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Reuvers JRD, Budding AE, van Egmond M, Stockmann HBAC, Twisk JWR, Kazemier G, Abis GSA, Oosterling SJ, Bonjer HJ, Tuynman JB, van Egmond M, Stockmann HBAC, de Korte N, Acherman YIZ, Oosterling SJ, den Boer FC, Sonneveld DJA, Budding AE, Poort L. Gut Proteobacteria levels and colorectal surgical infections: SELECT trial. Br J Surg 2023; 110:129-132. [PMID: 35998096 DOI: 10.1093/bjs/znac288] [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] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 01/18/2023]
Affiliation(s)
- J Reinder D Reuvers
- Department of Surgery, Spaarne Gasthuis, Hoofddorpthe Netherlands.,Department of Surgery, Cancer Centre Amsterdam, Amsterdam University Medical Centres, VU University, Amsterdam, the Netherlands.,Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | | | - Marjolein van Egmond
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam University Medical Centres, VU University, Amsterdam, the Netherlands.,Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | | | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam University Medical Centres, VU University, Amsterdam, the Netherlands
| | - Gabor S A Abis
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
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van Rijswijk A, van Olst N, Meijnikman AS, Acherman YIZ, Bruin SC, van de Laar AW, van Olden CC, Aydin O, Borger H, Beuers UHW, Herrema H, Verheij J, Apers JA, Bäckhed F, Gerdes VEA, Nieuwdorp M, de Brauw LM. The effects of laparoscopic Roux-en-Y gastric bypass and one-anastomosis gastric bypass on glycemic control and remission of type 2 diabetes mellitus: study protocol for a multi-center randomized controlled trial (the DIABAR-trial). Trials 2022; 23:900. [PMID: 36273149 PMCID: PMC9588204 DOI: 10.1186/s13063-022-06762-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Metabolic surgery induces rapid remission of type 2 diabetes mellitus (T2DM). There is a paucity of high level evidence comparing the efficacy of the laparoscopic Roux-en-Y gastric bypass (RYGB) and the laparoscopic one-anastomosis gastric bypass (OAGB) in glycemic control. Also, the mechanisms that drive the conversion of T2DM in severe obese subjects to euglycemia are poorly understood. Methods The DIABAR-trial is an open, multi-center, randomized controlled clinical trial with 10 years follow-up which will be performed in 220 severely obese patients, diagnosed with T2DM and treated with glucose-lowering agents. Patients will be randomized in a 1:1 ratio to undergo RYGB or OAGB. The primary outcome is glycemic control at 12 months follow-up. Secondary outcome measures are diverse and include weight loss, surgical complications, psychologic status and quality of life, dietary behavior, gastrointestinal symptoms, repetitive bloodwork to identify changes over time, glucose tolerance and insulin sensitivity as measured by mixed meal tests, remission of T2DM, presence of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis in liver biopsy, oral and fecal microbiome, cardiovascular performance, composition of bile acids, and the tendency to develop gallstones. Discussion The DIABAR-trial is one of the few randomized controlled trials primarily aimed to evaluate the glycemic response after the RYGB and OAGB in severe obese patients diagnosed with T2DM. Secondary aims of the trial are to contribute to a deeper understanding of the mechanisms that drive the remission of T2DM in severe obese patients by identification of microbial, immunological, and metabolic markers for metabolic response and to compare complications and side effects of RYGB and OAGB. Trial registration ClinicalTrials.gov NCT03330756; date first registered: October 13, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06762-3.
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Affiliation(s)
- A van Rijswijk
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - N van Olst
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands.,Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - A S Meijnikman
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - Y I Z Acherman
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - S C Bruin
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - A W van de Laar
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - C C van Olden
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - O Aydin
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - H Borger
- Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - U H W Beuers
- Department of Gastroenterology and Hepatology and Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - H Herrema
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - J Verheij
- Department of Pathology, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - J A Apers
- Department of Surgery, Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, the Netherlands
| | - F Bäckhed
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, SE-413 45, Gothenburg, Sweden.,Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, Building 7, DK-2200, Copenhagen, Denmark
| | - V E A Gerdes
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands.,Department of Internal Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - M Nieuwdorp
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, SE-413 45, Gothenburg, Sweden.,Department of Internal Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Institute for Cardiovascular research, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - L M de Brauw
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands.
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van Olst N, van Rijswijk AS, Mikdad S, Schoonmade LJ, van de Laar AW, Acherman YIZ, Bruin SC, van der Peet DL, de Brauw LM. Long-term Emergency Department Visits and Readmissions After Laparoscopic Roux-en-Y Gastric Bypass: a Systematic Review. Obes Surg 2021; 31:2380-2390. [PMID: 33813682 PMCID: PMC8113200 DOI: 10.1007/s11695-021-05286-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE There is considerable evidence on short-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB), but data on long-term outcome is scarce, especially on postoperative emergency department (ED) visits and readmissions. We aim to systematically review evidence on the incidence, indications, and risk factors of ED visits and readmissions beyond 30 days after LRYGB. MATERIALS AND METHODS A systematic search in PubMed, Scopus, Embase.com , Cochrane Library, and PsycINFO was performed. All studies reporting ED visits and readmissions > 30 days after LRYGB, with ≥ 50 patients, were included. PRISMA statement was used and the Newcastle-Ottawa Scale for quality assessment. RESULTS Twenty articles were included. Six studies reported on ED visits (n = 2818) and 19 on readmissions (n = 276,543). The rate of patients with an ED visit within 90 days after surgery ranged from 3.9 to 32.6%. ED visits at 1, 2, and 3 years occurred in 25.6%, 30.0%, and 31.1% of patients. Readmissions within 90 days and at 1-year follow-up ranged from 4.1 to 20.5% and 4.75 to 16.6%, respectively. Readmission was 29% at 2 years and 23.9% at 4.2 years of follow-up. The most common reason for ED visits and readmissions was abdominal pain. CONCLUSION Emergency department visits and readmissions have been reported in up to almost one in three patients on the long-term after LRYGB. Both are mainly indicated for abdominal pain. The report on indications and risk factors is very concise. A better understanding of ED visits and readmissions after LRYGB is warranted to improve long-term care, in particular for patients with abdominal pains.
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Affiliation(s)
- N van Olst
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.
| | - A S van Rijswijk
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - S Mikdad
- Department of Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - L J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - A W van de Laar
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Y I Z Acherman
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - S C Bruin
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - D L van der Peet
- Department of Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - L M de Brauw
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
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Van Olden CC, Van de Laar AW, Meijnikman AS, Aydin O, Van Olst N, Hoozemans JB, De Brauw LM, Bruin SC, Acherman YIZ, Verheij J, Pyykkö JE, Hagedoorn M, Sanderman R, Bosma NC, Tremaroli V, Lundqvist A, Olofsson LE, Herrema H, Lappa D, Hjorth S, Nielsen J, Schwartz T, Groen AK, Nieuwdorp M, Bäckhed F, Gerdes VEA. A systems biology approach to understand gut microbiota and host metabolism in morbid obesity: design of the BARIA Longitudinal Cohort Study. J Intern Med 2021; 289:340-354. [PMID: 32640105 PMCID: PMC7984244 DOI: 10.1111/joim.13157] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Received: 01/23/2020] [Revised: 05/01/2020] [Accepted: 05/25/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Prevalence of obesity and associated diseases, including type 2 diabetes mellitus, dyslipidaemia and non-alcoholic fatty liver disease (NAFLD), are increasing. Underlying mechanisms, especially in humans, are unclear. Bariatric surgery provides the unique opportunity to obtain biopsies and portal vein blood-samples. METHODS The BARIA Study aims to assess how microbiota and their metabolites affect transcription in key tissues and clinical outcome in obese subjects and how baseline anthropometric and metabolic characteristics determine weight loss and glucose homeostasis after bariatric surgery. We phenotype patients undergoing bariatric surgery (predominantly laparoscopic Roux-en-Y gastric bypass), before weight loss, with biometrics, dietary and psychological questionnaires, mixed meal test (MMT) and collect fecal-samples and intra-operative biopsies from liver, adipose tissues and jejunum. We aim to include 1500 patients. A subset (approximately 25%) will undergo intra-operative portal vein blood-sampling. Fecal-samples are analyzed with shotgun metagenomics and targeted metabolomics, fasted and postprandial plasma-samples are subjected to metabolomics, and RNA is extracted from the tissues for RNAseq-analyses. Data will be integrated using state-of-the-art neuronal networks and metabolic modeling. Patient follow-up will be ten years. RESULTS Preoperative MMT of 170 patients were analysed and clear differences were observed in glucose homeostasis between individuals. Repeated MMT in 10 patients showed satisfactory intra-individual reproducibility, with differences in plasma glucose, insulin and triglycerides within 20% of the mean difference. CONCLUSION The BARIA study can add more understanding in how gut-microbiota affect metabolism, especially with regard to obesity, glucose metabolism and NAFLD. Identification of key factors may provide diagnostic and therapeutic leads to control the obesity-associated disease epidemic.
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Affiliation(s)
- C C Van Olden
- From the, Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Experimental Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - A W Van de Laar
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - A S Meijnikman
- From the, Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - O Aydin
- From the, Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - N Van Olst
- From the, Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - J B Hoozemans
- From the, Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - L M De Brauw
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - S C Bruin
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Y I Z Acherman
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - J Verheij
- Department of Pathology, Amsterdam UMC, Amsterdam, The Netherlands
| | - J E Pyykkö
- Department of Health Psychology, Groningen UMC, Groningen, The Netherlands
| | - M Hagedoorn
- Department of Health Psychology, Groningen UMC, Groningen, The Netherlands
| | - R Sanderman
- Department of Health Psychology, Groningen UMC, Groningen, The Netherlands
| | - N C Bosma
- From the, Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - V Tremaroli
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - A Lundqvist
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - L E Olofsson
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - H Herrema
- Department of Experimental Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - D Lappa
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - S Hjorth
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Kobenhavn, Denmark
| | - J Nielsen
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - T Schwartz
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Kobenhavn, Denmark
| | - A K Groen
- Department of Experimental Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - M Nieuwdorp
- From the, Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Experimental Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - F Bäckhed
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Goteborg, Sweden.,Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Kobenhavn, Denmark.,Department of Clinical Physiology, Region Västtra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - V E A Gerdes
- From the, Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
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Geubbels N, Evren I, Acherman YIZ, Bruin SC, van de Laar AWJM, Hoen MB, de Brauw LM. Randomized clinical trial of an enhanced recovery after surgery programme versus conventional care in laparoscopic Roux-en-Y gastric bypass surgery. BJS Open 2019; 3:274-281. [PMID: 31183442 PMCID: PMC6551390 DOI: 10.1002/bjs5.50143] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background Enhanced recovery after surgery (ERAS) programmes have led to a decreased duration of hospital stay in several surgical fields, but have not been fully tested in patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) for obesity. This study aimed to investigate an ERAS programme versus standard care in these patients. Methods Between January 2013 and July 2014, patients undergoing LRYGB were randomized to ERAS or conventional care. The primary outcome was functional hospital stay, defined as the time between end of surgery and when predefined discharge criteria (pain adequately controlled, fever and postoperative nausea and vomiting (PONV) absent, full liquid diet tolerated, mobilized and feeling fit for discharge) were met. Secondary outcomes were total length of hospital stay, 30-day complication and mortality rates, duration of surgery, time spent on the recovery ward and health-related quality of life. Results A total 220 patients were randomized to ERAS (110 patients) or conventional (110) care. Patients in the ERAS group had shorter functional hospital stay (17·4 versus 20·5 h; P < 0·001), quicker pain control, tolerated liquid diet earlier, had earlier control of PONV, mobilized sooner and were comfortable with discharge sooner than those receiving conventional care. Total length of hospital stay, duration of surgery, time spent on the recovery ward, health-related quality of life, complication and readmission rates did not differ between the study groups. There were no deaths. Conclusion Patients under ERAS care recovered faster after LRYGB surgery than those receiving conventional care, with no increase in readmission and postoperative morbidity rates. Registration number: NTR3853 (http://www.trialregister.nl/).
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Affiliation(s)
- N Geubbels
- Department of Metabolic and Bariatric Surgery Slotervaart Medical Centre Amsterdam the Netherlands
| | - I Evren
- Department of Metabolic and Bariatric Surgery Slotervaart Medical Centre Amsterdam the Netherlands
| | - Y I Z Acherman
- Department of Metabolic and Bariatric Surgery Slotervaart Medical Centre Amsterdam the Netherlands
| | - S C Bruin
- Department of Metabolic and Bariatric Surgery Slotervaart Medical Centre Amsterdam the Netherlands
| | - A W J M van de Laar
- Department of Metabolic and Bariatric Surgery Slotervaart Medical Centre Amsterdam the Netherlands
| | - M B Hoen
- Department of Anaesthesiology Slotervaart Medical Centre Amsterdam the Netherlands
| | - L Maurits de Brauw
- Department of Metabolic and Bariatric Surgery Slotervaart Medical Centre Amsterdam the Netherlands
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Abis GSA, Stockmann HBAC, Bonjer HJ, van Veenendaal N, van Doorn-Schepens MLM, Budding AE, Wilschut JA, van Egmond M, Oosterling SJ, Abis GSA, Bonjer HJ, van Veenendaal N, van Doorn-Schepens MLM, Budding AE, de Lange ESM, Tuynman JB, E. Vandenbroucke-Grauls CMJ, Wilschut JA, van Egmond M, C. Stockmann HBA, van der Bij GJ, de Korte N, Oosterling SJ, Acherman YIZ, den Boer FC, Sonneveld DJA, Poort L. Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery (SELECT trial). Br J Surg 2019; 106:355-363. [DOI: 10.1002/bjs.11117] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/29/2018] [Accepted: 12/13/2018] [Indexed: 12/30/2022]
Abstract
Abstract
Background
Infectious complications and anastomotic leakage affect approximately 30 per cent of patients after colorectal cancer surgery. The aim of this multicentre randomized trial was to investigate whether selective decontamination of the digestive tract (SDD) reduces these complications of elective colorectal cancer surgery.
Methods
The effectiveness of SDD was evaluated in a multicentre, open-label RCT in six centres in the Netherlands. Patients with colorectal cancer scheduled for elective curative surgery with a primary anastomosis were eligible. Oral colistin, tobramycin and amphotericin B were administered to patients in the SDD group to decontaminate the digestive tract. Both treatment and control group received intravenous cefazolin and metronidazole for perioperative prophylaxis. Mechanical bowel preparation was given for left-sided colectomies, sigmoid and anterior resections. Anastomotic leakage was the primary outcome; infectious complications and mortality were secondary outcomes.
Results
The outcomes for 228 patients randomized to the SDD group and 227 randomized to the control group were analysed. The trial was stopped after interim analysis demonstrated that superiority was no longer attainable. Effective SDD was confirmed by interspace DNA profiling analysis of rectal swabs. Anastomotic leakage was observed in 14 patients (6·1 per cent) in the SDD group and in 22 patients (9·7 per cent) in the control group (odds ratio (OR) 0·61, 95 per cent c.i. 0·30 to 1·22). Fewer patients in the SDD group had one or more infectious complications than patients in the control group (14·9 versus 26·9 per cent respectively; OR 0·48, 0·30 to 0·76). Multivariable analysis indicated that SDD reduced the rate of infectious complications (OR 0·47, 0·29 to 0·76).
Conclusion
SDD reduces infectious complications after colorectal cancer resection but did not significantly reduce anastomotic leakage in this trial. Registration number: NCT01740947 (https://www.clinicaltrials.gov).
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Affiliation(s)
- G S A Abis
- Department of Surgery, VU University Medical Centre, Amsterdam, the Netherlands
| | - H B A C Stockmann
- Department of Surgery, Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands
| | - H J Bonjer
- Department of Surgery, VU University Medical Centre, Amsterdam, the Netherlands
| | - N van Veenendaal
- Department of Surgery, VU University Medical Centre, Amsterdam, the Netherlands
| | - M L M van Doorn-Schepens
- Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, the Netherlands
| | - A E Budding
- Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, the Netherlands
| | - J A Wilschut
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - M van Egmond
- Department of Surgery, VU University Medical Centre, Amsterdam, the Netherlands
| | - S J Oosterling
- Department of Surgery, Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands
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Boerlage TCC, Acherman YIZ, Houweling ST, Holleman F, Gerdes VEA. [Bariatric surgery: who, when and where?; an overview for the referring physician]. Ned Tijdschr Geneeskd 2017; 161:D1249. [PMID: 28745245] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
- Bariatric surgery is performed in patients with a body mass index (BMI) > 40kg/m2, or BMI > 35 kg/m2 with obesity-related comorbidities. The Roux-en-Y gastric bypass and sleeve gastrectomy are the most frequently used procedures.- On average, patients have lost 25-27% of their original weight 10 years after surgery.- Obesity-related comorbidities improve dramatically in many patients following surgery. The effect is most noticeable in patients with diabetes mellitus type 2 and obstructive sleep apnoea syndrome. - The prevalence of 30-day complications is < 5%. Mortality is < 0.2% in centres with a lot of experience. - Commonly occurring long-term complications of bariatric surgery include deficiencies, particularly of iron and vitamin B12, along with gallstone disease and sagging skin. - Specific complications can arise following Roux-en-Y gastric bypass, such as internal herniation and hypoglycaemia, and these are often not recognised.
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Abstract
AIM Pseudomyxoma peritonei (PMP) is a rare disease characterized by the abundance of mucus in the abdomen without extra-peritoneal growth. METHODS Our patients with PMP have been treated with cytoreduction and hyperthermic intraperitoneal chemotherapy since 1996. The clinical and histopathological features of PMP and the relation of these features with disease-free interval and survival were assessed. RESULTS Sixty-two patients with PMP (24 M/38 F) were studied. Adenomatous mucosal changes were present in 31 patients. In females, the ovaries were normal in 5 patients and pseudomyxoma ovarii was present in 20 patients. Patients with minimal atypia and with 1% focal proliferation or less (n=38) had a better survival (p=0.0008) than those with more focal proliferation (n=14). CONCLUSION In most patients with PMP the appendix is affected; in females the ovaries are usually also involved. Focal proliferation appears to be a prognostic factor.
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Affiliation(s)
- S van Ruth
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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