Critical Pathway for Colorectal and Gastric Cancer

PURPOSE: The critical pathway (CP) is to standardize the clinical practice of specialists working to optimize care. The objective of this study was to develop a critical pathway for the surgical treatment of patients with colorectal or gastric cancer and to evaluate the results of the CP. METHODS: Twenty-one patients with colorectal cancer, who were managed according to the CP between August 2005 and November 2005, were compared with 18 patients for whom this pathway had not been used between June 2004 and September 2004. Forty-eight patients with gastic cancer, who were managed according to the CP between June 2005 and September 2005, were compared with 49 patients for whom this pathway had not been used daring the same period in 2004. The length of stay and the cost per patients were compared between the CP group and the non-CP group. RESULTS: For patients with colorectal cancer, the postoperative hospital length of stay in the CP group was significantly shorter (9.0 vs. 12.3 days, P<0.001), but for patients with gastric caner, there was no difference (10.6 vs. 11.4, P=0.134). The mean hospital charges were won5,037,816 and won5,263,508 for colorectal cancer and for gastric cancer, respectively, and won4,808,602 and won4,674,329, for the CP and the non-CP groups, respectively, but these differences were not significant. CONSLUSIONS: The critical pathway in colorectal and stomach surgery decreased the length of stay and might regulate hospital charges. Such a pathway could be easily designed and implemented at hospitals and could standardize clinical practice.

Internal Hernia in Adult Patients: Transmesenteric Hernia and Internal Hernia through a Defect of the Broad Ligament

An internal hernia is a rare disease that causes bowel obstruction. It is difficult to diagnose because the symptoms and the signs are the same as those for other obstructive diseases of the bowel. Early diagnosis and management are essential, and early surgical management may reduce complications such as ischemia, and strangulation. We experienced two cases of internal hernias. One patient underwent a laparotomy, and had a transmesenteric defect with a herniated and strangulated small bowel segment. The other patient underwent a laparoscopic surgery, and we found that the left broad ligament had a focal defect with a herniated small bowel segment. An internal hernia is an uncommon disease, and its differentiation from other obstructive diseases of the bowel is difficult. However, the clinician should consider that the internal hernia might be the cause of the bowel obstruction, especially in patient with no previous history of intra- abdominal surgery. Early diagnosis can improve the clinical outcome through early surgery.