Short-Term Outcomes of Laparoscopy Combined with Enhanced Recovery Pathway after Ileocecal Resection for Crohn’s Disease: a Case-Matched Analysis

Spinelli, Antonino; Bazzi, Piero; Sacchi, Matteo; Danese, Silvio; Fiorino, Gionata; Malesci, Alberto; Gentilini, Lorenzo; Poggioli, Gilberto; Montorsi, Marco

doi:10.1007/s11605-012-2012-5

Cited by 56 publications

(34 citation statements)

References 29 publications

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“…Conversion to laparoscopy was easy to perform owing to the configuration of the robotic arms that allowed the assistant and the surgeon to access the patient rapidly. The postoperative major complication (Clavien–Dindo ≥3) rate was 4.4%, which does not differ significantly from the overall results after minimally invasive surgery previously reported from our practice . The haptic feedback, alerting the surgeon of possible inadvertent damage while moving the instruments, could have played a role in preventing intra‐operative complications.…”

Section: Discussionsupporting

confidence: 44%

First experience in colorectal surgery with a new robotic platform with haptic feedback

et al. 2018

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Section: Discussionsupporting

confidence: 44%

First experience in colorectal surgery with a new robotic platform with haptic feedback

et al. 2018

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“…In favor of avoiding bowel preparation and implementing minimally invasive surgery whenever possible, an enhanced recovery pathway without MBP in laparoscopic CD surgery did not lead to increased complication rates with shorter hospital stay in a study by Spinelli et al. [28]. Notably, SSI per se were not reported in the study but Clavien-Dindo grade I–II complications (which included opening of a wound at the bedside) were similar.…”

Section: Discussionmentioning

confidence: 90%

Outcome of no oral antibiotic prophylaxis and bowel preparation in Crohn’s diseases surgery

Unger

Riss

Argeny

et al. 2019

Wien Klin Wochenschr

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SummaryBackgroundRecent studies support the use of mechanical bowel preparation and/or oral antibiotic prophylaxis in patients operated on for Crohn’s disease (CD); however, data are scarce, especially for laparoscopic surgery. Therefore, this study was carried out to investigate the effect of laparoscopic surgery on complication rates in patients not undergoing standardized bowel preparation but single shot antibiotics.MethodsIn this study 255 consecutive patients who underwent a laparoscopic intestinal resection for CD at a tertiary referral center between 1997 and 2014 were retrospectively analyzed. Superficial surgical site infections (SSI), organ/space infections and ileus were recorded and grouped according to the type of resection (colorectal vs. small intestine ± ileocecal).ResultsThe baseline characteristics of the groups were comparable. Colorectal resections showed a significantly increased risk of organ/space infection (4.6% in small intestine ± ileocecal vs. 14.3% in colorectal resections p = 0.039). The superficial SSI rate was low in both groups (1.8% in small intestine ± ileocecal resection vs. 0% in colorectal resections, p = 1.000). Univariate binary logistic regression analysis revealed a statistically significant influence of duration of surgery (p = 0.001) and type of resection (p = 0.031) on organ/space infection. In multivariate analysis, only duration of surgery (OR 1.111, 95% CI 1.026–1.203 for every 10 min, p = 0.009) remained significant for postoperative organ/space infections.ConclusionsSingle-shot antibiotic therapy without bowel preparation is safe in patients undergoing minimally invasive surgery and was associated with a low number of complications; however, organ/space infections were more common if colorectal resections were performed. Therefore, combined bowel preparation might be beneficial when the (sigmoid) colon or rectum are involved.

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“…Nutritional guidelines merge with enhanced recovery after surgery (ERAS) guidelines [65], which are beneficial for surgical patients regarding outcome, length of stay, and costs. Recent reports suggested that enhanced recovery combined with minimally invasive techniques may lead to further improvements in surgical outcomes of Crohn’s patients [66,67]. Whenever possible, elective surgical patients should be treated according to the ERAS protocol: avoidance of long term fasting, integration of nutritional strategies into the overall management of the patient, metabolic homeostasis, and early mobilization [4].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Nutritional Conditioning of Crohn’s Patients—Systematic Review of Current Evidence and Practice

Grass¹,

Pache²,

Martín³

et al. 2017

Nutrients

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Crohn’s disease is an incurable and frequently progressive entity with major impact on affected patients. Up to half of patients require surgery in the first 10 years after diagnosis and over 75% of operated patients require at least one further surgery within lifetime. In order to minimize surgical risk, modifiable risk factors such as nutritional status need to be optimized. This systematic review on preoperative nutritional support in adult Crohn’s patients between 1997 and 2017 aimed to provide an overview on target populations, screening modalities, routes of administration, and expected benefits. Pertinent study characteristics (prospective vs. retrospective, sample size, control group, limitations) were defined a priori. Twenty-nine studies were retained, of which 14 original studies (9 retrospective, 4 prospective, and 1 randomized controlled trial) and 15 reviews. Study heterogeneity was high regarding nutritional regimens and outcome, and meta-analysis could not be performed. Most studies were conducted without matched control group and thus provide modest level of evidence. Consistently, malnutrition was found to be a major risk factor for postoperative complications, and both enteral and parenteral routes were efficient in decreasing postoperative morbidity. Current guidelines for nutrition in general surgery apply also to Crohn’s patients. The route of administration should be chosen according to disease presentation and patients’ condition. Further studies are needed to strengthen the evidence.

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Short-Term Outcomes of Laparoscopy Combined with Enhanced Recovery Pathway after Ileocecal Resection for Crohn’s Disease: a Case-Matched Analysis

Abstract: This is the first reported experience of laparoscopy with ERP in CD patients and suggests that optimized perioperative care combined with minimally invasive techniques may lead to further improvements in surgical outcomes for CD patients.

Cited by 56 publications

References 29 publications

First experience in colorectal surgery with a new robotic platform with haptic feedback

First experience in colorectal surgery with a new robotic platform with haptic feedback

Outcome of no oral antibiotic prophylaxis and bowel preparation in Crohn’s diseases surgery

Preoperative Nutritional Conditioning of Crohn’s Patients—Systematic Review of Current Evidence and Practice

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