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Steven D. Wexner - One of the best experts on this subject based on the ideXlab platform.
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A narrative celebrating the recent contributions of women to Colorectal Surgery.
Surgery, 2020Co-Authors: Deborah S. Keller, Mariana Berho, Gina Brown, Tracy L. Hull, Gabriela Moeslein, Steven D. WexnerAbstract:Abstract Background To interview extraordinary women who have made recent significant contributions to the field of Colorectal Surgery. Design The authors asked some of the many extraordinary women who have made significant contributions to the field of Colorectal Surgery to answer several questions. These women were selected from many potential candidates based upon their extraordinary recent contributions to the field of Colorectal Surgery. These thought leaders were asked about their contributions to Colorectal Surgery, their mentors, whether they had any women as role models, and, lastly, what they would tell their younger selves. The study was structured to recognize these women for their remarkable recent contributions to Colorectal Surgery, and we wished to encourage women to pursue leadership in Colorectal Surgery including the allied fields of Colorectal pathology and Colorectal imaging. Furthermore, the authors hoped to inspire male Colorectal surgeons to actively mentor and help the career development of women Colorectal surgeons. The potential limitations of the study include the fact that there are many more well-deserving women who could have been included in the sample survey but, because of space constraints, were not invited. Conclusion Women in Colorectal Surgery and in the allied specialties of Colorectal pathology and Colorectal radiology have made many recent major significant contributions to Colorectal Surgery. The expectation is that the volume and frequency of such contributions as well as the number of women making these contributions should further significantly increase with time.
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Converted laparoscopic Colorectal Surgery.
Surgical endoscopy, 2001Co-Authors: Pascal Gervaz, Alon J. Pikarsky, M. Utech, Michelle Secic, Jonathan Efron, Bruce Belin, Anil Jain, Steven D. WexnerAbstract:Background Conversion rates following laparoscopic Colorectal Surgery vary widely between studies, and the outcome of converted patients remains controversial.
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Bowel preparation for Colorectal Surgery.
Diseases of the colon and rectum, 2001Co-Authors: Oded Zmora, Alon J. Pikarsky, Steven D. WexnerAbstract:PURPOSE: The aim of this study was to assess recent literature regarding bowel preparation for colonoscopy and Surgery. METHODS: The study was conducted by an Index Medicus English-language search of articles relevant to both oral mechanical and parenteral and oral antibiotic preparation for elective Colorectal Surgery and mechanical bowel preparation for colonoscopy. The study period was from 1975 to 2000. In addition, studies of elective Colorectal Surgery without mechanical bowel preparation were also considered. RESULTS: Although several recent prospective, randomized trials have suggested that elective Colorectal Surgery can be safely performed without any mechanical bowel preparation, mechanical bowel preparation remains the standard of care, at least in North America at the present time. A recent survey of the members of The American Society of Colon and Rectal Surgeons revealed that the majority currently use sodium phosphate for bowel preparation and use a dual oral antibiotic regimen before elective Colorectal Surgery, combined with two doses of parenteral antibiotics. Although some of the use patterns are based on prospective, randomized study, others seem founded strictly on habit and theory. CONCLUSIONS: The current methods of bowel cleansing for both colonoscopy and Surgery include sodium phosphate and polyethylene glycol; Colorectal surgeons practicing in North America currently prefer sodium phosphate. Additional preparation for Colorectal Surgery includes perioperative parenteral antibiotics and, to a slightly lesser degree, preoperative oral antibiotic preparation. Although some recent prospective, randomized studies have suggested that omission of mechanical bowel preparation for elective Colorectal Surgery is not only feasible but potentially preferable, caution is recommended before routinely omitting these widely practiced measures, because data to support such routine omission are limited.
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Mechanical bowel preparation for elective Colorectal Surgery
Diseases of the Colon & Rectum, 1997Co-Authors: Lucia Oliveira, Steven D. Wexner, Norma Daniel, Deborah Demarta, Eric G. Weiss, Juan J. Nogueras, Mitchel BernsteinAbstract:AIM: The aim of this study was to compare the cleansing ability, patient compliance, and safety of two oral solutions for elective Colorectal Surgery. METHODS: All eligible patients were prospectively randomized to receive either 4 1 of standard polyethylene glycol (PEG) solution or 90 ml of sodium phosphate (NaP) as mechanical bowel preparation for Colorectal Surgery. A detailed questionnaire was used to assess patient compliance. In addition, the surgeons, blinded to the preparation, intraoperatively evaluated its quality. Postoperative septic complications were also assessed. The calcium serum level was monitored before and after bowel preparation. Statistical analysis was performed using the Wilcoxon's rank-sum test and Fisher's exact test. RESULTS: Two hundred patients, well matched for age, gender, and diagnosis, were prospectively randomized to receive either PEG or NaP solutions for elective Colorectal Surgery. All patients completed all phases of the trial. There was a significant decrease in serum calcium levels after administration of both NaP (mean, 9.3-8.8 mg/dl) and PEG (9.2-8.9 mg/dl), respectively ( P
Renzo Dionigi - One of the best experts on this subject based on the ideXlab platform.
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Mechanical bowel preparation for Colorectal Surgery.
Surgical infections, 2006Co-Authors: Francesca Rovera, Mario Diurni, Gianlorenzo Dionigi, Luigi Boni, Alberta Ferrari, Giulio Carcano, Veronica Bianchi, Renzo DionigiAbstract:Nosocomial infections are the most frequent complications of surgical patients. Most surgical site infections (SSI) are acquired intraoperatively and arise from the flora of the patient's skin, gastrointestinal tract, or mucous membranes. Although preoperative mechanical cleansing of the bowel is considered by many surgeons a cornerstone of modern elective Colorectal Surgery and, in association with antibiotic prophylaxis, a fundamental component of an intestinal antisepsis program, many surgeons do not perform preoperative mechanical preparation routinely. Review of the pertinent literature. Some recent randomized trials and a Cochrane review found no proof that mechanical bowel preparation reduces the risk of complications after elective Colorectal Surgery. Indeed, there is some evidence that this intervention is associated with a higher rate of anastomotic leakage and wound complications. The dogma that mechanical bowel preparation is necessary before elective Colorectal Surgery may need to be reconsidered. On the other hand, such preparation decreases operating time by improving bowel handling during construction of the anastomosis. Moreover, it is helpful when intestinal palpation will be necessary for identification of a lesion.
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Antibiotic prophylaxis in Colorectal Surgery.
Expert review of anti-infective therapy, 2005Co-Authors: Francesca Rovera, Mario Diurni, Gianlorenzo Dionigi, Luigi Boni, Alberta Ferrari, Giulio Carcano, Renzo DionigiAbstract:Nosocomial infections are the most frequent complications observed in surgical patients. In Colorectal Surgery, the opening of the viscera causes the dissemination into the operative field of microorganisms originating from endogenous sources, increasing the chance of developing postoperative complications. It is reported that without antibiotic prophylaxis, wound infection after Colorectal Surgery develops in approximately 40% of patients. This percentage decreases to approximately 11% after antibiotic prophylaxis. Specific criteria in the choice of correct antibiotic prophylaxis have to be respected, on the basis of the microorganisms usually found in the surgical site, and on the specific hospital microbiologic epidemiology.
Timothy A. Rockall - One of the best experts on this subject based on the ideXlab platform.
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Laparoscopic and open Colorectal Surgery: a prospective cost analysis.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2012Co-Authors: H. M. Dowson, Heather Gage, Daniel Jackson, Yue Qiao, Peter Williams, Timothy A. RockallAbstract:Aim Cost has been perceived to be a factor limiting the development of laparoscopic Colorectal Surgery. This study aimed to compare the costs of laparoscopic and open Colorectal Surgery. Method Patients undergoing laparoscopic or open elective Colorectal Surgery were recruited into a prospective study to evaluate the healthcare costs of each operative procedure in a district general hospital in England. All healthcare resources used (operation, hospital and community) were recorded and converted to costs in British pounds, 2006–2007. Costs of laparoscopic and open Surgery were compared. Results In all, 201 consecutive patients consented and were recruited (131 laparoscopic, 70 open). Operative costs were greater in the laparoscopic group (£2049 vs£1263, P
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Systematic review of the costs of laparoscopic Colorectal Surgery.
Diseases of the colon and rectum, 2007Co-Authors: H. M. Dowson, Andy Huang, Yuen Soon, Heather Gage, D.p. Lovell, Timothy A. RockallAbstract:Recent studies have confirmed the clinical efficacy of laparoscopic Colorectal Surgery; however, its use has not become widespread. One reason for this is perceived economic implications. A systematic review was undertaken examining the costs of laparoscopic Colorectal Surgery. Electronic databases were searched for articles comparing laparoscopic Colorectal Surgery and open Surgery. Primary outcome measures were operating room, direct hospital, and indirect costs. Secondary outcomes were conversion rates and length of hospital stay. The percentage difference in costs was used for comparisons between studies. Twenty-nine articles were identified in which cost data were presented (total number of patients 3,681); the economic data in most studies was limited. Operating room costs were greater for laparoscopic Colorectal Surgery than open Surgery in all studies (median difference, 50 percent; interquartile range, 27–78 percent; P
Deborah S. Keller - One of the best experts on this subject based on the ideXlab platform.
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A narrative celebrating the recent contributions of women to Colorectal Surgery.
Surgery, 2020Co-Authors: Deborah S. Keller, Mariana Berho, Gina Brown, Tracy L. Hull, Gabriela Moeslein, Steven D. WexnerAbstract:Abstract Background To interview extraordinary women who have made recent significant contributions to the field of Colorectal Surgery. Design The authors asked some of the many extraordinary women who have made significant contributions to the field of Colorectal Surgery to answer several questions. These women were selected from many potential candidates based upon their extraordinary recent contributions to the field of Colorectal Surgery. These thought leaders were asked about their contributions to Colorectal Surgery, their mentors, whether they had any women as role models, and, lastly, what they would tell their younger selves. The study was structured to recognize these women for their remarkable recent contributions to Colorectal Surgery, and we wished to encourage women to pursue leadership in Colorectal Surgery including the allied fields of Colorectal pathology and Colorectal imaging. Furthermore, the authors hoped to inspire male Colorectal surgeons to actively mentor and help the career development of women Colorectal surgeons. The potential limitations of the study include the fact that there are many more well-deserving women who could have been included in the sample survey but, because of space constraints, were not invited. Conclusion Women in Colorectal Surgery and in the allied specialties of Colorectal pathology and Colorectal radiology have made many recent major significant contributions to Colorectal Surgery. The expectation is that the volume and frequency of such contributions as well as the number of women making these contributions should further significantly increase with time.
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Laparoscopic Procedures: Single-Incision Laparoscopic Colorectal Surgery
Techniques in Minimally Invasive Rectal Surgery, 2017Co-Authors: Daniel P. Geisler, Deborah S. KellerAbstract:Laparoscopy was the greatest technological advance in Colorectal Surgery in the last quarter century. The first laparoscopic colon resection in the United States was performed in 1991. Since that time, the benefits of a minimally invasive approach for Colorectal Surgery have been well documented, including earlier return of bowel function, decreased analgesic requirement, faster recovery, superior cosmesis, and shorter length of stay without increasing readmission rates [1–10]. Despite proven benefits, there has been a limited adoption of traditional multiport laparoscopic Colorectal Surgery. Currently, the use of laparoscopic Colorectal Surgery is estimated in half of applicable elective cases [11] and even fewer Colorectal cancer cases [12]. Reasons cited for limited use include the additional learning curve and added technical and ergonomic complexities of the Surgery. Multiple minimally invasive variations have been devised to help increase adoption and penetrance, including hand-assisted and robot-assisted laparoscopic platforms. However, the paradigm of high-quality, high-satisfaction Surgery has continued to progress toward less invasive modalities, such as reduced port and single-incision laparoscopic Surgery (SILS).
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Minimally invasive Colorectal Surgery: status and technical specifications.
Minerva chirurgica, 2015Co-Authors: Deborah S. Keller, S Ibarra, Eric M. HaasAbstract:Laparoscopy was the most significant technologic advance in Colorectal Surgery in the last quarter century. The safety, feasibility and oncologic equivalence have been proven, and undisputed clinical benefits have also been demonstrated over open approaches. Despite proven benefits, laparoscopic has not dominated the market, especially for colon and rectal cancer cases. Adaptations in laparoscopic technique were developed to increase use of minimally invasive Surgery. Concurrently, there has been a paradigm shift toward less invasive technologies to further optimize patient outcomes. From these needs, hand assisted laparoscopic Surgery (HALS), single incision laparoscopic Surgery (SILS), and robotic assisted laparoscopic Surgery (RALS) were applied to Colorectal Surgery. Each platform has unique costs and benefits, and similar outcomes when likened to each other in comparative studies. However, conventional laparoscopy, HALS, SILS, and RALS actually serve a complementary role as tools to increase the use of minimally invasive Colorectal Surgery. The goal of this paper is to review the history, current status, technical specifications, and evolution of the major minimally invasive platforms for Colorectal Surgery.
Luigi Boni - One of the best experts on this subject based on the ideXlab platform.
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Financial Impact of Anastomotic Leakage in Colorectal Surgery
Journal of Gastrointestinal Surgery, 2019Co-Authors: Davide La Regina, Luigi Boni, Matteo Di Giuseppe, Massimo Lucchelli, Andrea Saporito, Christopher Efthymiou, Stefano Cafarotti, Michele Marengo, Francesco MongelliAbstract:Background Anastomotic leakage after Colorectal Surgery is a complication that requires additional treatments strongly affecting the economic outcomes. We evaluated the use of resources and the economic burden associated with anastomotic leaks following Colorectal Surgery. Methods Between January 2015 and December 2016, we retrospectively evaluated patients who underwent Colorectal Surgery with primary anastomosis. We compared the medical resource utilization and the DRG-based reimbursement of cases with uncomplicated Surgery and cases complicated by anastomotic leakage. Results Of the 95 patients included in the study, 87 (92%) presented an uneventful postoperative course and 8 patients (8%) developed an anastomotic leakage requiring Surgery. The statistical analysis showed no significant differences in terms of demographics, risks factor, and operative results, except the length of hospital stay (9.7 vs. 29.1 days, p
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Mechanical bowel preparation for Colorectal Surgery.
Surgical infections, 2006Co-Authors: Francesca Rovera, Mario Diurni, Gianlorenzo Dionigi, Luigi Boni, Alberta Ferrari, Giulio Carcano, Veronica Bianchi, Renzo DionigiAbstract:Nosocomial infections are the most frequent complications of surgical patients. Most surgical site infections (SSI) are acquired intraoperatively and arise from the flora of the patient's skin, gastrointestinal tract, or mucous membranes. Although preoperative mechanical cleansing of the bowel is considered by many surgeons a cornerstone of modern elective Colorectal Surgery and, in association with antibiotic prophylaxis, a fundamental component of an intestinal antisepsis program, many surgeons do not perform preoperative mechanical preparation routinely. Review of the pertinent literature. Some recent randomized trials and a Cochrane review found no proof that mechanical bowel preparation reduces the risk of complications after elective Colorectal Surgery. Indeed, there is some evidence that this intervention is associated with a higher rate of anastomotic leakage and wound complications. The dogma that mechanical bowel preparation is necessary before elective Colorectal Surgery may need to be reconsidered. On the other hand, such preparation decreases operating time by improving bowel handling during construction of the anastomosis. Moreover, it is helpful when intestinal palpation will be necessary for identification of a lesion.
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Antibiotic prophylaxis in Colorectal Surgery.
Expert review of anti-infective therapy, 2005Co-Authors: Francesca Rovera, Mario Diurni, Gianlorenzo Dionigi, Luigi Boni, Alberta Ferrari, Giulio Carcano, Renzo DionigiAbstract:Nosocomial infections are the most frequent complications observed in surgical patients. In Colorectal Surgery, the opening of the viscera causes the dissemination into the operative field of microorganisms originating from endogenous sources, increasing the chance of developing postoperative complications. It is reported that without antibiotic prophylaxis, wound infection after Colorectal Surgery develops in approximately 40% of patients. This percentage decreases to approximately 11% after antibiotic prophylaxis. Specific criteria in the choice of correct antibiotic prophylaxis have to be respected, on the basis of the microorganisms usually found in the surgical site, and on the specific hospital microbiologic epidemiology.
