Diseases of the colon and rectum
-
Comparative Study
Thiopurine therapy is associated with postoperative intra-abdominal septic complications in abdominal surgery for Crohn's disease.
Thiopurines are important as maintenance therapy in Crohn's disease, but there have been concerns whether thiopurines increase the risk for anastomotic complications. The present study was performed to assess whether thiopurines alone, or together with other possible risk factors, are associated with postoperative intra-abdominal septic complications after abdominal surgery for Crohn's disease. ⋯ Thiopurine therapy is associated with postoperative intra-abdominal septic complications. The risk for intra-abdominal septic complications was related to the number of identified risk factors. This increased risk should be taken into consideration when planning surgery for Crohn's disease.
-
Comparative Study
Can sensory and/or motor reactions during percutaneous nerve evaluation predict outcome of sacral nerve modulation?
A major advantage of sacral nerve modulation in the treatment of fecal incontinence is the ability to determine the likely treatment outcome before implantation by means of a percutaneous nerve evaluation and a test stimulation period. This study evaluated the predictive value of both sensory and motor responses during percutaneous nerve evaluation for determining the outcome of subchronic test stimulation and permanent stimulation. ⋯ Positive motor responses during percutaneous nerve evaluation are highly predictive of a successful outcome of subchronic test stimulation and permanent sacral nerve modulation. Sensory responses also have the same predictive value. For this reason, percutaneous nerve evaluation preferably should be performed in awake patients under local anesthesia to avoid missing those who may benefit from permanent stimulation but who do not have a motor response during the procedure.
-
Comparative Study
The impact of cirrhosis and portal hypertension on mortality following colorectal surgery: a nationwide, population-based study.
Population-based data on outcomes associated with colorectal procedures in cirrhotic patients are sparse. We sought to assess the impact of liver cirrhosis and portal hypertension on mortality following colorectal surgery. ⋯ Patients with liver cirrhosis, in particular, those with portal hypertension, have increased in-hospital mortality and morbidity following colorectal surgery. Strategies are needed to optimize preoperative risk.
-
The classic surgical treatment of acute complicated sigmoid diverticulitis with peritonitis is often a two-stage operation with colon resection and a temporary stoma. This approach is associated with high mortality and morbidity and the reversal of the stoma is in many cases not performed because of concurrent diseases and age. Recently, several studies have experimented with laparoscopic lavage as a treatment of acute complicated diverticulitis. The aim of this review was to give an overview of the literature for this new approach and to determine the safety compared with Hartmann's procedure for patients with acute complicated sigmoid diverticulitis. ⋯ Primary laparoscopic lavage for complicated diverticulitis may be a promising alternative to more radical surgery in selected patients. Larger studies have to be made before clinical recommendations can be given.
-
The combination of laparoscopic colorectal surgery together with an enhanced recovery program has resulted in short hospital stays. The purpose of this study was to assess the acceptability and safety of a 23-hour-stay protocol developed for patients undergoing laparoscopic colectomy. ⋯ A 23-hour-stay laparoscopic colectomy is possible with modification of the enhanced recovery program. Patients find it acceptable and it seems to be safe.