Diseases of the colon and rectum
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Meta Analysis Comparative Study
Pursestring Closure versus Conventional Primary Closure Following Stoma Reversal to Reduce Surgical Site Infection Rate: A Meta-analysis of Randomized Controlled Trials.
Stoma reversal is a surgical procedure commonly used following temporary defunctioning stoma surgery. Surgical site infection is one of the most common postoperative morbidities. A few skin closure methods have been developed to decrease surgical site infection. However, the optimal skin closure method is still in debate. ⋯ Pursestring closure has significantly fewer surgical site infections and achieves better cosmetic outcomes following stoma reversal than conventional primary closure.
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Adhesiolysis during repeat surgery is associated with a high incidence of iatrogenic enterotomies and an increase in postoperative complications. Identification of risk factors would improve preoperative counseling and operating room strategy. ⋯ This study demonstrates that 4 or more previous laparotomies and the presence or history of an intraperitoneal synthetic mesh are independently associated with a longer duration of adhesiolysis needed to gain access to the abdomen. A short time interval between median laparotomies or a history of peritonitis did not prolong the duration of adhesiolysis.
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Local recurrences of rectal cancer are best treated with surgical resection. Health-related quality of life is an important outcome measure in rectal cancer, but it has been poorly investigated in local recurrences. ⋯ Quality of life of patients with locally recurrent rectal cancer is improved by R0 and ameliorated with R1 resection, irrespective of surgical extent. Full recovery, similar to that of nonrecurrent cancer survivors, can be expected in R0 patients but requires longer follow-up times. Surgery with macroscopic involvement of resection margins accelerates quality of life decline and shortens survival.
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Comorbidity has a negative influence on the long-term prognosis in patients with colorectal cancer, whereas its impact on the postoperative course is less clear. ⋯ Comorbidity failed to predict anastomotic leak, but it was associated with an inferior short-term outcome in patients with this surgical complication.