Correspondence
Confusing nomenclature doi:10.1111/codi.12536
Dear Sir, We read the letter to the editor by Meng et al. [1] regarding the randomized controlled trial (RCT) by Ng et al. [2] comparing hand-assisted laparoscopic colectomy (HALC) with total laparoscopic colectomy for right colon cancer published in Colorectal Disease in 2012. We are puzzled by their interpretation of its conclusions, which reported no advantage for HALC. Specifically, we noted that there was no significant difference in surgical site infection (SSI) rates, despite recent evidence suggesting that superficial incision SSI rates following HALC were significantly higher than after open surgery [3]. Moreover, adhesive small bowel obstruction (SBO) was not reported by Ng et al. at the 5-year follow-up, but it seems reasonable to expect higher rates following HALC, which entails direct surgical manipulation of the intra-abdominal organs. We would also like to comment on the use of the term ‘total laparoscopic’ colectomy referred to by Meng et al. [1] and Ng et al. [2]. In actual fact the approach described by both authors should be referred to as laparoscopic-assisted colectomy, which includes an extracorporeal anastomosis [4]. This is in contrast with the term totally laparoscopic right colectomy with intracorporeal anastomosis, which is well described [5,6].
C. Foppa and R. Bergamaschi State University of New York, Stony Brook Division of Colon & Rectal Surgery, Health Science Center T18, Suite 046B, Stony Brook, New York 11794-8191, USA E-mail: [email protected] Received 1 December 2013; accepted 7 December 2013; Accepted Article online 21 December 2013
References 1 Meng WJ, Wang ZQ, Zhou ZG. Hand-assisted laparoscopic right colectomy: a consideration of hand-device placement and trocar arrangement. Colorectal Dis 2013; 15: 908–13. 2 Ng LWC, Tung LM, Cheung HYS, Wong JCH, Chung CC, Li MKW. Hand-assisted laparoscopic versus total laparoscopic right colectomy: a randomized controlled trial. Colorectal Dis 2012; 14: e612–7. 3 Bishawi M, Fakhoury M, Denoya PI, Stein S, Bergamaschi R. Surgical site infection rates: open versus hand-assisted
colorectal resections. Tech Coloproctol 2013. [Epub ahead of print] PMID: 24061500. 4 Bergamaschi R, Larach S, Pigazzi A, Marecik S, Valsdottir EB, Amrani S. Laparoscopic colon and rectal surgery. In: Corman’s Colon and Rectal Surgery (ed. Corman ML). 6th edition. Philadelphia, PA: Lippincott, Williams and Wilkins, 2012. pp. 548. 5 Casciola L, Ceccarelli G, Di ZL et al. Laparoscopic right hemicolectomy with intracorporeal anastomosis. Technical aspects and personal experience. Minerva Chir 2003; 58: 621–7. 6 Tarta C, Bishawi M, Bergamaschi R. Intracorporeal ileocolic anastomosis: a review. Tech Coloproctol 2013; 17: 479–85.
Comment on Ihedioha et al.: Patient education videos for elective colorectal surgery – results of a randomized controlled trial doi:10.1111/codi.12550
Dear Sir, We read with great interest the article by Ihedioha et al. [1] entitled ‘Patient education videos for elective colorectal surgery: results of a randomized controlled trial’. Patient consent is an important item of the enhanced recovery programme and strengthening the patient’s knowledge with educational videos could be helpful. As the article found no improvement in the results after the videos, their benefit may be underrated. The main value of such videos is not so much to improve the clinical postoperative result but to help implement other items of enhanced recovery. Thus improved knowledge by the patient may lead to better compliance with the protocol, such as early food intake and mobilization, which are critical for expeditious postoperative recovery. Quantification of this knowledge was difficult in the authors’ studies [1,2] and a reliable measure is still needed to facilitate understanding of the whole programme. Another benefit of the videos is that it saves the doctor’s time in explaining the protocol to the patient. This is efficient since patient knowledge is equal or superior to that of patients not exposed to the videos. There were some defects in the study. First it failed to give detailed information on all items of the enhanced recovery programme, e.g. the protocol of anaesthesia was not mentioned. As constantly mentioned by Kehlet et al. [3] inadequate trial design can lead to inappropriate conclusions. Other omissions
Colorectal Disease ª 2014 The Association of Coloproctology of Great Britain and Ireland. 16, 315–318
315
Copyright of Colorectal Disease is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Confusing nomenclature doi:10.1111/codi.12536
Dear Sir, We read the letter to the editor by Meng et al. [1] regarding the randomized controlled trial (RCT) by Ng et al. [2] comparing hand-assisted laparoscopic colectomy (HALC) with total laparoscopic colectomy for right colon cancer published in Colorectal Disease in 2012. We are puzzled by their interpretation of its conclusions, which reported no advantage for HALC. Specifically, we noted that there was no significant difference in surgical site infection (SSI) rates, despite recent evidence suggesting that superficial incision SSI rates following HALC were significantly higher than after open surgery [3]. Moreover, adhesive small bowel obstruction (SBO) was not reported by Ng et al. at the 5-year follow-up, but it seems reasonable to expect higher rates following HALC, which entails direct surgical manipulation of the intra-abdominal organs. We would also like to comment on the use of the term ‘total laparoscopic’ colectomy referred to by Meng et al. [1] and Ng et al. [2]. In actual fact the approach described by both authors should be referred to as laparoscopic-assisted colectomy, which includes an extracorporeal anastomosis [4]. This is in contrast with the term totally laparoscopic right colectomy with intracorporeal anastomosis, which is well described [5,6].
C. Foppa and R. Bergamaschi State University of New York, Stony Brook Division of Colon & Rectal Surgery, Health Science Center T18, Suite 046B, Stony Brook, New York 11794-8191, USA E-mail: [email protected] Received 1 December 2013; accepted 7 December 2013; Accepted Article online 21 December 2013
References 1 Meng WJ, Wang ZQ, Zhou ZG. Hand-assisted laparoscopic right colectomy: a consideration of hand-device placement and trocar arrangement. Colorectal Dis 2013; 15: 908–13. 2 Ng LWC, Tung LM, Cheung HYS, Wong JCH, Chung CC, Li MKW. Hand-assisted laparoscopic versus total laparoscopic right colectomy: a randomized controlled trial. Colorectal Dis 2012; 14: e612–7. 3 Bishawi M, Fakhoury M, Denoya PI, Stein S, Bergamaschi R. Surgical site infection rates: open versus hand-assisted
colorectal resections. Tech Coloproctol 2013. [Epub ahead of print] PMID: 24061500. 4 Bergamaschi R, Larach S, Pigazzi A, Marecik S, Valsdottir EB, Amrani S. Laparoscopic colon and rectal surgery. In: Corman’s Colon and Rectal Surgery (ed. Corman ML). 6th edition. Philadelphia, PA: Lippincott, Williams and Wilkins, 2012. pp. 548. 5 Casciola L, Ceccarelli G, Di ZL et al. Laparoscopic right hemicolectomy with intracorporeal anastomosis. Technical aspects and personal experience. Minerva Chir 2003; 58: 621–7. 6 Tarta C, Bishawi M, Bergamaschi R. Intracorporeal ileocolic anastomosis: a review. Tech Coloproctol 2013; 17: 479–85.
Comment on Ihedioha et al.: Patient education videos for elective colorectal surgery – results of a randomized controlled trial doi:10.1111/codi.12550
Dear Sir, We read with great interest the article by Ihedioha et al. [1] entitled ‘Patient education videos for elective colorectal surgery: results of a randomized controlled trial’. Patient consent is an important item of the enhanced recovery programme and strengthening the patient’s knowledge with educational videos could be helpful. As the article found no improvement in the results after the videos, their benefit may be underrated. The main value of such videos is not so much to improve the clinical postoperative result but to help implement other items of enhanced recovery. Thus improved knowledge by the patient may lead to better compliance with the protocol, such as early food intake and mobilization, which are critical for expeditious postoperative recovery. Quantification of this knowledge was difficult in the authors’ studies [1,2] and a reliable measure is still needed to facilitate understanding of the whole programme. Another benefit of the videos is that it saves the doctor’s time in explaining the protocol to the patient. This is efficient since patient knowledge is equal or superior to that of patients not exposed to the videos. There were some defects in the study. First it failed to give detailed information on all items of the enhanced recovery programme, e.g. the protocol of anaesthesia was not mentioned. As constantly mentioned by Kehlet et al. [3] inadequate trial design can lead to inappropriate conclusions. Other omissions
Colorectal Disease ª 2014 The Association of Coloproctology of Great Britain and Ireland. 16, 315–318
315
Copyright of Colorectal Disease is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
