Diseases of the colon and rectum
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Multicenter Study
A method for estimating the risk of surgical site infection in patients with abdominal colorectal procedures.
Surgical site infection is one of the most common and significant morbidities following colon and rectal surgery, representing a marker of institutional quality. Various measures have been implemented to lower its incidence. However, the level of incidence remains unacceptable in many reports. ⋯ Surgical site infection is common morbidity following colon and rectal surgery. Nomograms using key patient characteristics can be used to accurately calculate a patients' risk of surgical site infection. This tool could be applied in the clinical setting to prospectively identify patients at highest risk of surgical site infection.
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Comparative Study
Comparison of anastomotic leak rate after colorectal surgery using different databases.
Anastomotic leaks are one of the most important clinical outcomes after colorectal anastomosis. Because of the lack of measurement of this outcome in databases, research has been limited by the need to perform chart review. ⋯ Although the clinical registry had higher sensitivity and specificity for anastomotic leak, both databases had low sensitivity. Future research on anastomotic leaks would benefit greatly from a uniform definition and recording of this outcome in national databases.
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Patient and technical factors influencing postoperative infectious complications after elective colorectal resections for cancer are well described. Tumor related factors, however, have not been extensively evaluated. ⋯ Advanced tumors increase the risk of infectious complications after colorectal resection, with other risk factors including malnutrition, obesity, and resection by laparotomy. Optimization of modifiable risk factors through nutritional repletion and the choice of a minimally invasive operation should be considered.
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Anastomotic leaks after low anterior resection for rectal cancer remain a major cause of morbidity and mortality. Few studies have focused on their management, particularly on the technique of transanal drainage. ⋯ : For the management of low anastomotic leaks, transanal drainage allows preservation of the anastomosis and sepsis control with a high rate of ileostomy closure. It is a valuable option in patients with a diverting ileostomy.
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Practice Guideline
Practice parameters for the management of rectal cancer (revised).