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2013, Number 6

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Cir Cir 2013; 81 (6)

Evidence based improvements in elective bowel anastomoses in children

Dávila-Pérez R, Bracho-Blanchet E, Fernández-Portilla E, Tovilla-Mercado JM, Zalles-Vidal CR, Nieto-Zermeño J

Language: Spanish
References: 28
Page: 548-555
PDF size: 402.25 Kb.


ABSTRACT

Background: Before the year 1993, the gold standard treatment in elective bowel anastomosis were two layer anastomosis, use of nasogastric tube for draining and the start of the oral intake after the 5th day. These were controversial topics, so we designed several clinical trials to resolve these questions.
Results: We demonstrated that one layer anastomosis in elective bowel anastomoses showed the same risk for complications than the two layer anastomosis, but we used less surgical and anesthetic time to do the one layer. We showed in an equivalence study that the use of nasogastric tube does not confer any protective factor against surgical complications; right now we don’t use the nasogastric tube after an elective bowel anastomosis in our hospital. Finally we demonstrated that we can start the enteral feeding before the 5th day safely after an elective bowel anastomosis. In another study we reduced the rate of surgical infections in elective bowel anastomosis using a quality improvement model, showing that standardized perioperative surgical steps are important in the treatment of our patients.
Discussion: Before 1993 the therapeutic gold Standard in elective bowel anastomoses was based on a tradicional knowledge more than a scientific one. Using clinical trials we changed the empirical based routines instead of evidence based improvements in pediatric bowel anastomoses.
Conclusions: With all this evidence based improvements we change our treatment in benefit for our children.


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