Emergency Colorectal Surgery in Patients with Cirrhosis: a Population-based Descriptive Study

Abstract Purpose Even though anastomotic leakage after colorectal surgery is a major clinical problem in need of a timely diagnosis, early indicators of leakage have been insufficiently studied. We therefore conducted a population-based observational study to determine whether the patient’s early postoperative pain is an independent marker of anastomotic leakage. Methods By combining the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry, we retrieved prospectively collected data on 3084 patients who underwent anastomotic colorectal surgery for cancer in 2014–2017. Postoperative pain, measured with the numerical rating scale (NRS), was considered exposure, while anastomotic leakage and reoperation due to leakage were outcomes. We performed logistic regression to evaluate associations, estimating odds ratios (ORs) and 95% confidence intervals (CIs), while multiple imputation was used to handle missing data. Results In total, 189 patients suffered from anastomotic leakage, of whom 121 patients also needed a reoperation due to leakage. Moderate or severe postoperative pain (NRS 4–10) was associated with an increased risk of anastomotic leakage (OR 1.69, 95% CI 1.21–2.38), as well as reoperation (OR 2.17, 95% CI 1.41–3.32). Severe pain (NRS 8–10) was more strongly related to leakage (OR 2.38, 95% CI 1.44–3.93). These associations were confirmed in multivariable analyses and when reoperation due to leakage was used as an outcome. Conclusion In this population-based retrospective study on prospectively collected data, increased pain in the post-anaesthesia care unit is an independent marker of anastomotic leakage, possibly indicating a need for further diagnostic measures.

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IMPACT OF LAPAROSCOPIC COLORECTAL SURGERY ON BODY IMAGE

British Journal of Surgery ◽

10.1093/bjs/znab160.023 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

A Fernández Candela ◽

L Sánchez-Guillén ◽

L García Catalá ◽

C Curtis Martínez ◽

M Bosch Ramírez ◽

...

Keyword(s):

Body Image ◽

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Wound Complication ◽

Descriptive Study ◽

Surgical Quality ◽

Body Image Scale ◽

Study Results ◽

The Impact ◽

Observational Descriptive Study

Abstract INTRODUCTION The aim of this study is to evaluate the impact of laparoscopic colorectal surgery (LCS) on body image using the validated Body Image Scale (BIS) as a parameter of surgical quality. MATERIAL AND METHODS We conducted an observational descriptive study. Patients who underwent scheduled LCS between June 2015 and December 2019 by a General Hospital Coloproctology Unit were included. RESULTS The sample included 180 patients, 115 men (63.9%) and 65 women (36.1%) with a median age of 67 years. Right hemicolectomies (31.7%) and sigmoidectomies (28.3%) were the main procedures performed. In most patients, a suprapubic (69.4%) or transverse (19.4%) incision was made. 21.9% suffered some type of postoperative complication (13.9% wound complication, 10.6% incisional hernia). The general result of the BIS questionnaire was satisfactory, with a median of 0 in the responses (no alteration of body image). We found that 46.2% of the women had some alteration in body image, compared to 28.7% of the men (p = 0.018) and low and ultra-low anterior resection were the surgeries that obtained worst scores, with 13,5% and 12,5% respectively of patients with a BIS score above 5 (p = 0.044). Patients with a stoma also obtained worst punctuation (25% above 5 vs 6,1%, p = 0.001). No statistically significant differences were found regarding type of incision, presence of complications and anxiety or depression. CONCLUSION Study results show, in general, good post-surgical body image after LCS. However, patients with stoma and women were more dissatisfied. Interestingly, there is no worse body image due to type of incision, so we recommend the least iatrogenic one.

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