Diseases of the colon and rectum
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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.
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Anastomotic leaks after low anterior resection for rectal cancer remain a major cause of morbidity and mortality. Few studies have focused on their management, particularly on the technique of transanal drainage. ⋯ : For the management of low anastomotic leaks, transanal drainage allows preservation of the anastomosis and sepsis control with a high rate of ileostomy closure. It is a valuable option in patients with a diverting ileostomy.
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Practice Guideline
Practice parameters for the management of rectal cancer (revised).