Objective We searched and reviewed medical evidence to find the guide of bowel preparation we should choose before large bowel preparation. Method Firstly, we put forward clinical questions. Secondly, we searched medical evidence from PubMed, MEDLINE, EMbase, Cochrane Library, Science and ACP in recent 10 years. And then we reviewed the results. Results We finally identified 17 literatures including 2 system reviews, 6 meta-analyses and 9 randomized control trials which included 4 multicentre randomized clinical trials. Most of literature suggested that there was no evidence showing the benefit of mechanical bowel preparation (MBP). No MBP before large bowel surgery would not increase rate of anastomotic leakage. On the contrary, MBP may increase the percentage of anastomotic leakage and wound infection. Considering the research with the clinical situation, we produced a new method of simplified MBP to treat the patient. It reached the predictive effect. Conclusion No evidence of systematic review and meta-analysis supports the benefit of BMP. The new simplified bowel preparation before surgery in West China Hospital was worthy to test.
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.
Objective To evaluate the association between intraoperative fluid management and prolonged postoperative ileus (PPOI) after colorectal surgery. Methods We reviewed the data of 980 patients who underwent elective colorectal surgery in West China Hospital of Sichuan University between July and December 2016. The primary outcome was PPOI. The association of intraoperative fluid volume and fluid balance with PPOI were analyzed. Results Nine hundred and eighty patients undergoing elective colorectal surgery were included, and the incidence of PPOI was 31.1% (305/980). Compared with non-PPOI patients, patients with PPOI had longer postoperative hospital stay and increased total hospital cost (P<0.05). Multivariate logistic regression analysis did not find intraoperative fluid volume and fluid balance were associated with PPOI in patients undergoing colorectal surgery (P>0.05). Conclusions There is no clinically relevant association between intraoperative fluid management and PPOI in adult patients underwent colorectal surgery. However, the occurrence of PPOI may prolong postoperative hospital stay and increase hospitalization cost.