Randomized clinical trial to evaluate the effects of perioperative supplemental oxygen administration on the colorectal anastomosis.

BACKGROUND: Perioperative supplemental oxygen therapy may have beneficial effects on wound healing following colorectal surgery. The aim of this study was to evaluate the effects of such therapy on colorectal anastomotic pH and partial pressure of carbon dioxide (PCO(2)) gap. METHODS: Forty-five patients undergoing anterior resection for rectal or sigmoid cancer were randomized to receive 30 or 80 per cent perioperative oxygen. Administration was commenced after induction of anaesthesia and maintained for 6 h after surgery. Intragastric and anastomotic tonometric catheters were placed in each patient and intramucosal pH (pHi) was measured immediately after operation, and 6 and 24 h later. Gastric and anastomotic pHi and PCO(2) gap in each group were compared. RESULTS: There was a significantly lower anastomotic pHi and wider PCO(2) gap for gastric readings in the 30 per cent O(2) group, both 30 min (pHi, P = 0.006; PCO(2) gap, P = 0.006) and 6 h (pHi, P = 0.024; PCO(2) gap, P = 0.036) after surgery. There were no differences 24 h after surgery while breathing room air (pHi, P = 0.131; PCO(2) gap P = 0.139). No difference was found between gastric and anastomotic readings at any time point in the 80 per cent O(2) group. CONCLUSION: Perioperative administration of 80 per cent O(2) both during surgery and for 6 hours afterwards is associated with an improvement in relative anastomotic hypoperfusion as assessed by the measurement of pHi and PCO(2) gap.

A prospective audit of the complications of loop ileostomy construction and takedown.

AIM: A prospective review of the complications of ileostomy construction and takedown. MATERIALS AND METHODS: One hundred twenty-seven consecutive patients undergoing construction of a loop ileostomy were included in a prospective nonrandomized computer database. Complications of the loop ileostomy were assessed prior to and after closure. Three closure techniques were performed [enterotomy suture (25.7%), resection and hand sewn (31.2%) or stapled anastomosis (43.1%)] and compared. RESULTS: One hundred twenty-seven (73 male, 54 female) patients, mean age 54 years were included from 1992 to 2002. Seventy-two patients underwent anterior resection for low rectal carcinoma, 30 an ileoanal pouch for ulcerative colitis and 25 for miscellaneous conditions. Fifty-nine pre-takedown complications occurred in 50 (39.4%) patients. The most common were dermatitis (12.6%) and erythema (7.1%). The most severe were dehydration in 1 patient and stomal prolapse in 4 patients. Closure was associated with a complication rate of 33.1% and a mortality rate of 0.9%. Wound infection occurred in 18.3% and small bowel obstruction in 4.6%. Anastomotic leak requiring reanastomosis occurred in 2.8% and enterocutaneous fistula treated conservatively in 5.5%. There were no statistically significant differences in morbidity between closure techniques (p = 0.892). There were no statistically significant differences in complications (p = 0.516) between patients with ulcerative colitis and those with neoplasia (39.29% vs. 32.2%). CONCLUSIONS: Loop ileostomy construction and takedown is associated with considerable morbidity, mostly minor. No differences exist between technique used for closure or the baseline pathology of the patient.

Complicaciones de la cirugía proctológica / Complications in proctology surgery

Introducción. Los programas de corta estancia y cirugía ambulatoria ha contribuido a cambiar los costes y el tratamiento de estos pacientes, pero no ha disminuido la tasa de complicaciones. Objetivo. Auditar la tasa de complicaciones en cirugía proctológica. Material y métodos. Estudio retrospectivo de 835 pacientes divididos en cirugía proctológica simple (n = 695) y compleja (n = 140). La cirugía simple comprende hemorroidectomías, ligadura con banda elástica, esfinterotomía lateral interna, drenaje de abscesos y fistulotomías sencillas. La compleja engloba esfinteroplastias, hemorroidectomías circunferenciales, colgajos mucosos y cirugía del prolapso. Se registraron las complicaciones precoces ( 30 días).Resultados. En el grupo de cirugía sencilla las tasas de complicaciones precoces y tardías oscilaron entre un 0 y un 3 por ciento. La cirugía compleja presentó unas tasas de complicaciones precoces entre un 0 y un 35,71 por ciento. Las tardías se presentaron entre un 0 y un 10,71 por ciento. Todas las complicaciones tardías están referidas a la incontinencia. Conclusiones. Los programas de cirugía ambulatoria no han disminuido la tasa de complicaciones. El factor cirujano sigue considerándose probablemente como el de mayor impacto en las tasas de complicaciones (AU)