Bundles reduce anastomosis leak in patients undergoing elective colorectal surgery. A propensity score-matched study.

Background: anastomosis leak still being a handicap in colorectal surgery. Bowel mechanical preparation and oral antibiotics are not a practice recommended in many clinical practice guides. The aim is to analyse the decrease in frequency and severity of postoperative complications, mainly related to anastomotic leak, after the establishment of a bundle. Methods: Single-center, before-after study. A bundle was implemented to reduce anastomotic leaks and their consequences. The Bundle group were matched to Pre-bundle group by propensity score matching. Mechanical bowel preparation, oral and intravenous antibiotics, inflammatory markers measure and early diagnosis algorithm were included at the bundle. Results: The bundle group shown fewer complications, especially in Clavien Dindós Grade IV complications (2.3% vs. 6.2% p < 0.01), as well as a lower rate of anastomotic leakage (15.5% vs. 2.2% p < 0.01). A significant decrease in reinterventions, less intensive unit care admissions, a shorter hospital stay and fewer readmissions were also observed. In multivariate analysis, the application of a bundle was an anastomotic leakage protective factor (OR 0.121, p > 0.05). Conclusions: The implementation of our bundle in colorectal surgery which include oral antibiotics, mechanical bowel preparation and inflammatory markers, significantly reduces morbidity adjusted to severity of complications, the anastomotic leakage rate, hospital stay and readmissions. Register study: The study has been registered at clinicaltrials.gov Code: nct04632446.

Adult intussusception - 14 case reports and their outcomes.

AIMS: To analyze diagnostic and therapeutic options depending on the clinical symptoms, location, and lesions associated with intussusception, together with their follow-up and complications. PATIENTS AND METHODS: Patients admitted to the Morales Meseguer General University Hospital (Murcia) between January 1995 and January 2009, and diagnosed with intestinal invagination. Data related to demographic and clinical features, complementary explorations, presumptive diagnosis, treatment, follow-up, and complications were collected. RESULTS: There were 14 patients (7 males and 7 females; mean age: 41.9 years-range: 17-77) who presented with abdominal pain. The most reliable diagnostic technique was computed tomography (8 diagnoses from 10 CT scans). A preoperative diagnosis was established in 12 cases. Invaginations were ileocolic in 8 cases (the most common), enteric in 5, and colocolic in 2 (coexistence of 2 lesions in one patient). The etiology of these intussusceptions was idiopathic or secondary to a lesion acting as the lead point for invagination. Depending on the nature of this lead point, the cause of the enteric intussusceptions was benign in 3 cases and malignant in 2. Ileocolic invaginations were divided equally (4 benign and 4 malignant), and colocolic lesions were benign (2 cases). Conservative treatment was implemented for 4 patients and surgery for 10 (7 in emergency). Five right hemicolectomies, 3 small-bowel resections, 2 left hemicolectomies, and 1 ileocecal resection were performed. Surgical complications: 3 minor and 1 major (with malignant etiology and subsequent death). The lesion disappeared after 3 days to 6 weeks in patients with conservative management. Mean follow-up was 28.25 months (range: 5-72 months). CONCLUSIONS: A suitable imaging technique, preferably CT, is important for the diagnosis of intussusception. Surgery is usually necessary but we favor conservative treatment in selected cases.

Intususcepción en el adulto. Revisión de 14 casos y su seguimiento / Adult intussusception - 14 case reports and their outcomes

Objetivos: analizar las opciones terapéuticas en función de laclínica, localización y lesión asociada a la intususcepción, asícomo, su seguimiento y complicaciones.Pacientes y métodos: pacientes ingresados en el HGU MoralesMeseguer (Murcia) desde enero de 1995 hasta enero 2009,con diagnóstico de invaginación intestinal. Se recogieron datosdemográficos, clínicos, exploraciones complementarias, diagnósticopresuntivo, tratamiento, seguimiento y complicaciones.Resultados: 14 pacientes (edad media 41,9 años, rango: 17-77), 7 varones y 7 mujeres, que debutaron principalmente condolor abdominal. La exploración más fiable en el diagnóstico fuela tomografía computerizada, TC (8 diagnósticos, de 10 exploraciones).El diagnóstico preoperatorio se obtuvo en 12 casos, encontrando,invaginaciones ileocólicas en 8 casos (las más frecuentes),entéricas en 5 casos y colocólicas en 2, teniendo en cuentaque son 14 los pacientes y 15 las lesiones debido a la coexistenciade 2 invaginaciones en un mismo sujeto. La etiología de las intususcepcioneses idiopática o secundaria a una lesión que hace de cabeza de invaginación. Según la naturaleza de dichas lesiones lacausa de intususcepciones entéricas fue benigna en 3 casos y malignaen 2. De las ileocólicas, se repartieron equitativamente (4benignas y 4 malignas); y de las colocólicas, sus lesiones fueronbenignas (2 casos). Se realizó tratamiento conservador en 4 pacientesy quirúrgico en 10 (7 urgente). Con 5 hemicolectomías derechas,3 resecciones de intestino delgado, 2 hemicolectomías izquierdasy una resección ileocecal. Las complicacionesquirúrgicas: 3 menores y 1 mayor (de etiología maligna y consecuenteexitus). En los pacientes con manejo conservador desaparecióla lesión entre 3 días y 6 semanas. Se siguieron durante28,25 meses de media (rango 5-72 meses)...(AU)

Aims: to analyze diagnostic and therapeutic options dependingon the clinical symptoms, location, and lesions associated withintussusception, together with their follow-up and complications.Patients and methods: patients admitted to the MoralesMeseguer General University Hospital (Murcia) between January1995 and January 2009, and diagnosed with intestinal invagination.Data related to demographic and clinical features, complementaryexplorations, presumptive diagnosis, treatment, followup,and complications were collected.Results: there were 14 patients (7 males and 7 females; meanage: 41.9 years-range: 17-77) who presented with abdominal pain.The most reliable diagnostic technique was computed tomography(8 diagnoses from 10 CT scans). A preoperative diagnosis was establishedin 12 cases. Invaginations were ileocolic in 8 cases (themost common), enteric in 5, and colocolic in 2 (coexistence of 2 lesionsin one patient). The etiology of these intussusceptions was idiopathicor secondary to a lesion acting as the lead point for invagination.Depending on the nature of this lead point, the cause of theenteric intussusceptions was benign in 3 cases and malignant in 2.Ileocolic invaginations were divided equally (4 benign and 4 malignant),and colocolic lesions were benign (2 cases). Conservativetreatment was implemented for 4 patients and surgery for 10 (7 inemergency). Five right hemicolectomies, 3 small-bowel resections,2 left hemicolectomies, and 1 ileocecal resection were performed.Surgical complications: 3 minor and 1 major (with malignant etiologyand subsequent death). The lesion disappeared after 3 days to6 weeks in patients with conservative management. Mean follow-upwas 28.25 months (range: 5-72 months).Conclusions: a suitable imaging technique, preferably CT, isimportant for the diagnosis of intussusception. Surgery is usuallynecessary but we favor conservative treatment in selected cases(AU)