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ACKNOWLEDGEMENTSThe Organising Committee of the Coloproctology (7 th Malaysian Colorectal Conference) wishes tothank the following for their support and contribution:MAJOR SPONSORSEthicon Endo-Surgery, Ethicon Suture and Johnson & Johnson Medical MalaysiaTyco Healthcare Medical Supplies Sdn Bhd (Covidien)SPONSORSMerck Sdn BhdFresenius Kabi Malaysia Sdn BhdAstraZeneca Sdn BhdBH Enterprise Sdn BhdConvatec Malaysia Sdn BhdEndodynamics (M) Sdn BhdGenzyme Malaysia Sdn BhdKS Tekno-Med Sdn BhdLap Tech Medical Sdn BhdMalaysian Healthcare Sdn BhdMedi-Life (M) Sdn BhdMKS Medic Sdn BhdSanofi-Aventis (Malaysia) Sdn BhdStryker MalaysiaT-Medic Sdn BhdUnited Italian Trading (M) Sdn BhdUnited Malaysian Medical Industries Sdn BhdYakult (M) Sdn BhdServier Malaysia Sdn Bhd10
S Y M P O S I U M 1 • R E C T A L C A N C E RFAST TRACK SURGERYMichael J SolomonDepartment of Colorectal Surgery & Surgical Outcome Research Centre (SOuRCe) University of Sydney, AustraliaFast track surgery has certainly gained the imagination of international colorectal surgeons and not theleast medical administrators with their potential financial gains in decreased length of stay with minimalor no increase in hospital costs usually associated with the advent of newer more expensive technologiessuch as laparoscopic surgery or colonic stenting. Our own prospective trials in laparoscopic rectal surgeysince the early 1990's demonstrated a length of stay of 10 days for open versus 5 days for laparoscopic,however, in a prospective RCT when clinical pathways were introduced the length of stay dropped to2 days for the laparoscopic group compared with 5 days for the open group. Thus both laparoscopic andopen groups dropped their length of stays by 50% when a fast track type clinical pathway was introduced.Disappointingly, when the trial completed the length of stay have started to drop away to 3 – 4 dayswithout a clinical pathway in situ. Geographical differences in practice also see improvements in widelydifferent ranges of length of stay with similar temporal trials in Australasia (Zargar-Shoshtari et alDCR 2008) demonstrating a 2 day benefit with Fast Track from 6.5 to 4 days and in Asia (Tan et al,Asian J Surg 2005) from 12. to 10.4 days.The confusion now relates as to whether Fast Track is really a predefined “new treatment” or the gradualevolution of colorectal surgery particularly since the advent of minimally invasive technology. There are17 published aspects to Fast Track surgery with most studies using a variety of combination in strategieswith a range of 4 – 12 in most controlled trials and a mean of 9 variables. This relative confusion has alsolead to changes of names in strategies from Fast Track to Enhanced Recovery, Multimodal Rehabilitationand Clinical Colorectal Care Pathways.Many aspects such as no bowel preparation, same day admissions, epidural pain control, no drains,no nasogastric tubes and early feeding all predate the Fast Track movement. Perhaps the most excitingdevelopment in the Fast Track movement is the research into the fluid requirements (Restrictive vsLiberal) and the carbohydrate loading and insulin resistance data.Whatever the definition of Fast Track there is little doubt that the majority of colorectal patients cantolerate early resumption of fluid and solid diet and do better the earlier they are mobilized and withoutthe need for bowel preparation. This phenomena requires close collaboration between surgeons andanesthetists but more importantly an informed and motivated patient and their postoperative nursedriven care to reach the targets of Fast Track protocols. Length of stay primary outcomes needs to bebalanced with readmission rates. 2 nd day discharges have more than 20% readmissions however a morerealistic 3 – 4 day goal after colorectal surgery this rate drops to 10% (Anderson et al BJS 2007).If morbidity rates do drop as suggested by a pooled analysis by Wind et al (BJS 2006) then Fast Track willbecome mandatory practice irrespective of length of stay and readmission rates. Some caution needs tobe placed in the restrictive fluid aspect of Fast Track with some data suggesting an increase in morbiditymay be associated with restriction (Kehlet at al BR J Anaesth 2008).• Solomon MJ, Eyers AA. Laparoscopic rectopexy using mesh fixation with a spiked chromium staple. Diseases of the Colon & Rectum 1996; 39(3):279-284• Solomon MJ, Young CJ, Eyers AA, Roberts RA. Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. British Journal of Surgery,2002; 89(1):35-39• Tan JJ, Foo AY, Cheong DM. Colorectal clinical pathways: a method of improving clinical outcomes. Asian J Surg 2005;28:252-6.• Zargar-Shoshtari K et al. Fast-track surgery may reduce complications following major colonic surgery. Dis Colon Rectum 2008;51:1633-40• Soop M, Nygren J, Ljungqvist, O. Optimizing perioperative management of patients undergoing colorectal surgery: what is new? Curr Opin Crit Care 2006;12:166-170• Kehlet H, Wilmore D. Evidence-Based Care and the evolution of Fast-Track Surgery. Ann Surg 2008;248:189-198• Holte K et al. Liberal or restrictive fluid administration in fast-track surgery: an RCT double blind study. Br J Anaesth 2007;99:500-8• Anderson et al. Readmission rates aftewr planned hospital stay 2 versus 3 days in fast-track colonic surgery. Br J Surg 2007; 94:890-893• Wind et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 2006;93:800-911
Page 2 and 3: CONTENTSOrganising Committee 1Messa
Page 4 and 5: MESSAGEThe Organising Committee of
Page 6 and 7: PRE-CONFERENCE WORKSHOP 5 th March
Page 8 and 9: DAILY PROGRAMME 6 th March 2009, Fr
Page 10 and 11: DAILY PROGRAMME 7 th March 2009, Sa
Page 14 and 15: S Y M P O S I U M 2 • A L L I E D
Page 16 and 17: S Y M P O S I U M 2 • A L L I E D
Page 18 and 19: S Y M P O S I U M 3 • A N O R E C
Page 20 and 21: H O W I D O I T ( 1 )PELVIC EXENTER
Page 22 and 23: S Y M P O S I U M 6 • I N F L A M
Page 24 and 25: P L E N A R Y 3PELVIC EXENTERATION
Page 26 and 27: S Y M P O S I U M 8 • P O T P O U
Page 28 and 29: H O W I D O I T ( 2 )TEMS PROCEDURE
Page 30 and 31: PO 10 Fleet Verses Picoprep Solutio
Page 32 and 33: PO 27 A Study On The Staging And Su
Page 34 and 35: P O S T E R 2SYNCHRONOUS RECTAL CAR
Page 36 and 37: P O S T E R 4CASE REPORT: CONCURREN
Page 38 and 39: P O S T E R 6OUTCOMES IN YOUNG COLO
Page 40 and 41: P O S T E R 8A CASE REPORT OF MUIR-
Page 42 and 43: P O S T E R 1 0FLEET VERSES PICOPRE
Page 44 and 45: P O S T E R 1 2A REVIEW OF PREOPERA
Page 46 and 47: P O S T E R 1 4RESULTS OF SURGICAL
Page 48 and 49: P O S T E R 1 6CASE REPORT: FLEXI-S
Page 50 and 51: P O S T E R 1 8THE LIGATION OF INTE
Page 52 and 53: P O S T E R 2 0HAEMORRHOIDAL ARTERY
Page 54 and 55: P O S T E R 2 2A RETROSPECTIVE COHO
Page 56 and 57: P O S T E R 2 4A PROSPECTIVE COMPAR
Page 58 and 59: P O S T E R 2 6THE IDENTIFICATION O
Page 60 and 61: P O S T E R 2 8AN AUDIT ON THE DEMO
Page 62 and 63:
P O S T E R 3 0INCIDENCE OF POLYPS
Page 64:
P O S T E R 3 2SOLITARY RECTAL ULCE
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