, Espin-Basany E, Fichtner-Feigl S, Kashuk J, Kouwenhoven E, Leppaniemi A, Beghdadi N, Memeo R, Milone M, Moore E, Peitzmann A, Pessaux P, Pikoulis M, Pisano M, Ris F, Sartelli M, Spinoglio G, Sugrue M, Tan E, Gavriilidis P, Weber D, Kluger Y, Catena F. Robotic surgery in emergency setting: 2021 WSES position paper. World J Emerg Surg 2022; 17:4. [PMID: 35057836 PMCID: PMC8781145 DOI: 10.1186/s13017-022-00410-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/27/2021] [Indexed: 12/11/2022] Open
Abstract
Background Robotics represents the most technologically advanced approach in minimally invasive surgery (MIS). Its application in general surgery has increased progressively, with some early experience reported in emergency settings. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a systematic review of the literature to develop consensus statements about the potential use of robotics in emergency general surgery.
Methods This position paper was conducted according to the WSES methodology. A steering committee was constituted to draft the position paper according to the literature review. An international expert panel then critically revised the manuscript. Each statement was voted through a web survey to reach a consensus.
Results Ten studies (3 case reports, 3 case series, and 4 retrospective comparative cohort studies) have been published regarding the applications of robotics for emergency general surgery procedures. Due to the paucity and overall low quality of evidence, 6 statements are proposed as expert opinions. In general, the experts claim for a strict patient selection while approaching emergent general surgery procedures with robotics, eventually considering it for hemodynamically stable patients only. An emergency setting should not be seen as an absolute contraindication for robotic surgery if an adequate training of the operating surgical team is available. In such conditions, robotic surgery can be considered safe, feasible, and associated with surgical outcomes related to an MIS approach. However, there are some concerns regarding the adoption of robotic surgery for emergency surgeries associated with the following: (i) the availability and accessibility of the robotic platform for emergency units and during night shifts, (ii) expected longer operative times, and (iii) increased costs. Further research is necessary to investigate the role of robotic surgery in emergency settings and to explore the possibility of performing telementoring and telesurgery, which are particularly valuable in emergency situations. Conclusions Many hospitals are currently equipped with a robotic surgical platform which needs to be implemented efficiently. The role of robotic surgery for emergency procedures remains under investigation. However, its use is expanding with a careful assessment of costs and timeliness of operations. The proposed statements should be seen as a preliminary guide for the surgical community stressing the need for reevaluation and update processes as evidence expands in the relevant literature.
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18
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Badia JM, Amillo Zaragüeta M, Rubio-Pérez I, Espin-Basany E, González Sánchez C, Balibrea JM. ¿Qué hemos aprendido de las encuestas de la AEC, AECP y del Observatorio de Infección en Cirugía? Cumplimiento de las medidas de prevención de infección postoperatoria y comparación con las recomendaciones de la AEC. Cir Esp 2021. [DOI: 10.1016/j.ciresp.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Maeda Y, Espin-Basany E, Gorissen K, Kim M, Lehur PA, Lundby L, Negoi I, Norcic G, O'Connell PR, Rautio T, van Geluwe B, van Ramshorst GH, Warwick A, Vaizey CJ. European Society of Coloproctology guidance on the use of mesh in the pelvis in colorectal surgery. Colorectal Dis 2021; 23:2228-2285. [PMID: 34060715 DOI: 10.1111/codi.15718] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/14/2021] [Accepted: 03/23/2021] [Indexed: 12/31/2022]
Abstract
This is a comprehensive and rigorous review of currently available data on the use of mesh in the pelvis in colorectal surgery. This guideline outlines the limitations of available data and the challenges of interpretation, followed by best possible recommendations.
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Affiliation(s)
- Yasuko Maeda
- Cumberland Infirmary and University of Edinburgh, Carlisle, UK
| | | | | | - Mia Kim
- Department of General, Gastrointestinal, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Lilli Lundby
- Department of Surgery Pelvic Floor Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Ionut Negoi
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gregor Norcic
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - P Ronan O'Connell
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Tero Rautio
- Medical Research Center, University of Oulu, Oulu, Finland
| | | | | | - Andrea Warwick
- QEII Jubilee Hospital, Acacia Ridge, Queensland, Australia
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20
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Knight SR, Shaw CA, Pius R, Drake TM, Norman L, Ademuyiwa AO, Adisa AO, Aguilera ML, Al-Saqqa SW, Al-Slaibi I, Bhangu A, Biccard BM, Brocklehurst P, Costas-Chavarri A, Chu K, Dare A, Elhadi M, Fairfield CJ, Fitzgerald JE, Ghosh D, Glasbey J, van Berge Henegouwen MI, Ingabire JA, Kingham TP, Lapitan MC, Lawani I, Lieske B, Lilford R, Martin J, McLean KA, Moore R, Morton D, Nepogodiev D, Ntirenganya F, Pata F, Pinkney T, Qureshi AU, Ramos-De la Medina A, Riad A, Salem HK, Simões J, Spence R, Smart N, Tabiri S, Thomas H, Weiser TG, West M, Whitaker J, Harrison EM, Gjata A, Modolo MM, King S, Chan E, Nahar SN, Waterman A, Vervoort D, Lawani I, Bedada AG, De Azevedo B, Figueiredo AG, Sokolov M, Barendegere V, Ekwen G, Agarwal A, Dare A, Liu Q, Camilo Correa J, Malemo KL, Bake J, Mihanovic J, Kuncarová K, Orhalmi J, Salem H, Teras J, Kechagias A, Arnaud AP, Lindert J, Tabiri S, Kalles V, Aguilera-Arevalo ML, Recinos G, Baranyai Z, Kumar B, Neelamraju Lakshmi H, Zachariah SK, Alexander P, Kumar Venkatappa S, Pramesh C, Amandito R, Fleming C, Ansaloni L, Pata F, Pellino G, Altibi AM, Nour I, Hamdun I, Elhadi M, Ghellai AM, Venskutonis D, Poskus T, Zilinskas J, Whitaker J, Malemia P, Tew YY, Borg E, Ellul S, Ramos-De la Medina A, Wafqui FZ, Borowski DW, van Dalen AS, Wells C, Adamou H, Ademuyiwa A, Adisa A, Søreide K, Qureshi AU, Al-Slaibi I, Al Saqqa S, Alser O, Tahboub H, Segovia Lohse HA, Shu Yip S, Lapitan MC, Major P, Simões J, Sampaio Soares A, Bratu MR, Litvin A, Vardanyan A, Allen Ingabire JC, Costas-Chavarri A, Gudal A, Albati N, Juloski J, Lieske B, Rems M, Rayne S, Van Straten S, Moodley Y, Chu K, Moore R, Ortega Vázquez I, Ruiz-Tovar J, Senanayake KJ, Thalgaspitiya SPB, Omer OA, Homeida A, Cengiz Y, Clerc D, Alshaar M, Bouaziz H, Altinel Y, Doe M, Freigofer M, Teasdale E, Kabariti R, Clements JM, Knight SR, Ashfaq A, Azodo I, Wagner G, Trostchansky I, Maimbo M, Linyama D, Nina H, Zeko A, Fermani CG, Modolo MM, Villalobos S, Carballo F, Farina P, Guckenheimer S, Dickfos M, Ajmera A, Chong C, Gourlay R, Hussaini S, Lee YJ, Majid A, Martin P, Miles R, Morris OJ, Phua J, Ridley W, Saluja T, Tan RR, Teh J, Wells A, Arora B, Dollie Q, Ho D, Ma Y, Perera OM, Truong A, Dawson AC, Lim B, Pahalawatta U, Phan J, Woon-Shoo-Tong XMS, Yeoh A, Charman L, Drane A, Laura S, Lo CCW, Mozes A, Poon R, Tan HH, Wall E, Chopra P, De Giovanni J, Dhital B, Draganic B, Duller A, Gani J, Goh YK, Jeong JY, McManus B, Nagappan P, Pockney P, Rugendyke A, Sarrami M, Smith S, Wills V, Wong HV, Ye G, Zhang G, Brooker E, Feng D, Lau B, Ngai C, Birks S, Gyorki D, Otero de Pablos J, Abbosh A, Gillespie C, Mahmoud A, Kwan B, Lawson J, Warwick A, Bingham J, Cockbain AJ, Dudi-Venkata NN, Ellaby-Hall J, Finlay B, Humphries E, Pisaniello J, Pisaniello M, Salih S, Sammour T, Abd Wahab HH, De Silva A, Hayward N, Iyer K, Maddern G, Prevost GA, Annapureddy N, Settipalli KP, Yeo J, Hempenstall L, Pham L, Purcell S, Talavera C, Vaska AI, Chaggar G, Chrapko P, Cocco A, Coulter-Nile SMCJ, Ctercteko G, French J, Gong H, Gosselink M, Jegathees T, Jin I, Kalachov M, Kiefhaber K, Lee K, Luong J, Phan S, Pleass H, Veale K, Zeng Z, Au A, DeBiasio A, Deng I, Myooran J, Nair A, Stewart P, Stift A, Unger LW, Wimmer K, Ahmed N, Hasan S, Rahman S, O'Shea M, Padmore G, Peters A, Perduca P, Pulcina G, Tinton N, Buxant F, Dabin E, Garofalo G, Dossou F, Lawani I, Gnangnon FHR, Imorou Souaibou Y, Bedada AG, Motlaleselelo P, Tlhomelang O, Lima Buarque I, Mendonça Ataíde Gomes G, Vieira Barros A, Batashki I, Damianov N, Stoyanov V, Dardanov D, Maslyankov S, Petkov P, Sokolov M, Todorov G, Zhivkov E, Akisheva A, Castilla Moreno MA, Genov G, Ilieva I, Ivanov T, Karamanliev M, Khan A, Mitkov E, Yotsov T, Atanasov B, Belev N, Slavchev M, Nsengiyumva C, Jones E, Stock S, Ekwen G, Kyota S, Brown J, Mabanza K. 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Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet 2021; 397:387-397. [PMID: 33485461 PMCID: PMC7846817 DOI: 10.1016/s0140-6736(21)00001-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. METHODS This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. FINDINGS Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. INTERPRETATION Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. FUNDING National Institute for Health Research Global Health Research Unit.
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Wogensen F, Sokratous A, Breistrand M, Thorarinsdottir H, Sigurdadottir J, Nikberg M, Chabok A, Hjertberg M, Elbe P, Saraste D, Rutkowski W, Forlin L, Niska K, Sund M, Oswald D, Peros G, Bluelle R, Reinisch K, Frey D, Palma A, Raptis DA, Zumbühl L, Zuber M, Schmid R, Werder G, Nocito A, Gerosa A, Mahanty S, Widmer LW, Müller J, Gübeli A, Zuk G, Gulcicek OB, Vartanoglu T, Kose E, Karahan SR, Aydin MC, Sahbaz NA, Halicioglu I, Alis H, Sapci I, Adiyaman C, Pektaş AM, Cengiz TB, Tansoker I, Işler V, Cevik M, Mutlu D, Ozben V, Ozmen BB, Bayram S, Yolcu S, Kobal BB, Toto ÖF, Çakaloğlu HC, Karabulut K, Mutlu V, Ozkan BB, Celik S, Semiz A, Bodur S, Gül E, Murutoglu B, Yildirim R, Baki BE, Arslan E, Ulusahin M, Guner A, Tomas K, Walker N, Shrimanker N, Cole S, Breslin R, Srinivasan R, Elshaer M, Hunter K, Al-Bahrani A, Liew I, Mairs NG, Rocke A, Dick L, Qureshi M, Chowdhury D, Wright N, Skerritt C, Kufeji D, Ho A, Dissanayake T, Tennakoon A, Ali W, Lim SJ, Tan C, O'Neill S, Jones C, Knight S, Nassif D, Sharma A, Warren O, White R, Mehdi A, Post N, Kalakouti E, Dashnyam E, Stourton F, Mykoniatis I, Currow C, Wong F, Gupta A, Shatkar V, Luck J, Kadiwar S, Smedley A, Wakefield R, Herrod P, Blackwell J, Lund J, Cohen F, Bandi A, Giuliani S, Bond-Smith G, Pezas T, Farhangmehr N, Urbonas T, Perenyei M, Ireland P, Blencowe N, Bowling K, Bunting D, Longstaff L, Keogh K, Jeon H, Iqbal MR, Khosla S, Jeffery A, Perera J, Ibrahem AA, Alhammali T, Salama Y, Oram S, Kidd T, Cullen F, Owen C, Wilson M, Chiu S, Sarafilovic H, Ploski J, Evans E, Abbas A, Kamya S, Ishak N, Bisset C, Andress C, Chin YR, Patel P, Evans D, Haslegrave A, Boggon A, Laurie K, Connor K, Mann T, Mansuri A, Davies R, Griffiths E, Shahbaz AR, Eng C, Din F, L'Heveder A, Park EHG, Ravishankar R, McIntosh K, Yau JD, Chan L, McGarvie S, Tang L, Lim H, Yap S, Park J, Ng ZH, Mirza S, Ang YL, Walls L, Roy C, Paterson-Brown S, Camilleri-Brennan J, Mclean K, D'Souza MS, Pronin S, Henshall DE, Ter EZ, Fouad D, Minocha A, English W, Morgan C, Townsend D, Maciejec L, Mahdi S, Akpenyi O, Hall E, Caydiid H, Rob Z, Abbott T, Torrance HD, Johnston R, Gani MA, Gravante G, Rajmohan S, Majid K, Dindyal S, Smith C, Palliyil M, Patel S, Nicholson L, Harvey N, Baillie K, Shillito S, Kershaw S, Bamford R, Orton P, Reunis E, Tyler R, Soon WC, Jama GM, Dhillon D, Patel K, Nanthakumaran S, Heard R, Chen KY, Barmayehvar B, Datta U, Kamarajah SK, Karandikar S, Iftekhar Tani S, Monaghan E, Donnelly P, Walker M, Parakh J, Blacker S, Kaul A, Paramasivan A, Farag S, Nessa A, Awadallah S, Lim J, Chean Khun Ng J, Kiran RP, Murray A, Etchill E, Dasari M, Puyana J, Haddad N, Zielinski M, Choudhry A, Caliman C, Beamon M, Duane T, Swaroop M, Myers J, Deal R, Schadde E, Hemmila M, Napolitano L, To K, Makupe A, Musowoya J, van der Naald N, Kumwenda D, Reece-Smith A, Otten K, Verbeek A, Prins M, Baquero Suarez AA, Balmaceda R, Deane C, Dijan E, Elfiky M, Koskenvuo L, Thollot A, Limoges B, Capito C, Alexandre C, Kotobi H, Leroux J, Pinnagoda K, Henric N, Azzis O, Rosello O, Francois P, Etienne S, Buisson P, Hmila S, Clegg-Lamptey JN, Imoro O, Abem OE, Papageorgiou D, Soulou V, Asturias S, Peña L, O'Connor DB, Luc AR, Russo AA, Ruzzenente A, Taddei A, Cona C, Bottini C, Pascale G, Rotunno G, Solaini L, Pascale MM, Notarnicola M, Corbellino M, Sacco M, Ubiali P, Cautiero R, Bocchetti T, Muzio E, Guglielmo V, Morandi E, Mao P, de Luca E, Ali FM, Žilinskas J, Strupas K, Kondrotas P, Baltrunas R, Kutkevicius J, Ignatavicius P, Tan CL, Siaw JY, Yam SY, Wilson L, Aziz MRA, Bondin J, Zorrilla CD, Majbar A, Sale D, Abdullahi L, Osagie O, Faboya O, Fatuga A, Taiwo A, Nwabuoku E, Bliksøen M, Khan ZA, Coronel J, Miranda C, Vasquez I, Helguero-Santin LM, Rickard J, Adedeji A, Alqahtani S, Rath M, Van Niekerk M, Koto MZ, Matos-Puig R, Israelsson L, Schuetz T, Yuksek MA, Mericliler M, Ulusahin M, Wolf B, Fairfield C, Yong GL, Whitehurst K, Redgrave N, Musyoka CK, Olivier J, Lee K, Cox M, Farhan-Alanie MMH, Callan R, Chibuye C, Ali THA, Rekhis S, Rommaneh M, Sam ZH, Pugliesi TB, Pardo G, Blanco R. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018; 18:516-525. [PMID: 29452941 PMCID: PMC5910057 DOI: 10.1016/s1473-3099(18)30101-4] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. METHODS This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. FINDINGS Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). INTERPRETATION Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. FUNDING DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
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Trenti L, Galvez A, Biondo S, Solis A, Vallribera-Valls F, Espin-Basany E, Garcia-Granero A, Kreisler E. Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer: A cross-sectional study. Eur J Surg Oncol 2018; 44:1031-1039. [PMID: 29665980 DOI: 10.1016/j.ejso.2018.03.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 12/03/2017] [Revised: 03/06/2018] [Accepted: 03/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of this study was to analyze the quality of life (QoL), low anterior resection syndrome (LARS) and fecal incontinence after surgery for mid to low rectal cancer and its relationship with the type of surgical procedure performed. METHODS A cross-sectional cohort survey study of 358 patients operated on for mid to low rectal cancer. Patients were included in three groups: abdominoperineal resection (APR), low mechanical colorectal anastomosis (CRA) and hand-sewn coloanal anastomosis (CAA). The QLQ-C30/CR29 questionnaires, LARS and Vaizey scores were used to study QoL and defecatory dysfunction. Multivariable analysis was used to estimate the prognostic effect of the variables on QoL and LARS scores. RESULTS 62.6% of the patients answered the survey. The global QoL score was similar among APR, CRA and CAA. Patients' body image perception was significantly worse after APR than after CRA or CAA. LARS score was better in CRA group (p = 0.002). A major LARS was observed in 83.3% of the patients who underwent CAA and in 56.6% of the patients who underwent CRA. No relationship between surgical procedures and the global QoL score was observed. Neoadjuvant radiotherapy (p = 0.048) and CAA (p = 0.005) were associated with a major LARS. The Vaizey score was higher for CAA than for CRA (p = 0.036). CONCLUSIONS Though CAA group presents worse LARS and higher faecal incontinence scores respect CRA patients, and APR is related with a worse body image, global QoL was similar in the three groups.
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Affiliation(s)
- Loris Trenti
- Department of General and Digestive Surgery, Colorectal Unit.Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Ana Galvez
- Department of General and Digestive Surgery, Colorectal Unit.Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Colorectal Unit.Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain.
| | - Alejandro Solis
- Department of General and Digestive Surgery, Colorectal Unit Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Francesc Vallribera-Valls
- Department of General and Digestive Surgery, Colorectal Unit Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Eloy Espin-Basany
- Department of General and Digestive Surgery, Colorectal Unit Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Alvaro Garcia-Granero
- Department of General and Digestive Surgery, Colorectal Unit.Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - Esther Kreisler
- Department of General and Digestive Surgery, Colorectal Unit.Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
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Blanco-Colino R, Espin-Basany E. Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 2017; 22:15-23. [PMID: 29230591 DOI: 10.1007/s10151-017-1731-8] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/31/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Indocyanine green (ICG) fluorescence imaging has been proven to be an effective tool to assess anastomotic perfusion. The aim of this systematic review and meta-analysis was to evaluate its efficacy in reducing the anastomotic leakage (AL) rate after colorectal surgery. METHODS PubMed, Scopus, WOS, Google Scholar and Cochrane Library were searched up to January 2017 for studies comparing fluorescence imaging with standard care. ClinicalTrials.gov register was searched for ongoing trials. The primary outcome measure was AL rate with at least 1 month of follow-up. ROBINS-I tool was used for quality assessment. A meta-analysis with random-effects model was performed to calculate odds ratios (ORs) from the original data. RESULTS One thousand three hundred and two patients from 5 non-randomized studies were included. Fluorescence imaging significantly reduced the AL rate in patients undergoing surgery for colorectal cancer (OR 0.34; CI 0.16-0.74; p = 0.006). Low AL rates were shown in rectal cancer surgery (ICG 1.1% vs non-ICG 6.1%; p = 0.02). There was no significant decrease in the AL rate when colorectal procedures for benign and malignant disease were combined. To date, there are no published randomized control trials (RCTs) on this subject, though 3 ongoing RCTs were identified. CONCLUSIONS ICG fluorescence imaging seems to reduce AL rates following colorectal surgery for cancer. However, the inherent bias of the non-randomized studies included, and their differences in AL definition and diagnosis could have influenced results. Large well-designed RCTs are needed to provide evidence for its routine use in colorectal surgery.
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Affiliation(s)
- R Blanco-Colino
- Department of Surgery, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - E Espin-Basany
- Department of Surgery, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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Garcia-Granero A, Biondo S, Espin-Basany E, González-Castillo A, Valverde S, Trenti L, Gil-Moreno A, Kreisler E. Pelvic exenteration with rectal resection for different types of malignancies at two tertiary referral centres. Cir Esp 2017; 96:138-148. [PMID: 29229359 DOI: 10.1016/j.ciresp.2017.11.001] [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: 08/20/2017] [Revised: 09/28/2017] [Accepted: 11/04/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Pelvic exenteration (PE) offers the best chance of cure for locally advanced primary or recurrent pelvic organ malignancies invading adjacent organs. The aims of this study were to analyse results for any pelvic exenteration that includes rectal resection and the analysis of results of fecal and urinary reconstruction. METHOD From January 2000 to April 2014, 111 PE with rectal resection for any pelvic cancer were analysed retrospectively at two national tertiary referral centers. RESULTS Thirty-six colorectal anastomosis were performed. Urologic reconstructions performed were 30 double barrelled wet colostomy (DBWC), 14 Bricker ileal conduit (BIC), and 2 ureterocutaneostomies. Postoperative complications occurred in 71 patients (64%). Six deaths (5.4%) occurred within 30 postoperative days. Five-year overall survival following R0 resection was 62.6%; R1: 42.7%; R2: 24.2% (P=.018). The resection margin status was associated with overall survival, local recurrence and distant recurrence. CONCLUSION Pelvic exenterations for any cause need to be performed in referral centers and by specialized surgeons. Anastomosis after modified supralevator pelvic exenteration for ovarian cancer, is safe. DBWC can be considered a valid option for urologic reconstruction. The most important prognostic factor after pelvic exenteration for malignant pelvic tumors is the status of surgical margins.
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Affiliation(s)
- Alvaro Garcia-Granero
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, Universidad de Barcelona e IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Sebastiano Biondo
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, Universidad de Barcelona e IDIBELL, Hospitalet de Llobregat, Barcelona, España.
| | - Eloy Espin-Basany
- Servicio de Cirugía General y Digestiva, Unidad Colorrectal, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Ana González-Castillo
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, Universidad de Barcelona e IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Silvia Valverde
- Servicio de Cirugía General y Digestiva, Unidad Colorrectal, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Loris Trenti
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, Universidad de Barcelona e IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Antonio Gil-Moreno
- Servicio de Ginecología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Esther Kreisler
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, Universidad de Barcelona e IDIBELL, Hospitalet de Llobregat, Barcelona, España
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Jimenez-Gomez LM, Espin-Basany E, Trenti L, Martí-Gallostra M, Sánchez-García JL, Vallribera-Valls F, Kreisler E, Biondo S, Armengol-Carrasco M. Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer. Colorectal Dis 2017; 20:195-200. [PMID: 28963744 DOI: 10.1111/codi.13901] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/14/2017] [Indexed: 12/13/2022]
Abstract
AIM To assess factors independently associated with low anterior resection syndrome (LARS) following resection or rectal cancer. METHOD Cross-sectional study carried out in two acute-care teaching hospitals in Barcelona, Spain. Patients who had undergone sphincter preserving low anterior resection with curative intent, with total or partial mesorectal excision (with and without protective ileostomy) between January 2001 and December 2009 completed a self-administered questionnaire to assess bowel dysfunction after rectal cancer surgery. Predictors of LARS were assessed by univariate and multivariate analyses. RESULTS The questionnaire was sent to 329 patients (response rate 57.7%). Six cases of incomplete questionnaires were excluded. The study population included 184 patients (66.8% men) with a mean age of 63 years. There were 44 (23.9%) patients with no LARS, 36 (19.6%) with minor LARS and 104 (56.2%) with major LARS. In the univariate analysis, total mesorectal excision (P = 0.0008), protective ileostomy (P = 0.002), preoperative and postoperative radiotherapy (P = 0.0000), postoperative chemotherapy (P = 0.0046) and age (P = 0.035) were significantly associated with major LARS, whereas in the multivariate analysis, total mesorectal excision (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.02-4.65), preoperative radiotherapy (OR 4.33, 95% CI 2.03-9.27) and postoperative radiotherapy (OR 9.52, 95% CI 1.74-52.24) were independent risk factors for major LARS. CONCLUSIONS In this study, the risk of having major LARS increases with total mesorectal excision and both neoadjuvant and adjuvant radiotherapy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Luis Miguel Jimenez-Gomez
- Colorectal Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Unit of Coloproctology, Service of General Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Eloy Espin-Basany
- Colorectal Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Loris Trenti
- Department of Surgery-Colorectal Unit, Hospital Universitari de Bellvitge, University of Barcelona and Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Martí-Gallostra
- Colorectal Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Luis Sánchez-García
- Colorectal Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Vallribera-Valls
- Colorectal Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esther Kreisler
- Department of Surgery-Colorectal Unit, Hospital Universitari de Bellvitge, University of Barcelona and Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastiano Biondo
- Department of Surgery-Colorectal Unit, Hospital Universitari de Bellvitge, University of Barcelona and Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Armengol-Carrasco
- Colorectal Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Biondo S, Frago R, Kreisler E, Espin-Basany E. Impact of resection versus no resection of the primary tumor on survival in patients with colorectal cancer and synchronous unresectable metastases: protocol for a randomized multicenter study (CR4). Int J Colorectal Dis 2017; 32:1085-1090. [PMID: 28497402 DOI: 10.1007/s00384-017-2827-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to determine whether patients diagnosed with colorectal cancer and synchronous unresectable metastases (stage IV) can benefit from resection of the primary tumor in terms of an improvement in cancer-specific survival. METHODS Stage IV colorectal cancer patients are eligible for inclusion in a randomized multicenter study carried out in 22 hospitals throughout Spain. Exclusion criteria are rectal tumors below 12 cm from the anal verge or locally advanced tumors, multiple bone or central nervous system metastases, and history of another primary cancer. The parallel design of the trial includes an arm of systemic chemotherapy alone versus an arm of resection of the primary tumor plus systemic chemotherapy after surgery. The primary endpoint of the study is cancer-specific survival that is assessed with a minimum follow-up of 24 months. Secondary endpoints are postoperative morbidity and mortality associated with resection of the primary tumor, complications and need of surgery in patients treated with systemic chemotherapy only, safety of systemic chemotherapy in both treatment strategies, and quality of life. CONCLUSIONS Confirmation of a survival benefit of surgical resection of the primary tumor in stage IV colorectal cancer patients not amenable to curative therapy is very relevant from a clinical and societal perspective, particularly considering the increase in the incidence and prevalence of colorectal cancer in developed countries. ClinicalTrials.gov Identifier: NCT02015923.
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Affiliation(s)
- Sebastiano Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Ricardo Frago
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Esther Kreisler
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Eloy Espin-Basany
- Department of General and Digestive Surgery, Colorectal Unit, Vall d'Hebron University Hospital, Autonomic University of Barcelona, Barcelona, Spain
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Biondo S, Miquel J, Espin-Basany E, Sanchez JL, Golda T, Ferrer-Artola AM, Codina-Cazador A, Frago R, Kreisler E. A Double-Blinded Randomized Clinical Study on the Therapeutic Effect of Gastrografin in Prolonged Postoperative Ileus After Elective Colorectal Surgery. World J Surg 2016; 40:206-14. [PMID: 26446450 DOI: 10.1007/s00268-015-3260-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Postoperative ileus is a common problem with significant clinical and economic consequences. We hypothesized that Gastrografin may have therapeutic utility by accelerating the recovery of postoperative ileus after colorectal surgery. The aim of this trial was to study the impact of oral Gastrografin administration on postoperative prolonged ileus (PPI) after elective colorectal surgery. METHODS The main endpoint of this randomized, double-blinded, controlled trial was time of resolution of PPI. The secondary endpoints were overall hospital length of stay, time to start oral intake, time to first passage of flatus or stools, time of need of nasogastric tube, and need of parenteral nutrition. Included criteria were patients older than 18 years, operated for colonic neoplasia, inflammatory bowel disease, or diverticular disease. There were two treatments: Gastrografin administration and placebo. The sample size was calculated taking into account the average length of postoperative ileus after colorectal resection until tolerance to oral intake. Statistical analysis showed that 29 subjects in each group were needed. RESULTS Twenty-nine patients per group were randomized. Groups were comparable for age, gender, ASA Physical Status Classification System, stoma construction, and surgical technique. No statistical differences were observed in mean time to resolution between the two groups, 9.1 days (CI 95%, 6.51-11.68) in Gastrografin group versus 10.3 days (CI 6.96-10.29) in Placebo group (P = 0.878). Even if not statistically significant, time of resolution of PPI, overall length of stay, time of need of nasogastric tube, and time to tolerance of oral intake were shorter in the G group. CONCLUSIONS Gastrografin does not accelerate significantly the recovery of prolonged postoperative ileus after elective colorectal resection when compared with placebo. However, it seems to clinically improve all the analyzed variables.
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Affiliation(s)
- Sebastiano Biondo
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Jordi Miquel
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Eloy Espin-Basany
- Colorectal Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jose Luis Sanchez
- Colorectal Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Thomas Golda
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Ana Maria Ferrer-Artola
- Department of Pharmacy, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Antonio Codina-Cazador
- Colorectal Unit, Department of General and Digestive Surgery, Josep Trueta University Hospital, Girona, Spain
| | - Ricardo Frago
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Esther Kreisler
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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Øresland T, Bemelman WA, Sampietro GM, Spinelli A, Windsor A, Ferrante M, Marteau P, Zmora O, Kotze PG, Espin-Basany E, Tiret E, Sica G, Panis Y, Faerden AE, Biancone L, Angriman I, Serclova Z, de Buck van Overstraeten A, Gionchetti P, Stassen L, Warusavitarne J, Adamina M, Dignass A, Eliakim R, Magro F, D'Hoore A. European evidence based consensus on surgery for ulcerative colitis. J Crohns Colitis 2015; 9:4-25. [PMID: 25304060 DOI: 10.1016/j.crohns.2014.08.012] [Citation(s) in RCA: 226] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Ortiz H, Armendariz P, Kreisler E, Garcia-Granero E, Espin-Basany E, Roig JV, Martín A, Parajo A, Valero G, Martínez M, Biondo S. Influence of Rescrubbing Before Laparotomy Closure on Abdominal Wound Infection After Colorectal Cancer Surgery. ACTA ACUST UNITED AC 2012; 147:614-20. [DOI: 10.1001/archsurg.2012.150] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Lenisa L, Schwandner O, Stuto A, Jayne D, Pigot F, Tuech JJ, Scherer R, Nugent K, Corbisier F, Espin-Basany E, Hetzer FH. STARR with Contour Transtar: prospective multicentre European study. Colorectal Dis 2009; 11:821-7. [PMID: 19175625 PMCID: PMC2774156 DOI: 10.1111/j.1463-1318.2008.01714.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The stapled transanal rectal resection (STARR) in patients with defecation disorders is limited by the shape and capacity of the circular stapler. A new device has been recently developed, the Contour Transtar stapler, in order to improve the safety and effectiveness of the STARR technique. The study has been designed to confirm this declaration. METHOD From January to June 2007 a prospective European multicentre study of consecutive patients with defecation disorder caused by internal rectal prolapse underwent the new STARR technique. The assessment of perioperative morbidity and functional outcome after 6 weeks, 3 and 12 months was documented by different scores. RESULTS In all 75 patients, median age 64, the Transtar procedure was performed with 9% intraoperative difficulties, 7% postoperative complications and no mortality. The mean reduction of the ODS score was -15.6 (95%-CI: -17.3 to -13.8, P < 0.0001), mean reduction of SSS was -12.6 (95%-CI: -14.2 to -11.2; P < 0.0001). 41% stated improvement of their continence status by CCF score, only 4 patients (5%) had deterioration. CONCLUSION The Transtar procedure is technically demanding, with good functional results similar to the conventional STARR.
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Affiliation(s)
- L Lenisa
- Department of Surgery, Casa di Cura San Pio XMilan, Italy
| | - O Schwandner
- Department of Surgery, Caritas-Krankenhaus St. JosefRegensburg, Germany
| | - A Stuto
- Department of Surgery, Ospedale S. Maria degli AngeliPordenone, Italy
| | - D Jayne
- Academic Surgical Unit, St James University HospitalLeeds, UK
| | - F Pigot
- Department of Proctology, Bagatelle-Maison de SanteTalence-Cedex, France
| | - JJ Tuech
- Department of Digestive Surgery, University HospitalRouen, France
| | - R Scherer
- Department of Surgery, Krankenhaus WaldfriedeBerlin, Germany
| | - K Nugent
- Department of Surgery, General HospitalSouthampton, UK
| | - F Corbisier
- Department of Surgery, C.H.N.D.R.F.Charleroi, Belgium
| | - E Espin-Basany
- Department of Surgery, Hospital Valle de HebronBarcelona, Spain
| | - F H Hetzer
- Department of Surgery, Cantonal HospitalSt Gallen, Switzerland
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Abstract
The use of a sublay mesh in open surgery has been probed to be an efficient strategy for the prevention of parastomal hernia. Based on these previous reports, placing a composite mesh (polypropylene/cellulose) in an intraperitoneal fashion seems to be a good technique when a laparoscopic approach is performed. This technique is easy to perform. Mesh is kept in place with the help of tackers, normal intra-abdominal pressure, and the colon itself. We report the description of a laparoscopic technique for placing an intraperitoneal mesh for the prevention of a parastomal hernia.
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Affiliation(s)
- Manuel López-Cano
- Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain
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Arroyo A, González-Argenté FX, García-Domingo M, Espin-Basany E, De-la-Portilla F, Pérez-Vicente F, Calpena R. Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome. Br J Surg 2008; 95:1521-7. [PMID: 18942056 DOI: 10.1002/bjs.6328] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND This prospective multicentre study assessed the safety and effectiveness of stapled transanal rectal resection (STARR) for treatment of obstructive defaecation syndrome (ODS). METHODS Between February 2001 and June 2006, 104 patients diagnosed with ODS were treated with STARR. Follow-up was scheduled for 1, 3 and 6 months after surgery, and annually thereafter. Variables related to the patient, surgical technique and outcome were analysed. RESULTS Mean operating time was 46.7 min. Haemorrhage at the staple line occurred in 55 patients (52.9 per cent). Three patients required surgical revision in the first 48 h owing to persistent bleeding. The median postoperative pain score was 2.4 on a scale from 1 to 10. Mean hospital stay was 2.2 days. The mean constipation score improved from 13.5 before surgery to 5.1 at 1-year follow-up (P = 0.006). Twenty-three patients reported faecal incontinence at 4 weeks after surgery, but only nine still had minor residual incontinence by 1 year. At a median follow-up of 26 (range 12-72) months, ODS had recurred or persisted radiologically and/or clinically in 11 patients. CONCLUSION STARR is associated with low morbidity and a short hospital stay, and is an effective alternative treatment for ODS.
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Affiliation(s)
- A Arroyo
- Coloproctology Unit, Hospital General Universitario Elche, Elche, Spain.
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Espin-Basany E, Sanchez-Garcia JL, Lopez-Cano M, Lozoya-Trujillo R, Medarde-Ferrer M, Armadans-Gil L, Alemany-Vilches L, Armengol-Carrasco M. Prospective, randomised study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics? Int J Colorectal Dis 2005; 20:542-6. [PMID: 15843938 DOI: 10.1007/s00384-004-0736-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2004] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The use of prophylactic antibiotics in addition to mechanical cleansing is the current standard of care prior to colonic surgery. The question of whether the antibiotics should be administered intravenously or orally, or by both routes, remains controversial. Our aim was to compare three methods of prophylactic antibiotic administration in elective colorectal surgery. METHODS Three hundred consecutive elective colorectal resections were studied. All patients had preoperative mechanical colon cleansing with oral sodium phosphate and intravenous antibiotic prophylaxis with cefoxitin (one dose before skin incision and two postoperative doses). Patients were randomised to one of the following three groups: group A: three doses of oral antibiotic (neomycin and metronidazole) at the time of mechanical colon cleansing; group B: one dose of oral antibiotic; group C: no oral antibiotics. All patients were followed during their hospital stay and at 7, 14 and 30 days post-surgery. RESULTS Vomiting occurred in 31%, 11% and 9% of the studied patients (groups A, B and C, respectively) (p<0.001). Nausea was present in 44%, 18% and 13% of patients (p<0.001). Abdominal pain was recorded in 13%, 10% and 4% of patients (p: 0.077). Wound infection was present in 7%, 8% and 6% and suture dehiscence occurred in 2%, 2% and 3% of the patients in the three groups (no differences among them). Neither were differences found among the three groups in terms of urinary infections, pneumonia, postoperative ileus or intra-abdominal abscess. CONCLUSION The addition of three doses of oral antibiotics to intravenous antibiotic prophylaxis is associated with lower patient tolerance in terms of increased nausea, vomiting and abdominal pain, and has shown no advantages in the prevention of postoperative septic complications. Therefore, we recommend that oral antibiotics should not be used prior to colorectal surgery.
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Affiliation(s)
- Eloy Espin-Basany
- Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, 4th Floor, Pg Valle de Hebron 119-129, Barcelona, 08035, Spain.
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