Diseases of the Colon & Rectum最新文献

Background: Narrative operative reports may omit or obscure data from an operation.

Objective: To develop a synoptic operative report for rectal prolapse that includes core descriptors as developed by an international consensus of expert pelvic floor surgeons.

Design: Descriptors for patients undergoing rectal prolapse surgery were generated through review. Members of the Pelvic Floor Disorders Consortium were recruited to participate in a 3-round Delphi process using a 9-point Likert scale. Descriptors that achieved 70% agreement were kept from the first round, and descriptors scoring 40% to 70% agreement were recirculated in subsequent rounds. A final list of operative descriptors was determined at a consensus meeting, with a final consensus meeting more than 70% agreement.

Settings: This survey was administered to members of the Pelvic Floor Disorders Consortium.

Patients: No patient data are included in this study.

Main outcome measures: Descriptors meeting greater than 70% agreement were selected.

Results: One hundred seventy-six surgeons representing colorectal surgeons, urogynecologists, and urologists distributed throughout North America (56%), Latin America (4%), Western Europe (29%), Asia (4%), and Africa (1%) participated in the first round of Delphi voting. After 2 additional rounds and a final consensus meeting, 16 of 30 descriptors met 70% consensus. Descriptors that met consensus were surgery type, posterior dissection, ventral dissection, mesh used, type of mesh used, mesh location, sutures used, suture type, pouch of Douglas and peritoneum reclosed, length of rectum imbricated, length of bowel resected, levatoroplasty, simultaneous vaginal procedure, simultaneous gynecologic procedure, simultaneous enterocele repair, and simultaneous urinary incontinence procedure.

Limitations: The survey represents the views of members of the Delphi panel and may not represent the viewpoints of all surgeons.

Conclusions: This Delphi survey establishes international consensus descriptors for intraoperative variables that have been used to produce a synoptic operative report. This will help establish defined operative reporting to improve clinical communication, quality measures, and clinical research. See Video Abstract .

Desarrollo de un protocolo operatorio sinptico derivado de consenso para el prolapso rectal un informe del consorcio de trastornos del piso plvico: ANTECEDENTES:Los protocolos operativos narrativos frecuentemente pueden omitir u oscurecer datos de un procedimiento.OBJETIVO:Nuestro objetivo es desarrollar un protocolo operatorio sinóptico para el prolapso rectal que incluya descriptores básicos desarrollados por un consenso internacional de cirujanos expertos en piso pélvico.DISEÑO:Los descriptores para pac

Background: Few studies have investigated trends in global surgical site infection rates in colorectal surgery in the past decade.

Objective: This study seeks to describe changes in rates of different surgical site infections from 2013 to 2020, identify risk factors for surgical site infection occurrence, and evaluate the association of minimally invasive surgery and infection rates in colorectal resections.

Design: A retrospective analysis of the National Surgical Quality Improvement Program database 2013-2020 identifying patients undergoing open or laparoscopic colorectal resections by procedure codes was performed. Patient demographic information, comorbidities, procedures, and complications data were obtained. Univariable and multivariable logistic regression analyses were performed.

Setting: This was a retrospective study.

Patients: A total of 279,730 patients received colorectal resections from 2013 to 2020.

Main outcome measures: The primary outcome measure was the rate of surgical site infection, divided into superficial, deep incisional, and organ space infections.

Results: There was a significant decrease in rates of superficial infections ( p < 0.01) and deep incisional infections ( p < 0.01) from 5.9% in 2013 to 3.3% in 2020 and from 1.4% in 2013 to 0.6% in 2020, respectively, but a rise in organ space infections ( p < 0.01) from 5.2% in 2013 to 7.1% in 2020. Minimally invasive techniques were associated with decreased odds of all surgical site infections compared to open techniques ( p < 0.01) in multivariate analysis, and adoption of minimally invasive techniques increased from 59% in 2013 to 66% in 2020.

Limitations: The study is limited by its retrospective nature and variables available for analysis.

Conclusions: Superficial and deep incisional infection rates have significantly decreased, likely secondary to improved adoption of minimally invasive techniques and infection prevention bundles. Organ space infection rates continue to increase. Additional research is warranted to clarify current recommendations for mechanical bowel preparation and oral antibiotic use as well as to study novel interventions to decrease postoperative infection occurrence. See Video Abstract .

Tendencias modernas en las tasas de infeccin del sitio quirrgico para ciruga colorrectal un estudio del proyecto nacional de mejora de la calidad quirrgica: ANTECEDENTES:Hay pocos estudios que investiguen las tendencias en las tasas globales de infección del sitio quirúrgico en cirugía colorrectal en la última década.OBJETIVO:Este estudio busca describir cambios en las tasas de diferentes infecciones del sitio quirúrgico entre 2013 y 2020, identificar factores de riesgo para la aparición de ISQ y evaluar la asociación de la cirugía mínimame

Background: Although surgery is commonly regarded as the primary curative treatment for colorectal cancer, it could potentially be associated with postoperative morbidity and mortality.

Objective: To determine the pooled effect of exercise and multidisciplinary prehabilitation interventions on postoperative hospital length of stay and functional capacity in patients undergoing resection of colorectal cancer.

Data sources: A systematic search was conducted in MEDLINE (via PubMed) and Web of Science databases from inception to November 2022.

Study selection: The original systematic search retrieved 2005 studies. After the removal of duplicates and screening by title and abstract, 77 eligible full-text documents were evaluated for final inclusion in the meta-analysis. A total of 12 randomized controlled trials, 5 nonrandomized controlled trials, and 3 uncontrolled before-and-after studies were selected.

Main outcome measures: Postoperative hospital length of stay (in days) and functional capacity (assessed with the peak of oxygen consumption [VO2 peak] and 6-minute walking test) were the outcome measures.

Results: The meta-analysis was conducted on 20 studies (3805 participants). Randomized controlled trials and nonrandomized controlled trials showed significant reductions in postoperative hospital length of stay (d = -0.10, nearly 2 days) and significant incremental improvements in VO2 peak (d = 0.27) and 6-minute walking test (d = 0.31). Regarding the before-and-after studies, the pooled effect of multidisciplinary prehabilitation interventions was positively significant for VO2 peak (d = 0.29) and 6-minute walking test (d = 0.29). There was no risk of publication bias (Egger test: p > 0.05), with a score of 0.71 (0-1) on average.

Limitations: There was a high between-studies heterogeneity, and several outcomes did not have the required number of studies for a desirable statistical power.

Conclusions: These findings suggest that multidisciplinary prehabilitation interventions might be effective at decreasing postoperative hospital length of stay (nearly 2 days) and improving functional capacity.

Registration: PROSPERO registration number CRD42022373982.