Colorectal Disease最新文献

Aim: Obstetric anal sphincter injuries (OASIs) are associated with devastating consequences, mainly faecal incontinence. A timely and correct repair is necessary to reduce the risk of maternal morbidity. The aim was to explore the experience and practice of on-call general surgeons in the acute repair of OASIs.

Method: A cross-sectional, observational questionnaire study was performed. Registrars and consultants participating in an emergency general surgical rota in the UK were included. A 33-item questionnaire was disseminated over a 9-month period from April 2023. A descriptive, thematic analysis of the data was undertaken.

Results: In all, 310 responses were analysed. 42.3% of colorectal respondents (of which 29% were pelvic floor specialists), 24.3% of general surgeons, 16.7% of hepato-biliary surgeons and 13.7% of upper gastrointestinal surgeons were contacted to assist with an acute repair. Of those contacted, 52.3% typically assisted with a 3C or 4 tear, 54.2% received no training and 95.5% performed less than three acute repairs in the previous year. 57.6% of all respondents were not confident at all in the repair of these injuries, 55% highlighted a lack of experience and 36% mentioned a curricular gap.

Conclusion: Surgeons may be called to assist with an acute OASI repair, particularly in cases of severe anatomical disruption. This occurs infrequently. There is a lack of consensus as to who is responsible for these injuries. Obstetricians have structured training in both the recognition and repair of these injuries. This paper serves to highlight the lack of training for surgeons who report doing this surgery despite lacking the required competences.

Aim: Most of the literature on the environmental impact of surgery has analysed operating theatre practice in terms of its contribution to global warming (by greenhouse gas effects). The aim of this study was to assess the overall environmental impact of a complete perioperative pathway with and without implementation of an enhanced recovery programme (ERP).

Method: We compared two scenarios: an ERP scenario and a conventional scenario (CONV) for colorectal surgery. We carried out a lifecycle analysis for perioperative procedures, devices and consumables. We measured the impact on 17 environmental variables in addition to global warming.

Results: The overall environmental impact of ERP was 6% lower than that of conventional care. The reduction of impact due to ERP ranged from 5% for greenhouse gas emissions (18 kg CO₂ equivalent less per intervention) to 27% for water consumption (3 m³ less). The stages that had the most impact on the environment were the preoperative stage (essentially owing to patient travel) and the intraoperative stage with the surgical part (medical devices representing 83.3% of the impact of the procedure) and the anaesthesia part (halogenated gases and ventilation representing 54.9% of the impact of anaesthesia care).

Conclusion: This study found an ERP approach to be more eco-responsible than conventional care. This is an additional benefit of ERP implementation. The impact of ERP implementation might be further reduced by action on the preoperative and intraoperative stages.

Aim: Pilonidal sinus disease (PSD) is a common condition particularly affecting the young population. The disease is incompletely understood, and optimal treatment is still debated. However, off-midline closure techniques have become the standard of care in more advanced cases. The literature is, however, lacking disease stratification in evaluation of surgical results. The aim of this study was to evaluate the surgical outcomes in a prospective cohort following Bascom's cleft lift (BCL) in primary extensive disease, nonhealing wounds after previous surgery and recurrence on a large Danish cohort from a high-volume centre.

Method: The study is based on a prospective database established at Randers Regional Hospital in 2016. All patients undergoing BCL surgery from June 2016 until June 2020 were included in this study.

Results: Three hundred and ninety two patients (326 men/66 women) underwent BCL surgery over a 4-year period. Of these, 127 (32.4%) presented with primary extensive PSD, 136 (34.7%) with nonhealing wounds and 129 (33.9%) with recurrent PSD. Overall, 87% healed uneventfully within the first 3 months, and 17% had recurrence at a median follow-up of 60 months (45-73 months). However, the risk of recurrence was higher among patients with nonhealing wounds (20%) and recurrence (17%) compared with primary extensive manifestation (13%).

Conclusion: Treatment of advanced PSD remains challenging with a high rate of wound complications and recurrences, stressing the need for dedicated care. Patients with either failed surgery or recurrence need particular attention.