Colorectal Surgery Retrospective Analysis

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COLORECTAL SURGERY RETROSPECTIVE ANALYSIS ENRIQUE MONCADA. Colo-proctology Unit Dept. of Surgery H. Meixoeiro- CHUVI XVII Colo-proctology Course. Baiona February 2009

POSTOPERATIVE STAY IN COLORECTAL SURGERY Europe USA F-T/ERAS

[object Object],[object Object],[object Object]

PERIOPERATIVE CARE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CONVENTIONAL EBM

Mechanical preparation of the colon ,[object Object],[object Object]

Guenaga KKFG, Matos D, Wille-Jørgensen P Cochrane Database of Systematic Reviews 2009, Issue 1. ,[object Object],[object Object],[object Object],[object Object],[object Object]

Guenaga KKFG, Matos D, Wille-Jørgensen P Cochrane Database of Systematic Reviews 2009, Issue 1. ,[object Object],[object Object]

MECHANICAL PREPARATION OF COLON Spain Roig JV Colorectal Dis 2008 Europe USA F-T/ERAS Kehlet JAmColSurg 2006

PREOPERATIVE FASTING ,[object Object],Hunger Anxiety Pre-op Stress Catecholamines Increased insulin resistance Post-op Hyperglycemia

EBM ,[object Object],[object Object],Soop M et al. Br. J Surg 2004

VERTICAL INCISIONS ,[object Object],[object Object],[object Object],[object Object]

HORIZONTAL INCISIONS ,[object Object],[object Object],[object Object],[object Object],Brown SR et al. Transverse verses midline incisions for abdominal surgery. Cochrane Database of Systematic Reviews 2005, Issue 4 .

Laparoscopic Access ,[object Object],[object Object],[object Object],[object Object],[object Object],Schwenk W et al. Short term benefits for laparoscopic colorectal Resection. Cochrane Database Syst Rev 2005

Laparoscopic colorectal surgery UK France Germany Italy Spain USA Kehlet el al. J Am Coll Surg .2006

Postoperative Fasting ,[object Object],[object Object],[object Object]

Nutrition immediately postoperative ,[object Object],[object Object],[object Object],[object Object],Lewis el al BMJ 2001

Postoperative Nutrition: introduction of liquids. UK France Germany Italy Spain USA F-T/ERAS Kehlet JAm Coll Surg 2006

Postoperative Nutrition: First solid food UK France Germany Italy Spain USA F-T/ERAS Kehlet. J Am Coll Surg 2006

Postoperative rest ,[object Object],[object Object],[object Object],[object Object],[object Object]

Postoperative movilization ,[object Object],[object Object],[object Object],Kehlet J Am Coll Surg 2006

NGT ,[object Object],[object Object],[object Object],[object Object],[object Object]

Cheatham et al. Ann.Surg 1995. Meta-analysis compares a selective routinary use of NGT on 6850 patients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

NGT in Spain 1996 2006 Roig JV. Cir Esp. 2008

Prophylactic drains ,[object Object],[object Object],[object Object],[object Object],[object Object]

Karliczec A et al. Drainage or non drainage in elective colorectal anastomosis: a systematic review and meta analysis. Colorectal Dis. 2006 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Drains in Spain Routinary Selective Roig JV. Cir Esp. 2008

Foley ( urine )catheter ,[object Object],[object Object],[object Object]

Benoist S . Optimal duration of urinary drainage after rectal resection: A randomized controlled trial. Surgery 1999 ,[object Object],[object Object],[object Object]

Surgical practice evidence based Ubbink DT Br J Surg 2004

Surgeons are questioning the veracity and accuracy of the publications : “one thing is what has been published and another……”

THE NEAR FUTURE ,[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kehet H, Wilmore D. Ann Surg 2008

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