Quality of life after colorectal surgery: A prospective study of patients compared with their spouses.

BACKGROUND: Although radical surgery for colorectal cancer improves the oncological outcomes, a significant portion of patients suffer from alterations in their quality of life (QoL). There are many studies investigating the QoL of patients who have colorectal cancer but none of these focus on the QoL of spouses. AIM: To compare the QoL of patients after colorectal surgery to the QoL of spouses. METHODS: This prospective study consisted of patients who were married and who underwent surgery at the University of Ankara, Department of Surgery between March 2006 and November 2010. Patients' spouses were also enrolled. The study was approved by the Ethics Committee of the Faculty of Medicine, Ankara University, and all patients provided written informed consent. The study included patients who underwent curative surgery for colorectal carcinoma [n = 100; abdominoperineal excision (n = 33), low anterior resection (n = 33), left hemicolectomy (n = 34)] and their spouses (n = 100). The patients and spouses completed the Medical Outcome Study 36-item Short Form Survey (SF-36) and the World Health Organization Disability Assessment Schedule II (WHODAS-II) preoperatively and at postoperative months 15 to 18. RESULTS: During this 4.5-year study period, 273 patients with sigmoid or rectal cancer were admitted to the hospital. Of these patients, 119 were eligible and willing to participate. Eleven patients had either systemic or locally inoperable disease, three patients had a severe surgical complication, and five patients were lost to follow-up. Therefore, a total of 100 patients completed the follow-up period. There was a statistically significant positive correlation between the disability scores of patients and the scores of their spouses for some of the WHODAS-II subscales, such as "self-care," "life activities," and "participation in society," as well as for the total WHODAS-II score. There was also a positive correlation between the QoL of patients and the QoL of their spouses in most of the SF-36 subscales. Statistically significant correlations were observed for the "bodily pain," "general health," "vitality," "social function," "emotion," "mental health," and mental component summary score subscales of the SF-36. When gender differences were evaluated, the QoL of male patients' spouses changed more when compared with female patients' spouses for all of the WHODAS-II subscales. Colorectal cancer surgery has a significant effect on the QoL of both patients and their spouses, these effects were more significant among male patients' spouses. CONCLUSION: Preoperative counseling regarding potential problems should therefore collectively address patient and their spouse as a couple rather than the patient alone, particularly for patients undergoing low anterior resection and abdominoperineal resection procedures.

Do Nano-crystalline Silver-Coated Hernia Grafts Reduce Infection?

PURPOSE: Inguinal hernia repairs are the most common interventions in adults in general surgery clinics. Depending on the type of mesh and repair, the incidence of mesh-related infection ranges from 0.6 to 8%. Methicillin-resistant Staphylococcus aureus is the most common microorganism causing graft infection. The aim of this study was to investigate the efficacy of nano-crystalline silver-coated polypropylene grafts against graft infection created with MRSA in rats. METHODS: A total of 60 female, Wistar albino rats were used in the study. Polypropylene grafts 1 × 1 cm in size were coated in silver ion-doped, calcium phosphate-based, antibacterial ceramic powder (NS-coated graft) to provide an antimicrobial effect. The MRSA seeding procedure was applied at the same time as surgery. In Group 1, normal graft was applied without MRSA seeding, in Group 2, normal graft with MRSA seeding, in Group 3, NS-coated graft without MRSA seeding, and in Group 4, NS-coated graft with MRSA seeding. For the groups which were to be infected, the bacteria were seeded in the surgical area during the operation. On the 7th day postoperatively, all the animals were killed. The grafts were removed and one from each group was examined under electron microscope and the others were implanted in culture medium and the number of colonies was counted after 24 h. RESULTS: In Groups 1 and 3, the incision site was seen to have healed on day 3, no clinical surgical area infection was seen during follow-up, and in the exploration made on the 7th day, no findings of infection were observed. In Group 2, hyperemia and collection were seen to have formed on day 3, abscess had started to form in all the rats of this group on day 4, a purulent discharge in the wound site had started in 12 animals on day 5, separation of the wound site was observed in 6 on day 6, and in the exploration on day 7, there was seen to be a fibrin and pus-rich collection around the graft in all cases. In Group 4, there were hyperemia and collection in 6 animals on day 4, and in 3 of these, abscess was seen to have formed on the 5th day. No purulent discharge or wound separation was observed. In the exploration on the 7th day, it was seen that in the animals with abscess development, the formation was of a localized abscess. The results of the cultures of the grafts removed from Groups 1 and 3 showed no production, whereas production was seen in all the grafts removed from Groups 2 and 4. Clinical surgical area infection was seen to have developed in 100% of Group 2 and in 40% of Group 4. In the comparison of the number of colonies, a statistically significantly lower number of bacteria were determined in Group 4 compared to Group 2 (p < 0.05). In the SEM images taken of Group 2, bacteria clusters were seen attached to the graft. CONCLUSION: Consistent with previous findings in the literature, the NS-coated polypropylene graft was seen to have a significantly better bactericidal effect than the normal polypropylene graft. Development of NS-coated grafts seems to be a reliable and applicable method to reduce the incidence of postoperative graft infection.

Permanent stoma not only affects patients' quality of life but also that of their spouses.

BACKGROUND: Living with a permanent colostomy can significantly diminish a patient's quality of life. However, little is known about the effects on the patient's spouse. Therefore, the aim of the present study was to evaluate the quality of life of spouses whose partners had undergone sphincter-sacrificing surgery for rectal carcinoma. METHODS: We studied 56 couples after one partner underwent sphincter-sacrificing surgery for rectal carcinoma: female spouses (n = 30) and male spouses (n = 26). To identify how surgery affected the life standards of the spousal population, questionnaires were constructed by the Department of Public Health, General Surgery and Psychology at the University of Ankara. RESULTS: Sixteen of 26 male spouses increased time spent at home, whereas 10 of 30 female spouses increased time spent at home (p < 0.05, male spouses versus female spouses). All of the spouses had been sexually active before their partners' operation; however 20 of 26 male spouses and 10 of 30 female spouses were sexually inactive afterward (p < 0.05, male spouses versus female spouses). Ten male patients and 3 female patients wanted their colostomy care to be managed by their spouses (p < 0.01, female spouses versus male spouses). CONCLUSIONS: In a patient with a colostomy, the social and sexual aspects of the life of the patient's spouse are affected. This observation needs to be taken into account when patients are preoperatively counseled. Therefore, preoperative counseling regarding the possible problems after surgery should not only include the patient but also the spouse.