Subscribe to RSS
DOI: 10.1055/s-2004-822735
© Georg Thieme Verlag Stuttgart · New York
Postoperative Wundinfektionen nach kolorektalen Eingriffen
Postoperative Wound Infections in Colorectal SurgeryPublication History
Publication Date:
08 July 2004 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200403/lookinside/thumbnails/10.1055-s-2004-822735-1.jpg)
Zusammenfassung
Einleitung: Ein Problem der spezifischen postoperativen Komplikationen in der kolorektalen Chirurgie stellen die Wundinfektionen dar. Diese besitzen neben der medizinischen auch eine große sozialmedizinische und ökonomische Bedeutung. Für kolorektale Eingriffe gilt dabei eine Wundinfektionsrate von unter 10 % als zu erreichendes Qualitätskriterium.
Material/Methode: Seit dem 1.1.2000 wird durch das An-Institut für Qualitätssicherung in der operativen Medizin gGmbH an der Otto-von-Guericke Universität Magdeburg die prospektive bundesweite Erfassung der Patienten mit einem kolorektalen Karzinom durchgeführt. Die vorliegende Arbeit umfasst den Untersuchungszeitraum 2000-2002. Es werden die Wundinfektionsraten der Laparotomie gesamt, sowie getrennt nach Kolon- und Rektumkarzinomen, bei elektiven und Notfalleingriffen und kurativer bzw. palliativer Resektion dargestellt. Bei den abdomino-perinealen Rektumexstirpationen wird die perineale Wundinfektionsrate berechnet. Zur Untersuchung, welchen Einfluss verschiedene Parameter auf die Wundinfektion der Laparotomie bzw. der Sakralwunde haben, wird das mathematische Modell der logistischen Regression herangezogen.
Ergebnisse: Im Zeitraum 2000-2002 wurden 28 643 Patienten, davon 18 308 mit einem Kolon- und 10 335 mit einem Rektumkarzinom prospektiv erfasst. Die perioperative Antibiotikaprophylaxe war Standard ebenso die präoperative Darmvorbereitung. Unter diesen Voraussetzungen lag die Wundinfektionsrate der Laparotomie bei 4,4 % (n = 1 172). Beim Kolonkarzinom traten 4,3 % (n = 766) und beim Rektumkarzinom 4,4 % (n = 406) Wundinfektionen auf. Dabei handelte es sich um 85,6 % oberflächliche (epifasziale) und 14,4 % tiefe (subfasziale) Wundinfektionen der Laparotomie. Die Rektumexstirpationsrate in der Studie lag bei 26 %. Davon entwickelten 17,8 % (n = 436) eine Wundheilungsstörung der perinealen Wunde. Die logistische Regression zeigte: BMI, ASA-Klassifikation, renale Risikofaktoren, Diabetes mellitus (insulinpflichtig), kardiovaskuläre Erkrankungen, pulmonale Risikofaktoren, Alkoholabusus, multiviszerale Resektion, OP-Dauer, Notfalleingriff als signifikante Einflussfaktoren auf die Wundinfektionsrate der Laparotomie beim kolorektalen Karzinom.
Diskussion: Die in der vorliegenden Untersuchungen dargestellten Wundinfektionsraten entsprechen der internationalen Literatur und zeigen die Einhaltung der geforderten Qualitätsindikatoren. Es dominieren die oberflächlichen Wundinfektionen. Eine Reihe von Faktoren wirkt signifikant auf die Wundinfektionsrate ein. Die konsequente perioperative Antibiotikaprophylaxe hat einen entscheidenden Anteil an der Reduktion vor allem auch der Wundinfektionen in der kolorektalen Chirurgie. Weiterhin gehört zum derzeitigen Standard die präoperative mechanische Darmreinigung. Ein spezifisches Problem der Rektumchirurgie stellt die perineale Wundheilungsstörung nach abdomino-perinealer Rektumexstirpation dar. Die Rate dieser Komplikation schwankt in der Literatur und ist abhängig von der Art des Wundverschlusses, einer neoadjuvanten Vorbehandlung und der Operationstechnik. Randomisierte Studien zur Art des perinealen Wundverschlusses liegen nicht vor. Als Behandlungsziel kann eine Rate von perinealen Wundheilungsstörungen von unter 20 % gelten.
Abstract
Introduction: Wound infections are considered a characteristic problem in the spectrum of specific postoperative complications in colorectal surgery, which have a great impact on the outcome. Wound infection rate lower than 10 % is the today's criterion of quality control in colorectal surgery. In addition, wound infections are an important public health issue of enormous economic relevance.
Material/Methods: Since January 01, 2000, patients with colorectal carcinoma in Germany have been registered prospectively by the Institute for Quality Management in Operative Medicine at the Otto-von-Guericke University, Magdeburg (Germany). The study period comprises 36 months, from 2000-2002. Wound infection rate i) of laparotomy overall, ii) in colon carcinoma (Ca), iii) in rectum Ca, iv) in elective versus emergency interventions, and v) resections with curative versus palliative intention was determined. In abdominoperineal rectum exstirpations, perineal wound infections were documented. Logistic regression was used to determine, which parameters have a significant impact on the critical healing of laparotomy or perineal wound.
Results: Over 3 years, 28 643 patients (colon Ca, 18 308; rectum Ca, 10 335 were prospectively enrolled in the study. Perioperative prophylaxis with antibiotics is standardized as well as the preoperative bowel cleansing. Practicing these standards, wound infection rate of the laparotomy overall was 4.4 % (n = 1 172), whereas in the colon and rectum Ca, the rate was 4.3 % (n = 766) and 4.4 % (n = 406), respectively. In 85.6 % of cases, superficial (epifascial) wound infections were found, in the remaining 14.4 %, wound infection was located subfascially. The rectum exstirpation rate in this study was 26 %. Out of them, 17.8 % (n = 436) developed a perineal alteration of wound healing. Logistic regression revealed that BMI, ASA classification, renal & pulmonal risk factors, Insulin-dependent diabetes mellitus, cardiovascular diseases, alcohol abuse, multivisceral resection, duration of surgical intervention, and emergency laparotomy have a significant impact on the wound infection rate in surgery of colorectal Ca.
Discussion: The wound infection rate reported here are in accordance with data from the international literature and indicates that the rate is within the limits of quality control. Interestingly, superficial wound infections predominated. A wide spectrum of relevant factors does have a significant impact in determining wound infection rate. Consequent perioperative prophylaxis with antibiotics is one of the essential determinants in reducing significantly the rate of wound infections in colorectal surgery. In addition, a further standard is the mechanical bowel cleansing preoperatively. A specific problem of rectal surgery is the alteration of perineal wound healing after abdominoperineal rectum exstirpation, the rate of which underlies a great variety as indicated by the data from the literature. It depends on the type of wound closure, occurrence of neoadjuvant pre-treatment, and the surgical technique. Though, randomized studies comparing different techniques of perineal wound closure do not exist, 20 % are a realistic aim for the rate of alterations in perineal wound healing.
Schlüsselwörter
Wundinfektion - kolorektales Karzinom - Antibiotikaprophylaxe - präoperative Darmvorbereitung - perineale Wundheilungsstörung
Key words
Wound infection - colorectal carcinoma - perioperative prophylaxis with antibiotics - mechanical bowel preparation - alteration of perineal wound healing
Literatur
- 1 Zastrow K D. 16 Jahre „Richtlinie für Krankenhaushygiene und Infektionssprävention” des BGA - eine Standortbestimmung. Bundesgesundheitsblatt. 1992; 35 470-473
- 2 Wenzel R P. Preoperative antibiotic prophylaxis. N Engl J Med. 1992; 326 337-339
- 3 Taylor E W, Lindsay G. Selective decontamination of the colon before elective colorectal surgery. West of Scotland Surgical Infection Study Group. World J Surg. 1994; 18 926-931
- 4 Kager L, Malmborg A S, Nord C E. Impact of short term as compared with long-term prophylaxis with Cefoxitin on the colonic microflora in patients undergoing colorectal surgery. Drugs Exptl Clin Res. 1983; 9 387-392
- 5 Kappstein I, Schulgen G, Richtmann R, Farthmann E, Schlosser V, Geiger K, Just H, Schumacher M, Daschner F. Verlängerung der Krankenhausverweildauer durch nosokomiale Pneumonie und Wundinfektion. Dtsch med Wschr. 1991; 116 281-287
- 6 Gross P A. Striving for Benchmark Infektion Rates. Progress in Control for Patient Mix. American Journal of Medicine. 1991; 91 (Suppl 3 B) 16 S-20 S
- 7 McLaws M-L, Murphy C, Whitby M. Standardising surveillance of nosocomial infections: The HISS Programm. J Qual Clin Practice. 2000; 20 6-11
- 8 Marusch F, Koch A, Schmidt U, Zippel R, Geissler S, Pross M, Roessner A, Köckerling F, Gastinger I, Lippert H. Prospektive Multizenterstudien „Kolon-Rektumkarzinome” als flächendeckende chirurgische Qualitätssicherung. Chirurg. 2002; 73 138-146
- 9 Marusch F, Koch A, Schmidt U, Geissler S, Meyer L, Jost J, Ulrich B, Köckerling F, Gastinger I, Lippert H. Prospektive Multizenterstudie „Kolon-Rektum Karzinome (Primärtumor)” Überblick über den Jahrgang 2000. Zentralbl Chir. 2002; 127 332-349
- 10 Jensen L S, Andersen A, Fristrup S C, Holme J B, Hvid H M, Kraglund K, Rasmussen P C, Toftgaard C. Comparison of on dose versus three doses of prophylactic antibiotics, an the influence of blood transfusion, on infectious complications in acute and elective colorectal surgery. Br J Surg. 1990; 77 513-518
- 11 Lumley J W, Siu S K, Pillay S P, Stitz R, Kemp R J, Faoagali J, Nathanson L K, White S. Single dose ceftriaxone as prophylaxis for sepsis in colorectal surgery. Aust N Z J Surg. 1992; 62 292-296
- 12 Zaheer S, Pemberton J H, Farouk R, Dozois R R, Wolff B G, Ilstrup D. Surgical Treatment of Adenocarcinoma of the Rectum. Annals of Surgery. 1998; 227 800-811
- 13 Yalcin A N, Bakir M, Bakici Z, Dökmetas I, Sabir N. Postoperative wound infections. Journal of Hospital Infection. 1995; 29 305-309
- 14 Slanetz C A, Herter F P, Grinnell R S. Anterior resection versus abdomino-perineal resection for cancer of the rectum and rectosigmoid. An analysis of 524 cases. Am J Surg. 1972; 123 110-117
- 15 Rothenberger D A, Wong W D. Abdominoperineal resection for adenocarcinoma of the low rectum. World J Surg. 1992; 16 478-485
- 16 Petrelli N J, Nagel S, Rodriguez-Bugas M, Piedmonte M, Herrera L. Morbidity and mortality following abdominoperineal resection for rectal adenocarcinoma. Am Surg. 1993; 59 400-404
- 17 Menke H, Graf J M, Heintz A, Klein A, Junginger T. Risikofaktoren der perioperativen Morbidität und Letalität beim kolorektalen Karzinom unter besonderer Berücksichtigung von Tumorstadium, Lokalisation und Lebensalter. Zentralbl Chir. 1993; 118 40-46
- 18 Pollard C W, Nivatvongs S, Rojanasakul A, Ilstrup D M. Carcinoma of the rectum. Profiles of intraoperative and early postoperative complications. Dis Colon Rectum. 1994; 37 866-874
- 19 Safi F, Beger H G. Morbidität und Letalität der operativen Therapie des colorectalen Carcinoms. Chirurg. 1994; 65 127-131
- 20 Bruch H P, Roblick U J, Schwandner O. Rektumkarzinom. Optimierung durch tiefe Resektion oder Exstirpation. Zentralbl Chir. 1999; 124 422-427
- 21 Galizia G, Lieto E, Castellano P, Pelosio L, Imperatore V, Canfora F, Pignatelli C. Comparison between the biofragmentable anastomosis ring and stapled anastomoses in the extraperitoneal rectum: a prospective, randomized study. Int J Colorectal Dis. 1999; 14 286-290
- 22 Poon R T-P, Law W-L, Chu K-W, Wong J. Emergency resection and primary anastomsis for left-sided obstructing colorectal carcinoma in the elderly. Br J Surg. 1998; 85 1539-1542
- 23 Bokey E L, Chapuis P H, Fung C, Hughes W J, Koorey S G, Brewer D, Newland R C. Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum. 1995; 38 480-486
- 24 Perez Ruiz L, Luca F, Gomez L, Vinas J, Torres S, Andreoni B. Prognostic significance of postoperative septic complications in surgery of rectal carcinoma. Minerva Chir. 1996; 51 447-450
- 25 Marusch F, Koch A, Schmidt U, Pross M, Köckerling F, Bauer H, Schönleben K, Halbfaß H J, Scheele J, Gastinger I, Lippert H. Stellenwert der Rektumexstirpation im Therapiekonzept des tief sitzenden Rektumkarzinoms. Chirurg. 2003; 74 341-352
- 26 Gastinger I, Koch A, Marusch F, Lippert H. Perioperative Risikoprävention in der Viszeralchirurgie. In: Huchzermeyer H, Lippert H (Hrsg). Infektionsmedizin in Gastroenterologie und Viszeralchirurgie. Schattauer, Stuttgart, New York 2000, 57-59
- 27 Milson J W, Smith D L, Corman M L, Howerton R A, Yellin A E, Luke D R. Double-blind comparison of single-dose alatrofloxacin and cefotetan as prophylaxis of infection following elective colorectal surgery. Trovafloxacin Surgical Group. Am J Surg. 1998; 176 46-52
- 28 Matikainen M, Hiltunen K M. Parenteral single dose ceftriaxone with tinidatsole versus aminoglycoside with tinidatsole in colorectal surgery: a prospective single-blind randomized multicentre study. Int J Colorectal Dis. 1993; 8 148-150
- 29 Jensen L S, Andersen A, Fristrup S C, Holme J B, Hvid H M, Kraglund K, Rasmussen P C, Toftgaard C. Comparison of on dose versus three doses of prophylactic antibiotics, an the influence of blood transfusion, on infectious complications in acute and elective colorectal surgery. Br J Surg. 1990; 77 513-518
- 30 Taylor E W, Lindsay G. Selective decontamination of the colon before elective colorectal surgery. West of Scotland Surgical Infection Study Group. World J Surg. 1994; 18 926-931
- 31 Beltrami V. Age related risk and prevention of postoperative complications. Clin Ter. 1998; 149 435-438
- 32 Torrosian M H. Perioperative nutrition support for Patients undergoing gastrointestinal surgery: Critical analysis and recommendations. World J Surg. 1999; 23 565-569
- 33 Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri S F. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999; 134 36-42
- 34 Heyland D K, Mac Donald S, Keefe L, Drover J W. Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA. 1998; 280 1013-1019
- 35 Braunschweig C L, Levy P, Sheean P M, Wang X. Enteral compared with parenteral nutrition: a metaanalysis. Am J Clin Nutr. 2001; 74 534-542
- 36 Nichols R L, Holmes J WC. Prophylaxic and therapeutic antibiotics in colon and rectal surgery. Perspect Colon Recatl Surg. 1990; 3 183-199
- 37 Polk H C, Simpson C J, Simmons B P, Alexander J W. Guidelines for prevention of surgical wound infection. Arch Surg. 1983; 118 1213-1217
- 38 Ulnalp K, Condon R E. Antibiotics prophylaxis for scheduled operative procedures. Surg Clin North Am. 1992; 6 613-625
- 39 Farnell M B, Worthington-Self S, Mucha P, Ilstrup D M, McIlrath D C. Closure of abdominal incisions with subcutaneous catheters. Arch Surg. 1986; 121 641-648
- 40 Olson M, O'Connor M, Schwartz M L. Surgical wound infections. A 5-year prospective study of 20 193 wounds at the Mineapolis VA Medical Center. Ann Surg. 1984; 199 253-259
- 41 Sugarbaker P H. Influence of surgical techniques on survival in patients with colorectal cancer. Dis Colon Rectum. 1982; 25 545-557
- 42 Gorbach S H. Antimicrobial prophylaxis for appendectomy and colorectal surgery. Rev Infect Dis. 1991; 13 (Suppl 10) 815-820
- 43 Gross P A, Barrett T L, Dellinger E P, Krause P J. et al . Consensus development of quality standards. Infect Control Hosp Epidemiol. 1994; 15 189
- 44 Durig M, Neff U, Rittmann W W, Leutenegger A, Oberholzer M, Wolff G. Antibiotic prophylaxis in colon surgery with Cefazolin. Helv Chir Acta. 1980; 46 721-726
- 45 Ulrich C. 24-hour systemic antibiotic prophylaxis in large-bowel surgery. Neth J Surg. 1981; 33 3-9
- 46 Dellinger E P, Gross P A, Barrett T L, Krause P J, Martone W J, McGowan J E, Sweet R L, Wenzel R P. Quality standard for antimicrobial prophylaxis in surgical procedures. Infect Control Hosp Epidemiol. 1994; 15 182-188
- 47 Gross P A, Barrett T L, Dellinger E P, Krause P J, Martone W J, McGowan J E, Sweet R L, Wenzel R P. Consensus development of quality standards. Infect Control Hosp Epidemiol. 1994; 15 180-181
- 48 Rau H G, Zimmermann A, Lachmann A. et al . Perioperative Infektionsprophylaxe bei der elektiven Kolonresektion: Ceftriaxon vs. andere Beta-Laktame - eine Kosteneffektivitätsanalyse. Z Antimikr Antineopl Chemoth. 1998; 16 25-33
- 49 Shepherd A, Roberts A, Ambrose N S. et al . Ceftriaxone with metronidazole as single dose prophylaxis in colorectal surgery. Coloproctology. 1986; 8 91-94
- 50 Diamond T, Mulholland C K, Hanna W A, Parks T G. A prospective randomised trial to compare triple dose mezlocillin with triple dose cefuroxime plus metronidazol as prophylaxis in colorectal surgery. J Hosp Infect. 1988; 12 215-219
- 51 Stubbs R S, Griggs N J, Kelleher J P, Dickinson I K, Moat N, Rimmer D M. Single dose mezlocillin versus three dose cefuroxime plus metronidazole for the prophylaxis of wound infections after large bowel surgery. J Hosp Infect. 1987; 9 285-290
- 52 Zuber M, During M, Neff U, Laffer U. Antibioticaprophylaxe in der Kolonchirurgie: Cefazolin-Ornidazol versus Cefazolin-Plazebo. Helv Chir Acta. 1989; 56 211-215
- 53 Arnaud J P, Bellissant E, Boissel P, Carlet J, Chastang C, Lafaix C, Rio Y, Berganeschi R. Single-dose amoxycillin-clavulanic acid vs. cefotetan for prophylaxis in elective colorectal surgery: a multicentre, prospective, randomised study. The PRODIGE Group. J Hosp Infect. 1992; 22 (Suppl A) 23-32
- 54 Menzel J, Bauer J, von Pritzbuer E, Klempa I. Perioperative Anwendung von Ampicillin/Sulbactam, Cefoxitin und Piperacillin/Metronidazol in der elektiven Kolon- und Rektumchirurgie. Eine prospektive Qualitätssicherungsstudie bei 422 Patienten. Chirurg. 1993; 64 649-652
- 55 Burke F. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery. 1961; 50 161-165
- 56 Classen D C, Evans R S, Pestotnik S L, Horn S D, Menlove R L, Burke J P. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992; 326 281-286
- 57 Song F, Glenny A M. Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomised controlled trials. Br J Surg. 1998; 85 1232-1241
- 58 Aberg C, Thore M. Singel versus triple dose antimicrobial prophylaxis in elective abdominal surgery and the impact on bacterial ecology. J Hosp Infect. 1991; 18 149-154
- 59 Hershman M J, Swift R I, Reilly D T, Logan W A, Sackier J M, Gompertz H, Horner J, Baker N W, Wood C B. Prospective comparative study of cefotetan with piperacillin for prophylaxis against infection in elective colorectal surgery. J R Coll Surg Edinb. 1990; 35 29-32
- 60 Jagelmann D G, Fabian T C, Nichols R L. Single dose cefotetan vs multidose cefoxitin as prophylaxis in colorectal surgery. Am J Surg. 1988; 155 71
- 61 Periti P, Mazzei T, Tonelli F. Single-dose cefotetan vs. multiple dose cefoxitin - antimicrobial prophylaxis in colorectal surgery. Dis Colon Rectum. 1989; 32 121-127
- 62 Rowe-Jones D C, Peel A LG, Kingston R D, Shaw J F. et al . Single-dose cefotaxim plus metronidazol as prophylaxis against wound infection in colorectal surgery: a multicentre prospective randomized study. BMJ. 1990; 300 18-22
- 63 Aberg C, Thore M. Single versus triple dose antimicrobial prophylaxis in elective abdominal surgery and the impact on bacterial ecology. J Hosp Infect. 1991; 18 149-154
- 64 Hershman M J, Swift R I, Reilly D T, Logan W A, Sackier J M, Gompertz H, Horner J, Baker N W, Wood C B. Prospective comparative study of cefotetan with piperacillin for prophylaxis against infection in elective colorectal surgery. J R Coll Surg Edinb. 1990; 35 29-32
- 65 Jagelman D G, Fabian T C, Nichols R L, Stone H H, Wilson S E, Zellner S R. Single-dose cefotetan versus multiple-dose cefoxitin as prophylaxis in colorectal surgery. Am J Surg. 1988; 155 71-76
- 66 Periti P, Mazzei T, Tonelli F. Single-dose cefotetan vs. multiple-dose cefoxitin - antimicrobial prophylaxis in colorectal surgery. Results of a prospective, multicenter, randomized study. Dis Colon Rectum. 1989; 32 121-127
- 67 Rowe-Jones D C, Peel A L, Kingston R D, Shaw J F, Teasdale C, Cole D S. Single dose cefotaxime plus metronidazole versus three dose cefuroxime plus metronidazole as prophylaxis against wound infection in colorectal surgery: multicentre prospective randomised study. BMJ. 1990; 300 18-22
- 68 McDonald P J, Sanders R, Turnidge J, Hakendorf P, Jolley P, McDonald H, Petrucco O. Optimal duration of cefotaxime prophylaxis in abdominal and vaginal hysterectomy. Drugs. 1988; 35 (Suppl 2) 216-220
- 69 Olak J, Jeyasingham K, Forrester-Wood C, Hutter J, al-Zeerah M, Brown E. Randomized trial of one-dose versus six-dose cefazolin prophylaxis in elective general thoracic surgery. Ann Thorac Surg. 1991; 51 956-958
- 70 Trilla A, Mensa J. Preoperative antibiotic prophylaxis. In: Wenzel RP (ed). Prevention and control of nosocomial infections. Williams & Wilkins, Baltimore 1997; 867
- 71 Reers B, Hell-Türler K, Kullmann K H. Kosteneinsparungen mittels perioperativer Antibiotikaprophylaxe anhand einer Modellrechnung. Z Antimikr Antineopl Chemoth. 1996; 14 233-236
- 72 Lippert H, Gastinger I, Hell K. Wert der effizienten Antibiotikaprophylaxe vor dem Hintergrund des neuen Gesundheitsstrukturgesetzes. In: Jahrbuch der Chirurgie. Biermann, Zülpich 1996; 189-196
- 73 Baum M L, Anish D S, Chalmers T C. et al . A survey of clinical trials of antibiotic prophylaxis in colon surgery: evidence against further use of no treatment controls. New Engl J Med. 1981; 305 795-799
- 74 Zelenitsky S A, Silverman R E, Duckworth H, Harding G K. A prospective, randomized, double-blind study of single high dose versus multiple standard dose gentamicin both in combination with metronidazole for colorectal surgical prophylaxis. J Hospital Infection. 2000; 46 135-140
- 75 Guenaga K F, Matos D, Castro A A. et al .Mechanical bowel preparation for elective colorectal surgery (Cochrane Review). In: The Cochran Library, Issue 3. Oxford 2003. Update Software
- 76 Bruke P, Mealy K, Gillen P. et al . Requirement for bowel preparation in colorectal surgery. Brit J of Surg. 1994; 81 907-910
- 77 Miettinen R P, Laitinen S T, Maekelae J T. et al . Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery: prospective, randomized study. Dis Colon Rectum. 2000; 43 669-675
- 78 Oliveira L, Wexner S D, Daniel N, DeMarta D, Weiss E G, Nogueras J J, Bernstein M. Mechanical bowel preparation for elective colorectal surgery. A prospective, randomized, surgeon-blinded trial comparing sodium phosphate and polyethylene glycol-based oral lavage solutions. Dis Colon Rectum. 1997; 40 585-591
- 79 Platell C, Hall J. What is the role of mechanical bowel preparation in patients undergoing colorectal surgery. Dis Colon Rectum. 1998; 41 875-882
- 80 SIGN (Scottish Intercollegiate Guidelines Netwerk) .Management of colorectal cancer. A national clinical guideline. SIGN, Royal College of Physicians, Edinburgh, March 2003
- 81 Santos J C, Batista J, Sirimarco M T. et al . Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Brit J Surg. 1994; 81 1673-1676
- 82 Wille-Jorgensen P, Guenaga K F, Castro A A, Matos D. Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery: a systematic review. Dis Colon Rectum. 2003; 46 1019-1020
- 83 Irvin T T, Goligher J C. A controlled clinical trial of three different methods of perineal wound management following excision of the rectum. Br J Surg. 1975; 62 287-291
- 84 Campos R R, Ayllon J G, Paricio P P. et al . Management of the perineal wound following abdominoperineal resection: prospective study of three methods. Br J Surg. 1992; 79 29
- 85 Gall F P. Wie wird die sakrale Wundhöhle nach abdomino-sakraler Rektumamputation versorgt. Chir Praxis. 1991/92; 44 282-283
- 86 Kapiteijn E, Marijnen C AM, Nagtegaal I D. et al . Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001; 345 638
- 87 Pollard C W, Nivatvongs S, Rojanasakul A, Ilstrup D M. Carcinoma of the Rectum. Profiles of intraoperative and early postoperative complications. Dis Colon Rectum. 1994; 37 866-874
- 88 Kopp I, Koller M, Stinner B, Hainbach S, Rothmund M, Lorenz W. Chirurgische Therapie des Rektumkarzinoms der realen Versorgungssituation einer kreisbezogenen Qualitätssicherungsstudie. Chirurg. 2002; 72 1467
- 89 Kneist W, Heintz A, Wolf K H, Junginger Th. Totale Mesorektumexzision bei Karzinom des mittleren und unteren Rektumdrittels. Chirurg. 2003; 74 125-131
- 90 Anthony J P, Mathes S J. The recalcitrant perineal wound after rectal extirpation. Arch Surg. 1990; 125 1371-1377
- 91 Loessin S J, Meland N B, Devine R M, Wolff B G, Nelson H, Zimcke H. Management of sacral and perineal defects following abdominoperineal resection and radiation with transpelvic muscle flaps. Dis Colon Rectum. 1995; 38 940-945
- 92 Temple L, Lindsay R L, Temple W J, Magi E, Ketcham A S. Rectus myocutaneous flaps for primary repair of composite defects of the pelvis. Perspect Colon Rectal Surg. 1993; 6 171-174
Priv.-Doz. Dr. Frank Marusch
Chirurgische Klinik · Carl-Thiem-Klinikum
Thiemstr. 111
03048 Cottbus
Phone: 03 55/46 23 27
Fax: 03 55/46 23 37
Email: marusch-cottbus@t-online.de