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DOI: 10.1055/a-1533-2612
Die „Big Five“ der Invasivität – Sinnhaftigkeit von Drainagen, Sonden und Kathetern in der kolorektalen Chirurgie
The "Big Five" of Invasiveness - the Usefulness of Drains, Probes and Catheters in Colorectal SurgeryZusammenfassung
Das perioperative Management bei kolorektalen Resektionen ist häufig durch tradierte Vorgehensweisen und ausgeprägtes Sicherheitsdenken gekennzeichnet. Evidenzbasierte Maßnahmen, wie sie in Fast-Track- oder ERAS-Programmen etabliert wurden, werden hingegen seltener standardisiert angewandt. Viele Patienten erhalten daher im Rahmen elektiver kolorektaler Chirurgie weiterhin routinemäßig zentralvenöse Zugänge, Periduralkatheter, Blasenkatheter, Drainagen und/oder Magensonden („Big Five“ der Invasivität). In dieser Arbeit wird die aktuell vorhandene Evidenz zu diesen Maßnahmen in der kolorektalen Chirurgie dargestellt. Zudem werden Ergebnisse mit Bezug zu den „Big Five“ aus dem eigenen Zentrum vorgestellt. Diese Arbeit zeigt auf, dass die „Big Five“ der Invasivität klinisch nicht erforderlich und mit fehlender Evidenz belegt sind. Zudem führen sie häufig zu einer Einschränkung des Patienten.
Abstract
The perioperative management of colorectal resections is often dominated by traditional procedures and a strong focus on safety. Evidence-based measures such as those established in Fast Track or ERAS programs, are rarely applied in a standardised manner. As part of elective colorectal surgery, many patients therefore continue to routinely receive central venous access, peridural catheters, urinary catheters, drains and/or gastric tubes (“Big Five” of invasiveness). This article presents the currently available evidence on these measures in colorectal surgery. In addition, results relating to the “Big Five” from the author’s own centre are presented. This review shows that the “Big Five” of invasiveness are clinically unnecessary or supported by evidence. In addition, they often impair the patient’s function.
Publication History
Received: 05 April 2021
Accepted after revision: 17 June 2021
Article published online:
19 October 2021
© 2021. Thieme. All rights reserved.
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