Omental torsion is a rare cause of acute surgical abdomen from omental twisting leading to distal vascular compromise. Preoperative diagnosis has been a dilemma as clinical features, laboratory and radiographic findings are nonspecific and variable, closely mimicking acute appendicitis. Surgical excision has been suggested to offer rapid symptom relief and postoperative recovery. Presented here is a case of a 59-year-old male with omental torsion who presented with generalized abdominal tenderness and was preoperatively diagnosed as ruptured appendicitis who underwent laparotomy with uneventful post-operative course.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Abdomen, Acute ; Appendicitis

Locally advanced low rectal cancers pose a challenge for surgeons as reported local recurrence remain high despite the performance of Total Mesorectal Excision and the provision of neoadjuvant treatment. Extralevator Abdominoperineal Excision offers better oncologic margins with reported decreased recurrence rates when compared to the conventional technique. The improvement in oncologic outcomes, however, comes at the cost of producing larger perineal defects—and with this comes concerns related to coverage. Presented here is a case of a patient with a locally advanced low rectal cancer with gluteal extension where a Vertical Rectus Abdominis Myocutaneous flap was utilized as a means of perineal reconstruction.

Human ; Male ; Aged: 65-79 Yrs Old ; Rectal Cancer ; Rectal Neoplasms

BACKGROUND

The Division of Colorectal Surgery at the Philippine General Hospital (PGH) conducts hundreds of surgeries annually for benign and malignant colorectal conditions. Since 2019, the Division has implemented an Enhanced Recovery After Surgery (ERAS) program to improve patient outcomes. However, its impact on hospital costs—critical for a government hospital—has not yet been studied.

OBJECTIVE

This study aimed to evaluate the effect of ERAS on healthcare costs for elective colorectal surgeries performed at PGH in 2021.

METHODS

A retrospective observational study was conducted on adult patients who underwent elective colorectal surgeries under the ERAS protocol in 2021. Medical and billing records were retrieved using the hospital’s electronic medical records (EMR) system, excluding cases with incomplete data. Procedures were categorized by type [stoma closure, colonic or rectal resection, reversal of Hartmann’s, or cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)] and surgical approach (open, laparoscopic, or robotic). Costs were classified into diagnostics, facility fees, medications, surgery, and hospital supplies. ERAS compliance rates were extracted from the online ERAS Interactive Audit System (EIAS), and linear regression analysis was performed.

RESULTS

Among 114 elective colorectal surgeries, records for 90 cases were analyzed. Surgery-related expenses accounted for the highest mean hospital costs across all procedure types. An inverse correlation between ERAS compliance and total cost was observed for open surgeries, with statistically significant reductions in stoma closures and open colon resections (p-value: 0.0213 and 0.0134, respectively). However, minimally invasive surgeries (MIS) did not demonstrate cost reductions with increasing ERAS compliance, likely due to additional expenses associated with advanced equipment. Linear regression indicated that higher compliance rates generally led to decreased hospital costs.

CONCLUSION

Standardized care through ERAS has been associated with cost savings compared to traditional perioperative management. This study supports the conclusion that higher ERAS compliance can reduce hospital costs in open colorectal surgeries. However, the higher costs of MIS procedures, driven by equipmentrelated expenses, may offset potential savings from ERAS adherence. Further research is warranted to explore the cost implications of ERAS in MIS cases.

Costs And Cost Analysis ; Colorectal Surgery

BACKGROUND

The Division of Colorectal Surgery at the Philippine General Hospital (PGH) conducts hundreds of surgeries annually for benign and malignant colorectal conditions. Since 2019, the Division has implemented an Enhanced Recovery After Surgery (ERAS) program to improve patient outcomes. However, its impact on hospital costs—critical for a government hospital—has not yet been studied.

OBJECTIVE

This study aimed to evaluate the effect of ERAS on healthcare costs for elective colorectal surgeries performed at PGH in 2021.

METHODS

A retrospective observational study was conducted on adult patients who underwent elective colorectal surgeries under the ERAS protocol in 2021. Medical and billing records were retrieved using the hospital’s electronic medical records (EMR) system, excluding cases with incomplete data. Procedures were categorized by type [stoma closure, colonic or rectal resection, reversal of Hartmann’s, or cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)] and surgical approach (open, laparoscopic, or robotic). Costs were classified into diagnostics, facility fees, medications, surgery, and hospital supplies. ERAS compliance rates were extracted from the online ERAS Interactive Audit System (EIAS), and linear regression analysis was performed.

RESULTS

Among 114 elective colorectal surgeries, records for 90 cases were analyzed. Surgery-related expenses accounted for the highest mean hospital costs across all procedure types. An inverse correlation between ERAS compliance and total cost was observed for open surgeries, with statistically significant reductions in stoma closures and open colon resections (p-value: 0.0213 and 0.0134, respectively). However, minimally invasive surgeries (MIS) did not demonstrate cost reductions with increasing ERAS compliance, likely due to additional expenses associated with advanced equipment. Linear regression indicated that higher compliance rates generally led to decreased hospital costs.

CONCLUSION

Standardized care through ERAS has been associated with cost savings compared to traditional perioperative management. This study supports the conclusion that higher ERAS compliance can reduce hospital costs in open colorectal surgeries. However, the higher costs of MIS procedures, driven by equipmentrelated expenses, may offset potential savings from ERAS adherence. Further research is warranted to explore the cost implications of ERAS in MIS cases.

Costs And Cost Analysis ; Colorectal Surgery