, Minsung Kim Enhanced recovery after surgery (ERAS) protocols are designed to minimize surgical stress, preserve physiological function, and expedite recovery through standardized perioperative care for primary colorectal surgery patients. This narrative review explores the benefits of current ERAS protocols in improving outcomes for these patients and provides insights into future advancements. Numerous studies have shown that ERAS protocols significantly reduce the length of hospital stays by several days compared to conventional care. Additionally, the implementation of ERAS is linked to a reduction in postoperative complications, including lower incidences of surgical site infections, anastomotic leaks, and postoperative ileus. Patients adhering to ERAS protocols also benefit from quicker gastrointestinal recovery, marked by an earlier return of bowel function. Some research indicates that colorectal cancer patients undergoing surgery with ERAS protocols may experience improved overall survival rates. High compliance with ERAS protocols leads to better outcomes, yet achieving full adherence continues to be a challenge. Despite these advantages, implementation challenges persist, with compliance rates affected by varying clinical practices and resource availability. However, the future of ERAS looks promising with the incorporation of prehabilitation strategies and technologies such as wearable devices and telemedicine. These innovations provide real-time monitoring, enhance patient engagement, and improve postoperative follow-up, potentially transforming perioperative care in colorectal surgery and offering new avenues for enhanced patient outcomes.
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Over the past 3 years, the COVID-19 pandemic has posed significant challenges to the healthcare system, leading to delays in the diagnosis and treatment of various diseases due to the need for social distancing measures. Colorectal cancer has not been immune to these disruptions, and research in various countries has explored the impact of COVID-19 on the diagnosis and treatment of colorectal cancer. One notable consequence has been the postponement of colorectal cancer screenings, potentially resulting in disease progression, which can adversely affect surgical and oncological outcomes. Furthermore, the treatment approach for colorectal cancer may vary depending on the extent of disease progression and the healthcare policies implemented in response to the COVID-19 pandemic. In this systematic review, we examine treatment strategies, surgical outcomes, and oncological variables across multiple studies focusing on colorectal cancer treatment during the COVID-19 pandemic. The purpose of this analysis was to assess how medical policies enacted in response to the COVID-19 pandemic have influenced the outcomes of colorectal cancer treatment. We hope that this review will provide valuable insights and serve as a foundational resource for developing guidelines to address potential medical crises in the future.
Enhanced recovery after surgery (ERAS) aims to promote postoperative recovery in patients by minimizing the surgical stress response through evidence-based multimodal interventions. In 2023, updated clinical practice guidelines were published in North America, potentially superseding the most recent guidelines previously announced at the ERAS Society in 2019. This review compares and reviews these two guidelines to examine the principle of ERAS and items related to colorectal surgery and to introduce the latest relevant study results published within the last 5 years. In the pre-hospitalization stage, the concept of pre-hospitalization is emphasized; this involves checking and reinforcing the patient’s nutritional status and physical functional status before surgery. In the preoperative stage, large-scale studies have prompted a change in the recommendation of mechanical bowel preparation combined with oral antibiotics in elective colorectal surgery. In the intraoperative stage, laparoscopic surgery has become a widespread and important component of ERAS, and more technologically advanced single-incision laparoscopic surgery and robotic surgery are the focus of active research. Ileus-prevention items, such as opioid-sparing multimodal pain management and euvolemic fluid therapy, are recommended in the postoperative stage. The adoption of ERAS protocols is expanding to encompass a wide range of surgical procedures, clinical scenarios, healthcare institutions, and professional medical societies. In order to maximize the effect by increasing adherence to ERAS, medical staff must fully understand the clinical basis and meaning of each item, and the protocol must be maintained and developed steadily through a team approach and audit system.
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Hemorrhoids are varicose veins of the rectum that are located in or near the anal canal and are covered by mucosa. They can occur at any age, are generally symptomless, and affect both sexes equally. Hemorrhoids are a common complaint among younger women and are more likely to occur during pregnancy and the menstrual cycle. In this article, we discuss the many approaches in the treatment of hemorrhoids. Laxatives, stool softeners, and fiber supplements are all considered safe for use by pregnant women. Moderate use of laxatives is also acceptable. Since there is a lack of sufficient evidence to support the safety and efficiency of topical medicines or oral phlebotomies during pregnancy, these treatments must to be utilized with an increased degree of extreme caution. In the case that considerable bleeding occurs, anal packing may be a straight forward and helpful operation to implement. A hemorhoidectomy is the treatment option for hemorrhoids that have become strangulated, badly thrombosed, or have bleeding that cannot be controlled.
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, Young-Sun kim, Sa-Young Park, Jin-Hyuk Choi, Soon-Nam Lee, Hwa-Soon Chung Thrombohemorrhagic complications in chronic myeloproliferative disease(CMPD) including chronic myelogenous leukemia(CML) are not rare. Lower incidence of disordered hemostasis is reported in CML compared with other CMPD. The mechanism of thrombohemorrhagic complications might be a consequence of qualitative platelet abnormalites and prolonged bleeding time rather than that of thrombocytosis. Although defect of platelet function has been extensively investigated, there was no established consistent correlation between clinical bleeding and number and function of platelet. The most common site of bleeding complications in the CMPD is superficial mucosa. Bleeding in deep tissue and viscera is very unusual. We report a case of CML which developed a huge spontaneous retroperitoneal hematoma.
, Guie Young Lee No abstract available in English.
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, Kee-Duck Park, Kyoung-Gyu Choi, Hea-Soo Koo , Jeong Pyo Kang, Jun Ho Jung, Sang Hyu Roh, Joon Yong Kim, Bong Suk Shim, Sung Won Kwon We retrospectively reviewed the cases of transurethral prostatectomy benign prostatic hyperplasia. We defined the morbidity, hospitalization and urethral catheter time, complication and operator's skilled experience and compared to transurethral prostatectomy in the historical series.
A retrospective chart review of 720 consecutive patients who underwent tranasurethral prostatectomy between 1990 and 1999 at our institution for symptomatic benign prostatic hyperplasia was performed. Perioperative and late postoperative morbidity and their risk factors, hospitalization and urethral catheter time, operator's skilled experience were analyzed. The objective cases were divided by operator's experience into 5 groups, and compared in each group.
Patients were identified with an average of 66 years(range 45 to 88). Significant co-morbidity(2 or more co-morbid disease processes) was identified preoperatively in 22.1% of the patients. The most common indication for transurethral prostatectomy was prostatism only(63%). Average weight of resected tissue was 18.6gm. There was no perioperative patient mortality. Blood transfusion rate was 6.9%. The rates of early and late postoperative complications were 13.7% and 6.2%. Total average hospital stay was 5.5 days and 5.3 days from 1995 through 1999. Average preoperative symptom score was 23.8(range 10 to 35) and postoperative symptom score was 9.5(range 3 to 30) with an average follow up of 42 months(range 6 to 44 months).
In the 1990s complications of transurethral prostatectomy were relatively lower than rates in historical series. The average hospital stay and urethral catheter time have steadily decreased during the last 10 years. Transurethral resection of prostate could provide relief of lower urinary tract symptoms with high safety rate and low complication rate. Our study suggest that technique of trnasurthral resection is improving step by step by accumulating experience of operation and stabilized skillful technique will be achieved after experience of more than 150 cases.
, Ho Seong Han, Young Woo Kim, Eu Gene Kim, Nam Jun Yi, Seong Hoon Park The number of the aged patient who undergo the operation has been increased in recent years. The risk of the operation is formidable in old patient. After general surgery, the morbidity and the mortality are associated with the pre-operative medical illness. And, the old age have more pre-operative medical illnesses than the younger. We experienced multiple postoperative complications in 85 years old patient. He has past history of old myocardiac infarction without other disease. He underwent the total gastrectomy with esophagojejunostomy due to advanced gastric cancer. After surgery, multiple post operative complications have occurred such as arrhythmia, hyponatremia, intraperitoneal abscess, gastrointestinal hemorrhage, pneumonia, heart failure, post operative delirium, phlebitis, hearing disturbance, nephropathy, would seroma, liver dysfunction, glucose intolerance. We summarized this case and give a brief review of the literature.
Recently, postoperative results of cervical spondylosis, disc herniation, tumor, and ossiication of posterior longitudinal ligament(OPLL) after anterior cervical surgeries have been improving due to new kinds of medical imaging, electrophysiological examinations, improved operative equipment, and improved surgical technique. However, occasional unsatisfactory cases needing a secondary operation remain. The author analyzed and developed strategies for multioperated cervical cases : all patients had two or more operations. From Sep. 93 to Aug. 98, 167 anterior cervical surgeries with fusions were performed in Dept. of Neurosurgery, Tong Dae Moon hospital. The author experienced 11 cases(6.6%) of failed anterior cervical surgeries and fusions : 8 men and 3 women. Initial diagnosis was 1 spondylosis, 2 cervical traumas, 3 disc herniations, and 5 cases of ossification of posterior longitudinal ligament. These multioperated cases were classified by the following cases : hardware-related complications, graft-related complications, and others. These groups were analyzed, and the resulting surgical strategies, including indications and techniques of anterior surgery, are described. The results of this study indicates that in order to reduce the need for multioperated cases, initial skillful surgical techniques and proper understanding of cervical spinal anatomy are necessary.
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