Is prophylactic mesh closure effective to decrease the incidence of incisional hernia after laparotomy in colorectal surgery?

BACKGROUND: few studies have studied prophylactic mesh closure after laparotomy for colorectal surgery. METHODS: a retrospective cohort study was performed to compare patients with and without prophylactic mesh closure after open colorectal surgery. RESULTS: 309 patients were included from January 2014 to December 2016. Prophylactic mesh closure was performed in 98 patients (31.7%). After a mean follow-up of 21.7 months, incisional hernia was developed in 9 and 54 patients in the group with and without mesh respectively (9.2% vs. 25.7%, OR = 0.3, p = 0.001). In the multivariate Cox model prophylactic mesh closure was associated with a protective effect on incisional hernia development with a Hazard Ratio of 0.46 (p = 0.033). Surgical site infection was more frequent in the mesh group (19.4% vs. 9.5%, OR = 2.3, p = 0.015). CONCLUSIONS: prophylactic mesh closure is effective to decrease the incidence of incisional hernia after colorectal surgery.

Surgical Wound Complications after Colorectal Surgery with Single-Use Negative-Pressure Wound Therapy Versus Surgical Dressing over Closed Incisions: A Randomized Controlled Trial.

BACKGROUND: Global studies indicate that surgical site infections (SSIs) are a major healthcare challenge within hospitals and can have a profound impact on patient quality of life and healthcare costs. Closed-incision negative-pressure therapy (ciNPT) has been reported to provide positive clinical benefits for patients with various incisions, including those following colorectal surgeries. METHODS: Investigators performed a prospective, randomized, multicenter trial to evaluate complications of surgical incisions in patients who received a ciNPT dressing versus a conventional surgical dressing (control) over their closed incision following colorectal surgery. The incidence of SSI was determined at 7, 15, and 30 days postsurgery. RESULTS: A total of 148 patients participated in the study. Results showed that the SSI rate on day 7 was lower in the ciNPT group versus the control group (10/75 [13.3%] vs 17/73 [23.3%]), but this difference was not statistically significant. On day 15, the SSI rate was 12/75 (16.0%) in the ciNPT group versus 21/73 (28.8%) in the control group; however, this difference was only marginally statistically significant (P = .0621). At 1 month, the SSI rate remained lower in the ciNPT group (13/75 [17.3%] vs 21/73 [28.8%], P = .0983) compared with the control group. CONCLUSIONS: Future studies with larger population sizes are necessary to determine the impact of ciNPT on patients' incisions after colorectal surgery.

Trocar-site incisional hernia after laparoscopic colorectal surgery: a significant problem? Incidence and risk factors from a single-center cohort.

BACKGROUND: Trocar-site incisional hernia (TSIH) after laparoscopic surgery has been scarcely studied. TSIH incidence and risk factors have never been properly studied for laparoscopic colorectal surgery. METHODS: A retrospective analytic study in a tertiary hospital was performed including patients who underwent elective laparoscopic colorectal surgery between 2014 and 2016. Clinical and radiological TSIH were analyzed. RESULTS: 272 patients with a mean age of 70.7 years were included. 205 (75.4%) underwent surgery for a malignant disease. The most common procedure was right colectomy (108 patients, 39.7%). After a mean follow-up of 30.8 months 64 (23.5%) patients developed a TSIH. However, only 7 out of 64 (10.9%) patients with a TSIH underwent incisional hernia repair. That means that 2.6% of all the patients underwent TSIH repair. 44 (68.8%) patients had TSIH in the umbilical Hasson trocar. In the multivariate analysis, the existence of an umbilical Hasson trocar orifice was the only statistically significant risk factor for TSIH development. CONCLUSIONS: Incidence of TSIH was high, although few patients underwent incisional hernia repair. Most TSIH were observed in the umbilical Hasson trocar, which was the only risk factor for TSIH development in the multivariate analysis. Efforts should be addressed to avoid TSIH in the umbilical Hasson trocar.

Neumatosis portal y gástrica secundaria a suboclusión intestinal. Éxito del manejo no quirúrgico / No disponible

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Portal venous gas and pneumatosis intestinalis secondary to intestinal subocclusion: success of non-surgical management.

The association of intestinal and portal pneumatosis in the same patient usually occurs in intestinal ischemic-necrotic processes, with ominous prognosis. However, there are forms of presentation outside this context, with a radically different management and evolution. We present the case of a patient with portal and gastric pneumatosis, managed conservatively successfully. The clinical presentation and a multidisciplinary management will be critical in the decision-making process to obtain favorable results.

Traumatismo abdominal leve en pacientes con enfermedad de Crohn: ¿mayor susceptibilidad a la perforación de colon? / Mild abdominal trauma in patients with Crohn's disease: greater susceptibility to colon perforation?

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Resultados de la implantación de un protocolo de fast-track en una unidad de cirugía colorrectal: estudio comparativo / Results of applying a fast-track protocol in a colorectal surgery unit: comparative study

Objetivo: Implantar un protocolo de fast-track (FT) en una unidad de cirugía colorrectal, comprobando la seguridad de aplicación del mismo, en pacientes sometidos a cirugía colorrectal electiva, mediante la evaluación de las diferencias de morbilidad y estancia hospitalaria con respecto a un grupo control (GC) con cuidados tradicionales. Analizamos también la recuperación funcional del grupo FT. Material y método Se compararon mediante un estudio de cohorte prospectivo con control no concurrente, un grupo de 108 pacientes intervenidos por cáncer colorrectal entre 2008 y 2009, a los que se les aplicó el protocolo FT y un GC de 147 pacientes intervenidos entre 2005 y 2007 de similares características, con cuidados postoperatorios tradicionales. Resultados Fueron similares en ambos grupos las características demográficas, el riesgo anestésico y los procedimientos quirúrgicos realizados, con un mayor número de pacientes con abordaje laparoscópico en el grupo FT. El cumplimiento de los ítems incluidos en nuestro protocolo FT fue elevado (72,2-92,6%).Se observaron complicaciones en 77 pacientes (52%) del GC frente a 30 (27,8%) en el grupo FT (p<0,001), debido fundamentalmente a la disminución de la infección de la herida quirúrgica (p<0,001). Mortalidad y número de reingresos fueron menores en el grupo FT, sin diferencias estadísticamente significativas. La mediana de estancia hospitalaria fue de 14 días en el GC y de 8 en el FT (p<0,001).Conclusiones La aplicación de un programa de FT en cirugía colorrectal es segura, permitiendo una disminución significativa de la morbilidad y la estancia hospitalaria, sin aumentar el número de reingresos (AU)

Objective: To implement a fast-track (FT) protocol in a colorectal surgery unit, checking its safety when applied to patients subjected to elective colorectal surgery, by evaluating the differences in morbidity and hospital stay compared to a control group with traditional care. We also analyse the functional recovery of the FT group. Material and method: A prospective cohort study with non-concurrent control, was conducted on a group of 108 patients operated on for colorectal cancer between 2008 and 2009,to which the FT protocol was applied, and a control group (CG) of 147 patients subjected to surgery between 2005 and 2007 with similar characteristics, with traditional postoperative care. Results: The demographic characteristics, anaesthetic risk, and the surgical procedures performed were similar, with a higher number of patients with laparoscopic approach in the FT group. The compliance with the items in our FT protocol was high (72.2-92.6%).Complications were observed in 77 patients (52%) in the GC compared to 30 (27.8%) in the FT group (P<.001), mainly due to the decrease in surgical wound infection (P<.001). Mortality and the number of readmissions were less in the FT group, with no statistically significant differences. The median hospital stay was 14 days in the CG and 8 in the FT group (P<.001).Conclusions: The applying of an FT program in colorectal surgery is safe, leading to a significant decrease in morbidity and hospital stay, without increasing the number of readmissions (AU)

[Results of applying a fast-track protocol in a colorectal surgery unit: comparative study]. / Resultados de la implantación de un protocolo de fast-track en una unidad de cirugía colorrectal: estudio comparativo.

OBJECTIVE: To implement a fast-track (FT) protocol in a colorectal surgery unit, checking its safety when applied to patients subjected to elective colorectal surgery, by evaluating the differences in morbidity and hospital stay compared to a control group with traditional care. We also analyse the functional recovery of the FT group. MATERIAL AND METHOD: A prospective cohort study with non-concurrent control, was conducted on a group of 108 patients operated on for colorectal cancer between 2008 and 2009, to which the FT protocol was applied, and a control group (CG) of 147 patients subjected to surgery between 2005 and 2007 with similar characteristics, with traditional postoperative care. RESULTS: The demographic characteristics, anaesthetic risk, and the surgical procedures performed were similar, with a higher number of patients with laparoscopic approach in the FT group. The compliance with the items in our FT protocol was high (72.2-92.6%). Complications were observed in 77 patients (52%) in the GC compared to 30 (27.8%) in the FT group (P<.001), mainly due to the decrease in surgical wound infection (P<.001). Mortality and the number of readmissions were less in the FT group, with no statistically significant differences. The median hospital stay was 14 days in the CG and 8 in the FT group (P<.001). CONCLUSIONS: The applying of an FT program in colorectal surgery is safe, leading to a significant decrease in morbidity and hospital stay, without increasing the number of readmissions.

3p21, 5q21, 9p21 and 17p13.1 allelic deletions are potential markers of individuals with a high risk of developing adenocarcinoma in Barrett's epithelium without dysplasia.

BACKGROUND/AIMS: A common genetic abnormality detected in Barrett's adenocarcinoma is LOH (loss of heterozygosity) at the sites of known or putative tumor suppressor genes. Thus, some deletions have also been determined in peritumoral Barrett's epithelium. These findings suggest that a tissue field of somatic genetic alterations precede the histopathological phenotypic changes of carcinoma. We investigated 32 cases of Barrett's esophagus with no evidence of dysplasia for LOH at 5q21 (APC), 3p21, 9p21 (p16) and 17p13.1 (p53) chromosomal regions. METHODOLOGY: Two groups were randomly selected and compared: 16 cases of Barrett's epithelium adjacent to adenocarcinoma and 16 cases of Barrett's epithelium with no evidence of malignant transformation in a 5-10 years follow-up period. In three adenocarcinomas cases several previous endoscopic biopsies of Barrett's esophagus were available. RESULTS: We determined frequent allelic losses in adenocarcinomas at p53 (54%), p16 (50%), 3p21 (40%) and 5q21 (33%). Identical LOH was present in most cases in the Barrett's epithelium adjacent to adenocarcinoma. LOH at these loci was unusual in Barrett's epithelium with no evidence of malignant transformation. However, in cases where sequential endoscopic biopsies were performed in advance to the adenocarcinoma diagnosis LOH was already present in the Barrett's epithelium. CONCLUSIONS: We suggest that LOH at these loci may be present before the onset of the malignant growth and LOH studies may supplement the histopathological evaluation of Barrett's epithelium. LOH at 3p21, 5q21, 9p21 and 17p13 chromosomal regions in cells of Barrett's epithelium without dysplasia may have a role as a potential marker for individuals with a high risk of developing adenocarcinoma.