Bowel Preparation before Elective Colorectal Surgery: Its Current Role

Bowel preparation for elective colorectal surgery has been performed for decades with the assumption to decrease infectious complications and anastomotic leaks. Nevertheless, the scientific basis of the same is still debatable. Various methods of bowel preparation are mechanical bowel preparation (MBP) with or without prophylactic oral antibiotics (POA), preoperative POA alone without MBP, and preoperative enema alone without MBP and POA. However, there is no consensus on the optimal type of bowel preparation. The available agents for MBP are polyethylene glycol (PEG) and sodium phosphate (NaP) or picosulphate. The most common prophylactic oral antibiotic regimen used in preoperative bowel preparation is Neomycin and Metronidazole a day before surgery, although the microbiological basis of this is unverified. Most studies around the beginning of this century indicate inadequate evidence for using MBP for colorectal surgery to suggest harm caused by the process and accordingly advise against it. However, several retrospective studies and meta-analyses, which were done after 2014, arguably demonstrate that preoperative MBP and POA reduce the postoperative surgical site infection rate. However, as per the current evidence, it can be suggested that MBP and preoperative POA can be safely included in the preoperative preparation of elective colorectal surgery

How e-Health Has Influenced Patient Care and Medical Education: Lessons Learned from the COVID-19 Pandemic

The concept of e-Health involves the application of information and communication technologies from off-site locations to various domains of healthcare ranging from patient care, public health, and administration to health education. It refers to health informatics, telemedicine, electronic health records, and clinical decision support systems. The e-health initiatives aim to improve health outcomes in terms of quality, access, affordability, and efficient monitoring. The application of e-health interventions has particularly expanded in recent times because of the restrictions imposed by the pandemic. It has been proven to be nearly as effective as in-person care along with high patient and provider satisfaction and at decreased costs. We present our experience from the use of various e-health interventions during the COVID-19 pandemic along with a review of related literature. This ranged from Internet-based services, interactive TV or Polycom’s, kiosks, online monitoring of patient’s vital signs, and remote consultations with experts. Our success and experience with various e-health interventions during the pandemic allow us to provide a more hybrid form of healthcare in the future both for patient care and medical education and training

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A retrospective observational study over surgical management of giant thoracic tumours: horrendous but manageable

Abstract Background Giant thoracic tumour (GTT) does not have a clear definition, but, as per usual terminology, they are thoracic masses whose long axis is > 10 cm or covering more than 50% of the hemithorax. The mediastinum is a unique space in the thoracic cavity that can have a wide range of masses of different cellular origins imposing both diagnostic and therapeutic challenges. This retrospective observational study aims to evaluate the surgical treatment outcomes of giant intrathoracic tumours and final histopathological diagnosis with evidence for manageability. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines has been followed for reporting this observational study. Results Between January 2018 and December 2022, the medical data of a total of 11 patients (06 males, 05 females; age range, 05 to 52 years) who underwent radical surgery for GTT in our centre were retrospectively reviewed in this observational study. We evaluated presenting symptoms, radiological findings, presumptive pathological diagnosis, and surgically excised mass gross and histopathological examination. Six (54.5%) of our patients were male, and five (45.5%) were female. The age range was between 05 and 52 years. The tumour localisations of our patients were five (45.5%) hemithorax and six (54.5%) mediastinal. The largest excised mass was 26 × 24 × 12 cm, and the heaviest mass was 3600 g. All patients underwent conventional open surgery. The overall survival was 100%, with no immediate postoperative mortality, indicating an excellent prognosis despite a dreadful appearance. Conclusion Due to neighbouring vascular structures, the surgical resection of manoeuvres in this crucial cavity with the excision of giant masses may be difficult and tricky. Preoperative diagnostic investigations and planning play a significant role in accurately localising the mass and the invasion possibility of adjacent vital structures. The results of this study may provide scientific evidence to guide the treatment of giant thoracic tumours in clinical practice

Spigelian Hernia: Clinical Features and Management

The Spigelian hernia is a rare variety of ventral hernia and has an incidence ranging from 0.1–2% of all abdominal wall hernias. It occurs through a well-defined defect in the Spiegel’s fascia adjacent to the semilunar line. It can be congenital or acquired. The acquired variety is predisposed by stretching and weakening of the abdominal wall by factors that increase the intraabdominal pressure. These hernias are most commonly located in the interparietal plane with no visible or palpable mass, and only 50% of cases could be diagnosed clinically before any surgical intervention. Radiological investigations like USG and CT scans confirm the clinical diagnosis or pick up the subclinical varieties that present with non-specific pain in the anterior abdominal wall. Surgery is the mainstay of management. These hernias are prone to early incarceration and strangulation and therefore should be operated at the earliest. It is stressed that a prosthetic mesh should be used for a better outcome as it decreases recurrence. Conventional open hernioplasty has been largely replaced by a laparoscopic approach such as TAPP, TEP, IPOM and robotic-assisted surgery. Early diagnosis and surgery prevent morbidity and dreaded complications