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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Colorectal Surgery Retrospective Analysis

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

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

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

10.

11.

12.

13.

14.

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

16.

17.

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

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

20.

21.

22.

23.

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

25.

26.

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

28.

29.

30.

31. Surgical practice evidence based Ubbink DT Br J Surg 2004

32. ¿MEDICINE BASED ON EVIDENCE?

33.

34. Eminence-based medicine.

35. Medicine based on vehemence

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

37.

38.

39. Thank You

Colorectal Surgery Retrospective Analysis

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Colorectal Surgery Retrospective Analysis