Objective To summarize the experience of single incision laparoscopic colorectal surgery and to discuss the operative techniques. Methods The clinical data of 21 cases who underwent single incision laparoscopic colorectal surgery in Shengjing Hospital from Jan. 2010 to Jun. 2011 were collected and analyzed. Results Of 21 cases underwent single incision laparoscopic surgery， right hemicolectomy performed in 5 cases， sigmoidectomy performed in 2 cases， rectal anterior resection performed in 9 cases， rectal abdominoperineal resection performed in 2 cases， total colectomy performed in 1 case， and colostomy performed in 2 cases. Twenty cases completed by single incision， but 1 case was added an extra 12 mm incision in order to dissect the lower segment of rectum. The operative time was （189±75） min （40-335min）；the postoperative hospitalization time was （11.5±3.4） d （7-16d）. There were no bleeding， anastomosis leakage or intestinal obstruction after operation， and no incision infection， rupture or hernia were founded. No recurrence was found within 6 months’ follow up after operation. Conclusions Under reasonable selection of indication， single incision laparoscopic colorectal surgery is safe and feasible， and it also has a satisfactory cosmetic effect and better minimally invasive effect.
Objective To evaluate the effect of perioperative period clinical care mode through fast-track (FT) under nonminimal invasive operation on the inflammatory response of colorectal cancer resection. Methods Fifty-five patients underwent elective colorectal cancer resection were randomized divided into two groups: FT group (n=29) in which patients were performed FT perioperative care and tradition group (n=26) in which patients were received traditional perioperative care. The nonminimal invasive operations were performed in this study. The venous blood samples were respectively collected at 24 h before operation, at 24 h, 72 h, and 7 d after operation, and were used to detect the concentrations of serum C-reactive protein (CRP) and serum amyloid A protein (SAA).Results There was no complication such as infection, fistula of stoma and inflammatory ileus that was potential to influence the study results in two groups, and no patient died. The trend of changes in the concentrations of CRP and SAA of patients was accordant in each group. The peak concentrations of CRP and SAA of patients in FT group were respectively observed at 24 h after operation 〔CRP: (72.36±60.94) mg/L; SAA: (328.97±267.20) mg/L〕, while which were respectively delayed to 72 h after operation in tradition group 〔CRP: (112.71±63.92) mg/L; SAA: (524.18±331.03) mg/L〕. At the same time, the concentrations of CRP and SAA in FT group began to descend 〔CRP: (57.21±30.42) mg/L; SAA: (237.43±215.66) mg/L〕. The peak concentrations of CRP and SAA in tradition group were significantly higher than that in FT group (Plt;0.001) and the concentrations of CRP and SAA in FT group were significantly lower than those in tradition group at 72 h after operation (Plt;0.001). On 7 d after operation, the concentrations of CRP and SAA further decreased, but the difference between two groups was not significant (Pgt;0.05). Likewise, the concentrations of CRP and SAA at 7 d after operation were significant higher than those 24 h and 72 h after operation (Plt;0.001), lower than that 24 h before operation (Plt;0.001), respectively. Conclusion This study demonstrates that perioperative period clinical care mode through FT under non-minimal invasive operation can reduce the inflammatory response of colorectal carcinoma resections and scientific clinical care is an important means to promote quick rehabilitation.
ObjectiveTo investigate the risk factors for surgical site infection (SSI) in patients after colorectal surgery, in order to provide a basis for regulation and implementation of preventive measures against SSI. MethodsFrom February to December 2012, a targeted surveillance on surgical site infection of "colon resection" and "rectum resection" surgery patients in the Department of Gastrointestinal Surgery was carried out. We analyzed the monitoring data, and explored the occurrence of postoperative SSI. At the same time, by case-control study, both single and multiple regression logistic analyses were performed on the 12 variables such as hypertension, diabetes mellitus duration during operation, America Society of Anesthesiologists score, grade of incision and so on to analyze the risk factors for SSI. ResultsAmong the 535 patients who underwent colorectal resections, 44 had SSI with an infection rate of 8.22%. Multiple logistic regression analysis showed that the length of hospital stay[OR=1.070,95%CI(1.033,1.109), P<0.001]and emergency surgery[OR=6.320,95%CI(1.932,20.669),P=0.002] were independent risk factors for SSI after colorectal resections. ConclusionThere are many risk factors for SSI after colorectal surgery. Through the implementation of targeted surveillance, we can find the main risk factors, which provides a basis for the regulation and implementation of intervention measures against SSI.
ObjectiveTo determine the benefits and harms of mechanical bowel preparation(MBP) in elective colorectal surgery. MethodsCochrane systematic evaluation was used to search through Cochrane libraries of clinical comparative trials, PubMed, Embase, Cancer Lit, and the Chinese BioMedical Literature on disc. The quality of literatures was independently evaluated and cross-checked by two evaluators, indicator for assessment including anastomotic leak, overall surgical site infection(SSI), extra-abdominal septic complications, wound infections, reoperation or second intervention rate, and death. The results were analysed with RevMan 5.1 software. ResultsFourteen RCTs were included in this analysis with a total number of 5 373 patients. Comparing with no MBP for elective colorectal surgery, the study results showed that MBP had not reduce any postoperative complications when concerning anastomotic leak[OR(95% CI), 1.08(0.82-1.43);P=0.56];overall SSI[OR(95% CI), 1.26(0.94-1.68);P=0.12];extra-abdominal septic complications[OR(95% CI), 0.98(0.81-1.18);P=0.81];wound infections[OR(95% CI), 1.21(1.00-1.46);P=0.05];reoperation or second intervention rate[OR(95% CI), 1.11(0.86-1.45);P=0.42], and death[OR(95% CI), 0.97(0.63-1.48);P=0.88]. ConclusionNo evidence supporting the use of MBP in patients undergoing elective colorectal surgery. MBP should be omitted in routine clinical practice.
ObjectiveTo assess impact of typical parameters recommended by enhanced recovery after surgery (ERAS) program in elective colorectal surgery, and provide some recommendations for surgeon and anesthesiologist. MethodThe published articles about ERAS program in elective colorectal surgery in recent years were searched in these databases(EMBASE, PubMed, Cochrane Library, Ovid), the impact of each parameter was evaluated basing on hospital stay and rate of postoperative complications. ResultsAfter analyzing the literatures, the parameters, which were applied in current rehabilitation programs and covered the pre-, intraand post-operative periods in colorectal surgery, were identified as potential impacting consequences of colorectal surgery. Strong agreements were obtained for the following recommendations:① Preoperative management:bowel preparation, fasting, preanesthetic medication, and nutritional care.② Intraoperative management:fluid management, preventing hypothermia, method of surgery and incision, drugs usages of antibiotics, glucocorticoid and prevention of postoperative nausea and vomiting.③ Postoperative management:managements of drainage tube, nasogastric intubation and urinary catheter, postoperative analgesia, prevention of thromboembolism, and measures of intestinal function recovery (including early mobilization, feeding and chew gum). ConclusionUse of a series of effective measures in ERAS has an effective result, could reduce surgical stress and complications, enhance recovery, shorten hospital stay.
ObjectiveTo summary and analyze the actuality of application for the fast track (FT) in China. MethodsThe clinical literatures of FT in China were collected and obtained from the WanFang database and China Hospital Knowledge Database (from Jan. 2006 to Dec. 2014), and then the actuality of application for the 22 items of FT was analyzed. ResultsA total of 62 literatures were collected, and there were 58 hospitals and 2 944 cases who underwent colorectal operation included. In all of the 62 literatures, the programmes were carried out 15 items at most, and there were only 3 items (average 10.06 items) at least. There were some important FT programmes were poorly developed (less than 60.00%) which included:normal preoperative feeding (45.16%, 28/62), intake carbohydrate drinks up until 2 hours before operation (54.84%, 34/62), thoracic epidural analgesia (58.06%, 36/62), avoid the opioids (35.48%, 22/62), minimally invasive operation (58.06%, 36/62), no nasogastric intubation (53.22%, 33/62), establish discharge criteria (27.42%, 17/62), follow-up (14.52%, 9/62), and audit of clinical outcomes (1.61%, 1/62). And that, there were serious distortions to some FT programmes, such as:distorted the surgery with epidural anesthesia to the thoracic epidural analgesia (46.77%, 29/62), distorted the early remove nasogastric intubation postoperative to avoidance the nasogastric intubation (17.74%, 11/62), and the minimally invasive surgery was independent of FT (6.45%, 4/62)/control the fluid therapy intraoperatively only (6.45%, 4/62). ConclusionThe current situation of the FT is not optimistic in China, it has existed that the concept of FT is fuzziness, the measures are not standardized and the application of some important programmes are deficient.
Objective To compare preventive effect between continuous dissecting suture and traditional interrupted suture, silver ion dressing and traditional dressing, on the incisional surgical site infection (SSI) after ostomy for colorectal surgery, and to explore the influencing factors of SSI. Methods ① Sixty patients underwent the firstly elective open ostomy for colorectal surgery, who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Mar. 2015 to Jan. 2016, were collected to equivalently divided into continuous dissecting suture group and traditional interrupted suture group randomly. ② Twenty-seven patients with emergency open ostomy for colorectal surgery, who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Jan. 2009 to Jun. 2015, as well as 33 patients with elective open ostomy for colorectal surgery, who were treated in the same 2 Departments from Jul. 2015 to May. 2016, were collected to equivalently divided into silver ion dressing group and traditional dressing group. ③ Clinical data of 184 patients with elective open ostomy for colorectal surgery who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Jan. 2009 to May. 2016 were collected to analyze the influencing factors of SSI after elective open ostomy for colorectal surgery. Results ① There was no significant difference in the incidence of SSI between continuous dissecting suture group (3.3%, 1/30) and traditional interrupted suture group (16.7%, 5/30), P=0.085. ② The incidence of SSI in silver ion dressing group (6.7%, 2/30) was significantly lower than that of traditional dressing group (30.0%, 9/30), P=0.020. ③ There were 28 patients (15.2%) of the 184 elective patients and 11 patients (40.7%) of the 27 emergency patients suffered from SSI after open ostomy for colorectal surgery, and the incidence of SSI in elective surgery group was lower than that of emergency surgery group (P=0.001). ④ Results of logistic regression model showed that, patients with body mass index (BMI) <25 kg/m2 had lower risk of SSI than patients with BMI≥25 kg/m2(OR=0.383, P=0.023), patients received permanent colostomy had higher risk of SSI than patients received protective ileostomy (OR=4.370, P=0.004), patients underwent Mile’s surgery had higher risk of SSI than patients received distal anastomosis (OR=4.406, P=0.005). Conclusions The ostomy is a high risk factor for incisional SSI after elective open ostomy for colorectal surgery, especially for the obesity patients and patients who receive colostomy. The using of silver ion dressing play an important role in preventing the incisional SSI.
ObjectiveTo comprehensively evaluate the incidence of venous thromboembolism (VTE) after colorectal surgery.MethodsWe searched PubMed/Medline, Web of science, and Embase databases by computer, collected studies by using the combination of corresponding English keywords. Then, we screened literatures according to inclusion and exclusion criteria, and evaluated the quality of literatures by using Downs and Black tools. Finally, we used Stata 15.1 and R Project 3.4.1 for meta-analysis.ResultsA total of 15 studies (n=721 730) were included in the meta-analysis. The combined incidence of VTE after colorectal surgery was 2.26% [95% CI was (1.93%, 2.61%), P<0.000 1], and the incidence of VTE after adjusting for publication bias was 1.82% [95% CI was (1.53%, 2.13%), P<0.000 1]. Meta regression analysis revealed that patients’ age (P<0.000 1), smoking (P=0.000 4), open surgery (P=0.020 0), preoperative albumin level (P=0.023 6), and malignant tumor (P=0.036 4) were correlated with the incidence of VTE after colorectal surgery, which may be potential factors for heterogeneity.ConclusionsThe incidence of VTE after colorectal surgery is not insignificant. It is necessary for clinicians to be vigilant about the occurrence of VTE after colorectal surgery and provide appropriate preventive interventions in combination with patients’ own risk factors, disease-related factors, and surgical factors.