Abstract:Purpose:The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review. Methods: Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse… Show more
“…Endoluminal pressure at the anastomotic site has been reported to be associated with anastomotic leakage [31] and can be an important factor in the prevention of anastomotic leakage after rectal surgery. The proximal diversion, by means of either a colostomy or an ileostomy, minimizes the consequences of anastomotic leakage by preventing fecal flow through the anastomosis [32][33][34].…”
“…Endoluminal pressure at the anastomotic site has been reported to be associated with anastomotic leakage [31] and can be an important factor in the prevention of anastomotic leakage after rectal surgery. The proximal diversion, by means of either a colostomy or an ileostomy, minimizes the consequences of anastomotic leakage by preventing fecal flow through the anastomosis [32][33][34].…”
Background and Objectives
The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high‐dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE.
Methods
A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow‐up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used.
Results
Most conducts and management strategies reviewed were strongly recommended by the participants.
Conclusions
Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.
“…It has been found that the use of a stapler is not superior to the handsewn technique. Moreover the ileostomy technique looks to be the best choice for colorectal anastomoses decompression 4,5,6 . Further research on these surgical issues must be undertaken in order to obtain answers that are more definitive.…”
Section: Surgical Practice -Is It Evidence-based?mentioning
confidence: 99%
“…As a result a lot of good scientific evidence has been accumulated, particularly in colorectal surgery. Research questions such as the need for preoperative mechanical bowel preparation, pain control by means of epidural analgesia, time interval until starting postoperative administration of oral fluids and food, choice of surgical technique in colorectal anastomoses, use of drains and use of a nasogastric tube after elective laparotomy have been adressed 1,2,3,4,5,6,7 . Most of these studies are Cochrane reviews focusing on important healthcare interventions with particular emphasis given to surgical practice.…”
In order to improve the quality of postoperative recovery and diminish the morbi-mortality rates a number of systematic reviews and meta-analyses have been conducted in the last decade within the field of surgery. As a result a lot of good scientific evidence has been accumulated, particularly in colorectal surgery. Research questions such as the need for preoperative mechanical bowel preparation, pain control by means of epidural analgesia, time interval until starting postoperative administration of oral fluids and food, choice of surgical technique in colorectal anastomoses, use of drains and use of a nasogastric tube after elective laparotomy have been adressed 1,2,3,4,5,6,7 . Most of these studies are Cochrane reviews focusing on important healthcare interventions with particular emphasis given to surgical practice.However recent analysis of the results from a multinational survey of care following colonic operations, in Europe and the United States, has concluded that strategies that can contribute to improved recovery and reduced complications after colonic operations do not appear to be applied optimally in clinical practice 8
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