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Background: The present study aimed to analyze risk factors and management strategies for organ space infections (OSI) specifically after colonic resections. Methods: This was a retrospective analysis of all consecutive colonic resections performed between February 2012 and October 2017 in a single-center quality-improvement project. All OSIs were assessed prospectively by an independent national surveillance program ( www.swissnoso.ch ) and classified according to the U.S. Centers for Disease Control and Prevention (CDC) criteria (infection involves organ and spaces other than the incision), including anastomotic leaks. Risk factors for OSI were identified by univariable and multivariable analysis. Results: The study cohort included 1,263 patients (731 elective and 532 emergency colectomies). One hundred fifty-three patients (12%) were found to have an OSI, which occurred at median POD 8 [interquartile range 4-14]. Treatment strategies consisted of surgical management in 85 cases (56%), percutaneous drainage in 36 cases (24%), and antibiotic treatment alone in 32 patients (21%). Independent risk factors for OSI were emergency surgery (odds ratio [OR] 2.06; 95% confidence interval [CI] 1.35-3.16), operation duration >180 minutes (OR 2.10; 95% CI 1.29-3.40), and open surgery (OR 2.51; 95% CI 1.73-3.65). Conclusions: Organ space infections after colonic surgery were more frequent after open emergency surgery and occurred early in the post-operative course. Invasive management was required in 79% of cases.

Summary Background Surgical site infections (SSIs) are the most frequent complication after colorectal surgery and have a major impact on length of stay and costs. Aim To analyse the incidence, timing, and treatment of SSIs within 30 days after colonic surgery. Methods This was a quality improvement project through retrospective analysis of consecutive colonic surgeries between February 2012 and October 2017 at Lausanne University Hospital (CHUV). SSIs were prospectively assessed by an independent national surveillance programme ( www.swissnoso.ch ) up to 30 postoperative days. Treatment strategies including drainage of infection (direct wound opening or percutaneous) and surgical management were reviewed. Findings The study cohort included 1263 patients with 532 procedures (42%) performed as emergencies. SSIs were observed in 271 patients (21%), occurring at median postoperative day (POD) 9 (interquartile range (IQR): 4–16). Specifically, 53 (4%) were superficial incisional, 65 (5%) deep incisional, and 153 (12%) organ space infections (anastomotic insufficiency included). Superficial incisional SSI occurred at a median of POD 10.5 (IQR: 7–15), deep incisional at a median of POD 10 (8–15) and organ space at a median of POD 8 (5–11). Diagnosis was performed post discharge in 64 cases (24%). Whereas 47% of organ space infections were detected by POD 7, this rate was only 26% for superficial and deep incisional infections (P = 0.003). Surgical management was necessary in 133 cases (49%), and the remaining cases were managed by drainage without general anaesthesia (138 cases, 51%). Conclusion Organ space infections occurred early in the postoperative course, whereas incisional infections were mostly detected post discharge over the entire 30-day observation period, emphasizing the importance of proper follow-up using a systematic, complete and independent surveillance programme.

International audience; AIM: The management of postoperative ileus following colorectal surgery remains controversial. It is the commonest complication after elective colorectal resection and is associated with an increased incidence of postoperative adverse events. The prevention and management of postoperative ileus remains unstandardized. This study aims to describe an international profile of gastrointestinal recovery after colorectal surgery and will assess the role of non-steroidal anti-inflammatory drugs, when used as postoperative analgesia, in expediting the return of gastrointestinal function.METHODS: A multicentre, student- and trainee-led, prospective cohort study will be conducted across both Europe and Australasia. Adult patients undergoing elective colorectal resection during 2-week data collection periods between January and April 2018 will be included. A site-specific questionnaire will capture compliance to Enhanced Recovery after Surgery components at participating centres. The primary outcome is time to gastrointestinal recovery, measured using a composite outcome of bowel function and oral tolerance. The impact of non-steroidal anti-inflammatory drugs on gastrointestinal recovery will be evaluated along with safety data with respect to anastomotic leak, acute kidney injury and complications within 30days of surgery.DISCUSSION: This protocol describes the methodology of an international, observational assessment of gastrointestinal recovery after colorectal surgery. It discusses key challenges and describes how the results will impact on future investigation. The study will be conducted across a large student- and trainee-led collaborative network, with prospective quality assurance and data validation strategies.

Iatrogenic ureteral injuries are a source of major concern among surgeons performing colorectal procedures. Although they are uncommon, these lesions lead to severe morbidity and long-term functional disabilities, as well as an increase in mortality, hospital stay, and cost. The laparoscopic approach has gained popularity in the field of colorectal surgery and is associated with improved global postoperative outcomes. However, it is also considered to increase the risk of ureteral injury when compared to open surgery, especially during left colonic and rectal resections. To overcome these difficulties, surgical techniques have been improved over time through standardization of both open and laparoscopic procedures. However, these techniques are not infallible, and, in difficult cases, instrumental aids such as preoperative ureteral stenting may be used. To substitute the reduced haptic feedback in laparoscopic surgery, lighted stents have been developed. Unfortunately, prophylactic stenting, whether standard or lighted, is also associated with its own morbidity and its benefit-risk ratio remains highly controversial. To enhance the surgeon's visualization capabilities, augmented reality technologies have been developed. Near-infrared fluorescence and hyperspectral imaging are two promising techniques, which have been tested both in the preclinical and clinical settings. Early results show that these technologies could improve our ability to identify and protect the ureters, although technical limitations remain to be solved. Reviewing the current literature, this article aims to evaluate pre- and intraoperative techniques to identify the ureters and potentially to avoid iatrogenic injury. In addition, future trends are explored.

Although internal hernias are rare complications of laparoscopic colorectal surgery, they can lead to serious outcomes and are associated with a high mortality of up 20 %.AIM OF THE STUDY: The aim of this study was to describe our experience regarding internal herniation following laparoscopic colorectal surgery.MATERIALS AND METHODS: From 2009 to 2015, more than 1,093 laparoscopic colorectal procedures were performed, and 6 patients developed internal herniation. Data were obtained from patients' charts and reviewed retrospectively. Perioperative course and outcomes were analyzed.RESULTS: All patients were previously operated due to colorectal cancer. Two patients presented with ischemia at laparotomy, and 2 had endoscopic examinations before surgery. One patient was diagnosed with cancer on screening colonoscopy. One patient died after laparotomy.CONCLUSION: Internal herniation that develops following laparoscopic colorectal surgery may be associated with a high mortality. More efforts should be made to identify risk factors of internal herniation, as this could indicate which patients would benefit from closure of mesenteric defects during laparoscopic colorectal surgery.

INTRODUCTION:VMS is a Dutch risk assessment tool for hospitalized older adults that includes a short evaluation of four geriatric domains: risk for delirium, risk for undernutrition, risk for physical impairments, and fall risk. We investigated whether the information derived from this tool has prognostic value for outcomes of colorectal surgery.METHODS:All consecutive patients over age 70 years who underwent elective colorectal cancer surgery in three Dutch hospitals (2014-2016) were studied. The presence of risk was scored prior to surgery and per geriatric domain as either 0 (risk absent) or 1 (risk present). The total number of geriatric risk factors was summed. The primary outcome was long-term survival. Secondary outcomes were postoperative complications, including delirium. Cox proportional hazards models were used to evaluate the sumscore and risk factors associated with overall survival.RESULTS:Five hundred fifty patients were included. Median age was 76.5 years, and median follow-up was 870 days. Patients with intermediate (1-2) or high (3-4) sumscore were independently associated with lower overall survival, with hazard ratio (HR) of 1.9 [95% confidence interval (CI) 1.1-3.5; p = 0.03] and 8.7 (95% CI 4.0-19.2; p CONCLUSIONS:This easy-to-use geriatric sumscore has strong associations with long-term outcome and morbidity after colorectal cancer surgery. This information may be included in risk models for morbidity and mortality and can be used in shared decision-making.

Blockade of parietal nociceptive afferents by the use of continuous wound infiltration with local anesthetics may be beneficial in a multimodal approach to postoperative pain management after major surgery. The role of continuous preperitoneal infusion of ropivacaine for pain relief and postoperative recovery after open colorectal resections was evaluated in a randomized, double-blinded, placebo-controlled trial.