Diseases of the colon and rectum
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There is no consensus about the risk factors for anastomotic failure after elective or emergency colorectal surgery. The purpose of this study was to analyze the factors that may contribute in anastomotic dehiscence. ⋯ Obesity is a factor predicting anastomotic leak risk after resection and primary anastomosis for left-sided colonic emergencies.
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A positive circumferential resection margin is associated with a high risk of local recurrence and distant metastasis after total mesorectal excision for rectal cancer. The mesorectum is thinner anteriorly than posteriorly, and the risk of a positive resection margin may be higher for anterior than for posterior tumors. We sought to determine the effect of the tumor's position in the circumference of the rectum on the treatment and outcomes of rectal cancer patients treated by total mesorectal excision. ⋯ Tumor stage is the main criterion to estimate prognosis in rectal cancer patients. The position of the tumor within the circumference of the rectum may provide valuable clinical information. Anterior tumors tend to be more advanced and, at least in male patients, has a higher risk of recurrence and death than tumors in other locations.
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Randomized Controlled Trial
Interacting effects of preoperative information and patient choice in adaptation to colonoscopy.
The aim of this study was to match patient information requirements by determining whether giving patients a choice for additional preprocedural audiovisual information modifies the effectiveness of this information on anxiety, worry, knowledge, and patient satisfaction. ⋯ There appears to be no additional benefits in terms of patient outcomes by allowing patients to choose whether they want additional audiovisual information. We suggest that all patients undergoing colonoscopy would benefit from watching such an educational video in the week before their procedure.
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The aim of this study was to ascertain the preva lence and pattern of surgical and medical adverse events in patients undergoing Hartmann's reversal for diverticular dis ease. A comparison of postoperative outcomes is made be tween Hartmann's reversal and primary resection and anas tomosis. ⋯ Hartmann's reversal is a complex surgical procedure that is associated with a high prevalence of postoperative adverse events in comparison with primary resection and anastomosis. To minimize the prevalence of such adverse events, patients who undergo Hartmann's reversal need careful preoperative evaluation and close monitoring in their postoperative period.
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Comparative Study
A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study.
Defunctioning ileostomy or colostomy is still routinely performed after low anterior resection in the belief that diverting the fecal stream will prevent anastomotic dehiscence. However, an ileostomy is not without morbidity for the patient. This study aims to determine if a diverting stoma is really necessary after a low anastomosis. ⋯ A diverting stoma does not reduce postoperative anastomotic leak rate. Rather, it reduces the otherwise catastrophic effects of an anastomotic leak such as fecal peritonitis and septicemia. An ileostomy carries certain morbidity and also adds to the cost of the entire operation. Therefore, it should not be performed routinely. Instead, it should be performed selectively in patients with poorly prepared bowels, coupled with a distal limb washout, and in patients with significant comorbidities who can ill afford the complications of a leak.