Mosapride Reduces Prolonged Postoperative Ileus after Open Colorectal Surgery in the Setting of Enhanced Recovery after Surgery (ERAS): A Matched Case-Control Study

Objective: To evaluate the effects of mosapride, a selective 5-hydroxytryptamine-4 agonist, on gastrointestinal recovery in patients undergoing open colorectal surgery. Methods: A prospectively collected database of the patients undergoing elective ‘open’ colorectal resection under enhanced recovery after surgery (ERAS) from May 2013 to April 2017 was reviewed. From April 2016, mosparide was routinely given from postoperative day 1 to discharge date. Eighty-four patients receiving mosapride were matched to 168 control patients (historical comparison with a ratio of 1:2). Surgical outcomes and postoperative gastrointestinal recovery was compared. Results: The patient characteristics were comparable except more patients in control group had perioperative administration of NSAIDs. The mosapride group had a 1.5% higher compliance rate of ERAS protocol. The control group had higher incidences of prolonged postoperative ileus (17.3% vs 7.1%; p=0.029) and prolonged postoperative ileus requiring nasogastric tube decompression (8.9% vs 3.6%; p=0.19). Overall complication, clinical intestinal transit and length of hospitalization were not significantly different between groups. However, the patients with prolonged postoperative ileus had significantly prolonged hospitalization (p<0.001). Median length of hospital stay was 4 days (IQR 4-5) in those without prolonged ileus (n=217), 5 days (IQR 5-6) in those with prolonged ileus without a need of gastric decompression (n=17) and 10.5 days (IQR 7-14.5) in those with prolonged ileus requiring nasogastric tube decompression (n=18) (p<0.001). A multivariate analysis showed that administration of mosapride was only a protective factor for prolonged postoperative ileus (OR=0.37, 95% CI=0.15-0.93, p=0.029). Conclusion: Postoperative administration of mosapride reduced the incidence of prolonged postoperative ileus after open colorectal surgery

Mosapride Reduces Prolonged Postoperative Ileus after Open Colorectal Surgery in the Setting of Enhanced Recovery after Surgery (ERAS): A Matched Case-Control Study

Objective: To evaluate the effects of mosapride, a selective 5-hydroxytryptamine-4 agonist, on gastrointestinal recovery in patients undergoing open colorectal surgery. Methods: A prospectively collected database of the patients undergoing elective ‘open’ colorectal resection under enhanced recovery after surgery (ERAS) from May 2013 to April 2017 was reviewed. From April 2016, mosparide was routinely given from postoperative day 1 to discharge date. Eighty-four patients receiving mosapride were matched to 168 control patients (historical comparison with a ratio of 1:2). Surgical outcomes and postoperative gastrointestinal recovery was compared. Results: The patient characteristics were comparable except more patients in control group had perioperative administration of NSAIDs. The mosapride group had a 1.5% higher compliance rate of ERAS protocol. The control group had higher incidences of prolonged postoperative ileus (17.3% vs 7.1%; p=0.029) and prolonged postoperative ileus requiring nasogastric tube decompression (8.9% vs 3.6%; p=0.19). Overall complication, clinical intestinal transit and length of hospitalization were not significantly different between groups. However, the patients with prolonged postoperative ileus had significantly prolonged hospitalization (p<0.001). Median length of hospital stay was 4 days (IQR 4-5) in those without prolonged ileus (n=217), 5 days (IQR 5-6) in those with prolonged ileus without a need of gastric decompression (n=17) and 10.5 days (IQR 7-14.5) in those with prolonged ileus requiring nasogastric tube decompression (n=18) (p<0.001). A multivariate analysis showed that administration of mosapride was only a protective factor for prolonged postoperative ileus (OR=0.37, 95% CI=0.15-0.93, p=0.029). Conclusion: Postoperative administration of mosapride reduced the incidence of prolonged postoperative ileus after open colorectal surgery

Effect of Intraoperative Hypothermia on Surgical Outcomes after Colorectal Surgery within an Enhanced Recovery after Surgery Pathway

Objective: The adverse effects of intraoperative hypothermia from the published literature were mainly based on nonenhanced recovery after surgery (ERAS) settings. This study aimed to determine association between intraoperative hypothermia and outcomes following colorectal surgery under ERAS pathway. Methods: A prospectively collected database of patients undergoing elective colorectal surgery under ERAS pathway from 2011 to 2015 was reviewed. Patients were divided into 2 groups: hypothermic group (core temperature <36oC continuously exceeding 30 minutes during an operation) and normothermic group. Short-term outcomes were compared. Results: This study included 195 patients: 150 (77%) in hypothermic group and 45 (23%) in normothermic group. Rectal surgery (OR=5.15), operative time exceeding 3 hours (OR=3.80), multi-organ resection (OR=3.12) and male gender (OR=2.62) were significant predictors for intraoperative hypothermia. Rates of postoperative complication and wound infection were comparable between hypothermic patients and normothermic patients (23% vs 13%; p=0.17 and 6.0 vs 6.7%; p=0.87, respectively). Hypothermic patients had a longer time to tolerate normal diet (2.0 days vs 1.3 days; p=0.023) but a comparable time to first bowel movement (2.6 days vs 2.6 days; p=0.84). Hypothermic patients had a significant longer hospitalization (5.7 days vs 4.4 days; p=0.048). A multivariate analysis showed that intraoperative hypothermia was an independent predictor for delayed food intake (OR=2.9, 95%CI=1.2-6.9; p=0.014) but not for prolonged hospitalization (OR=1.7, 95%CI=0.7-3.9; p=0.207). Conclusion: Intraoperative hypothermia prolonged time to tolerate food intake after colorectal surgery within an ERAS setting but it did not adversely affect the return of bowel function, wound infection, complication and length of hospitalization

Comparative Study of Health-Related Quality of Life between Colorectal Cancer Patients with Temporary and Permanent Stoma

Objective: To compare the health-related quality of life (HRQOL) between colorectal cancer (CRC) patients with temporary and permanent stoma. Methods: This survey was a cross-sectional study that was conducted on 110 CRC patients living with stoma. A validated Thai version of Padilla and Grant’s HRQOL (as a cancer nursing outcome variable) was used. Enrolled patients must have age between 40-60 years and live with stoma over a period of 3 months. Results: There were 83 patients with temporary stoma and 27 patients with permanent stoma. The majority was male and got married. The common indication for temporary and permanent stoma was low anterior resection and abdominoperineal resection, respectively. Overall mean HRQOL index was not significantly different between groups. There was also no difference in the mean QOL of each domain - namely physical well-being, psychological well-being, body image concerns about stoma, social support concern, and diagnosis/treatment response between those with temporary and permanent stoma. Notably, the domain of body image concern had the lowest QOL index in both groups. Conclusion: Postoperative health-related quality of life was not different between Thai colorectal cancer patients with temporary or permanent stoma. However, the patients with permanent stoma appeared to have non-significant higher score in every domain of health-related quality of life than those with temporary stoma

Effect of Intraoperative Hypothermia on Surgical Outcomes after Colorectal Surgery within an Enhanced Recovery after Surgery Pathway

Objective: The adverse effects of intraoperative hypothermia from the published literature were mainly based on non-enhanced recovery after surgery (ERAS) settings. This study aimed to determine association between intraoperative hypothermia and outcomes following colorectal surgery under ERAS pathway. Methods: A prospectively collected database of patients undergoing elective colorectal surgery under ERAS pathway from 2011 to 2015 was reviewed. Patients were divided into 2 groups: hypothermic group (core temperature <36oC continuously exceeding 30 minutes during an operation) and normothermic group. Short-term outcomes were compared. Results: This study included 195 patients: 150 (77%) in hypothermic group and 45 (23%) in normothermic group. Rectal surgery (OR=5.15), operative time exceeding 3 hours (OR=3.80), multi-organ resection (OR=3.12) and male gender (OR=2.62) were significant predictors for intraoperative hypothermia. Rates of postoperative complication and wound infection were comparable between hypothermic patients and normothermic patients (23% vs 13%; p=0.17 and 6.0 vs 6.7%; p=0.87, respectively). Hypothermic patients had a longer time to tolerate normal diet (2.0 days vs 1.3 days; p=0.023) but a comparable time to first bowel movement (2.6 days vs 2.6 days; p=0.84). Hypothermic patients had a significant longer hospitalization (5.7 days vs 4.4 days; p=0.048). A multivariate analysis showed that intraoperative hypothermia was an independent predictor for delayed food intake (OR=2.9, 95%CI=1.2-6.9; p=0.014) but not for prolonged hospitalization (OR=1.7, 95%CI=0.7-3.9; p=0.207). Conclusion: Intraoperative hypothermia prolonged time to tolerate food intake after colorectal surgery within an ERAS setting but it did not adversely affect the return of bowel function, wound infection, complication and length of hospitalization

What are the risk factors of colonoscopic perforation?

<p>Abstract</p> <p>Background</p> <p>Knowledge of the factors influencing colonoscopic perforation (CP) is of decisive importance, especially with regard to the avoidance or minimization of the perforations. The aim of this study was to determine the incidence and risk factors of CP in one of the endoscopic training centers accredited by the World Gastroenterology Organization.</p> <p>Methods</p> <p>The prospectively collected data were reviewed of all patients undergoing either colonoscopy or flexible sigmoidoscopy at the Faculty of Medicine Siriraj Hospital, Bangkok, Thailand between January 2005 and July 2008. The incidence of CP was evaluated. Eight independent patient-, endoscopist- and endoscopy-related variables were analyzed by a multivariate model to determine their association with CP.</p> <p>Results</p> <p>Over a 3.5-year period, 10,124 endoscopic procedures of the colon (8,987 colonoscopies and 1,137 flexible sigmoidoscopies) were performed. There were 15 colonic perforations (0.15%). Colonoscopy had a slightly higher risk of CP than flexible sigmoidoscopy (OR 1.77, 95%CI 0.23-13.51; p = 1.0). Patient gender, emergency endoscopy, anesthetic method, and the specialty or experience of the endoscopist were not significantly predictive of CP rate. In multivariate analysis, patient age of over 75 years (OR = 6.24, 95%CI 2.26-17.26; p < 0.001) and therapeutic endoscopy (OR = 2.98, 95%CI 1.08-8.23; p = 0.036) were the only two independent risk factors for CP.</p> <p>Conclusion</p> <p>The incidence of CP in this study was 0.15%. Patient age of over 75 years and therapeutic colonoscopy were two important risk factors for CP.</p

Incidence of synchronous appendiceal neoplasm in patients with colorectal cancer and its clinical significance

<p>Abstract</p> <p>Background</p> <p>The aims of this study were to evaluate the incidence of synchronous appendiceal neoplasm in patients with colorectal cancer, and to determine its clinical significance.</p> <p>Methods</p> <p>Pathological reports and medical records were reviewed of patients with colorectal adenocarcinoma who underwent oncological resection of the tumor together with appendectomy at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand between September 2000 and April 2008.</p> <p>Results</p> <p>This study included 293 patients with an average age of 62 years (range 19–95) and 51 percent were male. Of the patients studied, 228 (78 percent) had right hemicolectomy, whereas the others (22 percent) had surgery for left-sided colon cancer or rectal cancer. One patient (0.3 percent) had epithelial appendiceal neoplasm (mucinous cystadenoma) and 3 patients (1.0 percent) had metastatic colorectal cancer in the mesoappendix. However, the presence of synchronous appendiceal tumors and/or metastasis did not alter postoperative management, as these patients had received adjuvant therapy and were scheduled for surveillance program because of nodal involvement.</p> <p>Conclusion</p> <p>The incidence of synchronous primary appendiceal neoplasm and secondary (metastatic) appendiceal neoplasm in colorectal cancer patients was 0.3 and 1.0 percent, respectively. However, these findings did not change the postoperative clinical management.</p

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.Peer reviewe

Pediatric trauma and emergency surgery: an international cross-sectional survey among WSES members

Background: In contrast to adults, the situation for pediatric trauma care from an international point of view and the global management of severely injured children remain rather unclear. The current study investigates structural management of pediatric trauma in centers of different trauma levels as well as experiences with pediatric trauma management around the world. Methods: A web-survey had been distributed to the global mailing list of the World Society of Emergency Surgery from 10/2021-03/2022, investigating characteristics of respondents and affiliated hospitals, case-load of pediatric trauma patients, capacities and infrastructure for critical care in children, trauma team composition, clinical work-up and individual experiences with pediatric trauma management in response to patients´ age. The collaboration group was subdivided regarding sizes of affiliated hospitals to allow comparisons concerning hospital volumes. Comparable results were conducted to statistical analysis. Results: A total of 133 participants from 34 countries, i.e. 5 continents responded to the survey. They were most commonly affiliated with larger hospitals (&gt; 500 beds in 72.9%) and with level I or II trauma centers (82.0%), respectively. 74.4% of hospitals offer unrestricted pediatric medical care, but only 63.2% and 42.9% of the participants had sufficient experiences with trauma care in children ≤ 10 and ≤ 5&nbsp;years of age (p = 0.0014). This situation is aggravated in participants from smaller hospitals (p &lt; 0.01). With regard to hospital size (≤ 500 versus &gt; 500 in-hospital beds), larger hospitals were more likely affiliated with advanced trauma centers, more elaborated pediatric intensive care infrastructure (p &lt; 0.0001), treated children at all ages more frequently (p = 0.0938) and have higher case-loads of severely injured children &lt; 12&nbsp;years of age (p = 0.0009). Therefore, the majority of larger hospitals reserve either pediatric surgery departments or board-certified pediatric surgeons (p &lt; 0.0001) and in-hospital trauma management is conducted more multi-disciplinarily. However, the majority of respondents does not feel prepared for treatment of severe pediatric trauma and call for special educational and practical training courses (overall: 80.2% and 64.3%, respectively). Conclusions: Multi-professional management of pediatric trauma and individual experiences with severely injured children depend on volumes, level of trauma centers and infrastructure of the hospital. However, respondents from hospitals at all levels of trauma care complain about an alarming lack of knowledge on pediatric trauma management

It is time to define an organizational model for the prevention and management of infections along the surgical pathway : a worldwide cross-sectional survey

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.Peer reviewe