94 research outputs found
A preliminary phenomenological exploration of experiences of the empty pelvis syndrome derived from a modified-Delphi: the price of survival following pelvic exenteration for advanced pelvic cancer
No full textObjective: The empty pelvis syndrome (EPS) is common after pelvic exenteration (PE), causing fluid collections, bowel obstruction, perineal sinuses, and fistulas. The best approach to fill the pelvis to mitigate this remains controversial, and the impact of EPS on health-related quality of life (HrQoL) is unknown. This study is the first to begin to explore lived-experiences of EPS complications. Methods: Unstructured EPS virtual focus group meetings were conducted with a convenience sample of patients who underwent PE, as an extension of a modified-Delphi study. Interpretative phenomenological analysis was conducted on verbatim transcripts to generate group experiential themes. Results: Twelve patients (eight UK, one Dutch, and three Belgian) participated in four focus groups. Eight EPS complications were reported, (two pelvic collections, five chronic perineal sinuses, and one bowel obstruction). Group experiential themes were ‘Out of Options’, depicting patients forced to accept complications or limited survival; ‘The New Normal’, with EPS potentially delaying adaptation to post-PE HrQoL; ‘Information Influencing Adaptation,’ emphasising the significance of patients understanding EPS to cope with its effects; and ‘Symptoms,’ reporting manifestations of EPS, the resultant physical limitations, and an intangible feeling that patients lost part of themselves. Conclusions: EPS may influence patient decision-making, regret, adaptation, and information-seeking. It can cause a variety of unpleasant symptoms and physical limitations, which may include phantom phenomenon. This work supports ongoing purposeful HrQoL research to better define these themes.</p
An international assessment of surgeon practices in abdominal wound closure and surgical site infection prevention by the European Society for Coloproctology
No full textAim: The burden of abdominal wound failure can be profound. Recent clinical guidelines have highlighted the heterogeneity of laparotomy closure techniques. The aim of this study was to investigate current midline closure techniques and practices for prevention of surgical site infection (SSI).Method: An online survey was distributed in 2021 among the membership of the European Society of Coloproctology and its partner societies. Surgeons were asked to provide information on how they would close the abdominal wall in three specific clinical scenarios and on SSI prevention practices.Results: A total of 561 consultants and trainee surgeons participated in the survey, mainly from Europe (n = 375, 66.8%). Of these, 60.6% identified themselves as colorectal surgeons and 39.4% as general surgeons. The majority used polydioxanone for fascial closure, with small bite techniques predominating in clean-contaminated cases (74.5%, n = 418). No significant differences were found between consultants and trainee surgeons. For SSI prevention, more surgeons preferred the use of mechanical bowel preparation (MBP) alone over MBP and oral antibiotics combined. Most surgeons preferred 2% alcoholic chlorhexidine (68.4%) or aqueous povidone-iodine (61.1%) for skin preparation. The majority did not use triclosan-coated sutures (73.3%) or preoperative warming of the wound site (78.5%), irrespective of level of training or European/non-European practice.Conclusion: Abdominal wound closure technique and SSI prevention strategies vary widely between surgeons. There is little evidence of a risk-stratified approach to wound closure materials or techniques, with most surgeons using the same strategy for all patient scenarios. Harmonization of practice and the limitation of outlying techniques might result in better outcomes for patients and provide a stable platform for the introduction and evaluation of further potential improvements
Stoma Considerations Following Exenteration
No full textThe majority of patients who undergo exenterative surgery for urological, gynecological, or colorectal cancer will require urinary and/ or fecal diversion. The decision-making and formation of a stoma can be complex, with major impact on the quality of life (QoL) of patients. Patients needing pelvic exenteration have a QoL heavily influenced by morbidity relating to stoma complications. This chapter describes various possible urinary and/or combined fecal diversion methods. Accumulation of urine in continent urinary reservoirs can result in metabolic acidosis by reabsorption of ammonia, chloride, and hydrogen and secretion of bicarbonate and sodium. Uretero-ileocecal appendicostomy could be considered as a modification of the Penn pouch, using a detubularized colonic segment folded into a U-shape. Orthotopic neobladder is well known for reconstruction after cystectomy. Comparative studies on continent and incontinent urinary diversion techniques are scarce. Urological leaks can be demonstrated by contrast extravasation on radiological imaging such as computer tomography scans or conduitograms
Reply to Comment on, “Complications and Impact on Quality of Life of Vertical Rectus Abdominis Myocutaneous Flaps for Reconstruction in Pelvic Exenteration Surgery”
No full text
- …
