Colorectal surgery

This chapter studies colorectal surgery. It begins with ulcerative colitis, Crohn’s disease, and other forms of colitis, before looking at colorectal polyps and colorectal cancer. Ulcerative colitis is an acute and chronic inflammatory disease originating in the co-lonic columnar mucosa; it is often precipitated by an apparent acute GI infection. Meanwhile, Crohn’s disease is a chronic inflammatory non-caseating, granulomatous disease affecting any part of the GI tract; it is associated with several extraintestinal disorders. The chapter then explains restorative pelvic surgery and minimally-invasive colorectal surgery. It also discusses diverticular disease of the colon; rectal prolapse; pilonidal sinus disease; fistula-in-ano; haemorrhoids; acute anorectal pain; acute rectal bleeding; acute severe colitis; and post-operative anastomotic leakage.

TP7.2.4 Skin-to-gel is a safe and effective method to prevent patients sliding during minimally invasive colorectal surgery

Aims Minimally invasive colorectal surgery often requires manipulating the patient position to facilitate exposure of the surgical field, such as a steep Trendelenburg position. However, this exposes patients to risks of sliding on the operating table. Preventive interventions are available, such as bean bags; we explore our experiences of gel pads within a district general hospital. Methods A retrospective analysis was performed of all colorectal patients undergoing laparoscopic resections over the last ten years, identifying complications associated with the use of intra-operative gel pads (skin-to-gel) with no shoulder support. Results Over 500 patients have undergone laparoscopic colorectal resections during this time, all utilising pressure-relieving gel pads. Patients are placed skin-to-gel, lying on a single torso-length gel pad laid directly on the operating table mattress. Dependent upon the operative approach, the legs can be placed in stirrups or maintained supine on table extensions. There have been no DATIX recorded skin-tears, pressure or position-related injuries. The pads have also proven to prevent patient movement on the operating table, negating the use of shoulder supports when adopting the Trendelenburg position. On discussions with theatre staff, the Consultant body and interrogation of the DATIX database, there has only been one reported incidence of slipping when a patient was left on the slide sheet on top of the gel pad. They are relatively inexpensive, durable and easily maintained, proving a highly cost-effective piece of equipment. Conclusion Gel pads have proven to be highly effective in preventing both pressure-related injuries and patient movement during laparoscopic surgery.

Trends in Open, Laparoscopic, and Robotic Approaches to Colorectal Operations

The use of robotic approach has gained momentum in colorectal surgery. We analyzed the trends in the adoption of robotic-assisted platform (RAP) for colorectal surgery over a 6-year period (2013-2018) using the American College of Surgeons National Surgical Quality Improvement Project. We assessed yearly prevalence of robotic, laparoscopic, and open approaches, and evaluated trends in the adoption of RAP across age, gender, BMI, and American Society of Anesthesiology (ASA) subgroups. Overall, the frequency of open, laparoscopic, and robotic approach was 36%, 46.8%, and 7.8%, respectively. While the use of laparoscopic cases remained stable over the study period, the prevalence of RAP increased from 2.8% to 11.4%. This was accompanied by a concomitant decline in the use of open approach, from 40.8% to 33%. The use of RAP also increased across all age, gender, BMI, and ASA subgroups. Robotic-assisted platform is increasingly utilized for higher risk, older, and obese patients, allowing more patients to receive minimally invasive colorectal surgery.