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Complicated Diverticulitis Excluding Perforation
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
On table lavage is a technique which allows clearing of the faecal-laden, obstructed colon before a potential anastomosis. The technique has been described by Murray et al.29 and involves mobilisation of the splenic flexure and at times the hepatic flexure. A foley catheter attached to warm irrigation fluid is introduced through the appendix. If surgically absent, the catheter may be placed through a caecotomy or ileostomy. Corrugated anaesthesia tubing is placed through the distal colon and secured with umbilical tape. The colon is lavaged until the returns are clear. The technique may be used in selected patients who are haemodynamically stable and in whom there is minimal contamination. Whilst the need for mechanical bowel preparation has been called into question for elective colon resection, this claim has not been critically evaluated in patients with bowel obstruction.
Diverticular Disease of the Colon
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
Mary Stuever, Akpofure Peter Ekeh
Recommendation: Laparoscopic colon resection is a safe and effective approach for the elective treatment of patients with diverticular disease demonstrating no increased morbidity and a shorter hospital stay, quicker resumption of bowel function, and reduced blood loss. It is appropriate for elderly patients (Grade C, level IIb).
Right Colectomy - Open
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Robert R Cima, John H Pemberton
A right colon resection is performed for a number of indications. However, the most common is for the treatment of a colonic malignancy. Other reasons include intestinal polyps not amenable to endoscopic removal, regional inflammatory conditions (e.g. Crohn’s disease, perforated appendicitis), and rarely mechanical problems such as volvulus. Open resection represents the ‘gold standard’ comparison for other techniques, such as laparoscopic-assisted and hand-assisted right colectomy. Keys to the success of the operation, as for any intestinal operation, include adequate exposure, identification of the appropriate dissection planes, preservation of a blood supply, and a tension-free anastomosis.
Sixth Annual Enhanced Recovery After Surgery Symposium highlights: work in progress or standard care?
Published in Baylor University Medical Center Proceedings, 2023
Lucas Fair, Elizabeth Duggan, Evan P. Dellinger, Nicole Bedros, Kimberly Godawa, Cynthia Krusinski, Rachel Curran, Charlette Hart, Alex Zhu, Walter Peters, James Fleshman, Alessandro Fichera
The ERAS program at BSWH started in 2016 under the guidance of Dr. Walter Peters. The initial approach was a pilot study in colorectal surgery correlating compliance to ERAS elements with length of stay. It was clear from the very beginning that, as compliance with the bundle improved, our length of stay after colon resection significantly decreased from 5.9 to 4.1 days. From August 2016 to June 2018, >1000 colectomies were performed by 10 surgeons, resulting in a progressive increase in compliance to ERAS elements from 60% to 80%. Surgeons varied in their rate of accepting the changes, which translated into a significant difference in length of stay between early adopters and “laggards.” Surgical outcomes at Baylor University Medical Center and quality metrics reported in the National Surgical Quality Improvement Program significantly improved over the course of the implementation, reaching exemplary status in many of those metrics.
Clinical outcome of decompressing colostomy for acute left-sided colorectal obstruction: a consecutive series of 100 patients
Published in Scandinavian Journal of Gastroenterology, 2022
Jelle F. Huisman, Job W. A. de Haas, Richard M. Brohet, Frank P. Vleggaar, Wouter H. de Vos tot Nederveen Cappel, Henderik L. van Westreenen
Elective segmental colon resection was performed in 59 of 100 patients (59%) (Table 3). Eight of these 59 patients (14%) underwent resection with primary anastomosis and simultaneous DC reversal and another 8 patients underwent resection with simultaneous closure of the DC and creation of an end colostomy (Hartmann procedure). For the remaining 41 patients, elective resection was not performed in 39 patients and 2 patients were lost to follow up (Figure 1). The median hospital stay after elective resection was 5 days [range 2–53] and the median time between DC and colonic resection was 10 weeks [range 2–60]. Forty-three patients (73%) were planned for laparoscopic resection. Laparoscopy was converted to an open procedure in 12 of these patients, because of complex diverticulitis (n = 8), or multivisceral resections for cT4 tumors (n = 4). A primary open procedure was planned in 16 patients. The morbidity rate after resection was 20%; minor morbidity in 11 patients and major morbidity 1 patient (pulmonary embolism requiring admission to intensive care). Mortality occurred in 1 patient (2%).
Vitamin D Supplementation and Survival in Metastatic Colorectal Cancer
Published in Nutrition and Cancer, 2018
Z. Antunac Golubić, I. Baršić, N. Librenjak, S. Pleština
A total of 35 women and 37 men were included in our study. Median age was 69 yr (24–79). There were 37 patients randomized in the interventional group and 34 in the control group. The groups were well adjusted regarding age, gender, 25(OH)D, CEA, chemotherapy regimen, and the location of the tumor. Fifty-nine patients had undergone colon resection before chemotherapy. The most common site of metastatic disease was the liver (72%), with it being the only metastatic site in 32% of the patients. A total of 65 patients (90%) received the FOLFIRI regimen (leucovorin, fluorouracil, and irinotecan) as first-line therapy, 19 of which also received bevacizumab. Only 10% received the oxaliplatinum or 5 FU-based regimen as first-line therapy. The patients' characteristics are summarized in Table 1.