Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges
| Autor: | Frédéric Ris, Christian Toso, Nicolas C. Buchs, Niki Christou, Surennaidoo P. Naiken, Emilie Liot, Jeremy Meyer |
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| Rok vydání: | 2019 |
| Předmět: |
Opinion Review
medicine.medical_specialty Leak Colon Anastomosis medicine.medical_treatment Anastomotic Leak Enema Rectal surgery 03 medical and health sciences 0302 clinical medicine Preoperative Care Humans Surgical Wound Infection Anastomotic leakage Medicine Fluorescein Angiography Cathartics Fluorescence angiography business.industry Incidence Prevention Anastomosis Surgical Rectum Gastroenterology General Medicine Colorectal surgery Anti-Bacterial Agents Gastrointestinal Microbiome Surgery Diverting stoma Treatment Outcome 030220 oncology & carcinogenesis Colic surgery Bowel preparation 030211 gastroenterology & hepatology Complication business Surgical site infection |
| Zdroj: | World Journal of Gastroenterology |
| ISSN: | 1007-9327 |
| Popis: | Anastomotic leak (AL) constitutes a significant issue in colorectal surgery, and its incidence has remained stable over the last years. The use of intra-abdominal drain or the use of mechanical bowel preparation alone have been proven to be useless in preventing AL and should be abandoned. The role or oral antibiotics preparation regimens should be clarified and compared to other routes of administration, such as the intravenous route or enema. In parallel, preoperative antibiotherapy should aim at targeting collagenase-inducing pathogens, as identified by the microbiome analysis. AL can be further reduced by fluorescence angiography, which leads to significant intraoperative changes in surgical strategies. Implementation of fluorescence angiography should be encouraged. Progress made in AL comprehension and prevention might probably allow reducing the rate of diverting stoma and conduct to a revision of its indications. |
| Databáze: | OpenAIRE |
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