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PubMed2004

Colorectal surgery: the risk and burden of adhesion-related complications.

OBJECTIVES: Adhesions are associated with serious medical complications. This study examines the real-time burden of adhesion-related readmissions following colorectal surgery and assesses the impact of previous surgery on adhesion-related outcomes. PATIENTS AND METHODS: The study used data from the Scottish National Health Service Medical Record Linkage Database to identify three cohorts of patients who had undergone open colorectal surgery during the financial years 1996-97, 1997-98 and 1998-99. Each cohort was followed up for at least 2 years and the number and category of adhesion-related readmissions was recorded. The influence of any previous operations on adhesion-related readmissions was also determined by performing a subanalysis within the 1996-97 cohort of patients who had no record of abdominal surgery within either the previous 5 or 15 years. The relative risk of adhesion-related readmissions was also assessed. RESULTS: In the 1996-97 cohort, 9.0% of patients were readmitted within a year after surgery; 2.1% had complications directly related to adhesions and 6.9% had complications that were possibly related. After 4 years, 19.0% of patients were readmitted for reasons directly or possibly related to adhesions. Many patients were readmitted on more than one occasion and the relative risk of adhesion-related complications was 29.7 per 100 initial procedures over 4 years. In the subgroups that had no record of abdominal surgery within the previous 5 or 15 years, the relative risks of adhesion-related complications were 24.8% and 23.5%, respectively. There was no change in the rate of adhesion-related readmissions following colorectal surgery between 1996 and 1999. CONCLUSION: Colorectal surgery is associated with a considerable rate of adhesion-related readmissions. Preventative measures should be considered to reduce this risk.

Adult↗

PubMed1993

Experience with laparoscopic colorectal surgery for malignant disease.

Laparoscopic or laparoscopic-assisted surgery for colorectal cancer was attempted in 59 patients suffering from malignant disease of the anus, rectum and colon over a 20-month period. Conversion to open surgery was necessary in 5 patients (8.4%). The peroperative (30-day) mortality was 5.8%, and in two of the three patients who died this was attributable to thrombo-embolic complications. The cancer-related mortality was 8%. There were 5 Dukes' A, 21 Dukes' B and 25 Dukes' C lesions resected, and thus far all recurrences were in patients who had Dukes' C lesions. The resection margins and lymph node yield in these specimens were similar to those achieved with conventional open surgery. Six patients also had hepatic metastases recognized at the time of primary surgery. These preliminary data indicate the feasibility of performing laparoscopic-assisted resection of colorectal cancer without compromising the accepted principles of excisional surgery for malignant disease. However, a number of important issues such as thrombo-embolic prophylaxis, specimen retrieval and the long-term recurrence rates require further study before these procedures are widely adopted for colorectal cancer.

Adult↗

PubMed2001

Uptake of gallium-67 citrate in clean surgical incisions after colorectal surgery.

Non-specific accumulation of gallium-67 citrate (gallium) in uncomplicated surgical incisions is not uncommon. It is important to know the normal pattern of gallium uptake at surgical incision sites in order to properly interpret the gallium scan when investigating possible wound infection in patients who have undergone abdominal surgery. We studied 42 patients without wound infection after colorectal surgery and performed gallium scans within 40 days after surgery. Patients were divided into three groups according to the interval between the operation and the scan. In group A (26 patients) gallium scan was performed within 7 days after surgery, in group B (8 patients) between 8 and 14 days after surgery, and in group C (8 patients) between 15 and 40 days after surgery. Our data showed that in group A, 61.5% had gallium accumulation at the surgical incision site. In group B, 50% had accumulation of gallium at the surgical incision site, while in group C only one patient (12.5%) showed gallium uptake. It is concluded that the incidence of increased gallium uptake at clean surgical incision sites is high after colorectal surgery. Nuclear medicine physicians should bear in mind the high incidence of non-specific gallium uptake at such sites during the interpretation of possible wound infection in patients after colorectal surgery.

Adolescent↗

PubMed1982

Prophylaxis of deep venous thrombosis in colorectal surgery.

A group of 230 patients undergoing elective colorectal surgery was analyzed for the presence of deep venous thrombosis (DVT). Prophylaxis against DVT was practiced with low-dose heparin (either 5000 IU every eight hours, or 5000 IU every 12 hours for seven days) in 199 patients. Prevention of infection was attempted with preoperative administration of Enterobiotic in 155 patients and of Vibramycin in 11 patients. DVT was diagnosed in 46 patients. The frequency of DVT did not differ significantly between patients who underwent resections of the colon and those who underwent rectal surgery. DVT was diagnosed in 27 of the 73 infected patients, which was significantly higher than the incidence of 19 with DVT among the 157 uninfected patients. The frequency of DVT among patients in the two heparin regimens was 15 and 17 per cent respectively, which was significantly lower than with untreated patients. No lethal pulmonary embolism was found and no patient showed clinical signs of embolism. It is assumed that measures aimed at reducing postoperative infection, combined with low-dose heparin, will reduce the incidence of postoperative DVT after colorectal surgery.

Adult↗

PubMed1991

New advances in antibiotic prophylaxis for colorectal surgery.

The major advances in antibiotic prophylaxis in colorectal surgery have come from an awareness of the need for appropriate agents against the known likely pathogens and from knowledge of the pharmacokinetics of these drugs. Intensive study has been undertaken to identify optimal regimens, but as there is great variability in the settings under which these operations take place, it is not always possible to compare the results of these various investigations. There is little doubt that in many cases there is gross contamination with faecal organisms and the term prophylaxis is inappropriate so that prolonged courses of antibiotics would appear to be safer. However, work towards identifying patients at increased susceptibility of developing septic complications may well further improve the outcome of colorectal surgery.

Anti-Bacterial Agents↗

PubMed2006

[Introduction of laparoscopic colorectal surgery in the Sint Franciscus Gasthuis, Rotterdam, 2002/2005].

OBJECTIVE: Analysis of the introduction of laparoscopic colorectal surgery in practice DESIGN: Retrospective and descriptive. METHOD: The introduction process of laparoscopic colorectal surgery in the Sint Franciscus Gasthuis (hospital) in Rotterdam, The Netherlands, was divided into 3 phases: the pioneers phase (1 August 2002 to 31 August 2004), the course phase (1 September 2004 to 31 December 2004) and the implementation phase (1 January 2005 to 31 August 2005). All patients who received elective laparoscopic colorectal resection (n = 88) of the total 255 patients who, according the current standard could be treated laparoscopically, were analysed for iatrogenic complications, operation time and the percentage that was performed by surgical residents. RESULTS: The percentage of elective colorectal procedures that were performed laparoscopically increased significantly in the 3 phases from 17% (27/163), to 50% (18/36) and 77% (43/56). Of these procedures, 30% (8/27), 17% (3/18) and 16% (7/43) were converted to an open procedure respectively. During the pioneers phase, 5 iatrogenic complications occurred: 2 ureter stenoses, 1 colon lesion, 1 inferior mesenteric artery bleeding lesion and 1 renal vein bleeding resulting in secondary splenectomy. During the course and implementation phases, no iatrogenic complication lesion occurred. The average operation time decreased from 191 via 186 to 182 minutes, despite the fact that the percentage of procedures performed by surgical residents increased from 15% (4/27), to 22% (4/18) and to 44% (19/43) in the respective phases and despite the fact that the amount of rectum resections increased from 19% (5/27) via 44% (8/18) to 37% (16/43). CONCLUSION: Specific training in laparoscopic colorectal surgery was combined with a safe and fast introduction of this technique in practice and the training program of surgical residents. This training could therefore avoid iatrogenic complication.

Aged↗

PubMed1988

Prophylactic antibiotics in elective colorectal surgery.

A randomized prospective study was conducted on 194 patients who underwent elective colorectal surgery for carcinoma. All patients received the same mechanical bowel preparation. In addition, patients in group A received oral neomycin and erythromycin base; patients in group B received systemic metronidazole and gentamicin, while patients in group C received both oral and systemic antibiotics. Postoperative septic complications related to colorectal surgery occurred in 27.4 per cent, 11.9 per cent and 12.3 per cent respectively in groups A, B and C (chi 2 = 7; P less than 0.05). The incidence of sepsis in groups B and C was almost identical. Patients who received oral antibiotics alone (group A) had significantly higher risks of postoperative sepsis when compared with patients in either group B or group C (P less than 0.05). As there is no additional advantage of combining oral and systemic antibiotics, we recommend systemic metronidazole and gentamicin to be used with mechanical bowel preparation in elective colorectal surgery.

Administration, Oral↗

PubMed1997

[Current antibiotic prophylaxis in colorectal surgery].

Over a one-year period (November 1996 to November 1997), in the Emergency Surgery Clinic perioperative parenteral antibiotic prophylaxis during colorectal operations is performed in a series of 32 patients, admitted on an emergency and deferred urgency basis, or for routine operative treatment. Of them 30 present malignant processes involving colon and rectum, and two--inflammatory diseases. All patients receive single i.v. injections with Cephalothin/Cefazolin at dose 2.0 g and Metronidazole 0.5 g immediately after anesthesia induction. In nine cases additional early treatment is necessitated--within 24 hours after the operative intervention--by administration of the same drug combination 4 times at 6-hour intervals, and in another two prophylaxis is substituted for continuous 5-day treatment using the same therapeutic scheme. In 30 patients the postoperative period runs a course free of noteworthy complications. In two instances there is evidence of operative wound suppuration, and in further two--urinary tract infection development unrelated to the antibiotic prophylaxis applied. The specific features characterizing the application of antibiotic prophylaxis during colorectal surgery are discussed, and appropriate drug therapy schemes are recommended, consistent with worldwide and Bulgarian experience along this line, as well as with the concrete hospital and economical conditions in this country. Special emphasis is laid on two aspects: optimization of the timing of antibiotic agent/agents injection, and reaching peak serum and tissue bactericidal concentrations in the immediate vicinity of the surgical incision; optimization of the duration of antibiotic prophylaxis on the ground of well established indications for the application of antibiotic prophylaxis in colorectal surgery in compliance with the dynamic patterns of intra- and postoperative septic risk. The modest number of patients subjected to updated parenteral perioperative antibiotic prophylaxis does not warrant a definitive interpretation of the data from the comparative clinical and pharmaco-economical analyses performed. Nevertheless, the preliminary results point to the economical expedience of the therapeutic approach suggested.

Adult↗

PubMed2006

Predictors of intra- and postoperative complications in laparoscopic colorectal surgery: results of an expert survey.

BACKGROUND: The decision which patient should undergo laparoscopic rather than open colorectal surgery depends on weighing its benefits against its complications. We explored which criteria prognosticate complications in a laparoscopic intervention by assembling experienced visceral surgeons' beliefs. METHODS: A two-round postal survey was conducted: 21 experts in laparoscopic surgery were contacted and asked to list (first round) and weigh (second round) indicators (scale 1-10) they believed predicted intra- or postoperative complications in patients undergoing laparoscopic colorectal surgery. Median ratings and interquartile ranges (IQRs) were calculated. Rates >or=6 and IQRs <or=3 depicted an important prognostic indicator for complications. RESULTS: Thirty-nine intraoperative and 43 postoperative listings and ratings of 19 experts (90%) were available for analysis. The experts depicted three domains of indicators (tumor, comorbidity and related institution). The strongest indicators for intraoperative complications were surgeon's experience (median 9, IQR 8-10) and portal hypertension (median 9, IQR 7-10), and those for postoperative complications were liver cirrhosis Child B/C (median 8, IQR 7.75-10) and experience of the surgeon (median 8, IQR 7-10). CONCLUSION: This survey provides additional evidence of risk indicators for intra- and postoperative complications in patients undergoing laparoscopic colorectal surgery. Whether the identified indicators can be compiled into a prognostic instrument requires confirmation in a properly designed and sized study.

Colon↗

PubMedDate not supplied

The limited use of ultrasound in the detection of abdominal abscesses in patients after colorectal surgery: compared with gallium scan and computed tomography.

BACKGROUND/AIMS: Ultrasound has been suggested to be a first-line test for the detection of intra-abdominal abscess (IAA). However, according to our experience, ultrasound seemed not so effective when applied to the patients after colorectal surgery. Computed tomography (CT) and gallium scan have also been suggested as very useful for the detection of IAA. The purpose of this study was to evaluate the efficacy of sonography and gallium scan in diagnosing intra-abdominal abscess after colorectal surgery and to compare these results with CT. METHODOLOGY: Twenty-three patients with suspected IAA after colorectal surgery at our institution were eligible for the study. A positive IAA was verifed only if pus was drained or on postmortem examination. Negative reports of abscesses were verified by adequate outpatient review following hospital discharge that indicated the clinical absence of an abscess. Within 4 days of the clinical suspicion of abscess, all patients were evaluated by three techniques: sonography, CT and gallium scan. We compared the sensitivity, specificity and accuracy of these modalities. RESULTS: Fourteen of the 23 patients (60.9%) were verified as IAA. We found the sensitivity, specificity, and accuracy of CT scan for the detection of LAA in the patients with colorectal surgery to be 92.9%, 100%, and 95.7%, respectively. The sensitivity, specificity and accuracy of gallium scan were 100%, 77.8% and 91.3%, respectively. Ultrasound had a 42.9% sensitivity, 100% specificity, and 65.2% overall accuracy for diagnosing IAA. CONCLUSIONS: Sonography plays a small role in the detection of IAA in the patients after colorectal surgery. CT and gallium scan are more helpful than sonography for the detection of IAA.

Abdominal Abscess↗

PubMed1983

Single dose metronidazole with and without cefuroxime in elective colorectal surgery.

Seventy patients undergoing elective colorectal surgery for malignant and inflammatory bowel disease were allocated randomly to one of two groups. Patients in group 1 were given, after induction of anaesthesia, a single dose of metronidazole 500 mg i.v. Patients in group 2 were given in addition a single dose of cefuroxime 1.5 g i.v. Of 34 patients in group 1, 4 (11.8 per cent) developed postoperative infection. Of 36 patients in group 2, 5 (13.6 per cent) developed postoperative infection. No significant difference was noted in the incidence of postoperative sepsis between the two treatment groups.

Adolescent↗

PubMed1992

Evaluation of tissue oximetry in perioperative monitoring of colorectal surgery.

Twenty patients undergoing elective colorectal surgery were studied during and after operation by means of tissue oximetry measuring the subcutaneous partial pressure of oxygen (PscO2) and by gastric intramural pH measurement. Mean(s.d.) PscO2 recorded 24 h after surgery was significantly lower than the peroperative value: 14(10) versus 24(14) mmHg, P less than 0.02. The postoperative PscO2 was also significantly lower than that measured in a control group of ten healthy volunteers: 14(10) versus 34(18) mmHg, P less than 0.001. The peroperative PscO2 of the patients who developed a postoperative complication was significantly lower than that of those who had an uneventful postoperative clinical outcome: 16(9) versus 32(14) mmHg, P less than 0.02. The peroperative PscO2 of the patient group with complications was also significantly lower than that of the control group: 16(9) versus 34(18) mmHg, P less than 0.02. The peroperative PscO2 of the group of patients without complications was almost identical to that of the control group. During operation only one patient developed gastric intramural acidosis. Perioperative oxygen debt and the response of subcutaneous tissue oxygen tension to oxygen breathing seemed to correlate better with clinical outcome than gastric wall pH values and the conventional parameters of tissue perfusion.

Adult↗

PubMed2005

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

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 prospectively 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 [-1.2 to +1.4 d]). CONCLUSION: Gastrografin not only allowed early oral feeding but also reduced the duration of hospitalization after elective colorectal surgery.

Aged↗

PubMed1994

Incidental cholecystectomy during colorectal surgery.

OBJECTIVE: To assess the risks and benefits of incidental cholecystectomy in patients having colorectal surgery. SUMMARY BACKGROUND DATA: Cholelithiasis is found commonly during abdominal surgery. Previous studies used disparate methods to assess the risks and benefits of incidental cholecystectomy and have reached contradictory conclusions. METHODS: All patients in whom asymptomatic cholelithiasis was noted during colorectal surgery between January 1982 and December 1986 were studied. Operative morbidity and long-term outcome were assessed by chart review and questionnaire. RESULTS: Three hundred five patients were identified, of whom 195 (63.9%) had an incidental cholecystectomy and 110 (36.1%) did not. The two groups were similar in terms of age, sex, primary disease, and associated medical conditions, although fewer emergency procedures, abdominoperineal resections, and Hartmann's procedures were needed in the cholecystectomy group. The overall operative morbidity rate was the same in both groups. The long-term risk for developing small bowel obstruction was also similar. After a median follow-up of 6 years after hospital discharge, biliary pain or cholecystitis developed in 16 patients (14.6%) in the "no cholecystectomy" group, 12 of whom have had cholecystectomy. Two additional patients had cholecystectomy for acute postoperative cholecystitis while still in the hospital. Six more patients have had incidental cholecystectomy at subsequent laparotomies. The cumulative probability of needing cholecystectomy at 2 and 5 years after the initial colorectal operation was 12.1% and 21.6%, respectively. CONCLUSIONS: Incidental cholecystectomy was not associated with increased postoperative morbidity, whereas the long-term risk that previously asymptomatic gallstones would become symptomatic was substantial. Unless there are clear contraindications, patients with asymptomatic gallstones who have colorectal surgery should have concomitant cholecystectomy.

Adolescent↗

PubMed2006

Venous thromboembolism: a review of risk and prevention in colorectal surgery patients.

Hospitalization for surgery has a high risk of developing venous thromboembolism, a condition that encompasses both deep-vein thrombosis and its potentially fatal complication, pulmonary embolism. Colorectal surgery implies a specific high risk for postoperative thromboembolic complications relative to other general surgery. This may be a result of pelvic dissection, the perioperative positioning of these patients, or the presence of additional risk factors common to this patient group, such as cancer, advanced age, or inflammatory bowel disease. The potential impact of venous thromboembolism and the need for effective thromboprophylaxis often are underestimated in these patients. Recommendations for thromboprophylaxis in colorectal surgery patients are based on the American College of Chest Physicians guidelines for thrombosis prevention in general surgery patients, with treatment stratified according to the type of surgery and additional venous thromboembolism risk factors present. Prophylaxis with low-molecular-weight heparin or unfractionated heparin is recommended for colorectal surgery patients classified as moderate to high risk. The small number of studies focusing specifically on colorectal patients, or on cancer or abdominal surgery patients with a colorectal subgroup, has shown that both low-molecular-weight heparin and unfractionated heparin can effectively reduce the incidence of venous thromboembolism. Low-molecular-weight heparin has the practical advantage of once-daily administration and shows a lower risk of heparin-induced thrombocytopenia. This review will assess the risk of venous thromboembolism in colorectal surgery patients and discuss current evidence-based guidelines and recommendations for prevention of venous thromboembolism.

Anticoagulants↗

PubMed2005

Laparoscopic colorectal surgery in obese patients.

BACKGROUND: The aim of the study was to the evaluate results of laparoscopic colorectal surgery in obese patients. METHODS: All patients who underwent elective laparoscopic colorectal surgery from January 1993 to December 2003 were included in the study. BMI>30 was used as an objective obesity criterion. The evaluated parameters included BMI, age, sex, diagnosis and associated diseases, American Society of Anesthesiologists classification score (ASA), type and duration of procedure, peroperative and postoperative complications, postoperative course, reoperation, length of hospitalization, morbidity and early mortality. RESULTS: 435 patients were evaluated. There were 80 patients (18%) in the obese group, and 355 patients (82%) were non-obese. The samples were comparable in terms of age, gender, ASA, diagnosis and procedure. Peroperative complications occurred more frequently in the obese group of patients (4% vs 2.5%, P>0.05) and the operating time was longer as well (151 min vs 141 min, P>0.05), both statistically not significant. There was no difference in postoperative course in both groups with regard to intravenous administration of analgesics (2 days), start of solid diet (day 3) and first bowel movement (day 4). Morbidity was higher in the obese group of patients (33% vs 24%, P>0.05), and reoperations were also more frequent here (13% vs 7%, P>0.05), which was reflected in prolonged hospital stay (14 days vs 12 days, P>0.05). On the other hand, early mortality was surprisingly lower in the obese group of patients (2.5% vs 6%, P>0.05). However, none of these differences achieved statistical significance on the set significance level of P=0.05. CONCLUSION: With sufficient experience, laparoscopic colorectal surgery in obese patients is feasible and safe. It is associated with no increased risk of complications and preserves all benefits of the mini-invasive approach.

Adolescent↗

PubMed1999

Hypothermia in open and laparoscopic colorectal surgery.

PURPOSE: Perioperative hypothermia has been shown to be an important determinant of outcome after open colorectal resections. The degree of hypothermia occurring with laparoscopic-assisted colorectal surgery is, however, unknown, and the effectiveness of standard warming measures is untested. This study was designed to assess hypothermia in open and laparoscopic-assisted colonic resections using a standardized warming protocol. METHODS: A prospective, nonrandomized study was performed with temperature measurements recorded every ten minutes. Statistical analysis was based on repeated measures analysis of variance models with significance set at the conventional 95 percent (two tailed). RESULTS: A total of 107 patients were entered into the trial; 68 had open and 39 had laparoscopic colectomies. The groups were well matched for age, weight, and duration of surgery, with a median operating time of 180 minutes in each group. The average drop in temperature from commencement of surgery to lowest point was 0.68 degrees C (standard deviation, 0.08) in the open group, compared with 0.53 degrees C (standard deviation, 0.06) in the laparoscopic group (P = 0.126). CONCLUSIONS: Laparoscopic-assisted colorectal surgery is not associated with a higher incidence of perioperative hypothermia than open colorectal surgery using a standard warming regimen for both groups. On the basis of these results, standard temperature conservation is adequate, even for long, complex laparoscopic procedures.

Colon↗

PubMed2002

Complications after colorectal surgery without mechanical bowel preparation.

BACKGROUND: The current practice of mechanical bowel preparation (MBP) before colorectal surgery is questionable. Mechanical bowel preparation is unpleasant for the patient, often distressful, and potentially harmful. The results are often less than desired, increasing the risk of contamination. Cleansing the colon and rectum before surgery has never been shown in clinical trials to benefit patients. In animal experiments MBP has a detrimental effect on colonic healing. STUDY DESIGN: To investigate the outcomes of colorectal surgery without MBP, we prospectively evaluated a consecutive series of patients who underwent resection and primary anastomosis of the colon and upper rectum, including emergency operations. One surgeon performed all operations. Endpoints were wound infection, anastomotic failure, and death. Late signs and symptoms that might be secondary to leakage of the anastomosis were considered as an anastomotic failure as well, during a followup of 1 year. RESULTS: Two hundred fifty operations were performed, of which 199 (79.6%) were elective. Colectomies were left-sided in 65.6%. Anastomoses were ileocolic in 32%, colocolic in 20.8%, colorectal intraperitoneal in 34.4%, and extraperitoneal in 12.8%. No patient suffered from fecal impaction. Followup was complete in 97.2%. Eight patients (3.3%; 95% confidence interval [CI]: 1.4-6.4) developed superficial wound infections. In three patients there was leakage from an extraperitoneal colorectal anastomosis, in two of them after hospital discharge. The overall anastomotic failure rate was 1.2% (95% CI: 0.3-3.6). The in-hospital mortality rate was 0.8% (95% CI: 0.1-2.9) and was not related to abdominal or septic complications. CONCLUSION: Mechanical bowel preparation is not a sine qua non for safe colorectal surgery.

Adolescent↗