RESUMO
BACKGROUND: Much controversy exists regarding the role of antibiotics in the development of fistula in-ano after incision and drainage. We evaluated the role of postoperative antibiotics in the prevention of fistula in-ano after incision and drainage of perianal abscess. METHODS: In a randomized single blind clinical trial study, 307 patients were randomly selected from those referring for incision and drainage of perianal abscess at Shahid Faghihi Hospital, Shiraz, Iran, during September 2013 to September 2014. Patients were allocated randomly either to receive 7 days of oral metronidazole and ciprofloxacin in addition to their standard care or to only receive standard care without any antibiotics after they were discharged from the hospital. Patients were followed for 3 months and final results were evaluated. The study was registered at the clinical trial registry (www.irct.ir; Irct201311049936n7). RESULTS: Seven patients were lost to follow-up. Those who used prophylactic antibiotics (n = 155) had significantly lower rates of fistula formation compared with those who did not use any medication (n = 144; P < .001). Men had higher rates of fistula formation (P = .002). Patients who used more cigarettes had higher rates of fistula development (P = .001). In the univariate analysis, only postoperative antibiotic use showed a protective role against fistula formation (odds ratio = 0.426; confidence interval, 0.206-0.881). In the regression analysis postoperative antibiotic use remained protective against fistula development (odds ratio = 0.371; confidence interval, 0.196-0.703), furthermore male sex presented as a risk factor for developing fistula in-ano (odds ratio = 3.11; confidence interval, 1.31-7.38). CONCLUSION: Postoperative prophylactic antibiotic therapy including ciprofloxacin and metronidazole play an important role in preventing fistula in-ano formation. Considering the complications of fistula in-ano formation and the minor side effects of antibiotic therapy, based on our results, a 7-10 course of postoperative antibiotics is advised after incision and drainage of perianal abscess.
Assuntos
Abscesso/cirurgia , Antibacterianos/uso terapêutico , Doenças do Ânus/cirurgia , Drenagem/efeitos adversos , Fístula Retal/prevenção & controle , Antibioticoprofilaxia , Ciprofloxacina/uso terapêutico , Drenagem/métodos , Humanos , Metronidazol/uso terapêutico , Fístula Retal/etiologia , Método Simples-Cego , Ferida Cirúrgica/complicaçõesRESUMO
AIMS OF STUDY: Retinoid-mediated signal transduction plays a crucial role in the embryogenesis of various organs. We previously reported the successful induction of anorectal malformations in mice using retinoic acid (RA). Retinoic acid controls the expression of essential target genes for cell differentiation, morphogenesis, and apoptosis through a complicated interaction in which RA receptors form heterodimers with retinoid X receptors. In the present study, we investigated whether the retinoid antagonist, LE135, could prevent the induction of anorectal malformations (ARMs) in mice. METHODS: Retinoic acid was intraperitoneally administered as 100 mg/kg of all-trans RA on E9; and then the retinoid antagonist, LE135, was intraperitoneally administered to pregnant ICR strain mice on the eighth gestational day (E8), 1 day before administration of RA (group B) or on E9, simultaneously (group C) with RA administration. All of the embryos were obtained from the uteri on E18. Frozen sections were evaluated for concentric layers around the endodermal epithelium by hematoxylin and eosin staining. RESULTS: In group A, all of the embryos demonstrated ARM with rectoprostatic urethral fistula, or rectocloacal fistula, and all of the embryos showed the absence of a tail. In group B, 36% of the embryos could be rescued from ARM. However, all of the rescued embryos had a short tail that was shorter than their hind limb. The ARM rescue rates in group B were significantly improved compared to those in group A (P < .01). In group C, 45% of the embryos were rescued from ARM, but all of the rescued embryos had short tail. The ARM rescue rate in group C was significantly improved compared to that in group A (P < .01). However, there was no significant difference in the ARM rescue rate between group B and Group C. CONCLUSION: The present study provides evidence that in the hindgut region, RAR selective retinoid antagonist, LE135, could rescue embryos from ARM. However, the disturbance of all-trans RA acid was limited to the caudal region. Further study to establish an appropriate rescue program for ARM in a mouse model might suggest a step toward protection against human ARM in the future.
Assuntos
Anormalidades Induzidas por Medicamentos/prevenção & controle , Anormalidades Múltiplas/prevenção & controle , Canal Anal/anormalidades , Dibenzazepinas/uso terapêutico , Receptores do Ácido Retinoico/antagonistas & inibidores , Reto/anormalidades , Tretinoína/toxicidade , Anormalidades Induzidas por Medicamentos/embriologia , Anormalidades Induzidas por Medicamentos/etiologia , Anormalidades Múltiplas/induzido quimicamente , Anormalidades Múltiplas/embriologia , Animais , Cloaca/anormalidades , Cloaca/embriologia , Dibenzazepinas/administração & dosagem , Dibenzazepinas/farmacologia , Esquema de Medicação , Avaliação Pré-Clínica de Medicamentos , Feminino , Fístula/induzido quimicamente , Fístula/embriologia , Fístula/prevenção & controle , Regulação da Expressão Gênica no Desenvolvimento/efeitos dos fármacos , Humanos , Injeções Intraperitoneais , Masculino , Camundongos , Camundongos Endogâmicos ICR , Modelos Animais , Gravidez , Doenças Prostáticas/induzido quimicamente , Doenças Prostáticas/embriologia , Doenças Prostáticas/prevenção & controle , Distribuição Aleatória , Fístula Retal/induzido quimicamente , Fístula Retal/embriologia , Fístula Retal/prevenção & controle , Especificidade da Espécie , Cauda/anormalidades , Tretinoína/administração & dosagemRESUMO
Resection of the rectosigmoid colon with anastomosis below the peritoneal reflection carries appreciable mortality and morbidity rates particularly because of leakage and resulting sepsis, Protecting the anastomosis with a transverse colostomy does not prevent this complication although it does reduce the catastrophic sequelae that often occur. Anastomotic leakage rates have been reported to be as high as 69% and fecal fistula rates as high as 27% following this type of surgery. A pelvic. A pelvic hematoma may act as a culture medium should sepsis occur and may interfere with anastomotic healing. A method of removing accumulated blood and serum from the pelvis following low anterior resection has been employed with the aim of reducing anastomotic leakage, and a 10-year experience has been compiled. Sixty consecutive patients were studied from July 1970 to June 1980. All underwent barium enema examination and/or proctosigmoidoscopy following low anterior resection with concomitant or previous transverse colostomy. There were four subclinical leaks seen at 6 weeks for an incidence of 6.8%. All resolved spontaneously within 6 additional weeks. No fecal fistulas or pelvic abscesses were encountered. Contaminated blood and serum are significant contributing factors to low anterior anastomotic breakdown. By removing such material before it can become infected, this complication can be significantly reduced.
Assuntos
Pelve , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Retais/cirurgia , Reto/cirurgia , Idoso , Colostomia , Estudos de Avaliação como Assunto , Humanos , Pessoa de Meia-Idade , Fístula Retal/prevenção & controle , Sucção/métodos , Técnicas de Sutura , Irrigação Terapêutica/métodosRESUMO
Out of a total of 2727 operations of the large bowel because of tumors and inflammatory disease, performed over a 14-year period, 897 were one-stage resections of the colon and rectum without relaxing colostomy. Standard preoperative preparation of the bowel consists of a balanced diet, laxatives, and enema supplemented by 9 g Neomycin and 1.8 g Achromycin, within a 2-day period. Disturbances in wound healing occurred in 12.5%, seroma included. Anastomotic insufficiency occurred in 4%, and fatal fecal peritonitis due to tumors in 1.3% and due to diverticulitis in 1.2%. Total mortality was about 5.7%. Postoperative hospitalization after resections because of tumors was 15 days and because of diverticulitis, 19 days.