Advertisement

Checklist for Patients and OR Team in Preparation for Laparoscopic Colorectal Surgery

  • Samuel Eisenstein
  • Alexis L. Grucela
Chapter

Abstract

Careful planning for laparoscopic colorectal surgery is the key to ensuring optimal patient outcomes. This begins long before the patient ever enters the operating room. Many postoperative complications can be prevented simply by risk stratifying patients prior to surgery and ensuring they are medically optimized. Patients should be educated as to what to expect from their surgery, and stoma marking and education should be performed. On the day of surgery, prior to incision, preoperative checklists should be employed. Regional anesthetic modalities should be considered, and venous thromboembolism prophylaxis should be administered based on preoperative risk. The antibiotic regimen and dosing schedule, positioning, and equipment setup should also be verified. Urinary catheterization is generally used for laparoscopic colorectal procedures, and ureteral stenting should be considered in select cases as a useful measure if the patient is high risk for a ureteral injury. By ensuring careful preparation and planning for laparoscopic colorectal surgery, complications can be avoided, and the patient experience can be improved dramatically.

Keywords

Preoperative Checklist Risk assessment Stoma marking Patient education Regional anesthesia Venous thromboembolism Antibiotics Positioning Ureteral stent Time-out 

References

  1. 1.
    American Society of Anesthesiologists. Schaumburg. Available from: https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system.
  2. 2.
    Smith RK, Broach R, Traci H, Mahmoud NN, Paulson EC. Impact of BMI on postoperative outcomes in patients undergoing proctectomy for rectal cancer: A National Surgical Quality Improvement Program analysis. Dis Colon Rectum. 2014;57:687–93.CrossRefPubMedGoogle Scholar
  3. 3.
    van Vugt JLA, Cakir H, Kornmann VNN, Doodeman HJ, Stoot JH, Boerma D, et al. The new body mass index as a predictor of postoperative complications in elective colorectal cancer surgery. Clin Nut. 2015;34(4):700–40.CrossRefGoogle Scholar
  4. 4.
    Odonkor PN, Grigore AM. Patients with ischemic heart disease. Med Clin N Am. 2013;97:1033–50.CrossRefPubMedGoogle Scholar
  5. 5.
    Fleisher LA, Bechman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary. JACC. 2007;50:1707–32.CrossRefPubMedGoogle Scholar
  6. 6.
    Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Circulation. 1999;100:1043–9.CrossRefGoogle Scholar
  7. 7.
    Gupta S, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124:381–7.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Markel TA, Lou DC, Pfefferkorn M, Scherer LR 3rd, West K, Rouse T, et al. Steroids and poor nutrition are associated with infectious wound complications in children undergoing first stage procedures for ulcerative colitis. Surgery. 2008;144:540–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Fleshner P, Ippoliti A, Dubinsky M, Ognibene S, Vasiliauskas E, Chelly M, et al. A prospective multivariate analysis of clinical factors associated with pouchitis after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol. 2007;5:952–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Lim M, Sagar P, Abdulgader A, Thekkinkattil D, Burke D. The impact of preoperative immunomodulation on pouch-related septic complications after ileal pouch-anal anastomosis. Dis Colon Rectum. 2007;50:943–51.CrossRefPubMedGoogle Scholar
  11. 11.
    Lake JP, Firoozmand E, Kang JC, Vassiliu P, Chan LS, Vukasin P, et al. Effect of high-dose steroids on anastomotic complications after proctocolectomy with ileal pouch-anal anastomosis. J Gastrointest Surg. 2004;8:547–51.CrossRefPubMedGoogle Scholar
  12. 12.
    Ziv Y, Church JM, Fazio VW, King TM, Lavery IC. Effect of systemic steroids on ileal pouch-anal anastomosis in patients with ulcerative colitis. Dis Colon Rectum. 1996;39:504–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Kelly KN, Domajnko B. Perioperative stress-dose steroids. Clin Colon and Rectal Surg. 2013;26:163–7.CrossRefGoogle Scholar
  14. 14.
    Zaghiyan K, Melmed GY, Berel D, Ovsepyan G, Murrell Z, Fleshner P. A prospective, randomized, noninferiority trial of steroid dosing after major colorectal surgery. Ann Surg. 2014;259:32–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Mahadevan U, Loftus EV Jr, Tremaine WJ, Pemberton JH, Harmsen WS, Schleck CD, et al. Azathioprine or 6-mercaptopurine before colectomy for ulcerative colitis is not associated with increased postoperative complications. Inflamm Bowel Dis. 2002;8:311–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Huang W, Tang Y, Nong L, Sun Y. Risk factors for postoperative intra-abdominal septic complications after surgery in Crohn’s disease: a meta-analysis of observational studies. J Crohns Colitis. 2015;9:293–301.CrossRefPubMedGoogle Scholar
  17. 17.
    Selvaggi F, Pellino G, Canonico S, Sciaudone G. Effect of preoperative biologic drugs on complications and function after restorative proctocolectomy with primary ileal pouch formation: systematic review and meta-analysis. Inflamm Bowel Dis. 2015;21(1):79–92.CrossRefPubMedGoogle Scholar
  18. 18.
    Mor IJ, Vogel JD, da Luz Moreira A, Shen B, Hammel J, Remzi FH. Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy. Dis Colon Rectum. 2008;51:1202–10.CrossRefPubMedGoogle Scholar
  19. 19.
    Coquet-Reinier B, Berdah SV, Grimaud JC, Birnbaum D, Cougard PA, Barthet M, et al. Preoperative infliximab treatment and postoperative complications after laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis: a case-matched study. Surg Endosc. 2010;24:1866–71.CrossRefPubMedGoogle Scholar
  20. 20.
    Narula N, Charleton D, Marshall JK. Meta-analysis: peri-operative anti-TNFα treatment and post-operative complications in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;37:1057–64.CrossRefPubMedGoogle Scholar
  21. 21.
    Nørgård BM, Nielsen J, Qvist N, Gradel KO, de Muckadell OB, Kjeldsen J. Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with ulcerative colitis – a nationwide cohort study. Aliment Pharmacol Ther. 2012;35:1301–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Lau C, Dubinsky M, Melmed G, Vasiliauskas E, Berel D, McGovern D, et al. The impact of preoperative serum anti-TNFα therapy levels on early postoperative outcomes in inflammatory bowel disease surgery. Ann Surg. 2015;261:487–96.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Hawn MT, Houston TK, Campagna EJ, Graham LA, Singh J, Bishop M, et al. The attributable risk of smoking on surgical complications. Ann Surg. 2011;254:914–20.CrossRefPubMedGoogle Scholar
  24. 24.
    Sorensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012;255:1069–79.CrossRefPubMedGoogle Scholar
  25. 25.
    Sorensen LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg. 2012;147:373–83.CrossRefPubMedGoogle Scholar
  26. 26.
    Lumb AB. Pre-operative respiratory optimisation: an expert review. Anaesthesia. 2019;74 Suppl 1:43–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Anthenelli RM, Benowitz NL, West R, St Aubin L, McRae T, Lawrence D, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet. 2016;387:2507–20.CrossRefPubMedGoogle Scholar
  28. 28.
    Hu WH, Cajas-Monson L, Eisenstein S, Parry L, Cosman B, Ramamoorthy S. Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: an analysis of ACS-NSQIP. Nutr J. 2015;14:91.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    van Rooijen S, Carli F, Dalton S, Thomas G, Bojesen R, Le Guen M, et al. Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation. BMC Cancer. 2019;19:98.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Brennan GT, Ha I, Hogan C, Nguyen E, Jamal MM, Bechtold ML, et al. Does preoperative enteral or parenteral nutrition reduce postoperative complications in Crohn’s disease patients: a meta-analysis. Eur J Gastroenterol Hepatol. 2018;30:997–1002.CrossRefPubMedGoogle Scholar
  31. 31.
    Calder PC. Immunonutrition. BMJ. 2003;327:117–8.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Probst P, Ohmann S, Klaiber U, Hüttner FJ, Billeter AT, Ulrich A, et al. Meta-analysis of immunonutrition in major abdominal surgery. Br J Surg. 2017;104:1594–608.CrossRefPubMedGoogle Scholar
  33. 33.
    Wahl TS, Patel FC, Goss LE, Chu DI, Grams J, Morris MS. The obese colorectal surgery patient: surgical site infection and outcomes. Dis Colon Rectum. 2018;61:938–45.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Hill C, Khashab MA, Kalloo AN, Kumbhari V. Endoluminal weight loss and metabolic therapies: current and future techniques. Ann N Y Acad Sci. 2018;1411:36–52.CrossRefPubMedGoogle Scholar
  35. 35.
    Faria SL, Faria OP, de Almeida Cardeal M, Ito MK. Effects of a very low calorie diet in the preoperative stage of bariatric surgery: a randomized trial. Surg Obes Relat Dis. 2015;11:230–7.CrossRefGoogle Scholar
  36. 36.
    Yolsuriyanwong K, Thanavachirasin K, Sasso K, Zuro L, Bartfield J, Marcotte E, et al. Effectiveness, compliance, and acceptability of preoperative weight loss with a liquid very low-calorie diet before bariatric surgery in real practice. Obes Surg. 2019;29:54–60.CrossRefPubMedGoogle Scholar
  37. 37.
    Aquina CT, Rickles AS, Probst CP, Kelly KN, Deeb AP, Monson JR, et al. Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery. Dis Colon Rectum. 2015;58:220–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Sirany AM, Chow CJ, Kunitake H, Madoff RD, Rothenberger DA, Kwaan MR. Colorectal surgery outcomes in chronic dialysis patients: an American College of Surgeons National Surgical Quality Improvement Program Study. Dis Colon Rectum. 2016;59:662–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Deng J, Lenart J, Applegate RL. General anesthesia soon after dialysis may increase postoperative hypotension – a pilot study. Heart Lung Vessel. 2014;6:52–9.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Currie A, Malietzis G, Askari A, Nachiappan S, Swift P, Jenkins JT, et al. Impact of chronic kidney disease on postoperative outcome following colorectal cancer surgery. Color Dis. 2014;16:879–85.CrossRefGoogle Scholar
  41. 41.
    Cavallaro PM, Milch H, Savitt L, Hodin RA, Rattner DW, Berger DL, et al. Addition of a scripted pre-operative patient education module to an existing ERAS pathway further reduces length of stay. Am J Surg. 2018;216(4):652–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Park JS, Choi GS, Kwak KH, Jung H, Jeon Y, Park S, et al. Effect of local wound infiltration and transversus abdominis plane block on morphine use after laparoscopic colectomy: a nonrandomized, single-blind prospective study. J Surg Res. 2015;195:61–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Abdallah FW, Chan VW, Brull R. Transversus abdominis plane block: a systematic review. Reg Anesth Pain Med. 2012;37:193–209.CrossRefPubMedGoogle Scholar
  44. 44.
    Courtot L, Le Roy B, Memeo R, Voron T, de Angelis N, Tabchouri N, et al. Risk factors for postoperative ileus following elective laparoscopic right colectomy: a retrospective multicentric study. Int J Color Dis. 2018;33:1373–82.CrossRefGoogle Scholar
  45. 45.
    Halabi WJ, Kang CY, Nguyen VQ, Carmichael JC, Mills S, Stamos MJ, et al. Epidural analgesia in laparoscopic colorectal surgery: a nationwide analysis of use and outcomes. JAMA Surg. 2014;149:130–6.CrossRefPubMedGoogle Scholar
  46. 46.
    Borzellino G, Francis NK, Chapuis O, Krastinova E, Dyevre V, Genna M. Role of epidural analgesia within an ERAS program after laparoscopic colorectal surgery: a review and meta-analysis of randomised controlled studies. Surg Res Pract. 2016;2016:7543684.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Ventham NT, Kennedy ED, Brady RR, Paterson HM, Speake D, Foo I, et al. Efficacy of intravenous lidocaine for postoperative analgesia following laparoscopic surgery: a meta-analysis. World J Surg. 2015;39:2220–34.CrossRefPubMedGoogle Scholar
  48. 48.
    Herroeder S, Pecher S, Schönherr ME, Kaulitz G, Hahnenkamp K, Friess H, et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg. 2007;246:192–200.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Day AR, Smith RV, Scott MJ, Fawcett WJ, Rockall TA. Randomized clinical trial investigating the stress response from two different methods of analgesia after laparoscopic colorectal surgery. Br J Surg. 2015;102:1473–9.CrossRefPubMedGoogle Scholar
  50. 50.
    McNally MP, Burns CJ. Venous thromboembolic disease in colorectal patients. Clin Colon Rectal Surg. 2009;22:34–40.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Bergqvist D. Venous thromboembolism: a review of risk and prevention in colorectal surgery patients. Dis Colon Rectum. 2006;49:1620–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Buchberg B, Masoomi H, Lusby K, Choi J, Barleben A, Magno C, et al. Incidence and risk factors of venous thromboembolism in colorectal surgery. Arch Surg. 2011;146:739–43.CrossRefPubMedGoogle Scholar
  53. 53.
    Gross ME, Vogler SA, Mone MC, Sheng X, Sklow B. Postoperative venous thromboembolism prophylaxis in IBD: a National Surgical Quality Improvement Program analysis. Dis Colon Rectum. 2014;57:482–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Bahl V, Hu HM, Henke P, Wakefield TW, Campbell DA Jr, Caprini JA. A validation study of retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251:344–50.CrossRefPubMedGoogle Scholar
  55. 55.
    Pollak AW, McBane RD. Succinct review of the new VTE prevention and management guidelines. Mayo Clinic Proc. 2014;89:394–408.CrossRefGoogle Scholar
  56. 56.
    Richardson WS, Hamad GG, Stefanidis D. VTE prophylaxis for laparoscopic surgery guidelines: an update [Internet] 2017. Available from: https://www.sages.org/publications/guidelines/guidelines-for-deep-venous-thrombosis-prophylaxis-during-laparoscopic-surgery/.
  57. 57.
    National Guideline Clearinghouse. Rockville. Available from: http://www.guideline.gov/content.aspx?id=39533.
  58. 58.
    Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70:195–283.CrossRefPubMedGoogle Scholar
  59. 59.
    Leff EI, Groff W, Rubin RJ, Eisenstat TE, Salvati EP. Use of ureteral catheters in colonic and rectal surgery. Dis Colon Rectum. 1982;25:457–60.CrossRefPubMedGoogle Scholar
  60. 60.
    Nam YS, Wexner SD. Clinical value of prophylactic ureteral stent indwelling during laparoscopic colorectal surgery. J Korean Med Sci. 2002;17:633–5.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Tsukinaka S, Wexner SD, DaSilva G. Prophylactic ureteric catheters in laparoscopic colorectal surgery. Tech Coloproctol. 2008;12:45–50.CrossRefGoogle Scholar
  62. 62.
    MIS Safety Checklist [Internet]. Available from: https://www.sages.org/wp-content/uploads/SAGES_AORN_MIS_Checklist.pdf.
  63. 63.
    Surgical Safety Checklist [Internet]. Available from: whqlibdoc.who.int/publications/2009/9789241598590_eng_Checklist.pdf.

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020

Authors and Affiliations

  • Samuel Eisenstein
    • 1
  • Alexis L. Grucela
    • 2
  1. 1.University of California San Diego Health Systems, Department of Surgery, Division of Colon and Rectal SurgeryLa JollaUSA
  2. 2.New York University Langone Health, New York University, Department of Surgery, Division of Colon and Rectal SurgeryNew YorkUSA

Personalised recommendations