F. AlSaleh, B. Hussein, Hadiel Kaiyasah, Omar Almarzouqi
Background: Laparoscopic surgery has a well-documented role in colon resection with improved postoperative outcomes even in low-volume centers. Recently, we have integrated minimally invasive laparoscopic resection, followed by the enhanced recovery after surgery (ERAS) protocol, to improve postoperative outcomes in our hospital. Objectives: To review our experience of laparoscopic colonic resection with the ERAS protocol and compare our outcomes with those in the literature. Design: Observational retrospective. Setting: Governmental tertiary hospital. Materials (Patients) and Methods: Data of patients over 18 years of age who had undergone laparoscopic colonic resection between January 2016 and December 2021 were retrospectively obtained from medical records. Patients with trauma-related injuries were excluded. The variables collected included patient demographics, disease information, operative and postoperative data, and histopathological reports. Data were compared with similar published studies and landmark trials. Sample Size: 92 patients. Main Outcome Measures: Rates of conversion to open procedure, number of lymph nodes harvested, hospital length of stay, percentage of positive margins, 30-day morbidity, and 30-day mortality. Results: During the study period, 92 patients (59% men) underwent laparoscopic colon resections, of which eight (8.6%) required an open procedure. The average operative time was 233 minutes, and the average intraoperative blood loss was 78 mL. Intraoperative complications occurred in four cases with no postoperative sequelae. The median length of hospital stay was 5 days. Malignant specimens revealed 100% disease-free margins with an average of 22 lymph nodes harvested. The postoperative 30-day morbidity, mortality, and histopathological results were comparable with landmark trials. Conclusion: As a new technique in a low-volume center, laparoscopic colon resection was challenging. Despite the presence of an experienced laparoscopic surgeon, extensive training was required to safely complete the procedure within a reasonable operative time with a successful outcome. Furthermore, the implementation of the ERAS protocol was difficult; however, the team mastered it after the first few cases. This study showed that both efficacy and safety can be achieved in laparoscopic colon resections in low-volume centers. Moreover, the ERAS protocols can be implemented; however, their implementation will require additional training, which may lead to better outcomes. Limitations: The lack of general surgery wards in a busy tertiary trauma center meant that patients with variable wound contamination would share the same unit. Conflict of Interest Statement: None. Number of similar cases published: N/A.
{"title":"Laparoscopic colon resection: A newly established single practice center and a single-surgeon observational study","authors":"F. AlSaleh, B. Hussein, Hadiel Kaiyasah, Omar Almarzouqi","doi":"10.4103/wjcs.wjcs_22_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_22_22","url":null,"abstract":"Background: Laparoscopic surgery has a well-documented role in colon resection with improved postoperative outcomes even in low-volume centers. Recently, we have integrated minimally invasive laparoscopic resection, followed by the enhanced recovery after surgery (ERAS) protocol, to improve postoperative outcomes in our hospital. Objectives: To review our experience of laparoscopic colonic resection with the ERAS protocol and compare our outcomes with those in the literature. Design: Observational retrospective. Setting: Governmental tertiary hospital. Materials (Patients) and Methods: Data of patients over 18 years of age who had undergone laparoscopic colonic resection between January 2016 and December 2021 were retrospectively obtained from medical records. Patients with trauma-related injuries were excluded. The variables collected included patient demographics, disease information, operative and postoperative data, and histopathological reports. Data were compared with similar published studies and landmark trials. Sample Size: 92 patients. Main Outcome Measures: Rates of conversion to open procedure, number of lymph nodes harvested, hospital length of stay, percentage of positive margins, 30-day morbidity, and 30-day mortality. Results: During the study period, 92 patients (59% men) underwent laparoscopic colon resections, of which eight (8.6%) required an open procedure. The average operative time was 233 minutes, and the average intraoperative blood loss was 78 mL. Intraoperative complications occurred in four cases with no postoperative sequelae. The median length of hospital stay was 5 days. Malignant specimens revealed 100% disease-free margins with an average of 22 lymph nodes harvested. The postoperative 30-day morbidity, mortality, and histopathological results were comparable with landmark trials. Conclusion: As a new technique in a low-volume center, laparoscopic colon resection was challenging. Despite the presence of an experienced laparoscopic surgeon, extensive training was required to safely complete the procedure within a reasonable operative time with a successful outcome. Furthermore, the implementation of the ERAS protocol was difficult; however, the team mastered it after the first few cases. This study showed that both efficacy and safety can be achieved in laparoscopic colon resections in low-volume centers. Moreover, the ERAS protocols can be implemented; however, their implementation will require additional training, which may lead to better outcomes. Limitations: The lack of general surgery wards in a busy tertiary trauma center meant that patients with variable wound contamination would share the same unit. Conflict of Interest Statement: None. Number of similar cases published: N/A.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47797222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Priya Gupta, Vishakha Kalikar, R. Patankar, Advait Patankar
Complications after stapled hemorrhoidopexy may include recurrence, severe pain, rectal stenosis, bleeding, fecal urgency, and incontinence. Furthermore, persistence of symptoms may warrant surgical intervention. A treatment modality for persistent complaints after stapled hemorrhoidopexy (SHP) is agraffectomy (removal of the retained staples), which ranges from the removal of staples through an anoscope to excision of the entire staple line with the associated scar tissue.
{"title":"Agraffectomy: A novel technique for treatment of complications after stapled hemorrhoidopexy- A case study and review of literature","authors":"Priya Gupta, Vishakha Kalikar, R. Patankar, Advait Patankar","doi":"10.4103/wjcs.wjcs_2_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_2_23","url":null,"abstract":"Complications after stapled hemorrhoidopexy may include recurrence, severe pain, rectal stenosis, bleeding, fecal urgency, and incontinence. Furthermore, persistence of symptoms may warrant surgical intervention. A treatment modality for persistent complaints after stapled hemorrhoidopexy (SHP) is agraffectomy (removal of the retained staples), which ranges from the removal of staples through an anoscope to excision of the entire staple line with the associated scar tissue.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46120045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Himanshu Shekhar, D. Raghavendra, Loganathan Jayapal, K. Palaniswamy, P. Reddy
Adenocarcinoma occurring at the end ileostomy site is a rare complication, with 70 cases reported in the literature to date. Most patients with adenocarcinoma occurring at the ileostomy site underwent total proctocolectomy for ulcerative colitis and familial adenomatous polyposis. Here, we present a case of adenocarcinoma arising at the end ileostomy site post total proctocolectomy for colorectal adenocarcinoma.
{"title":"Primary mucinous adenocarcinoma at the end ileostomy site with multiple metachronous colorectal cancers: A case report","authors":"Himanshu Shekhar, D. Raghavendra, Loganathan Jayapal, K. Palaniswamy, P. Reddy","doi":"10.4103/wjcs.wjcs_14_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_14_22","url":null,"abstract":"Adenocarcinoma occurring at the end ileostomy site is a rare complication, with 70 cases reported in the literature to date. Most patients with adenocarcinoma occurring at the ileostomy site underwent total proctocolectomy for ulcerative colitis and familial adenomatous polyposis. Here, we present a case of adenocarcinoma arising at the end ileostomy site post total proctocolectomy for colorectal adenocarcinoma.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49075698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The incidence of colorectal cancer (CRC) has drastically increased in several Asian countries during the past four decades. These rapid epidemiological variations suggest that environmental parameters contribute to neoplastic transformation within the intestinal epithelium. A Western type of diet (rich in animal fat and proteins) is a recognized risk factor. In addition, there is a strong link between the type of diet and composition of the microbiota. These findings suggest that some bacteria may contribute to neoplastic transformation in the colon and rectum. However, a causal relationship between a specific microorganism and the development of CRC remains elusive. In this paper, we recapitulate the clinical evidence, suggesting that epigenetic transformation mediated by commensal bacteria is a prerequisite for tumor development in the large bowel. We review the experimental evidence, suggesting that a type of Campylobacter is likely to be involved in this neoplastic process. Campylobacter is highly prevalent in modern cattle and poultry farms and has the capacity to adhere to the colonic epithelium and contribute to genomic instability by releasing DNA-damaging toxins. Therefore, we hypothesize that the Campylobacter/Helicobacter group of bacteria may play a role in development of the two most common neoplasia of the digestive tract, i.e. adenocarcinoma of the colon and stomach, respectively.
{"title":"Campylobacter jejuni causes colorectal cancer","authors":"P. Gervaz, Álvaro De Campos, Alberto Caeiro","doi":"10.4103/wjcs.wjcs_19_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_19_22","url":null,"abstract":"The incidence of colorectal cancer (CRC) has drastically increased in several Asian countries during the past four decades. These rapid epidemiological variations suggest that environmental parameters contribute to neoplastic transformation within the intestinal epithelium. A Western type of diet (rich in animal fat and proteins) is a recognized risk factor. In addition, there is a strong link between the type of diet and composition of the microbiota. These findings suggest that some bacteria may contribute to neoplastic transformation in the colon and rectum. However, a causal relationship between a specific microorganism and the development of CRC remains elusive. In this paper, we recapitulate the clinical evidence, suggesting that epigenetic transformation mediated by commensal bacteria is a prerequisite for tumor development in the large bowel. We review the experimental evidence, suggesting that a type of Campylobacter is likely to be involved in this neoplastic process. Campylobacter is highly prevalent in modern cattle and poultry farms and has the capacity to adhere to the colonic epithelium and contribute to genomic instability by releasing DNA-damaging toxins. Therefore, we hypothesize that the Campylobacter/Helicobacter group of bacteria may play a role in development of the two most common neoplasia of the digestive tract, i.e. adenocarcinoma of the colon and stomach, respectively.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46262482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maikal Kujur, M. Aslam, Rajashree Kundu, M. Ansari
A foreign body in the rectum is not an uncommon encounter in current medical practice. In most cases, rectal foreign bodies are a result of sexual eroticism, sexual abuse, assault, or rarely, accidental involuntary insertion. It poses diagnostic difficulties and management challenges among medical professionals. The diagnostic approach usually involves careful history and physical and radiological examination. Here, we present the case of a 22-year-old man with a retained rectal foreign body for a duration of 3 hours. He presented with impacted foreign body per rectum, non-specific abdominal pain, abdominal mass, and non-passage of stool and flatus. Successful removal of the rectal foreign body was done manually under local anesthesia in the lithotomy position in the operation theatre.
{"title":"Unusual finding of deodorant bottle in the rectum: A case report","authors":"Maikal Kujur, M. Aslam, Rajashree Kundu, M. Ansari","doi":"10.4103/wjcs.wjcs_13_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_13_22","url":null,"abstract":"A foreign body in the rectum is not an uncommon encounter in current medical practice. In most cases, rectal foreign bodies are a result of sexual eroticism, sexual abuse, assault, or rarely, accidental involuntary insertion. It poses diagnostic difficulties and management challenges among medical professionals. The diagnostic approach usually involves careful history and physical and radiological examination. Here, we present the case of a 22-year-old man with a retained rectal foreign body for a duration of 3 hours. He presented with impacted foreign body per rectum, non-specific abdominal pain, abdominal mass, and non-passage of stool and flatus. Successful removal of the rectal foreign body was done manually under local anesthesia in the lithotomy position in the operation theatre.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46383565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parkes Weber syndrome (PWS) is a rare disorder of limb hypertrophy and vascular abnormalities, including arteriovenous malformations (AVMs). To the best of our knowledge, this is the first case of a refractory lower gastrointestinal bleeding due to AVMs in a patient with PWS. We describe the case of a 54-year-old woman with PWS who presented with refractory lower gastrointestinal bleeding due to extensive AVMs in the sigmoid colon and rectum. We review her colonoscopy and computed tomography imaging and ultimate surgical management, including a low anterior resection and diverting loop ileostomy. In rare cases, PWS can cause severe lower gastrointestinal bleeding. It is imperative to understand the role of surgical intervention in such cases of refractory lower gastrointestinal bleeding.
{"title":"Refractory lower gastrointestinal bleeding in a patient with parkes weber syndrome: A case report and review of the literature","authors":"E. Abeles, Joy Z Done, C. Atallah","doi":"10.4103/wjcs.wjcs_12_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_12_22","url":null,"abstract":"Parkes Weber syndrome (PWS) is a rare disorder of limb hypertrophy and vascular abnormalities, including arteriovenous malformations (AVMs). To the best of our knowledge, this is the first case of a refractory lower gastrointestinal bleeding due to AVMs in a patient with PWS. We describe the case of a 54-year-old woman with PWS who presented with refractory lower gastrointestinal bleeding due to extensive AVMs in the sigmoid colon and rectum. We review her colonoscopy and computed tomography imaging and ultimate surgical management, including a low anterior resection and diverting loop ileostomy. In rare cases, PWS can cause severe lower gastrointestinal bleeding. It is imperative to understand the role of surgical intervention in such cases of refractory lower gastrointestinal bleeding.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41754403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alejandro Hoyos-Torres, Francisco E. Alvarez-Bautista, Emilio Ramoz, N. Salgado-Nesme
Anal neoplasms are frequently associated with human papillomavirus infection. However, the differential diagnosis should consider benign lesions that affect a small proportion of patients. We present the case of a previously healthy 30-year-old woman who presented to our clinic with the complaint of a foreign body sensation in the perianal region and a progressive increase in the volume of a palpable lesion. The patient underwent resection of the lesion and histopathological examination showed a benign giant fibroepithelial polyp.
{"title":"Rare, benign, giant anal tumor in a healthy woman: A case report","authors":"Alejandro Hoyos-Torres, Francisco E. Alvarez-Bautista, Emilio Ramoz, N. Salgado-Nesme","doi":"10.4103/wjcs.wjcs_23_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_23_22","url":null,"abstract":"Anal neoplasms are frequently associated with human papillomavirus infection. However, the differential diagnosis should consider benign lesions that affect a small proportion of patients. We present the case of a previously healthy 30-year-old woman who presented to our clinic with the complaint of a foreign body sensation in the perianal region and a progressive increase in the volume of a palpable lesion. The patient underwent resection of the lesion and histopathological examination showed a benign giant fibroepithelial polyp.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43464191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Perirectal abscesses most commonly occur as a result of bacteria entering the anal crypt and invading the anal duct and gland. Multiple complications can occur with perirectal abscesses; the most common complication is the formation of a perirectal fistula. The primary goal of this study is to explore the use of computed tomography- or ultrasound-guided percutaneous catheter-based drainage of perirectal abscesses in comparison to traditional incision and drainage. We conducted a PubMed search for “rectal abscess” and “perianal abscess,” which yielded a total of 908 articles. We included articles in English with no time restrictions. All articles were reviewed for their relevance. The relevant articles were cross-referenced for additional articles. The traditional treatment for perirectal abscesses is adequate surgical drainage with antibiotics as an adjunct. The use of catheter-based percutaneous drainage as an alternative lacks evidence in the current available literature. Ultrasound- and computed tomography-guided percutaneous drainage has been the standard of care for small, radiologically accessible diverticular abscesses. Ultrasound- and computed tomography-guided percutaneous drainage should be considered for the adequate treatment of uncomplicated pelvic and intraabdominal abscesses.
{"title":"A brief literature review of catheter-based drainage of perirectal abscesses: A potential alternative to traditional surgical drainage","authors":"V. Kovalev, Benjamin S. Hopkins","doi":"10.4103/wjcs.wjcs_25_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_25_22","url":null,"abstract":"Perirectal abscesses most commonly occur as a result of bacteria entering the anal crypt and invading the anal duct and gland. Multiple complications can occur with perirectal abscesses; the most common complication is the formation of a perirectal fistula. The primary goal of this study is to explore the use of computed tomography- or ultrasound-guided percutaneous catheter-based drainage of perirectal abscesses in comparison to traditional incision and drainage. We conducted a PubMed search for “rectal abscess” and “perianal abscess,” which yielded a total of 908 articles. We included articles in English with no time restrictions. All articles were reviewed for their relevance. The relevant articles were cross-referenced for additional articles. The traditional treatment for perirectal abscesses is adequate surgical drainage with antibiotics as an adjunct. The use of catheter-based percutaneous drainage as an alternative lacks evidence in the current available literature. Ultrasound- and computed tomography-guided percutaneous drainage has been the standard of care for small, radiologically accessible diverticular abscesses. Ultrasound- and computed tomography-guided percutaneous drainage should be considered for the adequate treatment of uncomplicated pelvic and intraabdominal abscesses.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43848346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although minimally invasive surgery has reduced postoperative pain and length of hospital stay after right hemicolectomy, identification of anatomic landmarks is critical in ensuring safe technique through the narrow lens of the laparoscope. Well-known anatomical eponyms, such as the fold of Treves and Gerota's fascia, are commonly referenced during the teaching of this procedure when performing mobilization of the right colon off the peritoneal wall and entry into the lesser sac. In addition, there are lesser-known landmarks involved in this procedure, such as the Bouchet area and Fredet's fascia, that facilitate access to the lesser sac and bloodless dissection planes. However, little is usually known about the biographical information of the physicians after whom these landmarks are named. To enhance the teaching of this procedure, the steps involved in a right hemicolectomy with their corresponding eponymous landmarks are narrated alongside the biographical background of each of the physicians after whom they are named.
{"title":"A view from the shoulders of giants: Using history to optimize the modern minimally invasive right hemicolectomy","authors":"E. Blears, R. Fortunato","doi":"10.4103/wjcs.wjcs_24_21","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_24_21","url":null,"abstract":"Although minimally invasive surgery has reduced postoperative pain and length of hospital stay after right hemicolectomy, identification of anatomic landmarks is critical in ensuring safe technique through the narrow lens of the laparoscope. Well-known anatomical eponyms, such as the fold of Treves and Gerota's fascia, are commonly referenced during the teaching of this procedure when performing mobilization of the right colon off the peritoneal wall and entry into the lesser sac. In addition, there are lesser-known landmarks involved in this procedure, such as the Bouchet area and Fredet's fascia, that facilitate access to the lesser sac and bloodless dissection planes. However, little is usually known about the biographical information of the physicians after whom these landmarks are named. To enhance the teaching of this procedure, the steps involved in a right hemicolectomy with their corresponding eponymous landmarks are narrated alongside the biographical background of each of the physicians after whom they are named.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49016029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Groot, Sheev Dattani, P. Mondal, Rhonda Darbyshire, Carolyn Morin, D. Ginther, H. Phạm, Jivanjot Gill
Background: The rate of surgical site infection (SSI) in clean-contaminated wounds resulting from elective colorectal procedures ranges from 15 to 30%. Within the region considered in the study, the SSI rate is 20% despite the adoption of preventative measures. Objective: The objective of this study was to determine the effectiveness of prophylactic negative pressure wound therapy (NPWT) in reducing superficial SSIs in clean-contaminated wounds resulting from elective colorectal surgery to below 10%. Design: An unblinded randomized controlled trial was conducted. Settings: The study was conducted at two Canadian tertiary academic hospitals. Patients and Methods: Patients undergoing elective, non-emergent, clean-contaminated colorectal resection by both laparoscopic and open procedures were included. Participants were randomized to either standard surgical dressing (SSD) or NPWT over a closed incision. Main Outcome Measures: Incidence of superficial SSI on postoperative day 30. Results: The study closed early due to lack of accrual. From the planned group of 398 patients, 126 were randomly assigned to SSD (n = 61) or NPWT (n = 61). The analysis included 55 patients from the SSD group and 47 from the NPWT group. The mean age for the groups was 64.9 years (SSD) and 65.1 years (NPWT) with males comprising 52.7% (n = 29) and 44.7% (n = 21) of the populations, respectively. The results showed a clinically important but statistically non-significant difference between the two groups. The overall rate of SSI in the as-treated analysis was 14.7%, while it was slightly lower at 13.5% in the intent-to-treat (ITT) analysis. In both cases, there was a trend toward higher rates of SSI in the SSD, with the ITT analysis showing somewhat larger differences; however, in both the logistic regression models, the trends were non-significant. Conclusion: We present a randomized controlled trial of prophylactic NPWT following elective colorectal resection. The results indicated a clinically important reduction in the superficial SSI rate compared with standard surgical dressing. A more extensive randomized study is needed to clarify the effectiveness of NPWT to reduce wound infections in this patient population. Limitations: Neither patients nor clinicians were blinded to the treatment. The lack of recruitment introduced a type two statistical error, which led to a non-significant difference between the cases and controls. Conflict of Interest: None.
{"title":"A randomized controlled trial of negative pressure wound therapy to reduce colorectal surgical site infection","authors":"G. Groot, Sheev Dattani, P. Mondal, Rhonda Darbyshire, Carolyn Morin, D. Ginther, H. Phạm, Jivanjot Gill","doi":"10.4103/wjcs.wjcs_6_21","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_6_21","url":null,"abstract":"Background: The rate of surgical site infection (SSI) in clean-contaminated wounds resulting from elective colorectal procedures ranges from 15 to 30%. Within the region considered in the study, the SSI rate is 20% despite the adoption of preventative measures. Objective: The objective of this study was to determine the effectiveness of prophylactic negative pressure wound therapy (NPWT) in reducing superficial SSIs in clean-contaminated wounds resulting from elective colorectal surgery to below 10%. Design: An unblinded randomized controlled trial was conducted. Settings: The study was conducted at two Canadian tertiary academic hospitals. Patients and Methods: Patients undergoing elective, non-emergent, clean-contaminated colorectal resection by both laparoscopic and open procedures were included. Participants were randomized to either standard surgical dressing (SSD) or NPWT over a closed incision. Main Outcome Measures: Incidence of superficial SSI on postoperative day 30. Results: The study closed early due to lack of accrual. From the planned group of 398 patients, 126 were randomly assigned to SSD (n = 61) or NPWT (n = 61). The analysis included 55 patients from the SSD group and 47 from the NPWT group. The mean age for the groups was 64.9 years (SSD) and 65.1 years (NPWT) with males comprising 52.7% (n = 29) and 44.7% (n = 21) of the populations, respectively. The results showed a clinically important but statistically non-significant difference between the two groups. The overall rate of SSI in the as-treated analysis was 14.7%, while it was slightly lower at 13.5% in the intent-to-treat (ITT) analysis. In both cases, there was a trend toward higher rates of SSI in the SSD, with the ITT analysis showing somewhat larger differences; however, in both the logistic regression models, the trends were non-significant. Conclusion: We present a randomized controlled trial of prophylactic NPWT following elective colorectal resection. The results indicated a clinically important reduction in the superficial SSI rate compared with standard surgical dressing. A more extensive randomized study is needed to clarify the effectiveness of NPWT to reduce wound infections in this patient population. Limitations: Neither patients nor clinicians were blinded to the treatment. The lack of recruitment introduced a type two statistical error, which led to a non-significant difference between the cases and controls. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43324864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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