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  1. Article ; Online: Opioid-free analgesia: is it achievable in open colorectal surgery without neuraxial block?

    Lohsiriwat, Varut

    Minerva surgery

    2022  Volume 77, Issue 6, Page(s) 573–581

    Abstract: Background: This study aimed to evaluate feasibility and results of opioid-free analgesia (OFA) in open colorectal operation, and to determine factors influencing successful OFA.: Methods: This study included 89 adult patients having elective open ... ...

    Abstract Background: This study aimed to evaluate feasibility and results of opioid-free analgesia (OFA) in open colorectal operation, and to determine factors influencing successful OFA.
    Methods: This study included 89 adult patients having elective open colectomy and/or proctectomy (without neuraxial or nerve block) from 2018 to 2020 in a university hospital. Current opioid users were excluded. Non-opioid analgesics were given based on patient's comorbidity. Successful OFA was determined by whether patients required morphine administered by intravenous patient-controlled analgesia. Clinical outcomes were prospectively collected and compared between OFA group and the other. Factors influencing successful OFA were determined (Trial registration number: TCTR20211220007).
    Results: The studied population had an average age of 68±12 years. Colorectal resection with stoma formation was performed in 17 cases (19%). OFA was achieved in 15 cases (17%). Median amount of morphine used was 18 mg per person (interquartile range 10-30) in those requiring opioid. There was no significant difference in patient's characteristics, intraoperative parameters and clinical outcomes between OFA group and the other except lower pain scores in the OFA group. The regimen of perioperative analgesia was the only predictor of successful OFA. Patients receiving multimodal analgesia with acetaminophen, selective cyclooxygenase-2 inhibitor and nefopam had the highest chance of successful OFA (5 of 15 cases, 33%).
    Conclusions: This study showed that OFA was achievable in 17% of patients undergoing open colorectal resection without neuraxial block. The regimen of perioperative analgesia was the predictor of successful OFA.
    MeSH term(s) Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Analgesics, Opioid/therapeutic use ; Pain, Postoperative/drug therapy ; Colorectal Surgery ; Pain Measurement ; Analgesia, Patient-Controlled/methods ; Morphine/therapeutic use ; Colorectal Neoplasms/surgery
    Chemical Substances Analgesics, Opioid ; Morphine (76I7G6D29C)
    Language English
    Publishing date 2022-10-04
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 3067899-7
    ISSN 2724-5438
    ISSN (online) 2724-5438
    DOI 10.23736/S2724-5691.22.09678-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Intersphincteric Exploration and Ligation of the Intersphincteric Fistula Tract for Acute Anorectal Abscess: Worth Doing?

    Lohsiriwat, Varut

    Diseases of the colon and rectum

    2021  Volume 64, Issue 6, Page(s) e382

    MeSH term(s) Abscess/surgery ; Anus Diseases/surgery ; Humans ; Ligation ; Rectal Fistula/surgery
    Language English
    Publishing date 2021-03-26
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000002050
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  3. Article ; Online: Embolization of the superior rectal artery for bleeding haemorrhoids (emborrhoid technique): A summary of early results from the literature and a few cautions for the future of this innovative procedure.

    Lohsiriwat, Varut

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2021  Volume 23, Issue 6, Page(s) 1584–1585

    MeSH term(s) Embolization, Therapeutic ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/therapy ; Hemorrhoids/complications ; Hemorrhoids/surgery ; Humans ; Mesenteric Artery, Inferior/diagnostic imaging
    Language English
    Publishing date 2021-04-12
    Publishing country England
    Document type Letter
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15646
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    Zs.A 5799: Show issues Location:
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  4. Article: High Compliance With Surgical Site Infection (SSI) Prevention Bundle Reduces Incisional SSI After Colorectal Surgery.

    Lohsiriwat, Varut

    Annals of coloproctology

    2020  Volume 37, Issue 3, Page(s) 146–152

    Abstract: Purpose: This study aimed to evaluate association between compliance with surgical site infection (SSI) prevention bundle and the development of superficial or deep incisional SSI following colorectal surgery and to evaluate the impact of incisional SSI ...

    Abstract Purpose: This study aimed to evaluate association between compliance with surgical site infection (SSI) prevention bundle and the development of superficial or deep incisional SSI following colorectal surgery and to evaluate the impact of incisional SSI on surgical outcomes.
    Methods: A prospectively collected database of consecutive patients undergoing elective colectomy and/or proctectomy from 2011 to 2019 in a university hospital was reviewed. The association between compliance with Thailand's SSI Prevention Bundle (10 level-1A interventions) and the incidence of incisional SSI was determined. Surgical outcomes were compared between those with incisional SSI and those without.
    Results: This study included 600 patients with a median age of 64 years (range, 18-102 years). Some 126 patients (21.0%) had stoma formation and 52 (8.7%) underwent laparoscopy. The incidence of incisional SSI was 5.5% (n = 33; 32 superficial incisional SSI and 1 deep incisional SSI). Higher compliance with care bundle tended to decrease incisional SSI (P = 0.20). In multivariate analysis, compliance of 70% or more was the only dependent factor for reducing incisional SSI (odds ratio, 0.39; 95% confidence interval, 0.15 to 0.99; P = 0.047). None of individual interventions were significantly associated with a lower probability of incisional SSI. Compared with counterparts, patients with incisional SSI had a 2-day longer length of postoperative stay (6 day vs. 4 day, P < 0.001) but comparable time for gastrointestinal recovery and similar rate of 30-day mortality or readmission.
    Conclusion: High compliance with SSI prevention bundle (especially ≥ 70%) reduced incisional SSI after colorectal surgery.
    Language English
    Publishing date 2020-05-15
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 2711906-3
    ISSN 2287-9722 ; 2287-9714
    ISSN (online) 2287-9722
    ISSN 2287-9714
    DOI 10.3393/ac.2020.04.10.2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Outcome of Enhanced Recovery After Surgery (ERAS) for Colorectal Surgery in Early Elderly and Late Elderly Patients.

    Lohsiriwat, Varut

    Annals of the Academy of Medicine, Singapore

    2020  Volume 48, Issue 11, Page(s) 347–353

    Abstract: Introduction: This study aimed to determine the outcome of enhanced recovery after surgery (ERAS) programme in elderly colorectal surgery patients.: Materials and methods: Details and surgical outcomes of elderly patients undergoing elective ... ...

    Abstract Introduction: This study aimed to determine the outcome of enhanced recovery after surgery (ERAS) programme in elderly colorectal surgery patients.
    Materials and methods: Details and surgical outcomes of elderly patients undergoing elective colectomy and/or proctectomy according to ERAS protocol from 2011 to 2017 were retrospectively reviewed. Patients were divided into 2 groups: early elderly (EE, n = 107) aged 65-74 years old and late elderly (LE, n = 74) aged ≥75 years old.
    Results: This study included 181 patients. The LE group had poorer baseline characteristics, but the operative details in both groups were comparable. Overall complication and severe complication rates were 28% and 3.3%, respectively. The LE group had a higher overall complication rate (38% vs 22%;
    Conclusion: ERAS is a safe and effective protocol that can be used in EE and LE colorectal surgery patients.
    MeSH term(s) Aged ; Colectomy/rehabilitation ; Enhanced Recovery After Surgery ; Female ; Follow-Up Studies ; Guideline Adherence ; Humans ; Incidence ; Male ; Patient Readmission/trends ; Postoperative Complications/epidemiology ; Postoperative Complications/rehabilitation ; Prognosis ; Recovery of Function ; Retrospective Studies ; Thailand/epidemiology ; Time Factors
    Language English
    Publishing date 2020-01-20
    Publishing country Singapore
    Document type Journal Article
    ZDB-ID 604527-3
    ISSN 0304-4602
    ISSN 0304-4602
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.B 2420: Show issues Location:
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  6. Article ; Online: Topical Sucralfate for Treatment of Chronic Anal Fissure.

    Lohsiriwat, Varut / Mongkhonsupphawan, Aitsariya

    Journal of the anus, rectum and colon

    2023  Volume 7, Issue 4, Page(s) 311–312

    Language English
    Publishing date 2023-10-25
    Publishing country Japan
    Document type Journal Article
    ISSN 2432-3853
    ISSN (online) 2432-3853
    DOI 10.23922/jarc.2023-031
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  7. Article: Learning curve of enhanced recovery after surgery program in open colorectal surgery.

    Lohsiriwat, Varut

    World journal of gastrointestinal surgery

    2019  Volume 11, Issue 3, Page(s) 169–178

    Abstract: Background: Enhanced recovery after surgery (ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients' outcomes is unknown.: Aim: To evaluate and establish a ... ...

    Abstract Background: Enhanced recovery after surgery (ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients' outcomes is unknown.
    Aim: To evaluate and establish a learning curve of ERAS program for open colorectal surgery.
    Methods: This was a review of prospectively collected database of 380 "unselected" patients undergoing elective "open" colectomy and/or proctectomy under ERAS protocol from 2011 (commencing ERAS application) to 2017 in a university hospital. Patients were divided into 5 chronological groups (76 cases per quintile). Surgical outcomes and ERAS compliance among quintiles were compared. Learning curves were calculated based on criteria of optimal recovery: defined as absence of major postoperative complications, discharge by postoperative day 5, and no 30-d readmission.
    Results: Hospitalization more than 5 d occurred in 22.6% (
    Conclusion: A number of 76 colorectal operations are required for a multidisciplinary team to achieve a significantly higher rate of optimal recovery and high compliance with ERAS program for open colorectal surgery.
    Language English
    Publishing date 2019-01-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2573700-4
    ISSN 1948-9366
    ISSN 1948-9366
    DOI 10.4240/wjgs.v11.i3.169
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  8. Article ; Online: Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review.

    Lohsiriwat, Varut / Jitmungngan, Romyen

    Medicina (Kaunas, Lithuania)

    2022  Volume 58, Issue 3

    Abstract: Background and Objectives: Excisional hemorrhoidectomy is considered as a mainstay operation for high-grade hemorrhoids and complicated hemorrhoids. However, postoperative pain remains a challenging problem after hemorrhoidectomy. This systematic review ... ...

    Abstract Background and Objectives: Excisional hemorrhoidectomy is considered as a mainstay operation for high-grade hemorrhoids and complicated hemorrhoids. However, postoperative pain remains a challenging problem after hemorrhoidectomy. This systematic review aims to identify pharmacological and non-pharmacological interventions for reducing post-hemorrhoidectomy pain. Materials and Methods: The databases of Ovid MEDLINE, PubMed and EMBASE were systematically searched for randomized controlled trails (published in English language with full-text from 1981 to 30 September 2021) to include comparative studies examining post-hemorrhoidectomy pain as their primary outcomes between an intervention and another intervention (or a sham or placebo). Results: Some 157 studies were included in this review with additional information from 15 meta-analyses. Fundamentally, strategies to reduce post-hemorrhoidectomy pain were categorized into four groups: anesthetic methods, surgical techniques, intraoperative adjuncts, and postoperative interventions. In brief, local anesthesia-alone or combined with intravenous sedation was the most effective anesthetic method for excisional hemorrhoidectomy. Regarding surgical techniques, closed (Ferguson) hemorrhoidectomy performed with a vascular sealing device or an ultrasonic scalpel was recommended. Lateral internal anal sphincterotomy may be performed as a surgical adjunct to reduce post-hemorrhoidectomy pain, although it increased risks of anal incontinence. Chemical sphincterotomy (botulinum toxin, topical calcium channel blockers, and topical glyceryl trinitrate) was also efficacious in reducing postoperative pain. So were other topical agents such as anesthetic cream, 10% metronidazole ointment, and 10% sucralfate ointment. Postoperative administration of oral metronidazole, flavonoids, and laxatives was associated with a significant reduction in post-hemorrhoidectomy pain. Conclusions: This systematic review comprehensively covers evidence-based strategies to reduce pain after excisional hemorrhoidectomy. Areas for future research on this topic are also addressed at the end of this article.
    MeSH term(s) Hemorrhoidectomy/adverse effects ; Hemorrhoidectomy/methods ; Hemorrhoids/complications ; Hemorrhoids/surgery ; Humans ; Ointments/therapeutic use ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Vascular Surgical Procedures
    Chemical Substances Ointments
    Language English
    Publishing date 2022-03-12
    Publishing country Switzerland
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 2188113-3
    ISSN 1648-9144 ; 1010-660X
    ISSN (online) 1648-9144
    ISSN 1010-660X
    DOI 10.3390/medicina58030418
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6270: Show issues Location:
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  9. Article ; Online: Massive Bleeding From Anal Pseudoaneurysm After Rubber Banding Ligation for Hemorrhoids.

    Methasate, Asada / Lohsiriwat, Varut / Mongkhonsupphawan, Aitsariya

    Diseases of the colon and rectum

    2023  Volume 66, Issue 8, Page(s) e847

    MeSH term(s) Humans ; Hemorrhoids/surgery ; Rubber ; Aneurysm, False/diagnosis ; Aneurysm, False/etiology ; Aneurysm, False/surgery ; Anal Canal ; Hemorrhage ; Ligation/adverse effects
    Chemical Substances Rubber (9006-04-6)
    Language English
    Publishing date 2023-07-19
    Publishing country United States
    Document type Letter
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000002635
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  10. Article: Rectovaginal fistula after low anterior resection: Prevention and management.

    Lohsiriwat, Varut / Jitmungngan, Romyen

    World journal of gastrointestinal surgery

    2021  Volume 13, Issue 8, Page(s) 764–771

    Abstract: Rectovaginal fistula after low anterior resection for rectal malignancy is one of the most challenging postoperative complications because it is difficult to treat and may complicate plans of adjuvant therapy. This problematic complication could lead to ... ...

    Abstract Rectovaginal fistula after low anterior resection for rectal malignancy is one of the most challenging postoperative complications because it is difficult to treat and may complicate plans of adjuvant therapy. This problematic complication could lead to multiple operations, stoma formation, sexual dysfunction, fecal incontinence and psychosocial ramifications. This review comprehensively covers an overview of its incidence, risk factors, presentation and evaluation, management (ranging from conservative measures, endoscopic treatment and local tissue repair to radical resection and redo anastomosis) and treatment outcomes of rectovaginal fistula after low anterior resection. Notably, these therapeutic options and outcomes are influenced by several factors, including the size and location of the fistula, tumor clearance, cancer staging, quality of colorectal anastomosis and surrounding tissue, presence of diverting stoma, previous attempted repair, and the surgeon's experience. Also, strategies to prevent rectovaginal fistula after low anterior resection are presented with illustrations. Finally, a decision-making algorithm for managing this complication is proposed.
    Language English
    Publishing date 2021-09-02
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2573700-4
    ISSN 1948-9366
    ISSN 1948-9366
    DOI 10.4240/wjgs.v13.i8.764
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