Annals of Coloproctology

Original Article

ERAS

Clinical impact of a multimodal pain management protocol for loop ileostomy reversal: Jeong Sub Kim, Chul Seung Lee, Jung Hoon Bae, Seung Rim Han, Do Sang Lee, In Kyu Lee, Yoon Suk Lee, In Kyeong Kim; Ann Coloproctol. 2024;40(3):210-216. Published online June 19, 2024; DOI: https://doi.org/10.3393/ac.2022.01137.0162

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Purpose
As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy.
Methods
Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B).
Results
Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6 ± 1.3 vs. 3.2 ± 1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7 ± 9.5 vs. 21.2 ± 8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3 ± 1.5 days vs. 4.1 ± 1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate.
Conclusion
Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.

Citations

Citations to this article as recorded by

Multimodal analgesia for postoperative pain: pursuing liberation from pain, not redemption
Soo Yeun Park
Annals of Coloproctology.2024; 40(3): 189. CrossRef
Clinical outcomes and future directions of enhanced recovery after surgery in colorectal surgery: a narrative review
Ji Hyeong Song, Minsung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef
Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

Case Reports

Benign bowel disease

Perioperative considerations for acute appendicitis in patients with COVID-19 infection: two case reports: In-Kyeong Kim, Seung-jin Kwag, Han-Gil Kim, Young-Tae Ju, Seung-Jun Lee, Tae-Jin Park, Sang-Ho Jeong, Eun-Jung Jung, Jin-Kwon Lee; Ann Coloproctol. 2023;39(6):521-525. Published online December 7, 2021; DOI: https://doi.org/10.3393/ac.2021.00647.0092

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Abstract PDF: We report considerations related with surgery through 2 cases of acute apendicitis with COVID-19 infection. In November and December 2020, two patients infected with COVID-19 developed acute apendicitis and underwent emergency surgery. In case 1, an 84-year-old woman was asymptomatic and diagnosed with acute apendicitis on the 20th day of infection. She was discharged after surgery without complication. In contrast, case 2 was a 69-year-old male patient with pneumonia treated with antibiotics, steroids and remdesivir. After surgery, he was hospitalized for a long duration due to persistent pneumonia and wound complications. We should perform appendectomy in well-established negative pressure operating rooms, personal protective equipment, and protocols. Since the physical examination and blood tests were limited, image examination like computed tomography scan should be considered if acute apendicitis is suspected. If the patient has pneumonia before surgery, it can get worse after surgery, and complications such as wound infections can occur.

Colorectal cancer

Experience of surgical treatment in a granular cell tumor in the ascending colon: a case report: In-Kyeong Kim, Young-Tae Ju, Han-Gil Kim, Jin-Kwon Lee, Dong-Chul Kim, Jae-Myung Kim, Jin Kyu Cho, Ji-Ho Park, Ju-Yeon Kim, Chi-Young Jeong, Soon-Chan Hong, Seung-Jin Kwag; Ann Coloproctol. 2023;39(3):275-279. Published online July 6, 2021; DOI: https://doi.org/10.3393/ac.2020.00836.0119

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Abstract PDF: We report a case about successful surgical treatment of a granular cell tumor in the ascending colon. A 36-year-old man underwent screening colonoscopy. An endoscopic examination revealed a 10-mm yellowish and hemispheric mass in the ascending colon, and lower endoscopic ultrasonography revealed a hypoechoic-to-isoechoic mass invaded the submucosal layer. The mass was suspected to be a colonic carcinoid tumor. Based on the preoperative evaluation, endoscopic complete resection was considered difficult. Therefore, the lesion was removed via laparoscopic right hemicolectomy. Histological examination revealed that the tumor consisted of nests of polygonal cells with abundant granular eosinophilic cytoplasm. Immunohistochemical staining revealed diffuse positivity for S100 and CD68. Therefore, the tumor was diagnosed as a granular cell tumor. We suggest that surgical resection should be considered if it is located in the thin-walled ascending colon prone to perforation, difficult to rule out malignant tumor due to submucosal invasion, or to remove endoscopically.

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