EP.TH.282Adherence to ERAS® Society recommendations following elective colonic surgery (2012) in regard to urinary drainage, postoperative nutritional care and intra-abdominal drainage

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Dimitra Limnatitou ◽  
Joshua Franklyn ◽  
Walter Douie
Keyword(s):  
Rectal Surgery ◽  
Normal Diet ◽  
University Teaching ◽  
Colonic Surgery ◽  
Abdominal Drainage ◽  
Elective Colorectal Surgery ◽  
Nutritional Care ◽  
Abdominal Drain ◽  
Urinary Drainage ◽  
Drain Placement

Abstract Aims Evaluating adherence to ERAS® recommendations for post-operative urinary drainage, nutritional care and intra-abdominal drain placement in elective colorectal surgery. Methods Approval was obtained by the audit department of a university teaching hospital. Data was collected prospectively over a seven-week period for nineteen (n = 19) patients. Results were compared against the standard set by the ERAS® Society (2012). Results Right colonic surgery (n = 5): catheter removed on post-operative day (POD) 1 n = 1 (20%), normal diet started on POD 0 or 1 n = 3 (60%), IV fluids discontinued on POD 1 n = 3 (60%) and n = 4 (80%) did not have a drain placed. High anterior resection or left/subtotal colectomy (n = 9): catheter removed on POD 1 n = 3 (33%), normal diet started on POD 0 or 1 n = 4 (44%), IV fluids discontinued on POD 1 n = 3 (33%) and n = 2 (22%) did not have a drain placed. Low rectal surgery (n = 4*, *one patient, n = 1, excluded from all domains except intra-abdominal drainage due to immediate post-op complication): catheter removed on POD 3 n = 4 (100%), normal diet started on POD 0 or 1 n = 2 (50%), IV fluids discontinued on POD 1 n = 1 (25%) and all patients had a drain placed n = 5 (100%). Conclusions Adherence for urinary drainage in low rectal surgery and intra-abdominal drainage for right colonic surgery was satisfactory. Multiple areas of improvement were identified, in order to optimise compliance, and recommendations were generated. The exception may be drains for lower rectal surgery where recent data has recommended selective drain placement.

scholarly journals Postoperative pain after colorectal surgery

2020 ◽  
Vol 35 (7) ◽  
pp. 1265-1272 ◽  
Author(s):  
Margaretha Lindberg ◽  
Oskar Franklin ◽  
Johan Svensson ◽  
Karl A. Franklin
Keyword(s):  
Postoperative Pain ◽  
Colorectal Surgery ◽  
Minimally Invasive ◽  
Severe Pain ◽  
Rating Scale ◽  
Enhanced Recovery ◽  
Rectal Surgery ◽  
Young Patients ◽  
Colonic Surgery ◽  
Elective Colorectal Surgery

Abstract Purpose Postoperative pain is a keystone in perioperative programs, as pain negatively impacts recovery. This study aimed to evaluate pain after elective colorectal surgery and to identify risk factors for postoperative pain. Methods This prospective cohort study comprised consecutive patients undergoing elective colorectal surgery within the Enhanced Recovery after Surgery (ERAS) perioperative program between March 2013 and April 2017. The numeric rating scale (NRS) was used to estimate maximum pain. Logistic regression was used to model associations with the type of surgery, age, gender, and comorbidities. Results The cohort comprised 434 of 459 eligible patients. On the day of surgery to postoperative day 3, 50–64% of patients reported moderate to severe pain (NRS 4–10). Postoperative pain was similar for open and minimally invasive rectal surgery, while patients undergoing minimally invasive colonic surgery experienced more pain on the day of surgery and less pain on postoperative days 2 and 3 vs. open colonic surgery. Younger age was associated with more pain every postoperative day and by 0.7 NRS/10 years (95% CI 0.5–0.9, P < 0.001) on the day of surgery, while having diabetes type 2 was associated with less postoperative pain by − 1.3 NRS (95% CI − 2.4 to − 0.2) on the day of surgery. Conclusions The majority, and young patients in particular, experience moderate to severe pain after open and minimally invasive colorectal surgery, despite following ERAS perioperative program. There is a need for effective and individualized analgesia after colorectal surgery, since the individual pain response to surgery is difficult to predict.

scholarly journals Postoperative Ileus

2019 ◽  
Vol 32 (03) ◽  
pp. 166-170 ◽  
Author(s):  
Cristina Harnsberger ◽  
Justin Maykel ◽  
Karim Alavi
Keyword(s):  
Postoperative Ileus ◽  
Enhanced Recovery ◽  
Rectal Surgery ◽  
Oral Intake ◽  
Bowel Function ◽  
Colon And Rectal Surgery ◽  
Open Approach ◽  
Elective Colorectal Surgery ◽  
Invasive Approach ◽  
American Society

AbstractPostoperative ileus (POI) is a common complication following colon and rectal surgery, with reported incidence ranging from 10 to 30%. It can lead to increased morbidity, cost, and length of stay. Although definitions vary considerably in the literature, in its pathologic form, it can be characterized by a temporary inhibition of gastrointestinal motility after surgical intervention due to nonmechanical causes that prevents sufficient oral intake. Various risk factors for development of POI have been identified including increasing age, American Society of Anesthesiologists scores 3 to 4, open approach, operative difficulty, operative duration more than 3 hours, bowel handling, drop in hematocrit or need for a transfusion, increasing crystalloid administration, and delayed mobilization. While treatment is expectant and supportive, significant investigations into strategies to mitigate development of POI or shorten its duration have been undertaken with mixed results. There is significant evidence to suggest that a minimally invasive approach and multimodal pain regimens reduce the development of POI. The beneficial effect of chewing gum, alvimopan, and enhanced recovery after surgery protocols may decrease development of POI in selected groups of patients who undergo elective colorectal surgery, and shorten time to return of bowel function, but overall, the data remain inconclusive.

scholarly journals 1385 “Pre-Op Fasting Times Audit in Colorectal Surgery at A University Teaching Hospital”

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Khan ◽  
R Mohideen ◽  
K Khan ◽  
C Helbren
Keyword(s):  
Colorectal Surgery ◽  
Teaching Hospital ◽  
Elective Surgery ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Hospital Data ◽  
Elective Colorectal Surgery ◽  
Operation Room ◽  
Theatre Staff ◽  
University Teaching Hospitals

Abstract Aim Hull University teaching hospitals NHS trust has guidelines for patient fasting times prior to major elective surgery. We aimed to assess the compliance of pre-op fasting times for patients undergoing elective colorectal surgery. Method An initial and later re-audit was undertaken, prospectively, of 20 consecutive patients admitted for elective colorectal surgery at Castle Hill Hospital. Data was collected on a structured proforma and was completed following patient’s interview, ORMIS (operation room system) and Lorenzo (hospital intranet). Results Initial audit demonstrated 10% (2 out of 20) and 5% (1 out of 20) compliance with liquid and solid fasting times, respectively. Following implementation of changes, re-audit demonstrated 60% (12 out of 20) and 0% (0 out of 20) compliance with liquid and solid fasting times respectively Conclusions We concluded that liquid fasting times can be improved further by communication between theatre staff and ward. Whilst solid fasting times can be improved but at an expense of losing a theatre space. A further re-audit [planned in a month period.

Closed-Suction Drain Placement at Laparotomy in Isolated Solid Organ Injury is Not Associated with Decreased Risk of Deep Surgical Site Infection

2012 ◽  
Vol 78 (10) ◽  
pp. 1187-1191 ◽  
Author(s):  
Shahin Mohseni ◽  
Peep Talving ◽  
Leslie Kobayashi ◽  
Dennis Kim ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Injury Severity ◽  
Severe Injury ◽  
Stepwise Logistic Regression ◽  
Solid Organ ◽  
Abdominal Drain ◽  
Closed Suction ◽  
Suction Drain ◽  
Closed Suction Drain ◽  
Increased Risk ◽  
Drain Placement

The purpose of this study was to investigate the role of intra-abdominal closed-suction drainage after emergent trauma laparotomy for isolated solid organ injuries (iSOI) and to determine its association with deep surgical site infections (DSSI). All patients subjected to trauma laparotomy between January 2006 and December 2008 for an iSOI at two Level I urban trauma centers were identified. Patients with isolated hepatic, splenic, or renal injuries were included. Study variables extracted included demographics, clinical characteristics, intra-abdominal injuries, drain placement, DSSI, septic events, intensive care unit and hospital length of stay, and in-hospital mortality. Diagnosis of DSSI was based on abdominal computed tomography scan demonstrating an intra-abdominal collection combined with fever and elevated white blood cell count. For the analysis, patients were stratified based on injury severity. To identify an independent association between closed-suction drain placement and DSSI, stepwise logistic regression analysis was performed. Overall, 142 patients met the inclusion criteria with 80 per cent (n = 114) having severe iSOI. In 47 per cent (n = 53) of the patients with a severe injury, an intra-abdominal drain was placed. A drain was placed more often in patients with a blunt trauma with more severe injury defined by Injury Severity Score and abdominal Abbreviated Injury Scale Score and those who underwent splenectomy ( P < 0.05). There was a three-fold increased risk of DSSI in patients subjected to drain placement (odds ratio, 2.8; 95% confidence interval, 1.0 to 8.2; P = 0.046). Subgroup analysis demonstrated those who sustained severe hepatic injury receiving a drain had a significantly increase risk of DSSI ( P = 0.02). There was no statistical difference in the rate of DSSI based on the presence or absence of an intra-abdominal drain after severe splenic injury (17 vs 18%, P = 0.88). The use of intra-abdominal closed-suction drains after iSOI is not associated with decreased risk of DSSI.

scholarly journals Utility of Abdominal Drain in Gastrectomy (ADiGe) Trial: study protocol for a multicenter non-inferiority randomized trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
J. Weindelmayer ◽  
◽  
V. Mengardo ◽  
A. Veltri ◽  
G. L. Baiocchi ◽  
...  
Keyword(s):  
Subtotal Gastrectomy ◽  
Composite Endpoint ◽  
Convincing Evidence ◽  
Drop Out ◽  
Primary Analysis ◽  
Curative Intent ◽  
Oncological Treatment ◽  
Abdominal Drain ◽  
Primary Composite Endpoint ◽  
Drain Placement

Abstract Background Prophylactic use of abdominal drain in gastrectomy has been questioned in the last 15 years, and a 2015 Cochrane meta-analysis on four RCTs concluded that there was no convincing evidence to the routine drain placement in gastrectomy. Nevertheless, the authors evidenced the moderate/low quality of the included studies and highlighted how 3 out of 4 came from Eastern countries. After 2015, only retrospective studies have been published, all with inconsistent results. Methods ADiGe (Abdominal Drain in Gastrectomy) Trial is a multicenter prospective randomized non-inferiority trial with a parallel design. It aimed to verify whether avoiding routine use of abdominal drain is burdened with complications, particularly an increase in postoperative invasive procedures. Patients with gastric cancer, scheduled for subtotal or total gastrectomy with curative intent, are eligible for inclusion, irrespective of previous oncological treatment. The primary composite endpoint is reoperation or percutaneous drainage procedures within 30 postoperative days. The primary analysis will verify whether the incidence of the primary composite endpoint is higher in the experimental arm, avoiding routine drain placement, than control arm, undergoing prophylactic drain placement, in order to falsify or support the null hypothesis of inferiority. Secondary endpoints assessed for superiority are overall morbidity and mortality, Comprehensive Complications Index, incidence and time for diagnosis of anastomotic and duodenal leaks, length of hospital stay, and readmission rate. Assuming one-sided alpha of 5%, and cumulative incidence of the primary composite endpoint of 6.4% in the control arm and 4.2% in the experimental one, 364 patients allow to achieve 80% power to detect a non-inferiority margin difference between the arm proportions of 3.6%. Considering a 10% drop-out rate, 404 patients are needed. In order to have a balanced percentage between total and subtotal gastrectomy, recruitment will end at 202 patients for each type of gastrectomy. The surgeon and the patient are blinded until the end of the operation, while postoperative course is not blinded to the patient and caregivers. Discussion ADiGe Trial could contribute to critically re-evaluate the role of prophylactic drain in gastrectomy, a still widely used procedure. Trial registration Prospectively registered (last updated on 29 October 2020) at ClinicalTrials.gov with the identifier NCT04227951.

Intra-Operative Abdominal Drain Placement for Gallbladder Cancer Surgery and Risk of Infectious Complications

2021 ◽  
Author(s):  
Bima J. Hasjim ◽  
Areg Grigorian ◽  
Zeljka Jutric ◽  
Ronald F. Wolf ◽  
Maki Yamamoto ◽  
...  
Keyword(s):  
Gallbladder Cancer ◽  
Infectious Complications ◽  
Cancer Surgery ◽  
Abdominal Drain ◽  
Drain Placement

scholarly journals Peritonitis from an abdominal wall biloma: a unique reason to avoid prophylactic surgical drainage

2011 ◽  
Vol 93 (7) ◽  
pp. e144-e146 ◽  
Author(s):  
SG Thrumurthy ◽  
VD Shetty ◽  
JB Ward ◽  
KG Pursnani ◽  
MM Mughal
Keyword(s):  
Abdominal Wall ◽  
Abdominal Cavity ◽  
Major Surgery ◽  
Emergency Laparotomy ◽  
Surgical Drainage ◽  
Abdominal Drainage ◽  
Abdominal Drain ◽  
Prophylactic Drainage ◽  
Peritoneal Space ◽  
Internal Oblique

Prophylactic drainage of the peritoneal space after major surgery is widely practised despite evidence against its efficacy. We describe the case of a 56-year-old woman who underwent a converted cholecystectomy and whose correctly sited abdominal drain resulted in the formation of a biloma between the external and internal oblique musculature. Subsequent leakage from the biloma into the abdominal cavity presented as peritonitis days after surgery, necessitating an emergency laparotomy. This case represents the first reported description of an abdominal wall biloma as a complication of post-cholecystectomy abdominal drainage. The evidence surrounding prophylactic drainage is discussed.

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