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Continuous wound infusion of local anaesthetic agents following colorectal surgery:Systematic review and meta-analysis

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World Journal of Gastroenterology 2008年第34期14卷 5301-5305页

作者： Alan Karthikesalingam Stewart R Walsh Sheraz R Markar Umar Sadat Tjun Y Tang Charles M Malata Department of General surgery Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation Trust Department of Plastic and Reconstructive surgery Addenbrooke’s HospitalCambridge University Hospitals Foundation Trust

AIM:To provide a specifi c review and meta-analysis of the available evidence for continuous wound infusion of local anaesthetic agents following midline laparoto-my for major colorectal surgery. METHODS: Medline, Embase, trial registries, conference proceedings and article reference lists were searched to identify randomised, controlled trials of continuous wound infusion of local anaesthetic agents following colorectal surgery. The primary outcomes were opioid consumption, pain visual analogue scores (VASs), return to bowel function and length of hospital stay. Weighted mean difference were calculated for continuous outcomes. RESULTS: Five trials containing 542 laparotomy wounds were eligible for inclusion. There was a sig- nificant decrease in post-operative pain VAS at rest on day 3 (weighted mean difference: -0.43; 95% CI: -0.81 to -0.04; P = 0.03) but not on post-operative day 1 and 2. Local anaesthetic infusion was associated with a signifi cant reduction in pain VAS on movement on all three post-operative days (day 1 weighted mean difference: -1.14; 95% CI: -2.24 to -0.041; P = 0.04, day 2 weighted mean difference: -0.97, 95% CI: -1.91to -0.029; P = 0.04, day 3 weighted mean difference: -0.61; 95% CI: 1.01 to -0.20; P = 0.0038). Local an- aesthetic wound infusion was associated with a signifi - cant decrease in total opioid consumption (weighted mean difference: -40.13; 95% CI: -76.74 to -3.53; P = 0.03). There was no signifi cant decrease in length of stay (weighted mean difference: -20.87; 95% CI: -46.96 to 5.21; P = 0.12) or return of bowel function (weighted mean difference: -9.40; 95% CI: -33.98 to 15.17; P = 0.45). CONCLUSION: The results of this systematic re- view and meta-analysis suggest that local anaesthetic wound infusion following laparotomy for major color- ectal surgery is a promising technique but do not pro- vide conclusive evidence of benefi t. Further research is required including cost-effectiveness analysis.

关键词： colorectal surgery Laparotomy Local anaesthesia Infusion Wound healing

Improving the outcomes in oncological colorectal surgery

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World Journal of Gastroenterology 2014年第35期20卷 12445-12457页

作者： Jeroen LA van Vugt Kostan W Reisinger Joep PM Derikx Djamila Boerma Jan HMB Stoot Department of surgery St Antonius Hospital Department of surgery Maastricht University Medical Center and Nutrim School for NutritionToxicology and MetabolismMaastricht University Department of surgery Orbis Medical Center Department of surgery Atrium Medical Center

During the last several decades,colorectal cancer surgery has experienced some major perioperative *** risk-assessment of nutrition,frailty,and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy,contributed to improved postoperative *** recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient *** an initially indecisive start due to uncertainty about oncological safety,the most significant improvement in intraoperative care was the introduction of *** surgery for colon and rectal cancer is associated with better short-term outcomes,whereas long-term outcomes regarding survival and recurrence rates are ***,long-term results in rectal surgery remain to be *** recognition of anastomotic leakage remains a challenge,though multiple improvements have allowed better management of this complication.

关键词： Laparoscopic surgery colorectal surgery Anastomotic leakage Frailty Nutritional status Sarcopenia Enhanced recovery after surgery Audits

Artificial intelligence based real-time microcirculation analysis system for laparoscopic colorectal surgery

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World Journal of Gastroenterology 2020年第44期26卷 6945-6962页

作者： Sang-Ho Park Hee-Min Park Kwang-Ryul Baek Hong-Min Ahn In Young Lee Gyung Mo Son Department of Electronic Engineering Pusan National UniversityBusan 46241South Korea Department of surgery Pusan National University Yangsan HospitalGyeongsangnam-do 50612South Korea Department of Medicine Pusan National UniversityGyeongsangnam-do 50612South Korea Department of surgery Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsan-si 50612South Korea

BACKGROUND Colonic perfusion status can be assessed easily by indocyanine green(ICG)angiography to predict ischemia related anastomotic complications during laparoscopic colorectal ***,various parameter-based perfusion analysis have been studied for quantitative evaluation,but the analysis results differ depending on the use of quantitative parameters due to differences in vascular anatomical ***,it can help improve the accuracy and consistency by artificial intelligence(AI)based real-time analysis microperfusion(AIRAM).AIM To evaluate the feasibility of AIRAM to predict the risk of anastomotic complication in the patient with laparoscopic colorectal cancer *** The ICG curve was extracted from the region of interest(ROI)set in the ICG fluorescence video of the laparoscopic colorectal ***-processing was performed to reduce AI performance degradation caused by external environment such as background,light source reflection,and camera shaking using MATLAB 2019 on an I7-8700k Intel central processing unit(CPU)*** learning and evaluation were performed by dividing into a training patient group(n=50)and a test patient group(n=15).Training ICG curve data sets were classified and machine learned into 25 ICG curve patterns using a self-organizing map(SOM)*** predictive reliability of anastomotic complications in a trained SOM network is verified using test *** AI-based risk and the conventional quantitative parameters including T1/2max,time ratio(TR),and rising slope(RS)were consistent when colonic perfusion was favorable as steep increasing ICG curve *** the ICG graph pattern showed stepped rise,the accuracy of conventional quantitative parameters decreased,but the AI-based classification maintained accuracy *** receiver operating characteristic curves for conventional parameters and AI-based classification were comparable for predicting the anastomotic complication *** pe

关键词： Indocyanine green Laparoscopic Artificial intelligent Anastomotic complications colorectal surgery Microcirculation analysis

Introducing an enhanced recovery after surgery program in colorectal surgery:A single center experience

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World Journal of Gastroenterology 2014年第46期20卷 17578-17587页

作者： Stefano Bona Mattia Molteni Riccardo Rosati Ugo Elmore Pietro Bagnoli Roberta Monzani Monica Caravaca Marco Montorsi Department of General surgery University of Milan School of MedicineHumanitas Research Hospital20089 RozzanoMilanItaly

AIM: To study the implementation of an enhanced recovery after surgery (ERAS) program at a large University Hospital from “pilot study” to “standard of care”.

关键词： Enhanced recovery after surgery Fast-track surgery Implementation of enhanced recovery after surgery protocol Compliance to enhanced recovery after surgery protocol colorectal surgery

Evolution and future of laparoscopic colorectal surgery

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World Journal of Gastroenterology 2014年第41期20卷 15119-15124页

作者： Andreas M Kaiser Department of colorectal surgery Keck School of MedicineUniversity of Southern California

The advances of laparoscopic surgery since the early 1990 s have caused one of the largest technical revolutions in medicine since the detection of antibiotics(1922,Flemming),the discovery of DNA structure(1953,Watson and Crick),and solid organ transplantation(1954,Murray).Perseverance through a rocky start and increased familiarity with the chop-stick surgery in conjunction with technical refinements has resulted in a rapid expansion of the indications for minimally invasive ***-related factors initially contributed to this success and included the improved postoperative recovery and cosmesis,fewer wound complications,lower risk for incisional hernias and for subsequent adhesionrelated small bowel obstructions; the major breakthrough however came with favorable long-term outcomes data on oncological *** future will have to determine the specific role of various technical approaches,define prognostic factors of success and true progress,and consider directing further innovation while potentially limiting approaches that do not add to patient outcomes.

关键词： Laparoscopic Laparoscopy Open surgery colorectal surgery Colectomy Robot

Pattern of colorectal surgery and long-term survival:10-year experience from a single center

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World Journal of Gastrointestinal Oncology 2024年第11期16卷 4383-4391页

作者： De-Xiang Zhu Miao Chen Dong-Hao Xu Guo-Dong He Ping-Ping Xu Qi Lin Li Ren Jian-Min Xu Department of colorectal surgery Zhongshan Hospital Fudan UniversityShanghai 200032China

BACKGROUND The incidence of colorectal cancer(CRC)has increased in recent decades,and ranks fourth among males and third among females in *** resection remains the most important treatment modality for curative intent in *** studies found that surgeon volumes and specialization appeared to be associated with improved overall survival(OS).Moreover,numerous reports have suggested that specialization and minimally invasive surgery have gained increased popularity in CRC ***,few studies have specifically examined the role and long-term survival of all stage CRC in a real-world *** To evaluate the effect of surgeon specialization on survival changes and minimally invasive surgery utilization in a real world *** A retrospective analysis on the association between surgeon specialization and OS between 2008 and 2013 in Zhongshan Hospital CRC database was *** demographic,clinicopathologic,surgical and follow-up data were obtained from the CRC *** specialty was categorized as colorectal surgeon(CS)and general surgeon(GS).CRC patients who underwent primary surgical resection were *** A total of 5141 CRC patients who underwent primary surgical resection between 2008 and 2013 were evaluated,1748(34.0%)of these by *** percentage of minimally invasive procedures in the CS group showed an increasing *** was no benefit associated with surgeon specialization for stage I,II and IV *** specialization exhibited a significant association with OS solely among stage III patients,with 5-year OS rates of 76%and 67%for the CS and GSgroups,respectively(Psurgery in stage III rectal patien

关键词： colorectal surgery Minimally invasive surgery Primary location Overall survival Tumor stage Follow-up

Endoluminal vacuum-assisted therapy as a treatment for anastomotic leakage in colorectal surgery

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World Journal of Gastroenterology 2022年第28期28卷 3747-3752页

作者： Maria Michela Chiarello Valentina Bianchi Pietro Fransvea Giuseppe Brisinda Department of surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168taly Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

Anastomotic leakage(AL)has a wide range of clinical features ranging from radiological only findings to peritonitis and sepsis with multiorgan *** early diagnosis of AL is essential in order to establish the most appropriate treatment for this *** AL continues to be a dreadful complication after colorectal surgery,there has been no consensus on its ***,based on patient’s presentation and timing of the AL,there has been a gradual shift to a more conservative management,keeping surgery as the last option Reoperation for sepsis control is rarely necessary especially in those patients who already have a diverting stoma at the time of the leak.A nonoperative management is usually preferred in these *** are several treatment options,also for patients without a stoma who do not require a reoperation for a contained pelvic leak,including recently developed endoscopic procedures,such as clip placement or endoluminal vacuum-assisted *** conservative treatments could be an option in patients who are clinically stable or in presence of a small defect.

关键词： Anastomotic leakage colorectal cancer colorectal surgery Mortality Morbidity

Effect of water-soluble contrast in colorectal surgery: A prospective randomized trial

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World Journal of Gastroenterology 2005年第18期11卷 2802-2805页

作者： Jia-HuiChen Chung-BaoHsieh Pei-ChiehChao Hsiao-DungLiu Chung-JuengChen Yao-ChiLiu Jyh-CherngYu DivisionofGeneralsurgery DepartmentofSurgeryTri-ServiceGeneralHospitalNationalDefenseMedicalCenterTaipeiTaiwanChina Divisionofcolorectalsurgery DepartmentofSurgeryTri-ServiceGeneralHospitalNationalDefenseMedicalCenterTaipeiTaiwanChina

AIM: Postoperative gastrointestinal-tract motility is normally delayed. Early feeding after colorectal surgery has been reported recently, but late feeding is common. Gastrografin not only enhances bowel peristalsis, but also decreases bowel-wall edema. Whether contrast medium allows early oral feeding and reduces the duration of hospitalization requires clarification. METHODS: Fifty patients underwent elective colorectal surgery In a regional medical center. Patients were prosp-ectively randomized into a Gastrografin group or control group (n=25 each). Patients in the Gastrografin group began their feeding schedule with 100 mL of 5% dextrose water with 100 mL of Gastrografin on postoperative d 3 and were advanced to a full liquid diet when the contrast reached the colon in 4 h. Patients in the control group began their feeding schedule with 200 mL of 5% dextrose water on postoperative d 3 and were advanced to a full liquid diet after the passage of flatus and stool. Nasogastric tubes were inserted for persistent postoperative vomiting. Fullness, nausea, vomiting, complications, time of anesthesia, time of operation, time of mobilization, time of oral feeding, and duration of hospital stay were recorded and analyzed with Student's t-test. RESULTS: In the Gastrografin group, one patient had aspiration pneumonia and one patient had anastomotic leakage resulting in sepsis and eventual death. This mortality was excluded from the subsequent statistical analysis. In the control group, two patients had wound infections. There was no significant difference between the two groups at the time of anesthesia, time of operation, or time of mobilization. There were significant differences between the two groups in the time of oral feeding (3.3±0.3 d in the Gastrografin group VS 4.8±0.4 d in the control group; P=odds ratio--, 95%CI [-0.5 to +0.7 d]) and in the length of hospital stay (7.6±1.1 d in the Gastrografin group VS 10.2±1.3 d in the control group; P=odds ratio--, 95% CI [-

关键词： colorectal surgery Contrast Gastrografin

Evolution of laparoscopy in colorectal surgery:An evidencebased review

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World Journal of Gastroenterology 2014年第17期20卷 4926-4933页

作者： Alexander Emmanuel Blackmore Mark Te Ching Wong Choong Leong Tang Department of colorectal surgery Singapore General HospitalSingapore 169856Singapore

Open surgery for colorectal disease has progressed significantly over the past century from humble beginnings to form the mainstay of treatment for colorectal cancer and a number of benign *** the introduction of laparoscopic abdominal surgery,the next stage in the evolution of the specialty began in the 1990s with the first laparoscopic colonic *** some early concerns regarding its safety and oncological efficacy during the latter part of that decade,laparoscopic colorectal surgery rapidly came into mainstream use in the early part of the current century with evidence supporting its use being made available from large scale randomised controlled *** article provides an evidence-based summary of this evolutionary process as it relates to both benign and malignant colorectal disease,as well as discussion of the next phase of new technologies such as robotic surgery.

关键词： colorectal surgery colorectal cancer Pelvic floor Laparoscopy Robotics Laparoscopic resection of gastrointestinal