Diseases of the colon and rectum
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Review Meta Analysis
Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials.
Enhanced recovery after surgery programs in colorectal surgery aim to attenuate the surgical stress response, reduce complications and shorten hospital stay. ⋯ Enhanced recovery after surgery programs are safe and effective, and increased implementation is justified for perioperative care in colorectal surgery. Future studies may examine the benefits of enhanced recovery after surgery programs in elderly patients and in other GI surgery.
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Multicenter Study
A method for estimating the risk of surgical site infection in patients with abdominal colorectal procedures.
Surgical site infection is one of the most common and significant morbidities following colon and rectal surgery, representing a marker of institutional quality. Various measures have been implemented to lower its incidence. However, the level of incidence remains unacceptable in many reports. ⋯ Surgical site infection is common morbidity following colon and rectal surgery. Nomograms using key patient characteristics can be used to accurately calculate a patients' risk of surgical site infection. This tool could be applied in the clinical setting to prospectively identify patients at highest risk of surgical site infection.
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Comparative Study
Comparison of anastomotic leak rate after colorectal surgery using different databases.
Anastomotic leaks are one of the most important clinical outcomes after colorectal anastomosis. Because of the lack of measurement of this outcome in databases, research has been limited by the need to perform chart review. ⋯ Although the clinical registry had higher sensitivity and specificity for anastomotic leak, both databases had low sensitivity. Future research on anastomotic leaks would benefit greatly from a uniform definition and recording of this outcome in national databases.
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Patient and technical factors influencing postoperative infectious complications after elective colorectal resections for cancer are well described. Tumor related factors, however, have not been extensively evaluated. ⋯ Advanced tumors increase the risk of infectious complications after colorectal resection, with other risk factors including malnutrition, obesity, and resection by laparotomy. Optimization of modifiable risk factors through nutritional repletion and the choice of a minimally invasive operation should be considered.
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Computed tomography-colonography is a diagnostic modality that can be used when the colon is not completely intubated during colonoscopy. It may have the additional advantage that information on extracolonic lesions can be obtained. ⋯ Computed tomography-colonography can be of added value in patients with incomplete colonoscopy, because it revealed 27 relevant additional (both intra- and extracolonic) lesions in 19.1% of patients. In cases where CT-colonography detected colorectal cancer after incomplete colonoscopy, it can also be used for staging purposes.