Skip to main content
Erschienen in:

15.07.2023 | Original Article

How to reduce the colorectal anastomotic leakage? The MIRACLe protocol experience in a cohort in a single high-volume centre

verfasst von: Rosa Marcellinaro, Michele Grieco, Domenico Spoletini, Raffaele Troiano, Pasquale Avella, Gioia Brachini, Andrea Mingoli, Massimo Carlini

Erschienen in: Updates in Surgery | Ausgabe 6/2023

Einloggen, um Zugang zu erhalten

Abstract

This article reports the results of a novel perioperative treatment implementing the gut microbiota to prevent anastomotic fistula and leakage (AL) in patients undergoing laparoscopic colorectal resections for cancer and represents the continuation of our pilot study on 60 cases. A series of 131 patients underwent elective colorectal surgery at the S. Eugenio Hospital (Rome—Italy) between December 1, 2020, and November 30, 2022, and received a perioperative preparation following the Microbiota Implementation to Reduce Anastomotic Colorectal Leaks (MIRACLe) protocol comprising oral antibiotics, mechanical bowel preparation and perioperative probiotics. The results obtained in the MIRACLe group (MG) were compared to those registered in a Control group (CG) of 500 patients operated on between March 2015 and November 30, 2020, who received a standard ERAS protocol. Propensity score-matching (PSM) analysis was performed to overcome patients’ selection bias. Patients were categorised according to perioperative preparation (MIRACLe protocol vs standard ERAS protocol) into two groups: 118 patients were in post-matched MIRACLe group (pmMG) and 356 were in post-matched Control group (pmCG). In the pmMG, only 2 anastomotic leaks were registered, and the incidence of AL was just 1.7% vs. 6.5% in the pmCG (p = 0.044). The incidence of surgical site infections (1.7% vs. 3.1%; p = 0.536), reoperations (0.8% vs. 4.2%; p = 0.136) and postoperative mortality (0% vs. 2.0%; p = 0.200) was lower in pmMG. Additionally, the postoperative outcomes were better: the times to first flatus, to first stool and to oral feeding were shorter (1 vs. 2, 2 vs. 3 and 2 vs. 3 days, respectively; p < 0.001). The postoperative recovery was faster, with a shorter time to discharge (5 vs. 6 days; p < 0.001). The MIRACLe protocol was confirmed to be safe and significantly able to reduce anastomotic leaks in patients receiving elective laparoscopic colorectal surgery for cancer.
Literatur
1.
Zurück zum Zitat Keshvari A, Mollamohammadi L, Keramati MR, Behboudi B, Fazeli MS, Kazemeini A et al (2023) Assessment of the efficacy of handmade vacuum-assisted sponge drain for treatment of anastomotic leakage after low anterior rectal resection. Updates Surg Keshvari A, Mollamohammadi L, Keramati MR, Behboudi B, Fazeli MS, Kazemeini A et al (2023) Assessment of the efficacy of handmade vacuum-assisted sponge drain for treatment of anastomotic leakage after low anterior rectal resection. Updates Surg
2.
Zurück zum Zitat Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3):339–351CrossRefPubMed Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3):339–351CrossRefPubMed
3.
Zurück zum Zitat Calise F, Giuliani A, Sodano L, Crolla E, Bianco P, Rocca A et al (2015) Segmentectomy: is minimally invasive surgery going to change a liver dogma? Updates Surg 67(2):111–115CrossRefPubMed Calise F, Giuliani A, Sodano L, Crolla E, Bianco P, Rocca A et al (2015) Segmentectomy: is minimally invasive surgery going to change a liver dogma? Updates Surg 67(2):111–115CrossRefPubMed
4.
Zurück zum Zitat Rocca A, Scacchi A, Cappuccio M, Avella P, Bugiantella W, De Rosa M et al (2021) Robotic surgery for colorectal liver metastases resection: a systematic review. Int J Med Robot 17(6):e2330CrossRefPubMed Rocca A, Scacchi A, Cappuccio M, Avella P, Bugiantella W, De Rosa M et al (2021) Robotic surgery for colorectal liver metastases resection: a systematic review. Int J Med Robot 17(6):e2330CrossRefPubMed
5.
Zurück zum Zitat Rocca A, Porfidia C, Russo R, Tamburrino A, Avella P, Vaschetti R et al (2023) Neuraxial anesthesia in hepato-pancreatic-bilio surgery: a first western pilot study of 46 patients. Updates Surg 1–11 Rocca A, Porfidia C, Russo R, Tamburrino A, Avella P, Vaschetti R et al (2023) Neuraxial anesthesia in hepato-pancreatic-bilio surgery: a first western pilot study of 46 patients. Updates Surg 1–11
6.
Zurück zum Zitat Romanzi A, Dragani TA, Adorni A, Colombo M, Farro A, Maspero M et al (2023) Neuraxial anesthesia for abdominal surgery, beyond the pandemic: a feasibility pilot study of 70 patients in a suburban hospital. Updates Surg 1–7 Romanzi A, Dragani TA, Adorni A, Colombo M, Farro A, Maspero M et al (2023) Neuraxial anesthesia for abdominal surgery, beyond the pandemic: a feasibility pilot study of 70 patients in a suburban hospital. Updates Surg 1–7
7.
Zurück zum Zitat Carlini M, Grieco M, Spoletini D, Menditto R, Napoleone V, Brachini G et al (2022) Implementation of the gut microbiota prevents anastomotic leaks in laparoscopic colorectal surgery for cancer:the results of the MIRACLe study. Updates Surg 74(4):1253–1262CrossRefPubMed Carlini M, Grieco M, Spoletini D, Menditto R, Napoleone V, Brachini G et al (2022) Implementation of the gut microbiota prevents anastomotic leaks in laparoscopic colorectal surgery for cancer:the results of the MIRACLe study. Updates Surg 74(4):1253–1262CrossRefPubMed
8.
Zurück zum Zitat Leenen JPL, Hentzen J, Ockhuijsen HDL (2019) Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Updates Surg 71(2):227–236CrossRefPubMed Leenen JPL, Hentzen J, Ockhuijsen HDL (2019) Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Updates Surg 71(2):227–236CrossRefPubMed
9.
Zurück zum Zitat Zhao Y, Li B, Sun Y, Liu Q, Cao Q, Li T et al (2022) Risk factors and preventive measures for anastomotic leak in colorectal cancer. Technol Cancer Res Treat 21:15330338221118984CrossRefPubMedPubMedCentral Zhao Y, Li B, Sun Y, Liu Q, Cao Q, Li T et al (2022) Risk factors and preventive measures for anastomotic leak in colorectal cancer. Technol Cancer Res Treat 21:15330338221118984CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Guyton K, Alverdy JC (2017) The gut microbiota and gastrointestinal surgery. Nat Rev Gastroenterol Hepatol 14(1):43–54CrossRefPubMed Guyton K, Alverdy JC (2017) The gut microbiota and gastrointestinal surgery. Nat Rev Gastroenterol Hepatol 14(1):43–54CrossRefPubMed
11.
Zurück zum Zitat Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM et al (2016) New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 16(12):e276–e287CrossRefPubMed Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM et al (2016) New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 16(12):e276–e287CrossRefPubMed
13.
Zurück zum Zitat Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMed Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMed
14.
Zurück zum Zitat Zaimi I, Sparreboom CL, Lingsma HF, Doornebosch PG, Menon AG, Kleinrensink GJ et al (2018) The effect of age on anastomotic leakage in colorectal cancer surgery: a population-based study. J Surg Oncol 118(1):113–120CrossRefPubMed Zaimi I, Sparreboom CL, Lingsma HF, Doornebosch PG, Menon AG, Kleinrensink GJ et al (2018) The effect of age on anastomotic leakage in colorectal cancer surgery: a population-based study. J Surg Oncol 118(1):113–120CrossRefPubMed
15.
Zurück zum Zitat Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P (2002) Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 26(4):499–502CrossRefPubMed Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P (2002) Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 26(4):499–502CrossRefPubMed
16.
Zurück zum Zitat Buchs NC, Gervaz P, Bucher P, Huber O, Mentha G, Morel P (2007) Lessons learned from one thousand consecutive colonic resections in a teaching hospital. Swiss Med Wkly 137(17–18):259–264PubMed Buchs NC, Gervaz P, Bucher P, Huber O, Mentha G, Morel P (2007) Lessons learned from one thousand consecutive colonic resections in a teaching hospital. Swiss Med Wkly 137(17–18):259–264PubMed
17.
Zurück zum Zitat Krarup PM, Jorgensen LN, Andreasen AH, Harling H (2012) A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis 14(10):e661–e667CrossRefPubMed Krarup PM, Jorgensen LN, Andreasen AH, Harling H (2012) A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis 14(10):e661–e667CrossRefPubMed
18.
Zurück zum Zitat Bakker IS, Grossmann I, Henneman D, Havenga K, Wiggers T (2014) Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 101(4):424–432 (discussion 32)CrossRefPubMed Bakker IS, Grossmann I, Henneman D, Havenga K, Wiggers T (2014) Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 101(4):424–432 (discussion 32)CrossRefPubMed
19.
Zurück zum Zitat Grieco M, Pernazza G, Gasparrini M, Marino P, Apponi F, Persiani R et al (2019) The “Lazio Network” experience. The first Italian regional research group on the Enhanced Recovery After Surgery (ERAS) program. A collective database with 1200 patients in 2016–2017. Ann Ital Chir 90:157–61PubMed Grieco M, Pernazza G, Gasparrini M, Marino P, Apponi F, Persiani R et al (2019) The “Lazio Network” experience. The first Italian regional research group on the Enhanced Recovery After Surgery (ERAS) program. A collective database with 1200 patients in 2016–2017. Ann Ital Chir 90:157–61PubMed
20.
Zurück zum Zitat Grieco M, Lorenzon L, Pernazza G, Carlini M, Brescia A, Santoro R et al (2020) Impact of implementation of the ERAS program in colorectal surgery: a multi-center study based on the “Lazio Network” collective database. Int J Colorectal Dis 35(3):445–453CrossRefPubMed Grieco M, Lorenzon L, Pernazza G, Carlini M, Brescia A, Santoro R et al (2020) Impact of implementation of the ERAS program in colorectal surgery: a multi-center study based on the “Lazio Network” collective database. Int J Colorectal Dis 35(3):445–453CrossRefPubMed
21.
Zurück zum Zitat Grieco M, Cassini D, Spoletini D, Soligo E, Grattarola E, Baldazzi G et al (2019) Laparoscopic resection of splenic flexure colon cancers: a retrospective multi-center study with 117 cases. Updates Surg 71(2):349–357CrossRefPubMed Grieco M, Cassini D, Spoletini D, Soligo E, Grattarola E, Baldazzi G et al (2019) Laparoscopic resection of splenic flexure colon cancers: a retrospective multi-center study with 117 cases. Updates Surg 71(2):349–357CrossRefPubMed
22.
Zurück zum Zitat Grieco M, Cassini D, Spoletini D, Soligo E, Grattarola E, Baldazzi G et al (2019) Intracorporeal versus extracorporeal anastomosis for laparoscopic resection of the splenic flexure colon cancer: a multicenter propensity score analysis. Surg Laparosc Endosc Percutan Tech 29(6):483–488CrossRefPubMed Grieco M, Cassini D, Spoletini D, Soligo E, Grattarola E, Baldazzi G et al (2019) Intracorporeal versus extracorporeal anastomosis for laparoscopic resection of the splenic flexure colon cancer: a multicenter propensity score analysis. Surg Laparosc Endosc Percutan Tech 29(6):483–488CrossRefPubMed
23.
Zurück zum Zitat Grieco M, Spoletini D, Marcasciano M, Grattarola E, Shihab V, Carlini M (2020) Subcuticular sutures in laparoscopic colorectal surgery: a comparative study to evaluate wound infection rates and cosmetic results. Updates Surg 72(4):1005–1011CrossRefPubMed Grieco M, Spoletini D, Marcasciano M, Grattarola E, Shihab V, Carlini M (2020) Subcuticular sutures in laparoscopic colorectal surgery: a comparative study to evaluate wound infection rates and cosmetic results. Updates Surg 72(4):1005–1011CrossRefPubMed
24.
Zurück zum Zitat Grieco M, Apa D, Spoletini D, Grattarola E, Carlini M (2018) Major vessel sealing in laparoscopic surgery for colorectal cancer: a single-center experience with 759 patients. World J Surg Oncol 16(1):101CrossRefPubMedPubMedCentral Grieco M, Apa D, Spoletini D, Grattarola E, Carlini M (2018) Major vessel sealing in laparoscopic surgery for colorectal cancer: a single-center experience with 759 patients. World J Surg Oncol 16(1):101CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Grieco M, Marcellinaro R, Spoletini D, Menditto R, Lisi G, Russo G et al (2022) Laparoscopic right colectomy: changes in surgical technique and perioperative management allow better postoperative results in a comparative series of 361 patients. Updates Surg 74(3):883–890CrossRefPubMed Grieco M, Marcellinaro R, Spoletini D, Menditto R, Lisi G, Russo G et al (2022) Laparoscopic right colectomy: changes in surgical technique and perioperative management allow better postoperative results in a comparative series of 361 patients. Updates Surg 74(3):883–890CrossRefPubMed
26.
Zurück zum Zitat Capparelli R, Cuomo P, Gentile A, Iannelli D (2023) Microbiota-liver diseases interactions. Int J Mol Sci 24(4) Capparelli R, Cuomo P, Gentile A, Iannelli D (2023) Microbiota-liver diseases interactions. Int J Mol Sci 24(4)
27.
Zurück zum Zitat Cuomo P, Capparelli R, Alifano M, Iannelli A, Iannelli D (2022) Gut microbiota host-gene interaction. Int J Mol Sci 23(22) Cuomo P, Capparelli R, Alifano M, Iannelli A, Iannelli D (2022) Gut microbiota host-gene interaction. Int J Mol Sci 23(22)
28.
Zurück zum Zitat Gibiino G, De Siena M, Sbrancia M, Binda C, Sambri V, Gasbarrini A et al (2021) Dietary habits and gut microbiota in healthy adults: focusing on the right diet. A systematic review. Int J Mol Sci 22(13) Gibiino G, De Siena M, Sbrancia M, Binda C, Sambri V, Gasbarrini A et al (2021) Dietary habits and gut microbiota in healthy adults: focusing on the right diet. A systematic review. Int J Mol Sci 22(13)
29.
Zurück zum Zitat Shogan BD, Carlisle EM, Alverdy JC, Umanskiy K (2013) Do we really know why colorectal anastomoses leak? J Gastrointest Surg 17(9):1698–1707CrossRefPubMed Shogan BD, Carlisle EM, Alverdy JC, Umanskiy K (2013) Do we really know why colorectal anastomoses leak? J Gastrointest Surg 17(9):1698–1707CrossRefPubMed
30.
Zurück zum Zitat Shogan BD, Smith DP, Christley S, Gilbert JA, Zaborina O, Alverdy JC (2014) Intestinal anastomotic injury alters spatially defined microbiome composition and function. Microbiome 2:35CrossRefPubMedPubMedCentral Shogan BD, Smith DP, Christley S, Gilbert JA, Zaborina O, Alverdy JC (2014) Intestinal anastomotic injury alters spatially defined microbiome composition and function. Microbiome 2:35CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Koliarakis I, Athanasakis E, Sgantzos M, Mariolis-Sapsakos T, Xynos E, Chrysos E et al (2020) Intestinal microbiota in colorectal cancer surgery. Cancers (Basel) 12(10) Koliarakis I, Athanasakis E, Sgantzos M, Mariolis-Sapsakos T, Xynos E, Chrysos E et al (2020) Intestinal microbiota in colorectal cancer surgery. Cancers (Basel) 12(10)
32.
Zurück zum Zitat Avella P, Vaschetti R, Cappuccio M, Gambale F, Rafanelli F et al (2022) The role of liver surgery in simultaneous synchronous colorectal liver metastases and colorectal cancer resections: a literature review of 1730 patients underwent open and minimally invasive surgery. Minerva Surg 77(6):582–590CrossRefPubMed Avella P, Vaschetti R, Cappuccio M, Gambale F, Rafanelli F et al (2022) The role of liver surgery in simultaneous synchronous colorectal liver metastases and colorectal cancer resections: a literature review of 1730 patients underwent open and minimally invasive surgery. Minerva Surg 77(6):582–590CrossRefPubMed
33.
Zurück zum Zitat Rocca A, Cipriani F, Belli G, Berti S, Boggi U, Bottino V et al (2021) The Italian Consensus on minimally invasive simultaneous resections for synchronous liver metastasis and primary colorectal cancer: a Delphi methodology. Updates Surg Rocca A, Cipriani F, Belli G, Berti S, Boggi U, Bottino V et al (2021) The Italian Consensus on minimally invasive simultaneous resections for synchronous liver metastasis and primary colorectal cancer: a Delphi methodology. Updates Surg
34.
Zurück zum Zitat Garritano S, Selvaggi F, Spampinato MG (2016) Simultaneous minimally invasive treatment of colorectal neoplasm with synchronous liver metastasis. Biomed Res Int 2016:9328250CrossRefPubMedPubMedCentral Garritano S, Selvaggi F, Spampinato MG (2016) Simultaneous minimally invasive treatment of colorectal neoplasm with synchronous liver metastasis. Biomed Res Int 2016:9328250CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Wei D, Johnston S, Goldstein L, Nagle D (2020) Minimally invasive colectomy is associated with reduced risk of anastomotic leak and other major perioperative complications and reduced hospital resource utilization as compared with open surgery: a retrospective population-based study of comparative effectiveness and trends of surgical approach. Surg Endosc 34(2):610–621CrossRefPubMed Wei D, Johnston S, Goldstein L, Nagle D (2020) Minimally invasive colectomy is associated with reduced risk of anastomotic leak and other major perioperative complications and reduced hospital resource utilization as compared with open surgery: a retrospective population-based study of comparative effectiveness and trends of surgical approach. Surg Endosc 34(2):610–621CrossRefPubMed
36.
Zurück zum Zitat Liu Y, Li B, Wei Y (2022) New understanding of gut microbiota and colorectal anastomosis leak: a collaborative review of the current concepts. Front Cell Infect Microbiol 12:1022603CrossRefPubMedPubMedCentral Liu Y, Li B, Wei Y (2022) New understanding of gut microbiota and colorectal anastomosis leak: a collaborative review of the current concepts. Front Cell Infect Microbiol 12:1022603CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Bosmans JW, Jongen AC, Bouvy ND, Derikx JP (2015) Colorectal anastomotic healing: why the biological processes that lead to anastomotic leakage should be revealed prior to conducting intervention studies. BMC Gastroenterol 15:180CrossRefPubMedPubMedCentral Bosmans JW, Jongen AC, Bouvy ND, Derikx JP (2015) Colorectal anastomotic healing: why the biological processes that lead to anastomotic leakage should be revealed prior to conducting intervention studies. BMC Gastroenterol 15:180CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Ianiro G, Tilg H, Gasbarrini A (2016) Antibiotics as deep modulators of gut microbiota: between good and evil. Gut 65(11):1906–1915CrossRefPubMed Ianiro G, Tilg H, Gasbarrini A (2016) Antibiotics as deep modulators of gut microbiota: between good and evil. Gut 65(11):1906–1915CrossRefPubMed
39.
Zurück zum Zitat EspinBasany E, Solís-Peña A, Pellino G, Kreisler E, Fraccalvieri D, Muinelo-Lorenzo M et al (2020) Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial. Lancet Gastroenterol Hepatol 5(8):729–738CrossRef EspinBasany E, Solís-Peña A, Pellino G, Kreisler E, Fraccalvieri D, Muinelo-Lorenzo M et al (2020) Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial. Lancet Gastroenterol Hepatol 5(8):729–738CrossRef
40.
Zurück zum Zitat Kiran RP, Murray AC, Chiuzan C, Estrada D, Forde K (2015) Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 262(3):416–425 discussion 23–25 Kiran RP, Murray AC, Chiuzan C, Estrada D, Forde K (2015) Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 262(3):416–425 discussion 23–25
41.
Zurück zum Zitat Migaly J, Bafford AC, Francone TD, Gaertner WB, Eskicioglu C, Bordeianou L et al (2019) The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the use of bowel preparation in elective colon and rectal surgery. Dis Colon Rectum 62(1):3–8CrossRefPubMed Migaly J, Bafford AC, Francone TD, Gaertner WB, Eskicioglu C, Bordeianou L et al (2019) The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the use of bowel preparation in elective colon and rectal surgery. Dis Colon Rectum 62(1):3–8CrossRefPubMed
42.
Zurück zum Zitat World Health Organization FaAO (2001) Report of a Joint FAO WHO Expert Consultation Health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria World Health Organization FaAO (2001) Report of a Joint FAO WHO Expert Consultation Health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria
43.
Zurück zum Zitat Mizuta M, Endo I, Yamamoto S, Inokawa H, Kubo M, Udaka T et al (2016) Perioperative supplementation with bifidobacteria improves postoperative nutritional recovery, inflammatory response, and fecal microbiota in patients undergoing colorectal surgery: a prospective, randomized clinical trial. Biosci Microbiota Food Health 35(2):77–87CrossRefPubMed Mizuta M, Endo I, Yamamoto S, Inokawa H, Kubo M, Udaka T et al (2016) Perioperative supplementation with bifidobacteria improves postoperative nutritional recovery, inflammatory response, and fecal microbiota in patients undergoing colorectal surgery: a prospective, randomized clinical trial. Biosci Microbiota Food Health 35(2):77–87CrossRefPubMed
44.
Zurück zum Zitat Kotzampassi K, Stavrou G, Damoraki G, Georgitsi M, Basdanis G, Tsaousi G et al (2015) A Four-Probiotics Regimen Reduces Postoperative Complications After Colorectal Surgery: A Randomized, Double-Blind, Placebo-Controlled Study. World J Surg 39(11):2776–2783CrossRefPubMed Kotzampassi K, Stavrou G, Damoraki G, Georgitsi M, Basdanis G, Tsaousi G et al (2015) A Four-Probiotics Regimen Reduces Postoperative Complications After Colorectal Surgery: A Randomized, Double-Blind, Placebo-Controlled Study. World J Surg 39(11):2776–2783CrossRefPubMed
45.
Zurück zum Zitat Veziant J, Bonnet M, Occean BV, Dziri C, Pereira B, Slim K (2022) Probiotics/synbiotics to reduce infectious complications after colorectal surgery: a systematic review and meta-analysis of randomised controlled trials. Nutrients 14(15) Veziant J, Bonnet M, Occean BV, Dziri C, Pereira B, Slim K (2022) Probiotics/synbiotics to reduce infectious complications after colorectal surgery: a systematic review and meta-analysis of randomised controlled trials. Nutrients 14(15)
Metadaten
Titel
How to reduce the colorectal anastomotic leakage? The MIRACLe protocol experience in a cohort in a single high-volume centre
verfasst von
Rosa Marcellinaro
Michele Grieco
Domenico Spoletini
Raffaele Troiano
Pasquale Avella
Gioia Brachini
Andrea Mingoli
Massimo Carlini
Publikationsdatum
15.07.2023
Verlag
Springer International Publishing
Erschienen in
Updates in Surgery / Ausgabe 6/2023
Print ISSN: 2038-131X
Elektronische ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-023-01588-3

Neu im Fachgebiet Chirurgie

Ab sofort gelten die neuen Verordnungsausnahmen für Lipidsenker

Freie Fahrt für Lipidsenker? Das nicht, doch mit niedrigerem Schwellenwert fürs Infarktrisiko und neuen Indikationen hat der G-BA die Verordnungs-Handbremse ein gutes Stück weit gelockert.

Appendizitis und Darminfarkt durch Blinddarm-Lipom

Eigentlich sind Lipome recht harmlos. Im Zäkum können sie jedoch erhebliche Komplikationen mit Darminfarkt und Appendizitis verursachen.

Gluteuslappen nach Rektumkarzinom-Op. schützt vor Abszessen

Die Wunddeckung mit einem autologen Rotationslappen nach Entfernung eines Rektumkarzinoms konnte in einer randomisierten Studie gegenüber dem primären Wundverschluss vor allem in einer Hinsicht punkten: Sie führte deutlich seltener zu präsakralen Abszessen.

MedTalk Leitlinie KOMPAKT: S3-Leitline zu peripheren Nervenverletzungen

  • Webinar | 10.02.2025 | 13:00

Über den Weg zur finalen Fassung der S3-Leitlinie "Versorgung peripherer Nervenverletzungen" sprechen Prof. Dr. Leila Harhaus-Wähner und Ressortleiter Dr. Gunter Freese im WebTalk Leitlinie KOMPAKT, einer neuen Webcast-Serie von SpringerMedizin passend zu Ihrem Fachmagazin Orthopädie und Unfallchirurgie Mitteilungen und Nachrichten. In dem kurzen Video geht es darum, was sich im Vergleich zur vorigen Fassung der Leitlinie geändert hat, welche Aspekte für die tägliche Praxis besonders wichtig sind und was jeder gemäß Leitlinie nun anders oder besser machen sollte.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.