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Harrison's Manual of Medicine
Like this presentation? Why not share! Embed Size px. Ciga et al.
Thus, they concluded that in selected patients, an emergency left-colon, 1-stage resection and primary anastomosis might be performed without colonic preparation as safely as elective surgery. On the other hand, Rencuzogullari et al. They found that the omission of MBP was deleterious in terms of surgical site infection, anastomotic dehiscence, ileus, length of hospitalization, and even recurrence of the neoplasm when compared to colon surgery with MBP, especially when in the American studies MBP was combined with oral antibiotic administration.
The no MBP group presents several pieces of rational evidence. Firstly, MBP does not minimize the risk of postoperative septic complications, such as anastomotic dehiscence and superficial surgical site infections. Secondly, MBP is a time-consuming, expensive procedure and causes severe discomfort to the patient.
Mechanical Bowel Preparation, Do It or Not: When Crossing a River, What Do People Do?
Lastly, MBP has been associated with serious complications, such as electrolyte and volume disturbances, in both healthy patients and patients with existing cardiac or renal disease. Furthermore they pointed out that no prospective, randomized, controlled study supporting MBP as an efficient tool against leakage and infectious has been published.
Yes, all of their conclusions are, of course, true. However, I cannot help but worry that they saw only what they wanted to see. What are we missing in our practice?
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This issue includes a non-scientific problem. That is, health care providers should not forget that the safety of patients is the most important and invariant virtue in medical practice.
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Thus, we must consider the safety of patients before cost effectiveness or shortness of hospital stay. Frankly speaking, everybody knows every anastomosis, however good, has a risk of leakage, and everybody knows that the clinical course of fecal peritonitis is worse than that of any other type of peritonitis.
This means that albeit the incidence of severe complication being very low, if a complication happens, the influence on the patient may be too serious to overcome. Every health care provider is directly responsible for protecting patients from such hazardous conditions. Must we sacrifice a few for the benefit of many? The editors have again assembled a group of experienced authors, each of whom has an international reputation within coloproctology or an allied specialty and a desire to see ever-improving standards in coloproctology throughout Europe.
By including contributions from authors across Europe, the book provides a great breadth of knowledge and reflects diversity of clinical practice.
Clinical and Experimental Gastroenterology | Editor in Chief - Dove Press
The manual provides surgical trainees with a comprehensive and condensed guide to the knowledge required for the European Board of Surgery Qualification EBSQ examination. It will also be a valuable aid to the many practicing coloproctologists across Europe and beyond who undertake continuing professional development and a useful source of information for researchers and clinicians in allied disciplines.
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