Colorectal surgery is associated with a high sepsis rate. Intra-abdominal sepsis may be spontaneous (at time of colonic catastrophe) or postoperative. The relative contributions to sepsis control depend on (a) the initial severity of infection (disease factor), (b) timeliness and adequacy of attempts at treatment (surgeon factor), and (c) the patient’s general health and consequent ability to withstand the process (patient factor). It is important to elucidate the relative contributions in the prognosis of sepsis, sepsis source control failure, and its mitigation in colorectal surgery. The prevention of the progression of sepsis is by early goal-directed therapy and sepsis source control. The presence of viable organisms in the surgical field before wound closure and the inter-individual variation in the host-defence mechanisms are the most important factors in postoperative sepsis. The arguments for a defunctioning ileostomy following anterior resection of rectal cancer because of the burden of an anastomotic leak can be balanced against arguments for a proactive approach that avoids the burden of an ileostomy. The patient factor predominates in the prognosis of sepsis in emergency colorectal surgery, but the surgeon-related factors can influence the morbidity and mortality in both elective (planned) and emergency colorectal surgery.
Elroy Patrick Weledji (Tue,) studied this question.