Download PDF
Zentralbl Chir 2023; 148(05): 406-414
DOI: 10.1055/a-1533-2612
Originalarbeit

Die „Big Five“ der Invasivität – Sinnhaftigkeit von Drainagen, Sonden und Kathetern in der kolorektalen Chirurgie

The "Big Five" of Invasiveness - the Usefulness of Drains, Probes and Catheters in Colorectal Surgery
Franziska Koch
1   Klinik für Allgemein- und Viszeralchirurgie, HELIOS Kliniken Schwerin, Schwerin, Deutschland (Ringgold ID: RIN62491)
,
Martina Green
1   Klinik für Allgemein- und Viszeralchirurgie, HELIOS Kliniken Schwerin, Schwerin, Deutschland (Ringgold ID: RIN62491)
,
Melanie Dietrich
1   Klinik für Allgemein- und Viszeralchirurgie, HELIOS Kliniken Schwerin, Schwerin, Deutschland (Ringgold ID: RIN62491)
,
Lutz Moikow
2   Klinik für Anästhesiologie, HELIOS Kliniken Schwerin, Schwerin, Deutschland (Ringgold ID: RIN62491)
,
Jörg-Peter Ritz
3   Klinik für Allgemein- und Viszeralchirurgie, HELIOS Kliniken Schwerin, Schwerin, Germany (Ringgold ID: RIN62491)
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Das perioperative Management bei kolorektalen Resektionen ist häufig durch tradierte Vorgehensweisen und ausgeprägtes Sicherheitsdenken gekennzeichnet. Evidenzbasierte Maßnahmen, wie sie in Fast-Track- oder ERAS-Programmen etabliert wurden, werden hingegen seltener standardisiert angewandt. Viele Patienten erhalten daher im Rahmen elektiver kolorektaler Chirurgie weiterhin routinemäßig zentralvenöse Zugänge, Periduralkatheter, Blasenkatheter, Drainagen und/oder Magensonden („Big Five“ der Invasivität). In dieser Arbeit wird die aktuell vorhandene Evidenz zu diesen Maßnahmen in der kolorektalen Chirurgie dargestellt. Zudem werden Ergebnisse mit Bezug zu den „Big Five“ aus dem eigenen Zentrum vorgestellt. Diese Arbeit zeigt auf, dass die „Big Five“ der Invasivität klinisch nicht erforderlich und mit fehlender Evidenz belegt sind. Zudem führen sie häufig zu einer Einschränkung des Patienten.

Abstract

The perioperative management of colorectal resections is often dominated by traditional procedures and a strong focus on safety. Evidence-based measures such as those established in Fast Track or ERAS programs, are rarely applied in a standardised manner. As part of elective colorectal surgery, many patients therefore continue to routinely receive central venous access, peridural catheters, urinary catheters, drains and/or gastric tubes (“Big Five” of invasiveness). This article presents the currently available evidence on these measures in colorectal surgery. In addition, results relating to the “Big Five” from the author’s own centre are presented. This review shows that the “Big Five” of invasiveness are clinically unnecessary or supported by evidence. In addition, they often impair the patient’s function.

Schlüsselwörter

ERAS - Fast Track - PDK - Drainage - laparoskopische kolorektale Chirurgie

Keywords

ERAS - Fast Track - Laparoscopic colorectal surgery


Publication History

Received: 05 April 2021

Accepted after revision: 17 June 2021

Article published online:
19 October 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Gustafsson UO, Scott MJ, Hübner M. et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: 2018. World J Surg 2019; 43: 659-695
    CrossrefPubMedSearch in Google Scholar
  • 2 Adamina M, Kehlet H, Tomlinson GA. et al. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 2011; 149: 830-840
    CrossrefPubMedSearch in Google Scholar
  • 3 Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery – A Review. JAMA Surg 2017; 152: 292-298
    CrossrefPubMedSearch in Google Scholar
  • 4 Beisbarth H, Fekl W. Pathophysiology of post-aggression metabolism. Zentralbl Chir 1989; 114: 1045-1058
    PubMedSearch in Google Scholar
  • 5 Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 2008; 248: 189-198
    CrossrefPubMedSearch in Google Scholar
  • 6 Taylor RW, Palagiri AV. Central venous catheterization. Crit Care Med 2007; 35: 1390-1396
    CrossrefPubMedSearch in Google Scholar
  • 7 Kiran RP, Delaney CP, Senagore AJ. Operative Blood Loss and Use of Blood Products After Laparoscopic and Conventional Open Colorectal Operations. Arch Surg 2004; 139: 39-42
    CrossrefPubMedSearch in Google Scholar
  • 8 Haas A, Schürholz T, Reuter DA. Perioperative medikamentöse Kreislaufunterstützung in der täglichen Routine. Anaesthesist 2020; 69: 781-792
    CrossrefPubMedSearch in Google Scholar
  • 9 Lewis T, Merchan C, Altshuler D. et al. Safety of the peripheral administration of vasopressor agents. J Intensive Care Med 2019; 34: 26-33
    CrossrefPubMedSearch in Google Scholar
  • 10 Cardenas-Garcia J, Schaub KF, Belchikov YG. et al. Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med 2015; 10: 581-585
    CrossrefPubMedSearch in Google Scholar
  • 11 Liu SS, Carpenter RL, Mackey DC. et al. Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 1995; 83: 757-765
    CrossrefPubMedSearch in Google Scholar
  • 12 Scott AM, Starling JR, Ruscher AE. et al. Thoracic versus lumbar epidural anaesthesia’s effect on pain control and ileus resolution after restorative proctocolectomy. Surgery 1996; 120: 688-697
    CrossrefPubMedSearch in Google Scholar
  • 13 Kolker AR, Hirsch CJ, Gingold BS. Use of epidural anesthesia and spontaneous ventilation during transabdominal colon and rectal procedures in selected high-risk patient groups. Dis Colon Rectum 1997; 40: 339-343
    CrossrefPubMedSearch in Google Scholar
  • 14 Christensen P, Brandt MR, Rem J. et al. Influence of extradural morphine on the adrenocortical and hyperglycaemic response to surgery. Br J Anaesth 1982; 54: 23-27
    CrossrefPubMedSearch in Google Scholar
  • 15 Spence AA, Smith G. Postoperative analgesia and lung function: a comparison of morphine with extradural block. Br J Anaesth 1971; 43: 144-148
    CrossrefPubMedSearch in Google Scholar
  • 16 Halabi WJ, Kang CY, Nguyen VQ. et al. Epidural Analgesia in Laparoscopic Colorectal Surgery – A Nationwide Analysis of Use and Outcomes. JAMA Surg 2014; 149: 130-136
    CrossrefPubMedSearch in Google Scholar
  • 17 Hanna MH, Jafari MD, Jafari F. et al. Randomized Clinical Trial of Epidural Compared with Conventional Analgesia after Minimally Invasive Colorectal Surgery. J Am Coll Surg 2017; 225: 622-630
    CrossrefPubMedSearch in Google Scholar
  • 18 Turi S, Gemma M, Braga M. et al. Epidural analgesia vs systemic opioids in patients undergoing laparoscopic colorectal surgery. Int J Colorectal Dis 2019; 34: 915-921
    CrossrefPubMedSearch in Google Scholar
  • 19 Torgeson M, Kileny J, Pfeifer C. et al. Conventional Epidural vs Transversus Abdominis Plane Block with Liposomal Bupivacaine: A Randomized Trial in Colorectal Surgery. J Am Coll Surg 2018; 227: 78-83
    CrossrefPubMedSearch in Google Scholar
  • 20 Pirrera B, Alagna V, Lucchi A. et al. Transversus abdominis plane (TAP) block versus thoracic epidural analgesia (TEA) in laparoscopic colon surgery in the ERAS program. Surg Endosc 2018; 32: 376-382
    CrossrefPubMedSearch in Google Scholar
  • 21 Imbelloni LE, Vieira EM, Gouveia MA. et al. Pudendal block with bupivacaine for postoperative pain relief. Dis Colon Rectum 2007; 50: 1656-1661
    CrossrefPubMedSearch in Google Scholar
  • 22 Saint S, Trautner BW, Fowler KE. et al. A multicenter study of patient-reported infectious and noninfectious complications associated with indwelling urethral catheters. JAMA Intern Med 2018; 178: 1078-1085
    CrossrefPubMedSearch in Google Scholar
  • 23 Kidd EA, Stewart F, Kassis NC. et al. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev 2015; (12) CD004203
    CrossrefPubMedSearch in Google Scholar
  • 24 Alyami M, Lundberg P, Passot G. et al. Laparoscopic Colonic Resection Without Urinary Drainage: Is It Feasible?. J Gastrointest Surg 2016; 20: 1388-1392
    CrossrefPubMedSearch in Google Scholar
  • 25 Eriksen JR, Munk-Madsen P, Kehlet H. et al. Postoperative Urinary Retention After Laparoscopic Colorectal Resection with Early Catheter Removal: A Prospective Observational Study. World J Surg 2019; 43: 2090-2098
    CrossrefPubMedSearch in Google Scholar
  • 26 Schreiber A, Aydil E, Walschus U. et al. Early removal of urinary drainage in patients receiving epidural analgesia after colorectal surgery within an ERAS protocol is feasible. Langenbecks Arch Surg 2019; 404: 853-863
    CrossrefPubMedSearch in Google Scholar
  • 27 Grass F, Slieker J, Frauche P. et al. Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway. J Surg Res 2017; 207: 70-76
    CrossrefPubMedSearch in Google Scholar
  • 28 Urbach DR, Kennedy ED, Cohen MM. Colon and Rectal Anastomoses Do Not Require Routine Drainage – A Systematic Review and Meta-Analysis. Ann Surg 1999; 229: 174-180
    CrossrefPubMedSearch in Google Scholar
  • 29 Rolph R, Duffy J, Alagaratnam S. et al. Intra-abdominal drains for the prophylaxis of anastomotic leak in elective colorectal surgery. Cochrane Database Syst Rev 2004; (04) CD002100
    CrossrefPubMedSearch in Google Scholar
  • 30 Podda M, Di Saverio S, Davies RJ. et al. Prophylactic intra-abdominal drainage following colorectal anastomoses. A systematic review and meta-analysis of randomized controlled trials. Am J Surg 2020; 219: 164-174
    CrossrefPubMedSearch in Google Scholar
  • 31 Merad F, Yahchouchi E, Hay JM. et al. Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis: a multicenter study controlled by randomization. French Associations for Surgical Research. Arch Surg 1998; 133: 309-314
    CrossrefPubMedSearch in Google Scholar
  • 32 Guerra F, Giuliani G, Coletta D. et al. A Metaanalysis of randomized controlled trials on the use of suction drains following rectal surgery. Dig Surg 2018; 35: 482-490
    CrossrefPubMedSearch in Google Scholar
  • 33 Berliner SD, Burson LC, Lear PE. The use and abuse of intraperitoneal drains in colon surgery. Arch Surg 1964; 89: 686-690
    CrossrefPubMedSearch in Google Scholar
  • 34 Hermann G. Intraperitoneal drainage. Surg Clin North Am 1969; 49: 1279-1288
    CrossrefPubMedSearch in Google Scholar
  • 35 Duthie HL. Drainage of the abdomen. N Engl J Med 1972; 287: 1081-1083
    CrossrefPubMedSearch in Google Scholar
  • 36 Hoffmann J, Shokouh-Amiri MH, Damm P. et al. A prospective controlled study of prophylactic drainage after colonic anastomoses. Dis Colon Rectum 1987; 30: 449-452
    CrossrefPubMedSearch in Google Scholar
  • 37 Reissman P, Teoh TA, Cohen SM. et al. Is Early Oral Feeding Safe After Elective Colorectal Surgery? A Prospective Randomized Trial. Ann Surg 1995; 222: 73-77
    CrossrefPubMedSearch in Google Scholar
  • 38 Bauer VP. The Evidence against Prophylactic Nasogastric Intubation and Oral Restriction. Clin Colon Rectal Surg 2013; 26: 182-185
    Thieme ConnectPubMedSearch in Google Scholar
  • 39 Chapman SJ, Pericleous A, Downey C. et al. Postoperative ileus following major colorectal surgery. Br J Surg 2018; 105: 797-810
    CrossrefPubMedSearch in Google Scholar
  • 40 Venara A, Hamel JF, Cotte E. et al. Intraoperative nasogastric tube during colorectal surgery may not be mandatory: a propensity score analysis of a prospective database. Surg Endosc 2020; 34: 5583-5592
    CrossrefPubMedSearch in Google Scholar