Diseases of the colon and rectum
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Comparative Study
The digital rectal examination scoring system (DRESS).
Assessment of anal sphincter tone is a critical part of anorectal examination, yet no standardized, quantifiable method for describing anal sphincter tone on digital rectal examination exists. We developed a novel scoring system for anal sphincter tone using a scale of 0 to 5 for both resting pressure and squeeze pressure. The score ranges from 0 = no discernable pressure to 5 = extremely tight and 3 = normal. We hypothesized that the digital rectal examination scoring system (DRESS) score would correlate with anorectal manometry pressures. ⋯ The DRESS score correlated very well with manometry pressures for resting pressure and squeeze pressure. The DRESS system may be a useful description of anal sphincter resting pressure and squeeze pressure in the clinical setting. Further validation may support adoption of the DRESS system as part of the standard anorectal examination.
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Patients with inflammatory bowel disease are often at highest risk for surgical site infections. We sought to define the predictors of surgical site infections and to develop a risk score for predicting those at highest risk. ⋯ Patients with inflammatory bowel disease are at high risk for surgical site infections. Preoperative factors including weight loss, smoking, emergent surgery and an ASA score >2 are strong predictors of surgical site infections. Operative time and wound class are important intraoperative predictors. A risk score, based on pre- and intraoperative variables, can be used to identify patients at highest risk of developing surgical site infections. This may allow for appropriate process measures to be implemented to prevent and lessen the impact of surgical site infections in this high-risk population.
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Comparative Study
Comparative study of one-stage colectomy of the descending colon in emergency and elective surgery without mechanical preparation.
The aim of this study was to compare one-stage colectomy of the descending colon without mechanical preparation in emergency and elective surgery. ⋯ In emergencies involving the descending colon one-stage surgery may be performed without colonic preparation as safely as elective surgery in selected patients considered suitable for segmental resection of the descending colon and primary anastomosis.
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Comparative Study
Single-incision laparoscopic right colectomy: experience with 17 consecutive cases and comparison with multiport laparoscopic right colectomy.
Recently, single-incision laparoscopic surgery has begun to develop as an extension of standard laparoscopic minimally invasive procedures. However, there have been a limited number of reports of single-incision procedures in colorectal disease. ⋯ Single-incision laparoscopic right colectomy is feasible, and appears to have results similar to standard multiport right colectomy in our initial comparisons. Ongoing development in instrumentation may help to further shorten operative time and minimize complications, and may make this an equivalent or preferred method for minimally invasive colorectal surgery. Large, prospective, randomized, controlled trials should be conducted to further compare the safety and efficacy of this approach.
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This study was designed to review the results of laparoscopic lavage for the management of perforated sigmoid diverticulitis. ⋯ Laparoscopic washout is an emerging technique that is particularly applicable to the management of Hinchey III perforated peritonitis. Short- and long-term problems exist with the technique that may be overcome with further improvement in technique and case selection. Resection and radiological drainage remain widely used in managing perforated sigmoid diverticulitis.