Perioperative care in digestive surgery
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- [Show abstract] [Hide abstract] ABSTRACT: The present "point of view" tries to assess the state of the art in 2008 on the role of mechanical bowel preparation before colorectal surgery. The case of bowel preparation has been questioned by several meta-analyses of small randomized trials, suggesting also its detrimental effect in terms of anastomotic leaks. In 2007 two large trials were published and pooling their data suggested an increased risk of deep abscesses when bowel preparation was omitted. A further meta-analysis including all published data on this topic appeared useful. This meta-analysis included almost 5 000 patients and showed bowel preparation involves no benefit in terms of surgical site infections, with more infections after bowel preparation (Odds ratio 1.40 [1.05-1.87]). Sensitivity analysis showed an increased risk of abscesses when bowel preparation was omitted but this risk is not clinically relevant since the number needed to harm was as high as 333 patients. In conclusion this meta-analysis including a huge number of patients does not confirm the detrimental effect of bowel preparation but did not show any benefit of it; these conclusions being valid only for colonic surgery, rectal surgery needing further studies.0Comments 0Citations
- [Show abstract] [Hide abstract] ABSTRACT: Optimizing the perioperative (pre- and postoperative) management of patients undergoing surgery is a key step in improving the results of surgery. Immunonutrition, a nutritional therapy aiming to reinforce the immune system's defenses, has a demonstrated impact on the reduction of infectious complications and the length of the hospital stay in patients with and without a degraded nutritional state after surgery for digestive cancer. In a question-and-answer format, we discuss the practical aspects of prescribing immunonutrition to provide assistance in this area and thus optimize the application of the guidelines and patient management.0Comments 1Citation
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