McDonnell, John G
The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. We evaluated its analgesic efficacy in patients during the first 24 postoperative hours after abdominal surgery, in a randomized, controlled, double-blind clinical trial.
Manzano, Roberta Munhoz; Carvalho, Celso Ricardo Fernandes de; Saraiva-Romanholo, Beatriz Mangueira; Vieira, Joaquim Edson
Abdominal surgical procedures increase pulmonary complication risks. The aim of this study was to evaluate the effectiveness of chest physiotherapy during the immediate postoperative period among patients undergoing elective upper abdominal surgery. This randomized clinical trial was performed in the post-anesthesia care unit of a public university hospital. Thirty-one adults were randomly assigned to control (n = 16) and chest physiotherapy (n = 15) groups. Spirometry, pulse oximetry and anamneses were performed preoperatively and on the second postoperative day. A visual pain scale was applied on the second postoperative day, before and after chest physiotherapy. The chest physiotherapy group received treatment at the post-anesthesia care unit, while the controls did not. Surgery duration, length of hospital stay and postoperative pulmonary complications were gathered from patients' medical records. The control and chest physiotherapy groups presented decreased spirometry values after surgery but without any difference between them (forced vital capacity from 83.5 +/- 17.1% to 62.7 +/- 16.9% and from 95.7 +/- 18.9% to 79.0 +/- 26.9%, respectively). In contrast, the chest physiotherapy group presented improved oxygen-hemoglobin saturation after chest physiotherapy during the immediate postoperative period (p postoperative day. The medical record data were similar between groups. Chest physiotherapy during the immediate postoperative period following upper abdominal surgery was effective for improving oxygen-hemoglobin saturation without increased abdominal pain. Breathing exercises could be adopted at post-anesthesia care units with benefits for patients.
Sada, Fatos; Krasniqi, Avdyl; Hamza, Astrit; Gecaj-Gashi, Agreta; Bicaj, Besnik; Kavaja, Floren
Background Carbohydrate-rich liquid drinks (CRLDs) have been recommended to attenuate insulin resistance by shortening the preoperative fasting interval. The aim of our study the effect of preoperative oral administration of CRLDs on the well-being and clinical status of patients. Methods A randomized, double blind, prospective study of patients undergoing open colorectal operations (CR) and open cholecyctectomy (CH) was conducted. Patients were divided into three groups: study, placebo, and ...
Sada, Fatos; Krasniqi, Avdyl; Hamza, Astrit; Gecaj-Gashi, Agreta; Bicaj, Besnik; Kavaja, Floren
Carbohydrate-rich liquid drinks (CRLDs) have been recommended to attenuate insulin resistance by shortening the preoperative fasting interval. The aim of our study the effect of preoperative oral administration of CRLDs on the well-being and clinical status of patients. A randomized, double blind, prospective study of patients undergoing open colorectal operations (CR) and open cholecyctectomy (CH) was conducted. Patients were divided into three groups: study, placebo, and control. Visual analogue scale (VAS) scores for seven parameters (thirst, hunger, anxiety, mouth dryness, nausea, weakness and sleep quality) were recorded and compared for two different time periods (up to 24 h postoperatively and from 36 to 48 h postoperatively). The Simplified Acute Physiology Score changes (SAPS)-II between the three groups were also studied. There were 142 patients American Society of Anesthesiology (ASA) I or II enrolled in the study (CR = 71 and CH = 71). There were no significant differences in postoperative SAPS-II scores or lengths of hospital stay (LOS) between the groups. However, in CR patients, the degree of thirst was partially improved by drinking CRLDs (P = 0.027). In CH patients, on the other hand, feelings of thirst, hunger, mouth dryness, nausea and weakness showed significant improvement (P carbohydrate-rich liquid drinks (CRLDs) improves the well-being in patients undergoing CH, but the effect is less evident in patients undergoing CR. No significant improvements were seen in clinical status or in length of hospital stay in either group. ANZCTR.org.au: ACTRN12614000995673 (registered on 16/09/2014).
Dronkers, J.J.; Lamberts, H.; Reutelingsperger, I.M.M.D.; Naber, R.H.; Dronkers-Landman, C.M.; Veldman, A.; Meeteren, N.L.U. van
Objective: Investigation of the feasibility and preliminary effect of a short-term intensive preoperative exercise programme for elderly patients scheduled for elective abdominal oncological surgery. Design: Single-blind randomized controlled pilot study. Setting: Ordinary hospital in the
The effect of using an abdominal binder on postoperative gastrointestinal function, mobilization, pulmonary function, and pain in patients undergoing major abdominal surgery: A randomized controlled trial.
Arici, Emine; Tastan, Sevinc; Can, Mehmet Fatih
Evidence on the effectiveness of using a binder following abdominal surgery and its effect on gastrointestinal function, mobilization, pulmonary function, and pain is currently unclear. The purpose of this study is to determine the effect of abdominal binder usage on gastrointestinal function, mobilization, pulmonary function, and postoperative pain in patients undergoing major abdominal surgery. This research was conducted as a randomized controlled trial. The study was conducted at the Department of General Surgery at a military education and research hospital in Ankara, Turkey, between September 2013 and April 2014. 104 patients were assessed for eligibility. The study was conducted on 84 eligible patients. The study sample consisted of 84 patients who underwent effective major abdominal surgery. The patients were randomized into two groups, the intervention group, which used an abdominal binder and the control group, which did not. Gastrointestinal function, mobilization, pulmonary function, and the pain status of both groups were evaluated on the first, fourth, and seventh days before and after surgery, and the intergroup results were compared. No significant difference was found between the two groups in terms of gastrointestinal and pulmonary function on the first, fourth, and seventh days following surgery (p>0.05). A comparative assessment of mobility by walking distance showed that patients in the intervention group were able to walk further on the fourth [mean (SD); 221.19 (69.08) m] and seventh [227.85 (60.02) m] days after surgery (p=0.003, pbinder does not have any effect on postoperative gastrointestinal and pulmonary function. However, an abdominal binder increases patient mobility soon after surgery. There was also a measurable effect on pain, with lower scores reported by patients who used an abdominal binder after any exercise or activity. These results indicate that the use of a routine abdominal binder is helpful for patients undergoing major
Kakkar, Ajay K; Agnelli, Giancarlo; Fisher, William; George, Daniel; Lassen, Michael R; Mismetti, Patrick; Mouret, Patrick; Murphy, Judith; Lawson, Francesca; Turpie, Alexander G G
To compare efficacy and safety of thromboprophylaxis with semuloparin started postoperatively versus enoxaparin started preoperatively in major abdominal surgery. Venous thromboembolism is an important complication following major abdominal surgery. Semuloparin is a novel ultra-low-molecular-weight heparin with high antifactor Xa and minimal antifactor IIa activity. In this double-blind noninferiority trial, adult patients undergoing major abdominal or pelvic operation under general anesthesia lasting more than 45 minutes were assigned to either daily enoxaparin 40 mg commenced preoperatively or daily semuloparin 20 mg commenced postoperatively, for 7 to 10 days. Patients underwent bilateral leg venography between 7 and 11 days postsurgery. The primary efficacy end point was the composite of any deep vein thrombosis, nonfatal pulmonary embolism, or all-cause death. The primary safety outcome was bleeding. Both were independently adjudicated. In total, 4413 patients were randomized; 3030 (1499 in the enoxaparin and 1531 in the semuloparin groups) were evaluable for the primary efficacy end point, which occurred in 97 patients (6.3%) in the semuloparin group and 82 patients (5.5%) in the enoxaparin group [odds ratio (OR) = 1.16, 95% confidence interval (CI): 0.84-1.59]. On the basis of a noninferiority margin of 1.25, postoperative semuloparin did not demonstrate noninferiority to preoperative enoxaparin. Major bleeding occurred in 63 of 2175 patients (2.9%) in the semuloparin group and 98 of 2177 patients (4.5%) in the enoxaparin group (OR = 0.63, 95% CI: 0.46-0.87). Semuloparin commenced postoperatively did not demonstrate noninferiority to enoxaparin initiated preoperatively for thromboprophylaxis after major abdominal surgery. Study registered with clinicaltrials.gov: NCT00679588.
Probst, Pascal; Knebel, Phillip; Grummich, Kathrin; Tenckhoff, Solveig; Ulrich, Alexis; Büchler, Markus W; Diener, Markus K
Industry sponsorship has been identified as a source of bias in several fields of medical science. To date, the influence of industry sponsorship in the field of general and abdominal surgery has not been evaluated. A systematic literature search (1985-2014) was performed in the Cochrane Library, MEDLINE, and EMBASE to identify randomized controlled trials in general and abdominal surgery. Information on funding source, outcome, and methodological quality was extracted. Association of industry sponsorship and positive outcome was expressed as odds ratio (OR) with 95% confidence interval (CI). A χ test and a multivariate logistic regression analysis with study characteristics and known sources of bias were performed. A total of 7934 articles were screened and 165 randomized controlled trials were included. No difference in methodological quality was found. Industry-funded trials more often presented statistically significant results for the primary endpoint (OR, 2.44; CI, 1.04-5.71; P = 0.04). Eighty-eight of 115 (76.5%) industry-funded trials and 19 of 50 (38.0%) non-industry-funded trials reported a positive outcome (OR, 5.32; CI, 2.60-10.88; P declaration of funding source. Industry involvement in surgical research has to ensure scientific integrity and independence and has to be based on full transparency.
Legemate Dink A
Full Text Available Abstract Background Intravenous (IV fluid administration is an essential part of postoperative care. Some studies suggest that a restricted post-operative fluid regime reduces complications and postoperative hospital stay after surgery. We investigated the effects of postoperative fluid restriction in surgical patients undergoing major abdominal surgery. Methods In a blinded randomized trial, 62 patients (ASA I-III undergoing elective major abdominal surgical procedures in a university hospital were allocated either to a restricted (1.5 L/24 h or a standard postoperative IV fluid regime (2.5 L/24 h. Primary endpoint was length of postoperative hospital stay (PHS. Secondary endpoints included postoperative complications and time to restore gastric functions. Results After a 1-year inclusion period, an unplanned interim analysis was made because of many protocol violations due to patient deterioration. In the group with the restricted regime we found a significantly increased PHS (12.3 vs. 8.3 days; p = 0.049 and significantly more major complications: 12 in 30 (40% vs. 5 in 32 (16% patients (Absolute Risk Increase: 0.24 [95%CI: 0.03 to 0.46], i.e. a number needed to harm of 4 [95%CI: 2–33]. Therefore, the trial was stopped prematurely. Intention to treat analysis showed no differences in time to restore gastric functions between the groups. Conclusion Restricted postoperative IV fluid management, as performed in this trial, in patients undergoing major abdominal surgery appears harmful as it is accompanied by an increased risk of major postoperative complications and a prolonged postoperative hospital stay. Trial registration Current Controlled Trials ISRCTN16719551
Gefke, K; Schroeder, T V; Thisted, B
The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....
Vester-Andersen, M; Waldau, T; Wetterslev, J
BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care......·16; P = 0·828). Thirty (20·8 per cent) of 144 patients assigned to intermediate care and 37 (26·1 per cent) of 142 assigned to ward care died within the total observation period (hazard ratio 0·78, 95 per cent c.i. 0·48 to 1·26; P = 0·310). CONCLUSION: Postoperative intermediate care had...... ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. RESULTS: In total, 286 patients were included in the modified intention-to-treat analysis. The trial...
Barberan-Garcia, Anael; Ubré, Marta; Roca, Josep; Lacy, Antonio M; Burgos, Felip; Risco, Raquel; Momblán, Dulce; Balust, Jaume; Blanco, Isabel; Martínez-Pallí, Graciela
The aim of this study was to assess the impact of personalized prehabilitation on postoperative complications in high-risk patients undergoing elective major abdominal surgery. Prehabilitation, including endurance exercise training and promotion of physical activity, in patients undergoing major abdominal surgery has been postulated as an effective preventive intervention to reduce postoperative complications. However, the existing studies provide controversial results and show a clear bias toward low-risk patients. This was a randomized blinded controlled trial. Eligible candidates accepting to participate were blindly randomized (1:1 ratio) to control (standard care) or intervention (standard care + prehabilitation) groups. Inclusion criteria were: i) age >70 years; and/or, ii) American Society of Anesthesiologists score III/IV. Prehabilitation covered 3 actions: i) motivational interview; ii) high-intensity endurance training; and promotion of physical activity. The main study outcome was the proportion of patients suffering postoperative complications. Secondary outcomes included the endurance time (ET) during cycle-ergometer exercise. We randomized 71 patients to the control arm and 73 to intervention. After excluding 19 patients because of changes in the surgical plan, 63 controls and 62 intervention patients were included in the intention-to-treat analysis. The intervention group enhanced aerobic capacity [ΔET 135 (218) %; P high-risk candidates for elective major abdominal surgery, which can be explained by the increased aerobic capacity.
Spieth, Peter M; Güldner, Andreas; Uhlig, Christopher; Bluth, Thomas; Kiss, Thomas; Schultz, Marcus J; Pelosi, Paolo; Koch, Thea; Gama de Abreu, Marcelo
General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventilation. The PROtective VARiable ventilation trial ('PROVAR') is a single center, randomized controlled trial enrolling 50 patients who are planning for open abdominal surgery expected to last longer than 3 hours. PROVAR compares conventional (non-variable) lung protective ventilation (CV) with variable lung protective ventilation (VV) regarding pulmonary function and inflammatory response. The primary endpoint of the study is the forced vital capacity on the first postoperative day. Secondary endpoints include further lung function tests, plasma cytokine levels, spatial distribution of ventilation assessed by means of electrical impedance tomography and postoperative pulmonary complications. We hypothesize that VV improves lung function and reduces systemic inflammatory response compared to CV in patients receiving mechanical ventilation during general anesthesia for open abdominal surgery longer than 3 hours. PROVAR is the first randomized controlled trial aiming at intra- and postoperative effects of VV on lung function. This study may help to define the role of VV during general anesthesia requiring mechanical ventilation. Clinicaltrials.gov NCT01683578 (registered on September 3 3012).
Probst, Pascal; Grummich, Kathrin; Heger, Patrick; Zaschke, Steffen; Knebel, Phillip; Ulrich, Alexis; Büchler, Markus W; Diener, Markus K
Blinding is a measure in randomized controlled trials (RCT) to reduce detection and performance bias. There is evidence that lack of blinding leads to overestimated treatment effects. Because of the physical component of interventions, blinding is not easily applicable in surgical trials. This is a protocol for a systematic review and empirical study about actual impact on outcomes and future potential of blinding in general and abdominal surgery RCT. A systematic literature search in CENTRAL, MEDLINE and Web of Science will be conducted to locate RCT between 1996 and 2015 with a surgical intervention. General study characteristics and information on blinding methods will be extracted. The risk of performance and detection bias will be rated as low, unclear or high according to the Cochrane Collaboration's tool for assessing risk of bias. The main outcome of interest will be the association of a high risk of performance or detection bias with significant trial results and will be tested at a level of significance of 5 %. Further, trials will be meta-analysed in a Mantel-Haenszel model comparing trials with high risk of bias to other trials at a level of significance of 5 %. Detection and performance bias distort treatment effects. The degree of such bias in general and abdominal surgery is unknown. Evidence on influence of missing blinding would improve critical appraisal and conduct of general and abdominal surgery RCT. PROSPERO 2015: CRD42015026837.
Bennett-Guerrero, Elliott; Berry, Scott M; Bergese, Sergio D; Fleshner, Phillip R; Minkowitz, Harold S; Segura-Vasi, Alvaro M; Itani, Kamal M F; Henderson, Karen W; Rackowski, Felicia P; Aberle, Laura H; Stryjewski, Martin E; Corey, G Ralph; Allenby, Kent S
SI is a significant medical problem. DFA-02 is an investigational bioresorbable modified release gel consisting of both gentamicin (16.8 mg/mL) and vancomycin (18.8 mg/mL). A Phase 2a study, where the drug was applied during surgical incision closure, suggested safety and tolerability but was not designed to assess its efficacy. In a Phase 2b randomized, blinded trial patients undergoing abdominal, primarily colorectal, surgery were randomized (4:1:1) to one of three study arms: DFA-02, matching placebo gel, or standard of care (SOC) involving irrigation of the wound with normal saline. The DFA-02 and placebo gel groups received up to 20 mL of study drug inserted above the fascia during wound closure, and were treated in a double-blind manner; the SOC group was treated in a single-blind manner. The primary endpoint was SSI (adjudicated centrally by a blinded committee) through postoperative day 30. Overall, 445 subjects (intention-to-treat) were randomized at 35 centers with 425 subjects completing the study and being evaluable. There were 67 SSIs (15.8%): 64.2% superficial, 7.5% deep, and 28.4% organ space. The incidence of SSI was not statistically significantly different between the DFA-02 and the placebo gel/SOC arms combined, 42/287 = 14.6% vs 25/138 = 18.1% (p = 0.36), respectively. Rehospitalization within 30 days was also similar between study groups (DFA-02 28.6%, placebo gel 21.4%, SOC 27.3%). In this multicenter, blinded, randomized trial with central adjudication, the gentamicin/vancomycin gel was not associated with a significant reduction in SSI. Patients undergoing abdominal surgery were randomized to one of three study arms: DFA-02 gel consisting of both gentamicin and vancomycin, matching placebo gel, or standard of care (SOC). Of 425 patients completing the study at 35 sites the gentamicin/vancomycin gel was not associated with a significant reduction in SSI. Copyright © 2016 Elsevier Inc. All rights reserved.
Egan, Cameron; Bernstein, Ethan; Reddy, Desigen; Ali, Madi; Paul, James; Yang, Dongsheng; Sessler, Daniel I
The PerfecTemp is an underbody resistive warming system that combines servocontrolled underbody warming with viscoelastic foam pressure relief. Clinical efficacy of the system has yet to be formally evaluated. We therefore tested the hypothesis that intraoperative distal esophageal (core) temperatures with the PerfecTemp (underbody resistive) warming system are noninferior to upper-body forced-air warming in patients undergoing major open abdominal surgery under general anesthesia. Adults scheduled for elective major open abdominal surgery (liver, pancreas, gynecological, and colorectal surgery) under general anesthesia were enrolled at 2 centers. Patients were randomly assigned to underbody resistive or forced-air warming. Resistive heating started when patients were transferred to the operating room table; forced-air warming started after patients were draped. The primary outcome was noninferiority of intraoperative time-weighted average core temperature, adjusted for baseline characteristics and using a buffer of 0.5°C. Thirty-six patients were randomly assigned to underbody resistive heating and 34 to forced-air warming. Baseline and surgical characteristics were generally similar. We had sufficient evidence (P=0.018) to conclude that underbody resistive warming is not worse than (i.e., noninferior to) upper-body forced-air warming in the time-weighted average intraoperative temperature, with a mean difference of -0.12°C [95% confidence interval (CI) -0.37 to 0.14]. Core temperatures at the end of surgery averaged 36.3°C [95% CI 36 to 36.5] in the resistive warming patients and 36.6°C [95% CI 36.4 to 36.8] in those assigned to forced-air warming for a mean difference of -0.34°C [95% CI -0.69 to 0.01]. Mean intraoperative time-weighted average core temperatures were no different, and significantly noninferior, with underbody resistive heating in comparison with upper-body forced-air warming. Underbody resistive heating may be an alternative to forced
Staehr Anne K
Full Text Available Abstract Background A high perioperative inspiratory oxygen fraction (FiO2 may reduce the frequency of surgical site infection. Perioperative atelectasis is caused by absorption, compression and reduced function of surfactant. It is well accepted, that ventilation with 100% oxygen for only a few minutes is associated with significant formation of atelectasis. However, it is still not clear if a longer period of 80% oxygen results in more atelectasis compared to a low FiO2. Our aim was to assess if a high FiO2 is associated with impaired oxygenation and decreased pulmonary functional residual capacity (FRC. Methods Thirty-five patients scheduled for laparotomy for ovarian cancer were randomized to receive either 30% oxygen (n = 15 or 80% oxygen (n = 20 during and for 2 h after surgery. The oxygenation index (PaO2/FiO2 was measured every 30 min during anesthesia and 90 min after extubation. FRC was measured the day before surgery and 2 h after extubation by a rebreathing method using the inert gas SF6. Results Five min after intubation, the median PaO2/FiO2 was 69 kPa [53-71] in the 30%-group vs. 60 kPa [47-69] in the 80%-group (P = 0.25. At the end of anesthesia, the PaO2/FiO2 was 58 kPa [40-70] vs. 57 kPa [46-67] in the 30%- and 80%-group, respectively (P = 0.10. The median FRC was 1993 mL [1610-2240] vs. 1875 mL [1545-2048] at baseline and 1615 mL [1375-2318] vs. 1633 mL [1343-1948] postoperatively in the 30%- and 80%-group, respectively (P = 0.70. Conclusion We found no significant difference in oxygenation index or functional residual capacity between patients given 80% and 30% oxygen for a period of approximately 5 hours. Trial registration ClinicalTrials.gov Identifier: NCT00637936.
Cosmetic surgery of the abdomen; Tummy tuck; Abdominoplasty ... Most of the time, this surgery is an elective or cosmetic procedure because it is an operation you choose to have. It is not usually needed for health reasons. Cosmetic abdomen repair ...
Sun, Da-Li; Li, Wei-Ming; Li, Shu-Min; Cen, Yun-Yun; Xu, Qing-Wen; Li, Yi-Jun; Sun, Yan-Bo; Qi, Yu-Xing; Lin, Yue-Ying; Yang, Ting; Lu, Qi-Ping; Xu, Peng-Yuan
Early oral nutrition (EON) has been shown to improve recovery of gastrointestinal function, length of stay and mortality after abdominal surgery; however, early oral nutrition often fails during the first week after surgery. Here, a multi-modal early oral nutrition program is introduced to promote recovery of gastrointestinal function and tolerance of oral nutrition. Consecutive patients scheduled for abdominal surgery were randomized to the multimodal EON group or a group receiving conventional care. The primary endpoint was the time of first defecation. The secondary endpoints were outcomes and the cost-effectiveness ratio in treating infectious complications. The rate of infectious-free patients was regarded as the index of effectiveness. One hundred seven patients were randomly assigned to groups. Baseline characteristics were similar for both groups. In intention-to-treat analysis, the success rate of oral nutrition during the first week after surgery in the multimodal EON group was 44 (83.0%) versus 31 (57.4%) in the conventional care group (P = 0.004). Time to first defecation, time to flatus, recovery time of bowel sounds, and prolonged postoperative ileus were all less in the multimodal EON group (P oral nutrition group (P oral nutrition program was an effective way to improve tolerance of oral nutrition during the first week after surgery, decrease the length of stay and improve cost-effectiveness after abdominal surgery. Registration number: ChiCTR-TRC-14004395 . Registered 15 March 2014.
Spieth, Peter M; Güldner, Andreas; Uhlig, Christopher; Bluth, Thomas; Kiss, Thomas; Schultz, Marcus J.; Pelosi, Paolo; Koch, Thea; Gama de Abreu, Marcelo
Background General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventila...
Full Text Available Abstract Background Post-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia >2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure (PEEP and repeated recruitment maneuvers; the "open lung strategy", protects against post-operative pulmonary complications is uncertain. The present study aims at comparing a protective mechanical ventilation strategy with a conventional mechanical ventilation strategy during general anesthesia for abdominal non-laparoscopic surgery. Methods The PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure ("PROVHILO" trial is a worldwide investigator-initiated multicenter randomized controlled two-arm study. Nine hundred patients scheduled for non-laparoscopic abdominal surgery at high or intermediate risk for post-operative pulmonary complications are randomized to mechanical ventilation with the level of PEEP at 12 cmH2O with recruitment maneuvers (the lung-protective strategy or mechanical ventilation with the level of PEEP at maximum 2 cmH2O without recruitment maneuvers (the conventional strategy. The primary endpoint is any post-operative pulmonary complication. Discussion The PROVHILO trial is the first randomized controlled trial powered to investigate whether an open lung mechanical ventilation strategy in short-term mechanical ventilation prevents against postoperative pulmonary complications. Trial registration ISRCTN: ISRCTN70332574
Hemmes, Sabrine N T; Severgnini, Paolo; Jaber, Samir; Canet, Jaume; Wrigge, Hermann; Hiesmayr, Michael; Tschernko, Edda M; Hollmann, Markus W; Binnekade, Jan M; Hedenstierna, Göran; Putensen, Christian; de Abreu, Marcelo Gama; Pelosi, Paolo; Schultz, Marcus J
Post-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia >2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure (PEEP) and repeated recruitment maneuvers; the "open lung strategy", protects against post-operative pulmonary complications is uncertain. The present study aims at comparing a protective mechanical ventilation strategy with a conventional mechanical ventilation strategy during general anesthesia for abdominal non-laparoscopic surgery. The PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure ("PROVHILO") trial is a worldwide investigator-initiated multicenter randomized controlled two-arm study. Nine hundred patients scheduled for non-laparoscopic abdominal surgery at high or intermediate risk for post-operative pulmonary complications are randomized to mechanical ventilation with the level of PEEP at 12 cmH(2)O with recruitment maneuvers (the lung-protective strategy) or mechanical ventilation with the level of PEEP at maximum 2 cmH(2)O without recruitment maneuvers (the conventional strategy). The primary endpoint is any post-operative pulmonary complication. The PROVHILO trial is the first randomized controlled trial powered to investigate whether an open lung mechanical ventilation strategy in short-term mechanical ventilation prevents against postoperative pulmonary complications. ISRCTN: ISRCTN70332574.
Full Text Available Background: Perioperative pain is prevalent and poorly treated. Apart from that it makes the recovery from surgery unpleasent, pain often remains as a residual side effect of surgery, even though the tissue healing is complete. An essential observation is that tissue injury and the resulting nociceptor barrage initiates a cascade of events that can indelibly alter pain perception. Preemptive analgesia is the concept of initiating analgesic therapy before the onset of the noxious stimulus so as to prevent the nociceptor barrage and its consequences. However, anticipated clinical potency of preemptive analgesia, though has firmly grounded in the neurobiology of pain, has not been yet realized. As data accumulates, it has become clear that clinical studies emulating those from the laboratory and designed around a relatively narrow definition of preemptive analgesia have been largely unsupportive of its use. Nevertheless, preemptive analgesic interventions that recognize the intensity, duration, and somatotopic extent of major surgery can help reduce perioperative pain and its longer-term sequelae. surgeons spend a lot of time treating the pain of lower abdominal surgery. Methods: A total number of 48 consecutive patients who were going to undergo elective lower abdominal surgery. Were randomly assigned in two groups of 24 each. In one group the patients received an injection of 0.5 % bupivacaine in the planned skin for incision just before lower abdominal surgery, and in the other group, they received an equal amount of 0.5% bupivacaine after the surgery had been done. Pain was objectified by a numerical visual pain score, in the 24 hours following the lower abdominal surgery. Results: There were no differences in postoperative pain scores on the visual analog scale (VAS: In groups 1and 2, VAS at hour 4 were 6.37±1.13 versus 6.29±1.19; At hour 8 were 5.54 ± 1.17 versus 5.37±1.09; and at hour 12 were 4.5 ± 1.31 versus 4.45 ± 1
Perioperative goal-directed hemodynamic optimization using noninvasive cardiac output monitoring in major abdominal surgery: a prospective, randomized, multicenter, pragmatic trial: POEMAS Study (PeriOperative goal-directed thErapy in Major Abdominal Surgery).
Pestaña, David; Espinosa, Elena; Eden, Arieh; Nájera, Diana; Collar, Luis; Aldecoa, César; Higuera, Eva; Escribano, Soledad; Bystritski, Dmitri; Pascual, Javier; Fernández-Garijo, Pilar; de Prada, Blanca; Muriel, Alfonso; Pizov, Reuven
In this study, our objective was to determine whether a perioperative hemodynamic protocol based on noninvasive cardiac output monitoring decreases the incidence of postoperative complications and hospital length of stay in major abdominal surgery patients requiring intensive care unit admission. Secondary objectives were the time to peristalsis recovery and the incidence of wound infection, anastomotic leaks, and mortality. A randomized clinical trial was conducted in 6 tertiary hospitals. One hundred forty-two adult patients scheduled for open colorectal surgery, gastrectomy, or small bowel resection were enrolled. A hemodynamic protocol including fluid administration and vasoactive drugs based on arterial blood pressure, cardiac index, and stroke volume response was compared with standard practice. Patients were followed until hospital discharge (determined by a surgeon blinded to the study) or death. In contrast to previous studies, we designed a pragmatic trial (as opposed to explanatory trials) to mimic real practice and obtain maximal external validity for the study. Fluid administration was similar except for the number of colloid boluses (2.4 ± 1.8 [treated] vs 1.3 ± 1.4 [control]; P < 0.001) and packed red blood cell units (0.6 ± 1.3 [treated] vs 0.2 ± 0.6 [control]; P = 0.019). Dobutamine was used in 25% (intraoperatively) and 19.4% (postoperatively) of the treated patients versus 1.4% and 0% in the control group (P < 0.001). We have observed a reduction in reoperations in the treated group (5.6% vs 15.7%; P = 0.049). However, no significant differences were observed in overall complications (40% vs 41%; relative risk 0.99 [0.67-1.44]; P = 0.397), length of stay (11.5 [8-15] vs 10.5 [8-16]; P = 0.874), time to first flatus (62 hours [40-76] vs 72 hours [48-96]; P = 0.180), wound infection (7 vs 14; P = 0.085), anastomotic leaks (2 vs 5; P = 0.23), or mortality (4.2% vs 5.7%; P = 0.67). The results of our pragmatic study indicate that a perioperative
Full Text Available Background: Post-operative nausea and vomiting is one of the most common and distressing complications after anesthesia and surgery. It may lead to serious post-operative complications. Ramosetron is a newer 5-HT3 receptor antagonist and has more potent and longer duration of antiemetic effects compared to first generation 5HT3 receptor antagonists. The purpose of this study was to compare the efficacy of Ramosetron for the prevention of post-operative nausea and vomiting with that of Ondansetron in patients undergoing abdominal surgeries under general anesthesia. Methods: In this randomized, double-blind study, 60 patients, 18-60 years of both genders falling under ASA I-II category scheduled for abdominal surgery were included. Group I received I.V ramosetron 0.3 mg while group II received I.V Ondansetron 4 mg at the time of extubation. The standard general anesthetic technique was used throughout. Postoperatively the incidences of nausea, vomiting, and safety assessments were performed at 1, 2, 6, and 24 h during the first 24 h after surgery. Results: There were no differences between groups with respect to patient demographics. The percentage of patients who had complete response (no PONV, and no need for another rescue antiemetic from 0 to 24 h after anesthesia was 56% with ramosetron and 33% with ondansetron. The corresponding rates at 1, 2, 6, and 24 h after anesthesia were 76% and 63%, 76% and 50%, 100 and 83%, 100 and 93%, respectively. Safety profiles of the two drugs were comparable, as no clinically serious adverse effects caused by study drugs were observed in either of the groups. Conclusion: Our study concludes that prophylactic therapy with ramosetron is highly efficacious than ondansetron in preventing PONV in patients undergoing abdominal surgery under general anesthesia.
Kumar, Amaravadi Sampath; Augustine, Alfred Joseph; Pazhyaottayil, Zulfeequer Chundaanveetil; Ramakrishna, Anand; Krishnakumar, Shyam Krishnan
Introduction Surgical procedures in abdominal area lead to changes in pulmonary function, respiratory mechanics and impaired physical capacity leading to postoperative pulmonary complications, which can affect up to 80% of upper abdominal surgery. Aim To evaluate the effects of flow and volume incentive spirometry on pulmonary function and exercise tolerance in patients undergoing open abdominal surgery. Materials and Methods A randomized clinical trial was conducted in a hospital of Mangalore city in Southern India. Thirty-seven males and thirteen females who were undergoing abdominal surgeries were included and allocated into flow and volume incentive spirometry groups by block randomization. All subjects underwent evaluations of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow (PEF). Preoperative and postoperative measurements were taken up to day 5 for both groups. Exercise tolerance measured by Six- Minute Walk Test during preoperative period and measured again at the time of discharge for both groups. Pulmonary function was analysed by post-hoc analysis and carried out using Bonferroni’s ‘t’-test. Exercise tolerance was analysed by Paired ‘T’-test. Results Pulmonary function (FVC, FEV1, and PEFR) was found to be significantly decreased in 1st, 2nd and 3rd postoperative day when compared with preoperative day. On 4th and 5th postoperative day the pulmonary function (FVC, FEV1, and PEFR) was found to be better preserved in both flow and volume incentive spirometry groups. The Six-Minute Walk Test showed a statistically significant improvement in pulmonary function on the day of discharge than in the preoperative period. In terms of distance covered, the volume- incentive spirometry group showed a greater statistically significant improvement from the preoperative period to the time of discharge than was exhibited by the flow incentive spirometry group
Bello-Guerrero, Jorge Alberto; Cruz-Santiago, César Alberto; Luna-Martínez, Javier
Up to 93% of patients undergoing abdominal surgery will develop intra-abdominal adhesions with the subsequent morbidity that they represent. Various substances have been tested for the prevention of adhesions with controversial results; the aim of our study is to compare the capability of pirfenidone in adhesion prevention against sodium hyaluronate/carboxymethylcellulose. A randomized, prospective, longitudinal experimental study with Winstar rats. They were divided into 3 groups. The subjects underwent an exploratory laparotomy and they had a 4cm(2) cecal abrasion. The first group received saline on the cecal abrasion, and groups 2 and 3 received pirfenidone and sodium hyaluronate/carboxymethylcellulose respectively. All rats were sacrificed on the 21st day after surgery and the presence of adhesions was evaluated with the modified Granat scale. Simple frequency, central tendency and dispersion measures were recorded. For the statistical analysis we used Fisher's test. To evaluate adhesions we used the Granat's modified scale. The control group had a median adhesion formation of 3 (range 0-4). The pirfenidone group had 1.5 (range 0-3), and the sodium hyaluronate/carboxymethylcellulose group had 0 (range 0-1). There was a statistically significant difference to favor sodium hyaluronate/carboxymethylcellulose against saline and pirfenidone (Phyaluronate/carboxymethylcellulose is effective for the prevention of intra-abdominal adhesions. More experimental studies are needed in search for the optimal adhesion prevention drug. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
Association between Triclosan-Coated Sutures for Abdominal Wall Closure and Incisional Surgical Site Infection after Open Surgery in Patients Presenting with Fecal Peritonitis: A Randomized Clinical Trial.
Ruiz-Tovar, Jaime; Alonso, Natalia; Morales, Vicente; Llavero, Carolina
A factor that may influence the incidence of surgical site infections (SSIs) is the suture used for closure of the abdominal wall because bacteria may adhere to the suture material. Sutures can be coated with antibacterial substances that may reduce the bacterial load in the incision. The aim of this study was to evaluate the effect of triclosan-coated sutures used in abdominal wall closure in patients with fecal peritonitis. A randomized study was performed. Inclusion criteria were intra-operative diagnosis of fecal peritonitis secondary to acute diverticulitis perforation, neoplastic tumor perforation, or colorectal anastomotic leak of previous elective colorectal resection. The patients were randomly assigned to either abdominal wall closure with triclosan-coated sutures (group 1) or sutures without triclosan (group 2). Fifty patients were included in group 1 and 51 in group 2. The incisional SSI rate was 10% in group 1 and 35.3% in group 2 (p=0.004; odds ratio [OR]=0.204; 95% confidence interval [CI] 0.069-0.605). A significant reduction in SSIs caused by Escherichia coli and Enterococcus faecalis was observed in group 2. The use of triclosan-coated sutures in fecal peritonitis surgery reduces the incidence of incisional SSI.
Background: Thoracic epidural anaesthesia (TEA) has many benefits over general anaesthesia in major abdominal surgeries including avoidance of endotracheal intubation. Aims: To evaluate the feasibility of TEA for major abdominal surgeries in the private hospital setting. Patients and methods: This was a retrospective ...
Yamashita, Soichiro; Yokouchi, Takako; Tanaka, Makoto
To evaluate whether intraoperative high-dose remifentanil infusion increased local anesthetic consumption in postoperative epidural analgesia and postoperative pain scores compared with low-dose remifentanil infusion. Prospective, randomized controlled study. Operating room, university hospital. Thirty female patients scheduled for elective gynecological abdominal surgery. After epidural catheter placement and induction of general anesthesia, patients were randomly assigned to 2 anesthetic regimens. In the first group (high-dose remifentanil group), sevoflurane concentration was held constant at 1.2%, and the remifentanil infusion rate was titrated to maintain systolic blood pressure within 20% of baseline. In the second group (low-dose remifentanil group), the remifentanil infusion rate was held constant at 0.1μg/(kg min), and the sevoflurane concentration was titrated to maintain systolic blood pressure within 20% of baseline. As abdominal wall closure began, 6mL of 0.2% ropivacaine was administrated via epidural catheter; a patient-controlled analgesia device was set to deliver 4mL/h of 0.2% ropivacaine with 3μg/mL of fentanyl, with 2-mL incremental doses and a 15-minute lockout time. Local anesthetic consumption via postoperative epidural catheter and pain intensity with the Prince Henry pain scale were assessed for 48hours after surgery. The mean remifentanil infusion rate was 0.23μg/(kg min) in the high-dose remifentanil group, 2.3 times the rate used in the low-dose remifentanil group. The cumulative amount of local anesthetic used within 48hours of surgery was significant greater in the high-dose remifentanil group than in the low-dose remifentanil group (212±25mL vs. 181±35mL, respectively; Phigh-dose remifentanil infusion increased local anesthetic consumption in postoperative epidural analgesia relative to low-dose remifentanil. Copyright © 2016 Elsevier Inc. All rights reserved.
Mohammed A. Elgendy
Conclusion: The applied protocol for intraoperative GDT provided significant reduction of PO morbidities, ICU and hospital LOS but couldn‘t significantly reduce mortality rates in high risk patients scheduled for major abdominal surgeries.
Christoffersen, Jens Krogh; Hove, Lars Dahlgaard; Mikkelsen, Kim Lyngby
BACKGROUND: Well leg compartment syndrome (WLCS) is a complication to abdominal surgery. We aimed to identify risk factors for and outcome of WLCS in Denmark and literature. METHODS: Prospectively collected claims to the Danish Patient Compensation Association (DPCA) concerning WLCS after abdominal...... surgery (p = 0.04). Duration of the abdominal surgery was 4 times as important as the diagnostic delay for severity of the final outcome. DNPR recorded 4 new cases/year, and half were reported to DPCA. CONCLUSION: The first 24 h following abdominal surgery of >4 h' duration with elevated legs observation...... for WLCS should be standard. Pain in the calf is indicative of WLCS, and elevated serum CK can support the diagnosis. Mannitol infusion and acute four-compartment fasciotomy of the lower leg is the treatment. The risk of severe outcome of WLCS increases with duration of the primary operation. A broad...
Lytvyn, L; Quach, K; Banfield, L; Johnston, B C; Mertz, D
Postoperative infections, particularly surgical site infections (SSIs), cause significant morbidity and mortality. Probiotics or synbiotics are a potential prevention strategy. To evaluate the efficacy of probiotics/synbiotics for reducing postoperative infection risk following abdominal surgery. We searched AMED, Central, CINAHL, Embase, Medline, and grey literature for randomized controlled trials of elective abdominal surgery patients administered probiotics or synbiotics compared to placebo or standard care. Primary outcome was SSIs. Secondary outcomes were adverse events, respiratory tract infections (RTIs), urinary tract infections (UTIs), combined infections, length of hospital stay, and mortality. Using random-effects meta-analyses, we estimated the relative risk (RR) or mean difference (MD) and 95% confidence interval (CI). Tests were performed for heterogeneity, subgroup and sensitivity analyses were conducted, and the overall evidence quality was graded. We identified 20 trials (N = 1374 participants) reporting postoperative infections. Probiotics/synbiotics reduced SSIs (RR: 0.63; 95% CI: 0.41-0.98; N = 15 studies), UTIs (RR: 0.29; 95% CI: 0.15-0.57; N = 11), and combined infections (RR: 0.49; 95% CI: 0.35-0.70; N = 18). There was no difference between groups for adverse events (RR: 0.89; 95% CI: 0.61-1.30; N = 6), RTIs (RR: 0.60; 95% CI: 0.36-1.00; N = 14), length of stay (MD: -1.19; 95% CI: -2.94 to 0.56; N = 12), or mortality (RR: 1.20; 95% CI: 0.58-2.48; N = 15). Our review suggests that probiotics/synbiotics reduce SSIs and UTIs from abdominal surgeries compared to placebo or standard of care, without evidence of safety risk. Overall study quality was low, owing mostly to imprecision (few patients and events, or wide CIs); thus larger multi-centered trials are needed to further assess the certainty in this estimate. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Holsträter, Thorsten Frederik; Georgieff, Michael; Föhr, Karl Josef; Klingler, Werner; Uhl, Miriam Elisabeth; Walker, Tobias; Köster, Sarah; Grön, Georg; Adolph, Oliver
Both central sensitization after peripheral tissue injury and the development of opioid tolerance involve activation of N-methyl-D-aspartate (NMDA) receptors. At subanesthetic doses the NMDA receptor antagonist xenon suppresses pain-evoked sensitization of pain-processing areas in the central nervous system. Although numerous studies describe the effect of NMDA receptor antagonists on postoperative pain, clinical studies elucidating their intraoperative analgesic potency when applied in a low dosage are still largely missing. To analyze the analgesic effect of low-dose xenon using new application methods, the authors tested nasally applied xenon as an add-on treatment for analgesia in 40 patients undergoing abdominal hysterectomy. Within a randomized double-blind placebo-controlled study design, intraoperative and postoperative requirement of opioids as well as postoperative subjective experiences of pain were measured as primary outcome variables. Intranasal application of xenon significantly reduced intraoperative opioid requirement (mean difference [MD] -2.0 μg/min; 95% CI [CI95]-0.53 to -3.51, Bonferroni correction adjusted P value [pcorr]= 0.028) without relevant side effects and significantly reduced postoperative pain (MD -1.34 points on an 11-point rating scale; CI95 -0.60 to -2.09, pcorr = 0.002). However, postoperative morphine consumption (MD -8.8 μg/min; CI95 1.2 to -18.8, pcorr = 0.24) was not significantly reduced in this study. Low-dose xenon significantly reduces intraoperative analgesic use and postoperative pain perception. Because NMDA receptor antagonists suppress central sensitization, prevent the development of opioid tolerance, and reduce postoperative pain, the intraoperative usage of NMDA receptor antagonists such as xenon is suggested to improve effectiveness of pain management within a concept of multimodal analgesia.
Background: Thoracic epidural anaesthesia (TEA) has many benefits over general anaesthesia in major abdominal surgeries including avoidance of endotracheal intubation. Aims: To evaluate the ... Information obtained included: age, gender, ASA status, diagnosis and type of surgery performed. Data analysis was ...
Cirocchi, Roberto; Montedori, Alessandro; Farinella, Eriberto; Bonacini, Isabella; Tagliabue, Ludovica; Abraha, Iosief
Trauma is one of the leading causes of death in any age group. The 'lethal triad' of acidosis, hypothermia, and coagulopathy has been recognized as a significant cause of death in patients with traumatic injuries. In order to prevent the lethal triad two factors are essential, early control of bleeding and prevention of further heat loss. In patients with major abdominal trauma, damage control surgery (DCS) avoids extensive procedures on unstable patients, stabilizes potentially fatal problems at initial operation, and applies staged surgery after successful initial resuscitation. It is not currently known whether DCS is superior to immediate surgery for patients with major abdominal trauma. To assess the effects of damage control surgery compared to traditional immediate definitive surgical treatment for patients with major abdominal trauma. We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2012, Issue 12 of 12), MEDLINE, EMBASE, Web of Science: Science Citation Index & ISI Proceedings, Current Controlled Trials MetaRegister, Clinicaltrials.gov, Zetoc, and CINAHL for all published and unpublished randomised controlled trials. We did not restrict the searches by language, date, or publication status. The search was through December 2012. Randomised controlled trials of damage control surgery versus immediate traditional surgical repair were included in this review. We included patients with major abdominal trauma (Abbreviated Injury Scale > 3) who were undergoing surgery. Patient selection was crucial as patients with relatively simple abdominal injuries should not undergo unnecessary procedures. Two authors independently evaluated the search results. A total of 2551 studies were identified by our search. No randomised controlled trials comparing DCS with immediate and definitive repair in patients with major abdominal trauma were found. A total of 2551 studies were excluded because they were not relevant to the review
Fischer, Craig P; Bochicchio, Grant; Shen, Jessica; Patel, Bababhai; Batiller, Jonathan; Hart, James C
This study evaluated the hemostatic effectiveness and safety of Fibrin Pad (Omrix Biopharmaceuticals Ltd.) vs absorbable hemostat in patients undergoing nonemergent surgery. Fibrin Pad is a topical absorbable hemostat designed to be effective in a variety of soft tissues and across multiple bleeding intensities. Patients 18 years and older, requiring abdominal, retroperitoneal, pelvic, or thoracic (noncardiac) surgery and with an appropriate soft-tissue target bleeding site (TBS), were randomized to receive Fibrin Pad or absorbable hemostat (NCT00658723). Patients were stratified by bleeding severity at the TBS. Assessments included percentage of patients achieving hemostasis at 4 minutes after randomization with no rebleeding requiring treatment during the subsequent 6 minutes (primary endpoint), proportion of patients achieving hemostasis at 10 minutes, and incidence of treatment failure. On the primary endpoint, 98.3% of patients with Fibrin Pad and 53.3% with absorbable hemostat achieved hemostasis at 4 minutes (p < 0.0001). The treatment differential was magnified (efficacy was maintained with Fibrin Pad but decreased with absorbable hemostat) with increasing bleeding intensity: in patients with mild bleeding, 100.0% vs 80.0% achieved hemostasis with Fibrin Pad and absorbable hemostat (p = 0.03), respectively; rates were 96.6% vs 26.7%, respectively (p < 0.0001) with moderate bleeding. Percentages of patients who achieved hemostasis at 10 minutes were: Fibrin Pad, 98.3% and absorbable hemostat, 73.3% (p < 0.0001). Incidences of adverse events were comparable between groups. Fibrin Pad is superior to absorbable hemostat (SURGICEL Original Absorbable Hemostat [Ethicon]) in soft-tissue bleeding control and is safe and effective as an adjunct for rapidly and reliably achieving hemostasis for soft-tissue bleeding during surgery. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Joosten, Alexandre; Delaporte, Amelie; Ickx, Brigitte; Touihri, Karim; Stany, Ida; Barvais, Luc; Van Obbergh, Luc; Loi, Patricia; Rinehart, Joseph; Cannesson, Maxime; Van der Linden, Philippe
The type of fluid and volume regimen given intraoperatively both can impact patient outcome after major surgery. This two-arm, parallel, randomized controlled, double-blind, bi-center superiority study tested the hypothesis that when using closed-loop assisted goal-directed fluid therapy, balanced colloids are associated with fewer postoperative complications compared to balanced crystalloids in patients having major elective abdominal surgery. One hundred and sixty patients were enrolled in the protocol. All patients had maintenance-balanced crystalloid administration of 3 ml · kg · h. A closed-loop system delivered additional 100-ml fluid boluses (patients were randomized to receive either a balanced-crystalloid or colloid solution) according to a predefined goal-directed strategy, using a stroke volume and stroke volume variation monitor. All patients were included in the analysis. The primary outcome was the Post-Operative Morbidity Survey score, a nine-domain scale, at day 2 postsurgery. Secondary outcomes included all postoperative complications. Patients randomized in the colloid group had a lower Post-Operative Morbidity Survey score (median [interquartile range] of 2 [1 to 3] vs. 3 [1 to 4], difference -1 [95% CI, -1 to 0]; P colloid group. Under our study conditions, a colloid-based goal-directed fluid therapy was associated with fewer postoperative complications than a crystalloid one. This beneficial effect may be related to a lower intraoperative fluid balance when a balanced colloid was used. However, given the study design, the mechanism for the difference cannot be determined with certainty.
Hemmes, S.N.T.; Severgnini, P.; Jaber, S.; Canet, J.; Wrigge, H.; Hiesmayr, M.; Tschernko, E.M.; Hollmann, M.W.; Binnekade, J.M.; Hedenstierna, G.; Putensen, C.; Gama de Abreu, M.; Pelosi, P.; Schultz, M.J.
ABSTRACT: BACKGROUND: Post-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia > 2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure
Strik, C.; Stommel, M.W.J.; Schipper, L.J.; Goor, H. van; Broek, R.P.G ten
PURPOSE: Today, 40 to 66 % of elective procedures in abdominal surgery are reoperations. Reoperations show increased operative time and risk for intraoperative and postoperative complications, mainly due to the need to perform adhesiolysis. It is important to understand which patients will require
Full Text Available Minimal invasive surgery has become the standard of care for operations involving the thoracic and abdominal cavities for all ages. Laparoscopic complications can occur as well as more invasive surgical procedures and we can classify them into non-specific and specific. Our goal is to analyze the most influential available scientific literature and to expose important and recognized advices in order to reduce these complications. We examined the mechanism, risk factors, treatment and tried to outline how to prevent two major abdominal wall complications related to laparoscopy: bleeding and port site herniation .
Nielsen, P H; Jepsen, S B; Olsen, A D
Of 128 patients who underwent upper abdominal surgery, examined by standard preoperative and postoperative chest roentgenograms for the formation of postoperative pleural effusions, 89 had postoperative pleural effusions. Their presence was not related to the type of operation, infection, serum...... to postoperative sodium and water retention, and aggravated by an age-related relative cardiac decompensation. Early postoperative pleural effusions are common and do not require specific treatment....
Impact of intra-abdominal absorbable sutures on surgical site infection in gastrointestinal and hepato-biliary-pancreatic surgery: results of a multicenter, randomized, prospective, phase II clinical trial.
Maehara, Yoshihiko; Shirabe, Ken; Kohnoe, Shunji; Emi, Yasunori; Oki, Eiji; Kakeji, Yoshihiro; Baba, Hideo; Ikeda, Masataka; Kobayashi, Michiya; Takayama, Tadatoshi; Natsugoe, Shoji; Haraguchi, Masashi; Yoshida, Kazuhiro; Terashima, Masanori; Sasako, Mitsuru; Yamaue, Hiroki; Kokudo, Norihiro; Uesaka, Katsuhiko; Uemoto, Shinji; Kosuge, Tomoo; Sawa, Yoshiki; Shimada, Mitsuo; Doki, Yuichiro; Yamamoto, Masakazu; Taketomi, Akinobu; Takeuchi, Masahiro; Akazawa, Kouhei; Yamanaka, Takeharu; Shimokawa, Mototsugu
The use of absorbable sutures in wound closure has been shown to reduce the incidence of surgical site infection (SSI); however, there is no evidence that the intra-abdominal use of absorbable rather than silk sutures reduces the incidence of SSI after gastrointestinal surgery. We report the findings of a phase II trial, designed to evaluate the impact of the intra-abdominal use of absorbable sutures on the incidence of SSI. At 19 Japanese hospitals, 1147 patients undergoing elective gastrectomy, colorectal surgery, hepatectomy, or pancreaticoduodenectomy (PD) were randomly assigned to absorbable or silk intra-abdominal suture groups. The primary efficacy endpoint was the incidence of SSI. The secondary efficacy endpoints were the locations of SSI, time to resolution of SSI, length of hospital stay, and the incidence of bile leakage in hepatectomy and pancreatic fistula. The incidence of SSI was 11.3%, 15.5%, 11.3%, and 36.9% after gastrectomy, colorectal surgery, hepatectomy, and PD, respectively. The incidence of SSI was higher in the absorbable suture group than in the silk suture group for all the surgical procedures, but the difference was not significant. The intra-abdominal use of absorbable sutures did not have enough of an effect on the reduction of SSI in this phase II trial to justify the planning of a large-scale phase III trial.
Rosenberg-Adamsen, S; Lie, C; Bernhard, A
. METHODS: The authors studied the effect of oxygen therapy on arterial oxygen saturation and heart rate in 100 consecutive unselected patients randomly and double blindly allocated to receive air or oxygen therapy between the first and fourth day after major abdominal surgery. RESULTS: The median arterial...... supplementation were found between patients with or without an epidural catheter or between the postoperative day studied. CONCLUSION: Postoperative oxygen therapy increased arterial oxygen saturation and decreased heart rate after uncomplicated abdominal surgery in a consecutive unselected group of patients who......BACKGROUND: Cardiac complications are common during the postoperative period and may be associated with hypoxemia and tachycardia. Preliminary studies in high-risk patients after operation have shown a possible beneficial effect of oxygen therapy on arterial oxygen saturation and heart rate...
Bisgaard, J; Gilsaa, T; Rønholm, E
BACKGROUND: Post-operative complications after open elective abdominal aortic surgery are common, and individualised goal-directed therapy may improve outcome in high-risk surgery. We hypothesised that individualised goal-directed therapy, targeting stroke volume and oxygen delivery, can reduce...... complications and minimise length of stay in intensive care unit and hospital following open elective abdominal aortic surgery. METHODS: Seventy patients scheduled for open elective abdominal aortic surgery were randomised to individualised goal-directed therapy or conventional therapy. In the intervention......-operative complications, intensive care unit or hospital length of stay in open elective abdominal aortic surgery....
Loertzer, H; Schneider, P; Thelen, P; Ringert, R H; Strauß, A
In prolapse surgery several surgical techniques are available. The different open, laparoscopic and vaginal approaches are distinguished by distinct success and relapse rates and operation-specific complications. A safe and optimal therapeutic pelvic floor surgery should be based on the three support levels according to DeLancy and be individually adjusted for every patient. The vaginal approach may be used for all kinds of female genital prolapse and is a comparatively less invasive technique with a short time of convalescence. Apart from stress incontinence there is no need for synthetic meshes in primary approaches and excellent results with low complication and relapse rates can be achieved. An uncritical application of synthetic material is to be avoided in vaginal repair at all times. Abdominal surgical techniques, both open and laparoscopic, present their strengths in the therapeutic approach to level 1 defects or stress incontinence. They provide excellent functional and anatomical corrections and low relapse rates. Abdominally inserted meshes have lower complication rates than vaginal ones.
Kenngott, H G; Wagner, M; Nickel, F; Wekerle, A L; Preukschas, A; Apitz, M; Schulte, T; Rempel, R; Mietkowski, P; Wagner, F; Termer, A; Müller-Stich, Beat P
Computer-assisted surgery is a wide field of technologies with the potential to enable the surgeon to improve efficiency and efficacy of diagnosis, treatment, and clinical management. This review provides an overview of the most important new technologies and their applications. A MEDLINE database search was performed revealing a total of 1702 references. All references were considered for information on six main topics, namely image guidance and navigation, robot-assisted surgery, human-machine interface, surgical processes and clinical pathways, computer-assisted surgical training, and clinical decision support. Further references were obtained through cross-referencing the bibliography cited in each work. Based on their respective field of expertise, the authors chose 64 publications relevant for the purpose of this review. Computer-assisted systems are increasingly used not only in experimental studies but also in clinical studies. Although computer-assisted abdominal surgery is still in its infancy, the number of studies is constantly increasing, and clinical studies start showing the benefits of computers used not only as tools of documentation and accounting but also for directly assisting surgeons during diagnosis and treatment of patients. Further developments in the field of clinical decision support even have the potential of causing a paradigm shift in how patients are diagnosed and treated.
Filardo, Giovanni; Powell, Janet T; Martinez, Melissa Ashley-Marie; Ballard, David J
An abdominal aortic aneurysm (AAA) is an abnormal ballooning of the major abdominal artery. Some AAAs present as emergencies and require surgery; others remain asymptomatic. Treatment of asymptomatic AAAs depends on many factors, but an important one is the size of the aneurysm, as risk of rupture increases with aneurysm size. Large asymptomatic AAAs (greater than 5.5 cm in diameter) are usually repaired surgically; very small AAAs (less than 4.0 cm diameter) are monitored with ultrasonography. Debate continues over the appropriate roles of immediate repair and surveillance with repair on subsequent enlargement in people presenting with asymptomatic AAAs of 4.0 cm to 5.5 cm diameter. This is the third update of the review first published in 1999. To compare mortality, quality of life, and cost effectiveness of immediate surgical repair versus routine ultrasound surveillance in people with asymptomatic AAAs between 4.0 cm and 5.5 cm in diameter. For this update, the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (February 2014) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1). We checked reference lists of relevant articles for additional studies. Randomised controlled trials in which men and women with asymptomatic AAAs of diameter 4.0 cm to 5.5 cm were randomly allocated to immediate repair or imaging-based surveillance at least every six months. Outcomes had to include mortality or survival. Three members of the review team independently extracted the data, which were cross-checked by other team members. Risk ratios (RR) (endovascular aneurysm repair only), hazard ratios (HR) (open repair only), and 95% confidence intervals based on Mantel-Haenszel Chi(2) statistic were estimated at one and six years (open repair only) following randomisation. We included all relevant published studies in this review. For this update, four trials with a combined total of 3314 participants
Outcome of Emergency Abdominal Surgery at Kigali University Teaching Hospital: A review of 229 cases. ... abdominal surgery presented relatively late with an average of 3.6 days time interval between onset of symptoms and admission, serious attention is needed for these patients because the mortality is high.
Ungurian, V M; Grinev, M V; Demko, A E; Povzun, S A
The authors analyzed the data of 281 cases of iatrogenes of manipulator character in abdominal surgery in order to investigate the circumstances and character of origin. There were 187 cases of operative confirmation and 84 cases of unintentional intraoperative retained foreign bodies. It was detected, that primary planned intervention of higher category of complexity should be related to the high risk group of the development of the operative confirmation. Retained foreign bodies with soft fabric base were diagnosed in early postoperative period as the result of the beginning of postoperative complications. The retained foreign bodies with tough backer material as a rule didn't cause the complications in early postoperative period. They were diagnosed in long-term postoperative period in majority of cases.
Black, J J; Desai, J B
The proper management of patients with asymptomatic abdominal aortic aneurysms and significant coexistent coronary artery disease is still debatable. The most common approach has been to perform the coronary artery bypass surgery some weeks before the abdominal aortic aneurysm repair in the hope of reducing the cardiac morbidity and mortality. We report our initial experience of three consecutive elective cases where the coronary artery bypass surgery and the abdominal aortic aneurysm repair ...
Roberto de Cleva
Full Text Available OBJECTIVE:Patients undergoing abdominal surgery are at risk for pulmonary complications. The principal cause of postoperative pulmonary complications is a significant reduction in pulmonary volumes (FEV1 and FVC to approximately 65-70% of the predicted value. Another frequent occurrence after abdominal surgery is increased intra-abdominal pressure. The aim of this study was to correlate changes in pulmonary volumes with the values of intra-abdominal pressure after abdominal surgery, according to the surgical incision in the abdomen (superior or inferior.METHODS:We prospectively evaluated 60 patients who underwent elective open abdominal surgery with a surgical time greater than 240 minutes. Patients were evaluated before surgery and on the 3rd postoperative day. Spirometry was assessed by maximal respiratory maneuvers and flow-volume curves. Intra-abdominal pressure was measured in the postoperative period using the bladder technique.RESULTS:The mean age of the patients was 56±13 years, and 41.6% 25 were female; 50 patients (83.3% had malignant disease. The patients were divided into two groups according to the surgical incision (superior or inferior. The lung volumes in the preoperative period showed no abnormalities. After surgery, there was a significant reduction in both FEV1 (1.6±0.6 L and FVC (2.0±0.7 L with maintenance of FEV1/FVC of 0.8±0.2 in both groups. The maximum intra-abdominal pressure values were similar (p= 0.59 for the two groups. There was no association between pulmonary volumes and intra-abdominal pressure measured in any of the groups analyzed.CONCLUSIONS:Our results show that superior and inferior abdominal surgery determines hypoventilation, unrelated to increased intra-abdominal pressure. Patients at high risk of pulmonary complications should receive respiratory care even if undergoing inferior abdominal surgery.
Meyhoff, Christian Sylvest; Wetterslev, Jørn; Jorgensen, Lars N
A high perioperative inspiratory oxygen fraction may reduce the risk of surgical site infections, as bacterial eradication by neutrophils depends on wound oxygen tension. Two trials have shown that a high perioperative inspiratory oxygen fraction (FiO(2) = 0.80) significantly reduced risk of surg...... complications, such as atelectasis, pneumonia and respiratory failure. The aim of our trial is to assess the potential benefits and harms of a high perioperative oxygen fraction in patients undergoing abdominal surgery....... of surgical site infections after elective colorectal surgery, but a third trial was stopped early because the frequency of surgical site infections was more than doubled in the group receiving FiO(2) = 0.80. It has not been settled if a high inspiratory oxygen fraction increases the risk of pulmonary......A high perioperative inspiratory oxygen fraction may reduce the risk of surgical site infections, as bacterial eradication by neutrophils depends on wound oxygen tension. Two trials have shown that a high perioperative inspiratory oxygen fraction (FiO(2) = 0.80) significantly reduced risk...
Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue
INTRODUCTION: Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated. METHODS: A systematic review was conducted...... to reduce seroma formation after laparoscopic ventral herniotomy and a non-significant reduction in pain. Physical function was improved, whereas evidence supports a beneficial effect on psychological distress after open abdominal surgery. Evidence also supports that intra-abdominal pressure increases....... The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma...
Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue
INTRODUCTION: Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated. METHODS: A systematic review was conducted....... The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma...... to reduce seroma formation after laparoscopic ventral herniotomy and a non-significant reduction in pain. Physical function was improved, whereas evidence supports a beneficial effect on psychological distress after open abdominal surgery. Evidence also supports that intra-abdominal pressure increases...
Campos-Muñoz, Manuel Alejandro; Villarreal-Ríos, Enrique; Chimal-Torres, Mariano; Pozas-Medina, Josué Atila
Intra-abdominal pressure is the pressure's state of balance within the abdominal cavity when a patient is at rest. This pressure may vary during mechanical ventilation or spontaneous breathing. The objective was to establish the intra-abdominal pressure as a surgery predictor in patients with acute abdominal pain. From April to December, 2013, it was carried out a nested case-control study on patients with acute abdominal pain in the emergency room of a second level hospital. Thirty-seven patients fit the inclusion criteria; they all underwent surgery with a previous measurement of the intra-abdominal pressure. Based on the results of the anatomopathological study, we divided the patients into two groups: those with evidence of acute abdominal inflammatory process (n=28) (case group), and patients without evidence of acute abdominal inflammatory process (n=9) (control group). In the case group, 100 % of patients shown high intra-abdominal pressure with a p=0.01 (OR=5 [95 % CI=2.578-9.699]. In the case group, the mean intra-abdominal pressure was 11.46, and in the control group 9.2 (p=0.183). Abdominal pain requiring surgical intervention is directly related to intra-abdominal pressure>5 mmHg.
Sugawara, Kotaro; Kawaguchi, Yoshikuni; Nomura, Yukihiro; Suka, Yusuke; Kawasaki, Keishi; Uemura, Yukari; Koike, Daisuke; Nagai, Motoki; Furuya, Takatoshi; Tanaka, Nobutaka
Prolonged postoperative ileus (PPOI) is among the common complications adversely affecting postoperative outcomes. Predictors of PPOI after major abdominal surgery remain unclear, although various PPOI predictors have been reported in patients undergoing colorectal surgery. This study aimed to devise a model for stratifying the probability of PPOI in patients undergoing abdominal surgery. Between 2012 and 2013, 841 patients underwent major abdominal surgery after excluding patients who underwent less-invasive abdominal surgery, ileus-associated surgery, and emergency surgery. Postoperative managements were generally based on enhanced recovery after surgery (ERAS) program. The definition of PPOI was based on nausea, no oral diet, flatus absence, abdominal distension, and radiographic findings. A nomogram was devised by evaluating predictive factors for PPOI. Of the 841 patients, 73 (8.8%) developed PPOI. Multivariable logistic regression analysis revealed smoking history (P = 0.025), colorectal surgery (P = 0.004), and an open surgical approach (P = 0.002) to all be independent predictive factors for PPOI. A nomogram was devised by employing these three significant predictive factors. The prediction model showed relatively good discrimination performance, the concordance index of which was 0.71 (95%CI 0.66-0.77). The probability of PPOI in patients with a smoking history who underwent open colorectal surgery was calculated to be 19.6%. Colorectal surgery, open abdominal surgery, and smoking history were found to be independent predictive factors for PPOI in patients who underwent major abdominal surgery. A nomogram based on these factors was shown to be useful for identifying patients with a high probability of developing PPOI.
The Prevention of Respiratory Insufficiency after Surgical Management (PRISM) Trial. Report of the protocol for a pragmatic randomized controlled trial of CPAP to prevent respiratory complications and improve survival following major abdominal surgery.
Pearse, Rupert M; Abbott, Tom E; Haslop, Richard; Ahmad, Tahania; Kahan, Brennan C; Filipini, Claudia; Rhodes, Andrew; Ranieri, Marco
Over 300 million patients undergo surgery worldwide each year. Postoperative morbidity - particularly respiratory complications - are most frequent and severe among high-risk patients undergoing major abdominal surgery. However, standard treatments, like physiotherapy or supplemental oxygen, often fail to prevent these. Preliminary research suggests that prophylactic continuous positive airways pressure (CPAP) can reduce the risk of postoperative respiratory complications. However, without evidence from a large clinical effectiveness trial, CPAP has not become routine care. This trial aims to determine whether early postoperative CPAP reduces the incidence of respiratory complications and improves one-year survival following major intra-peritoneal surgery. This is an international multicenter randomized controlled trial with open study group allocation. The participants are aged 50 years and over undergoing major elective intra-peritoneal surgery. The intervention is CPAP for at least four hours, started within four hours of the end of surgery. The primary outcome is a composite of pneumonia, re-intubation, or death within 30 days of randomization. All participants with a recorded outcome will be analyzed on an intention-to-treat basis. The primary analysis will use a mixed-effects logistic regression model, which includes center as a random-intercept, and will be adjusted for the minimization factors and other pre-specified covariates. Trial Registration: ISRCTN 56012545. This is the first proposed clinical effectiveness trial of postoperative CPAP to prevent respiratory complications of which we are aware. The large sample size and multicenter international design will make the result generalizable to a variety of healthcare settings.
N00014-93-C-0279 Fmi Repd - A Vitual Reality -Based Simulation Of Abdominal Surgery Pa A-1 9 June 21,1994 Appendix A - Literature Search Chares J...Leaf Systems, Inc. e ARPA Contract number N00014-93-C-0279 Fmal Report -A Vitual Reality -Base Simuilation Of Abdominal Surgery Page A-22 June 21, 1994...415) 591-7881 In! IhNiI 1 SHORT TITLE: A Virtual Reality -Based Simulation of Abdominal Surgery REPORTING PERIOD: October 31, 1993-June 30, 1994 The
Costantini, Elisabetta; Mearini, Luigi; Lazzeri, Massimo; Bini, Vittorio; Nunzi, Elisabetta; di Biase, Manuel; Porena, Massimo
Few randomized, controlled trials have compared standard abdominal sacrocolpopexy and the laparoscopic approach. We tested the hypothesis that laparoscopic sacrocolpopexy could compete with abdominal sacrocolpopexy for pelvic organ prolapse repair. This randomized, controlled trial was done to compare laparoscopic sacrocolpopexy and abdominal sacrocolpopexy for pelvic organ prolapse repair in women referred to our tertiary Department of Urology for symptomatic stage 2 or greater pelvic organ prolapse. The primary outcome was quantitative evaluation by the POP-Q (Pelvic Organ Prolapse Quantification) system. Cure was defined as prolapse stage 1 or less, point C/D -5 or less at the apex and at least 7 cm total vaginal length. Secondary outcomes were the complication rate, operative time, intraoperative blood loss, hospital stay and PGI-I (Patient Global Impression of Improvement) scores. The Kaplan-Meier estimator with the log-rank test was used to estimate pelvic organ prolapse recurrence-free survival rates. A total of 200 patients were eligible for study. We compared 60 and 61 patients treated with abdominal and laparoscopic sacrocolpopexy, respectively. At a mean followup of 41.7 months the cure rate was of 100% for both approaches. Kaplan-Meier curves showed that overall pelvic organ prolapse recurrence-free survival was longer following the open approach. Patients treated with laparoscopic sacrocolpopexy showed significantly earlier recurrence (p = 0.030), mostly in the first 12 months after surgery. When evaluating the different compartments, a statistically significant difference was observed between the laparoscopic and abdominal approaches for anterior compartment descensus (11 vs 1, p = 0.004). Statistical results had high internal validity but may not be applicable to other populations or settings. Laparoscopic sacrocolpopexy provides outcomes as good as those of abdominal sacrocolpopexy for anatomical correction but not for anterior pelvic organ prolapse
Conclusion: intestinal obstruction was the commonest acute abdominal emergency in children. The high rates of postoperative morbidity observed could be attributed to delayed presentation to hospital. Key Words: Paediatric, emergency, abdominal surgery, outcome. Nigerian Journal of Surgical Research Vol.5(1&2) 2003: ...
Baracs, Jozsef; Huszár, Orsolya; Sajjadi, Shahram Ghotb; Horváth, O Peter
Surgical site infections (SSI) are the third most common hospital-acquired infections and account for 14% to 16% of all such infections. In elective colorectal operations, the international SSI rate ranges from 4.7%-25%. In a previous retrospective study in this department, the SSI rate was unacceptably high (25%), and the promising different international evaluations of triclosan-coated suture materials encouraged us to create a multicenter randomized trial to improve our results. The main goal of this study was to compare triclosan-coated and uncoated absorbable suture (PDS Plus(®) with PDS II(®)) in elective colorectal operations. This was an internet-based study involving seven surgical centers. All the elective colorectal operations were performed by experienced surgeons. For abdominal fascia closure, running looped PDS was applied; triclosan-coated or uncoated PDS was chosen by computer randomization. Pre-operative and peri-operative variables such as gender, body mass index, neoadjuvant therapy, type II diabetes mellitus, amount of wound dressing material used, nursing days, and microbiological results were recorded. After the operation, the patient's data and risk factors were collected in a password-protected online database. From 485 patients randomized, SSI was documented in 47 patients (12.5%), 23 (12.2%) in the group having triclosan-coated sutures (n=188) and 24 (12.2%) in the uncoated suture group (n=197), a non-significant difference. Of all SSIs, 13 (27.7%) were diagnosed only after discharge, being recognized in the outpatient setting, with four patients in the triclosan suture group (8.5%) and nine in the uncoated suture group (19.2%) being affected with no significant differences in the demographic data. Microbiological examinations, in addition to the same colon flora in both groups, revealed two gram-positive infections in the uncoated suture group. The hospital stay and costs of dressings were significantly higher in patients having SSIs
Fernandes, Shanlley Cristina da Silva; Santos, Rafaella Souza dos; Giovanetti, Erica Albanez; Taniguchi, Corinne; Silva, Cilene Saghabi de Medeiros; Eid, Raquel Afonso Caserta; Timenetsky, Karina Tavares; Carnieli-Cazati, Denise
ABSTRACT Objective To evaluate the vital capacity after two chest therapy techniques in patients undergoing abdominal surgical. Methods A prospective randomized study carried out with patients admitted to the Intensive Care Unit after abdominal surgery. We checked vital capacity, muscular strength using the Medical Research Council scale, and functionality with the Functional Independence Measure the first time the patient was breathing spontaneously (D1), and also upon discharge from the...
Hong, Jeong-Min; Kim, Kyung-Hoon; Lee, Hyeon Jeong; Kwon, Jae-Young; Kim, Hae-Kyu; Kim, Hyae-Jin; Cho, Ah-Reum; Do, Wang-Seok; Kim, Hyo Sung
Epidurally administered dexamethasone might reduce postoperative pain. However, the effect of epidural administration of dexamethasone on postoperative epidural analgesia in major abdominal surgery has been doubtful. To investigate the effects and optimal dose of epidural dexamethasone on pain after major abdominal surgery. A prospective randomized, double-blind study. University hospital. One hundred twenty ASA physical status I and II men, scheduled for gastrectomy, were enrolled. Patients were randomly assigned to receive one of 3 treatment regimens (n = 40 in each group): dexamethasone 5 mg (1 mL) with normal saline (1 mL) (group D) or dexamethasone 10 mg (2 mL) (group E) or 2 mL of normal saline (group C) mixed with 8 mL of 0.375% ropivacaine as a loading dose. After the surgery, 0.2% ropivacaine - fentanyl 4 ?g/mL was epidurally administered for analgesia. The infusion was set to deliver 4 mL/hr of the PCEA solution, with a bolus of 2 mL per demand and 15 minutes lockout time. The infused volume of PCEA, intensity of postoperative pain using visual analogue scale (VAS) during rest and coughing, incidence of postoperative nausea and vomiting (PONV), usage of rescue analgesia and rescue antiemetic, and side effects such as respiratory depression, urinary retention, and pruritus were recorded at 2, 6, 12, 24, and 48 hours after the end of surgery. The resting and effort VAS was significantly lower in group E compared to group C at every time point through the study period. On the contrary, only the resting VAS in group D was lower at 2 hours and 6 hours after surgery. Total fentanyl consumption of group E was significantly lower compared to other groups. There was no difference in adverse effect such as hypotension, bradycardia, PONV, pruritis, and urinary retention among groups. Use of epidural PCA with basal rate might interrupt an accurate comparison of dexamethasone effect. Hyperglycemia and adrenal suppression were not evaluated. Epidural dexamethasone was
Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue
INTRODUCTION: Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated. METHODS: A systematic review was conducted....... The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma...... formation and physical function. RESULTS: A total of 50 publications were identified; 42 publications were excluded leaving eight publications counting a total of 578 patients for analysis. Generally, the scientific quality of the studies was poor. Use of abdominal binder revealed a non-significant tendency...
Yamamoto, Masashi; Okuda, Junji; Tanaka, Keitaro; Kondo, Keisaku; Asai, Keiko; Kayano, Hajime; Masubuchi, Shinsuke; Uchiyama, Kazuhisa
The impact of previous abdominal surgeries on the need for conversion to open surgery and on short-term outcomes during/after laparoscopic colectomy was retrospectively investigated. This retrospective cohort study was conducted from December 1996 through December 2009. This study was conducted at Osaka Medical College Hospital. A total of 1701 consecutive patients who had undergone laparoscopic resection of the colon and rectum were classified as not having previous abdominal surgery (n = 1121) or as having previous abdominal surgery (n = 580). Short-term outcomes were recorded, and risk factors for conversion to open surgery were analyzed. There were no significant differences in operative time, blood loss, number of lymph nodes removed, or conversion rate between the groups. The rate of inadvertent enterotomy was significantly higher in the previous abdominal surgery group than in the not having previous abdominal surgery group (0.9% versus 0.1%; p = 0.03), and the postoperative recovery time was significantly longer in the previous abdominal surgery group than in the not having previous abdominal surgery group. Ileus was more frequent in the previous abdominal surgery group than in the not having previous abdominal surgery group (3.8% versus 2.1%; p = 0.04). Significant risk factors for conversion to open surgery were T stage ≥3 (OR, 2.81; 95% CI, 1.89-3.75), median incision (OR, 4.34; 95% CI, 1.23-9.41), upper median incision (OR, 2.78; 95% CI, 1.29-5.42), lower median incision (OR, 1.82; 95% CI, 1.09-3.12), and transverse colectomy (OR, 1.76; 95% CI, 1.29-2.41). The incidence of successfully completed laparoscopic colectomy after previous abdominal surgery remains high, and the short-term outcomes are acceptable.
Jessen Lundorf, Luise; Korvenius Nedergaard, Helene; Møller, Ann Merete
Acute postoperative pain is still an issue in patients undergoing abdominal surgery. Postoperative pain and side effects of analgesic treatment, in particular those of opioids, need to be minimized. Opioid-sparing analgesics, possibly including dexmedetomidine, seem a promising avenue by which to improve postoperative outcomes. Our primary aim was to determine the analgesic efficacy and opioid-sparing effect of perioperative dexmedetomidine for acute pain after abdominal surgery in adults.Secondary aims were to establish effects of dexmedetomidine on postoperative nausea and vomiting (PONV), gastrointestinal function and mobilization, together with the side effect profile of dexmedetomidine. We searched the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Institute for Scientific Information (ISI), Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL), and reference lists of articles to May 2014. We searched the Science Citation Index, ClinicalTrials.gov and Current Controlled Trials, and we contacted pharmaceutical companies to identify unpublished and ongoing studies. We applied no language restrictions. We reran the search in May 2015 and found nine studies of interest. We will deal with the studies of interest when we update the review. We included randomized, controlled trials of perioperative dexmedetomidine versus placebo or other drug during abdominal surgery in adults. Trials included one of the following outcomes: amount of 'rescue' opioid, postoperative pain, time to 'rescue' analgesia, participants requiring 'rescue' analgesia, postoperative sedation, PONV, time to first passage of flatus and stool or time to first out-of-bed mobilization. Two review authors independently screened the titles and abstracts for eligibility. We retrieved full trial reports if necessary, and we extracted relevant data from the included studies using a data collection form and assessed risk of bias. We
Li, Ji-ke; Wang, Jun; Li, Tian-fa
The management of cardiac arrest after cardiac surgery differs from the management of cardiac arrest under other circumstances. In other studies, interposed abdominal compression-cardiopulmonary resuscitation (IAC-CPR) resulted in a better outcome compared with conventional CPR. The aim of the present study was to determine the feasibility, safety and efficacy of IAC-CPR compared with conventional CPR in patients with cardiac arrest after cardiac surgery. Data on all cardiac surgical patients who suffered a sudden cardiac arrest during the first 24 h after surgery were collected prospectively. Cardiac arrest was defined as the cessation of cardiac mechanical activity with the absence of a palpable central pulse, apnoea and unresponsiveness, including ventricular fibrillation, asystole and pulseless electrical activity. Forty patients were randomized to either conventional CPR (n = 21) or IAC-CPR (n = 19). IAC-CPR was initially performed by compressing the abdomen midway between the xiphoid and the umbilicus during the relaxation phase of chest compression. If spontaneous circulation was not restored after 10-15 min, the surgical team would immediately proceed to resternotomy. The endpoints of the study were safety, return of spontaneous circulation (ROSC) >5 min, survival to hospital discharge and survival for 6 months. With IAC-CPR, there were more patients in terms of ROSC, survival to hospital discharge, survival for 6 months and fewer CPR-related injuries compared with patients who underwent conventional CPR. IAC-CPR is feasible and safe and may be advantageous in cases of cardiac arrest after cardiac surgery. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
N. I. Gabrielyan
Full Text Available This article provides an overview of new approaches to the prevention of infectious complications of bacterial nature after the high-technology operations in the abdominal surgery, first of all, after liver transplantation. At- tention is drawn to the first positive results of randomized studies on the use of biological preparations - probi- otics, prebiotics and synbiotics in patients after liver transplantation. The authors prove the prospects of further development of this subject based on successful model experiments on animals and various operational interven- tions in abdominal surgery.
Abdominal surgical emergencies constitute a significant portion of a surgeon's clinical experience and often ... collected data conducted in a tertiary health centre between. 2001 and 2005. Patients aged 14 years and over with ..... of appropriate road traffic regulations. Initial management includes fluid resuscitation and ...
Illuminati, Giulio; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco
With the increasing diffusion of percutaneous interventions (PCI), surgeons are often faced with the problem of operating on patients under dual antiplatelet treatment. Replacing dual antiplatelet regiment with low molecular weight heparin may expose to the abrupt thrombosis of coronary stent and massive myocardial infarction. The purpose of this study was to test the hypothesis that abdominal operations can be safely performed under dual antiplatelet treatment. Eleven patients underwent 5 colectomies, 3 nefrectomies, 2 gastrectomies and 1 hysterectomy under aspirin and plavix without any significant perioperative hemorrhage. These preliminary results show that abdominal operations can be safely performed under dual antiplatelet regimen. Abdominal surgery, Dual antiplatelet treatment.
Jønsson, Line Rokkedal; Ingelsrud, Lina Holm; Tengberg, Line Toft
BACKGROUND: Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical...... with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activePAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization. RESULTS: Fifty patients undergoing AHA surgery (mean age 61.4 ± 17...... for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. CONCLUSION: Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization...
Balén, E; Herrera, J; Miranda, C; Tarifa, A; Zazpe, C; Lera, J M
Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.
Giul'mamedov, F I; Belozertsev, A M; Ksenofontov, S S; Giul'mamedov, P F; Gudinov, I D; Bondarenko, A V; Makienko, E G
The experience of performance of urgent simultant operations (SO) on abdominal cavity organs in 63 patients (of them in 12--using laparoscopic technologies) was summarized. The material was compared and analyzed using statistical methods in three clinical groups, suffering concomitant surgical diseases in patients of gastroenterological, coloproctological and herniological profile. There were shown the possibilities and proved the expediency of SO performance in environment of the abdominal cavity urgent surgery in multiprofile general surgery clinic for enhancement of the patients treatment and an optimal surgical tactics choice.
Havey, Renee; Herriman, Emily; OʼBrien, Denise
The postoperative period following abdominal surgery presents many challenges to patients and clinicians as recovery progresses and discharge from the intensive care unit approaches. Physiologic changes including the release of inflammatory mediators, increased fatigue and reduction in body mass, and a decline in pulmonary function occurring after abdominal surgery are often potentiated by bed rest and immobility. Evidence-based interventions have the potential to prevent pulmonary complications, wound instability, drain displacement, and orthostatic hypotension. Promoting early mobility is one example of an evidence-based strategy to improve patient outcomes. By understanding the specific needs of the abdominal surgery population, the clinician can safely and effectively implement a mobility plan. The purpose of this article was to briefly review the inflammatory effects associated with bed rest, critical illness, and surgery; review the literature related to mobility in the abdominal surgery patient; describe the effects of immobility on postoperative outcomes; discuss the safety concerns and barriers to mobilization; discuss strategies to overcome barriers; and provide suggestions for application in practice.
Influence of early goal-directed therapy using arterial waveform analysis on major complications after high-risk abdominal surgery : study protocol for a multicenter randomized controlled superiority trial
Montenij, Leonard; de Waal, Eric; Frank, Michael; van Beest, Paul; de Wit, Ardine; Kruitwagen, Cas; Buhre, Wolfgang; Scheeren, Thomas
Background: Early goal-directed therapy refers to the use of predefined hemodynamic goals to optimize tissue oxygen delivery in critically ill patients. Its application in high-risk abdominal surgery is, however, hindered by safety concerns and practical limitations of perioperative hemodynamic
Aakerstroem, G.; Makridis, C.; Johansson, H. (Uppsala Univ. Hospital (Sweden). Dept. of Surgery)
In patients with midgut carcinoid tumors a curative, radical tumor removal should be attempted when possible. As these tumors are generally malignant, irrespective of size, the radical surgery implies that intestinal resection for excision of a primary tumor should be combined with an extended mesenteric resection. When the patients present with the carcinoid syndrome the disease is, with few exceptions, too advanced for curative surgery. However, surgery often has to be performed also in patients with the advanced carcinoids. Patients with more extensive disease may thus benefit from surgical debulking of large mesenteric or hepatic metastases. Moreover, when the patients present with abdominal symptoms it is important to exclude a threatening major abdominal complication such as intestinal obstruction or ischemia. As these complications may cause malnutrion and deterioration, it is important to treat them properly, sometimes by repeated surgery. (orig.).
Gogenur, I.; Wildschiotz, G.; Rosenberg, J.
Background. It is believed that the severely disturbed night-time sleep architecture after surgery is associated with increased cardiovascular morbidity with rebound of rapid eye movement (REM). The daytime sleep pattern of patients after major general surgery has not been investigated before. We...... decided to study the circadian distribution of sleep phases before and after surgery. Methods. Eleven patients undergoing elective major abdominal surgery were included in the study. Continuous ambulatory polysomnographic monitoring was made 24 h before surgery and 36 h after surgery, thus including two...... time awake (P=0.016) in the postoperative daytime period compared with the preoperative daytime period. Five patients had REM sleep during the daytime after surgery. Three of these patients did not have REM sleep during the preceding postoperative night. There was significantly reduced night-time REM...
Kissmeyer-Nielsen, Peter; Jensen, Martin Bach; Laurberg, Søren
and functional impairment follow major abdominal surgery. METHODS: Twenty-four patients with ulcerative colitis undergoing ileoanal J-pouch surgery were randomized to hGH (12 IU/day) or placebo treatment from 2 days before to 7 days after surgery. Measurements were performed 2 days before and 10, 30, and 90 days......OBJECTIVE: To evaluate short- and long-term effects of perioperative human growth hormone (hGH) treatment on physical performance and fatigue in younger patients undergoing a major abdominal operation in a normal postoperative regimen with oral nutrition. SUMMARY BACKGROUND DATA: Muscle wasting......, and at the 90-day follow-up total muscle strength was equal to baseline values in the hGH group, but still significantly 5.9% below in the placebo group. The work capacity decreased by approximately 20% at day 10 after surgery, with no significant difference between treatment groups. Both groups were equally...
Full Text Available Purpose. Transversus abdominis plane (TAP blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20 mL bupivacaine 2.5 mg/mL with epinephrine 5 μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36 hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0–10 at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36 hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23–48 mg (median, IQR within the first 48 postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery.
Apical; lateral—costal; postero-basal and diaphragmatic breathing exercises. The elective ... Vital capacity and peak expiratory ﬂow rates were measured daily after each exercise training session. ... that breathing exercise training improved vital capacity and peak expiratory ﬂow rate of the abdominal surgery patients. It was.
This study was aimed at determining the factors that affect fetal and maternal outcome following emergency non-obstetric abdominal surgery in pregnancy. ... High foetal loss seen in this study can be reduced by early presentation of the patients, early booking and high index of suspicion and prompt treatment by the ...
Background: Retained abdominal sponge after surgery is a quite rare condition which can have heavy medico-legal consequences; its frequency is generally underestimated. Few reports of these conditions are available in African environment with specific technical and medico-legal background. We present our local ...
38 (76%) had spontaneous deliveries, and there were 11 miscarriages (22%) and 1 perinatal death. The perinatal mortality rate was 0.093/1000 deliveries. The mean hospital stay was 5.52 days. Conclusion: Nonobstetric abdominal surgeries in pregnant women are an infrequent occurrence at Jos University Teaching ...
Rettig, Thijs C. D.; Verwijmeren, Lisa; Dijkstra, Ineke M.; Boerma, Djamila; Van De Garde, Ewoudt M. W.|info:eu-repo/dai/nl/304841528; Noordzij, Peter G.
Objective: To assess the association of systemic inflammation and outcome after major abdominal surgery. Background: Major abdominal surgery carries a high postoperative morbidity and mortality rate. Studies suggest that inflammation is associated with unfavorable outcome. Methods: Levels of
Damert, H G; Altmann, S; Stübs, P; Infanger, M; Meyer, F
There is overlap between general, abdominal and vascular surgery on one hand and plastic surgery on the other hand, e.g., in hernia surgery, in particular, recurrent hernia, reconstruction of the abdominal wall or defect closure after abdominal or vascular surgery. Bariatric operations involve both special fields too. Plastic surgeons sometimes use skin and muscle compartments of the abdominal wall for reconstruction at other regions of the body. This article aims to i) give an overview about functional, anatomic and clinical aspects as well as the potential of surgical interventions in plastic surgery. General/abdominal/vascular surgeons can benefit from this in their surgical planning and competent execution of their own surgical interventions with limited morbidity/lethality and an optimal, in particular, functional as well as aesthetic outcome, ii) support the interdisciplinary work of general/abdominal/vascular and plastic surgery, and iii) provide a better understanding of plastic surgery and its profile of surgical interventions and options. Georg Thieme Verlag KG Stuttgart · New York.
Tolstrup, Mai-Britt; Watt, Sara Kehlet; Gögenur, Ismail
PURPOSE: Emergency abdominal surgery results in a high rate of post-operative complications and death. There are limited data describing the emergency surgical population in details. We aimed to give a detailed analyses of complications and mortality in a consecutive group of patients undergoing...... acute abdominal surgery over a 4-year period. METHODS: This observational study was conducted between 2009 and 2013 at Copenhagen University Hospital Herlev, Denmark. All patients scheduled for emergency laparotomy or laparoscopy were included. Pre-, intra-, and post-operative data were collected from...... medical records. Complications were registered according to the Clavien-Dindo classification. Cox regression analysis was performed to identify risk factors for mortality. RESULTS: A total of 4,346 patients underwent emergency surgery, of whom 14 % had surgical complications and 23 % medical complications...
Jessen Lundorf, Luise; Korvenius Nedergaard, Helene; Møller, Ann Merete
Background: Acute postoperative pain is still an issue in patients undergoing abdominal surgery. Postoperative pain and side effects of analgesic treatment, in particular those of opioids, need to be minimized. Opioid-sparing analgesics, possibly including dexmedetomidine, seem a promising avenue...... by which to improve postoperative outcomes. Objectives: Our primary aim was to determine the analgesic efficacy and opioid-sparing effect of perioperative dexmedetomidine for acute pain after abdominal surgery in adults. Secondary aims were to establish effects of dexmedetomidine on postoperative nausea...... surgery in adults. Trials included one of the following outcomes: amount of 'rescue' opioid, postoperative pain, time to 'rescue' analgesia, participants requiring 'rescue' analgesia, postoperative sedation, PONV, time to first passage of flatus and stool or time to first out-of-bed mobilization. Data...
McDermott, Colleen D; Hale, Douglass S
Abdominal correction of pelvic organ prolapse remains a viable option for patients and surgeons. The transition from open procedures to less invasive laparoscopic and robotic-assisted surgeries is evident in the literature. This article reviews the surgical options available for pelvic organ prolapse repair and their reported outcomes. Procedures reviewed include apical support (sacral, uterosacral, and others), and abdominal anterior and posterior vaginal wall support. Long-term follow-up and appropriately designed studies will further help direct surgeons in deciding which approach to incorporate into their practice.
Miguelena Bobadilla, J M; Morales García, D; Serra Aracil, X; Sanz Sánchez, M; Iturburu, I; Docobo Durántez, F; Jover Navalón, J M; López De Cenarruzabeitia, I; Lobo Martínez, E
The training of residents in abdominal wall surgery is a fundamental aspect of surgical training, representing globally 20% of its activity. In this paper, we analyze the current state of resident training in this kind of surgery in Spain, taking into account the broad spectrum it covers: general services, specific functional units, ambulatory surgery programs. To do this, based on the specifications of the specialty program, specific data were used from several different sources of direct information and a review of the results obtained by residents in hernia surgery. In general, our residents agree with their training and the recorded results are in line with objectives outlined in the program. However, it would be important to structure their teaching schedules, a rotation period in any specific unit and their involvement in outpatient surgery programs. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.
Dinev, Dinko; Andonova, Maria
To compare the effect of anesthesia alone with anesthesia and abdominal surgery on plasma thromboxane B(2) concentrations in horses. Non-randomized experimental study. Six male mixed-bred horses (5-12 years, 350 +/- 18 kg). All horses were anesthetized for 2.5 hours using halothane, and a month later abdominal surgery was performed using the same anesthetic technique with a similar duration. The schedule of anesthesia included pre-medication with diazepam (0.1 mg kg(-1) IM), followed by xylazine (2.2 mg kg(-1) IV), and 10 minutes later anesthesia was induced with ketamine hydrochloride (2.2 mg kg(-1) IV). After orotracheal intubation, anesthesia was maintained with halothane. Blood samples for the determination of thromboxane B(2) (TXB(2)) were obtained before, at induction, at 60 minutes after halothane was first inspired, and at recovery from anesthesia as well as at the corresponding stages of the experimental abdominal surgery (before induction, prior to laparotomy, enterectomy, enteroanastomosis, abdominal wall closure). Baseline value for the anesthesia group was 76 +/- 12 pg mL(-1) and increased (p surgical intervention suggested that the anesthetic technique caused a significant increase in thromboxane B(2) and that surgery did not appear to contribute to this response.
Wolsted, Henrik; Møller, Ann Merete; Tolstrup, Mai-Britt
OBJECTIVE: Emergency major abdominal surgery carries a high mortality rate. The aim of this present study was to characterize a population of deceased abdominal surgical patients, to examine how many died unexpectedly and how many were subject to treatment limitations. MATERIALS AND METHODS: We...... included adult emergency abdominal surgical patients who died within 30 days postoperatively. We collected data from January 1, 2013, to December 31, 2014, in a Danish tertiary care hospital (Herlev). RESULTS: A total of 138 patients were included which corresponded to a crude mortality rate of 16......- or postoperatively, of which 4% were treated in the ICU ward. CONCLUSIONS: In the present study, we found a high number of patients with treatment limitations, offering one explanation to why so relatively few high-risk surgical patients are admitted to the ICU ward. Whether intermediary wards could serve...
BACKGROUND: Intra-abdominal pressure (IAP) is a harbinger of intra-abdominal mischief, and its measurement is cheap, simple to perform, and reproducible. Intra-abdominal hypertension (IAH), especially grades 3 and 4 (IAP > 18 mmHg), occurs in over a third of patients and is associated with an increase in intra-abdominal sepsis, bleeding, renal failure, and death. PATIENTS AND METHODS: Increased IAP reading may provide an objective bedside stimulus for surgeons to expedite diagnostic and therapeutic work-up of critically ill patients. One of the greatest challenges surgeons and intensivists face worldwide is lack of recognition of the known association between IAH, ACS, and intra-abdominal sepsis. This lack of awareness of IAH and its progression to ACS may delay timely intervention and contribute to excessive patient resuscitation. CONCLUSIONS: All patients entering the intensive care unit (ICU) after emergency general surgery or massive fluid resuscitation should have an IAP measurement performed every 6 h. Each ICU should have guidelines relating to techniques of IAP measurement and an algorithm for management of IAH.
Giul'mamedov, F I; Belozertsev, A M; Ksenofontov, S S; Giul'mamedov, P F; Gudinov, I D; Bondarenko, A V
The literature data concerning the problem of simultant operative interventions were analyzed and the unsolved topics were delineated. Basing on the detailed analysis of results of the operations obtained in 78 patients, performed for coexistent diseases, the authors consider the simultant operative interventions in elective surgery of the abdominal cavity the method of choice in presence of two-three coexistent diseases, which must be surgically treated.
Treatment of subcutaneous abdominal wound healing impairment after surgery without fascial dehiscence by vacuum assisted closure™ (SAWHI-V.A.C.®-study) versus standard conventional wound therapy: study protocol for a randomized controlled trial.
Seidel, Dörthe; Lefering, Rolf; Neugebauer, Edmund A M
A decision of the Federal Joint Committee Germany in 2008 stated that negative pressure wound therapy is not accepted as a standard therapy for full reimbursement by the health insurance companies in Germany. This decision is based on the final report of the Institute for Quality and Efficiency in Health Care in 2006, which demonstrated through systematic reviews and meta-analysis of previous study projects, that an insufficient state of evidence regarding the use of negative pressure wound therapy for the treatment of acute and chronic wounds exists. Further studies were therefore indicated. The study is designed as a multinational, multicenter, prospective randomized controlled, adaptive design, clinical superiority trial, with blinded photographic analysis of the primary endpoint. Efficacy and effectiveness of negative pressure wound therapy for wounds in both medical sectors (in- and outpatient care) will be evaluated. The trial compares the treatment outcome of the application of a technical medical device which is based on the principle of negative pressure wound therapy (intervention group) and standard conventional wound therapy (control group) in the treatment of subcutaneous abdominal wounds after surgery. The aim of the SAWHI-VAC® study is to compare the clinical, safety and economic results of both treatment arms. The study project is designed and conducted with the aim of providing solid evidence regarding the efficacy of negative pressure wound therapy. Study results will be provided until the end of 2014 to contribute to the final decision of the Federal Joint Committee Germany regarding the general admission of negative pressure wound therapy as a standard of performance within both medical sectors. Clinical Trials.gov NCT01528033German Clinical Trials Register DRKS00000648.
Clinical studies have shown that sevoflurane is cardio-protective in cardiac surgery patients, but this effect is doubtful in general surgery patients. This study has researched the influence of sevoflurane on the perioperative cardiac function and the incidence of cardiac ischaemic events in abdominal surgical patients. Out of 80 patients scheduled for elective colorectal surgery, 42 received balanced sevoflurane-fentanyl anaesthesia, while 38 received intravenous midazolam-fentanyl anaesthesia. The cardiac index (CI) and cardiac function index (CFI) were measured by the PiCCO device, and Troponin I levels were measured at the beginning of surgery, as well as 4, 12 and 24 h afterwards. BNP was measured at the beginning of surgery, and 24 h afterwards. The data analysis was conducted using the Mann-Whitney nonparametric test, with statistical significance set at p abdominal surgical patients. Further research on the preconditioning effect of volatile anaesthetics in general surgical population should be concentrated on the population of patients with a high perioperative cardiac risk.
Full Text Available Adriana Toro, Maurizio Mannino, Giulio Reale, Isidoro Di CarloDepartment of Surgical Sciences, Organ Transplantation, and Advanced Technologies, University of Catania, Cannizzaro Hospital, Catania, ItalyAbstract: The success of any surgical procedure is based on adequate hemostasis. Many different biomaterial products can be used to achieve that aim. The products that can be used during surgery may be classified as topical hemostats, sealants, and adhesives. Hemostats can clot blood. Sealants can create sealing barriers. Adhesives bond tissue together. Collagen, gelatin, and cellulose are hemostat agents. TachoSil® is a development of TachoComb® and TachoComb® H. TachoComb is made with equine collagen, bovine thrombin, bovine aprotinin, and human fibrinogen. The clinical efficacy of TachoSil was shown firstly by a clinical study of hepatic surgery. In the study, TachoSil proved to be superior to argon beamer in obtaining effective and fast intraoperative hemostasis. Following the study, many applications in different fields of surgery have been reported in the literature. The use of TachoSil in open abdominal surgery and its relevant results have encouraged the use of TachoSil in laparoscopic surgery. Unfortunately, its use in laparoscopy has not become as popular as it is in open surgery, due to a lack of efficacious techniques. Immunologic reactions to compounds of TachoSil and the transmission of infectious diseases are two major risks concerning topical hemostasis. Even though the risk of severe immunologic reactions to bovine material is low, TachoSil has gradually replaced all bovine material with material of human origin and has therefore eliminated the associated risks of bovine material. TachoSil has a good satisfaction rate among surgeons and reduces both the operating time for patients and the time spent in intensive care units.Keywords: TachoSil, abdominal surgery, hemostasis
Forsberg, Anton; Cervenka, Simon; Jonsson Fagerlund, Malin
OBJECTIVE: Surgery launches a systemic inflammatory reaction that reaches the brain and associates with immune activation and cognitive decline. Although preclinical studies have in part described this systemic-to-brain signaling pathway, we lack information on how these changes appear in humans....... This study examines the short- and long-term impact of abdominal surgery on the human brain immune system by positron emission tomography (PET) in relation to blood immune reactivity, plasma inflammatory biomarkers, and cognitive function. METHODS: Eight males undergoing prostatectomy under general...... to change in [(11) C]PBR28 binding (p = 0.027). INTERPRETATION: This study translates preclinical data on changes in the brain immune system after surgery to humans, and suggests an interplay between the human brain and the inflammatory response of the peripheral innate immune system. These findings may...
Gögenur, I; Rosenberg-Adamsen, S; Kiil, C
BACKGROUND: The aim of this study was to examine subjective sleep quality before and after laparoscopic vs open abdominal surgery. METHODS: Twelve patients undergoing laparoscopic cholecystectomy and 15 patients undergoing laparotomy were evaluated with the aid of a sleep questionnaire from 4 days...... before until 4 weeks after surgery. RESULTS: Following laparoscopic surgery, total sleep time increased during the 1st week after the operation compared with preoperative values (p = 0.02), whereas sleep duration during weeks 2, 3, and 4 did not differ from the times reported preoperatively. Following...... laparotomy, sleep duration increased during the 1st, 3rd, and 4th weeks after the operation compared with preoperative values (p sleep disturbance, with significantly more sleep during the daytime compared with preoperative values; the disturbance...
Full Text Available Aim: Laparoscopic abdominal surgical procedures are usually performed under general anesthesia. In this retrospective study, we aimed to evaluate laparoscopic surgical operations performed with regional anesthesia. Methods: We performed a retrospective chart review of 171 laparoscopic surgery patients including laparoscopic cholecystectomy (LC, laparoscopic appendectomy (LA and laparoscopic totally extraperitoneal (TEP inguinal hernia repair under regional anesthesia from May 2014 to July 2016. Demographic data, type of anesthesia and surgery, American Society of Anesthesiologist (ASA physical status score, length of procedure, co-existing disease, peroperative and postoperative side effects, postoperative surgical-site pain, and patient satisfaction were recorded. Results: Peroperative side effects were abdominal pain/discomfort (18.7%, shoulder pain (13.5%, anxiety (7.6% and hypotension (3.5%. Postoperative side effects were shoulder pain (8.7%, urinary retention (7%, headache (6.4%, nausea and vomiting (2.3%. In the first six hours after the surgery, no patients had surgical site pain requiring analgesic treatment. Patient satisfaction was sufficient in 97.7% of patients. Conclusion: Regional anesthesia is an effective and safe anesthesia technique in LC, LA and laparoscopic TEP inguinal hernia repair due to good postoperative pain control, minimal side effects, high patients satisfaction rates and absence of intubation-related complications.
Hahn, R G; Bahlmann, H; Nilsson, L
Assessment of dehydration in the preoperative setting is of potential clinical value. The present study uses urine analysis and plasma volume kinetics, which have both been validated against induced changes in body water in volunteers, to study the incidence and severity of dehydration before open abdominal surgery begins. Thirty patients (mean age 64 years) had their urine analysed before major elective open abdominal surgery for colour, specific weight, osmolality and creatinine. The results were scored and the mean taken to represent a 'dehydration index'. Thereafter, the patients received an infusion of 5 ml/kg of Ringer's acetate intravenously for over 15 min. Blood was sampled for 70 min and the blood haemoglobin concentration used to estimate the plasma volume kinetics. Distribution of fluid occurred more slowly (P dehydrated as compared with euhydrated patients. The dehydration index indicated that the fluid deficit in these patients corresponded to 2.5% of the body weight, whereas the deficit in the others was 1%. In contrast, the 11 patients who later developed postoperative nausea and vomiting had a very short elimination half-life, only 9 min (median, P dehydration before major surgery was modest as evidenced both by urine sampling and volume kinetic analysis. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Probst, P; Ohmann, S; Klaiber, U; Hüttner, F J; Billeter, A T; Ulrich, A; Büchler, M W; Diener, M K
The objective of this study was to evaluate the potential benefits of immunonutrition in major abdominal surgery with special regard to subgroups and influence of bias. A systematic literature search from January 1985 to July 2015 was performed in MEDLINE, Embase and CENTRAL. Only RCTs investigating immunonutrition in major abdominal surgery were included. Outcomes evaluated were mortality, overall complications, infectious complications and length of hospital stay. The influence of different domains of bias was evaluated in sensitivity analyses. Evidence was rated according to the GRADE Working Group grading of evidence. A total of 83 RCTs with 7116 patients were included. Mortality was not altered by immunonutrition. Taking all trials into account, immunonutrition reduced overall complications (odds ratio (OR) 0·79, 95 per cent c.i. 0·66 to 0·94; P = 0·01), infectious complications (OR 0·58, 0·51 to 0·66; P high and unclear risk of bias. Publication bias seemed to be present for infectious complications (P = 0·002). Non-industry-funded trials reported no positive effects for overall complications (OR 1·13, 0·88 to 1·46; P = 0·34), whereas those funded by industry reported large effects (OR 0·66, 0·48 to 0·91; P = 0·01). Immunonutrition after major abdominal surgery did not seem to alter mortality (GRADE: high quality of evidence). Immunonutrition reduced overall complications, infectious complications and shortened hospital stay (GRADE: low to moderate). The existence of bias lowers confidence in the evidence (GRADE approach). © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.
Austvoll-Dahlgren, Astrid; Underland, Vigdis; Straumann, Gyri Hval; Forsetlund, Louise
BACKGROUND Patient volume is assumed to affect quality, whereby complex procedures are best performed by those who perform them frequently. We have conducted a systematic review of the research on the association between patient volume and quality of vascular surgery. In this article we describe the outcomes for abdominal aortic aneurysm surgery.MATERIAL AND METHOD We undertook systematic searches in relevant databases. We searched for systematic reviews, and randomised and observational studies. The search was concluded in December 2015. We have summarised the results descriptively and assessed the overall quality of the evidence.RESULTS Forty-six observational studies fulfilled our inclusion criteria. We found a possible association for both hospital and surgeon volume. Higher patient volume may possibly be associated with lower 30-day mortality and lower hospital mortality for both open and endovascular surgery. Although the association appears to apply to both elective and acute hospitalisations, there is greater uncertainty with regard to the most ill patients. For hospital volume there may also be fewer complications for open and endovascular surgery, as well as for all surgery assessed as a whole. We considered the evidence base to be medium to very low quality.INTERPRETATION We found a possible correlation between patient volume and quality indicators such as mortality and complications. It may be advantageous to allocate planned procedures to institutions and surgeons with high volume, while this is less certain with regard to acute hospitalisations.
Stuart, Andrea; Källen, Karin
To compare the rates of abdominal surgery during pregnancy among women with previous bariatric surgery (women in the case group) and women with first-trimester body mass index (BMI) greater than 35 and no previous bariatric surgery (women in the control group). We conducted a national cohort study, merging data from the Swedish Medical Birth Registry and the Swedish National Patient Registry, comparing women who had bariatric surgery from 1987 to 2011 with women in a control group with first-trimester BMI greater than 35 who had not had bariatric surgery. Primary outcome variables were diagnosis and surgical procedure codes grouped as five outcome categories: 1) intestinal obstruction, 2) gallbladder disease, 3) appendicitis, 4) hernia, and 5) diagnostic laparoscopy or laparotomy without the presence of a diagnosis or surgical code for outcomes in outcome categories 1-4. Odds ratios were computed using multivariate linear regression analysis for each separate pregnancy. For all pregnancies in a given woman, general estimating equations with robust variance estimation were used. Adjustment was made for smoking, year of delivery, maternal age, and previous abdominal surgery. During the first pregnancy after bariatric surgery, the rate of surgery for intestinal obstruction was 1.5% (39/2,543; 95% confidence interval [CI] 1.1-2.0%) in women in the case group compared with 0.02% (4/21,909; 95% CI 0.0-0.04%) among women in the control group (adjusted odds ratio [OR] 34.3, 95% CI 11.9-98.7). Similarly, the rate of diagnostic laparoscopy or laparotomy was 1.5% (37/2,542; 95% CI 1.0-1.9%) among women in the case group compared with 0.1% (18/21,909; 95% CI 0.0-0.1%) among women in the control group (adjusted OR 11.3, 95% CI 6.9-18.5). Bariatric surgery is associated with an increased risk of abdominal surgery during pregnancy.
Draca, Petar; Miljković, Stamenko; Jakovljević, Branislava
Abdominal sling surgery is defined as attachment of either the connective tissue graft (fascia lata) or some synthetic material (Mersilene) to the anterior wall of the exposed vaginal vault following total hysterectomy or to the posterior wall of the uterine cervix in total and subtotal uterine prolapse, whereas the other end is attached to the anterior longitudinal ligament extending along the anterior surface of the vertebrae. Our analysis comprised 45 operations: 20 cases of vaginal vault prolapse following vaginal hysterectomy; 7 cases of vaginal vault prolapse following HTA: 2 cases of prolapse following subtotal hysterectomy; 3 cases of nondefined TH; 2 cases following Burch operation; 1 following Kocher; 1 following Manchester, 1 following Neugebauer-Le Fort operation in which HTA was performed 2 times. Abdominal sling operation was associated with the following surgical procedures: sling in 13 cases, sling + douglasorrhaphy in 16 cases, sling + douglasorrhaphy + colpoperineoplastics in 6 cases, sling + colpoperineoplastics in 9 cases and sling + marshall marcetti in 1 case. Recurrence of enterocele was recorded in 5 patients in whom closure of the douglas pouch had not been performed. This procedure was therefore later included into our approach to the operation. The abdominal sling operation has been a logical and physiologic approach to surgical therapy of genital prolapse, particularly of the vaginal vault prolapse following total hysterectomy. This operation ensures subsequent normal sexual relations.
Tsuruta, Kaoru; Mann, F A; Backus, Robert C
To describe the use of postoperative intrajejunal feeding and to evaluate the association of preoperative plasma albumin concentrations with intrajejunal feeding-related complications and clinical outcome. Prospective, observational study. University veterinary teaching hospital. Sixty-four dogs. Jejunostomy tube placement during abdominal surgery. Most dogs (81%) survived. The median intrajejunal feeding period was 2.1 days (range: 1-16 days; n = 64). Only 3 (5%) dogs received their estimated resting energy requirement by intrajejunal feeding. Of dogs that were fed intrajejunally (58 out of 64), most (55 out of 58) received intrajejunal feeding within 24 hours after surgery. Energy provision via the jejunal feeding tube did not differ between dogs with and without complications (P = 0.592), or between nonsurvivors and survivors (P = 0.298). Thirty-five dogs ate voluntarily concurrently with intrajejunal feeding. Of dogs that ate voluntarily concurrently with intrajejunal feeding for ≤50% of the postoperative period, most (74%) survived to discharge. Complications were seen in 22% of dogs, and none were life-threatening; gastrointestinal signs were most common. There was no difference in preoperative plasma albumin concentration between dogs with and without complications (P = 0.432) and between nonsurvivors and survivors (P = 0.727). Fecal score was not significantly different between the 2 liquid diets studied (FormulaV Enteral Care HLP and CliniCare Canine/Feline; P = 0.927). A jejunostomy tube placed during abdominal surgery was likely to be used at the study institution. Few complications were seen and none were life-threatening. Intrajejunal feeding was initiated early after surgery and did not interfere with the initiation of voluntary oral intake. Fecal scores were high and were useful for an objective assessment of fecal consistency in dogs with intrajejunal feeding. © Veterinary Emergency and Critical Care Society 2016.
Ritschard Ugi, K; Beldi, G; Candinas, D; Mischke, C
Background: Assessment of quality of life immediately after abdominal surgery is critical; however, potent tools that provide timely information about patient health are required in order to assess and improve postoperative quality of care. Interestingly, such assessment scales for early postoperative quality of life do not exist in German. The aim of this pilot study was to translate the English version of the "Abdominal Surgery Impact Scale" (ASIS) into German and to empirically test the German version. Methods: After the standardized translation, 30 German-speaking patients who had undergone visceral surgery (laparotomy) were recruited at the ward of the Bern University Hospital Visceral Surgery and Medicine. The internal consistency of the translated instrument (ASIS-D) was assessed on the third postoperative day; reliability, retest-reliability and construct validity were also assessed on the fifth postoperative day. Results: ASIS-D faithfully represented the content of the original version. Cronbach's α overall was 0.85 and for the 6 subscales 0.45-0.88. The overall score of retest-reliability was 0.57** and the construct validity was confirmed. Conclusion: The ASIS-D was shown to be reliable and valid even if other investigations are necessary. It provides specific insights into special postoperative symptoms such as wound pain and postoperative quality of sleep. After further tests, it might be suitable not only for capturing the short-term postal-surgical quality of life, but possibly also for evaluating nursing interventions. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Background:Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with perioperative administration of analgesics (pre-emptive analgesia it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after major gynecologic abdominal surgeries. Methods: In this prospective, double-blinded, randomized, and placebocontrolled trial, 60 ASA physical status I and II patients undergoing major abdominal gynecologic surgeries were randomized to receive 45 mL of bupivacaine 0.375% or 45mL of normal saline; 30 mL and 15 mL of the treatment solution was administered into the peritoneal cavity and incision, respectively, before wound closure. The pain score of the patients was evaluated by the visual analogue scale (VAS on awakening, and at 6, 12, and 24h after surgery. Time to first analgesia request and total analgesic requirements in the first 24h were recorded. Results: Pain scores were significantly higher in the placebo group than in the bupivacaine group on awakening (5.98±1.01 v.s 1.05±1.05; p<0.001, and at 6h after surgery (5.37±0.85 vs. 2.51±1.02; p<0.001. First request to analgesia was significantly longer in the bupivacaine patients than in the placebo group (5.87±3.04 h vs.1.35±0.36; p<0.001.Meperidine consumption over 24h was 96.00 ±17.53 mg in the placebo group compared with 23.28 ±14.89 mg in the bupivacaine patients (p<0.001.Conclusion:A combination of intraperitoneal and incisional bupivacaine infiltration at the end of abdominal gynecologic surgeries reduces postoperative pain on awakening and for 6 hours after surgery, and provides significant opioidsparing analgesia for 24 h after gynecologic abdominal surgeries.
Kvarnström, A L; Sarbinowski, R T; Bengtson, J-P; Jacobsson, L M; Bengtsson, A L
The objective of this study was to evaluate whether major abdominal surgery leads to complement activation and interleukin response and whether the kind of anaesthesia influence complement activation and the release of inflammatory interleukins. The study design was prospective and randomised. Fifty patients undergoing open major colorectal surgery due to cancer disease or inflammatory bowel disease were studied. Twenty-five patients were given total intravenous anaesthesia (TIVA) with propofol and remifentanil, and 25 patients were given inhalational anaesthesia with sevoflurane and fentanyl. To determine complement activation (C3a and SC5b-9) and the release of pro- and anti-inflammatory interleukins (tumour necrosis factor-a (TNF-a)), interleukin-1b (IL-1b), IL-6, IL-8, IL-4 and IL-10), blood samples were drawn preoperatively, 60 minutes after start of surgery, 30 minutes after end of surgery and 24 hours postoperatively. Complement was activated and pro-inflammatory interleukins (IL-6 and IL-8) and anti-inflammatory interleukins (IL-10) were released during major colorectal surgery. There was no significant difference between TIVA and inhalational anaesthesia regarding complement activation and cytokine release. Major colorectal surgery leads to activation of the complement cascade and the release of both pro-inflammatory and anti-inflammatory cytokines. There are no significant differences between total intravenous anaesthesia (TIVA) with propofol and remifentanil and inhalational anaesthesia with sevoflurane and fentanyl regarding complement activation and the release of pro- and anti-inflammatory interleukins. © 2012 The Authors. Scandinavian Journal of Immunology © 2012 Blackwell Publishing Ltd. Scandinavian Journal of Immunology.
Vliet, D.C. van; Meij, E van der; Bouwsma, E.V.; Noordegraaf, A. Vonk; Heuvel, B. van den; Meijerink, W.J.H.J.; Baal, W.M. van; Huirne, J.A.; Anema, J.R.
BACKGROUND: Evidence-based information on the resumption of daily activities following uncomplicated abdominal surgery is scarce and not yet standardized in medical guidelines. As a consequence, convalescence recommendations are generally not provided after surgery, leading to patients' insecurity,
Sørensen, Henrik; Grocott, Hilary P; Secher, Niels H
PURPOSE: Cerebral deoxygenation, as determined by near infrared spectroscopy (NIRS), seems to predict postoperative complications following cardiac surgery. We identify the type of non-vascular abdominal surgery associated with cerebral deoxygenation and/or hyperoxygenation, how such deviations a...
Rasmussen, A; Hansen, P T; Lindholt, J
In an open controlled study, 248 consecutive patients (age more than 40 yrs) admitted for major abdominal surgery were randomized to one of three prophylactic antithrombotic treatments. Eighty-five patients received subcutaneous heparin, 74 patients had graduated compression stockings to the knee...... of the lower limbs as a test for deep vein thrombosis. There were 29.7% positive tests in the stocking group, 29.4% in the group with heparin prophylaxis, and 25.8% in the combined group. Differences between treatments were not statistically significant....
Hasegawa, Kenji; Negishi, Chiharu; Nakagawa, Fumitoshi; Ozaki, Makoto
Purpose It has been reported that recently developed circulating-water garments transfer more heat than a forced-air warming system. The authors evaluated the hypothesis that circulating-water leg wraps combined with a water mattress better maintain intraoperative core temperature ≥36°C than either forced-air warming or carbon-fiber resistive heating during major abdominal surgery. Methods Thirty-six patients undergoing open abdominal surgery were randomly assigned to warming with: (1) circul...
Tanious, Adam; Wooster, Mathew; Jung, Andrew; Nelson, Peter R; Armstrong, Paul A; Shames, Murray L
As the integrated vascular residency program reaches almost a decade of maturity, a common area of concern among trainees is the adequacy of open abdominal surgical training. It is our belief that although their overall exposure to open abdominal procedures has decreased, integrated vascular residents have an adequate and focused exposure to open aortic surgery during training. National operative case log data supplied by the Accreditation Council for Graduate Medical Education were compiled for both graduating integrated vascular surgery residents (IVSRs) and graduating categorical general surgery residents (GSRs) for the years 2012 to 2014. Mean total and open abdominal case numbers were compared between the IVSRs and GSRs, with more in-depth exploration into open abdominal procedures by organ system. Overall, the mean total 5-year case volume of IVSRs was 1168 compared with 980 for GSRs during the same time frame (P surgery, representing 57% of all open abdominal cases. GSRs completed an average of 116 open alimentary tract surgeries during their training. Open abdominal surgery represented an average of 7.1% of the total vascular case volume for the vascular residents, whereas open abdominal surgery represented 21% of a GSR's total surgical experience. IVSRs reported almost double the number of total cases during their training, with double chief-level cases. Sixty-five percent of open abdominal surgeries performed by IVSRs involved the aorta or its renovisceral branches. Whereas open abdominal surgery represented 7.1% of an IVSR's surgical training, GSRs had a far broader scope of open abdominal procedures, completing nearly double those of IVSRs. The differences in open abdominal procedures pertain to the differing diseases treated by GSRs and IVSRs. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
Boshkoska, Biljana Mileva; Damij, Talib; Jelenc, Franc; Damij, Nadja
We provide a continuation of the existing Activity Table Modeling methodology with a modular spreadsheets simulation. The simulation model developed is comprised of 28 modeling elements for the abdominal surgery cycle process. The simulation of a two-week patient flow in an abdominal clinic with 75 beds demonstrates the applicability of the methodology. The simulation does not include macros, thus programming experience is not essential for replication or upgrading the model. Unlike the existing methods, the proposed solution employs a modular approach for modeling the activities that ensures better readability, the possibility of easily upgrading the model with other activities, and its easy extension and connectives with other similar models. We propose a first-in-first-served approach for simulation of servicing multiple patients. The uncertain time duration of the activities is modeled using the function "rand()". The patients movements from one activity to the next one is tracked with nested "if()" functions, thus allowing easy re-creation of the process without the need of complex programming. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Houe, T; Thorböll, J E; Sigild, U
to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine.......to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine....
Kalso, E; Pöyhiä, R; Onnela, P; Linko, K; Tigerstedt, I; Tammisto, T
Intravenous morphine and oxycodone were given double blind in doses of 0.05 mg/kg after major abdominal surgery to 39 patients. The dosing interval was 5 min, until the patient did not want any further analgesics. Less oxycodone was needed than morphine, both to achieve the "first state of pain relief" (13.2 mg vs. 24.9 mg) and during the whole 2-h study period (21.8 mg vs. 34.2 mg). The "first state of pain relief" was achieved faster (28 min vs. 46 min) and lasted longer (39 min vs. 27 min) with oxycodone than morphine. Morphine caused more sedation and a greater decrease in the mean arterial blood pressure than oxycodone. In other respects the two opioids were comparable.
Juliana de Moura Alonso
Full Text Available Intra-abdominal adhesions constitute a significant clinical and surgical problem that can lead to complications such as pain and bowel occlusion or subocclusion. These adhesions are frustrating and potentially fatal, representing a major postoperative complication in abdominal surgery. It is estimated that 32% of horses undergoing laparotomy will present clinical symptoms due to adhesions, but the true prevalence is not known because a large proportion of animals with postoperative recurrent colics are medically treated or submitted to euthanasia without necropsy. Adhesions are highly cellular, vascularized, dynamic structures that are influenced by complex signaling mechanisms. Understanding their pathogenesis could assist in applying better therapeutic strategies and in developing more effective antiadhesion products. Currently, there are no definitive strategies that prevent adhesion formation, and it is difficult to interpret the results of existing studies due to nonstandardization of an induction model and evaluation of their severity. The best clinical results have been obtained from using minimally traumatic surgical techniques, anti-inflammatory agents, antimicrobials, anticoagulants, and mechanical separation of serosal surfaces by viscous intraperitoneal solutions or physical barriers. This paper aims to review adhesion formation pathogenesis, guide the understanding of major products and drugs used to inhibit adhesion formation, and address their effectiveness in the equine species.
Critchley, L A; Leung, D H; Short, T G
The performance of impedance cardiography (TEBco), using the BoMed NCCOM3-R7S, and thermodilution (TDco) were compared in eight patients during major abdominal surgery. An opioid, volatile and relaxant anaesthetic technique was employed. This was supplemented with an epidural in five cases. Sets of three cardiac output readings, for both methods, were made at 10-20 min intervals throughout surgery. Data were compared using the Bland and Altman method, regression analysis and a nested model to measure variance components at different stages of surgery. Data from 157 sets of readings are presented. Agreement between the two devices was poor, with a ratio of TDco/TEBco of 115% and limits of agreement of 51-193%. The regression line was TDco = (0.98) x TEBco-0.95 with r = 0.60. A more detailed analysis, using nested data, showed good repeatability with coefficients of variation of 5.4% for TDco and 4.8% for TEBco. During surgery shifts in the bias between the two devices occurred, which were related to changes in surgical conditions. Between shifts both devices showed good repeatability over time. Variance components were 0.27 within nested data and 0.082 between bias shifts, with a significantly greater overall component of 1.2 (ANOVA; P = 0.0001). Shifts could be explained by deficiencies in the algorithm used to calculate TEBco. Current TEBco technology is too inaccurate for intra-operative use. However, under stable operating conditions TEBco and TDco showed good repeatability.
Yu, Tianwu; Cheng, Yao; Wang, Xiaomei; Tu, Bing; Cheng, Nansheng; Gong, Jianping; Bai, Lian
This is an update of the review published in 2013.Laparoscopic surgery is now widely performed to treat various abdominal diseases. Currently, carbon dioxide is the most frequently used gas for insufflation of the abdominal cavity (pneumoperitoneum). Although carbon dioxide meets most of the requirements for pneumoperitoneum, the absorption of carbon dioxide may be associated with adverse events. People with high anaesthetic risk are more likely to experience cardiopulmonary complications and adverse events, for example hypercapnia and acidosis, which has to be avoided by hyperventilation. Therefore, other gases have been introduced as alternatives to carbon dioxide for establishing pneumoperitoneum. To assess the safety, benefits, and harms of different gases (i.e. carbon dioxide, helium, argon, nitrogen, nitrous oxide, and room air) used for establishing pneumoperitoneum in participants undergoing laparoscopic general abdominal or gynaecological pelvic surgery. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 9), Ovid MEDLINE (1950 to September 2016), Ovid Embase (1974 to September 2016), Science Citation Index Expanded (1970 to September 2016), Chinese Biomedical Literature Database (CBM) (1978 to September 2016), ClinicalTrials.gov (September 2016), and World Health Organization International Clinical Trials Registry Platform (September 2016). We included randomised controlled trials (RCTs) comparing different gases for establishing pneumoperitoneum in participants (irrespective of age, sex, or race) undergoing laparoscopic abdominal or gynaecological pelvic surgery under general anaesthesia. Two review authors identified the trials for inclusion, collected the data, and assessed the risk of bias independently. We performed the meta-analyses using Review Manager 5. We calculated risk ratio (RR) for dichotomous outcomes (or Peto odds ratio for very rare outcomes), and mean difference (MD) or standardised
Rasmussen, Morten Schnack; Jørgensen, Lars Nannestad; Wille-Jørgensen, Peer
BACKGROUND: Major abdominal and pelvic surgery carries a high risk of venous thromboembolism (VTE). The efficacy of thromboprophylaxis with low-molecular weight heparin (LMWH) administered during the in-hospital period is well documented, but the optimal duration of thromboprophylaxis after surgery...... remains controversial. Some studies suggest that patients undergoing major abdominal surgery benefit from prolongation of the thromboprophylaxis to 1 month after surgery. No systematic review on prolonged thromboprophylaxis after major abdominal or pelvic surgery has been published. OBJECTIVES......: To evaluate the efficacy and safety of prolonged thromboprophylaxis with LMWH for at least 1 month after abdominal or pelvic surgery with thromboprophylaxis administered during the in-hospital period only in preventing late VTE. SEARCH STRATEGY: Electronic searches were performed January 2008 in the Medline...
Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H
This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated.
Fernandes, Shanlley Cristina da Silva; Santos, Rafaella Souza Dos; Giovanetti, Erica Albanez; Taniguchi, Corinne; Silva, Cilene Saghabi de Medeiros; Eid, Raquel Afonso Caserta; Timenetsky, Karina Tavares; Carnieli-Cazati, Denise
To evaluate the vital capacity after two chest therapy techniques in patients undergoing abdominal surgical. A prospective randomized study carried out with patients admitted to the Intensive Care Unit after abdominal surgery. We checked vital capacity, muscular strength using the Medical Research Council scale, and functionality with the Functional Independence Measure the first time the patient was breathing spontaneously (D1), and also upon discharge from the Intensive Care Unit (Ddis). Between D1 and Ddis, respiratory therapy was carried out according to the randomized group. We included 38 patients, 20 randomized to Positive Intermittent Pressure Group and 18 to Volumetric Incentive Spirometer Group. There was no significant gain related to vital capacity of D1 and Ddis of Positive Intermittent Pressure Group (mean 1,410mL±547.2 versus 1,809mL±692.3; p=0.979), as in the Volumetric Incentive Spirometer Group (1,408.3mL±419.1 versus 1,838.8mL±621.3; p=0.889). We observed a significant improvement in vital capacity in D1 (pabdominal surgery. Avaliar a capacidade vital comparando duas técnicas de fisioterapia respiratória em pacientes submetidos à cirurgia abdominal. Estudo prospectivo e randomizado realizado com pacientes admitidos em Unidade de Terapia Intensiva após cirurgia abdominal. Verificamos a capacidade vital, a força muscular por meio da escala do Medical Research Council e funcionalidade pela Medida de Independência Funcional no primeiro momento em que o paciente encontrava-se em respiração espontânea (D1) e na alta da Unidade de Terapia Intensiva (Dalta). Entre D1 e Dalta, foi realizada a fisioterapia respiratória, conforme o grupo randomizado. Foram incluídos 38 pacientes, sendo 20 randomizados para Grupo Pressão Positiva Intermitente e 18 para o Grupo Incentivador Inspiratório a Volume. A capacidade vital entre o D1 e Dalta do Grupo Pressão Positiva Intermitente não teve ganho significativo (média de 1.410mL±547,2 versus 1.809m
Full Text Available Laparoscopic gynecologic surgery has been widely used with a range of benefits. However, there are complications that are related to the abdominal entry process. Serious complications are gastrointestinal tract and major blood vessel injuries. This review introduces the recent available literature to prevent and eliminate the laparoscopic entry complications. The open entry technique is associated with a significant reduction of failed entry, compared to the closed entry technique; however there is no difference in the incidence of visceral or vascular injury. Laparoscopic entry by the left upper abdomen (i.e., Palmer's point or the middle upper abdomen (i.e., the Lee-Huang point could be considered in patients with suspected periumbilical adhesions or a history of umbilical hernia, or after three failed attempts of insufflation at the umbilicus. The Lee-Huang point has its own benefit for the operative laparoscopy in large pelvic pathologies and gynecology malignancy cases. The angle of Veress needle insertion varies from 45° in nonobese women to 90° in extraordinarily obese women. The high intra-peritoneal pressure entries, which range from 20 mmHg to 25 mmHg, minimize the risk of vascular injury. Therefore, this will not adversely affect the cardiopulmonary function in healthy women. The Veress intraperitoneal pressure (<10 mmHg is a reliable indicator of correct intraperitoneal placement of the Veress needle. The elevation of anterior abdominal wall for placement of a Veress needle increases the risks of failed entry and shows no advantage in regard to vascular or visceral complications. Surgeons should continue to increase their knowledge of anatomy, their training, and their experience to decrease laparoscopic complications.
Full Text Available Background: Postoperative pain is a significant problem in pediatrics. Preemptive administration of analgesics has recently emerged as a method to enhance pain management associated with surgery. The objective of this study was to compare the analgesic efficacy of a single-dose of preoperative oral ibuprofen versus acetaminophen in preventing pain after lower abdominal surgery in pediatrics. Methods: In this randomized, double-blind study, following lower abdominal surgery, 75 children, aging 3 to 12 years, were assigned to receive either ibuprofen 20 mg /kg (n=25 or acetaminophen 35 mg/kg (n=25 or placebo (n=25 2 hours before surgery. Agitation in recovery was measured and postoperative pain was quantified 3 and 24 hours after surgery by Oucher’s scale. The amount of postoperative analgesic needed in the ward was also assessed. Results: It was found that preoperative administration of ibuprofen and acetaminophen can reduce agitation in recovery but there was no difference in the agitation score between ibuprofen and acetaminophen groups (P=0.145. Agitation score was significantly lower in ibuprofen group compared to placebo (P>0.005. Similarly, patients in the acetaminophen group were considerably less agitated than those in the placebo group (P=0.002. No significant difference was observed in pain intensity 3 and 24 hours after operation between the three groups [(P=0.495 and (P=0.582 respectively]. The amount of postoperative analgesic needed during ward hospitalization was not significantly different among the three groups (P>0.005. Conclusion: These results provide evidence that preemptive acetaminophen and ibuprofen may reduce agitation during recovery but they neither improve the postoperative pain nor reduce analgesics consumption in ward Key words: Postoperative analgesia, Acetaminophen, Ibuprofen, Preemptive analgesia
Li, Rong; Quan, Zhuo-yong; Peng, Kai-qin; Zhu, Guo-chao; Shao, Yong-sheng; Zhang, Ying-tian
To evaluate the relationship among the microalbuminuria, surgical stress and postoperative fluid balance after abdominal surgery. A total of 191 patients undergoing an elective abdominal operation were studied. According to the extent of operative trauma, all patients were divided into 4 groups. GroupI: laparoscopic cholecystectomy (n=64); Group II: laparotomy of cholecyst and biliary tract (n=36); Group III: radical surgery of colorectal cancer (n=43); Group IV: distal subtotal gastrectomy (D2) or total gastectomy (D3) or pancreaticoduodenectomy (n=48). The operative severities were predicated by surgical stress score (SSS). Urine albumin-creatinine ratio (ACR) was measured at both pre- and post-operation. The levels of ACR were compared by ANOVA among these 4 groups. The correlation of ACR and SSS was analyzed. In Groups III and IV, body weight was measured by weight-bed simultaneously. The correlation of variation of ACR at 0 and 6 hours post-operation (ΔACR) and the volume of positive fluid balance in the first 24 hour post-operation were studied. We also compared the varied durations of ACR levels returning to normal or the pre-operative level and body weight reaching peak values. The levels of ACR increased in all groups. The level of ACR was the highest in Group IV and the lowest in Group I, significantly different from the levels of group II and III. There was a significant positive correlation between the increase in ACR and the severity of surgical trauma as measured by SSS. A positive correlation was observed between the volume of positive fluid balance in the first 24 hour post-operation and ΔACR at 0 and 6 hours post-operation. The varied duration of ACR levels returning normal or the pre-operative level was earlier than that of reaching the peak values. ACR has a positive correlation with the extent of surgical stress and volume of positive fluid balance. The fact that the ACR comes earlier than the change of body weight indicates that the change of
There is this wrong notion that the only standard abdominal incision is the midline incision. Cases have been seen in which an abdominal incision extends from the xyphoid process to the symphysis pubis just to remove a perforated appendix! It is also not unusual to see a groin incision together with a lower abdominal ...
Patel, Sunil V; Coughlin, Shaun C; Malthaner, Richard A
There has been recent interest in using high-concentration oxygen to prevent surgical site infections (SSIs). Previous meta-analyses in this area have produced conflicting results. With the publication of 2 new randomized controlled trials (RCTs) that were not included in previous meta-analyses, an updated review is warranted. Our objective was to perform a meta-analysis on RCTs comparing high- and low- concentration oxygen in adults undergoing open abdominal surgery. We completed independent literature reviews using electronic databases, bibliographies and other sources of grey literature to identify relevant studies. We assessed the overall quality of evidence using grade guidelines. Statistical analysis was performed on pooled data from included studies. A priori subgroup analyses were planned to explain statistical and clinical heterogeneity. Overall, 6 studies involving a total of 2585 patients met the inclusion criteria. There was no evidence of a reduction in SSIs with high-concentration oxygen (risk ratio 0.77, 95% confidence interval 0.50-1.19, p = 0.24). We observed substantial heterogeneity among studies. There is moderate evidence that high-concentration oxygen does not reduce SSIs in adults undergoing open abdominal surgery.
Sharan, Radhe; Verma, Rajan; Dhawan, Akshay; Kumar, Jugal
Ropivacaine, a newer local anesthetic, is gaining increased acceptance due to its improved safety profile over bupivacaine and lignocaine. Analgesic adjuvants have proved to be valuable in improving the quality of anesthesia and duration of analgesia. To compare the efficacy of clonidine and fentanyl as adjuvants to ropivacaine in spinal anesthesia in lower abdominal surgeries. A randomized, double-blind control study was carried out in 100 patients who were randomly divided into two groups. Ropivacaine-clonidine group (RC) received 30 μg of clonidine with 18.75 mg of 0.75% isobaric ropivacaine, Ropivacaine-fentanyl group (RF) received 25 μg of fentanyl with 18.75 mg of 0.75% isobaric ropivacaine intrathecally. The onset and duration of sensory and motor block, hemodynamic parameters, quality of surgical analgesia, total analgesia time, sedation score, and side effects were statistically analyzed using SPSS statistical package, paired and unpaired t-tests and Chi-square test. The duration of sensory block in RC (240.00 ± 20.99), RF (196.80 ± 18.34), and motor block in RC (192.20 ± 17.36), RF (139.20 ± 17.93) outlasted the duration of surgery. In clonidine group, there was significant prolongation of sensory block, motor block and the total analgesia time. Hypotension and bradycardia occurred more commonly in RC group, whereas pruritus was more in RF group. Ropivacaine when combined with either clonidine or fentanyl provided an adequate subarachnoid block for lower abdominal surgeries. As an adjuvant, clonidine has advantage over fentanyl as it increased the duration of the subarachnoid block and the postoperative analgesia.
Aahlin, E K; Tranø, G; Johns, N; Horn, A; Søreide, J A; Fearon, K C; Revhaug, A; Lassen, K
Major upper abdominal surgery is often associated with reduced health-related quality of life and reduced survival. Patients with upper abdominal malignancies often suffer from cachexia, represented by preoperative weight loss and sarcopenia (low skeletal muscle mass) and this might affect both health-related quality of life and survival. We aimed to investigate how health-related quality of life is affected by cachexia and how health-related quality of life relates to long-term survival after major upper abdominal surgery. From 2001 to 2006, 447 patients were included in a Norwegian multicenter randomized controlled trial in major upper abdominal surgery. In this study, six years later, these patients were analyzed as a single prospective cohort and survival data were retrieved from the National Population Registry. Cachexia was derived from patient-reported preoperative weight loss and sarcopenia as assessed from computed tomography images taken within three months preoperatively. In the original trial, self-reported health-related quality of life was assessed preoperatively at trial enrollment and eight weeks postoperatively with the health-related quality of life questionnaire Short Form 36. A majority of the patients experienced improved mental health-related quality of life and, to a lesser extent, deteriorated physical health-related quality of life following surgery. There was a significant association between preoperative weight loss and reduced physical health-related quality of life. No association between sarcopenia and health-related quality of life was observed. Overall survival was significantly associated with physical health-related quality of life both pre- and postoperatively, and with postoperative mental health-related quality of life. The association between health-related quality of life and survival was particularly strong for postoperative physical health-related quality of life. Postoperative physical health-related quality of life
Conclusions: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.
Cai, Zhenghao; Malbrain, Manu L. N. G.; Sun, Jing; Pan, Ruijun; Ma, Junjun; Feng, Bo; Dong, Feng; Zheng, Minhua
Introduction The incidence of acute gastrointestinal injury (AGI) after colorectal surgery is low when laparoscopic techniques are used. While elevated intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with AGI grade II, little is known about the relation between increased IAP during laparoscopy and subsequent AGI. Aim To assess the impact of increased IAP during laparoscopic colorectal surgery on the incidence of postoperative AGI. Material and methods Sixt...
Holzknecht, B J; Thorup, J; Arendrup, M C
Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients with gastrointes......Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients...
Hahn, Robert G; Bahlmann, Hans; Nilsson, Lena
Background Quantification of renal fluid conservation is possible by urine analysis, and the results can indicate dehydration. The present report sought to determine whether this fluid retention correlates with fluid requirements during major abdominal surgeries that have estimated operating times ??2?h. Methods Urine colour, specific weight, osmolality and creatinine concentration were used to calculate a composite ?fluid retention index? (FRI) in 97 patients prior to major abdominal surgery...
Zorić, Sava; Stamenković, Dusica; Stevanović, Slobodan; Malenković, Vesna; Dikić, Svetlana Dragojević; Randelović, Tomislav; Bilanović, Dragoljub
Almost ten years has past since Eldor described combined spinal-epidural-general anaesthesia (CSEOGA) as a new concept in anaesthesia in which all of these components can be used, with sub-anaesthetic doses of drugs, due to its sinergist effect. The clinics studies has not demonstrated crucial advantages CSEGA comparing with combined epidural-general anaesthesia (CEDGA), in sense of analgesia, pulmonary function and neuro-hormomal inhibition. However we have been routinely practising our technique CSEGA in big abdominal and thoraco-abdominal surgery, since 1997. This study is a retrospective analysis of our technique and clinic observations, during 4.5 years, which include 293 patients. Their demographic characteristics can be seen in table 2. We perform combined spinal-epidural anaesthesia (CSE) in one or two interspinal spaces, depending on the type of surgery, but always before induction in general anaesthesia (GA). For preemptive and intraoperative analgesia we use 0.25% plain bupivacaine (B), both for spinal (SA) and epidural (ED) blockade. The most important detail in our technique, despite precise order to administrate drugs, is analgesic solution (AS) which contain B 4.5 mg, fentanyl (Fe) 50 mcg and morphine hydrochloride (Mo) 0.2 mg, in total volume of 3 ml, in SA. After the ED test dose with 2% lidocaine 60 mg (3 ml), before the induction in GA, we inject more 10 ml B, but intraoperative analgesia is almost performed with B 3 to 5 ml in intermittent bolus doses. This ED bolus dosis is particularly important, partly to sufficiently cephalic migration of the SA somatosensorieblock, as well as for intraoperative analgesia. For very light GA only artificial ventilation with 66% N2O in O2 and muscle relaxation with paneuronium is needed. Co analgesia with intravenous (i.v.) Fe, was exceptionally seldom needed, except for induction. Intraoperative drugs consumption was very small as we see in table 5. With adequate liquid compensation, this technique achieve
The most common diagnoses were appendicitis (996, 26.8%), nonspecific abdominal pain (871, 23.4%), intestinal obstruction (498, 13.4%) and abdominal trauma (245, 6.6%). In all, 1 788 patients (48.1%) had operations during their emergency admission compared with 37.0% in our previous study. Appendicectomy (903 ...
Anaegbu, Nc; Olatosi, Oj; Tobi, Ku
Heat Moisture Exchangers (HMEs) conserve heat and moisture during expiration and make this available to inspired gases during subsequent inspiration. We sought to evaluate the effectiveness of HMEs in the prevention of perioperative hypothermia in patients scheduled for abdominal surgery under general anaesthesia relaxant technique with endotrachael intubation (GART.) Lagos University Teaching Hospital, in Modular theatre, Anaesthesia unit. The study was a randomized, controlled, longitudinal, interventional study Methods: 100 ASA I, II and III patients aged 18 to 65 years scheduled for abdominal surgery under GART were randomly assigned to 2 groups, groups H and C. Group H had HMEs, while group C served as controls. Core temperature measured using tympanic probe was every 10 minutes till end of anaesthesia Data from total 99 patients, 49 in group H and 50 in group C were eventually analysed. Although patients in both groups developed hypothermia in the course of anaesthesia, core temperature was significantly lower pHeat Moisture Exchangers, General endotracheal anaesthesia, Hypothermia, abdominal surgery.
Castelino, Tanya; Fiore, Julio F; Niculiseanu, Petru; Landry, Tara; Augustin, Berson; Feldman, Liane S
Early mobilization is considered an important element of postoperative care; however, how best to implement this intervention in clinical practice is unknown. This systematic review summarizes the evidence regarding the impact of specific early mobilization protocols on postoperative outcomes after abdominal and thoracic surgery. The review was performed according to PRISMA guidelines. We searched 8 electronic databases to identify studies comparing patients receiving a specific protocol of early mobilization to a control group. Methodologic quality was assessed using the Downs and Black tool. Four studies in abdominal surgery (3 randomized controlled trials [RCTs] and 1 observational prospective study) and 4 studies in thoracic surgery (3 RCTs and 1 observational retrospective study) were identified. None of the 5 studies evaluating postoperative complications reported differences between groups. One of 4 studies evaluating duration of stay reported a significant decrease in the intervention group. One of 3 studies evaluating gastrointestinal function reported differences in favor of the intervention group. One of 4 studies evaluating performance-based outcomes reported differences in favor of the intervention group. One of 5 studies evaluating patient-reported outcomes reported differences in favor of the intervention group. Overall methodologic quality was poor. Few comparative studies have evaluated the impact of early mobilization protocols on outcomes after abdominal and thoracic surgery. The quality of these studies was poor and results were conflicting. Although bed rest is harmful, there is little available evidence to guide clinicians in effective early mobilization protocols that increase mobilization and improve outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.
Nielsen, Liv Bjerre Juul; Tengberg, Line Toft; Bay-Nielsen, Morten
INTRODUCTION: Laparoscopy is well established in the majority of elective procedures in abdominal surgery. In contrast, it is primarily used in minor surgery such as appendectomy or cholecystectomy in the emergent setting. This study aimed to analyze the safety and effectiveness of a laparoscopic...... approach in a large cohort of major abdominal emergencies. METHODS: A population-based cohort from the Region of Copenhagen, Denmark, including n = 1,139 patients undergoing major abdominal emergency surgery in 2012. RESULTS: A total of 313 patients were operated with an initial laparoscopic approach; 37...... days in the laparoscopic group, 12 days in the converted group and 11 days in the group of open operations. CONCLUSIONS: In a large, unselected group of major abdominal emergencies, we report a low rate of complications for operations conducted by an initial laparoscopic approach, and a high rate...
Yang, Chun Kevin; Teng, Annabelle; Lee, David Y; Rose, Keith
Postoperative pulmonary complications (PPCs) after major abdominal surgery are common and associated with significant morbidity and high cost of care. The objective of this study was to identify the risk factors for PPCs after major abdominal surgery. The American College of Surgeons' National Surgical Quality Improvement Program database from 2005-2012 was queried for patients who underwent major abdominal surgery (esophagectomy, gastrectomy, pacnreatectomy, enterectomy, hepatectomy, colectomy, and proctectomy). Predictors of PPCs were identified using multivariate logistic regression. Of 165,196 patients who underwent major abdominal surgery 9595 (5.8%) suffered PPCs (pneumonia 3.2%, prolonged ventilator support ≥48 h 3.0%, and unplanned intubation 2.8%). On multivariate analysis, significant predictors of overall and individual PPCs include esophagectomy, advanced American Society of Anesthesiology Classification System, dependent functional status, prolonged operative time, age ≥80 y, severe chronic obstructive pulmonary disease, preoperative shock, ascites, and smoking. Obesity was not a risk factor. Female gender was overall protective for PPCs. PPCs after abdominal procedures are associated with a number of clinical variables. Esophageal operations and American Society of Anesthesiology Classification System were the strongest predictors. These results provide a framework for identifying patients at risk for developing pulmonary complications after major abdominal surgery. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available Background and Aims: There is limited data on the impact of perioperative fluid therapy guided by dynamic preload variables like stroke volume variation (SVV on outcomes after abdominal surgery. We studied the effect of SVV guided versus central venous pressure (CVP guided perioperative fluid administration on outcomes after major abdominal surgery. Material and Methods: Sixty patients undergoing major abdominal surgeries were randomized into two equal groups in this prospective single blind randomized study. In the standard care group, the CVP was maintained at 10-12 mmHg while in the intervention group a SVV of 10% was achieved by the administration of fluids. The primary end-points were the length of Intensive Care Unit (ICU and hospital stay. The secondary end points were intraoperative lactate, intravenous fluid use, requirement for inotropes, postoperative ventilation and return of bowel function. Results: The ICU stay was significantly shorter in the intervention group as compared to the control group (2.9 ± 1.15 vs. 5.4 ± 2.71 days. The length of hospital stay was also shorter in the intervention group, (9.9 ± 2.68 vs. 11.96 ± 5.15 days though not statistically significant. The use of intraoperative fluids was significantly lower in the intervention group than the control group (7721.5 ± 4138.9 vs. 9216.33 ± 2821.38 ml. Other secondary outcomes were comparable between the two groups. Conclusion: Implementation of fluid replacement guided by a dynamic preload variable (SVV versus conventional static variables (CVP is associated with lesser postoperative ICU stay and reduced fluid requirements in major abdominal surgery.
Meyhoff, Christian Sylvest; Jørgensen, Lars Nannestad; Wetterslev, Jørn
BACKGROUND: Administration of supplemental oxygen in the perioperative period is controversial, as it may increase long-term mortality. Our aim was to assess the association between 80% oxygen and occurrence of subsequent cancer in patients undergoing abdominal surgery in a post hoc analysis...... of the PROXI trial. METHODS: The 1386 patients in the PROXI trial underwent elective or emergency laparotomy between 2006 and 2008 with randomization to either 80% or 30% oxygen during and for 2 h after surgery. We retrieved follow-up status regarding vital status, new cancer diagnoses, and new histological...... vs 150 of 699 patients (21%) assigned to 30% oxygen; hazards ratio 1.06 [95% confidence interval (CI) 0.84, 1.34], P=0.62. Cancer-free survival was significantly shorter in the 80% oxygen group; hazards ratio 1.19 (95% CI 1.01, 1.42), P=0.04, as was the time between surgery and new cancer, median 335...
Santo, Caroline C; Gonçalves, Marcela T; Piccolo, Mariana M; Lima, Simone; Rosa, George J da; Paulin, Elaine; Schivinski, Camila S
to verify the physiotherapy performance in the respiratory and motor affections during postoperative period in pediatric patients undergoing abdominal surgery. was a literature review of articles published in the databases Lilacs, Medline and SciELO in the period 1983 to 2010 as well as books, papers presented at scientific meetings and journals of the area, who approached the post-therapy of abdominal surgery in children. The keywords used were: abdominal surgery, children and physiotherapy. 28 articles, one book chapter and one dissertation had been selected that examined the question and proposed that contained all, or at least two of the descriptors listed. Most of the material included covers the incidence of respiratory complications after surgery for pediatric abdominal surgery due to immaturity of the respiratory system of this population, abdominal manipulation of surgical period, the prolonged time in bed, pain at the incision site and waste anesthetic. Some authors also discuss the musculoskeletal and connective tissue arising from the inaction and delay of psychomotor development consequent to periods of hospitalization in early childhood, taking on the role of physiotherapy to prevent motor and respiratory involvement. there are few publications addressing this topic, but the positive aspects of physiotherapy have been described, especially in relation to the prevention of respiratory complications and motor, recognized the constraints and consequences of hospitalizations and surgeries cause in children.
Broekema, AA; Veen, A; Fidler, [No Value; Gielen, MJM; Hennis, PJ
We assessed the efficacy and side effects of postoperative analgesia with three different pain regimens in 90 patients undergoing major abdominal surgery. The patients were randomly assigned to one of three groups: epidural morphine (EM) or sufentanil (ES), both combined with bupivacaine, or IM
Bodnár, Zsolt; Sipka, Sándor; Hajdu, Zoltán
The abdominal compartment syndrome is a life threatening clinical entity which can develop within the first 12 hours of intensive care unit admission in high-risk surgical patients. The aim of this paper is to show the definitions, ethiology, pathophysiology, diagnosis and treatment of this serious, not only surgical problem. The mortality due to the abdominal compartment syndrome is extremely high (38-71%). It can be defined as adverse physiologic consequences that occur as a result of an acute increase in the intraabdominal pressure. The most common causes are retroperitoneal haemorrhage, visceral oedema, pancreatitis, bowel obstruction, tense ascites, peritonitis, tumor. The mostly affected systems are cardiovascular, pulmonary, renal, central nervous systems and splanchnic organs. The gold standard diagnostic method is the continuous intra-abdominal pressure monitoring. The treatment consists of adequate fluid resuscitation and surgical decompression. We show three typical short case reports treated by the above mentioned theories. Intraabdominal hypertension and abdominal compartment syndrome are frequent clinical findings among acute general surgical patients. Patients with comparable demographics and acute severity of illness are more likely to die if intraabdominal hypertension or abdominal compartment syndrome is present. We conclude that the early recognition and surgical decompression is urgent.
Tammisto, T; Tigerstedt, I; Korttila, K
Intravenous lysine acetylsalicylate (LAS) and oxycodone were compared under double-blind conditions for analgesia after upper abdominal surgery in sixty patients anaesthetized by N2O--O2--halothane--relaxant technique. Either 125 mg/10 kg or 250 mg/10 kg LAS or 0.4 mg/10 kg or 0.8 mg/10 kg oxycodone was randomly administered when the patients complained of moderate or severe postoperative pain. When 30 min had elapsed following the injection of the test drug, oxycodone was given in 4 mg increments on demand until adequate pain relief was achieved. At 15 min postdrug, the lower dose of LAS offered significantly less pain relief than all other test drugs. At 30 min, the effect of the higher dose of LAS reached almost the analgesic level of the higher dose of oxycodone but only the latter provided significantly (P less than 0.05) better analgesia than the low dose of LAS. About 50% less additional narcotic supplementation was demanded following higher doses of both drugs when compared to lower ones. LAS 250 mg/10 kg (c. 1.8 g/70 kg) was found approximately equipotent to oxycodone 0.8 mg/10 kg (c. 6 mg/70 kg). However, LAS had a slower onset of action. Sweating seemed to occur more frequently after LAS than oxycodone, but significant changes in respiratory rate or sedation following LAS-oxycodone combinations when compared to oxycodone alone were not noted. The results show that for analgesia after upper abdominal surgery, 1.8 g of LAS may be substituted for about 6 mg of oxycodone.
Pasquina, Patrick; Tramèr, Martin R; Granier, Jean-Max; Walder, Bernhard
To examine the efficacy of respiratory physiotherapy for prevention of pulmonary complications after abdominal surgery. We searched in databases and bibliographies for articles in all languages through November 2005. Randomized trials were included if they investigated prophylactic respiratory physiotherapy and pulmonary outcomes, and if the follow-up was at least 2 days. Efficacy data were expressed as risk differences (RDs) and number needed to treat (NNT), with 95% confidence intervals (CIs). Thirty-five trials tested respiratory physiotherapy treatments. Of 13 trials with a "no intervention" control group, 9 studies (n = 883) did not report on significant differences, and 4 studies (n = 528) did: in 1 study, the incidence of pneumonia was decreased from 37.3 to 13.7% with deep breathing, directed cough, and postural drainage (RD, 23.6%; 95% CI, 7 to 40%; NNT, 4.3; 95% CI, 2.5 to 14); in 1 study, the incidence of atelectasis was decreased from 39 to 15% with deep breathing and directed cough (RD, 24%; 95% CI, 5 to 43%; NNT, 4.2; 95% CI, 2.4 to 18); in 1 study, the incidence of atelectasis was decreased from 77 to 59% with deep breathing, directed cough, and postural drainage (RD, 18%; 95% CI, 5 to 31%; NNT, 5.6; 95% CI, 3.3 to 19); in 1 study, the incidence of unspecified pulmonary complications was decreased from 47.7% to 21.4 to 22.2% with intermittent positive pressure breathing, or incentive spirometry, or deep breathing with directed cough (RD, 25.5 to 26.3%; NNT, 3.8 to 3.9). Twenty-two trials (n = 2,734) compared physiotherapy treatments without no intervention control subjects; no conclusions could be drawn. There are only a few trials that support the usefulness of prophylactic respiratory physiotherapy. The routine use of respiratory physiotherapy after abdominal surgery does not seem to be justified.
Jan 8, 2016 ... Background: The need for nonobstetric abdominal surgical interventions in pregnant females arises periodically in practice and can be a source for concern for both the patient and the surgeon because of the risk of adverse outcome. Aims and Objectives: To determine the indications for, and assess ...
Lozano Sánchez, F; Sánchez Fernández, J; Palacios, E; Fernández, M; Ingelmo Morin, A; Gómez Alonso, A
We present a rare postoperative complication after surgical procedures for rupture of abdominal aortic aneurysms. The disease, a pseudomembranous colitis, was early recognized (by evidence of clostridium difficile after a coprocultive) and satisfactorily treated with vancomycin. From the literature review we found only a similar case but results were absolutely different from our case.
0.001), low base excess (p=0.002), pH (p<0.001), core temperature (p=0.002), and high blood transfusion requirement over 24 hours (p=0.002). Conclusion. The overall survival of patients after damage control procedures for abdominal trauma ...
Abe, Hayato; Mafune, Ken-ichi
To identify the risk factors for morbidity and mortality after elective and emergency abdominal surgeries in maintenance hemodialysis patients. We retrospectively evaluated the medical records of 63 hemodialysis patients who underwent elective (group 1) and 24 who underwent emergency (group 2) abdominal surgeries, and classified them according to the presence/absence of postoperative complications. The clinical, laboratory and procedure-related data were obtained and compared between the groups. Group 2 had significantly higher morbidity and mortality rates than group 1 (58.3 and 16.6 % vs. 33.3 and 16.6 %, respectively, P high BUN levels in the elective surgery patients and hypoproteinemia, hypoalbuminemia, a longer operation and older age in patients undergoing emergency surgery. Perioperative blood transfusion was also associated with a high complication rate in the emergency surgery group.
Ueda, Hiroshi; Hoshi, Takuo
The number of laparoscopic surgeries performed is increasing every year and in most cases the pneumoperitoneum method is used. One alternative is the abdominal wall lifting method and this study was undertaken to evaluate changes of functional residual capacity during the abdominal wall lift procedure. From January to April 2013, 20 patients underwent laparoscopic cholecystectomy at a single institution. All patients were anesthetized using propofol, remifentanil and rocuronium. FRC was measured automatically by Engstrom Carestation before the abdominal wall lift and again 15minutes after the start of the procedure. After abdominal wall lift, there was a significant increase in functional residual capacity values (before abdominal wall lift 1.48×103mL, after abdominal wall lift 1.64×103mL) (p<0.0001). No complications such as desaturation were observed in any patient during this study. Laparoscopic surgery with abdominal wall lift may be appropriate for patients who have risk factors such as obesity and respiratory disease. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel
AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating...... postoperative intermediate care after emergency abdominal surgery, the InCare trial. DESIGN: A qualitative study with individual semi-structured interviews. METHODS: We analysed interviews using Systematic Text Condensation. RESULTS: Eighteen patients (nine intervention/nine controls) were strategically sampled...
Full Text Available Abstract Background Development of incisional hernia after open abdominal surgery remains a major cause of post-operative morbidity. The aim of this study was to determine the current practice of surgeons in terms of access to and closure of the abdominal cavity in elective open surgery. Methods Twelve surgical departments of the INSECT-Trial group documented the following variables for 50 consecutive patients undergoing abdominal surgery: fascial closure techniques, applied suture materials, application of subcutaneous sutures, subcutaneous drains, methods for skin closure. Descriptive analysis was performed and consensus of treatment variables was categorized into four levels: Strong consensus >95%, consensus 75–95%, overall agreement 50–75%, no consensus Results 157 out of 599 patients were eligible for analysis (85 (54% midline, 54 (35% transverse incisions. After midline incisions the fascia was closed continuously in 55 patients (65%, using slowly absorbable (n = 47, 55%, braided (n = 32, 38% sutures with a strength of 1 (n = 48, 57%. In the transverse setting the fascia was closed continuously in 39 patients (72% with slowly absorbable (n = 22, 41% braided sutures (n = 27, 50% with a strength of 1 (n = 30, 56%. Conclusion In the present evaluation midline incision was the most frequently applied access in elective open abdominal surgery. None of the treatments for abdominal wall closure (except skin closure in the midline group is performed on a consensus level.
Full Text Available Background: Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo. Methods: A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1-2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale (VAS ≥3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes. Results: The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. Conclusion: A single dose of 300 mg pregabalin given 1-2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo.
Background: Enhanced recovery after surgery (ERAS) programmes employed in elective surgery have provided strong evidence for decreased lengths of hospital stay without increase in postoperative complications. The aim of this study was to explore the role and benefits of ERAS implemented in patients undergoing ...
Full Text Available Type and technique of anesthesia have an important effect on per operative surgical course. The aim of the study was prospective analyses of advantages of combined spinal, epidural and general anesthesia (CSEGA versus general anesthesia (GA in abdominal surgery according to: 1. operative course (haemodynamic stability of patients, quality of analgesia, undesirables effects, 2. postoperative course (quality of analgesia, unfavorable effects, temporary abode of patients in intensive care. Using prospective randomized double blind controlled study, we evaluated two groups of patients whom the same type of abdominal surgical intervention was planed and the only difference was the type of technique of anesthesia. First group of patients (n=34, was treated with CSEGA and second group of patients (n=33, was treated only with standard (GA. Both groups had intraoperative and 24-hour-long postoperative continued monitoring of blood pressure central venous pressure, and dieresis. In the 24 hours postoperative period the following parameters were analyzed: vigilance conditions, motor block level, pain intensity in rest and movement, necessity for a complementary analgesia, side effects and final subjective effect of analgesia. There was important difference in waking up the patients after a general anesthesia in the first group this period was shorter. In the first 24 hours, patients from the first group didn't get any systemic analgesic, while the patients from the second group needed fractionary application of parenteral analgesics in the period of 4-6 hours. Patients from the first group were also physically faster and easier recovered and they had less respiratory complications and there was not any example of thromboembolysm and the intestine motility was faster re-established. First group of patients spent less time in intensive care (three days than second group (six days. Final subjective effect of analgesia, according to verbal descriptive scale
Barrio, Javier; Errando, Carlos L; San Miguel, Guillermo; Salas, Boris I; Raga, Juan; Carrión, José L; García-Ramón, Jaime; Gallego, Juan
To evaluate the effect of neuromuscular blockade (NMB) upon the abdominal space during pneumoperitoneum establishment in laparoscopic surgery, comparing moderate NMB and deep NMB. Prospective, randomized, crossover clinical trial. Operating room. Seventy-six American Society of Anesthesiologists 1 to 2 patients scheduled for elective laparoscopic surgery. Two independent evaluations were performed at the establishment of pneumoperitoneum for a preset intraabdominal pressures (IAPs) of 8 and 12 mm Hg, both during moderate NMB (train-of-four count, 1-3) and deep NMB (posttetanic count, <5). Rocuronium was used to induce NMB, and sugammadex was used for reversal. We evaluated (i) the volume of CO2 introduced in 41 patients and (ii) the skin-sacral promontory distance in 35 patients, at pneumoperitoneum establishment. Compared to moderate NMB, deep NMB increased, in a significant manner, both the intraabdominal volume of CO2 insufflated (mean [SD], 2.24 [1.10] vs 2.81 [1.13] L at 8 mm Hg IAP, P<.001, and 3.52 [1.31] vs 4.09 [1.31] L at 12 mm Hg IAP, P<.001) and the skin-sacral promontory distance (11.78 [1.52] vs 12.16 [1.51] cm at 8 mm Hg IAP, P=.002, and 13.34 [1.87] vs 13.80 [1.81] cm at 12 mm Hg IAP, P<.001). Increase in intraabdominal volume after inducing deep NMB was observed in 88% and 81.7% of patients at 8 and 12 mm Hg pneumoperitoneum, with a volume increase of mean of 36.8% (95% confidence interval [CI], 22.8-50.8) and 25% (95% CI, 13.7-36.4), respectively (P=.003). Increase in distance was observed in 61% and 82% of patients at 8 and 12 mm Hg pneumoperitoneum, with a mean distance increase of 3.3% (95% CI, 1.3-5.4) and 3.6% (95% CI, 1.9-5.2), respectively (P=.840). Deep NMB, in comparison to moderate NMB, increased in a significant manner the abdominal space at pneumoperitoneum establishment. However, the effective increase in the abdominal cavity dimensions could be low, the increase showed a great interindividual variability, and it was not observed in
Lie, C; Kehlet, H; Rosenberg, J
Postoperative pulmonary complications play a significant role for the postoperative morbidity after abdominal surgery. To prevent this, an array of methods, such as lung physiotherapy, incentive spirometry, or mask treatment with positive airway pressure are used. The available controlled studies indicate that none of these treatment modalities reduce the occurrence of postoperative atelectasis, but only lung physiotherapy is able to reduce the development of postoperative pneumonia. Thus, we recommend lung physiotherapy as prophylactic treatment after abdominal surgery. The value of optimized pain alleviation and mobilisation in addition to lung physiotherapy should be evaluated in future trials.
Ciurea, M; Copca, N; Moisescu, V; Calomfirescu, M
Prosthesis use in surgical repair of abdominal wall is becoming nowadays a worldwide method, being imposed by its efficiency in solving the defects. The authors are speaking in the light of their experience gained with 100 patients that underwent the operation of prosthesis implant inside the abdominal wall between 1990 and 1996. There have been correlated the early and late postoperative results with some features of this surgical procedure (see below), to prove its efficacy. The authors discuss some principles of alloplastic treatment, which represent also the conclusions of the study: the moment of when a prosthesis is recommended, the choice of synthetic material, where and how is placed the prosthesis, some additional measures which contribute to therapeutic success.
Burcharth, J; Pommergaard, H-C; Klein, M
Background: Incisional hernia (IH) is a well-known complication after abdominal surgical procedures. The exact etiology of IH is still unknown even though many risk factors have been suggested. The aim of this study was to create an animal model of a weakly healed abdominal fascia that could...... be used to evaluate the actively healing fascia. Such an animal model may promote future research in the prevention of IH. Methods: 86 male Sprague-Dawley rats were used to establish a model involving six experiments (experiments A-F). Mechanical testing of the breaking strength of the healed fascia...... was performed by testing tissue strips from the healed fascia versus the unincised control fascia 7 and 28 days postoperatively. Results: During the six experiments a healing model was created that produced significantly weaker coherent fascia when compared with the control tissue measured in terms...
Hasegawa, Kenji; Negishi, Chiharu; Nakagawa, Fumitoshi; Mukai, Shihoko; Ozaki, Makoto
Perioperative hypothermia causes numerous severe complications, such as coagulopathy, surgical wound infections, and morbid myocardial outcomes. For prevention of intraoperative hypothermia, an inexpensive, non-disposable carbon fiber resistive warming system has been developed. We evaluated the efficacy of resistive-heating, comparing to circulating-water mattress and forced-air warming system. Twenty four patients undergoing elective abdominal surgery were randomly assigned to warming with: 1) a circulating water mattress, 2) a lower-body forced-air system, or 3) a carbon-fiber, resistive-heating blanket. Tympanic membrane temperature in the first two hours of surgery decreased by 1.9 +/- 0.5 degrees C in the water mattress group, 1.0 +/- 0.6 degree C in the forced-air group, 0.8 +/- 0.2 degree C in the resistive-heating group. The decreases in core temperature by the end of surgery were 2.0 +/- 0.8 degrees C in the water mattress group, 0.6 +/- 1.1 degrees C in the forced-air group, and 0.5 +/- 0.4 degree C in the resistive blanket group, respectively. There was no significant difference in the changes of core temperature between the forced-air group and the resistive-heating group. No side effects related to resistive-heating blanket were observed. Even during major abdominal surgery, carbon-fiber resistive-heating maintains core temperature as effectively as forced air.
Straatman, Jennifer; Van der Wielen, Nicole; Cuesta, Miguel A; de Lange-de Klerk, Elly S M; van der Peet, Donald L
Over the last decades longevity has increased significantly, with more octogenarians undergoing surgery. Here, we assess surgical outcomes after major abdominal surgery in octogenarians. Observational cohort of 874 patients undergoing major abdominal elective surgery between January 2009 and March 2014. Seventy-six octogenarians were propensity matched to 76 younger patients, corrected for sex, body mass index, American Society of Anesthesiologists classification, comorbidity, indication, and type of surgery. Minor complications were more prevalent in octogenarians (P = .01) and consisted mainly of respiratory complications; progressing to respiratory insufficiency requiring intubation in 28.6%. Preoperative weight loss (odds ratio 3 [1.1 to 8.3]) and upper gastrointestinal surgery (odds ratio 11 [2 to 60]) were associated with minor complications. Octogenarians are at increased risk of minor complications after major abdominal surgery. Major complication rates were similar, indicating the importance of preoperative assessment and standardized surgical techniques. Taking into account preoperative morbidities and type of surgery and techniques. Implementation of quality control algorithms may further improve outcomes in octogenarians. Copyright © 2016 Elsevier Inc. All rights reserved.
citation to normal physiology in the intensive care unit (ICU) ... Surgeons.8 All charts were reviewed and the data collected included age, sex ... base excess in the first 24 hours. .... DCS is becoming an increasingly accepted form of surgery.
outcomes following major surgery are poorly described at national and even at institutional ... performance variation. With no national ... Significant associations were further tested by a multivariate stepwise forward logistic regression model ...
Meyhoff, C S; Jorgensen, L N; Wetterslev, J; Siersma, V D; Rasmussen, L S
Administration of supplemental oxygen in the perioperative period is controversial, as it may increase long-term mortality. Our aim was to assess the association between 80% oxygen and occurrence of subsequent cancer in patients undergoing abdominal surgery in a post hoc analysis of the PROXI trial. The 1386 patients in the PROXI trial underwent elective or emergency laparotomy between 2006 and 2008 with randomization to either 80% or 30% oxygen during and for 2 h after surgery. We retrieved follow-up status regarding vital status, new cancer diagnoses, and new histological cancer specimens. Data were analysed using the Cox proportional hazards model. Follow-up was complete in 1377 patients (99%) after a median of 3.9 yr. The primary outcome of new cancer diagnosis or new malignant histological specimen occurred in 140 of 678 patients (21%) in the 80% oxygen group vs 150 of 699 patients (21%) assigned to 30% oxygen; hazards ratio 1.06 [95% confidence interval (CI) 0.84, 1.34], P=0.62. Cancer-free survival was significantly shorter in the 80% oxygen group; hazards ratio 1.19 (95% CI 1.01, 1.42), P=0.04, as was the time between surgery and new cancer, median 335 vs. 434 days in the 30% oxygen group. In patients with localized disease, non-significant differences in cancer and cancer-free survival were found with hazard ratios of 1.31 and 1.29, respectively. Although new cancers occurred at similar rate, the cancer-free survival was significantly shorter in the 80% oxygen group, but this did not appear to explain the excess mortality in the 80% oxygen group. ClinicalTrials.gov (NCT01723280). © The Author . Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Tengberg, L. T.; Bay-Nielsen, M.; Bisgaard, T.
Background: Acute high-risk abdominal (AHA) surgery carries a very high risk of morbidity and mortality and represents a massive healthcare burden. The aim of the present study was to evaluate the effect of a standardized multidisciplinary perioperative protocol in patients undergoing AHA surgery....... Methods: The AHA study was a prospective single-centre controlled study in consecutive patients undergoing AHA surgery, defined as major abdominal pathology requiring emergency laparotomy or laparoscopy including reoperations after elective gastrointestinal surgery. Consecutive patients were included...... after initiation of the AHA protocol as standard care. The intervention cohort was compared with a predefined, consecutive historical cohort of patients from the same department. The protocol involved continuous staff education, consultant-led attention and care, early resuscitation and high...
Vester-Andersen, Morten; Waldau, Tina; Wetterslev, Jørn
. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.Methods and design: The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency......ABSTRACT: BACKGROUND: Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality...... laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure...
Grantcharov, T P; Rosenberg, J
, and a manual search of relevant journals. The references cited in these studies were reviewed to find out whether any other trials fitted the selection criteria. MAIN OUTCOME MEASURES: Early complications including postoperative pain, pulmonary complications, burst abdomen, wound infection, and hospital stay...... with fewer complications (pain, burst abdomen, and pulmonary morbidity) and there is lower incidence of late incisional hernia after transverse compared with vertical laparotomy. A midline incision is still the incision of choice in conditions that require rapid intra-abdominal entry (such as trauma...
Toft, P; Nielsen, C H; Tønnesen, Else Kirstine
Cardiac and major abdominal surgery are associated with granulocytosis in peripheral blood. The purpose of the present study was to describe the granulocyte and monocyte oxidative burst and the expression of adhesion molecules following cardiac surgery with cardiopulmonary bypass and abdominal...... a role in reperfusion injury....
Cassell, O C; Oakley, N.; Forrest, A. R.; Thomas, W E; Dennison, A. R.
Numerous studies of post-operative fluid status have utilized sophisticated measurements of electrolyte distribution and fluid shift without relating results to clinical practice. The aim of this prospective randomized study was to investigate the response of patients undergoing abdominal surgery of moderate severity to conservative post-operative fluid administration. Forty-five patients undergoing open cholecystectomy were randomized to receive 2.51 of fluid (1 l normal saline and 1.51 5% d...
V. A. Zyryanov
Full Text Available Objective: to determine the efficiency of postoperative 3-in-1 parenteral nutrition with Oliclinomel N8-800 in correcting protein-energy malnutrition in patients undergoing extended surgical interventions into the abdominal organs. Subjects and methods. Forty-one patients with gastric and pancreatic neoplasms treated in the intensive care unit, N. N. Burdenko Main Military Clinical Hospital, in January to October 2013 were examined. All the patients were males. The mean age was 63.5±11.87 years. The study design: a prospective controlled randomized trial. Group 1 (a comparison group entered 21 patients. Conventional parenteral nutrition regimens with Oliclinomel N7-1000E 2000 ml were used on postoperative day 2. The intestine was lavaged with a glucose-electrolyte solution within the first postoperative hours. The glucose-electrolyte solution and standard enteral formula were intraintestinally administered as the absorptive and digestive functions of the small bowel recovered. On postoperative days 7 and 8, the parenteral nutrition was stopped and completely switched to enteral feeding. The dissimilarity of Group 2 (a study group (n=20 was that it received parenteral nutrition with Oliclinomel N8-800 2000 ml.Results. Complete parenteral nutrition, then mixed parenteral-enteral nutrition stabilized protein metabolic parameters in the patients of both groups in a unilateral fashion, but more promptly in Group 2 than in Group 1. The nutritional support program in Group 2 caused significantly less reduction in the body' cellular weight than in Group 2 in the first and entire period of the follow-up, which appears to be related to the administration of large amounts of nitrogen.Conclusion. The results suggest that the use of Oliclinomel N8-800 for parenteral nutrition adequately corrects postaggressive nitrogen deficiency, promotes the normalization of protein and carbohydrate metabolism and a positive nitrogen balance and the resolution of
Antoniou, Stavros A; Antoniou, George A; Antoniou, Athanasios I; Granderath, Frank-Alexander
Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927-2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concept, having performed the first laparoscopic appendectomy, inspiring Erich Mühe and many other surgeons around the world to perform a wide spectrum of procedures by minimally invasive means. Laparoscopic cholecystectomy soon became the gold standard, and various laparoscopic procedures are now preferred over open approaches, in the light of emerging evidence that demonstrates less operative stress, reduced pain, and shorter convalescence. Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) may be considered further steps toward minimization of surgical trauma, although these methods have not yet been standardized. Laparoscopic surgery with the use of a robotic platform constitutes a promising field of investigation. New technologies are to be considered under the prism of the history of surgery; they seem to be a step toward further minimization of surgical trauma, but not definite therapeutic modalities. Patient safety and medical ethics must be the cornerstone of future investigation and implementation of new techniques.
Spieth, Peter M; Güldner, Andreas; Uhlig, Christopher; Bluth, Thomas; Kiss, Thomas; Schultz, Marcus J.; Pelosi, Paolo; Koch, Thea; Gamba de Abreu, Marcelo
Background: General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventil...
Henebiens, M.; van den Broek, Th A. A.; Vahl, A. C.; Koelemay, M. J. W.
OBJECTIVES: Our aim was to analyse the relation between hospital volume and peri-operative mortality in abdominal aortic aneurysm surgery. DESIGN: Systematic review. METHOD: The Medline, Embase and Cochrane databases were searched to identify all population based studies reporting on the volume
Madsen, M V; Staehr-Rye, A K; Gätke, M R
BACKGROUND: The level of neuromuscular blockade (NMB) that provides optimal surgical conditions during abdominal surgery has not been well established. The aim of this systematic review was to evaluate current evidence on the use of neuromuscular blocking agents in order to optimise surgical...
Márquez Mesa, Elena; Baz Figueroa, Caleb; Suárez Llanos, José Pablo; Sanz Pereda, Pablo; Barrera Gómez, Manuel Ángel
Multimodal rehabilitation programs are perioperative standardized strategies with the objective of improving patient recovery, and decreasing morbidity, hospital stay and health cost. The nutritional aspect is an essential component of multimodal rehabilitation programs and therefore nutritional screening is recommended prior to hospital admission, avoiding pre-surgical fasting, with oral carbohydrate overload and early initiation of oral intake after surgery. However, there are no standardized protocols of diet progression after pancreatic surgery. A systematic review was been performed of papers published between 2006 and 2016, describing different nutritional strategies after pancreatic surgery and its possible implications in postoperative outcome. The studies evaluated are very heterogeneous, so conclusive results could not be drawn on the diet protocol to be implemented, its influence on clinical variables, or the need for concomitant artificial nutrition. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
CONCLUSION: Surgeons and cardiologists should be aware of this cerebrovascular complication secondary to PFO following major reconstructive surgery such as microvascular breast reconstruction. It also serves to challenge microvascular surgeons to reconsider routine use of central venous pressure lines in free flap patients who might otherwise have good peripheral vessels for postoperative fluid and antibiotic administration.
Cerantola, Yannick; Grass, Fabian; Cristaudi, Alessandra; Demartines, Nicolas; Schäfer, Markus; Hübner, Martin
Introduction. Preoperative malnutrition is a major risk factor for increased postoperative morbidity and mortality. Definition and diagnosis of malnutrition and its treatment is still subject for controversy. Furthermore, practical implementation of nutrition-related guidelines is unknown. Methods. A review of the available literature and of current guidelines on perioperative nutrition was conducted. We focused on nutritional screening and perioperative nutrition in patients undergoing digestive surgery, and we assessed translation of recent guidelines in clinical practice. Results and Conclusions. Malnutrition is a well-recognized risk factor for poor postoperative outcome. The prevalence of malnutrition depends largely on its definition; about 40% of patients undergoing major surgery fulfil current diagnostic criteria of being at nutritional risk. The Nutritional Risk Score is a pragmatic and validated tool to identify patients who should benefit from nutritional support. Adequate nutritional intervention entails reduced (infectious) complications, hospital stay, and costs. Preoperative oral supplementation of a minimum of five days is preferable; depending on the patient and the type of surgery, immune-enhancing formulas are recommended. However, surgeons' compliance with evidence-based guidelines remains poor and efforts are necessary to implement routine nutritional screening and nutritional support.
Full Text Available Introduction. Preoperative malnutrition is a major risk factor for increased postoperative morbidity and mortality. Definition and diagnosis of malnutrition and its treatment is still subject for controversy. Furthermore, practical implementation of nutrition-related guidelines is unknown. Methods. A review of the available literature and of current guidelines on perioperative nutrition was conducted. We focused on nutritional screening and perioperative nutrition in patients undergoing digestive surgery, and we assessed translation of recent guidelines in clinical practice. Results and Conclusions. Malnutrition is a well-recognized risk factor for poor postoperative outcome. The prevalence of malnutrition depends largely on its definition; about 40% of patients undergoing major surgery fulfil current diagnostic criteria of being at nutritional risk. The Nutritional Risk Score is a pragmatic and validated tool to identify patients who should benefit from nutritional support. Adequate nutritional intervention entails reduced (infectious complications, hospital stay, and costs. Preoperative oral supplementation of a minimum of five days is preferable; depending on the patient and the type of surgery, immune-enhancing formulas are recommended. However, surgeons' compliance with evidence-based guidelines remains poor and efforts are necessary to implement routine nutritional screening and nutritional support.
Shams, Wael E; Hanley, Gregory A; Orvik, Andrea; Lewis, Nicole; Shurbaji, M Salah
The use of peritoneal lavage with antiseptic solutions after bowel surgery remains controversial. This study compared peritoneal lavage using chlorhexidine gluconate at low concentrations and normal saline in mice with cecal ligation and perforation. A total of 180 mice were randomized to six groups. Groups A, B, and C received one-time intraperitoneal injections of normal saline, chlorhexidine gluconate 0.05%, and chlorhexidine gluconate 0.025%, respectively. Groups D, E, and F were all subject to cecal ligation and perforation, then underwent partial cecectomy and peritoneal lavage with normal saline only, chlorhexidine gluconate 0.05% followed by normal saline, and chlorhexidine gluconate 0.025% followed by normal saline, respectively. Animals were followed postoperatively then sacrificed and examined at necropsy for occurrence of intra-abdominal abscesses, adhesions, or other pathology. A total of 48 mice (26.7%) developed postoperative intra-abdominal abscesses. Group E mice that had chlorhexidine gluconate 0.05% lavage had significantly lower incidence of postoperative intra-abdominal abscesses compared with that of group D mice that had saline lavage only (P = 0.0113). There was no significant difference in occurrence of macroscopic adhesions among mice groups that had or did not have surgery. (P = 1 and P = 0.3728). Microscopic peritoneal fibrosis occurred significantly more among group E mice that had chlorhexidine gluconate 0.05% lavage compared with group D mice that had saline lavage only (P = Chlorhexidine gluconate 0.05% peritoneal lavage after partial colectomy (cecectomy) in mice reduces postoperative intra-abdominal infection without significant macroscopic adhesion formation. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available Tae Hoon Kim, Jae Seung Lee, Sei Won Lee, Yeon-Mok Oh Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Abstract: Postoperative pulmonary complications (PPCs are one of the most important causes of postoperative morbidity and mortality after abdominal surgery. Although chronic obstructive pulmonary disease (COPD has been considered a risk factor for PPCs, it remains unclear whether mild-to-moderate COPD is a risk factor. This retrospective cohort study included 387 subjects who underwent abdominal surgery with general anesthesia in a tertiary referral hospital. PPCs included pneumonia, pulmonary edema, pulmonary thromboembolism, atelectasis, and acute exacerbation of COPD. Among the 387 subjects, PPCs developed in 14 (12.0% of 117 patients with mild-to-moderate COPD and in 13 (15.1% of 86 control patients. Multiple logistic regression analysis revealed that mild-to-moderate COPD was not a significant risk factor for PPCs (odds ratio [OR] =0.79; 95% confidence interval [CI] =0.31–2.03; P=0.628. However, previous hospitalization for respiratory problems (OR =4.20; 95% CI =1.52–11.59, emergency surgery (OR =3.93; 95% CI =1.75–8.82, increased amount of red blood cell (RBC transfusion (OR =1.09; 95% CI =1.05–1.14 for one pack increase of RBC transfusion, and laparoscopic surgery (OR =0.41; 95% CI =0.18–0.93 were independent predictors of PPCs. These findings suggested that mild-to-moderate COPD may not be a significant risk factor for PPCs after abdominal surgery.Keywords: postoperative pulmonary complications, spirometry, risk factor, abdominal surgery, postoperative complications, postoperative care
Schaefer, Maximilian S; Wania, Viktoria; Bastin, Bea; Schmalz, Ursula; Kienbaum, Peter; Beiderlinden, Martin; Treschan, Tanja A
Electrical impedance tomography (EIT) of the lungs facilitates visualization of ventilation distribution during mechanical ventilation. Its intraoperative use could provide the basis for individual optimization of ventilator settings, especially in patients at risk for ventilation-perfusion mismatch and impaired gas exchange, such as patients undergoing major open upper abdominal surgery. EIT throughout major open upper abdominal surgery could encounter difficulties in belt positioning and signal quality. Thus, we conducted a pilot-study and tested whether EIT is feasible in patients undergoing major open upper abdominal surgery. Following institutional review board's approval and written informed consent, we included patients scheduled for major open upper abdominal surgery of at least 3 hours duration. EIT measurements were conducted prior to intubation, at the time of skin incision, then hourly during surgery until shortly prior to extubation and after extubation. Number of successful intraoperative EIT measurements and reasons for failures were documented. From the valid measurements, a functional EIT image of changes in tidal impedance was generated for every time point. Regions of interest were defined as horizontal halves of the picture. Monitoring of ventilation distribution was assessed using the center of ventilation index, and also using the total and dorsal ventilated lung area. All parameter values prior to and post intubation as well as extubation were compared. A p abdominal surgery lasting 4-13 hours were planned in 14 patients. The electrode belt was attached between the 2(nd) and 4(th) intercostal space. Consecutive valid measurements could be acquired in 13 patients (93%). 111 intraoperative measurements could be retrieved as planned (93%). Main obstacle was the contact of skin electrodes. Despite the high belt position, distribution of tidal volume showed a significant shift of ventilation towards ventral lung regions after intubation. This
Jønsson, Line Rokkedal; Ingelsrud, Lina Holm; Tengberg, Line Toft; Bandholm, Thomas; Foss, Nicolai Bang; Kristensen, Morten Tange
Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7). Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activePAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization. Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed.
Ellul, Thomas; Bullock, Nicholas; Abdelrahman, Tarig; Powell, Arfon G M T; Witherspoon, Jolene; Lewis, Wyn G
The number of citations a scientific article receives provides a good indication of its impact within any given field. This bibliometric analysis aimed to identify the 100 most cited articles in Emergency Abdominal Surgery (EAS), to highlight key areas of interest and identify those that have most significantly shaped contemporary clinical practice in this newly evolving surgical specialty. This is of increasing relevance as concerns grow regarding the variable and suboptimal outcomes in Emergency General Surgery. The Thomson Reuters Web of Science database was used to search using the terms [Emergency AND Abdom* AND Surg*] to identify all English language, full manuscripts. Results were ranked according to citation number. The top 100 articles were further analysed by subject, author, journal, year of publication, institution, and country of origin. The median (range) citation number of the top 100 out of 7433 eligible papers was 131 (1569-97). The most cited paper (by Goldman et al., Massachusetts General Hospital, New England Journal of Medicine; 1569 citations) focused on cardiac risk stratification in non-cardiac surgery. The Journal of Trauma, Injury, Infection and Critical Care published the most papers and received most citations (n = 19; 2954 citations. The majority of papers were published by centres in the USA (n = 52; 9422 citations), followed by the UK (n = 13; 1816 citations). The most common topics of publication concerned abdominal aneurysm management (n = 26) and emergency gastrointestinal surgery (n = 26). Vascular surgery, risk assessment and gastrointestinal surgery were the areas of focus for 59% of the contemporary most cited emergency abdominal surgery manuscripts. By providing the most influential references this work serves as a guide to what makes a citable emergency surgery paper. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.
Ahmad T. Alhammouri
Full Text Available Acute pericarditis is common but illusive, often mimicking acute coronary syndrome in its clinical and electrocardiographic presentation. Regional pericarditis, though rare, presents further challenge with a paucity of published diagnostic criteria. We present a case of postoperative regional pericarditis and discuss helpful electrocardiographic findings. A 66-year-old male with history of open drainage of a liver abscess presented with abdominal pain and tenderness. CT of the abdomen was concerning for pneumatosis intestinalis of the distal descending colon. He underwent lysis of liver adhesions; exploration revealed only severe colonic impaction, for which he had manual disimpaction and peritoneal irrigation. Postoperatively, he developed sharp chest pain. Electrocardiogram revealed inferior ST elevation. Echocardiogram revealed normal left and right ventricular dimensions and systolic function without wall motion abnormalities. Emergent coronary angiography did not identify a culprit lesion, and left ventriculogram showed normal systolic function without wall motion abnormalities. He received no intervention, and the diagnosis of regional pericarditis was entertained. His cardiac troponin was 0.04 ng/dL and remained unchanged, with resolution of the ECG abnormalities in the following morning. Review of his preangiography ECG revealed PR depression, downsloping baseline between QRS complexes, and reciprocal changes in the anterior leads, suggestive of regional pericarditis.
Banke, A.B.; Andersen, Jakob Steen; Heslet, L.
Care Unit's (ICU) Critical Information System, a blood bank and the database of a vascular surgery unit. RESULTS: The perioperative mortality was 8%, ICU mortality 22%, postoperative mortality 33% and 30-day mortality 39%. The ICU mortality for patients with renal failure and septic shock...... concentration. CONCLUSION: The treatment of patients with rAAA at RH is comparable to leading clinical practice results. Postoperative bleeding, septic shock and renal failure are identified as predictive factors for increased ICU mortality and morbidity, for which reason future monitoring and postoperative r...
Chylak, J; Michalska, W; Drews, M; Marciniak, R; Deja, A
The aim of this study was to determine bacterial flora infecting the peritoneal cavity during intraabdominal surgery by site of operation. Three groups of patients were examined. 29 patients who underwent surgery on the stomach, duodenum, biliary tract or pancreas, 15 patients operated on because of acute appendicitis and 63 patients operated on because of colon or rectum tumours. At the end of the operation but before closure cultures were obtained by swab from the completed anastomosis site. Samples were placed into transport medium and transported promptly to the laboratory. The results of the bacteriological examinations showed that the peritoneal cavity of all patients operated on were infected with bacteria characteristic for the digestive tract, especially by Enterobacteriaceae spp., Enterococcus spp. and Bacteroides spp. From patients operated on because of rectum or colon tumours 3 or 4 bacterial species were isolated most often and they were often infected with P. aeruginosa and C. albicans. This was in contrast to patients from the other groups. In patients infected with polymicrobial flora, B. fragilis and E. coli or enterococci and E. coli and enterococci were most often seen.
Ahmed, Khalid; Bashar, Khalid; Connelly, Tara T M; Fahey, Tom; Walsh, Stewart R
Surgical site infection (SSI) is one of the main causes of morbidity and death after surgical intervention. The use of physical barriers, including gloves, drapes, and gowns to reduce SSI after abdominal surgery is long-standing practice. The aim of this systematic review and meta-analysis was to determine the efficacy of ring incision retractors in reducing the risk of SSI in abdominal surgery. PubMed, CINAHL, the Cochrane randomized controlled trials (RCTs) Central Register, and the ISRCTN registry were searched for RCTs in which ring retractors were utilized to reduce SSI in abdominal surgery. The PRISMA guidelines and RevMan 5.3 were used for study selection and analysis. Additional subgroup analyses were performed, including trials using incision class (clean, clean-contaminated contaminated, and dirty) and trials that used the U.S. Centers for Disease Control and Prevention's SSI definition in their protocol. A total of 19 RCTs inclusive of 4,229 patients were included. The utility of ring retractors in reducing SSI was suggested by an overall risk ratio of 0.62 (95% confidence interval 0.48-0.81). However, study heterogeneity caused by differences in effect size between individual RCTs, the non-standardized utilization of concomitant measures to reduce SSI, and an overall lack of high-quality trials was found. A reduction in SSI incidence with the use of ring retractors is suggested by the findings. However, this result must be treated with caution because in addition to some old trials poor quality and the large number of factors affecting SSI, there were substantial differences between trials in effect sizes in statistical heterogeneity. Further RCTs are needed to confirm this provisional finding.
Bergman, Simon; Deban, Melina; Martelli, Vanessa; Monette, Michèle; Sourial, Nadia; Hamadani, Fadi; Teasdale, Debby; Holcroft, Christina; Zakrzewski, Helena; Fraser, Shannon
Measuring the quality of surgical care is essential to identifying areas of weakness in the delivery of effective surgical care and to improving patient outcomes. Our objectives were to (1) assess the quality of surgical care delivered to adult patients; and (2) determine the association between quality of surgical care and postoperative complications. This retrospective, pilot, cohort study was conducted at a single university-affiliated institution. Using the institution's National Surgical Quality Improvement Program database (2009-2010), 273 consecutive patients ≥18 years of age who underwent elective major abdominal operations were selected. Adherence to 10 process-based quality indicators (QIs) was measured and quantified by calculating a patient quality score (no. of QIs passed/no. of QIs eligible). A pass rate for each individual QI was also calculated. The association between quality of surgical care and postoperative complications was assessed using an incidence rate ratio, which was estimated from a Poisson regression. The mean overall patient quality score was 67.2 ± 14.4% (range, 25-100%). The mean QI pass rate was 65.9 ± 26.1%, which varied widely from 9.6% (oral intake documentation) to 95.6% (prophylactic antibiotics). Poisson regression revealed that as the quality score increased, the incidence of postoperative complications decreased (incidence rate ratio, 0.19; P = .011). A sensitivity analysis revealed that this association was likely driven by the postoperative ambulation QI. Higher quality scores, mainly driven by early ambulation, were associated with fewer postoperative complications. QIs with unacceptably low adherence were identified as targets for future quality improvement initiatives. Copyright © 2014 Mosby, Inc. All rights reserved.
Bailey, Jonathan G; Davis, Philip J B; Levy, Adrian R; Molinari, Michele; Johnson, Paul M
Postoperative complications have been identified as an important and potentially preventable cause of increased hospital costs. While older adults are at increased risk of experiencing complications and other adverse events, very little research has specifically examined how these events impact inpatient costs. We sought to examine the association between postoperative complications, hospital mortality and loss of independence and direct inpatient health care costs in patients 70 years or older who underwent nonelective abdominal surgery. We prospectively enrolled consecutive patients 70 years or older who underwent nonelective abdominal surgery between July 1, 2011, and Sept. 30, 2012. Detailed patient-level data were collected regarding demographics, diagnosis, treatment and outcomes. Patient-level resource tracking was used to calculate direct hospital costs (2012 $CDN). We examined the association between complications, hospital mortality and loss of independence cost using multiple linear regression. During the study period 212 patients underwent surgery. Overall, 51.9% of patients experienced a nonfatal complication (32.5% minor and 19.4% major), 6.6% died in hospital and 22.6% experienced a loss of independence. On multivariate analysis nonfatal complications (p abdominal surgery in older adults and accounted for 44% of overall costs. This represents a substantial opportunity for better patient outcomes and cost savings with quality improvement strategies tailored to the needs of this high-risk surgical population.
Hahn, Robert G; Bahlmann, Hans; Nilsson, Lena
Quantification of renal fluid conservation is possible by urine analysis, and the results can indicate dehydration. The present report sought to determine whether this fluid retention correlates with fluid requirements during major abdominal surgeries that have estimated operating times ≥ 2 h. Urine colour, specific weight, osmolality and creatinine concentration were used to calculate a composite "fluid retention index" (FRI) in 97 patients prior to major abdominal surgery. Goal-directed fluid volume optimization, with hydroxyethyl starch supplemented with a background administration of crystalloid fluid, was used. The median preoperative FRI was 3.0. Fluid retention, considered as present when FRI ≥ 3.5, was found in 37% of the patients. Fluid retention was followed by a significantly larger blood loss (+ 125%; 450 vs. 200 ml), higher haemorrhage rate (+ 41%; 123 vs. 87 ml/h) and greater need for both colloid (+ 43%; 1.43 vs. 1.00 l) and crystalloid (+ 18%; 1.28 vs. 1.08 l) fluids. Despite the larger blood loss, the total fluid balance was more positive after surgery in the dehydrated patients (+ 26%; 1.91 vs. 1.51 l; P retention, as detected in a urine sample, was associated with a greater blood loss and a more positive fluid balance during major abdominal surgery. ClinicalTrials.gov, NCT01458678.
Kawano, Takashi; Eguchi, Satoru; Iwata, Hideki; Yamanaka, Daiki; Tateiwa, Hiroki; Locatelli, Fabricio M; Yokoyama, Masataka
The present study aimed to explore the preventive or therapeutic effect of peri-operative pregabalin treatment on the memory deficits and related hippocampal inflammation following surgery in aged rats. Aged rats underwent abdominal or sham surgery, and were then divided into 2 groups, either early or late pregabalin treatment. Fourteen days after surgery, the cognitive function was assessed using novel object recognition test, followed by measurement of hippocampal cytokines and voltage-dependent calcium channel α2δ subunit (CACNA2D1). The parabiotic experiments determined whether the humoral or neuronal pathway was involved in the neuroinflammation development following the abdominal surgery. The effects of pregabalin on LPS-induced cytokine release from hippocampal microglia were also evaluated. Early pregabalin treatment, which was administered pre-operatively and continued for 3 or 7days after surgery, prevented memory deficits and decreased hippocampal pro-inflammatory cytokine levels. In contrast, no beneficial effects were observed when pregabalin was administered late in the post-operative period. The hippocampal levels of CACNA2D1 did not change under any experimental condition. The data from the cross-circulation (parabiosis) experiments indicated that abdominal surgery may induce neuroinflammation via a neural transmission pathway from the periphery to the brain. The ex vivo experiments further demonstrated that pregabalin had no effect on LPS-induced cytokines release from hippocampal microglia. Our findings highlight reveal that peri-operative pregabalin treatment during the early post-operative period can prevent neuroinflammation and memory deficits after surgery. It is likely this occurs through a peripheral and central neuro-immune interaction rather than through direct anti-inflammatory effects. Copyright © 2016 Elsevier Inc. All rights reserved.
Seeger John D
Full Text Available Abstract Background Pre-marketing clinical studies of tegaserod suggested an increased risk of abdominal surgery, particularly cholecystectomy. We sought to quantify the association between tegaserod use and the occurrence of abdominal or pelvic surgery, including cholecystectomy. Methods This cohort study was conducted within an insured population. Tegaserod initiators and similar persons who did not initiate tegaserod were followed for up to six months for the occurrence of abdominal or pelvic surgery. Surgical procedures were identified from health insurance claims validated by review of medical records. The incidence of confirmed outcomes was compared using both as-matched and as-treated analyses. Results Among 2,762 tegaserod initiators, there were 94 abdominal or pelvic surgeries (36 gallbladder: among 2,762 comparators there were 134 abdominal or pelvic surgeries (37 gallbladder (hazard ratio HR] = 0.70, 95% confidence interval [C.I.] = 0.54-0.91 overall, HR = 0.98, 95% C.I. = 0.62-1.55 for gallbladder. Current tegaserod exposure compared to nonexposure was associated with a rate ratio [RR] of 0.68 (95% C.I. = 0.48-0.95 overall, while the RR was 0.99 (95% C.I. = 0.56-1.77 for gallbladder surgery. Conclusions In this study, tegaserod use was not found to increase the risk of abdominal or pelvic surgery nor the specific subset of gallbladder surgery.
Rita Araújo; Céline Marques; David Fernandes; Emanuel Almeida; Joana Alves; Mariana Rodrigues; Miguel Ferreira; Ricardo Bernardo; Rita Santa-Bárbara; Sara de Freitas; Célia Xavier; Isabel Neves
Introduction: The Management of postoperative pain after abdominal surgery is a major challenge to the anesthesiologist. The optimization of postoperative analgesia improves prognosis contributing also to patient satisfaction and reducing morbidity and mortality. The aim of this randomized control study is to perform the comparative analysis in terms of effectiveness of an unconventional and still poorly technique implemented, continuous wound infusion, and the currently most applied and gold...
Comparison of the efficacy of chlorhexidine gluconate versus povidone iodine as preoperative skin preparation for the prevention of surgical site infections in clean-contaminated upper abdominal surgeries.
Srinivas, Anirudh; Kaman, Lileswar; Raj, Prithivi; Gautam, Vikas; Dahiya, Divya; Singh, Gurpreet; Singh, Rajinder; Medhi, Bikash
To compare the efficacy of chlorhexidine-gluconate versus povidone iodine in preoperative skin preparation in the prevention of surgical site infections (SSIs) in clean-contaminated upper abdominal surgeries. This was a prospective randomized controlled trial conducted on patients undergoing clean-contaminated upper abdominal surgeries. A total of 351 patients 18-70 years old were randomized into two groups; chlorhexidine and povidone iodine skin preparation before surgery. The incidence of SSIs in the chlorhexidine group was 10.8 %, in comparison to 17.9 % in the povidone iodine group. The odds ratio was 0.6 in favor of chlorhexidine use, but the results were not statistically significant (P = 0.06). In the first postoperative week, SSIs developed in 7 % of patients in the chlorhexidine group and 14.1 % in the povidone iodine group (P = 0.03), and in the second postoperative week, SSIs were present in 4.1 % of the patients in the chlorhexidine group and 4.4 % in the povidone iodine group, which was not statistically significant (P = 0.88). The incidence of SSIs after clean-contaminated upper abdominal surgeries was lower with the use of chlorhexidine skin preparation than with povidone iodine preparation, although the results were not statistically significant. However, the odds ratio between the two groups favored the use of chlorhexidine over povidone iodine for preventing SSIs.
Bisgaard, T; Kjaersgaard, M; Bernhard, A
: The study included twelve hospitalized patients after major abdominal surgery studied on day 2 to 4 after operation and twelve unhospitalized healthy volunteers. Measurements were performed for 24 consecutive hours. The actigraphy measurements were compared with self-reported activity- and sleep......OBJECTIVE: Assessment of early postoperative activity is important in the documentation of improvements of peri-operative care. This study was designed to validate computerized activity-based monitoring of physical activity and sleep (actigraphy) in patients after abdominal surgery. METHODS.......15). In both study groups, all correlation coefficients between actigraphy measurements and self-reported activity data were statistically significant (r, values for patients 0.4 to 0.8 and volunteers 0.6 to 0.9). A higher mean agreement between automated actigraphy sleep detection and self-reported sleep...
Goodenough, Christopher J; Ko, Tien C; Kao, Lillian S; Nguyen, Mylan T; Holihan, Julie L; Alawadi, Zeinab; Nguyen, Duyen H; Flores, Juan R; Arita, Nestor T; Roth, J Scott; Liang, Mike K
Ventral incisional hernias (VIH) develop in up to 20% of patients after abdominal surgery. No widely applicable preoperative risk-assessment tool exists. We aimed to develop and validate a risk-assessment tool to predict VIH after abdominal surgery. A prospective study of all patients undergoing abdominal surgery was conducted at a single institution from 2008 to 2010. Variables were defined in accordance with the National Surgical Quality Improvement Project, and VIH was determined through clinical and radiographic evaluation. A multivariate Cox proportional hazard model was built from a development cohort (2008 to 2009) to identify predictors of VIH. The HERNIAscore was created by converting the hazards ratios (HR) to points. The predictive accuracy was assessed on the validation cohort (2010) using a receiver operator characteristic curve and calculating the area under the curve (AUC). Of 625 patients followed for a median of 41 months (range 0.3 to 64 months), 93 (13.9%) developed a VIH. The training cohort (n = 428, VIH = 70, 16.4%) identified 4 independent predictors: laparotomy (HR 4.77, 95% CI 2.61 to 8.70) or hand-assisted laparoscopy (HAL, HR 4.00, 95% CI 2.08 to 7.70), COPD (HR 2.35; 95% CI 1.44 to 3.83), and BMI ≥ 25 kg/m(2) (HR1.74; 95% CI 1.04 to 2.91). Factors that were not predictive included age, sex, American Society of Anesthesiologists (ASA) score, albumin, immunosuppression, previous surgery, and suture material or technique. The predictive score had an AUC = 0.77 (95% CI 0.68 to 0.86) using the validation cohort (n = 197, VIH = 23, 11.6%). Using the HERNIAscore: HERNIAscore = 4(∗)Laparotomy+3(∗)HAL+1(∗)COPD+1(∗) BMI ≥ 25, 3 classes stratified the risk of VIH: class I (0 to 3 points),5.2%; class II (4 to 5 points),19.6%; and class III (6 points), 55.0%. The HERNIAscore accurately identifies patients at increased risk for VIH. Although external validation is needed, this provides a starting point to counsel patients and guide
Dreyer, Nikol E; Cutshall, Susanne M; Huebner, Marianne; Foss, Diane M; Lovely, Jenna K; Bauer, Brent A; Cima, Robert R
The purpose of this randomized controlled trial was to evaluate the effect of postoperative massage in patients undergoing abdominal colorectal surgery. One hundred twenty-seven patients were randomized to receive a 20-min massage (n = 61) or social visit and relaxation session (no massage; n = 66) on postoperative days 2 and 3. Vital signs and psychological well-being (pain, tension, anxiety, satisfaction with care, relaxation) were assessed before and after each intervention. The study results indicated that postoperative massage significantly improved the patients' perception of pain, tension, and anxiety, but overall satisfaction was unchanged. In conclusion, massage may be beneficial during postoperative recovery for patients undergoing abdominal colorectal surgery. Further studies are warranted to optimize timing and duration and to determine other benefits in this clinical setting. Copyright © 2015 Elsevier Ltd. All rights reserved.
Ashraf Abualhassan Abdellatif
Full Text Available Context: Supraglottic airway devices have been used as an alternative to tracheal intubation during laparoscopic surgery. Aims: The study was designed to compare the efficacy of Streamlined Liner of the Pharynx Airway (SLIPA for positive pressure ventilation and postoperative complications with the Laryngeal Mask Airway ProSeal (PLMA for patients undergoing lower abdominal laparoscopies under general anesthesia with controlled ventilation. Settings and Design: Prospective, crossover randomized controlled trial performed on patients undergoing lower abdominal laparoscopic surgeries. Methods: A total of 120 patients undergoing lower abdominal laparoscopic surgeries were randomly allocated into two equal groups; PLMA and SLIPA groups. Number of intubation attempts, insertion time, ease of insertion, and fiberoptic bronchoscopic view were recorded. Lung mechanics data were collected 5 minutes after securing the airway, then after abdominal insufflation. Blood traces and regurgitation were checked for; postoperative sore throat and other complications were recorded. Statistical Analysis: Arithmetic mean and standard deviation values were calculated and statistical analyses were performed for each group. Independent sample t-test was used to compare continuous variables exhibiting normal distribution, and Chi-squared test for noncontinuous variables. P value <0.05 was considered significant. Results: Insertion time, first insertion success rate, and ease of insertion were comparable in both groups. Fiberoptic bronchoscopic view was significantly better and epiglottic downfolding was significantly lower in SLIPA group. Sealing pressure and lung mechanics were similar. Gastric distension was not observed in both groups. Postoperative sore throat was significantly higher in PACU in PLMA group. Blood traces on the device were significantly more in SLIPA group. Conclusions: SLIPA can be used as a useful alternative to PLMA in patients undergoing lower
Salim, A S
This prospective randomised study examined the possibility of early resumption of oral hydration and discontinuation of intravenous fluid replacement after emergency or elective abdominal surgery. Following elective cholecystectomy alone or with a choledocholithotomy or an emergency Hartmann's procedure for large bowel obstruction, patients were randomised to early oral hydration (sips of water for 12 h followed by free fluids by mouth for 24 h, when oral intake of food was allowed--intraveno...
Full Text Available OBJECTIVES: The development of sepsis after abdominal surgery is associated with high morbidity and mortality. Due to inflammation, it may be difficult to diagnose infection when it occurs, but measurement of C-reactive protein could facilitate this diagnosis. In the present study, we evaluated the predictive value and time course of C-reactive protein in relation to outcome in patients admitted to the intensive care unit (ICU after abdominal surgery. METHODS: We included patients admitted to the ICU after abdominal surgery over a period of two years. The patients were divided into two groups according to their outcome: favorable (F; left the ICU alive, without modification of the antibiotic regimen and unfavorable (D; death in the ICU, surgical revision with or without modification of the antibiotic regimen or just modification of the regimen. We then compared the highest C-reactive protein level on the first day of admission between the two groups. RESULTS: A total of 308 patients were included: 86 patients had an unfavorable outcome (group D and 222 had a favorable outcome (group F. The groups were similar in terms of leukocytosis, neutrophilia, and platelet count. C-reactive protein was significantly higher at admission in group D and was the best predictor of an unfavorable outcome, with a sensitivity of 74% and a specificity of 72% for a threshold of 41 mg/L. No changes in C-reactive protein, as assessed based on the delta C-reactive protein, especially at days 4 and 5, were associated with a poor prognosis. CONCLUSIONS: A C-reactive protein cut-off of 41 mg/L during the first day of ICU admission after abdominal surgery was a predictor of an adverse outcome. However, no changes in the C-reactive protein concentration, especially by day 4 or 5, could identify patients at risk of death.
Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.
Patients in New Zealand have now developed a fear of mesh abdominal wall hernia repair due to inaccurate media reporting. This article outlines the extensive literature that confirms abdominal wall mesh hernia repair is safe and effective. The worsening confidence in the transvaginal mesh prolapse repair should not adversely affect the good results of mesh abdominal wall hernia repair. New Zealand general surgeons are well trained in providing modern hernia surgery.
Crawford, M E; Møiniche, S; Orbæk, Janne
Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...... hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients....
Tengberg, Line Toft; Foss, Nicolai Bang; Lauritsen, Morten Laksafoss
INTRODUCTION: Undergoing acute high-risk abdominal (AHA) surgery is associated with reduced survival and a great risk of an adverse outcome, especially in the elderly. The primary aim of this study was to investigate the residential status and quality of life in elderly patients undergoing AHA...... surgery. METHODS: From 1 November 2014 to 30 April 2015, consecutive patients (≥ 75 years) undergoing AHA surgery were included for follow-up after six months. The patients included answered a health-related quality-of-life questionnaire and a supplemental questionnaire regarding residential status....... The results were compared with an age-matched national control group. RESULTS: A total of 52 patients matched the inclusion crit-eria. Mortality at six months after surgery was 46%. Out of the 28 survivors, 22 participated in the study. Quality of life was estimated as good in 77% of the survivors...
Ehlers, Lars; Laursen, Kathrine Bang; Jensen, Morten Berg
Purpose: The purpose of this study was to describe the health-related quality-of-life (QoL) in patients after elective surgery for abdominal aortic aneurysm (AAA) compared to a normal population and to study the association between QoL and number of years since surgery. Methods: All Danish men who....... Limitations: The main limitation of the study was the cross-sectional design. Males with a higher risk of death were under-represented in the sample. Conclusion: A poorer quality-of-life was found in patients having had elective AAA surgery compared to the normal population....... underwent elective surgery for AAA at the age of 65 or more in the period from 1989–2007 in Denmark were invited to participate in the survey. Of 722 patients, 375 were alive and 328 (87%) responded. The nstruments EQ-5D (European Quality of life), EQ-VAS and SF-12 (Short Form Health Survey) were applied...
Aga, Emil; Keinan-Boker, Lital; Eithan, Arieh; Mais, Tamar; Rabinovich, Alia; Nassar, Faris
Abdominal surgeries have high rates of surgical site infections (SSIs), contributing to increased morbidity and mortality and costs for hospitalization. The aim of this study was to determine the SSI incidence rates and risk factors after abdominal surgeries. This prospective cohort study included all patients undergoing abdominal surgeries between 2005 and 2007 in the Western Galilee Medical Center in Nahariya, Israel. SSI incidence rates were calculated per 100 operations. Odds ratios (ORs) were estimated for each risk factor using univariate and multivariate analyses by logistic regression models. Among 302 patients in the study cohort, the total SSI incidence rate was 22.2%. The univariate analysis defined 13 variables significantly associated with SSI: age > 60 years, lower functional status, diabetes mellitus, congestive heart failure, immunocompromising underlying disease, treatment with chemotherapy and other immunosuppressive medications, impaired immune system open cholecystectomy, laparotomy, an American Society of Anesthesiologists (ASA) score > 2, drain insertion, and 'dirty wound' classification. In multivariate regression analysis, treatment with immunosuppressive medications (OR = 2.5, 95% confidence interval (CI) = 1.099-143.443), open cholecystectomy (OR = 2.25, 95% CI = 2.242-40.109), and dirty wound classification (OR = 2.179, 95% CI = 3.80-20.551) were significantly associated with SSI. The significant risk factors defined should be addressed preoperatively to decrease the risk for SSI. Wound surveillance in the post-discharge period is necessary for correct estimation of SSI rates.
Holzknecht, Barbara; Thorup, Jens Frederik; Arendrup, M C
Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients with gastrointes......Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients....... The candidaemia rate decreased from 1.5/1000 admissions in the pre-intervention to 0.3/1000 admissions in the post-intervention period (p 0.002). Numbers of BSIs and bed-days remained stable, and numbers of admissions and surgical procedures performed increased during the study period. Fluconazole consumption...... in the two abdominal surgery departments increased from 4.6 to 12.2 defined daily doses per 100 bed-days (p fluconazole-resistant strains (14/29 pre- and 2/7 post...
Lu, Ning; Marumoto, Ashley; Wong, Linda L
Abdominal surgery in critically ill patients has high mortality, contributing to high US healthcare costs. This study sought to identify specific predictors of mortality in this population. Using the National Surgical Quality Improvement Program database 2006 to 2012, we identified 4,901 patients who were intubated for more than 48 hours before undergoing common abdominal procedures. Mortality and predictors of mortality were determined using chi-square and/or regression analysis. Overall 30-day mortality was 44.2% with increasing mortality for additional procedures performed. Ventilated patients with the following preoperative risk factors were 2 to 3 times as likely to die within 30 days of surgery: age greater than 65-years old, coma, preoperative international normalized ratio greater than 3.0, esophageal varices, and disseminated cancer. Mortality is significant in ventilated patients who undergo abdominal surgery and is especially high with advanced age, disseminated cancer, and complications of liver disease. Physicians should carefully discuss this with patients and/or family and consider palliative options when appropriate. Copyright © 2016 Elsevier Inc. All rights reserved.
Linke, Georg R; Mieth, Markus; Hofer, Stefan; Trierweiler-Hauke, Birgit; Weitz, Jürgen; Martin, Eike; Büchler, Markus W
Surgical intensive care units (ICU) play a pivotal role in perioperative care of patients undergoing major abdominal surgery. Differences in quality of care provided by medical staff in ICUs may be linked to improved outcome. This review aims to elucidate the relationship between quality of care at various ICUs and patient outcome, with the ultimate aim of identifying key measures for achieving optimal outcome. We reviewed the literature in PubMed to identify current ICU structural and process concepts and variations before evaluating their respective impact on quality of care and outcome in major abdominal surgery. ICU leadership, nurse and physician staffing, and provision of an intermediate care unit are important structural components that impact on patients' outcome. A "mixed ICU" model, with intensivists primarily caring for the patients in close cooperation with the primary physician, seems to be the most effective ICU model. Surgeons' involvement in intensive care is essential, and a close cooperation between surgeons and anesthesiologists is vital for good outcome. Current general process concepts include early mobilization, enteral feeding, and optimal perioperative fluid management. To decrease failure-to-rescue rates, procedure-specific intensive care processes are particularly focused on the early detection, assessment, and timely and consistent treatment of complications. Several structures and processes in the ICU have an impact on outcome in major abdominal surgery. ICU structures and care processes connected with optimal outcome could be transmitted to other centers to improve outcome, independent of procedure volume.
Toft, P; Nielsen, C H; Tønnesen, Else Kirstine
Cardiac and major abdominal surgery are associated with granulocytosis in peripheral blood. The purpose of the present study was to describe the granulocyte and monocyte oxidative burst and the expression of adhesion molecules following cardiac surgery with cardiopulmonary bypass and abdominal...... surgery, 1, 5, 10 and 20 min after aortic clamping, and then 1, 5, 10 and 20 min and 1, 2 and 3 h after declamping. Samples from eight patients undergoing abdominal surgery were taken before surgery, at the end of surgery, and 2 and 3 h post-operatively. A decrease in number of granulocytes and monocytes...... during cardiopulmonary bypass was observed. The percentage of CD11a-positive granulocytes increased from 30% pre-operatively to 75% following cardiopulmonary bypass, while CD44-positive granulocytes increased from 5% to 13%. Despite the extent of the changes, these were not significant. The oxidative...
Maia, Lígia de A.; Samary, Cynthia S.; Oliveira, Milena V.; Santos, Cintia L.; Huhle, Robert; Capelozzi, Vera L.; Morales, Marcelo M.; Schultz, Marcus J.; Abreu, Marcelo G.; Pelosi, Paolo; Silva, Pedro L.; Rocco, Patricia Rieken Macedo
Intraoperative mechanical ventilation may yield lung injury. To date, there is no consensus regarding the best ventilator strategy for abdominal surgery. We aimed to investigate the impact of the mechanical ventilation strategies used in 2 recent trials (Intraoperative Protective Ventilation
Conclusion: Our analyses provided valuable information about the factors associated with PCEA consumption over time after upper abdominal surgery. However, the mechanism of how these factors interact over the course of time awaits further investigation.
Park, Chi-Min; Chun, Ho-Kyung; Jeon, Kyeongman; Suh, Gee Young; Choi, Dong Wook; Kim, Sung
Metabolic acidosis is frequently observed in perioperative patients, especially those who undergo major surgery. The aim of this study was to evaluate the factors related to post-operative metabolic acidosis and to attempt to identify the clinical effect of metabolic acidosis following major abdominal surgery. We included 172 patients admitted to a surgical intensive care unit (ICU) following major abdominal surgery. All cases were divided into either the acidosis or the normal group using immediate post-operative standard base excess (SBE). The following clinical data were retrospectively obtained from the chart and ICU database: basic clinical characteristics, operative data, type and volume of fluid infused during the operation, post-operative arterial blood gas analysis, lactate, and central venous oxygen saturation. The predominant intraoperative fluid was either 0.9% saline or lactated Ringer's solution. The operation length, estimated blood loss, total fluid infused, total saline infused, lactate and corrected chloride were significantly higher in the acidosis group; however, central venous oxygen saturation was lower in the normal group. Among these factors, total infused saline and lactate level were independent factors related to metabolic acidosis. The comparison between the types of fluid revealed that the saline group had a significantly lower SBE, strong ion difference and higher corrected chloride. SBE was significantly correlated with lactate and total infused saline. ICU and hospital length of stay were significantly longer in the acidosis group. Post-operative metabolic acidosis following major abdominal surgery was closely related to both hyperchloremic acidosis associated with large saline infusion and lactic acidosis caused by lactataemia. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.
Bouman, Esther A; Theunissen, Maurice; Bons, Sabrina A; van Mook, Walther N; Gramke, Hans-F; van Kleef, Maarten; Marcus, Marco A
Chronic postsurgical pain (CPSP) is a common complication of surgery with high impact on quality of life. Peripheral and central sensitization caused by enhanced and prolonged afferent nociceptive input are considered important mechanisms for the development of CPSP. This case-control study investigated whether epidural analgesia is associated with a reduced incidence of CPSP after open abdominal surgery. Six months after surgery, Short-Form-36 Health Survey (SF-36) pain scores, possible predictors of chronic pain, and quality of life were assessed. Patients treated with epidural analgesia in combination with general anesthesia (epidural group, N = 51) were compared to patients undergoing matched surgical procedures receiving general anesthesia alone (GA-group, N = 50). Multivariate analysis was performed by logistic regression analysis. Twenty-six (25.7%) patients experienced chronic pain, 9 in the epidural group (17.6%), 17 in the GA-group (34%), crude odds ratio (OR) 0.42 (95% confidence interval (CI) 0.16 to 1.05). After adjustment for the most prominent predictors of CPSP, such as age, sex, pre-operative pain, and acute postoperative pain, the OR for chronic pain in the epidural group was 0.19 (95% CI 0.05 to 0.76). Patients with CPSP reported a significantly lower quality of life compared to patients without CPSP (SF-36 total score median (IQR) 39.2 (27.2 to 56.7) vs. 84.3 (69.9 to 92.5, P abdominal surgery. Postoperative epidural analgesia is associated with a reduced incidence of CPSP after abdominal surgery. © 2013 World Institute of Pain.
Konstantatos, A H; Imberger, G; Angliss, M
The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia.......The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia....
Ostheimer, C; Meyer, F; Kornhuber, C; Reese, T; Vordermark, D
Radiooncological therapies are an integral part of the multimodal oncological treatment concepts in general and abdominal surgery. These include therapeutic approaches with a curative intention such as the neoadjuvant (pre-operative) radiotherapy of locoregionally advanced and/or N+ oesophageal and rectal cancer, definitive combined chemoradiotherapy of locally advanced, unresectable oesophageal cancer or oesophageal tumour lesions of the upper third, definitive radiotherapy of anal cancer (sphincter sparing) and pre- or post-operative radiotherapy of soft tissue sarcoma on the one hand. A yT0 stage achieved as characteristic of a curative effect by radiation in oesophageal and rectal cancer (omitting subsequent surgical intervention, naturally under clinical and imaging-based controls within short-term follow-up intervals) can be considered as a very interesting set-up with regard to its reasonable integration in daily clinical practice, which needs to be further and critically discussed. By integrating radiotherapy in interdisciplinary therapy concepts, improved tumour control and survival rates with clinically acceptable toxicity can be achieved. On the other hand, non-invasive, locally ablative radiooncological therapies such as extracranial stereotactic body radiotherapy constitute an effective and feasible treatment method for liver metastases in oligometastatic colorectal cancer or other tumour entities according to the decisions by the institutional tumour board, offering high local tumour control rates which can be part of multistep, multimodal procedures with curative intention. This review aims at providing an overview for the general and abdominal surgeon, outlining relevant radiooncological treatment aspects in the multimodal cancer therapy with a focus on the treatment of rectal, oesophageal and anal cancer as well as soft tissue sarcoma and hepatic metastases in oligometastatic colorectal cancer. Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Objective: The purpose of this study was to assess the effect of respiratory physiotherapy (walking, cough and kinesiotherapy on lung function in patients during the postoperative period of upper abdominal surgery. Methods: A total of 30 patients (14 female and 16 male; mean age of 53 years were evaluated clinically and by pulmonary function tests, measurements of respiratory muscle strength and arterial oxygen saturation. Patients were randomly included in Group A (walking and coughing or Group B (walking, coughing and kinesiotherapy – diaphragmatic exercises during sustained and non-sustained inhaling. Rresults: Compared to preoperative values, the forced expiratory volume during the first second decreased 24% in Group A and 31% in Group B during the first postoperative day; a 7 and a 14% (non significant decrease was maintained in the fifth postoperative day. The forced vital capacity decreased by 27% (Group A and by 33% (Group B in the first postoperative day; a 12% (non significant decrease in Group A, and a 20% decrease in Group B was maintained in the fifth postoperative day. The maximum inspiratory pressure decreased 16% in the first postoperative day (Groups A and B; a 4% (non significant drop was maintained in the fifth postoperative day (both groups. The maximum expiratory pressure decreased 20 (Group A and 18% (Group B in the first postoperative day; a 14% decrease (Group A and 15% decrease (Group B was maintained in the fifth postoperative day. Cconclusion: The progression of Group A was similar to that of Group B (which had a higher risk of complications, suggesting that adding kinesiotherapy was beneficial.
operative fluid management, minimally invasive surgical techniques, optimal pain control, early initiation of mobilization and feeding, and early discharge from hospital. The beneficial effects of this practice arise from early mobilization and feeding, and the reduced hospital stay. They include reduced costs, early discharge ...
Cihoric, Mirjana; Toft Tengberg, Line; Bay-Nielsen, Morten
BACKGROUND: With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has never...... been validated exclusively in an emergency setting. METHODS: A consecutive prospective single-center cohort study of 355 adults undergoing emergency high-risk abdominal surgery between June 2013 and May 2014 is presented. The primary outcome measure was 30-day mortality. Secondary outcome measures were...... emergency high-risk abdominal surgery. Despite its predictive value, the SAS cannot in its current version be recommended as a standalone prognostic tool in an emergency setting....
Full Text Available It is perceived that patients with a history of frequent alcohol consumption require more opioids for postoperative pain control and experience less postoperative nausea and vomiting than patients without such a history. However, there is scarce evidence supporting this notion. The aim of this study was to assess association between frequent alcohol consumption and opioid requirement for postoperative pain control and occurrence of postoperative nausea and vomiting.The medical records for 4143 patients using intravenous patient-control analgesia with opioids after abdominal surgery between January 2010 and September 2013 were obtained, and associations were sought between the cumulative opioid consumption (in intravenous morphine equivalence per body weight (mg/kg in the first 2 days after abdominal operation and several demographic and clinical variables by multiple regression analysis. The association between the occurrence of postoperative nausea and vomiting and several demographic and clinical variables was also sought by multiple logistic regression analysis.Frequent alcohol drinking, among other previously reported factors, was associated with increased opioid consumption for postoperative pain control (p < 0.001. The estimate effect of frequent alcohol drinking was 0.117 mg/kg. Frequent alcohol drinking was also associated with decreased risks of postoperative nausea (odds ratio = 0.59, p = 0.003 and vomiting (odds ratio = 0.49, p = 0.026.Frequent alcohol drinking was associated with increased opioid consumption for postoperative pain control and decreased risks of postoperative nausea and vomiting after abdominal surgery.
Hanada, Masatoshi; Tawara, Yuichi; Miyazaki, Takuro; Sato, Shuntaro; Morimoto, Yosuke; Oikawa, Masato; Niwa, Hiroshi; Eishi, Kiyoyuki; Nagayasu, Takeshi; Eguchi, Susumu; Kozu, Ryo
In cardiothoracic and abdominal surgery, postoperative complications remain major clinical problems. Early mobilization has been widely practiced and is an important component in preventing complications, including orthostatic hypotension (OH) during postoperative management. We investigated cardiovascular response during early mobilization and the incidence of OH after cardiothoracic and abdominal surgery. In this prospective observational study, we consecutively analyzed data from 495 patients who underwent elective cardiothoracic and abdominal surgery. We examined the incidence of OH, and the independent risk factors associated with OH during early mobilization after major surgery. Multivariate logistic regression was performed using various characteristics of patients to identify OH-related independent factors. OH was observed in 191 (39%) of 495 patients. The incidence of OH in cardiac, thoracic, and abdominal groups was 39 (33%) of 119, 95 (46%) of 208, and 57 (34%) of 168 patients, respectively. Male sex (OR 1.538; p = 0.03) and epidural anesthesia (OR 2.906; p mobilization after cardiothoracic and abdominal surgery. Sex was identified as an independent factor for OH during early mobilization after all three types of surgeries, while epidural anesthesia was only identified after thoracic surgery. Therefore, the frequent occurrence of OH during postoperative early mobilization should be recognized. University hospital Medical Information Network Center (UMIN-CTR) number UMIN000018632 . (Registered on 1st October, 2008).
Full Text Available Abstract Background There are two ways to open the abdominal cavity in elective general surgery: vertically or transversely. Various clinical studies and a meta-analysis have postulated that the transverse approach is superior to other approaches as regards complications. However, in a recent survey it was shown that 90 % of all abdominal incisions in visceral surgery are still vertical incisions. This discrepancy between existing recommendations of clinical trials and clinical practice could be explained by the lack of acceptance of these results due to a number of deficits in the study design and analysis, subsequent low internal validity, and therefore limited external generalisability. The objective of this study is to address the issue from the patient's perspective. Methods This is an intraoperatively randomized controlled observer and patient-blinded two-group parallel equivalence trial. The study setting is the Department of General-, Visceral-, Trauma Surgery and Outpatient Clinic of the University of Heidelberg, Medical School. A total of 172 patients of both genders, aged over 18 years who are scheduled for an elective abdominal operation and are eligible for either a transverse or vertical incision. To show equivalence of the two approaches or the superiority of one of them from the perspective of the patient, a primary endpoint is defined: the pain experienced by the patient (VAS 0–100 on day two after surgery and the amount of analgesic required (piritramide [mg/h]. A confidence interval approach will be used for analysis. A global α-Level of 0.05 and a power of 0.8 is guaranteed, resulting in a size of 86 patients for each group. Secondary endpoints are: time interval to open and close the abdomen, early-onset complications (frequency of burst abdomen, postoperative pulmonary complications, and wound infection and late complications (frequency of incisional hernias. Different outcome variables will be ranked by patients and
Sun, Zhen; Kong, Xin-Juan; Jing, Xue; Deng, Run-Jun; Tian, Zi-Bin
Background The nutritional risk screening (NRS 2002) has been applied increasingly in patients who underwent abdominal surgery for nutritional risk assessment. However, the usefulness of the NRS 2002 for predicting is controversial. This meta-analysis was to examine whether a preoperative evaluation of nutritional risk by NRS 2002 provided prediction of postoperative outcomes in patients undergoing abdominal surgery. Methods A systematic literature search for published papers was conducted using the following online databases: MEDLINE, EMBASE, the Cochrane library, EBSCO, CRD databases, Cinahl, PsycInfo and BIOSIS previews. The pooled odds ratio (OR) or weight mean difference (WMD) was calculated using a random-effect model or a fix-effect model. Results Eleven studies with a total of 3527 patients included in this study. Postoperative overall complications were more frequent in nutritional risk patients versus patients without nutritional risk (the pooled OR 3.13 [2.51, 3.90] pnutritional risk group and non-nutritional risk group was 3.61 [1.38, 9.47] (p = 0.009). Furthermore, the postoperative hospital stay was significant longer in the preoperative nutritional risk group than in the nutritional normal group (WMD 5.58 [4.21, 6.95] pnutritional risk have increased complication rates, high mortality and prolonged hospital stay after surgery. However, NRS 2002 needs to be validated in larger samples of patients undergoing abdominal surgery by better reference method. PMID:26172830
Gögenur, I; Rosenberg-Adamsen, S; Lie, C
BACKGROUND: Episodic hypoxaemia, cardiac arrhythmias, and myocardial ischaemia may be related after major abdominal surgery. METHODS: We studied 52 patients on the second and third nights after major abdominal operations, using continuous pulse oximetry and Holter ECG. We recorded the amount...... of time spent with oxygen saturation values less than 90, 85, and 80% during the night, and noted episodes of hypoxaemia, tachycardia, bradycardia, and ST-segment changes. RESULTS: In 87 study nights there were 2403 (individual range 1-229) episodes of hypoxaemia, 3509 (individual range 1-234) episodes...... of tachycardia, and 265 (individual range 1-73) episodes of ST segment deviation. Of the 52 patients, 50 had episodes of hypoxaemia and tachycardia, and 19 patients had one or more episodes of ST segment deviation. For 38% of the episodes of ST deviation, there was an episode of hypoxaemia at the same time...
Atallah, Vincent [Department of Radiation Oncology, Bergonie Institute, Bordeaux (France); Honore, Charles [Department of Digestive Surgery, Gustave-Roussy Institute, Paris (France); Orbach, Daniel; Helfre, Sylvie [Department of Pediatric Oncology, Curie Institute, Paris (France); Ducassou, Anne [Department of Radiation Oncology, Universitary Cancer Institute, Toulouse (France); Thomas, Laurence [Department of Radiation Oncology, Bergonie Institute, Bordeaux (France); Levitchi, Mihai-Barbu [Department of Radiation Oncology, Alexis-Vautrin Center, Nancy (France); Mervoyer, Augustin [Department of Radiation Oncology, Cancerologie de l' ouest Institute, Nantes (France); Naji, Salem [Department of Radiation Oncology, Paoli-Calmette Institute, Marseille (France); Dupin, Charles [Department of Radiation Oncology, Universitary Hospital, Bordeaux (France); Bosco-Levy, Pauline J. [Department of Radiation Oncology, Bergonie Institute, Bordeaux (France); Philippe-Chomette, Pascale [Department of Pediatric Surgery, University Paris 7 Denis Diderot, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris (France); Kantor, Guy; Henriques de Figueiredo, Benedicte [Department of Radiation Oncology, Bergonie Institute, Bordeaux (France); Sunyach, Marie-Pierre [Department of Radiation Oncology, Leon-Berard Center, Lyon (France); Sargos, Paul, E-mail: email@example.com [Department of Radiation Oncology, Bergonie Institute, Bordeaux (France)
Purpose: To identify the prognostic role of adjuvant abdominal radiation therapy (RT) on oncologic outcomes as a part of multimodal treatment in the management of desmoplastic small round cell tumor (DSRCT) and to determine its impact according to the quality of surgical resection. Methods and Materials: All patients treated for primary abdominal DSRCT in 8 French centers from 1991 to 2014 were included. Patients were retrospectively staged into 3 groups: group A treated with adjuvant RT after cytoreductive surgery, group B without RT after cytoreductive surgery, and group C by exclusive chemotherapy. Peritoneal progression-free survival (PPFS), progression-free survival (PFS), and overall survival (OS) were evaluated. We also performed a direct comparison between groups A and B to evaluate RT after cytoreductive surgery. Radiation therapy was also evaluated according to completeness of surgery: complete cytoreductive surgery (CCS) or incomplete cytoreductive surgery (ICS). Results: Thirty-seven (35.9%), thirty-six (34.9%), and thirty (28.0%) patients were included in groups A, B, and C, respectively. Three-year OS was 61.2% (range, 41.0%-76.0%), 37.6% (22.0%-53.1%), and 17.3% (6.3%-32.8%) for groups A, B, and C, respectively. Overall survival, PPFS, and PFS differed significantly among the 3 groups (P<.001, P<.001, and P<.001, respectively). Overall survival and PPFS were higher in group A (RT group) compared with group B (no RT group) (P=.045 and P=.006, respectively). Three-year PPFS was 23.8% (10.3%-40.4%) for group A and 12.51% (4.0%-26.2%) for group B. After CCS, RT improved PPFS (P=.024), but differences in OS and PFS were not significant (P=.40 and P=.30, respectively). After ICS, RT improved OS (P=.044). A trend of PPFS and PFS increase was observed, but the difference was not statistically significant (P=.073 and P=.076). Conclusions: Adjuvant RT as part of multimodal treatment seems to confer oncologic benefits for patients treated for abdominal DSRCT
Full Text Available Background. Malnutrition has serious implications for recovery after surgery. Early detection of malnutrition with nutritional support minimizes postoperative complications. Nutritional assessment tools need to be simple and suitable for use in everyday practice. In our study we wanted to determine, how many patients might benefit from nutritional support.Methods. From April to August 1999 fifty consecutively admitted patients predicted to major abdominal surgery have been examined. We used Mini nutritional assessment (MNA, Buzby’s nutrition risk index (NRI, blood albumin level and weight loss in the last 3 months period prior to the examination, to assess nutritional status.Results. We examined 50 patients (27 males and 23 females, age 76.5 ± 16.5 and confirmed malnutrition in 40% of patients with MNA and serum albumin level. The increased risk for nutrition-associated complications was confirmed by NRI and weight loss in 44%.Conclusions. A confident diagnosis of malnutrition and increased risk for nutrition-associated complications can be established by using a combination of simple methods like MNA, NRI, weight loss and serum albumin level. Almost half of the patients admitted for major abdominal surgery in General hospital Celje suffer from malnutrition and they may benefit with early nutritional intervention.
Lee, Regent; Jones, Amy; Woodgate, Felicity; Killough, Nicholas; Bellamkonda, Kirthi; Williams, Matthew; Hurst, Katherine; Fulford-Smith, Lucy; Cassimjee, Ismail; Handa, Ashok
As part of the Oxford Abdominal Aortic Aneurysm (OxAAA) Study, we conducted an international survey of vascular surgery professionals. One aspect of the survey is as published in the International Journal of Cardiology: "International Opinion on Priorities in Research for Small Abdominal Aortic Aneurysms and the Potential Path for Research to Impact Clinical Management". This Data-in-Brief article contains a detailed method for the conduct of this survey and additional original data. In this survey, we also provided vascular surgery colleagues with contemporary epidemiologic and surgical outcome data. This was followed by a hypothetical scenario whereby a patient had just been diagnosed with a small (40 mm) AAA and a novel biomarker predicted it to be fast growing in the coming years. We assessed the vascular professionals' perception of the patient's preference for management in this scenario, and their willingness to refer patients for a surgical trial that investigates the outcome of early versus late surgery in this setting. The survey then asked the vascular professionals to assume the role of the patient, and provided their own preferences in such a scenario.
V. V. Moroz
Full Text Available In elderly and senile patients, extracardiac surgery frequently leads to cardiovascular complications. For their prevention, it is necessary to early detect patients with a potentially poor postoperative period. Routine preoperative examination is of limited prognostic value and instrumental techniques are inaccessible. Objective: to reveal the predictors of cardiac complications of abdominal and small pelvic surgery in elderly and senile patients. Subjects and methods. The study covered 82 patients (63 men and 19 women aged over 60 years who had undergone at least one-hour open operations on the abdomen and small pelvis at the A. A. Vishnevsky Central Military Hospital Three in 2008—2011. In addition to routine procedures, the preoperative examination comprised the calculation of the Lee, Goldman, and Detsky scores and, in 35 patients, determination of NT-proBNP concentrations. Results. The logistic regression method applying the values routinely measured prior to surgery was used to make a cardiac complication-predicting model that included the Detsky index and blood glucose levels. Its dividing capacity proved to be satisfactory – AUC 0.75. Inclusion of echocardiographic data in the model failed to substantially improve its prognostic capacity. The cardiomarker NT-proBNP was the most effective predictor of postoperative complications. As its value became higher, there was an increase in the frequency of cardiac complications (p<0.001; AUC was 0.96. Conclusion. NT-proBNP is a highly effective predictor of postoperative complications in elderly and senile patients and may be included into preoperative screening. Key words: elderly and senile age, abdominal surgery, heart failure, surgery risk assessment, natriuretic peptides, Lee index, Goldman index, Detsky index, NT-proBNP.
Davidson, Tima; Lotan, Eyal; Klang, Eyal; Nissan, Johnatan; Goldstein, Jeffrey; Goshen, Elinor; Ben-Haim, Simona; Apter, Sara; Chikman, Bar
We describe FDG-PET/CT findings of postoperative fat necrosis in patients following abdominal surgery, and evaluate their changes in size and FDG uptake over time. FDG-PET/CT scans from January 2007-January 2016 containing the term 'fat necrosis' were reviewed. Lesions meeting radiological criteria of fat necrosis in patients with prior abdominal surgery were included. Forty-four patients, 30 males, mean age 68.4 ± 11.0 years. Surgeries: laparotomy (n=37; 84.1 %), laparoscopy (n=3; 6.8 %), unknown (n=4; 9.1 %). CTs of all lesions included hyperdense well-defined rims surrounding a heterogeneous fatty core. Sites: peritoneum (n=34; 77 %), omental fat (n=19; 43 %), subcutaneous fat (n=8; 18 %), retroperitoneum (n=2; 5 %). Mean lesion long axis: 33.6±24.9 mm (range: 13.0-140.0). Mean SUVmax: 2.6±1.1 (range: 0.6-5.1). On serial CTs (n=34), lesions decreased in size (p=0.022). Serial FDG-PET/CT (n=24) showed no significant change in FDG-avidity (p=0.110). Mean SUVmax did not correlate with time from surgery (p=0.558) or lesion size (p=0.259). Postsurgical fat necrosis demonstrated characteristic CT features and may demonstrate increased FDG uptake. However, follow-up of subsequent imaging scans showed no increases in size or FDG-avidity. Awareness of this entity is important to avoid misinterpretation of findings as recurrent cancer. • Postsurgical fat necrosis may mimic cancer in FDG-PET/CT. • Follow-up of fat necrosis showed no increase in FDG intensity. • CT follow-up showed a decrease in lesion size. • FDG uptake did not correlate with time lapsed from surgery.
Bulut, O; Aslak, K K; Levic, K
BACKGROUND: Potential benefits of single-port laparoscopic surgery may include improved cosmetic results, less postoperative pain, surgical trauma and faster recovery. Results of randomized prospective studies with a focus on single-port rectal surgery have not yet been presented. The aim...... of the present study was to compare single-port and conventional laparoscopic surgery for rectal cancer in terms of short-term outcomes including postoperative pain and trauma-induced changes in certain bioactive substances. METHODS: Patients with non-metastasized rectal cancer were prospectively randomized...... groups for plasma IL-6 and TIMP-1 at all time points, while the CRP levels were significantly lower in the single-port group at 6 (p Abdominal incisions lengths were significantly shorter in the single-port group (p = 0.001). There was no significant...
Akinremi, A A; Orotokun, A E; Sanya, A O
Obesity phenotypes are known to have varying effects on pulmonary function but their effects on trends of pulmonary function indices' recovery among abdominal surgery patients is unclear. To investigate the influence of obesity phenotype on pulmonary function trend among abdominal surgery patients. An observational study involving 28 female patients aged 20-60 years who were never-smokers. Participants were classified into four groups namely: healthy BMI without abdominal obesity; healthy BMI with abdominal obesity; overweight/obese without abdominal obesity; and overweight/obese with abdominal obesity. Pulmonary function indices (FEV1, FVC and PEF) were taken day-1 pre-op; 5th, 6th and 7th day post-surgery. Data were summarized using mean and standard deviation, while Kruskal-Wallis and Jonckheere trend test were used to test for differences and trend across the groups at p trend test showed that obesity pattern had significant effect on the trend of FEV1, FVC and PER with group I having the highest values, followed by group III and group II, while group IV had the lowest values. Obesity phenotype had significant effect on trend of pulmonary function indices among participants. Patients with abdominal obesity, irrespective of BMI, had poor pulmonary function.
Rangel, Erika L; Rios-Diaz, Arturo J; Uyeda, Jennifer W; Castillo-Angeles, Manuel; Cooper, Zara; Olufajo, Olubode A; Salim, Ali; Sodickson, Aaron D
Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients. Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval [CI], 1.6-3.7) and mortality at 30 days (hazard ratio [HR], 3.7; 95% CI, 1.9-7.4), 90 days (HR, 3.3; 95% CI, 1.8-6.0), 180 days (HR, 2.5; 95% CI, 1.4-4.4), and 1 year (HR, 2.4; 95% CI, 1.4-3.9). Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is
Mcilvoy, Laura; Richmer, Linda; Kramer, Deborah; Jackson, Rita; Shaffer, Leslee; Lawrence, Jeffrey; Inman, Kevin
The purpose of this study was to explore the effectiveness of the aromatherapy product QueaseEASE (QE) for decreasing postdischarge nausea (PDN) in patients undergoing outpatient abdominal surgery. Prospective exploratory study. Informed Consent was obtained preoperatively from a convenience sample of adult patients scheduled for outpatient abdominal surgery procedures. Prior to discharge, subjects were instructed in the use of QE and given instructions on how to rate their nausea on a 0-10 scale. They recorded nausea scales > 0 any time they occurred for the next 24 hours, used the QE, and recorded their nausea scales 3 minutes later. A study nurse called subjects the next day to collect the information. The sample included 70 outpatients who underwent abdominal surgery. Twenty-five participants (36%) reported experiencing PDN and their concomitant use of QE. There was a significant difference in mean age of those reporting PDN (37 years) versus those without nausea (48 years, P = .004) as well as a significant difference in mean intravenous fluid intake during hospitalization of those reporting PDN (1,310 mL) versus those without nausea (1,511 mL, P = .04). The PDN group had more female participants (72% vs 42%, P = .02), more participants that were less than 50 years of age (84% vs 53%, P = .02), and received more opioids (100% vs 76%, P = .006) than the no nausea group. The 25 PDN participants reported 47 episodes of PDN in which they used QE. For all of the 47 PDN episodes experienced, participants reported a decrease in nausea scale (0 to 10) after the use of QE; for 22 (47%) of the PDN episodes experienced, a nausea scale of 0 after using QE was reported. The mean decrease in nausea scale for all 25 participants was 4.78 (±2.12) after using QE. This study found that the aromatherapy QE was an effective treatment of PDN in select same-day abdominal surgery patients. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc
Rosenberg, J; Dirkes, W E; Kehlet, H
In 20 patients undergoing elective major abdominal surgery, heart rate and arterial oxygen saturation were monitored continuously during the night 2 days before operation and during the first and second nights after operation (23:00 to 07:30). Mean heart rate increased by 16 beat min-1 (P less than...... arrhythmias on the morning of the third day after operation. In another patient the episodes of desaturation correlated with increases in heart rate. There was no correlation between administration of opioids and heart rate and saturation disturbances. The mechanism and clinical relevance of episodic...
Rosenberg, J; Pedersen, U; Erichsen, C J
The effect of oxygen therapy (37% by face mask) and epidural local anesthetic blockade (9 ml 0.5% bupivacaine at Th9-11 level) on wound oxygenation was evaluated in eight otherwise healthy patients undergoing elective colorectal resection. The patients were monitored continuously for subcutaneous...... any of the measured values. Oxygen therapy before epidural blockade increased median subcutaneous oxygen tension from 60 to 71 mmHg (P oxygen tension with oxygen therapy was 30 (15-55) min...... without epidural blockade and 15 (10-20) min with blockade (P oxygen tension with or without oxygen therapy after elective uncomplicated major abdominal surgery....
Oleyar, Michael; Neustein, Steven M
Patients with a known difficult airway for intubation who present with intestinal obstruction are at an increased risk for receiving general anesthesia. It may be necessary to perform an awake fiberoptic intubation, or possibly a tracheostomy if an awake intubation cannot be performed. In some cases, an awake tracheostomy may not be possible due to the anatomy. We report a case in which a patient with extreme fixed neck flexion deformity in whom a tracheostomy would not have been possible, presented for emergency abdominal surgery.
Arsalani-Zadeh, Reza; Ullah, Sana; Khan, Shakeeb; MacFie, John
Any form of trauma, including surgery, is known to result in oxidative stress. Increased intra-abdominal pressure during pneumoperitoneum and inflation-deflation may cause ischemia reperfusion and, hence, oxidative stress may be greater during laparoscopic surgery. The aim of this study was to systemically review the literature to compare oxidative stress in laparoscopic and open procedures. A systematic search of the Medline, Pub Med, EMBASE, and Cochrane databases was performed with the following keywords: pneumoperitoneum AND surger $ OR laparoscop $ AND oxida $. The search was limited to articles published between 1980 and August 2010. The initial search identified 197 papers. After review of the abstracts, 17 papers met the inclusion criteria. Six more papers were identified through the reference lists. It was not possible to perform a meta-analysis due to heterogeneity of patient data, patient selection criteria, and diversity of biomarkers used. The majority of studies demonstrated greater immediate oxidative stress after open surgery. There was, however, a paucity of studies comparing open versus laparoscopic surgery with regards to tissue oxidative stress. Laparoscopic surgery seems to produce less systemic oxidative stress. However the effect of pneumoperitoneum on local oxidative stress and tissue hypoxia and its clinical significance need further investigation. Copyright © 2011 Elsevier Inc. All rights reserved.
Jean K Marshall
Full Text Available Maintenance of high tissue oxygenation (PtO2 is recommended during surgery because PtO2 is highly predictive of surgical site infection and colonic anastomotic leakage. However, surgical site perfusion is often sub-optimal, creating an obstructive hurdle for traditional, systemically applied therapies to maintain or increase surgical site PtO2. This research tested the hypothesis that insufflation of humidified-warm CO2 into the abdominal cavity would increase sub-peritoneal PtO2 during open abdominal surgery.15 Wistar rats underwent laparotomy under general anesthesia. Three sets of randomized cross-over experiments were conducted in which the abdominal cavity was subjected to alternating exposure to 1 humidified-warm CO2 & ambient air; 2 humidified-warm CO2 & dry-cold CO2; and 3 dry-cold CO2 & ambient air. Sub-peritoneal PtO2 and tissue temperature were measured with a polarographic oxygen probe.Upon insufflation of humidified-warm CO2, PtO2 increased by 29.8 mmHg (SD 13.3; p<0.001, or 96.6% (SD 51.9, and tissue temperature by 3.0°C (SD 1.7 p<0.001, in comparison with exposure to ambient air. Smaller, but significant, increases in PtO2 were seen in experiments 2 and 3. Tissue temperature decreased upon exposure to dry-cold CO2 compared with ambient air (-1.4°C, SD 0.5, p = 0.001.In a rat model, insufflation of humidified-warm CO2 into the abdominal cavity during open abdominal surgery causes an immediate and potentially clinically significant increase in PtO2. The effect is an additive result of the delivery of CO2 and avoidance of evaporative cooling via the delivery of the CO2 gas humidified at body temperature.
Smit, Linda C; Bruins, Marjan J; Patijn, Gijs A; Ruijs, Gijs J H M
Major resections for esophageal, gastric, hepatic, pancreatic, and colorectal cancer continue to be associated with a high peri-operative morbidity of up to 30%-40%. To a large extent, this morbidity is caused by infectious complications that add up to a considerable burden to patients and hospital costs. The objective of this large retrospective cross-sectional study was to determine independent patient and operation-related risk factors for infectious complications after major abdominal cancer operations to elucidate how infection rates can be reduced and improve health-care quality. In 1,389 cancer patients who underwent a major resection procedure between 2009 and 2013, infectious complications and their independent determinants were analyzed by multivariable logistic regression (p abdominal drainage (OR 1.41; p = 0.024) and a duration of surgery of ≥180 min (OR 1.85; p = 0.001) were risk factors for surgical site infections. Total parenteral nutrition was significantly associated with intravascular catheter-induced infections (OR 18.09; p abdominal cancer operations were identified, providing opportunities for further reducing peri-operative infections. General awareness and focus on preventing infectious complications may have a significant impact on health-care outcomes and costs.
Mans Christina M
Full Text Available Abstract Background In patients undergoing open cardiothoracic and upper abdominal surgery, postoperative pulmonary complications remain an important cause of postoperative morbidity and mortality, impacting upon hospital length of stay and health care resources. Adequate preoperative respiratory muscle strength may help protect against the development of postoperative pulmonary complications and therefore preoperative inspiratory muscle training has been suggested to be of potential value in improving postoperative outcomes. Methods/Design A systematic search of electronic databases will be undertaken to identify randomized trials of preoperative inspiratory muscle training in patients undergoing elective open cardiothoracic and upper abdominal surgery. From these trials, we will extract available data for a list of predefined outcomes, including postoperative pulmonary complications, hospital length of stay and respiratory muscle strength. We will meta-analyze comparable results where possible, and report a summary of the available pool of evidence. Discussion This review will provide the most comprehensive answer available to the question of whether preoperative inspiratory muscle training is clinically useful in improving postoperative outcomes in patients undergoing cardiothoracic and upper abdominal surgery. It will help inform clinicians working in the surgical arena of the likely effectiveness of instituting preoperative inspiratory muscle training programs to improve postoperative outcomes.
Greenawalt, Keith E; Colt, M Jude; Corazzini, Rubina L; Krauth, Megan C; Holmdahl, Lena
Sodium hyaluronate and carboxymethylcellulose (HA-CMC) membrane is an effective barrier material for limiting postoperative adhesions, but can be difficult to apply in certain situations due to its physical properties. We tested whether HA-CMC membrane hydrated in saline (slurry) is an effective alternative to HA-CMC membrane for preventing surgical adhesions in rat models of abdominal surgery. All studies were performed in rat cecal abrasion or sidewall defect models of adhesion formation. Adhesions were examined 7 d after surgery. In separate studies, the effects of variations in slurry composition, volume, and site of application on anti-adhesive properties were studied and compared with untreated controls. Finally, the effectiveness of HA-CMC membrane slurry for preventing adhesions was compared with that of conventional HA-CMC membrane. Application of HA-CMC membrane slurry to traumatized tissue resulted in a significant reduction in the incidence of adhesions compared with untreated controls in both rat surgery models. Slurry was equally effective when applied in low and high film-to-volume formulations, but had minimal effect when applied in a small volume or at a location distal to the injury. Comparison of HA-CMC membrane slurry and conventional HA-CMC membrane indicated similar efficacy for reducing postoperative adhesions. In rat models of abdominal surgery, HA-CMC membrane slurry reduced postoperative adhesion formation and may be an effective alternative for HA-CMC membrane in situations where its use is limited by its physical properties. Copyright © 2011 Elsevier Inc. All rights reserved.
Full Text Available Background and Aims: Advanced monitoring targeting haemodynamic and oxygenation variables can improve outcomes of surgery in high-risk patients. We aimed to assess the impact of goal directed therapy (GDT targeting cardiac index (CI and oxygen extraction ratio (O 2 ER on outcomes of high-risk patients undergoing abdominal surgery. Methods: In a prospective randomised trial, forty patients (American Society of Anaesthesiologists II and III undergoing major abdominal surgeries were randomised into two groups. In-Group A mean arterial pressure ≥ 65 mmHg, central venous pressure ≥ 8-10 mmHg, urine output ≥ 0.5 mL/kg/h and central venous oxygen saturation ≥ 70% were targeted intra-operatively and 12 h postoperatively. In-Group-B (enhanced GDT, in addition to the monitoring in-Group-A, CI ≥ 2.5 L/min/m 2 and O 2 ER ≤ 27% were targeted. The end-points were lactate levels and base deficit during and after surgery. The secondary end points were length of Intensive Care Unit (ICU and hospital stay and postoperative complications. Wilcoxon Mann Whitney and Chi-square tests were used for statistical assessment. Results: Lactate levels postoperatively at 4 and 8 h were lower in-Group-B (P < 0.05. The mean base deficit at 3, 4, 5 and 6 h intra-operatively and postoperatively after 4, 8 and 12 h were lower in-Group-B (P < 0.05. There were no significant differences in ICU stay (2.10 ± 1.52 vs. 2.90 ± 2.51 days or hospital stay (10.85 + 4.39 vs. 13.35 + 6.77 days between Group A and B. Conclusions: Implementation of enhanced GDT targeting CI and OER was associated with improved tissue oxygenation.
Full Text Available Background: Postoperative pulmonary complications (PPC are of the major reasons for death. Prolonged mechanical ventilation (PMV and delayed extubation are leading to the incidence of more seriously complications. The effect of hyperinflation has not been investigated in control of these complications in patients who have been weaned from mechanical ventilation and are undergoing T-tube support. Aim: Investigation of MHI effect on oxygenation of patients following abdominal surgery and T-tube support. Method: This clinical trial was performed on 40 patients undergoing abdominal surgery and T-tube support hospitalized in intensive care units of hospitals in Mashhad, Iran, in 2015-2016. The participants were divided randomly into two experimental and control groups. In the experimental group, MHI technique was performed using Mapleson circuit for three twenty-minute periods. The control group received routine hospital care. The two groups were compared for PaO2, PaCO2 and SpO2 before intervention, 5 and 20 minutes after intervention. Data were analyzed using SPSS software. Results: The mean age was 66.7±8.3 and 67.5±9.0 years in experimental and control groups, respectively. In intergroup comparison using independent t-test, the mean PaCO2, PaO2 and SpO2 had no significant differences in the experimental group before the intervention. However, the means SpO2 and PaO2 at 5 and 20 minutes after intervention were significantly higher in the experimental group (p
Pal, Anirban; Biswas, Jhuma; Mukhopadhyay, Purnava; Sanyal, Poushali; Dasgupta, Shyamal; Das, Shyamashis
The present study aimed to compare the efficacy of injectable diclofenac intramuscularly (IM), injection paracetamol intravenously (IV), or a combination of both to provide post-operative analgesia in patients undergoing lower abdominal gynecological surgeries. A total of 90 female patients (American Society of Anesthesiologists I and II), aged 20-50 years, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomized to receive 75 mg diclofenac IM 8 hourly (Group D) or 1 g paracetamol IV 8 hourly (Group P) or a combination of both 8 hourly (Group PD) for 24 h post-operative period from the start of surgery. The primary outcome measured was the requirement of rescue analgesic (tramadol), the secondary outcomes measured included visual analog score (VAS) for pain, time until first rescue analgesic administration, patient satisfaction score and any side effects. The requirement of rescue analgesic was significantly lower in Groups D and PD compared to Group P. Mean (standard deviation) tramadol requirement during 24 h was 56.67 (62.60) mg, 20.00 (40.68) mg and 20.00 (40.68) mg in the Groups P, D and PD respectively. Less number of patients in Groups D and PD (20% in both the groups) required rescue analgesic compared to Group P (50%). The VAS showed a significant decrease in Groups D and PD compared to Group P between 4 and 12 h post-operatively. However, Group PD showed no significant difference when compared to Group D alone. Injection diclofenac IM is more effective than paracetamol IV in terms of rescue analgesic requirement, but the combination of diclofenac IM and paracetamol IV provides no added advantage over diclofenac IM alone.
Full Text Available Introduction: Data on specific abdominal surgery and Cushing’s syndrome are infrequent and are usually included in the adrenalectomy reports. Current literature suggests the feasibility and reproducibility of the surgical adrenalectomies for patients diagnosed with non-functioning tumours and functioning adrenal tumours including pheochromocytoma, Conn’s syndrome and Cushing’s syndrome. Discussion: Medical treatment for Cushing’s syndrome is feasible but follow-up or clinical situations force the patient to undergo a surgical procedure. Laparoscopic surgery has become a gold standard nowadays in a broad spectrum of pathologies. Laparoscopic adrenalectomies are also standard procedures nowadays. However, despite the different characteristics and clinical disorders related to the laparoscopically removed adrenal tumours, the intraoperative and postoperative outcomes do not significantly differ in most cases between the different groups of patients, techniques and types of tumours. Tumour size, hormonal type and surgeon’s experience could be different factors that predict intraoperative and postoperative complications. Transabdominal and retroperitoneal approaches can be considered. Outcomes for Cushing’s syndrome do not differ depending on the surgical approach. Novel technologies and approaches such as single-port surgery or robotic surgery have proven to be safe and feasible. Conclusion: Laparoscopic adrenalectomy is a safe and feasible approach to adrenal pathology, providing the patients with all the benefits of minimally invasive surgery. Single-port access and robotic surgery can be performed but more data are required to identify their correct role between the different surgical approaches. Factors such as surgeon’s experience, tumour size and optimal technique can affect the outcomes of this surgery.
Maeso, Sergio; Reza, Mercedes; Mayol, Julio A; Blasco, Juan A; Guerra, Mercedes; Andradas, Elena; Plana, María N
The main aim of this review was to compare the safety and efficacy of the Da Vinci Surgical System (DVSS) and conventional laparoscopic surgery (CLS) in different types of abdominal intervention. DVSS is an emerging laparoscopic technology. The surgeon directs the robotic arms of the system through a console by means of hand controls and pedals, making use of a stereoscopic viewing system. DVSS is currently being used in general, urological, gynecologic, and cardiothoracic surgery. This systematic review analyses the best scientific evidence available regarding the safety and efficacy of DVSS in abdominal surgery. The results found were subjected to meta-analysis whenever possible. Thirty-one studies, 6 of them randomized control trials, involving 2166 patients that compared DVSS and CLS were examined. The procedures undertaken were fundoplication (9 studies, one also examining cholecystectomy), Heller myotomy (3 studies), gastric bypass (4), gastrectomy (2), bariatric surgery (1), cholecystectomy (4), splenectomy (1), colorectal resection (7), and rectopexy (1). DVSS was found to be associated with fewer Heller myotomy-related perforations, a more rapid intestinal recovery time after gastrectomy-and therefore a shorter hospital stay, a shorter hospital stay following cholecystectomy (although the duration of surgery was longer), longer colorectal resection surgery times, and a larger number of conversions to open surgery during gastric bypass. The publications reviewed revealed DVSS to offer certain advantages with respect to Heller myotomy, gastrectomy, and cholecystectomy. However, these results should be interpreted with caution until randomized clinical trials are performed and, with respect to oncologic indications, studies include variables such as survival.
Intraoperative blood salvage reduces the requirements for allogenic blood transfusion and transfusion related inflammatory response in abdominal aortic aneurysm surgery: Blood transfusion and abdominal aortic aneurysm surgery
Full Text Available Introduction. Intraoperative blood salvage (IBS is a procedure involving recovering blood looses during surgery and reinfusing it into the patient with a purpose to reduce the perioperative morbidity and mortality associated with complications after administration of allogenic transfusion (AT. The aim of this study was to investigate whether the IBS reduces the need for allogenic transfusion requirements and for non-invasive ventilation (NIV and/or oxygen supplementation and whether it was associated with decreased levels of inflammatory markers following abdominal aortic aneurysm (AAA surgery. Methods. Throughout the period from February to October 2010, 51 patients underwent both elective and emergency AAA surgery. During the study period, IBS using 'Haemonetics cell saver 5+' was applied in 24 (46.2% patients (CS group, while it wasn't used in 27 (51.9% cases (NCS group. Values of certain inflammatory biomarkers included: white blood cell count (WBCC, C-reactive protein (CRP, procalcitonin (PCT and fibrinogen were monitored during the first 48 hours postoperatively. Secondary outcome measures icluded: the need for allogenic transfusion and for non-invasive ventilation (NIV and/or oxygen supplementation. Results. The requirements for intra and postoperative alogenic red blood cells transfusions was significantly higher in patients from NCS group compared to patients in CS group (3.63 vs. 0.58 units per patient; p< 0.001. Non-invasive respiratory support was more frequently used in patient from NCS group (4/27 compared to those in CS (1/24 group but difference was not statistically significant (p=0.17. The postoperatively average WBCC was significantly higher among patients in NCS group compared to those from CS group (12.89 x 109 vs. 10.44 x109; p=0.014. Also CRP plasma levels postoperatively were significantly higher in NCS group compared to CS group (67.18 mg.L-1 vs. 47.54 mg.L-1; p=0.015. Conclusion(s. The usage of intraoperative blood
Yumioka, Tetsuya; Iwamoto, Hideto; Masago, Toshihiko; Morizane, Shuichi; Yao, Akihisa; Honda, Masashi; Muraoka, Kuniyasu; Sejima, Takehiro; Takenaka, Atsushi
To evaluate the influence of prior abdominal surgery on surgical outcomes of robot-assisted radical prostatectomy in an early single center experience in Japan. We reviewed medical records of patients with localized prostate cancer who underwent robot-assisted radical prostatectomy from October 2010 to September 2013 at Tottori University Faculty of Medicine, Yonago, Tottori, Japan. Patients with prior abdominal surgery were compared with those with no prior surgery with respect to total operative time, port-insertion time, console time, positive surgical margin and perioperative complication rate. Furthermore, the number of patients requiring minimal adhesion lysis was compared between the two groups. Of 150 patients who underwent robot-assisted radical prostatectomy, 94 (63%) had no prior abdominal surgery, whereas 56 patients (37%) did. The mean total operative time was 329 and 333 min (P = 0.340), mean port insertion time was 40 and 34.5 min (P = 0.003), mean console time was 255 and 238 min (P = 0.145), a positive surgical margin was observed in 17.9% and 17.0% patients (P = 0.896), and the incidence of perioperative complications was 25% and 23.4% (P = 0.825), respectively, in those with and without prior abdominal surgery. In the prior abdominal surgery group, 48 patients (80.4%) required adhesion lysis at the time of trocar placement or while operating the robotic console. Robot-assisted radical prostatectomy appears to be a safe approach for patients with prior abdominal surgery without increasing total operative time, robotic console time, positive surgical margin or the incidence of perioperative complications. © 2014 The Japanese Urological Association.
Lee, Yu Ri; Shin, Hye Sook
The purpose of this study was to examine the effectiveness of aromatherapy with ginger essential oil on nausea and vomiting in abdominal surgery patients. This was a quasi-experimental study with a nonequivalent control group and repeated measures. The experimental group (n = 30) received ginger essential oil inhalation. The placebo control group (n = 30) received normal saline inhalation. The level of postoperative nausea and vomiting was measured using a Korean version of the Index of Nausea, Vomiting, and Retching (INVR) at baseline and at 6, 12, and 24 h after aromatherapy administration. The data were collected from July 23 to August 22, 2012. Nausea and vomiting scores were significantly lower in the experimental group with ginger essential oil inhalation than those in the placebo control group with normal saline. In the experimental group, the nausea and vomiting scores decreased considerably in the first 6 h after inhaled aromatherapy with ginger essential oil. Findings indicate that ginger essential oil inhalation has implications for alleviating postoperative nausea and vomiting in abdominal surgery patients.
Pouwels, Sjaak; Stokmans, Rutger A; Willigendael, Edith M; Nienhuijs, Simon W; Rosman, Camiel; van Ramshorst, Bert; Teijink, Joep A W
The impact of postoperative complications after Major Abdominal Surgery (MAS) is substantial, especially when socio-economical aspects are taken into account. This systematic review focuses on the effects of preoperative exercise therapy (PEXT) on physical fitness prior to MAS, length of hospital admission and postoperative complications in patients eligible for MAS, and on what is known about the most effective kind of exercise regime. A systematic search identified randomised controlled trials on exercise therapy and pulmonary physiotherapy prior to MAS. The methodological quality of the included studies was rated using the 'Delphi List For Quality Assessment of Randomised Clinical Trials'. The level of agreement between the two reviewers was estimated with Cohen's kappa. A total of 6 studies were included, whose methodological quality ranged from moderate to good. Cohen's kappa was 0.90. Three studies reported on improving physical fitness prior to MAS with the aid of PEXT. Two studies reported on the effect of training on postoperative complications, showing contradictory results. Three studies focused on the effect of preoperative chest physiotherapy on postoperative lung function parameters after MAS. While the effects seem positive, the optimal training regime is still unclear. Preoperative exercise therapy might be effective in improving the physical fitness of patients prior to major abdominal surgery, and preoperative chest physiotherapy seems effective in reducing pulmonary complications. However consensus on training method is lacking. Future research should focus on the method and effect of PEXT before high-risk surgical procedures. Copyright © 2013 Surgical Associates Ltd. All rights reserved.
Elsayed, Yahya; Lekakou, Constantina; Ranzani, Tommaso; Cianchetti, Matteo; Morino, Mario; Arezzo, Alberto; Menciassi, Arianna; Geng, Tao; Saaj, Chakravarthini M
This paper investigates different types of crimped, braided sleeve used for a soft arm for robotic abdominal surgery, with the sleeve required to contain balloon expansion in the pneumatically actuating arm while it follows the required bending, elongation and diameter reduction of the arm. Three types of crimped, braided sleeves from PET (BraidPET) or nylon (BraidGreyNylon and BraidNylon, with different monofilament diameters) were fabricated and tested including geometrical and microstructural characterisation of the crimp and braid, mechanical tests and medical scratching tests for organ damage of domestic pigs. BraidPET caused some organ damage, sliding under normal force of 2-5 N; this was attributed to the high roughness of the braid pattern, the higher friction coefficient of polyethylene terephthalate (PET) compared to nylon, and the high frequency of the crimp peaks for this sleeve. No organ damage was observed for the BraidNylon, attributed to both the lower roughness of the braid pattern and the low friction coefficient of nylon. BraidNylon also required the lowest tensile force during its elongation to similar maximum strain as that of BraidPET, translating to low power requirements. BraidNylon is recommended for the crimped sleeve of the arm designed for robotic abdominal surgery.
Brian E Lacy
Full Text Available Abdominal bloating is a common and bothersome symptom of chronic idiopathic constipation. The objective of this trial was to evaluate the efficacy and safety of linaclotide in patients with chronic idiopathic constipation and concomitant moderate-to-severe abdominal bloating.This Phase 3b, randomized, double-blind, placebo-controlled clinical trial randomized patients to oral linaclotide (145 or 290 μg or placebo once daily for 12 weeks. Eligible patients met Rome II criteria for chronic constipation upon entry with an average abdominal bloating score ≥5 (self-assessment: 0 10-point numerical rating scale during the 14-day baseline period. Patients reported abdominal symptoms (including bloating and bowel symptoms daily; adverse events were monitored. The primary responder endpoint required patients to have ≥3 complete spontaneous bowel movements/week with an increase of ≥1 from baseline, for ≥9 of 12 weeks. The primary endpoint compared linaclotide 145 μg vs. placebo.The intent-to-treat population included 483 patients (mean age=47.3 years, female=91.5%, white=67.7%. The primary endpoint was met by 15.7% of linaclotide 145 μg patients vs. 7.6% of placebo patients (P<0.05. Both linaclotide doses significantly improved abdominal bloating vs. placebo (P<0.05 for all secondary endpoints, controlling for multiplicity. Approximately one-third of linaclotide patients (each group had ≥50% mean decrease from baseline in abdominal bloating vs. 18% of placebo patients (P<0.01. Diarrhea was reported in 6% and 17% of linaclotide 145 and 290 μg patients, respectively, and 2% of placebo patients. AEs resulted in premature discontinuation of 5% and 9% of linaclotide 145 μg and 290 μg patients, respectively, and 6% of placebo patients.Once-daily linaclotide (145 and 290 μg significantly improved bowel and abdominal symptoms in chronic idiopathic constipation patients with moderate-to-severe baseline abdominal bloating; in particular
Avrahami, R; Cohen, J D; Haddad, M; Singer, P; Zelikovski, A
To assess gastric emptying with a view to early postoperative enteral nutrition after elective abdominal aortic aneurysm (AAA) surgery. The paracetamol absorption test was used to assess gastric emptying in 13 consecutive patients at 6, 18 and 32 h following elective AAA surgery. All patients received postoperative analgesia with marcaine given via an epidural catheter during the first 48 postoperative hours. Normal emptying was defined as an area under the plasma paracetamol concentration curve at 60 min (AUC-60) of > 600 mg/min/l. The median time to normal gastric emptying was 18 +/- 7.7 h. One patient (7.6%) had normal emptying at 6 h, nine (69%) at 18 h and 12 (92%) at 32 h. The nasogastric tubes were removed at a median of 3.2 days after surgery, and enteral feeding was commenced on day 4. Gastric emptying was normal 18 h post-AAA surgery as assessed by the paracetamol absorption test. In view of the importance of maintaining an intact gastrointestinal mucosa, enteral nutrition may be commenced on the second postoperative day.
Sobol-Kwapinska, M; Plotek, W; Bąbel, P; Cybulski, M; Kluzik, A; Krystianc, J; Mandecki, M
The aim of this study was to predict acute postsurgical pain and coping with pain following surgery based on preoperative time perspectives. Time perspective is a basic dimension of psychological time. It is a tendency to focus on a particular time area: the past, the present and the future. Seventy-six patients completed measures of time perspective and pain 24 h before abdominal surgery. During the 3 days after surgery, measures of pain and coping with pain were completed. We performed hierarchical regression analyses to identify predictors of acute postsurgical pain and how patients cope with it. These analyses suggested that a preoperative past-negative time perspective can be a predictor of postoperative pain level and catastrophizing after surgery. The findings of our study indicate the importance of time perspective, especially the past perspective, in dealing with postoperative pain. Our research indicates that a preoperative past-negative time perspective is a significant predictor of acute postsurgical pain intensity and the strongest predictor of pain catastrophizing. © 2016 European Pain Federation - EFIC®.
Czyżewski, Piotr; Hryciuk, Dominika; Dąbek, Aneta; Szczepkowski, Marek
Early physiotherapy is an important part of the comprehensive treatment of patients after major abdominal surgery (MAS). Accelerated mobilization should be safe and requires the use of appropriate techniques. Most of the physiotherapists and surgeons recommends using abdominal belts. Opponents claim that belts have an adverse effect on lungs ventilation. The aim of the study was to determine the effect of abdominal belt on lung ventilation efficiency in the early period after MAS. The study involved 20 patients after MAS. Including 9 women and 11 men, aged between 40 to 90 years (x̅ 66.7). In the scheduled 7 patients and urgent 13. All of them were in the early period after surgery. Dynamic spirometry was performed twice in the postoperative period. For the first time wearing a belt, and then without the belt in the same group. Evaluated the forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF). For the analysis uses the Wilcoxon matched-pairs test and Spearman's rank correlations. P values belt were slightly lower than the values evaluated without the belt. The results are shown in percent predicted for age and gender, FEV wearing belt 52%, without belt 53%; FEV1 59% vs 61%; PEF 46% vs 51%. There were no statistically significant differences Conclusions. There were no significant negative influence of abdominal belt on lungs ventilation in early period after MAS. There was no correlations between age, body mass index and changes in ventilation indicators.
Full Text Available ABSTRACT Purpose: To evaluate the influence of prior abdominal surgery on the outcomes after robotic-assisted laparoscopic radical prostatectomy (RALP. Materials and Methods: We retrospectively analyzed patients with prostate cancer who underwent RALP between June 2012 and February 2015 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery while considering the mean total operating, console, and port-insertion times; mean estimated blood loss; positive surgical margin rate; mean duration of catheterization; and rate of complications. Results: A total of 203 patients who underwent RALP during the study period were included in this study. In all, 65 patients (32% had a prior history of abdominal surgery, whereas 138 patients (68% had no prior history. The total operating, console, and port-insertion times were 328 and 308 (P=0.06, 252 and 242 (P=0.28, and 22 and 17 minutes (P=0.01, respectively, for patients with prior and no prior surgery. The estimated blood losses, positive surgical margin rates, mean durations of catheterization, and complication rates were 197 and 170 mL (P=0.29, 26.2% and 20.2% (P=0.32, 7.1 and 6.8 days (P=0.74, and 12.3% and 8.7% (P=0.42, respectively. Furthermore, whether prior abdominal surgery was performed above or below the umbilicus or whether single or multiple surgeries were performed did not further affect the perioperative outcomes. Conclusions: Our results suggest that RALP can be performed safely in patients with prior abdominal surgery, without increasing the risk of complications.
Toft, P; Nielsen, C H; Tønnesen, E
burst of the granulocytes and monocytes decreased after declamping to 15% and 27% of initial values in vitro. Several hours after surgery, there was no significant difference between the two groups. These results can be explained by a granulocyte and monocyte refractory response developing subsequent......Cardiac and major abdominal surgery are associated with granulocytosis in peripheral blood. The purpose of the present study was to describe the granulocyte and monocyte oxidative burst and the expression of adhesion molecules following cardiac surgery with cardiopulmonary bypass and abdominal...... surgery. The ability to respond with an oxidative burst was measured by means of flow cytometry using 123-dihydrorhodamine. The adhesion molecules CD11a/CD18, CD11c/CD18, CD44 were measured using monoclonal antibodies. Blood samples from eight patients undergoing open-heart surgery were taken before...
Ashfaq, Awais; Chapital, Alyssa B; Johnson, Daniel J; Staley, Linda L; Arabia, Francisco A; Harold, Kristi L
Objectives Increasing number of mechanical circulatory assist devices (MCADs) are being placed in heart failure patients. Morbidity from device placement is high and the outcome of patients who require noncardiac surgery after, is unclear. As laparoscopic interventions are associated with decreased morbidity, we examined the impact of such procedures in these patients. Methods A retrospective review was conducted on 302 patients who underwent MCAD placement from 2005 to 2012. All laparoscopic abdominal surgeries were included and impact on postoperative morbidity and mortality studied. Results Ten out of 16 procedures were laparoscopic with 1 conversion to open. Seven patients had a HeartMate II, 2 had Total Artificial Hearts, and 1 had CentriMag. Four patients had devices for ischemic cardiomyopathy and 6 cases were emergent. Surgeries included 6 laparoscopic cholecystectomies, 2 exploratory laparoscopies, 1 laparoscopic colostomy takedown, and 1 laparoscopic ventral hernia repair with mesh. Median age of the patients was 63 years (range, 29-79 years). Median operative time was 123 minutes (range, 30-380 minutes). Five of 10 patients were on preoperative anticoagulation with average intraoperative blood loss of 150 mL (range, 20-700 mL). There were 3 postoperative complications; acute respiratory failure, acute kidney injury and multisystem organ failure resulting in death not related to the surgical procedure. Conclusion The need for noncardiac surgery in post-MCAD patients is increasing due to limited donors and due to more durable and longer support from newer generation assist devices. While surgery should be approached with caution in this high-risk group, laparoscopic surgery appears to be a safe and successful treatment option. © The Author(s) 2016.
Gheorghe, Adrian; Calvert, Melanie; Pinkney, Thomas D; Fletcher, Benjamin R; Bartlett, David C; Hawkins, William J; Mak, Tony; Youssef, Haney; Wilson, Sue
Assess the existing evidence on the clinical effectiveness of wound-edge protection devices (WEPDs) in reducing the surgical site infection (SSI) rate in patients undergoing open abdominal surgery. Surgical site infections are a common postoperative complication associated with considerable morbidity, extended hospital stay, increased health care costs, and reduced quality of life. Wound-edge protection devices have been used in surgery to reduce SSI rates for more than 40 years; however, they are yet to be cited in major clinical guidelines addressing SSI management. A review protocol was prespecified. A variety of sources were searched in November 2010 for studies containing primary data on the use of WEPDs in reducing SSI compared with standard care in patients undergoing open abdominal surgery. The outcome of interest was a well-specified, clinically based definition of an SSI. No language or time restrictions were applied. The quality assessment of the studies and the quantitative analyses were performed in line with the principles of the Cochrane Collaboration. Twelve studies reporting primary data from 1933 patients were included in the review. The quality assessment found all of them to be at considerable risk of bias. An exploratory meta-analysis was performed to provide a quantitative indication on the effect of WEPDs. The pooled risk ratio under a random effects model was 0.60 (95% confidence interval, 0.41-0.86), indicating a potentially significant benefit from the use of WEPDs. No indications of significant between-study heterogeneity or publication bias, respectively, were identified. Evidence to date suggests that WEPDs may be efficient in reducing SSI rates in patients undergoing open abdominal surgery. However, the poor quality of the existing studies and their small sample sizes raise the need for a large, good quality randomized controlled trial to validate this indication.
Full Text Available Abdominal surgery inhibits food intake and induces c-Fos expression in the hypothalamic and medullary nuclei in rats. Rikkunshito (RKT, a Kampo medicine improves anorexia. We assessed the alterations in meal microstructure and c-Fos expression in brain nuclei induced by abdominal surgery and the modulation by RKT in mice. RKT or vehicle was gavaged daily for 1 week. On day 8 mice had no access to food for 6-7 h and were treated twice with RKT or vehicle. Abdominal surgery (laparotomy-cecum palpation was performed 1-2 h before the dark phase. The food intake and meal structures were monitored using an automated monitoring system for mice. Brain sections were processed for c-Fos immunoreactivity (ir 2-h after abdominal surgery. Abdominal surgery significantly reduced bouts, meal frequency, size and duration, and time spent on meals, and increased inter-meal interval and satiety ratio resulting in 92-86% suppression of food intake at 2-24 h post-surgery compared with control group (no surgery. RKT significantly increased bouts, meal duration and the cumulative 12-h food intake by 11%. Abdominal surgery increased c-Fos in the prelimbic, cingulate and insular cortexes, and autonomic nuclei, such as the bed nucleus of the stria terminalis, central amygdala, hypothalamic supraoptic (SON, paraventricular and arcuate nuclei, Edinger-Westphal nucleus (E-W, lateral periaqueduct gray (PAG, lateral parabrachial nucleus, locus coeruleus, ventrolateral medulla and nucleus tractus solitarius (NTS. RKT induced a small increase in c-Fos-ir neurons in the SON and E-W of control mice, and in mice with surgery there was an increase in the lateral PAG and a decrease in the NTS. These findings indicate that abdominal surgery inhibits food intake by increasing both satiation (meal duration and satiety (meal interval and activates brain circuits involved in pain, feeding behavior and stress that may underlie the alterations of meal pattern and food intake inhibition
Romagnoli, Stefano; Zagli, Giovanni; Tuccinardi, Germana; Tofani, Lorenzo; Chelazzi, Cosimo; Villa, Gianluca; Cianchi, Fabio; Coratti, Andrea; De Gaudio, Angelo Raffaele; Ricci, Zaccaria
Acute kidney injury (AKI) is a frequent complication in high-risk patients undergoing major surgery and is associated with longer hospital stay, increased risk for nosocomial infection and significantly higher costs. A prospective observational study exploring the incidence of AKI (AKIN classification at any stage) in high-risk patients within 48 hours after major abdominal surgery was conducted. Patients' preoperative characteristics, intraoperative management, and outcome were evaluated for associations with AKI using a logistic regression model. Data from 258 patients were analyzed. Thirty-one patients (12%) developed AKI, reaching the AKIN stage 1. No patient reached an AKIN stage higher than 1. AKI patients were older (75.2 vs 70.2 years; P = 0.0113) and had a higher body mass index (26.5 vs 25.1 kg/m(2)). In addition, AKI patients had a significantly longer ICU length of stay (3.4 vs 2.4 days; P= .0017). Creatinine levels of AKI patients increased significantly compared to the preoperative levels at 24 (P= .0486), 48 (P= .0011) and 72 hours (P= .0055), while after 72 hours it showed a downwards trend. At ICU discharge, 28 out of 31 patients (90.3%) recovered preoperative levels. Multivariate analysis identified age (OR 1.088; P= .002) and BMI (OR 1.124; P= .022) as risk factors for AKI development. Moreover, AKI development was an independent risk factor for ICU stays longer than 48 hours (OR 2.561; P= .019). Mild AKI is a not rare complication in high-risk patients undergoing major abdominal surgery. Although in almost the totality of cases, the indicators of renal function recovered to preoperative levels, post-operative AKI represents a primary risk factor for a prolonged ICU stay. Copyright © 2016 Elsevier Inc. All rights reserved.
Lindholm, Elisabet; Persson, Eva; Carlsson, Eva; Hallén, Anne-Marie; Fingren, Jeanette; Berndtsson, Ina
The aim of this study was to prospectively evaluate ostomy-related complications and describe ostomy configuration in patients undergoing acute abdominal surgery. The study sample comprised 144 patients with a median age of 67 years (IOR: 53.5-78 years) who underwent an intestinal ostomy as part of an acute abdominal surgical procedure. The research setting was the surgical and gynecological clinics at the Sahlgrenska University Hospital in Gothenburg, Sweden. Ostomy configuration, diameter, height, and the presence of stomal and peristomal complications were assessed by a WOC nurse 1 to 2 times while in hospital, once at the ostomy outpatient clinic 2 weeks after discharge, and at 3, 6, 12, and 24 months following ostomy creation. The types of ostomies evaluated were end colostomy (58%), end ileostomy (18%), loop ileostomy (17%), and loop colostomy (7%). Most stomal or peristomal complications occurred within 1 year after surgery (31 of 57; 54.4%). Necrosis, separation, and stenosis were most common in patients with an end colostomy. Peristomal skin complications occurred in 45% of subjects during the first 6 months after surgery. The ostomy's diameter decreased significantly during the hospital course and over the first 2 weeks following hospital discharge in patients with end colostomy (Postomy had peristomal skin problems ranging between 21% and 57% over this time period. The frequency of using a pouching system that incorporated convexity was highest in the case of loop ileostomy, used in 67% at 6 months. During the first 2 weeks after discharge, the physical configuration of the ostomy evolves and the pouching system must be frequently adjusted by a WOC nurse. Stomal and peristomal complications are prevalent during the first 2 postoperative years and especially during the first 6 months.
Hughes, Michael; Coolsen, Marielle M E; Aahlin, Eirik K; Harrison, Ewen M; McNally, Stephen J; Dejong, C H C; Lassen, Kristoffer; Wigmore, Stephen J
Enhanced recovery after surgery (ERAS) is a well-established pathway of perioperative care in surgery in an increasing number of specialties. To implement protocols and maintain high levels of compliance, continued support from care providers and patients is vital. This survey aimed to assess the perceptions of care providers and patients of the relevance and importance of the ERAS targets and strategies. Pre- and post-operative surveys were completed by patients who underwent major hepatic, colorectal, or oesophagogastric surgery in three major centers in Scotland, Norway, and The Netherlands. Anonymous web-based and article surveys were also sent to surgeons, anesthetists, and nurses experienced in delivering enhanced recovery protocols. Each questionnaire asked the responder to rate a selection of enhanced recovery targets and strategies in terms of perceived importance. One hundred nine patients and 57 care providers completed the preoperative survey. Overall, both patients and care providers rated the majority of items as important and supported ERAS principles. Freedom from nausea (median, 10; interquartile range [IQR], 8-10) and pain at rest (median, 10; IQR, 8-10) were the care components rated the highest by both patients and care providers. Early return of bowel function (median, 7; IQR, 5-8) and avoiding preanesthetic sedation (median, 6; IQR, 3.75-8) were scored the lowest by care providers. ERAS principles are supported by both patients and care providers. This is important when attempting to implement and maintain an ERAS program. Controversies still remain regarding the relative importance of individual ERAS components. Copyright © 2015 Elsevier Inc. All rights reserved.
Transversus abdominis plane block in combination with general anesthesia provides better intraoperative hemodynamic control and quicker recovery than general anesthesia alone in high-risk abdominal surgery patients.
Tsuchiya, M; Takahashi, R; Furukawa, A; Suehiro, K; Mizutani, K; Nishikawa, K
Patients with severe cardiovascular disease are frequently hemodynamically unstable during abdominal surgery. Improving the safety of such patients by stabilizing intraoperative hemodynamics remains a major concern for anesthesiologists. Transversus abdominis plane (TAP) block in combination with general anesthesia may facilitate optimum anesthetic management of these high-risk patients. Patients with cardiovascular disease classified as American Society of Anesthesiologists (ASA) physical status 3 were enrolled. The patients were undergoing elective abdominal surgery and were randomized to a group receiving general anesthesia and TAP block (Group T, N.=33) or a group receiving general anesthesia alone (Group G, N.=35). We compared the groups for intraoperative hemodynamic stability, anesthesia emergence time, amounts of anesthetics and opioids given, and frequency of emergency treatment with cardiovascular agents. A preliminary study demonstrated that systolic blood pressure and heart rate were maintained stable within 70-110% of their preanesthesia values throughout surgery in ASA 1 elderly patients without cardiovascular disease. Thus, the hemodynamically stable time was defined as the time when systolic blood pressure and heart rate were 70-110% of their preanesthesia values. The ratio of hemodynamically stable time to total operative time was used as an index of hemodynamic stability. The median (minimum-maximum) percentage of hemodynamically stable time was longer in Group T (91[50-100]%) than Group G (79[40-91]%, Pabdominal surgery in patients with severe cardiovascular disease, combining TAP block with general anesthesia promotes intraoperative hemodynamic stability and early emergence from anesthesia.
Demirevska, L; Gotchev, D
and purpose: Postoperative atrial fibrillation (POAF) is a frequent complication post high-risk abdominal surgery in elderly patients. This study aimed to develop a predictive model of POAF based on preoperative transthoracic echocardiography (TTE) findings in these patients. We conducted a prospective study of 300 consecutive patients, age ≥ 65 years (mean age 72±6 years, 61% men), who underwent high-risk abdominal surgery under general anesthesia. Preoperative TTE was performed in all patients, including tissue Doppler imaging (TDI). We measured the time interval between the onset of the P-wave on ECG and a point of the peak-A wave on TDI from the lateral mitral annulus (PA lateral) and septal mitral annulus (PA septal). Left atrial (LA) dyssynchrony was measured by subtracting the PA septal from PA lateral. Right ventricular systolic pressure was estimated by using the tricuspid regurgitation jet (TRJ) Doppler velocity method. The primary endpoint was the occurance of new-onset POAF. Thirty-seven (12%) patients developed POAF. Multiple echocardiographic parameters were measured and tested in different combinations. The final model included the following variables with cutoff points predictive of POAF: PA lateral > 139 ms (69% sensitivity, 92% specificity), LA dyssynchrony > 35 ms (78% sensitivity, 89% specificity), and TRJ Doppler velocity >2.6 m/s (89% sensitivity, 64% specificity). A value of 0 was assigned when the result was below the cutoff point and a value of 1 if above the cutoff point. Coding of these three variables in the following order: PA lateral- TRJ Doppler- left atrial dyssynchrony can predict the probability of POAF. The model showed a postive predictive value of 79% and a negative predictive value of 95%. A model using three echocardiographic variables: PA lateral, LA dyssynchrony and TRJ Doppler velocity, can predict the incidence of POAF after high-risk abdominal surgery. The model can be used preoperatively to identify high-risk patients
Alsulaimy, Mohammad; Punchai, Suriya; Ali, Fouzeyah A; Kroh, Matthew; Schauer, Philip R; Brethauer, Stacy A; Aminian, Ali
Chronic abdominal pain after bariatric surgery is associated with diagnostic and therapeutic challenges. The aim of this study was to evaluate the yield of laparoscopy as a diagnostic and therapeutic tool in post-bariatric surgery patients with chronic abdominal pain who had negative imaging and endoscopic studies. A retrospective analysis was performed on post-bariatric surgery patients who underwent laparoscopy for diagnosis and treatment of chronic abdominal pain at a single academic center. Only patients with both negative preoperative CT scan and upper endoscopy were included. Total of 35 post-bariatric surgery patients met the inclusion criteria, and all had history of Roux-en-Y gastric bypass. Twenty out of 35 patients (57%) had positive findings on diagnostic laparoscopy including presence of adhesions (n = 12), chronic cholecystitis (n = 4), mesenteric defect (n = 2), internal hernia (n = 1), and necrotic omentum (n = 1). Two patients developed post-operative complications including a pelvic abscess and an abdominal wall abscess. Overall, 15 patients (43%) had symptomatic improvement after laparoscopy; 14 of these patients had positive laparoscopic findings requiring intervention (70% of the patients with positive laparoscopy). Conversely, 20 (57%) patients required long-term medical treatment for management of chronic abdominal pain. Diagnostic laparoscopy, which is a safe procedure, can detect pathological findings in more than half of post-bariatric surgery patients with chronic abdominal pain of unknown etiology. About 40% of patients who undergo diagnostic laparoscopy and 70% of patients with positive findings on laparoscopy experience significant symptom improvement. Patients should be informed that diagnostic laparoscopy is associated with no symptom improvement in about half of cases.
Toft, P; Nielsen, C H; Tønnesen, Else Kirstine
Cardiac and major abdominal surgery are associated with granulocytosis in peripheral blood. The purpose of the present study was to describe the granulocyte and monocyte oxidative burst and the expression of adhesion molecules following cardiac surgery with cardiopulmonary bypass and abdominal...... during cardiopulmonary bypass was observed. The percentage of CD11a-positive granulocytes increased from 30% pre-operatively to 75% following cardiopulmonary bypass, while CD44-positive granulocytes increased from 5% to 13%. Despite the extent of the changes, these were not significant. The oxidative...... to an increased per-operative oxidative burst activity, and the induction of adhesion molecules on granulocytes associated with the cardiopulmonary bypass and surgery. In conclusion, open-heart surgery with cardiopulmonary bypass was associated with a rapid and pronounced activation of leukocytes which may play...
Full Text Available Background: To study the effects of listening to a Thai traditional music program on acute pain alleviation among patients during the first 48 hours after open abdominal surgery. Objective: A cross over research design in adult patients’ aged 18-60 years at Siriraj Hospital. Methods: The sample was selected by purposive sampling based on inclusion criteria and assigned into the following two groups by simple random sampling: the group receiving the Thai traditional music program (experimental group and the group receiving routine care (control group. This study employed a cross over design with 44 samples in a private surgical ward at Siriraj Hospital, Bangkok. Pain was assessed before and after the intervention. Data were collected by the following three sets of instruments: 1 the demographic and treatment background form; 2 the Thai Short - Form McGill Pain Questionnaire with the vital sign form and 3 the post abdominal surgery early ambulation form. Results: The patients in the experimental group had lower mean pain descriptor scores, mean present pain intensity scores and mean Visual Analog Scale scores after the Thai traditional music program than before the intervention at 48 hours after abdominal surgery with statistical significance (t = 14.11, t = 17.41 and t = 16.47 (p < .001, respectively. When compared between groups, the patients in the experimental group had lower mean pain descriptor scores, mean present pain intensity scores and mean Visual Analog Scale scores than the control group at 48 hours with statistical significance (F = 138.71, F = 170 and F = 298.97 (p < .001, respectively. Furthermore, on the first and second postoperative days as well as the sum of both days, the experimental group was also found to have better early ambulation mean scores than the control group with statistical significance (F = 10.67, p < .002, F = 41.36, p < .001, F = 44.47, p < .001, respectively. Conclusion: The findings suggest that a Thai
Patierno, S; Raybould, H E; Sternini, C
Immunohistochemistry and confocal microscopy were used to investigate mu opioid receptor (muOR) internalization in enteric neurons of the guinea-pig ileum following abdominal surgery. The following surgical procedures were performed under halothane or isofluorane anesthesia: a) midline abdominal skin incision, b) laparotomy or c) laparotomy with intestinal manipulation. Gastrointestinal transit was evaluated by using a non-absorbable marker and measuring fecal pellet output. In neurons from normal and control (anesthesia alone) animals, muOR was predominantly at the cell surface. muOR endocytosis following skin incision was not significantly different from controls (21.2+/-3.5% vs. 13.7+/-2.1%, mean+/-S.E.M.), whereas it was significantly increased by laparotomy (46.5+/-6.1%; Pendocytosis remained elevated at 4 h (38.6+/-1.2%; Pendocytosis occurred in cholinergic and nitrergic neurons. Gastrointestinal transit was significantly delayed by laparotomy or laparotomy plus intestinal manipulation (12.8+/-1.2 and 13.8+/-0.6 h vs. 7.0+/-0.5 in controls; Pendocytosis in neurochemically distinct enteric neurons. muOR internalization can serve as indirect evidence of opioid release and as a means to visualize neuronal pathways activated by opioids.
Jensen, Kristian Kiim; Oma, Erling; Harling, Henrik
PURPOSE: Most literature on abdominal incision is based on patients undergoing elective surgery. In a cohort of patients with anastomotic leakage after colonic cancer resection, we analyzed the association between type of incision, fascial dehiscence, and incisional hernia. METHODS: Data were...... extracted from the Danish Colorectal Cancer Group database and merged with information from the Danish National Patient Register. All patients with anastomotic leakage after colonic resection in Denmark from 2001 until 2008 were included and surgical records on re-operations were retrieved. The primary...... for anastomotic leakage were included with a median follow-up of 5.4 years. Incisional hernia occurred in 41 of 227 (15.3%) patients undergoing midline incision compared with 14 of 81 (14.7%) following transverse incision, P = 1.00. After adjusting for confounders, there was no association between the type...
Meyhoff, Christian Sylvest; Jorgensen, Lars N; Wetterslev, Jørn
A high perioperative inspiratory oxygen fraction (80%) has been recommended to prevent postoperative wound infections. However, the most recent and one of the largest trials, the PROXI trial, found no reduction in surgical site infection, and 30-day mortality was higher in patients given 80% oxyg....... In this follow-up study of the PROXI trial we assessed the association between long-term mortality and perioperative oxygen fraction in patients undergoing abdominal surgery.......A high perioperative inspiratory oxygen fraction (80%) has been recommended to prevent postoperative wound infections. However, the most recent and one of the largest trials, the PROXI trial, found no reduction in surgical site infection, and 30-day mortality was higher in patients given 80% oxygen...
Full Text Available Jeffrey Gadsden,1 Sabry Ayad,2 Jeffrey J Gonzales,3 Jaideep Mehta,4 Jan Boublik,5 Jacob Hutchins6,7 1Department of Anesthesiology, Duke University Medical Center, Durham, NC, 2Department of Anesthesiology and Pain Management, Cleveland Clinic, Cleveland, OH, 3Department of Anesthesiology, University of Colorado Hospital, Aurora, CO, 4Department of Anesthesiology, UT Health, The University of Texas Health Science Center at Houston, Houston, TX, 5Department of Anesthesiology, NYU Langone Medical Center – Hospital for Joint Diseases, New York, NY, 6Department of Anesthesiology, 7Department of Surgery, University of Minnesota, Minneapolis, MN, USA Abstract: Transversus abdominis plane (TAP infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by
Wada, Hideyuki; Hyun, Hoon; Vargas, Christina; Gravier, Julien; Park, GwangLi; Gioux, Sylvain; Frangioni, John V; Henary, Maged; Choi, Hak Soo
Pancreas-related complications are some of the most serious ones in abdominal surgery. The goal of this study was to develop and validate novel near-infrared (NIR) fluorophores that would enable real-time pancreas imaging to avoid the intraoperative pancreatic injury. After initial screening of a large NIR fluorophore library, the performance of 3 selected pancreas-targeted 700 nm NIR fluorophores, T700-H, T700-F, and MB, were quantified in mice, rats, and pigs. Dose ranging using 25 and 100 nmol, and 2.5 µmol of T700-F, and its imaging kinetics over a 4 h period were tested in each species. Three different 800 nm NIR fluorophores were employed for dual-channel FLARE™ imaging in pigs: 2 μmol of ZW800-1 for vessels and kidney, 1 μmol of ZW800-3C for lymph nodes, and 2 μmol of ESNF31 for adrenal glands. T700-F demonstrated the highest signal to background ratio (SBR), with peak SBR at 4 h postinjection in mice. In pigs, T700-F produced an SBR≥2 against muscle, spleen, and lymph nodes for up to 8 h after a single intravenous injection. The combination of T700-F with each 800 nm NIR fluorophore provided simultaneous dual-channel intraoperative imaging of pancreas with surrounding organs in real time. Pancreas-targeted NIR fluorophores combined with the FLARE dual-channel imaging system enable the real-time intraoperative pancreas imaging which helps surgeons perform safer and more curative abdominal surgeries.
Lijftogt, N; Vahl, A C; Wilschut, E D; Elsman, B H P; Amodio, S; van Zwet, E W; Leijdekkers, V J; Wouters, M W J M; Hamming, J F
The Dutch Surgical Aneurysm Audit (DSAA) is mandatory for all patients with primary abdominal aortic aneurysms (AAAs) in the Netherlands. The aims are to present the observed outcomes of AAA surgery against the predicted outcomes by means of V-POSSUM (Vascular-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity). Adjusted mortality was calculated by the original and re-estimated V(physiology)-POSSUM for hospital comparisons. All patients operated on from January 2013 to December 2014 were included for analysis. Calibration and discrimination of V-POSSUM and V(p)-POSSUM was analysed. Mortality was benchmarked by means of the original V(p)-POSSUM formula and risk-adjusted by the re-estimated V(p)-POSSUM on the DSAA. In total, 5898 patients were included for analysis: 4579 with elective AAA (EAAA) and 1319 with acute abdominal aortic aneurysm (AAAA), acute symptomatic (SAAA; n = 371) or ruptured (RAAA; n = 948). The percentage of endovascular aneurysm repair (EVAR) varied between hospitals but showed no relation to hospital volume (EAAA: p = .12; AAAA: p = .07). EAAA, SAAA, and RAAA mortality was, respectively, 1.9%, 7.5%, and 28.7%. Elective mortality was 0.9% after EVAR and 5.0% after open surgical repair versus 15.6% and 27.4%, respectively, after AAAA. V-POSSUM overestimated mortality in most EAAA risk groups (p high risk groups, and underestimated in low risk groups (p Surgery. Published by Elsevier Ltd. All rights reserved.
Scepanovic, M S; Kovacevic, B; Cijan, V; Antic, A; Petrovic, Z; Asceric, R; Krdzic, I; Cuk, V
Anastomotic leakage (AL) represents a serious complication after abdominal surgery. Therefore, it is important to detect it early before it becomes clinically apparent. The predictive value of C-reactive protein (CRP) as a marker of infective postoperative complications, particularly in the form of anastomotic leakage, has been investigated by several authors with promising results. The aim of this study was to evaluate the diagnostic accuracy of C-reactive protein in predicting anastomotic leakage. The serum CRP level, white blood cell (WBC) count, and body temperature (BT) of 156 patients who underwent elective abdominal surgery with primary anastomosis were monitored daily until postoperative day (POD) 7. We recorded all postoperative complications and analyzed the data. Diagnostic accuracy of CRP with regard to development of AL was assessed by receiver operating characteristic curve analysis. Fifteen patients (9.6 %) developed anastomotic leakage. CRP was significantly higher every day during the first 7 postoperative days in patients who developed AL compared with those patients who did not develop complications, whereas the WBC count and BT were not. A CRP cutoff value of 135 mg/l on POD 3 yielded a sensitivity of 73 %, a specificity of 73 %, and a negative predictive value of 95.4 % for the detection of AL. According to our results, values of CRP less than 135 mg/l on POD 3 may contribute to a safe discharge from hospital. Patients with CRP values higher than 135 mg/l on POD 3 require prolonged hospitalization and an intensive search for infective complications, particularly AL.
Efeitos de duas técnicas de incentivo respiratório na mobilidade toracoabdominal após cirurgia abdominal alta Effects of two respiratory incentive techniques on chest wall mobility after upper abdominal surgery
Maria Elaine Trevisan
Full Text Available A cirurgia abdominal alta está associada a um risco elevado de complicações pulmonares que podem ser reduzidas pelo uso criterioso de manobras terapêuticas visando a expansão pulmonar. O objetivo foi comparar duas técnicas de incentivo respiratório na recuperação da dinâmica toracoabdominal em pacientes submetidos à cirurgia abdominal alta. O grupo de estudo experimental foi constituído por 16 pacientes internados na Clínica Cirúrgica do Hospital Universitário de Santa Maria distribuídos aleatoriamente em dois grupos: o grupo 1 foi constituído por dez pacientes que usaram o dispositivo Voldyne e o grupo 2, por seis pacientes submetidos ao padrão ventilatório com inspiração fracionada em três tempos. A expansibilidade toracoabdominal foi avaliada por cirtometria antes da cirurgia e no 1º, 3º¸ e 5º dias do pós-operatório (PO. Observou-se redução significativa dos valores de cirtometria no 1º PO que, gradualmente, foram sendo recuperados, não mais havendo diferença significativa no 5o PO em relação aos valores pré-operatórios em ambos os grupos. O grupo 1 obteve significativamente melhores índices de recuperação da mobilidade toracoabdominal do que o grupo 2. Também o tempo de recuperação do grupo 1 atingiu médias mais elevadas durante todo o período de PO investigado. Embora ambas as técnicas utilizadas fossem efetivas, o incentivo inspiratório por meio do Voldyne mostrou melhores resultados na recuperação da expansibilidade pulmonar após cirurgia abdominal alta.Upper abdominal surgery is associated to increased risk of pulmonary complications, which may be lessened by judicious use of therapeutic maneuvers aimed at lung expansion. The purpose here was to compare two respiratory incentive techniques on recovery of thoracic-abdominal dynamics in patients having undergone upper abdominal surgery. Sixteen patients in such condition were randomly divided into group 1 (n=10, who did respiratory training
Justin T. Dowdy MD
Full Text Available Cerebrospinal fluid (CSF leak is the most commonly encountered perioperative complication in transsphenoidal surgery for pituitary lesions. Direct closure with a combination of autologous fat, local bone, and/or synthetic grafts remains the standard of care for leaks encountered at the time of surgery as well as postoperatively. The development of the vascularized nasoseptal flap as a closure technique has increased the surgeon’s capacity to correct even larger openings in the dura of the sella as well as widely exposed anterior skull base defects. Yet these advances in the technical nuances for management of post-transsphenoidal CSF leak are useless without the ability to recognize a CSF leak by physical examination, clinical history, biochemical testing, or radiographic assessment. Here, we report a case of a patient who developed a CSF leak 28 years after transsphenoidal surgery, precipitated by a robotic-assisted hysterectomy during which increased intra-abdominal pressure and steep Trendelenberg positioning were both factors. Given the remote nature of the patient’s transsphenoidal surgery and relative paucity of data regarding such a complication, the condition went unrecognized for several months. We review the available literature regarding risk and pathophysiology of CSF leak following abdominal surgery and propose the need for increased vigilance in identification of such occurrences with the increasing acceptance and popularity of minimally invasive abdominal and pelvic surgeries as standards in the field.
MARIA VITÓRIA FRANÇA DO AMARAL
Full Text Available ABSTRACT We describe the preliminary national experience and the early results of the use of robotic surgery to perform the posterior separation of abdominal wall components by the Transversus Abdominis Release (TAR technique for the correction of complex defects of the abdominal wall. We performed the procedures between 04/2/2015 and 06/15/2015 and the follow-up time was up to six months, with a minimum of two months. The mean surgical time was five hours and 40 minutes. Two patients required laparoscopic re-intervention, since one developed hernia by peritoneal migration of the mesh and one had mesh extrusion. The procedure proved to be technically feasible, with a still long surgical time. Considering the potential advantages of robotic surgery and those related to TAR and the results obtained when these two techniques are associated, we conclude that they seem to be a good option for the correction of complex abdominal wall defects.
Noor, Nabila; Rahimi, Salma; Pereira, Elena; Treszezamsky, Alejandro; Garely, Alan; Vardy, Michael; Ascher-Walsh, Charles
Approaches for performing sacrocolpopexy (laparotomy, laparoscopy, and robotically assisted) differ with regard to length of surgery, postoperative pain, and cosmetic appearance of skin incisions. The aim of our study is to better understand what factors influence patient preferences for surgical approach. A cross-sectional study was performed using a survey. Females 18 years or older presenting to gynecologic offices were asked to complete a survey that included photographs of patient incisions 6 weeks postoperatively along with a schematic representation of each incision type (laparotomy with low transverse incision, traditional laparoscopy, and robotically assisted). Patients were first asked to rank each incision based on cosmetic appearance only. They were next given varying clinical scenarios associated with each surgical approach and asked if their preference of incision changed. A sample size of 90 subjects was needed in order to detect a 30% difference in incision preference based on appearance with an α of 0.05 and 80% power. One hundred fifty patients completed the survey. Based on cosmetic appearance alone, 70% chose laparoscopic surgery, 23% chose open, and 7% chose the robotic approach (P surgery (65.3%), and length of hospital stay (73.6%). When asked to rank factors important in decision making, complication rate (53.9%) and surgeon experience with the procedure (32.8%) were ranked as most important. Based on cosmetic appearance, patients prefer the laparoscopic approach for abdominal sacrocolpopexy for pelvic organ prolapse surgery. However, complication rates and surgeon experience with the procedure are important factors in the patient's decision making.
Shapiro Daniel E; Weydert Joy A; Acra Sari A; Monheim Cynthia J; Chambers Andrea S; Ball Thomas M
Abstract Background Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. Methods 22 children, aged 5 – 18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, an...
Wang, Yan-wen; Fu, Wen-bin; Ou, Ai-hua; Fan, Ling; Huang, Ye-fei
To assess the effect and methodological quality of clinically randomized controlled studies on abdominal acupuncture therapy for cervical spondylosis and to make out its current situation, validity and applicability. Using the PubMed, CNKI (China Academic Journals Full-text Database), VIP (VIP Chinese Science and Technology Periodicals Database) and Wanfang Digital Periodicals Electronic Database covering the period of 1989-2009, we did a literature search on the original articles of abdominal acupuncture treatment of cervical spondylosis and selected those accorded with the standards of randomized controlled studies. Animal studies, surveys, and news articles, and those duplicated, being absent in diagnostic criteria and non-randomized controlled trials were excluded. The papers' quality was analyzed by using the Jadad quality assessment scoring system and the therapeutic effect evaluated by using Review Manage 4.2.7 software. A total of 8 papers containing 909 cervical spondylosis patients and written in Chinese were included. These 8 studies used the effective rate as the primary outcome, 2 of them used the McGill Pain Questionnaire scales at the same time. Meta-analysis showed that the abdominal acupuncture group was better than the control group in visual analogue scale score (P acupuncture and routine acupuncture [OR = 3.29, 95% CI (0.13, 82.99)], EA [OR = 2.09, 95% CI (0.36, 11.95)] and traction therapy [OR = 6.06, 95% CI (3.01, 12.18)] in the total effective rate, pain rating index score [WMD = -2.24, 95% CI (-5.29, 0.81)] and the present pain intensity score [WMD = -0.84, 95% CI (-2.13, 0.44)]. At the present, there has been no sufficient evidence to ensure that in the treatment of cervical spondylosis, the abdominal acupuncture therapy is superior to routine acupuncture, EA and traction therapy. Attention should be paid to the randomized controlled study of larger samples and qualified design.
Hansen, E G; Duedahl, T H; Rømsing, J
Remifentanil, a widely used analgesic agent in anaesthesia, has a rapid onset and short duration of action. In clinical settings, this requires an appropriate pain strategy to prevent unacceptable pain in the post-operative period. The aim of this study was to investigate whether remifentanil had...... any impact on post-operative pain and opioid consumption after major abdominal surgery....
Noordzij, P. G.; van Geffen, O.; Dijkstra, I. M.; Boerma, D.; Meinders, A. J.; Rettig, T. C D; Eefting, F. D.; van Loon, D.; van de Garde, E. M W; van Dongen, E. P A
BACKGROUND: Postoperative non-cardiac complication rates are as high as 11-28% after high-risk abdominal procedures. Emerging evidence indicates that postoperative cardiac troponin T elevations are associated with adverse outcome in non-cardiac surgery. The aim of this study was to determine the
Rasmussen, A; Toftdahl, D; Lindholt, J
Deep vein thrombosis (DVT) detectable by the 99mTechnetium-labeled plasmin test developed in 13 (37%) of 35 sequentially studied patients, all above 40 years, undergoing elective major abdominal surgery. Ten of the 13 patients with DVT had an abnormal pulmonary perfusion scintigram, suggesting...
Epidural anaesthesia is one of the regional techniques for lower abdominal , lower limb , pelvic and vascular surgeries where complications are very less compared to spinal anaesthesia. Several central nervous system and cardiovascular adverse reactions have been linked to the R ( +) isomer of bupivacaine , one of the most widely used ...
Cramer, Holger; Thoms, Meral Sushila; Anheyer, Dennis; Lauche, Romy; Dobos, Gustav
Abdominal obesity is a major risk factor for morbidity and mortality. The aim of this study was to investigate the effect of yoga on waist circumference and other anthropometric and self-reported variables in women with abdominal obesity. 60 women with abdominal obesity (waist circumference ≥ 88 cm; body-mass index [BMI] ≥ 25) were randomly allocated in a 2:1 ratio to either a 12-week yoga intervention (n = 40) or a waiting list (n = 20). The waist circumference was the primary endpoint. Secondary (exploratory) endpoints included the waist/hip ratio, body weight, BMI, body fat percentage, body muscle mass percentage, blood pressure, health-related quality of life, self-esteem, subjective stress, body awareness, and body responsiveness, and the safety of the intervention. The persons assessing the outcomes were blinded to the group to which the patients belonged. The patients in the yoga group participated in a mean of 30.2±9.2 (maximum, 42) hours of supervised yoga practice. Their abdominal circum - ference was significantly reduced in comparison to the participants on the waiting list, with an intergroup difference of -3.8 cm (95% confidence interval [-6.1; -1,.5]; p = 0.001). There were further, moderate intergroup differences in the waist/hip ratio, body weight, BMI, body fat percentage, body muscle mass percentage, mental and physical well-being, self-esteem, subjective stress, body awareness, and trust in bodily sensations (all peffects on anthropometric and self-reported variables in women with abdominal obesity. Yoga is safe in this population and can be recommended as a technique for combating abdominal obesity in women.
Full Text Available Abstract The use of nonabsorbable prosthetic materials such as polypropylene, polyester, and ePTFE, have expanded and are now widely used in reparative surgery for abdominal wall hernias. There are still difficulties to find correct indication for prosthetic implant in emergency hernia surgery: as a matter of fact there is still a great debate if to use non-absorbable prostheses in potentially or truly infected operating fields [e.g. after intestinal resections]. All these problems can be avoided with the use of absorbable prosthetic materials such as those composed of lactic acid polymers or lactic and glycolic acid copolymers: however, the use of these absorbable prosthesis exposes the patient to a rapid and inevitable hernia recurrence. It is important to remember that prosthetic repair has been proven to have a significant less risk of recurrence than repair with direct sutures. Recently, new "biologic" prosthetic materials have been developed and proposed for the clinical use in infected fields. These materials can be called "remodeling" for the way by which they are replaced after their placement within the patient. The "remodeling" process is made possible through a process of incorporation, where a reproduction of a site-specific tissue similar to the original host tissue is created.
Trembach, Nikita; Zabolotskikh, Igor
The goal of the study was to evaluate the effect of a recruitment maneuver on respiratory biomechanics, oxygenation, and hemodynamics in patients suffering from chronic heart failure with different peripheral chemoreflex sensitivity. The study was conducted in 115 elderly patients which underwent major abdominal surgery under general/epidural surgery. Peripheral chemoreflex sensitivity (PCS) was evaluated with breath-holding duration (BHD) during breath-holding test. All patients were divided into two groups: group H had a high PCS (BHD = 38 seconds or less, n = 49); Group M had a middle PCS (BHD more than 38 seconds, n = 66). Recruitment maneuver improved oxygenation and respiratory biomechanics in all cases. However, cardiac output decreased by an average of 18%-31% in group H compared to 18%-28% in group M. SVR either remained unchanged or decreased by up to 14% of the initial value in group H, while, in group M, it had a tendency to increase, which was 24% of the initial value. So, recruitment maneuver is an effective method to improve oxygenation and biomechanical properties of the respiratory system but in patients with increased peripheral chemoreflex sensitivity it associates with the risk of hemodynamic disturbances.
van Vliet, Daphne C R; van der Meij, Eva; Bouwsma, Esther V A; Vonk Noordegraaf, Antonie; van den Heuvel, Baukje; Meijerink, Wilhelmus J H J; van Baal, W Marchien; Huirne, Judith A F; Anema, Johannes R
Evidence-based information on the resumption of daily activities following uncomplicated abdominal surgery is scarce and not yet standardized in medical guidelines. As a consequence, convalescence recommendations are generally not provided after surgery, leading to patients' insecurity, needlessly delayed recovery and prolonged sick leave. The aim of this study was to generate consensus-based multidisciplinary convalescence recommendations, including advice on return to work, applicable for both patients and physicians. Using a modified Delphi method among a multidisciplinary panel of 13 experts consisting of surgeons, occupational physicians and general practitioners, detailed recommendations were developed for graded resumption of 34 activities after uncomplicated laparoscopic cholecystectomy, laparoscopic and open appendectomy, laparoscopic and open colectomy and laparoscopic and open inguinal hernia repair. A sample of occupational physicians, general practitioners and surgeons assessed the recommendations on feasibility in daily practice. The response of this group of care providers was discussed with the experts in the final Delphi questionnaire round. Out of initially 56 activities, the expert panel selected 34 relevant activities for which convalescence recommendations were developed. After four Delphi rounds, consensus was reached for all of the 34 activities for all the surgical procedures. A sample of occupational physicians, general practitioners and surgeons regarded the recommendations as feasible in daily practice. Multidisciplinary convalescence recommendations regarding uncomplicated laparoscopic cholecystectomy, appendectomy (laparoscopic, open), colectomy (laparoscopic, open) and inguinal hernia repair (laparoscopic, open) were developed by a modified Delphi procedure. Further research is required to evaluate whether these recommendations are realistic and effective in daily practice.
Ireland, Claire J; Chapman, Timothy M; Mathew, Suneeth F; Herbison, G Peter; Zacharias, Mathew
Major abdominal surgery can be associated with a number of serious complications that may impair patient recovery. In particular, postoperative pulmonary complications (PPCs), including respiratory complications such as atelectasis and pneumonia, are a major contributor to postoperative morbidity and may even contribute to increased mortality. Continuous positive airway pressure (CPAP) is a type of therapy that uses a high-pressure gas source to deliver constant positive pressure to the airways throughout both inspiration and expiration. This approach is expected to prevent some pulmonary complications, thus reducing mortality. To determine whether any difference can be found in the rate of mortality and adverse events following major abdominal surgery in patients treated postoperatively with CPAP versus standard care, which may include traditional oxygen delivery systems, physiotherapy and incentive spirometry. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 9; Ovid MEDLINE (1966 to 15 September 2013); EMBASE (1988 to 15 September 2013); Web of Science (to September 2013) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (to September 2013). We included all randomized controlled trials (RCTs) in which CPAP was compared with standard care for prevention of postoperative mortality and adverse events following major abdominal surgery. We included all adults (adults as defined by individual studies) of both sexes. The intervention of CPAP was applied during the postoperative period. We excluded studies in which participants had received PEEP during surgery. Two review authors independently selected studies that met the selection criteria from all studies identified by the search strategy. Two review authors extracted the data and assessed risk of bias separately, using a data extraction form. Data entry into RevMan was performed by one review author and was checked by another for accuracy. We performed a
Koh, Christina Y; Inaba, Colette S; Sujatha-Bhaskar, Sarath; Nguyen, Ninh T
The Centers for Medicare & Medicaid Services (CMS) recently released the Overall Hospital Quality Star Rating to help patients compare hospitals based on a 5-star scale. The star rating was designed to assess overall quality of the institution; thus, its validity toward specifically assessing surgical quality is unknown. To examine whether CMS high-star hospitals (HSHs) have improved patient outcomes and resource use in advanced laparoscopic abdominal surgery compared with low-star hospitals (LSHs). Using the University HealthSystem Consortium database (which includes academic centers and their affiliate hospitals) from January 1, 2013, through December 31, 2015, this administrative database observational study compared outcomes of 72 662 advanced laparoscopic abdominal operations between HSHs (4-5 stars) and LSHs (1-2 stars). The star rating includes 57 measures across 7 areas of quality. Patients who underwent advanced laparoscopic abdominal surgery, including bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass), colorectal surgery (colectomy, proctectomy), or hiatal hernia surgery (paraesophageal hernia repair, Nissen fundoplication), were included. Risk adjustment included exclusion of patients with major and extreme severity of illness. Main outcome measures included serious morbidity, in-hospital mortality, intensive care unit admissions, and cost. A total of 72 662 advanced laparoscopic abdominal operations were performed in patients at 66 HSHs (n = 38 299; mean [SD] age, 51.26 [15.25] years; 12 096 [31.5%] male and 26 203 [68.4%] female; 28 971 [75.6%] white and 9328 [24.4%] nonwhite) and 78 LSHs (n = 34 363; mean [SD] age, 49.77 [14.77] years; 9902 [28.8%] male and 24 461 [71.2%] female; 21 876 [67.6%] white and 12 487 [32.4%] nonwhite). The HSHs were observed to have fewer intensive care unit admissions (1007 [2.6%] vs 1711 [5.0%], P abdominal surgery. No significant difference was found in serious morbidity between HSHs and
Floros, Nikolaos; Papadakis, Marios; Wagenhäuser, Markus Udo; Duran, Mansur; Simon, Florian; Schelzig, Hubert; Oberhuber, Alexander
Inflammatory abdominal aortic aneurysms (IAAAs) are rare clinical entities with an exaggerated inflammatory component. The aim of this study is to report outcomes of a single-center 10-year experience in open surgical management of IAAA and to compare the results with noninflammatory, atherosclerotic abdominal aortic aneurysms (non-IAAAs). We retrospectively reviewed the medical records of 18 patients with IAAA selected out of patients with AAA who underwent open surgery in the Department of Vascular and Endovascular Surgery at the University Hospital Dusseldorf from January 2006 to December 2015. These patients were matched with controls, selected from a prospectively retained database of patients with AAA undergoing open surgery during the study period. A 1:2 case-control match regarding age, gender, and year of treatment was performed. We analyzed both groups for preoperative parameters, intraoperative findings, and early postoperative outcomes. The 2 groups showed considerable similarities with no significant differences in the clinical features. Both groups outlined comparable aneurysm size (62 vs. 56 mm); however, the mean preoperative C-reactive protein was found to be significantly elevated in the study group (mean value: 2.6 vs. 0.9 mg/dL, P < 0.05). Most patients were operated using a standard transperitoneal median laparotomy approach; only 1 patient of each group was operated using a left retroperitoneal approach. There was no significant difference in operation time (190 vs. 194 min) and 30-day mortality 0%. The in-hospital mortality was 11% in the study group and 0% in the control group. We found a significant higher complication rate in the study group 10 (56%) vs. 12 (33%). The major complications were also more frequent in the study group 4 (22%) vs. 6 (16.7%). IAAA showed a statistically significant longer length of intensive care unit and hospital stay when compared with non-IAAA (7 and 20 days vs. 2 and 14 days, P < 0.05). IAAAs
Unlügenç, H; Gündüz, M; Ozalevli, M; Akman, H
We tested whether, after major abdominal surgery, the addition of magnesium or ketamine to tramadol for intravenous (IV) patient-controlled analgesia (PCA) improved analgesia and lowered pain scores, compared to a PCA containing only tramadol. Sixty-six patients were allocated randomly to receive a PCA with tramadol alone (T), tramadol plus magnesium (TM) or tramadol plus ketamin (TK), in a double-blind randomized study. Postoperative analgesia was started when the verbal rating scale (VRS) score was 2 or more. Following a loading dose of the study solution (which contained 1 mg/kg tramadol), a background infusion of 0.4 mg/kg/h was started. Patients were allowed to use bolus doses of 0.2 mg/kg every 20 min without a time limit. Discomfort, sedation, pain scores, total and bolus PCA tramadol consumption, and side-effects, were recorded for up to 24 h after the start of PCA. Pain and discomfort scores were lower (P ketamine significantly reduced the consumption of tramadol at 6, 12 and 24 h (P ketamine to tramadol improved analgesia and patient comfort and decreased the amount of tramadol required for postoperative pain management after major abdominal surgery.
Full Text Available BACKGROUND This prospective randomized double-blind study was designed to compare the analgesic efficacy and safety of intrathecal midazolam and fentanyl as an additive agent to bupivacaine for lower abdominal elective surgeries. METHODS Sixty patients classified in American Society of Anesthesiologists (ASA classes I and II scheduled for lower abdominal surgeries were studied. Patients were randomly divided to receive either 12.5 mg hyperbaric bupivacaine plus 1mg midazolam (group BM, n=30 or 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl (group BF, n=30 intrathecal. RESULTS The time of onset and the duration of motor blockade were comparable among the groups while the time to sensory block regression was same in group BM and group BF. The duration of postoperative analgesia was similar in group BM and group BF. While it was same for group BM and BF. Symptoms of pruritus and vomiting was more in group BF. CONCLUSION We conclude that midazolam is as effective as fentanyl in prolonging the durations of both sensory block and analgesia with less side effects.
Cihoric, Mirjana; Toft Tengberg, Line; Bay-Nielsen, Morten; Bang Foss, Nicolai
With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has never been validated exclusively in an emergency setting. A consecutive prospective single-center cohort study of 355 adults undergoing emergency high-risk abdominal surgery between June 2013 and May 2014 is presented. The primary outcome measure was 30-day mortality. Secondary outcome measures were postoperative major complications, defined according to the Clavien-Dindo scale as well as the American College of Surgeons' National Surgical Quality Improvement Program guidelines, and intensive care unit admission. The SAS was calculated postoperatively. Cochran-Armitage test for trend was used to evaluate the incidence of both outcomes. Area under the curve was used to demonstrate the scores' discriminatory power. One hundred eighty-one (51.0%) patients developed minor or no complications. The overall incidence of major complications was 32.7% and the overall death rate was 16.3%. Risk of major complications, death, and intensive care unit admission increased significantly with decreasing SAS (P high-risk abdominal surgery. Despite its predictive value, the SAS cannot in its current version be recommended as a standalone prognostic tool in an emergency setting.
de Jong, Myrthe A C; Ladha, Karim S; Melo, Marcos F Vidal
OBJECTIVES: In this study, we examined whether (1) positive end-expiratory pressure (PEEP) has a protective effect on the risk of major postoperative respiratory complications in a cohort of patients undergoing major abdominal surgeries and craniotomies, and (2) the effect of PEEP is differed.......91 (0.84 - 0.98)], whereas PEEP >5 cmH2O was not significantly associated with reduced odds of respiratory complications or hospital length of stay in patients undergoing craniotomy. CONCLUSIONS: The protective effects of PEEP are procedure specific with meaningful effects observed in patients...... by surgery type. BACKGROUND: Protective mechanical ventilation with lower tidal volumes and PEEP reduces compounded postoperative complications after abdominal surgery. However, data regarding the use of intraoperative PEEP is conflicting. METHODS: In this observational study, we included 5915 major...
Domínguez-Comesaña, Elías; López-Gómez, Victoria; Estevez-Fernández, Sergio Manuel; Mariño Padín, Esther; Ballinas-Miranda, Julio; Carrera-Dacosta, Ester; Piñon-Cimadevila, Miguel Ángel; Barreiro-Morandeira, Francisco
to evaluate the association between serum levels of procalcitonin and C-reactive protein, on the first 3 postoperative days, and the appearance of postoperative intra-abdominal infection. Prospective observational study including 67 patients operated on for colo-rectal, gastric and pancreatic cancer. Serum levels of procalcitonin and C-reactive protein were analyzed before surgery and daily until the third postoperative day. Values of procalcitonin (PCT) and C-reactive protein (CRP) were recorded as well as their accuracy for detection of postoperative intra-abdominal infection (PIAI). The incidence of postoperative intra-abdominal infection was 13.4%. CRP serum levels at 72h, PCT serum levels at 24, 48 and 72h and the ratio between serum levels of CRP at 72hours and serum levels of CRP at 48hours (CRP D3/CRP D2) were significantly associated with the appearance of postoperative intra-abdominal infection. The highest sensitivity corresponded to PCT at 72hours (88.9%); the highest specificity and positive predictive value corresponded to the ratio CRP D3/CRP D2 (96.49% and 71.4%, respectively); the highest negative predictive value to procalcitonin at 72h and 24h. Serum levels of PCT are significantly associated with the appearance of postoperative intra-abdominal infection. Sensitivity and predictive positive values are low, but negative predictive value is high, even at 24h after surgery. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.
Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1·6 per cent at 24 h (high 1·1 per cent, middle 1·9 per cent, low 3·4 per cent; P high 4·5 per cent, middle 6·0 per cent, low 8·6 per cent; P surgery (high 74·2 per cent, middle 68·8 per cent, low 60·5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2·78, 95 per cent c.i. 1·84 to 4·20) and low-income (OR 2·97, 1·84 to 4·81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. NCT02179112 (http://www.clinicaltrials.gov). © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.
Cohen, Marcela P; Herman, Paulo; Chojniak, Rubens; Poli, Miriam R B; Barbosa, Paula N V; Bitencourt, Almir G V
Because of its safety, relative low cost and widespread availability, conventional ultrasound (US) is the modality of choice for initial evaluation of the liver. Following US, in patients eligible for surgery, further computed tomography and/or magnetic resonance imaging is usually recommended for surgical planning. There are no recent published series focusing on conventional abdominal US exclusively employed for the evaluation of liver nodules before surgery. The objective of this study is to evaluate the efficacy of focused conventional preoperative US in detecting liver lesions, and the impact of US findings on surgical management. Sixty-seven noncirrhotic patients underwent surgical resection, after being previously submitted to focused liver US evaluation. US results were compared with intraoperative US (IOUS) and histology (gold standard). The IOUS was performed by the same radiologist who performed the preoperative US. Patient-by-patient and lesion-by-lesion analyses were performed. A total of 241 lesions were depicted in 67 patients. The mean number of lesions detected per patient by US and IOUS was 2.37 and 3.37, respectively (P = 0.001). In 52.2% of patients, US and IOUS depicted the same number of liver lesions. Surgery with curative intent was conducted in 61 (91.0%) patients. Histological evaluation was obtained in 196 lesions; 155 were considered malignant. The overall lesions detection rate by US was 65.6%. For lesions focused on liver evaluation, with the aim of lowering costs but not efficiency, places the method in focus again for use in the routine preoperative staging of candidates for liver resection. We suggest for preoperative evaluation that US could be associated with one section imaging method (computed tomography or magnetic resonance imaging) as routine.
Noordzij, P G; van Geffen, O; Dijkstra, I M; Boerma, D; Meinders, A J; Rettig, T C D; Eefting, F D; van Loon, D; van de Garde, E M W; van Dongen, E P A
Postoperative non-cardiac complication rates are as high as 11-28% after high-risk abdominal procedures. Emerging evidence indicates that postoperative cardiac troponin T elevations are associated with adverse outcome in non-cardiac surgery. The aim of this study was to determine the relationship between postoperative high-sensitive cardiac troponin T elevations and non-cardiac complications in patients after major abdominal surgery. This prospective observational single-centre cohort study included patients at risk for coronary artery disease undergoing elective major abdominal surgery. Cardiac troponin was measured before surgery and at day 1, 3, and 7. Multivariable logistic regression analysis was performed to examine the adjusted association for different cut-off concentrations of postoperative myocardial injury and non-cardiac outcome. In 203 patients, 690 high-sensitive cardiac troponin T measurements were performed. Fifty-three patients (26%) had a non-cardiac complication within 30 days after surgery. Hospital mortality was 4% (8/203). An increase in cardiac troponin T concentration ≥100% compared with baseline was a superior independent predictor of non-cardiac postoperative clinical complications (adjusted odds ratio 4.3, 95% confidence interval 1.8-10.1, Phigh-sensitive cardiac troponin T increase ≥100% is a strong predictor of non-cardiac 30 day complications, increased hospital stay and hospital mortality in patients undergoing major abdominal surgery. NCT02150486. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Neeff, Hannes P; Streule, Geraldine C; Drognitz, Oliver; Tittelbach-Helmrich, Dietlind; Spangenberg, Hans-Christian; Hopt, Ulrich T; Makowiec, Frank
Patients with liver cirrhosis have an increased risk of postoperative mortality. In addition, cirrhotic patients per se have a reduced life expectancy. Little is known about the combined effect of these factors on long-term outcomes after surgery. We thus evaluated early -and long-term survival in patients with cirrhosis who underwent abdominal surgery. We evaluated 30- and 90-day mortality as well as long-term survival after 212 general surgical procedures performed in 194 patients with liver cirrhosis. Risk factors for early and late mortality were assessed by uni- and multivariate methods. To avoid multicollinearity of data, different models (Child Turcotte Pugh [CTP], model for end-stage liver disease [MELD], or American Society of Anesthesiologists [ASA] score) were used in multivariate analysis. The 30- and 90-day mortality rates were 20% and 30%, respectively. CTP, MELD, and ASA were all independently associated with 30- and 90-day mortality. Although emergency operations and intraoperative transfusions independently influenced 30-day mortality, 90-day mortality also was influenced by the extent of the procedure and thrombocytopenia. Survival after surgery (n = 180) was 54% after one and 25% after 5 years (median survival 1.24 years). Long-term survival was independently influenced by CTP, MELD, ASA, hyponatremia, emergency operations, thrombocytopenia, and underlying malignancies. Survival in patients discharged after surgery (n = 140) was 69% after 1 and 33% after 5 years (median survival 2.8 years). Survival after discharge was independently influenced by MELD, CTP, hyponatremia, underlying malignant disease, and (partially) by serum creatinine. The inclusion of serum sodium into MELD scores did not further facilitate prediction of early and late mortality. A high postoperative mortality as well as a strongly reduced survival even after hospital discharge contribute to the very poor life expectancy in patients with liver cirrhosis requiring general
Vester-Andersen, Morten; Lundstrøm, Lars Hyldborg; Buck, David Levarett
OBJECTIVE: In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing ...... abdominal surgery, no statistically significant adjusted association between mortality and surgical delay was found. Additional research in diagnosis-specific subgroups of high-risk patients undergoing emergency abdominal surgery is warranted....... emergency abdominal surgery in general. MATERIAL AND METHODS: All in-patients aged ≥18 years having emergency abdominal laparotomy or laparoscopy performed within 48 h of admission between 1 January 2009 and 31 December 2010 in 13 Danish hospitals were included. Baseline and clinical data, including......OBJECTIVE: In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing...
Maia, Lígia de A; Samary, Cynthia S; Oliveira, Milena V; Santos, Cintia L; Huhle, Robert; Capelozzi, Vera L; Morales, Marcelo M; Schultz, Marcus J; Abreu, Marcelo G; Pelosi, Paolo; Silva, Pedro L; Rocco, Patricia Rieken Macedo
Intraoperative mechanical ventilation may yield lung injury. To date, there is no consensus regarding the best ventilator strategy for abdominal surgery. We aimed to investigate the impact of the mechanical ventilation strategies used in 2 recent trials (Intraoperative Protective Ventilation [IMPROVE] trial and Protective Ventilation using High versus Low PEEP [PROVHILO] trial) on driving pressure (ΔPRS), mechanical power, and lung damage in a model of open abdominal surgery. Thirty-five Wistar rats were used, of which 28 were anesthetized, and a laparotomy was performed with standardized bowel manipulation. Postoperatively, animals (n = 7/group) were randomly assigned to 4 hours of ventilation with: (1) tidal volume (VT) = 7 mL/kg and positive end-expiratory pressure (PEEP) = 1 cm H2O without recruitment maneuvers (RMs) (low VT/low PEEP/RM-), mimicking the low-VT/low-PEEP strategy of PROVHILO; (2) VT = 7 mL/kg and PEEP = 3 cm H2O with RMs before laparotomy and hourly thereafter (low VT/moderate PEEP/4 RM+), mimicking the protective ventilation strategy of IMPROVE; (3) VT = 7 mL/kg and PEEP = 6 cm H2O with RMs only before laparotomy (low VT/high PEEP/1 RM+), mimicking the strategy used after intubation and before extubation in PROVHILO; or (4) VT = 14 mL/kg and PEEP = 1 cm H2O without RMs (high VT/low PEEP/RM-), mimicking conventional ventilation used in IMPROVE. Seven rats were not tracheotomized, operated, or mechanically ventilated, and constituted the healthy nonoperated and nonventilated controls. Low VT/moderate PEEP/4 RM+ and low VT/high PEEP/1 RM+, compared to low VT/low PEEP/RM- and high VT/low PEEP/RM-, resulted in lower ΔPRS (7.1 ± 0.8 and 10.2 ± 2.1 cm H2O vs 13.9 ± 0.9 and 16.9 ± 0.8 cm H2O, respectively; Pmechanical power (63 ± 7 and 79 ± 20 J/min vs 110 ± 10 and 120 ± 20 J/min, respectively; P = .007). Low VT/high PEEP/1 RM+ was associated with less alveolar collapse than low VT/low PEEP/RM- (P = .03). E-cadherin expression was higher in
Thorup, J M; Cortes, D; Visfeldt, J
PURPOSE: Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides...... studied 17 nonpalpable testes in 10 patients 1 year and 7 months to 13(1/2) years old. Results of testicular biopsies of 13 intra-abdominal testes taken at stages 1 and 2 of surgery were available for histological comparison. RESULTS: Median number of spermatogonia per tubular cross section...
Full Text Available Splenosis is a benign condition caused by an ectopic autotransplantation of splenic tissues after splenic trauma or surgery. It usually occurs within the abdominal and pelvic cavity. Patients are generally asymptomatic and this entity is diagnosed accidentally. However, occasionally extensive abdominal splenosis poses a significant diagnostic dilemma for gastroenterologists, especially when this condition manifests as a disseminated metastatic malignant disease on abdominal imaging. This paper presents a concise review of the literature on this often misleading disorder. The crucial role of taking a thorough patient's medical history concerning splenic trauma in the past, the need for differential diagnosis of tumor-like lesions disclosed on abdominal imaging and novel diagnostics modalities that allow avoiding unnecessary laparotomy in case of abdominal splenosis are stressed. The increased prevalence of abdominal trauma due to road accidents and the growing armamentarium of available imaging modalities suggest that abdominal splenosis may be expected more often than ever. In order to prevent any possible diagnostic doubts and unnecessary future invasive examinations, confirmed splenosis should be recorded in the medical documentation of the patient.
Full Text Available Abstract Background Wound infection affects a considerable portion of patients after abdominal operations, increasing health care costs and postoperative morbidity and affecting quality of life. Antibacterial coating has been suggested as an effective measure to decrease postoperative wound infections after laparotomies. The INLINE metaanalysis has recently shown the superiority of a slowly absorbable continuous suture for abdominal closure; with PDS plus® such a suture has now been made available with triclosan antibacterial coating. Methods/Design The PROUD trial is designed as a randomised, controlled, observer, surgeon and patient blinded multicenter superiority trial with two parallel groups and a primary endpoint of wound infection during 30 days after surgery. The intervention group will receive triclosan coated polydioxanone sutures, whereas the control group will receive the standard polydioxanone sutures; abdominal closure will otherwise be standardized in both groups. Statistical analysis is based on intention-to-treat population via binary logistic regression analysis, the total sample size of n = 750 is sufficient to ensure alpha = 5% and power = 80%, an interim analysis will be carried out after data of 375 patients are available. Discussion The PROUD trial will yield robust data to determine the effectiveness of antibacterial coating in one of the standard sutures for abdominal closure and potentially lead to amendment of current guidelines. The exploration of clinically objective parameters as well as quality of life holds immediate relevance for clinical management and the pragmatic trial design ensures high external validity. Trial Registration The trial protocol has been registered with the German Clinical Trials Register (DRKS00000390.
Wright, Jesse P; Edwards, Gretchen C; Goggins, Kathryn; Tiwari, Vikram; Maiga, Amelia; Moses, Kelvin; Kripalani, Sunil; Idrees, Kamran
Low health literacy is known to adversely affect health outcomes in patients with chronic medical conditions. To our knowledge, the association of health literacy with postoperative outcomes has not been studied in-depth in a surgical patient population. To evaluate the association of health literacy with postoperative outcomes in patients undergoing major abdominal surgery. From November 2010 to December 2013, 1239 patients who were undergoing elective gastric, colorectal, hepatic, and pancreatic resections for both benign and malignant disease at a single academic institution were retrospectively reviewed. Patient demographics, education, insurance status, procedure type, American Society of Anesthesiologists status, Charlson comorbidity index, and postoperative outcomes, including length of stay, emergency department visits, and hospital readmissions, were reviewed from electronic medical records. Health literacy levels were assessed using the Brief Health Literacy Screen, a validated tool that was administered by nursing staff members on hospital admission. Multivariate analysis was used to determine the association of health literacy levels on postoperative outcomes, controlling for patient demographics and clinical characteristics. The association of health literacy with postoperative 30-day emergency department visits, 90-day hospital readmissions, and index hospitalization length of stay. Of the 1239 patients who participated in this study, 624 (50.4%) were women, 1083 (87.4%) where white, 96 (7.7%) were black, and 60 (4.8%) were of other race/ethnicity. The mean (SD) Brief Health Literacy Screen score was 12.9 (SD, 2.75; range, 3-15) and the median educational attainment was 13.0 years. Patients with lower health literacy levels had a longer length of stay in unadjusted (95% CI, 0.95-0.99; P = .004) and adjusted (95% CI, 0.03-0.26; P = .02) analyses. However, lower health literacy was not significantly associated with increased rates of 30-day
Kalarchian, Melissa A.; Marcus, Marsha D.; Courcoulas, Anita P.; Cheng, Yu; Levine, Michele D.
Background Studies of the impact of pre-surgery weight loss and lifestyle preparation on outcomes following bariatric surgery are needed. Objective To evaluate whether a pre-surgery behavioral lifestyle intervention improves weight loss through 24-months post-surgery. Setting Bariatric Center of Excellence at a large, urban medical center. Methods Candidates for bariatric surgery were randomized to a 6-month behavioral lifestyle intervention or to 6 months of usual pre-surgical care. The lifestyle intervention consisted of 8 weekly face-to-face sessions followed by 16 weeks of face-to-face and telephone sessions prior to surgery; the intervention also included 3 monthly telephone contacts after surgery. Assessments were conducted at 6-, 12- and 24-months post-surgery. Results Participants who underwent surgery (n = 143) were 90.2% female and 86.7% White. Average age was 44.9 years, and average BMI was 47.5 kg/m2 at study enrollment. At follow-up, 131 (91.6%), 126 (88.1%), 117 (81.8%) patients participated in the 6-, 12- and 24 month assessments, respectively. Percent weight loss from study enrollment to 6- and 12-months post-surgery was comparable for both groups, but at 24-months post-surgery, the lifestyle group had significantly smaller percent weight loss than the usual care group (26.5% vs. 29.5%, respectively, p = 0.02). Conclusions Pre-surgery lifestyle intervention did not improve weight loss at 24 months post-surgery. Findings raise questions about the utility and timing of adjunctive lifestyle interventions for bariatric surgery patients. PMID:26410538
Weinrich, Malte; Scheingraber, Stefan; Stephan, Bernhard; Weiss, Christel; Kayser, Anna; Kopp, Berit; Schilling, Martin K
Measurement of central venous oxygen saturation has become a surrogate parameter for fluid administration, blood transfusions and treatment with catecholamines in (early) goal directed therapy in the treatment of acute septic patients. These strategies are not easily transferred to the postoperative management of abdominal surgery due to the different conditions in surgical patients. A study population of 15 patients (8 females/7 males) underwent elective major abdominal surgery: 6 gastrectomies, 5 major liver resections and 4 lower anterior rectum resections. Surgery was performed for primary or secondary malignancy. The patients' age was 65.4+/-12.7 (mean+/-standard deviation, range 44-84, median 62) years. Blood samples were taken intraoperatively from indwelling central venous lines as well as from draining veins at the surgical site. Blood gas analyses to determine the oxygen saturations were performed immediately. All patients were operated in standardized general anesthesia including epidural analgesia and in a balanced volume status. Central venous oxygen saturations and oxygen saturations in blood from the draining veins of the surgical site showed a wide range with high intra- and interindividual differences intraoperatively. Overall, at most time points no correlation between the two oxygen saturations could be detected in three operation types. A significant correlation was only observed at one time point during liver resections. Our results show a lack of correlation between central venous oxygen saturations and oxygen saturations in the draining veins of the surgical site during major abdominal surgery. Measurement of central venous oxygen saturations does not seem to be a good surrogate for the local oxygen supply in the field of interest in major abdominal surgery even under standardized conditions.
Kahloul, Mohamed; Mhamdi, Salah; Nakhli, Mohamed Said; Sfeyhi, Ahmed Nadhir; Azzaza, Mohamed; Chaouch, Ajmi; Naija, Walid
Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness. This is a prospective, randomized, double-blind study conducted in the operating theatre of visceral surgery at Sahloul Teaching Hospital over a period of 4 months. Patients aged more than 18 undergoing a scheduled surgery under general anesthesia were included. Patients undergoing urgent surgery or presenting hearing or cognitive disorders were excluded. Before induction, patients wore headphones linked to an MP3 player. They were randomly allocated into 2 groups: Group M (with music during surgery) and group C (without music). Hemodynamic parameters, quality of arousal, pain experienced, patient's satisfaction, and awareness incidence during anesthesia were recorded. One hundred and forty patients were included and allocated into 2 groups that were comparable in demographic characteristics, surgical intervention type and anesthesia duration. Comparison of these two groups regarding the hemodynamic profile found more stability in group M for systolic arterial blood pressure. A calm recovery was more often noted in group M (77.1% versus 44%, p < 10-3). The average Visual Analog Scale (VAS) score was lower in the intervention group (33.8 ± 13.63 versus 45.1 ± 16.2; p < 10-3). The satisfaction rate was significantly higher among the experimental group (81.4% versus 51.4%; p < 10-3). The incidence of intraoperative awareness was higher in group C (8 cases versus 3 cases) but the difference was not statistically significant. Music therapy is a non-pharmacological, inexpensive, and non-invasive technique that can significantly enhance patient satisfaction and decrease patients' embarrassing experiences related to perioperative stress, pain, and awareness.
Misquith, Julie C R; Rao, Rammoorthi; Ribeiro, Karl Sa
Anaesthesia and upper abdominal surgeries alter lung compliance and functional residual capacity resulting from atelectasis. Upper abdominal surgeries also cause a decrease in peak expiratory flow rates, cough reflex due to pain limited inspiration. This study aimed to study the effect of thoracic epidural analgesia (TEA) on the peak expiratory flow rates in patients undergoing upper abdominal surgeries. A total of 44 patients posted for elective surgery were enrolled. Group 1 patients received GA + 0.125% bupivacaine infusion TEA and Group 2 received GA + Inj. Diclofenac sodium 50 mg slow i.v. TID for Postoperative analgesia. Haemodynamics, VAS pain score, PEFR measurements were done at 60 minutes, 24 hours, 48 hours and 4 days after surgery in both groups. ABG analysis was taken pre operatively and 24 hours after surgery. The SBP and DBP values obtained at 60 minutes (p<0.016) 24 and 48 hours (p<0.001) and day 4 (p<0.02) postoperative showed highly significant difference between the two groups which indicate better haemodynamic parameters in patients receiving epidural analgesia. Postoperatively the difference in PEFR values at 60 minutes, 24 hour, 48 hour and day 4 were very highly significant. (p<0.001). Group1 had a 10.739% deficit on day 4 from its pre operative baseline value while group 2 showed a 34.825 % deficit which was very highly significant (p<0.001). The difference in VAS scores recorded at 60 minutes, 24 hours, 48 hours and day 4 post op were very highly statistically significant (p < 0.001). The ABG taken at 24 hours shows statistically significant difference with patients in group 2 showing decreased values in pCO2 and pO2 reflecting poorer ventilation and oxygenation. Thoracic epidural analgesia provides superior analgesia, better cough reflex as seen by better PEFR values, were haemodynamically more stable and their ABG values were better than the NSAID group.
Cheng, Minhua; Shi, Jialiang; Gao, Tao; Shen, Juanhong; Zhao, Chenyan; Xi, Fengchan; Li, Weiqin; Li, Qiurong; Yu, Wenkui
Postoperative pain and anxiety are two common factors influencing patient's recovery. Benefits and safety in the use of sedative agents after abdominal operations to improve recovery are not well known. The present study is to evaluate the efficacy and safety of dexmedetomidine use in this population. A prospective randomized controlled trial of 145 patients undergoing abdominal operations was conducted in the Surgical Intensive Care Unit of Jinling Hospital between October and December 2015. Thirty-two patients were excluded, and 113 were included and divided into the experimental group (59 patients) receiving dexmedetomidine and analgesics for 72 h after abdominal operations, and the control group (54 patients) receiving only analgesics. Postoperative pain, inflammatory response, recovery of gastrointestinal function, adverse events, and sedation level were analyzed. Pain scores, assessed by Prince Henry Pain Scale (PHPS), in the experimental group were significantly lower than in the control group on the first (1.53 vs. 2.07, p ≤ 0.01), second (1.07 vs. 1.63, p ≤ 0.01), and third day (1.08 vs. 1.82, p = 0.01). Time to defecation was 0.60 days shorter in the experimental group than the control group (2.51 vs. 3.11, p = 0.01). There was no significant difference between inflammatory responses in the two groups (p > 0.05). Both groups had similar blood pressure, heart rate, prevalence of bradycardia, and hypotension requiring interventions (p > 0.05). The addition of dexmedetomidine to analgesia after abdominal operations is safe and could enhance gastrointestinal function recovery and pain control when monitored carefully. The capacity of dexmedetomidine to attenuate inflammatory responses requires further investigation.
Gaszyński, Tomasz M
Morbid obesity BMI 40 kg mL-2 is associated with several changes in anatomy and physiology of the respiratory system. Respiratory work is increased whereas compliance of the chest wall and lungs is decreased. Increased intra-abdominal pressure compresses the diaphragm and reduces its movability. Abdominal opening should influence respiratory mechanics. Forty-seven morbidly obese patients (BMI 49.54 ± 7.21 kg m-2) scheduled for elective bariatric surgery (open Roux-en-Y-Gastric Bypass - RYGB) were included in the study and divided into 3 groups: 4060. Measurements were performed during general anaesthesia at two time points: before (T1) and after abdominal opening (T2). All patients were ventilated using the volume control mode. Preoperative spirometry revealed significantly decreased FEV 1% in the BMI >60 group. The conditions of mechanical ventilation during general anaesthesia deteriorated with an increasing BMI. After abdominal opening,the mechanical ventilation conditions improved: increased lung compliance and decreased airway pressures. The difference was statistically significant in the entire population studied. After dividing the population into groups, however, the difference was no longer significant in patients with BMI >60. The most significant difference in peak and plateau pressures after abdominal opening was observed in patients with BMI opening improves the conditions of mechanical ventilation in morbidly obese patients; when BMI is over 60 kg m-2, this improvement may not be relevant.
Hasegawa, Kenji; Negishi, Chiharu; Nakagawa, Fumitoshi; Ozaki, Makoto
It has been reported that recently developed circulating-water garments transfer more heat than a forced-air warming system. The authors evaluated the hypothesis that circulating-water leg wraps combined with a water mattress better maintain intraoperative core temperature ≥36°C than either forced-air warming or carbon-fiber resistive heating during major abdominal surgery. Thirty-six patients undergoing open abdominal surgery were randomly assigned to warming with: (1) circulating-water leg wraps combined with a full-length circulating-water mattress set at 42°C, (2) a lower-body forced-air cover set on high (≈43°C), and (3) a carbon-fiber resistive-heating cover set at 42°C. Patients were anesthetized with general anesthesia combined with continuous epidural analgesia. The primary outcome was intraoperative tympanic-membrane temperature ≥36°C. In the 2 h after anesthesia induction, core temperature decreased 1.0 ± 0.5°C in the forced-air group, 0.9 ± 0.2°C in the carbon-fiber group, and 0.4 ± 0.4°C in the circulating-water leg wraps and mattress group (P warming systems.
Vester-Andersen, Morten; Lundstrøm, Lars Hyldborg; Buck, David Levarett; Møller, Morten Hylander
In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing emergency abdominal surgery in general. All in-patients aged ≥ 18 years having emergency abdominal laparotomy or laparoscopy performed within 48 h of admission between 1 January 2009 and 31 December 2010 in 13 Danish hospitals were included. Baseline and clinical data, including surgical delay and 90-day mortality were collected. The crude and adjusted association between surgical delay by hour and 90-day mortality was assessed by binary logistic regression. A total of 2803 patients were included. Median age (interquartile range [IQR]) was 66 (51-78) years, and 515 patients (18.4%) died within 90 days of surgery. Over the first 24 h after hospital admission, each hour of surgical delay beyond hospital admission was associated with a median (IQR) decrease in 90-day survival of 2.2% (1.9-3.3%). No statistically significant association between surgical delay by hour and 90-day mortality was shown; crude and adjusted odds ratio with 95% confidence interval 1.016 (1.004-1.027) and 1.003 (0.989-1.017), respectively. Sensitivity analyses confirmed the primary finding. In the present population-based cohort study of high-risk patients undergoing emergency abdominal surgery, no statistically significant adjusted association between mortality and surgical delay was found. Additional research in diagnosis-specific subgroups of high-risk patients undergoing emergency abdominal surgery is warranted.
Aksu, Recep; Patmano, Gülçin; Biçer, Cihangir; Emek, Ertan; Çoruh, Aliye Esmaoğlu
We aimed to evaluate the effect of bupivacaine and dexmedetomidine added to bupivacaine used in tranversus abdominis plane (TAP) block on postoperative pain and patient satisfaction in patients undergoing lower abdominal surgery. Patients submitted to lower abdominal surgery were enrolled in the study. After anesthesia induction, ultrasound guided TAP block was performed. TAP block was obtained with 21mL 0.9% saline in Group C (n=31), 20mL 0.5% bupivacaine+1mL saline in Group B (n=31), and 20mL 0.5% bupivacaine+1mL dexmedetomidine (100μg) in Group BD (n=31). Visual analog scale scores were lower in Group BD compared to Group C, at all time points (p0.05). The addition of dexmedetomidine to bupivacaine on TAP block decreased postoperative pain scores and morphine consumption; it also increased patient satisfaction in patients undergoing lower abdominal surgery. Dexmedetomidine did not have any effect on nausea and vomiting score and antiemetic requirement. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
Full Text Available Abstract Background and objectives We aimed to evaluate the effect of bupivacaine and dexmedetomidine added to bupivacaine used in tranversus abdominis plane (TAP block on postoperative pain and patient satisfaction in patients undergoing lower abdominal surgery. Methods Patients submitted to lower abdominal surgery were enrolled in the study. After anesthesia induction, ultrasound guided TAP block was performed. TAP block was obtained with 21 mL 0.9% saline in Group C (n = 31, 20 mL 0.5% bupivacaine + 1 mL saline in Group B (n = 31, and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 µg in Group BD (n = 31. Results Visual analog scale scores were lower in Group BD compared to Group C, at all time points (p 0.05. Conclusions The addition of dexmedetomidine to bupivacaine on TAP block decreased postoperative pain scores and morphine consumption; it also increased patient satisfaction in patients undergoing lower abdominal surgery. Dexmedetomidine did not have any effect on nausea and vomiting score and antiemetic requirement.
Chu, Edward W; Chernoguz, Artur; Divino, Celia M
The perioperative safety profile of clopidogrel, a potent antiplatelet agent used in the management of cardiovascular disease, is unknown, and there are no evidence-based guidelines recommending for either its interruption or continuation at this time. The aim of this study was to determine whether patients who are maintained on clopidogrel before general surgical procedures are at increased risk of perioperative bleeding complications. Patients receiving clopidogrel at the time of elective general surgery were randomized to either discontinue clopidogrel 1 week before surgery (group A) or continue clopidogrel into surgery (group B). All other antiplatelet and anticoagulant agents were discontinued before surgery. The primary end points were perioperative bleeding requiring intraoperative or postoperative transfusion of blood or blood components and bleeding-related readmission, reoperation, or mortality within 90 days of surgery. The secondary end points were perioperative myocardial infarction or cerebrovascular accidents within 90 days of surgery. Thirty-nine patients were enrolled and underwent 43 general surgical operations. Twenty-one procedures were randomized to group A and 22 to group B. The most commonly performed individual procedures were open inguinal hernia repair (23%), laparoscopic cholecystectomy (21%), open ventral hernia repair (15%), laparoscopic ventral hernia repair (11%), and laparoscopic inguinal hernia repair (9%). No perioperative mortalities, bleeding events requiring blood transfusion, or reoperations occurred. One readmission for intra-abdominal hematoma requiring percutaneous drainage occurred in each group (group A: 4.8% vs group B: 4.5%; P = 1.0). No myocardial infarctions or cerebrovascular accidents were observed or reported. The outcomes from this prospective study suggest that, patients undergoing commonly performed elective general surgical procedures can be safely maintained on clopidogrel without increased perioperative
Effect of early postextubation high-flow nasal cannula vs conventional oxygen therapy on hypoxaemia in patients after major abdominal surgery: a French multicentre randomised controlled trial (OPERA).
Futier, Emmanuel; Paugam-Burtz, Catherine; Godet, Thomas; Khoy-Ear, Linda; Rozencwajg, Sacha; Delay, Jean-Marc; Verzilli, Daniel; Dupuis, Jeremie; Chanques, Gerald; Bazin, Jean-Etienne; Constantin, Jean-Michel; Pereira, Bruno; Jaber, Samir
High-flow nasal cannula (HFNC) oxygen therapy is attracting increasing interest in acute medicine as an alternative to standard oxygen therapy; however, its use to prevent hypoxaemia after major abdominal surgery has not been evaluated. Our trial was designed to close this evidence gap. A multicentre randomised controlled trial was carried out at three university hospitals in France. Adult patients at moderate to high risk of postoperative pulmonary complications who had undergone major abdominal surgery using lung-protective ventilation were randomly assigned using a computer-generated sequence to receive either HFNC oxygen therapy or standard oxygen therapy (low-flow oxygen delivered via nasal prongs or facemask) directly after extubation. The primary endpoint was absolute risk reduction (ARR) for hypoxaemia at 1 h after extubation and after treatment discontinuation. Secondary outcomes included occurrence of postoperative pulmonary complications within 7 days after surgery, the duration of hospital stay, and in-hospital mortality. The analysis was performed on data from the modified intention-to-treat population. This trial was registered with ClinicalTrials.gov (NCT01887015). Between 6 November 2013 and 1 March 2015, 220 patients were randomly assigned to receive either HFNC (n = 108) or standard oxygen therapy (n = 112); all of these patients completed follow-up. The median duration of the allocated treatment was 16 h (interquartile range 14-18 h) with standard oxygen therapy and 15 h (interquartile range 12-18) with HFNC therapy. Twenty-three (21 %) of the 108 patients treated with HFNC 1 h after extubation and 29 (27 %) of the 108 patients after treatment discontinuation had postextubation hypoxaemia, compared with 27 (24 %) and 34 (30 %) of the 112 patients treated with standard oxygen (ARR 4, 95 % CI -8 to 15 %; p = 0.57; adjusted relative risk [RR] 0.87, 95 % CI 0.53-1.43; p = 0.58). Over the 7-day postoperative follow-up period
Hemmes, Sabrine N T; Gama de Abreu, Marcelo; Pelosi, Paolo; Schultz, Marcus J
The role of positive end-expiratory pressure in mechanical ventilation during general anaesthesia for surgery remains uncertain. Levels of pressure higher than 0 cm H2O might protect against postoperative pulmonary complications but could also cause intraoperative circulatory depression and lung injury from overdistension. We tested the hypothesis that a high level of positive end-expiratory pressure with recruitment manoeuvres protects against postoperative pulmonary complications in patients at risk of complications who are receiving mechanical ventilation with low tidal volumes during general anaesthesia for open abdominal surgery. In this randomised controlled trial at 30 centres in Europe and North and South America, we recruited 900 patients at risk for postoperative pulmonary complications who were planned for open abdominal surgery under general anaesthesia and ventilation at tidal volumes of 8 mL/kg. We randomly allocated patients to either a high level of positive end-expiratory pressure (12 cm H2O) with recruitment manoeuvres (higher PEEP group) or a low level of pressure (≤2 cm H2O) without recruitment manoeuvres (lower PEEP group). We used a centralised computer-generated randomisation system. Patients and outcome assessors were masked to the intervention. Primary endpoint was a composite of postoperative pulmonary complications by postoperative day 5. Analysis was by intention-to-treat. The study is registered at Controlled-Trials.com, number ISRCTN70332574. From February, 2011, to January, 2013, 447 patients were randomly allocated to the higher PEEP group and 453 to the lower PEEP group. Six patients were excluded from the analysis, four because they withdrew consent and two for violation of inclusion criteria. Median levels of positive end-expiratory pressure were 12 cm H2O (IQR 12-12) in the higher PEEP group and 2 cm H2O (0-2) in the lower PEEP group. Postoperative pulmonary complications were reported in 174 (40%) of 445 patients in the higher
You-sheng LI; Peng-fei WANG; Qi MAO; Jian WANG; Jie-shou LI
...) and the traditional surgery in a pig model of severe abdominal gunshot injury.Methods Thirty-two female domestic outbreeding pigs with multiple bowel injury and exsanguination followed by lethal triad...
Full Text Available Objective To compare the difference in systemic inflammatory response and early mortality between damage control surgery(DCS and the traditional surgery in a pig model of severe abdominal gunshot injury.Methods Thirty-two female domestic outbreeding pigs with multiple bowel injury and exsanguination followed by lethal triad(low body temperature,acidosis and coagulopathy were randomly divided into two groups(16 each: conventional surgery(CS and DCS groups.Laparotomy was performed after transfusion of appropriate amount of autologous blood and fluid infusion,pigs in CS group were then underwent end-to-end intestinal anastomosis,peritoneal lavage and definitive abdominal closure;while in DCS group the pigs received clamping of intestinal lumens,ligation of bleeding vessels,peritoneal lavage,and temporary abdominal closure.The operation time,blood loss and volume of fluid infusion were recorded.The hemodynamic parameters,arterial blood gases and coagulation parameters were examined.Six pigs of each group were sacrificed 6 hours after operation,and myocardium,lung,small intestine and liver were harvested for histological observation.The remaining 10 pigs of each group were used for assessment of 24h survival rate.Results No significant difference was detected in blood loss and mean arterial pressure(MAP between the two groups.Compared with CS group,the operation time in DCS group was shorter(1.1±0.2h vs 2.4±0.3h,P < 0.01,and the amount of infusion was less(3204±254ml vs 3756±313ml,P < 0.05.Pigs in DCS group showed higher urinary output,lower heart rate,and lower dagree of acidosis and coagulopathy.The tissue injuries and neutrophil infiltration were milder in DCS group than in CS group.Although the 24h survival rate was higher in DCS group(80% than in CS group(50%,no significant difference was found with statistical analysis(P=0.175.Conclusion Damage control surgery,compared with conventional surgery,may shorten the operation time,reduce fluid
Kalarchian, Melissa A; Marcus, Marsha D; Courcoulas, Anita P; Cheng, Yu; Levine, Michele D
Studies on the impact of presurgery weight loss and lifestyle preparation on outcomes following bariatric surgery are needed. To evaluate whether a presurgery behavioral lifestyle intervention improves weight loss through a 24-month postsurgery period. Bariatric Center of Excellence at a large, urban medical center. Candidates for bariatric surgery were randomized to a 6-month behavioral lifestyle intervention or to 6 months of usual presurgical care. The lifestyle intervention consisted of 8 weekly face-to-face sessions, followed by 16 weeks of face-to-face and telephone sessions before surgery; the intervention also included 3 monthly telephone contacts after surgery. Assessments were conducted 6, 12, and 24 months after surgery. Participants who underwent surgery (n = 143) were 90.2% female and 86.7% White. Average age was 44.9 years, and average body mass index was 47.5 kg/m(2) at study enrollment. At follow-up, 131 (91.6%), 126 (88.1%), 117 (81.8%) patients participated in the 6-, 12-, and 24-month assessments, respectively. Percent weight loss from study enrollment to 6 and 12 months after surgery was comparable for both groups, but at 24 months after surgery, the lifestyle group had significantly smaller percent weight loss compared with the usual care group (26.5% versus 29.5%, respectively, P = .02). Presurgery lifestyle intervention did not improve weight loss at 24 months after surgery. The findings from this study raise questions about the utility and timing of adjunctive lifestyle interventions for bariatric surgery patients. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Full Text Available Opioids are commonly used as effective analgesics for the treatment of acute and chronic pain. However, considerable individual differences have been widely observed in sensitivity to opioid analgesics. We focused on a G-protein-activated inwardly rectifying potassium (GIRK channel subunit, GIRK2, that is an important molecule in opioid transmission. In our initial polymorphism search, a total of nine single-nucleotide polymorphisms (SNPs were identified in the whole exon, 5'-flanking, and exon-intron boundary regions of the KCNJ6 gene encoding GIRK2. Among them, G-1250A and A1032G were selected as representative SNPs for further association studies. In an association study of 129 subjects who underwent major open abdominal surgery, the A/A genotype in the A1032G SNP and -1250G/1032A haplotype were significantly associated with increased postoperative analgesic requirements compared with other genotypes and haplotypes. The total dose (mean+/-SEM of rescue analgesics converted to equivalent oral morphine doses was 20.45+/-9.27 mg, 10.84+/-2.24 mg, and 13.07+/-2.39 mg for the A/A, A/G, and G/G genotypes in the A1032G SNP, respectively. Additionally, KCNJ6 gene expression levels in the 1032A/A subjects were significantly decreased compared with the 1032A/G and 1032G/G subjects in a real-time quantitative PCR analysis using human brain tissues, suggesting that the 1032A/A subjects required more analgesics because of lower KCNJ6 gene expression levels and consequently insufficient analgesic effects. The results indicate that the A1032G SNP and G-1250A/A1032G haplotype could serve as markers that predict increased analgesic requirements. Our findings will provide valuable information for achieving satisfactory pain control and open new avenues for personalized pain treatment.
Full Text Available Background and Design: The aim of this study is to investigate whether there can be a difference in types of scars developed on the same type of incisions due to cesarean section or benign gynecologic operations, and to examine the effect of regenerative process occurring in the puerperal period on scar formation. Materials and Methods: A total of 586 female patients aged 20-40 years, who applied to our dermatology and gynecology and obstetrics outpatient clinics, were included in this case control study. Patients who were operated due to benign gynecologic conditions were assigned to group 1 (n=293, and those who underwent cesarean section to group 2 (n=293, and the types of scars were compared. A p value of less than 0.05 was considered statistically significant. Results: Atrophic and hypertrophic scars were developed in 237 (80.9% and 56 (19.1% of group 1 patients, respectively. However, 245 (83.6% of patients in group 2 had atrophic scars and 48 (16.4% had hypertrophic scars. In terms of the type of scar distribution, no significant difference was found between the two groups (p>0.05. Patients with hypertrophic scar formation constituted 53.8% of group 1 patients and 46.2% of group 2 patients. There was no significant difference between the groups for the risk of hypertrophic scar formation (p>0.05. Conclusion: Our study concluded that there is no significant difference in scar formation on abdominal incision site between benign gynecologic surgeries performed at any period of childbearing age and cesarean section. In addition, the presence of striae, wound infection or hematoma, and duration of wound healing were found to be associated with the risk for hypertrophic scar formation in incision sites in both cesarean section and benign gynecological operations.
Full Text Available INTRODUCTION: Various adjuvants have been used with local anesthetics in spinal anesthesia to improve the quality of block and to provide prolonged postoperative analgesia. Dexmedetomidine, the new highly selective α2 - agonist drug, is now being used as a neuraxial adju vant. AIM: The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of dexmedetomidine or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine. METHOD OLOGY: Fifty patients classified in American Society of Anesthesiologists classes I and II scheduled for lower abdominal surgeries were included in this prospective cohort study at Amala Institute of Medical Sciences. Patients received either 15 mg hyperba ric bupivacaine plus 25 μg fentanyl (group 1, n = 25 or 15 mg hyperbaric bupivacaine plus 5 μg dexmedetomidine (group 2, n = 25 intrathecally . RESULTS : Patients in dexmedetomidine group (2 had a significantly longer duration of motor and sensory block t han patients in fentanyl group . (1 The mean time regression of motor block to reach Bromage 0 was 17 6 . 2± 5.71 min in d exmeditomid ine group and 16 6 . 36 ± 5.97 min in fentanyl group (P<0.05. Duration of analgesia was 2 39.52 ± 9.05 min in D exmed i tomidine gro up and 189.96 ± 5.35 min in fentanyl group ( p< 0.05. A significant decrease in heart rate was noted in dexmedetomidine group. CONCLUSION : Intrathecal dexmedetomidine is associated with prolonged duration of analgesia and motor block along with significant dec rease in heart rate.
Yu, Jiang-Hong; Wu, Ji-Xiang; Yu, Lei; Li, Jian-Ye
Giant hiatal hernia (GHH) comprises 5% of hiatal hernia and is associated with significant complications. The traditional operative procedure, no matter transthoracic or transabdomen repair of giant hiatal hernia, is characteristic of more invasion and more complications. Although laparoscopic repair as a minimally invasive surgery is accepted, a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation. The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia. We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution. The GHH was defined as greater than one-third of the stomach in the chest. Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients. Mean age was 67 years. The results showed that there were no conversions to open surgery and no intraoperative deaths. The mean duration of operation was 100 min (range: 90-130 min). One-side pleura was injured in 4 cases (14.8%). The mean postoperative length of stay was 4 days (range: 3-7 days). Median follow- up was 26 months (range: 6-38 months). Transient dysphagia for solid food occurred in three patients (11.1%), and this symptom disappeared within three months. There was one patient with recurrent hiatal hernia who was reoperated on. Two patients still complained of heartburn three months after surgery. Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient. Totally, satisfactory outcome was reported in 88.9% patients. It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible, safe, and effective for the patients who cannot tolerate the pneumoperitoneum.
Ambjørn, J.; Białas, P.; Jurkiewicz, J.; Burda, Z.; Petersson, B.
We propose a new, very efficient algorithm for sampling of random surfaces in the Monte Carlo simulations, based on so-called baby universe surgery, i.e. cutting and pasting of baby universe. It drastically reduces slowing down as compared to the standard local flip algorithm, thereby allowing
Pollard, Matthew E; Eilber, Karyn S; Anger, Jennifer T
Abdominal sacrocolpopexy has been considered the gold standard for vaginal vault prolapse repair for several decades. Although transvaginal approaches gained popularity as minimally invasive alternatives, complications related to the use of vaginal mesh have led surgeons to perform these repairs less frequently. By incorporating laparoscopic and robotic techniques into the traditional open abdominal sacrocolpopexy, surgeons can offer the benefits of minimally invasive surgery while avoiding risks of vaginal mesh. This review article aims to evaluate the efficacy and outcomes of abdominal sacrocolpopexy by comparing open, laparoscopic, and robotic assisted laparoscopic surgery. The excellent outcomes of open abdominal sacrocolpopexy have repeatedly been shown in published, randomized data. This has been further validated in minimally invasive techniques through randomized data evaluating the outcomes of laparoscopic sacrocolpopexy. Among the various sacrocolpopexy techniques, outcomes are similar among the open, laparoscopic, and robotic approaches. Minimally invasive surgeries have been shown to have advantages in terms of perioperative morbidity. The superior outcomes of abdominal sacrocolpopexy are available using minimally invasive techniques for pelvic organ prolapse repair. Further research with randomized data is required to establish how these approaches compare to each other. Given the inherent advantages of minimally invasive surgery, robotic or laparoscopic abdominal sacrocolpopexy may become the preferred approach to abdominal pelvic organ prolapse repair.
Олена Миколаївна Клигуненко
Full Text Available Thombosis affects veins nearly in 3 times more often than arteries. In USA the one third of 150 000 - 200 000 VTE every year is connected with lethal conclusion after surgery .Aim of research was to study an impact of presurgical start of thromboprophylaxis with nadrapirin calcium on hemodynamics, hemostasis and inflammation at the elective abdominal surgeries.Matherials and methods. After informed consent 60 patients were prospectively separated into groups depending of preparation and regimen of thromboprophylaxis. The 1 group (n = 30 used UFH (5000 OD for 2 hours before surgery on 5000 OD 2 times during 7 days after it. The 2 group (n = 30 used nadroparin calcium(«Fraxiparin»9500 aXA IU(0,3 ml for 2 hours before surgery on 2500 IU 1 time a day during 7 days after surgery. Patients were united on sex, age, contaminant pathology, class АSA (1-2 and type of surgical procedure (laparoscopic, cholecystectomy, hernioplasty. There were studied the number of trombocitises, prothrombin time, international normalized ratio (INR, activated partial thromboplastic time (APTT, fibrinogen, Х-а factor activity, antithrombin 111, prothein C, soluble fibrin monomeric complexes (SFMC D-dimer before surgery and in 1 and 5 days after it.Results and discussion: Administration of nadroparin calcium for 2 hours before surgery prolongs the time of clot formation from the first to fifth day at the expense of inhibition of the external way of coagulation. The risk of thrombotic complications decreases at administration of nadraparin calcium for 2 hours because of normalization of the level of protein C. At the same time the lysis of fibrin clots was accelerated on the background of nadraparin calcium.At comparative characteristics we detected that an analysis of hemodynamic state at the standard thromboprophylaxis with UFH with output relatively normodynamic type of blood circulation that was formed by power-consuming, isometric, rhythm-depending mechanism was
Christoffersen, M W; Olsen, B H; Rosenberg, J; Bisgaard, T
Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma-reducing effect of an abdominal binder in patients undergoing laparoscopic umbilical or epigastric hernia repair. Based on power analysis, a minimum of 54 patients undergoing laparoscopic umbilical and epigastric hernia repair were to be included. Patients were randomized to abdominal binders vs. no abdominal binders during the first postoperative week. Standardized surgical technique, anaesthesia, and analgesic regimens were used and study observers were blinded towards the intervention. Postoperative pain (visual analogue score) on day 1 was the primary outcome. In addition, ultrasonographic evaluation of seroma formation and several subjective patient-related parameters were registered. Furthermore, patients in the abdominal binder group were asked to rate benefits or discomforts of wearing the binder. Data from 56 patients (abdominal binder, n = 28; no binder, n = 28) were available for analysis. No significant intergroup differences in postoperative pain or any of the other surgical outcomes, including seroma formation, were found. However, the abdominal binder group reported subjective beneficial effect of wearing the binder in 24 of the 28 patients (86%). No adverse effects of the abdominal binder were found. There were no effects of an abdominal binder on pain, movement limitation, fatigue, seroma formation, general well-being, or quality of life. However, most patients claimed a subjective beneficial effect of using their abdominal binder.
Davies, Simon J; Yates, David; Wilson, R Jonathan T
Dopexamine has been shown to reduce both mortality and morbidity in major surgery when it is used as part of a protocol to increase oxygen delivery in the perioperative period. A European multicenter study has examined the use of dopexamine in patients undergoing major abdominal surgery, showing a trend toward improved survival and reduced complications in high-risk patients when receiving low-dose dopexamine (0.5 μg · kg(-1) · min(-1)). A reduced oxygen uptake at the anaerobic threshold (AT) has been shown to confer a significant risk of mortality in patients undergoing major abdominal surgery and allows objective identification of a high-risk operative group. In this study, we assessed the effects of low-dose dopexamine on morbidity after major abdominal surgery in patients who were at increased risk by virtue of a reduced AT. Patients undergoing elective major colorectal or urological surgery who had an AT of surgery, a radial arterial cannula was placed and attached to an Edwards Lifesciences FloTrac/Vigileo system for measuring cardiac output. Patients were given a 250-mL bolus of Voluven (6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride) until the stroke volume no longer increased by 10%, then received either dopexamine (0.5 μg · kg(-1) · min(-1)) or saline 0.9% for 24 hours. During surgery, fluid boluses of Voluven were given if the stroke volume variation was >10%. No crystalloid was given during surgery. A standardized postoperative fluid regime with Hartmann solution was prescribed at 1.5 mL · kg(-1) · h(-1) for 24 hours. The primary outcome measure was postoperative morbidity measured by the Postoperative Morbidity Survey. One hundred twenty-four patients were recruited over a 23-month period. The incidence of morbidity as measured by the Postoperative Morbidity Survey on day 5 was 55% in the control group versus 47% in the dopexamine group (P = 0.14). There was no significant reduction in morbidity on any measured postoperative day
Shapiro Daniel E
Full Text Available Abstract Background Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. Methods 22 children, aged 5 – 18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with ≤ 4 days of pain/month and no missed activities due to pain were defined as being healed. Depression, anxiety, and somatization were measured in both children and parents at baseline. Results At baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04. There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05, and two (82% vs. 45%, P Conclusion The therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominal pain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP.
Weydert, Joy A; Shapiro, Daniel E; Acra, Sari A; Monheim, Cynthia J; Chambers, Andrea S; Ball, Thomas M
Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. 22 children, aged 5-18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with Depression, anxiety, and somatization were measured in both children and parents at baseline. At baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04). There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05), and two (82% vs. 45%, P children who had learned guided imagery met the threshold of children who learned only the breathing exercises. The therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominal pain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP.
Dahl, J B; Rosenberg, J; Hansen, B L
In a double-blind, randomized study, epidural infusions of low-dose morphine (0.2 mg/h) combined with low-dose bupivacaine (10 mg/h) were compared with epidural infusions of low-dose morphine (0.2 mg/h) alone for postoperative analgesia at rest and during mobilization and cough in 24 patients after...... elective major abdominal surgery. All patients in addition received systemic piroxicam (20 mg daily). No significant differences were observed between the groups at any assessment of pain at rest (P greater than 0.05), whereas pain in the morphine/bupivacaine group was significantly reduced during...... mobilization from the supine into the sitting position 12 and 30 h after surgical incision and during cough 8, 12, and 30 h after surgical incision (P less than 0.05). We conclude, that low-dose epidural bupivacaine potentiates postoperative low-dose epidural morphine analgesia during mobilization and cough...
Leide da Silva Nunes, Francisca; Calado Ferreira Pinheiro Gadelha, Patricia; Damasceno de Souza Costa, Milena; Carolina Ribeiro de Amorim, Ana Carolina; Bezerra da Silva, Maria da Guia
The nutritional state is the independent factor that most influences the post-operational results in elective surgeries. to evaluate the influence of the nutritional state on the hospitalization period and on the post-operative complications of patients submitted to abdominal surgery. prospective study with 99 surgical patients over 18 years of age, submitted to abdominal surgeries in the period from April to October of 2013, in the Instituto de Medicina Integral Professor Fernando Figueira (IMIP). All patients were submitted to anthropometric nutritional evaluations through the body mass Index (BMI), arm circumference (AC) and triceps skinfold thickness (TEST). The biochemical evaluation was carried out from the leukogram and serum albumin results. The identification of candidate patients to nutritional therapy (NT) was carried out through the nutritional risk (NR) evaluation by using the BMI, loss of weight and hypoalbuminemia. The information about post-operational complications, hospitalization period and clinical diagnosis was collected from the medical records. Program SPSS version 13.0 and significance level of 5% were used for the statistical analysis. The malnutrition diagnosed by the AC showed significant positive association with the presence of post-operative complications (p=0.02) and with hospitalization period (p=0.02). The presence of NR was greater when evaluated by hypoalbuminemia (28.9%), however, only 4% of the sample carried out the NT in the pre-operational period. The hospitalization period was greater for patients with malignant neoplasia (p<0.01). The malnutrition diagnosis of patients submitted to abdominal surgeries is associated to greater risk of post-operational complications and longer hospitalization permanence. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Pronovost, P; Garrett, E; Dorman, T; Jenckes, M; Webb III, T H; Breslow, M; Rosenfeld, B; Bass, E
The purpose was to assess the current variation in complication rates and evaluate the association between specific types of complications and in-hospital mortality and total hospital charges for patients having abdominal aortic surgery. We studied 2987 patients for abdominal aortic surgery in Maryland from 1994 to 1996 and used discharge diagnoses and procedure codes to identify diagnoses that most likely represent major surgery complications. We evaluated how in-hospital mortality and total hospital charges related to specific complications, adjusting for patient demographics, severity of illness, comorbidity, and hospital and surgeon volumes. Discharge data was obtained from the hospital marketing departments. Complication rates varied widely among hospitals. Complications independently associated with increased risk of in-hospital death include cardiac arrest with an odds ratio (OR) of 90 and a 95% confidence interval (CI) of 32-251, septicemia (OR 6.1, CI 3.3-11.3), acute myocardial infarction (OR 5.7, CI 2.3-14.3), acute renal failure (OR 5.0, CI 2.3-11.0), surgical complications after a procedure (OR 3.1, CI 2.0-4.9), and reoperation for bleeding (OR 2.2, CI 1.1-4.8). The population-attributable risk for in-hospital mortality was 47% for cardiac arrest and 27% for acute renal failure. In abdominal aortic surgery on patients in Maryland, the rates of some complications vary widely and are independently associated with increased in-hospital mortality and hospital charges (charges differ from costs). Efforts to reduce these complications should help to decrease both levels.
Gürşen, Ceren; İnanoğlu, Deniz; Kaya, Serap; Akbayrak, Türkan; Baltacı, Gül
Abdominal muscle strength decreases and fat ratio in the waist region increases following cesarean section. Kinesio taping (KT) is an easily applicable method and stimulates muscle activation. The aim of this pilot randomized controlled trial (RCT) was to investigate the effects of KT combined with exercise in women with cesarean section on abdominal recovery compared to the exercise alone. Twenty-four women in between the fourth and sixth postnatal months who had cesarean section were randomly assigned to KT + exercise (n = 12) group or exercise group (n = 12). KT was applied twice a week for 4 weeks on rectus abdominis, oblique abdominal muscles and cesarean incision. All women were instructed to carry out posterior pelvic tilt, core stabilization and abdominal correction exercises. Outcome measures were evaluated with the manual muscle test, sit-up test, abdominal endurance test, Visual Analog Scale (VAS), circumference measurements and Roland Morris Disability Questionnaire (RMDQ). Mann-Whitney U and Wilcoxon tests were used to analyze data. p exercise group was significantly greater compared to the exercise group in terms of the strength of the rectus abdominis muscle, sit-up test, VAS, measurements of the waist circumference and RMDQ (p exercises in the postnatal physiotherapy program provides greater benefit for the abdominal recovery in women with cesarean section. Further studies with larger sample sizes and long-term follow-up are needed to verify these results.
The efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery. A double blind randomized multicentre trail with venographic assesment
Bergkvist, A; Eldor, A; Thorlacius-Ussing, O.
BACKGROUND: Surgery for malignant disease carries a high risk of deep vein thrombosis. The aim of this study was to evaluate the prophylactic effect of a low molecular weight heparin, enoxaparin, 40 mg once daily, beginning 2 h before surgery, compared with that of unfractionated low-dose heparin...... three times daily. METHODS: Patients included were over 40 years of age and undergoing planned elective curative abdominal or pelvic surgery for cancer. The study was designed as a prospective double-blind randomized multicentre trial with participating departments from ten countries. Primary outcome...... severe thrombocytopenia. There were no differences in mortality at either 30 days or 3 months. CONCLUSION: Enoxaparin, 40 mg once daily, is as safe and effective as unfractionated heparin three times daily in preventing venous thromboembolism in patients undergoing major elective surgery for abdominal...
Dahl, J B; Hansen, B L; Hjortsø, N C
We have studied the effect of continuous extradural analgesia with bupivacaine and morphine, initiated before or after colonic surgery, in a double-blind, randomized study. Thirty-two patients were allocated randomly to receive an identical extradural block initiated 40 min before surgical incision...
Roovers, Jan-Paul W. R.; van der Vaart, C. Huub; van der Bom, Johanna G.; van Leeuwen, Jules H. Schagen; Scholten, Piet C.; Heintz, A. Peter M.
OBJECTIVE: To compare the effects of vaginal hysterectomy (combined with anterior and/or posterior colporraphy) and abdominal sacro-colpopexy (with preservation of the uterus) on urogenital function. DESIGN: Randomised trial. SETTING: Three teaching hospitals in The Netherlands. POPULATION:
P.G. Richard (P.); Y. Issa (Yama); E.J. van Santbrink (Evert); N.D. Kannekens-Bouvy (Nicole); R.F.M.P. Kruitwagen (Roy); J. Jeekel (Hans); E.A. Bakkum (Erica); M.M. Rovers (Maroeska); H. van Goor (Harry)
markdownabstractAbstract Objective To estimate the disease burden of the most important complications of postoperative abdominal adhesions: small bowel obstruction, difficulties at reoperation, infertility, and chronic pain. Design Systematic review and meta-analyses. Data sources Searches
Kwaan, Mary R; Sirany, Anne Marie E; Rothenberger, David A; Madoff, Robert D
Colorectal surgical procedures have a high rate of surgical site infection (SSI), and obesity has been implicated as a predictor of such infection. We hypothesized that abdominal wall thickness (AWT), as a metric of obesity, would predict postoperative superficial and deep incisional SSI after colorectal surgery, and conducted a study to assess superficial and deep incisional SSI and its relationship to abdominal wall thickness. To measure pre-operative AWT through cross-sectional imaging, and to analyze its relationship to SSI, we conducted a retrospective study at a single academic medical center of patients who had had colorectal resection for any indication in 2008 and 2009. We identified 143 patients for inclusion in the study. Superficial or deep incisional SSI occurred in 43 patients (30%). Abdominal wall thickness at the midpoint between the umbilicus and pubis was associated with SSI (OR 1.03; p=0.014). Body-mass index (BMI) was also significantly associated with SSI (OR 1.08; p=0.014). Other significant (p<0.05) predictors of SSI by univariate analysis included a history of soft tissue infection, a surgical wound classification of 3 or 4, and lack of compliance with perioperative antibiotic guidelines. In a multivariable analysis of factors that were statistically significantly associated with SSI in univariate comparisons, lack of appropriate preoperative antibiotic administration independently predicted SSI (OR 4.33; 95% CI 1.08-17.40), but AWT and BMI were not significantly associated with SSI. Surgical site infection is common after colorectal surgery. Increased AWT predicts SSI by univariate analysis. Our findings could guide further studies of interventions that may decrease the risk of SSIs in patients with a thick abdominal wall.
Thevathasan, T; Shih, S L; Safavi, K C; Berger, D L; Burns, S M; Grabitz, S D; Glidden, R S; Zafonte, R D; Eikermann, M; Schneider, J C
We hypothesised that intraoperative non-depolarising neuromuscular blocking agent (NMBA) dose is associated with 30-day hospital readmission. Data from 13,122 adult patients who underwent abdominal surgery under general anaesthesia at a tertiary care hospital were analysed by multivariable regression, to examine the effects of intraoperatively administered NMBA dose on 30-day readmission (primary endpoint), hospital length of stay, and hospital costs. Clinicians used cisatracurium (mean dose [SD] 0.19 mg kg-1 [0.12]), rocuronium (0.83 mg kg-1 [0.53]) and vecuronium (0.14 mg kg-1 [0.07]). Intraoperative administration of NMBAs was dose-dependently associated with higher risk of 30-day hospital readmission (adjusted odds ratio 1.89 [95% Confidence Interval (CI) 1.26-2.84] for 5th quintile vs 1st quintile; P for trend: Psurgery) significantly modified the risk (interaction term: aOR 1.31 [95% CI 1.05-1.63], P=0.02), and the adjusted odds of readmission in patients undergoing ambulatory surgical procedures who received high-dose NMBAs vs low-dose NMBAs amounted to 2.61 [95% CI 1.11-6.17], P for trend: Phigh doses of NMBAs given during abdominal surgery was associated with an increased risk of 30-day readmission, particularly in patients undergoing ambulatory surgery.
Amaral, Maria Vitória França DO; Guimarães, José Ricardo; Volpe, Paula; Oliveira, Flávio Malcher Martins DE; Domene, Carlos Eduardo; Roll, Sérgio; Cavazzola, Leandro Totti
We describe the preliminary national experience and the early results of the use of robotic surgery to perform the posterior separation of abdominal wall components by the Transversus Abdominis Release (TAR) technique for the correction of complex defects of the abdominal wall. We performed the procedures between 04/2/2015 and 06/15/2015 and the follow-up time was up to six months, with a minimum of two months. The mean surgical time was five hours and 40 minutes. Two patients required laparoscopic re-intervention, since one developed hernia by peritoneal migration of the mesh and one had mesh extrusion. The procedure proved to be technically feasible, with a still long surgical time. Considering the potential advantages of robotic surgery and those related to TAR and the results obtained when these two techniques are associated, we conclude that they seem to be a good option for the correction of complex abdominal wall defects. RESUMO Descrevemos a experiência preliminar nacional na utilização da cirurgia robótica para realizar a separação posterior de componentes da parede abdominal pela técnica transversus abdominis release (TAR) na correção de defeitos complexos da parede abdominal e seus resultados precoces. As cirurgias foram realizadas entre 02/04/2015 e 15/06/2015 e o tempo de acompanhamento dos resultados foi de até seis meses, com tempo mínimo de dois meses. O tempo cirúrgico médio foi de cinco horas e 40 minutos. Dois pacientes necessitaram reintervenção por laparoscopia, pois um desenvolveu hérnia por migração peritoneal da tela e um teve escape da tela. A cirurgia provou ser factível do ponto de vista técnico, com um tempo cirúrgico ainda elevado. Tendo em vista as vantagens potenciais da cirurgia robótica e aquelas relacionadas ao TAR e os resultados obtidos ao se associar essas duas técnicas, conclui-se que elas parecem ser uma boa opção para a correção de defeitos complexos da parede abdominal.
Lai, Hou-Chuan; Chan, Shun-Ming; Lu, Chueng-He; Wong, Chih-Shung; Cherng, Chen-Hwan; Wu, Zhi-Fu
Reducing anesthesia-controlled time (ACT) may improve operation room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for open major upper abdominal surgery under general anesthesia (GA) is not available in the literature.This retrospective study uses our hospital database to analyze the ACT of open major upper abdominal surgery without liver resection after either desflurane/fentanyl-based anesthesia or TIVA via target-controlled infusion with fentanyl/propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, and postanesthetic care unit (PACU) stay time and percentage of prolonged extubation (≥15 minutes) were compared between these 2 anesthetic techniques.We included data from 343 patients, with 159 patients receiving TIVA and 184 patients receiving DES. The only significant difference is extubation time, TIVA was faster than the DES group (8.5 ± 3.8 vs 9.4 ± 3.7 minutes; P = 0.04). The factors contributed to prolonged extubation were age, gender, body mass index, DES anesthesia, and anesthesia time.In our hospital, propofol-based TIVA by target-controlled infusion provides faster emergence compared with DES anesthesia; however, it did not improve OR efficiency in open major abdominal surgery. Older, male gender, higher body mass index, DES anesthesia, and lengthy anesthesia time were factors that contribute to extubation time.
Full Text Available Objective To explore the correlation between the perioperative risk factors and postoperative pulmonary complications(POPC in elder patients undergoing upper abdominal surgery.Methods A retrospective survey of 169 elder patients(age over 60 years,received elective upper abdominal surgery under general anesthesia from Jan.1,2006 to Jan.1,2010 was conducted.The perioperative factors influencing respiratory function were evaluated,including clinical manifestations,chest X-ray,pulmonary function,arterial blood gas analysis,duration of anesthesia,incision type,duration of nasogastric tube and ambulation time.Meanwhile,the relationship between POPC and the factors mentioned above was analyzed.Results POPC were seen to occur in 77 of the 169 patients(45.6%,and the most common complication was pneumonia(20 cases,followed by atelectasis(18 cases,tracheobronchitis or acute exacerbations of chronic bronchitis(17 cases,bronchospasm(15 cases,acute respiratory failure(5 cases and pulmonary embolism(2 cases.Multivariate logistic analysis showed that the postoperative nasogastric intubation,preoperative respiratory symptoms,decreased forced expiratory volume in 1st second/forced vital capacity(FEV1/FVC and longer duration of anesthesia were the valuable risk factors for prediction of POPC.Conclusions It is recommend that a detailed preoperative pulmonary examination and pulmonary function test in elder patients who are going to have upper abdominal surgery should be done to identify the risk for POPC.Preoperative intervention therapy may be helpful to improve pulmonary function,decrease the incidence of POPC and lower mortality of the patients.
Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N
Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID use in patients who underwent bariatric surgery, and to determine the use of PPIs in patients who use NSAIDs after bariatric surgery. A randomized controlled intervention study in patients after bariatric surgery. Patients were randomized to an intervention or a control group. The intervention consisted of sending a letter to patients and their general practitioners on the risks of use of NSAIDs after bariatric surgery and the importance of avoiding NSAID use. The control group received care-as-usual. Dispensing data of NSAIDs and PPIs were collected from patients' pharmacies: from a period of 6 months before and from 3 until 9 months after the intervention. Two hundred forty-eight patients were included (intervention group: 124; control group: 124). The number of users of NSAIDs decreased from 22 to 18 % in the intervention group and increased from 20 to 21 % in the control group (NS). The use of a PPI with an NSAID rose from 52 to 55 % in the intervention group, and from 52 to 69 % in the control group (NS). Informing patients and their general practitioners by letter, in addition to care-as-usual, is not an effective intervention to reduce the use of NSAIDs after bariatric surgery (trial number NTR3665).
Ejlertsen, Tove; Nielsen, P H; Jepsen, S
In 130 patients with no cardiac or pulmonary disease at the time of elective upper abdominal surgery, chest radiography was performed 2 and 4 days postoperatively. The sputum was examined and the patients were monitored with measurement of body temperature, arterial oxygen tension and white blood...... counts. Pneumonic infiltrates appeared in 8.4% of the patients and atelectasis in 68.5%. Most of the patients had elevated body temperature, raised white blood count and reduced arterial oxygen tension postoperatively. None of these commonly employed clinical or laboratory findings, singly...
Wada, Morito; Kitayama, Masato; Hashimoto, Hiroshi; Kudo, Tsuyoshi; Kudo, Mihoko; Takada, Norikazu; Hirota, Kazuyoshi
A rectus sheath block can provide postoperative analgesia for midline incisions. However, information regarding the pharmacokinetics of local anesthetics used in this block is lacking. In this study, we detail the time course of ropivacaine concentrations after this block. Thirty-nine patients undergoing elective lower abdominal surgery were assigned to 3 groups receiving rectus sheath block with 20 mL of different concentrations of ropivacaine. Peak plasma concentrations were dose dependent, and there were no significant differences in the times to peak plasma concentrations. The present data also suggested a slower absorption kinetics profile for ropivacaine after rectus sheath block than other compartment blocks.
Cassell, O C; Oakley, N; Forrest, A R; Thomas, W E; Dennison, A R
Numerous studies of post-operative fluid status have utilized sophisticated measurements of electrolyte distribution and fluid shift without relating results to clinical practice. The aim of this prospective randomized study was to investigate the response of patients undergoing abdominal surgery of moderate severity to conservative post-operative fluid administration. Forty-five patients undergoing open cholecystectomy were randomized to receive 2.51 of fluid (1 l normal saline and 1.51 5% dextrose), 1 l of normal saline, or free oral fluids (groups 1, 2, 3, respectively). Serum and urine osmolality and electrolytes were measured pre-operatively and at 24 and 48 h post-operatively. Patients remained in the study irrespective of the urine output. Plasma electrolytes and osmolality remained within normal limits in all three groups despite significant changes in urine electrolyte and osmolality in groups 2 and 3. This confirms that a conservative approach to fluid administration has no detrimental effect on hydration in fit patients with uncomplicated surgery.
Full Text Available Objective: To study the intraoperative oxygenation function and trauma degree of pressurecontrolled ventilation-volume guaranteed (PCV-VG and volume-controlled ventilation (VCV mode for elderly patients with laparoscopic abdominal surgery. Methods: 60 elderly patients with laparoscopic abdominal surgery were selected for study and randomly divided into two groups (n=30, group A received ventilation in accordance with sequential VCV-PCV-VG mode, group B received ventilation in accordance with the sequential PCV-VG-VCV mode, and the respiratory function parameters and arterial blood gas parameters and serum damage indexes were determined before the start of pneumoperitoneum (T0, 1 h after the start of the first ventilation mode after the start of pneumoperitoneum (T1, 1 h after the switch of ventilation mode (T2 and after the end of pneumoperitoneum (T3. Results: At T1, Ppeak, mean airway pressure (Pmean and plateau airway pressure (Pplant of group A were significantly higher than those of group B (P<0.05, partial pressure of oxygen (PaO2 was significantly lower than that of group B (P<0.05, and pulse oxygen saturation (SpO2 and partial pressure of carbon dioxide (PaCO2 were not significantly different from those of group B; at T2 and T3, Ppeak, Pmean and Pplant of group A were significantly lower than those of group B (P<0.05, PaO2 were significantly lower than those of group B (P<0.05, and SpO2 and PaCO2 were not significantly different from those of group B. At T1, serum soluble receptor for advanced glycation endproduct (sRAGE, KL-6 (krebs. von den Iungen-6, tumor necrosis factor-α (TNF-α and malondialdehyde (MDA content of group A were significantly higher than those of group B (P<0.05; at T3, serum sRAGE, KL-6, TNF-α and MDA content of group A were significantly lower than those of group B (P<0.05. Conclusions: PCV-VG mode for elderly patients with laparoscopic abdominal surgery can reduce airway pressure, improve lung compliance and
Biagioni, E; Cavazzuti, I; Busani, S; Trevisan, D; Zavatti, L; Ferrari, E; Girardis, M; Massimo, G
Acute renal failure (ARF) often complicates the postoperative period of patients undergoing orthotopic liver transplantation (OLT); it is habitually associated with high mortality rates. Similarly, patients undergoing major nonelective abdominal surgery are prone to ARF because of their frequent preexistent morbidities, abdominal sepsis, and needed for extended surgical procedures. The aim of this study was to evaluate the incidence of ARF and use of renal replacement therapy (RRT) among OLT versus nonelective abdominal surgery patients and associations with clinical outcomes. We studied all the patients admitted to a surgical intensive care unit (ICU) from January 2008 to December 2009 after OLT or nonelective abdominal surgery. The inclusion criteria were an ICU stay of at least 48 hours and without prior end-stage renal failure. OLT patients (n=84) were younger and less severly ill than surgery patients (n=60). ARF occurrence was lower among the OLT (29%) than the surgery group (47%) requiring RRT in 71% and 53% of patients due to ARF, respectively. The ICU mortality of ARF patients in both groups (29% OLT and 51% surgery) were greater than among subjects without ARF (2% and 6%). The occurrence of ARF is common among these two patient groups, and associated with increased risk of death among in surgery (+45%) versus in OLT (+27%) patients. Copyright © 2011 Elsevier Inc. All rights reserved.
Samantha T. Grams
Full Text Available BACKGROUND: There is currently no consensus on the indication and benefits of breathing exercises for the prevention of postoperative pulmonary complications PPCs and for the recovery of pulmonary mechanics. OBJECTIVE: To undertake a systematic review of randomized and quasi-randomized studies that assessed the effects of breathing exercises on the recovery of pulmonary function and prevention of PCCs after upper abdominal surgery UAS. METHOD: Search Strategy: We searched the Physiotherapy Evidence Database PEDro, Scientific Electronic Library Online SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials. Selection Criteria: We included randomized controlled trials and quasi-randomized controlled trials on pre- and postoperative UAS patients, in which the primary intervention was breathing exercises without the use of incentive inspirometers. Data Collection and Analysis: The methodological quality of the studies was rated according to the PEDro scale. Data on maximal respiratory pressures MIP and MEP, spirometry, diaphragm mobility, and postoperative complications were extracted and analyzed. Data were pooled in fixed-effect meta-analysis whenever possible. RESULTS: Six studies were used for analysis. Two meta-analyses including 66 participants each showed that, on the first day post-operative, the breathing exercises were likely to have induced MEP and MIP improvement treatment effects of 11.44 mmH2O (95%CI 0.88 to 22 and 11.78 mmH2O (95%CI 2.47 to 21.09, respectively. CONCLUSION: Breathing exercises are likely to have a beneficial effect on respiratory muscle strength in patients submitted to UAS, however the lack of good quality studies hinders a clear conclusion on the subject.
Hemmati, Hossein; Kazemnezhad-Leili, Ehsan; Mohtasham-Amiri, Zahra; Darzi, Ali Asghar; Davoudi-Kiakalayeh, Ali; Dehnadi-Moghaddam, Anoush; Kouchakinejad-Eramsadati, Leila
Trauma, especially chest and abdominal trauma are increasing due to the growing number of vehicles on the roads, which leads to an increased incidence of road accidents. Urbanization, industrialization and additional problems are the other associated factors which accelerate this phenomenon. A better understanding of the etiology and pattern of such injuries can help to improve the management and ultimate the outcomes of these patients. This study aimed to evaluate the patients with chest and abdominal trauma hospitalized in the surgery ward of Poursina teaching hospital, Guilan, Iran. In this cross-sectional study, the data of all chest and abdominal trauma patients hospitalized in the surgery ward of Poursina teaching hospital were collected from March 2011 to March 2012. Information about age, gender, injured areas, type of injury (penetrating or blunt), etiology of the injury, accident location (urban or rural) and patients' discharge outcomes were collected by a questionnaire. In total, 211 patients with a mean age of 34.1 ± 1.68 years was entered into the study. The most common cause of trauma was traffic accidents (51.7%). Among patients with chest trauma, 45 cases (35.4%) had penetrating injuries and 82 cases (64.6%) blunt lesions. The prevalence of chest injuries was 35.5% and rib fractures 26.5%. In chest injuries, the prevalence of hemothorax was 65.3%, pneumothorax 2.7%, lung contusion 4% and emphysema 1.3%, respectively. There were 24 cases (27.9%) with abdominal trauma which had penetrating lesions and 62 cases (72.1%) with blunt lesions. The most common lesions in patients with penetrating abdominal injuries were spleen (24.2%) and liver (12.1%) lesions. The outcomes of the patients were as follow: 95.7% recovery and 4.3% death. The majority of deaths were observed among road traffic victims (77.7%). Considering the fact that road-related accidents are quite predictable and controllable; therefore, the quality promotion of traumatic patients' care
Samokhvalov, I M; Zhabin, A V; Grebnev, A R; Badalov, V I; Trufanov, G E; Suvorov, V V
In severe abdominal trauma ultrasound provides fast and accurate diagnostics of damages and detect the source of internal bleeding. In the absence of trained professionals (in injury care centre of 2-3rd levels, In emergency situations) it is possible to use by the method of research in the reduced volume. The article presents a comparative analysis of the use of traditional methods and reduced ultrasound diagnostics of abdominal injuries on 56 victims. Concluded that reduced ultrasound is affordable, mobile, fast and accurate method of diagnosis, allowing to use it repeatedly.
Matthaei, Hanno; Schmidt, Valeri; Branchi, Vittorio; Verrel, Frauke; Kalff, Jörg C; Koscielny, Arne
Background Continuous improvements in perioperative and neoadjuvant therapy concepts nowadays permit more extensive tumor resections with curative intention. In patients with arterial or venous tumour involvement in preoperative imaging, physicians with expertise in vascular surgery should be involved in the planning phase of the operation. Unexpected vascular complications during abdominal surgery demand prompt management by the oncological surgeon. However, skills in vascular surgery are still not obligatory for the visceral surgeon in training. This topic is controversial and is therefore the focus of the present study. Patients and Methods From 2010 - 2015, a total of 126 patients underwent visceral operations involving vascular surgical interventions. Of these, 30 operations were performed as radical tumour resections. Retrospective data acquisition was performed with a minimum follow-up of 12 months. Aside from comprehensive characterisation of patients and their diseases, an outcome analysis was conducted. Furthermore, visceral surgery training programs in accordance with all 17 German federal medical associations were analysed and compared with respect to vascular surgery teaching. Results Vascular surgery was necessary in most patients, due to lesions of the mesentericoportal venous system (n = 11; 37%) and visceral arteries (n = 14; 47%). Techniques involved were mostly vascular sutures, reanastomosis or patch plastic surgery (n = 19; 63%) and venous thrombectomy/arterial embolectomy (n = 18; 60%). Hospital mortality was 3%. During follow-up, 33% of oncological patients died, whereas solely venous injury was an independent adverse prognostic variable (arterial vs. venous complications: HR 0.028; 95%-CI 0.002 - 0.442; p = 0.01). Skills in vascular surgery are optional for up to 12 months within visceral surgery training. Conclusions Intraoperative vascular complications in visceral surgical oncology are rare but pose severe
Computed tomography prospective study of pleural-pulmonary changes after abdominal surgery : assessment of associated risk factors; Estudo prospectivo por tomografia computadorizada das alteracoes pleuro-pulmonares apos cirurgia abdominal: avaliacao dos fatores de risco associados
Rossi, Luis Antonio [Pontificia Univ. Catolica de Sao Paulo, SP (Brazil). Centro de Ciencias Medicas e Biologicas]. E-mail: email@example.com; Bromberg, Sansom Henrique [Instituto de Assistencia Medica ao Servidor Publico Estadual de Sao Paulo (IAMSPE), Sao Paulo, SP (Brazil). Curso de Pos-graduacao em Gastroenterologia Cirurgica
Postoperative pleural-pulmonary changes (PPC) are very common following elective abdominal surgery, resolving without clinical manifestations in most patients. The incidence and risk factors associated are unknown. Objective: to determine the incidence of PPC and possible association with risk factors using computerized tomography (CT). Material and method: thirty seven patients submitted to elective abdominal surgery were prospectively analyzed using CT performed in the preoperative period and 48 hours after surgery. The PPC was scored from 0 to III. The risk factors evaluated were: age, sex, obesity, smoking history, alcoholism, comorbid conditions, cancer, ASA classification, duration of surgery, surgical incision type and number of days of hospitalization. Results: Pleura effusion was detected by CT in 70.3% (26/37) of the patients and pulmonary atelectasis in 75.5% (28/37). Grade I and II PPC was found in 59.5% (22/37) of the patients and grade III in 21.6% (8/37). Two (5.4%) of these patients developed serious pulmonary complications whereas one patient died. Surgery due to cancer, class ASA >2, longitudinal incision and > 15 cm showed statistical significance and were associated with pleural effusion. The hospitalization was over 2.4 longer for patients with PPC. Conclusion: PPC is frequently seen in patients submitted to abdominal surgery. The use of the CT for the detection of pulmonary atelectasis and pleural effusion proved to be effective. Most cases of PPC are self-limited, resolving without symptoms. (author)
Barakat, Hashem M; Shahin, Yousef; Khan, Junaid A; McCollum, Peter T; Chetter, Ian C
The aim of the study was to assess the impact of a preoperative medically supervised exercise program on outcomes after elective abdominal aortic aneurysm (AAA) repair. Functional capacity is an important predictor of postoperative outcomes after elective AAA repair. Improving patients' preoperative fitness with exercise has the potential to positively influence recovery. A randomized controlled trial was performed at a tertiary vascular unit. Patients scheduled for open or endovascular AAA repair were randomized to either 6 weeks of preoperative supervised exercise or standard treatment using sealed envelopes. The primary outcome measure was a composite endpoint of cardiac, pulmonary, and renal complications. Secondary outcome measures were 30-day mortality, lengths of hospital and critical care stay, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, reoperation, and postoperative bleeding. One hundred twenty-four patients were randomized (111 men, mean [SD] age 73  y). Fourteen patients sustained postoperative complications in the exercise group (22.6%), compared with 26 in the nonexercise group (41.9%; P = 0.021). Four patients (2 in each group) died within the first 30 postoperative days. Duration of hospital stay was significantly shorter in the exercise group (median 7 [interquartile range 5-9] vs 8 [interquartile range 6-12.3] d; P = 0.025). There were no significant differences between the groups in the length of critical care stay (P = 0.845), APACHE II scores (P = 0.256), incidence of reoperations (P = 1.000), or postoperative bleeding (P = 0.343). A period of preoperative supervised exercise training reduces postoperative cardiac, respiratory, renal complications, and length of hospital stay in patients undergoing elective AAA repair.
Broek, R.P. Ten; Issa, Y.; Santbrink, E.J. van; Bouvy, N.D.; Kruitwagen, R.F.P.M.; Jeekel, J.; Bakkum, E.A.; Rovers, M.M.; Goor, H. van
OBJECTIVE: To estimate the disease burden of the most important complications of postoperative abdominal adhesions: small bowel obstruction, difficulties at reoperation, infertility, and chronic pain. DESIGN: Systematic review and meta-analyses. DATA SOURCES: Searches of PubMed, Embase, and Central,
Winfield, Robert D; Reese, Stacey; Bochicchio, Kelly; Mazuski, John E; Bochicchio, Grant V
Obesity is a risk factor for surgical site infection (SSI) after abdominal procedures; however, data characterizing the risk of SSI in obese patients during abdominal procedures are lacking. We hypothesized that obesity is an independent risk factor for SSI across wound classes. We analyzed American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data for 2011. We calculated body mass index (BMI), classifying patients according to National Institute of Health (NIH) BMI groups. We excluded records in which height/weight was not recorded and patients with BMI less than 18.5. We examined patients undergoing open abdominal procedures, performing univariate and multivariate analyses to assess the relative contribution of obesity to SSI. Study criteria were met by 89,148 patients. Obese and morbidly obese patients had significantly greater SSI rates in clean and clean-contaminated cases but not contaminated or dirty/infected cases. Logistic regression confirmed obesity and morbid obesity as being independently associated with the overall SSI development, specifically in clean [Obesity odds ratio (OR) = 1.757, morbid obesity OR = 2.544, P < 0.001] and clean-contaminated (obesity OR = 1.239, morbid obesity OR = 1.287, P < 0.001) cases. Obesity is associated with increased risk of SSI overall, specifically in clean and clean-contaminated abdominal procedures; this is independent of diabetes mellitus. Novel techniques are needed to reduce SSI in this high-risk patient population.
Liu, Qing; Jiang, Honglei; Xu, Dong; Jin, Junzhe
Chewing gum, as an alternative to sham feeding, had been shown to hasten the recovery of gut function following abdominal surgery. However, conclusions remained contradictory. We sought to conduct an updated meta-analysis to evaluate the efficacy of gum chewing in alleviating ileus following colorectal surgery. We searched PubMed, EMBASE, and Cochrane Library Databases through February 2017 to identify randomized controlled trials (RCTs) evaluating the efficacy of the additional use of chewing gum following colorectal surgery. After screening for inclusion, data extraction, and quality assessment, meta-analysis was conducted by the Review Manager 5.3 software. The outcomes of interest were the time to first flatus, time to first bowel movement, length of hospital stay, and some clinically relevant parameters. We also performed subgroup analyses according to the type of surgical approaches or on trials that adopted enhanced recovery after surgery (ERAS) protocol or sugared gum. A total of 18 RCTs, involving 1736 patients, were included. Compared with standardized postoperative care, Chewing gum resulted in a shorter passage to first flatus [WMD = -8.81, 95%CI: (-13.45, -4.17), P = 0.0002], earlier recovery of bowel movement [WMD = -16.43, 95%CI: (-22.68, -10.19), P safe and effective method to ameliorate ileus following colorectal surgery. However, tightly controlled, randomized and considerably larger multicenter trials are warranted to further validate our findings. Copyright © 2017. Published by Elsevier Ltd.
Guay, Joanne; Nishimori, Mina; Kopp, Sandra L
The aim of this review was to compare the effects of postoperative epidural analgesia with local anesthetics to postoperative systemic or epidural opioids in terms of return of gastrointestinal transit, postoperative pain control, postoperative vomiting, incidence of gastrointestinal anastomotic leak, hospital length of stay, and cost after abdominal surgery. Trials were identified by computerized searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 12), Medical Literature Analysis and Retrieval System Online (MEDLINE) (from 1950 to December, 2014) and Excerpta Medica dataBASE (EMBASE) (from 1974 to December 2014) and by checking the reference lists of trials retained. We included parallel randomized controlled trials comparing the effects of postoperative epidural local anesthetic with regimens based on systemic or epidural opioids. The quality of the studies was rated according to the Cochrane tool. Two authors independently extracted data. We judged the quality of evidence according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group scale. Based on 22 trials including 1138 participants, an epidural containing a local anesthetic will decrease the time required for return of gastrointestinal transit as measured by time required to observe the first flatus after an abdominal surgery standardized mean difference (SMD) -1.28 (95% confidence interval [CI], -1.71 to -0.86; high quality of evidence; equivalent to 17.5 hours). The effect is proportional to the concentration of local anesthetic used. Based on 28 trials including 1559 participants, we also found a decrease in time to first feces (stool): SMD -0.67 (95% CI, -0.86 to -0.47; low quality of evidence; equivalent to 22 hours). Based on 35 trials including 2731 participants, pain on movement at 24 hours after surgery is also reduced: SMD -0.89 (95% CI, -1.08 to -0.70; moderate quality of evidence; equivalent to 2.5 on a scale from 0 to
Christoffersen, Mette; Olsen, B H; Rosenberg, J
PURPOSE: Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma-reducing ......PURPOSE: Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma......-reducing effect of an abdominal binder in patients undergoing laparoscopic umbilical or epigastric hernia repair. METHODS: Based on power analysis, a minimum of 54 patients undergoing laparoscopic umbilical and epigastric hernia repair were to be included. Patients were randomized to abdominal binders vs....... no abdominal binders during the first postoperative week. Standardized surgical technique, anaesthesia, and analgesic regimens were used and study observers were blinded towards the intervention. Postoperative pain (visual analogue score) on day 1 was the primary outcome. In addition, ultrasonographic...
Bisgaard, Thue; Kehlet, Henrik
This review analyzes the literature and the historical concerns (restrictions, traditions, nasogastric tube) and pathophysiologic factors (postoperative ileus, risk of anastomotic dehiscence, nausea and vomiting, loss of appetite) invoked for not instituting early oral feeding after major abdominal...... procedures. It appears that several factors may promote postoperative oral feeding such as thoracic epidural analgesia, multimodal anti-emetic treatment, opioid-sparing analgesia, selective peripheral opioid antagonists, and enforced oral nutrition. Recent data from multimodal fast-track rehabilitation...
Wiebelitz, Karl Rüdiger; Beer, André-Michael
Karl Rüdiger Wiebelitz, André-Michael BeerDepartment of True Naturopathy, Blankenstein Hospital, Hattingen, GermanyAbstract: A patient with pancreatic carcinoma diagnosed in 2005 suffered from chronic abdominal pain 6 years later that did not respond to conventional pain treatment according to guidelines. Furthermore, several complementary medical approaches remained ineffective. In the long run, only an Iberis amara drug combination relieved pain sufficiently. The drug is...
Hernández, B; Peña, E; Pascual, G; Rodríguez, M; Calvo, B; Doblaré, M; Bellón, J M
The aims of this study are to experimentally characterize the passive elastic behaviour of the rabbit abdominal wall and to develop a mechanical constitutive law which accurately reproduces the obtained experimental results. For this purpose, tissue samples from New Zealand White rabbits 2150±50 (g) were mechanically tested in vitro. Mechanical tests, consisting of uniaxial loading on tissue samples oriented along the craneo-caudal and the perpendicular directions, respectively, revealed the anisotropic non-linear mechanical behaviour of the abdominal tissues. Experiments were performed considering the composite muscle (including external oblique-EO, internal oblique-IO and transverse abdominis-TA muscle layers), as well as separated muscle layers (i.e., external oblique, and the bilayer formed by internal oblique and transverse abdominis). Both the EO muscle layer and the IO-TA bilayer demonstrated a stiffer behaviour along the transversal direction to muscle fibres than along the longitudinal one. The fibre arrangement was measured by means of a histological study which confirmed that collagen fibres are mainly responsible for the passive mechanical strength and stiffness. Furthermore, the degree of anisotropy of the abdominal composite muscle turned out to be less pronounced than those obtained while studying the EO and IO-TA separately. Moreover, a phenomenological constitutive law was used to capture the measured experimental curves. A Levenberg-Marquardt optimization algorithm was used to fit the model constants to reproduce the experimental curves. Copyright © 2010 Elsevier Ltd. All rights reserved.
Korterink, Judith J.; Ockeloen, Lize E.; Hilbink, Mirrian; Benninga, Marc A.; Deckers-Kocken, Judith M.
The aim of the present study was to compare effects of 10 weeks of yoga therapy (YT) and standard medical care (SMC) on abdominal pain and quality of life (QoL) in children with abdominal pain-related functional gastrointestinal disorders (AP-FGIDs). Sixty-nine patients, ages 8 to 18 years, with
Probst, Pascal; Haller, Sebastian; Dörr-Harim, Colette; Bruckner, Thomas; Ulrich, Alexis; Hackert, Thilo; Diener, Markus K; Knebel, Phillip
The influence of patients' preoperative nutritional status on their clinical outcome has already been proven. Therefore, patients with malnutrition are in need of additional therapeutic efforts. However, for pancreatic surgery, evidence suggesting the adequacy of existing nutritional assessment scores to estimate malnutrition associated with postoperative outcome is limited. The aim of the observational trial "Nutritional Risk in Major Abdominal Surgery (NURIMAS) Pancreas" is to prospectively assess and analyze different nutritional assessment scores for their prognostic value on postoperative complications in patients undergoing pancreatic surgery. All patients scheduled to receive elective pancreatic surgery at the University Hospital of Heidelberg will be screened for eligibility. Preoperatively, 12 nutritional assessment scores will be collected and patients will be assigned either at risk or not at risk for malnutrition. The postoperative course will be followed prospectively and complications according to the Clavien-Dindo classification will be recorded. The prognostic value for complications will be evaluated for every score in a univariable and multivariable analysis corrected for known risk factors in pancreatic surgery. Final data analysis is expected to be available during Spring 2016. The NURIMAS Pancreas trial is a monocentric, prospective, observational trial aiming to find the most predictive clinical nutritional assessment score for postoperative complications. Using the results of this protocol as a knowledge base, it is possible to conduct nutritional risk-guided intervention trials to prevent postoperative complications in the pancreatic surgical population. germanctr.de: DRKS00006340; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006340 (Archived by WebCite at http://www.webcitation.org/6bzXWSRYZ).
Ashfaq, Awais; Johnson, Daniel J; Chapital, Alyssa B; Lanza, Louis A; DeValeria, Patrick A; Arabia, Francisco A
Abdominal complications following cardiopulmonary bypass (CPB) procedures may have mortality rates as high as 25%. Advanced procedures such as ventricular assist devices, artificial hearts and cardiac transplantation are being increasingly employed, changing the complexity of interventions. This study was undertaken to examine the changing trends in complications and the impact of cardiac surgery on emergency general surgery (EGS) coverage. A retrospective review was conducted of all CPB procedures admitted to our ICU between Jan. 2007 and Mar. 2010. The procedures included coronary bypass (CABG), valve, combination (including adult congenital) and advanced heart failure (AHF) procedures. The records were reviewed to obtain demographics, need for EGS consult/procedure and outcomes. Mean age of the patients was 66 ± 8.5 years, 71% were male. There were 945 CPB procedures performed on 914 patients during this study period. Over 39 months, 23 EGS consults were obtained, resulting in 10 operations and one hospital death (10% operative mortality). CABG and valve procedures had minimal impact on EGS workload while complex cardiac and AHF procedures accounted for significantly more EGS consultations (p surgery, advanced technology has increased the volume of complex CPB procedures increasing the EGS workload. Emergency general surgeons working in institutions that perform advanced procedures should be aware of the potential for general surgical complications perioperatively and the resultant nuances that are associated with operative management in this patient population. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Li, Yuan; Ren, Jianan; Wang, Gefei; Gu, Guosheng; Wu, Xiuwen; Ren, Huajian; Hong, Zhiwu; Hu, Dong; Wu, Qin; Li, Guanwei; Liu, Song; Anjum, Nadeem; Li, Jieshou
Diagnostic delay of Crohn's disease presents a challenge, and may increase the abdominal surgery rate. There have been no reports regarding diagnostic delay in Chinese patients. We aimed to evaluate the impact of diagnostic delay on outcomes of Chinese Crohn's disease patients, and identify potential risk factors for the delay. Altogether, 343 Crohn's disease patients from our hospital were retrospectively included. We assessed the effects of diagnostic delay on the outcomes, and identified the underlying risk factors. Diagnostic interval was defined as the interval between the first symptoms and the diagnosis of Crohn's disease. Diagnostic delay was defined according to the time interval in which the 76th to 100th percentiles of patients were diagnosed. The rates of subsequent surgery for diagnostic-delay and non-diagnostic-delay patients were 84.7% and 62.4%, respectively (odds ratio=1.108, P40 years at diagnosis (35.3% versus 18.2%, P=0.004), basic educational level (48.2% versus 30.6%, P=0.005), and no family history of Crohn's disease (0 versus 1.6%, P=0.045). Diagnostic delay of Crohn's disease was significantly associated with increased rates of intestinal surgery. Risk factors for diagnostic delay were age >40 years at diagnosis, basic educational level, and no family history of Crohn's disease. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Full Text Available Objectives: To analyze perforation rate in sterile gloves used by surgeons in the operating theatre of the Department of Endocrinological and General Surgery of Medical University of Lodz. Material and Methods: Randomized and controlled trial. This study analyses the incidents of tears in sterile surgical gloves used by surgeons during operations on 3 types of thyroid diseases according to the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10 codes. Nine hundred seventy-two pairs (sets of gloves were collected from 321 surgical procedures. All gloves were tested immediately following surgery using the water leak test (EN455-1 to detect leakage. Results: Glove perforation was detected in 89 of 972 glove sets (9.2%. Statistically relevant more often glove tears occurred in operator than the 1st assistant (p < 0.001. The sites of perforation were localized mostly on the middle finger of the non-dominant hand (22.5%, and the non-dominant ring finger (17.9%. Conclusions: This study has proved that the role performed by the surgeon during the procedure (operator, 1st assistant has significant influence on the risk of glove perforations. Nearly 90% of glove perforations are unnoticed during surgery.
Kassem, M I; El-Haddad, H M
To compare polypropylene mesh positioned onlay supported by omentum and/or peritoneum versus inlay implantation of polypropylene-based composite mesh in patients with complicated wide-defect ventral hernias. This was a prospective randomized study carried out on 60 patients presenting with complicated large ventral hernia in the period from January 2012 to January 2016 in the department of Gastrointestinal Surgery unit and Surgical Emergency of the Main Alexandria University Hospital, Egypt. Large hernia had an abdominal wall defect that could not be closed. Patients were divided into two groups of 30 patients according to the type of mesh used to deal with the large abdominal wall defect. The study included 38 women (63.3 %) and 22 men (37.7 %); their mean age was 46.5 years (range, 25-70). Complicated incisional hernia was the commonest presentation (56.7 %).The operative and mesh fixation times were longer in the polypropylene group. Seven wound infections and two recurrences were encountered in the propylene group. Mean follow-up was 28.7 months (2-48 months). Composite mesh provided, in one session, satisfactory results in patients with complicated large ventral hernia. The procedure is safe and effective in lowering operative time with a trend of low wound complication and recurrence rates.
Atallah, Sam; Nassif, George; Larach, Sergio
Frameless stereotaxy is an established method for real-time image-guided surgical navigation in neurological surgery. Though this is capable of providing sub-millimeter accuracy, it has not been used by other surgical specialists. A patient with locally advanced, distal rectal cancer and tumor abutting the prostate was selected for transanal TME using TAMIS, with intra-operative CT-guided navigation to ensure an R0 resection. The use of stereotactic TAMIS-TME was successfully performed with an accuracy of ±4 mm. The surgical specimen revealed an R0 resection, and this new approach aided in achieving adequate resection margins. This is the first report of the use of frameless stereotactic navigation beyond the scope of neurosurgery. Stereotactic navigation for transanal total mesorectal excision is shown to be feasible. Stereotactic navigation may potentially be applied toward other pelvic and fixed abdominal organs, thereby opening the gateway for a broader use by the general surgeon.
Shaposhnikov, S A; Sin'kov, S V; Zabolotskikh, I B
The retrospective research included 1983 patients with different abdominal surgical pathology. Parameters of homeostasis were estimated in preoperative period and early postoperative period. Frequency of occurrence and relevance of different clinical risk factors of thrombosis were analyzed. The rate of development of thromboembolic complications was investigated in studied subgroup of patients. It was revealed, that high risk groups of thrombosis progress were the patients with malignant disease of the pancreas, the esophagus, the large and straight intestine as well as obstructive jaundice of malignant genesis. The most significant clinical factors were the presence of malignant process, accompanied by cardiac pathology, dehydration and high number (3 and more) on ASA scale.
Wiebelitz, Karl Rüdiger; Beer, André-Michael
A patient with pancreatic carcinoma diagnosed in 2005 suffered from chronic abdominal pain 6 years later that did not respond to conventional pain treatment according to guidelines. Furthermore, several complementary medical approaches remained ineffective. In the long run, only an Iberis amara drug combination relieved pain sufficiently. The drug is registered in Germany for the indications irritable bowel syndrome and dyspepsia. The multi-target approach of this combination drug may account for the effectiveness under these fundamentally different pathophysiological conditions. No serious undesired effects have been described in the use of this drug for other indications and none were observed in this case.
Skjærbæk, Christian; Frystyk, Jan; Ørskov, Hans
Major surgery is accompanied by extensive proteolysis of insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3). Proteolysis of IGFBP-3 is generally believed to increase IGF bioavailability due to a diminished affinity of the IGFBP-3 fragments for IGFs. We have investigated 18 patients...... undergoing elective ileo-anal J-pouch surgery. Patients were randomized to treatment with GH (12 IU/day; n = 9) or placebo (n = 9) from 2 days before to 7 days after operation. Free IGF-I and IGF-II were measured by ultrafiltration of serum, and IGFBP-3 proteolytic activity was determined by a [125I...
Irwin, Melinda L; Yasui, Yutaka; Ulrich, Cornelia M; Bowen, Deborah; Rudolph, Rebecca E; Schwartz, Robert S; Yukawa, Michi; Aiello, Erin; Potter, John D; McTiernan, Anne
The increasing prevalence of obesity is a major public health concern. Physical activity may promote weight and body fat loss. To examine the effects of exercise on total and intra-abdominal body fat overall and by level of exercise. Randomized controlled trial conducted from 1997 to 2001. A total of 173 sedentary, overweight (body mass index > or =24.0 and >33% body fat), postmenopausal women aged 50 to 75 years who were living in the Seattle, Wash, area. Participants were randomly assigned to an intervention consisting of exercise facility and home-based moderate-intensity exercise (n = 87) or a stretching control group (n = 86). Changes in body weight and waist and hip circumferences at 3 and 12 months; total body, intra-abdominal, and subcutaneous abdominal fat at 12 months. Twelve-month data were available for 168 women. Women in the exercise group participated in moderate-intensity sports/recreational activity for a mean (SD) of 3.5 (1.2) d/wk for 176 (91) min/wk. Walking was the most frequently reported activity. Exercisers showed statistically significant differences from controls in baseline to 12-month changes in body weight (-1.4 kg; 95% confidence interval [CI], -2.5 to -0.3 kg), total body fat (-1.0%; 95% CI, -1.6% to -0.4%), intra-abdominal fat (-8.6 g/cm2; 95% CI, -17.8 to 0.9 g/cm2), and subcutaneous abdominal fat (-28.8 g/cm2); 95% CI, -47.5 to -10.0 g/cm2). A significant dose response for greater body fat loss was observed with increasing duration of exercise. Regular exercise such as brisk walking results in reduced body weight and body fat among overweight and obese postmenopausal women.
Ksiadzyna, Dorota; Peña, Amado Salvador
Splenosis is a benign condition caused by an ectopic autotransplantation of splenic tissues after splenic trauma or surgery. It usually occurs within the abdominal and pelvic cavity. Patients are generally asymptomatic and this entity is diagnosed accidentally. However, occasionally extensive abdominal splenosis poses a significant diagnostic dilemma for gastroenterologists, especially when this condition manifests as a disseminated metastatic malignant disease on abdominal imaging.This paper presents a concise review of the literature on this often misleading disorder. The crucial role of taking a thorough patient´s medical history concerning splenic trauma in the past, the need for differential diagnosis of tumor-like lesions disclosed on abdominal imaging and novel diagnostics modalities that allow avoiding unnecessary laparotomy in case of abdominal splenosis are stressed.The increased prevalence of abdominal trauma due to road accidents and the growing armamentarium of available imaging modalities suggest that abdominal splenosis may be expected more often than ever.In order to prevent any possible diagnostic doubts and unnecessary future invasive examinations, confirmed splenosis should be recorded in the medical documentation of the patient.
Berge, Camilla; Hagen, Anne I; Myhre, Hans O; Dahl, Torbjørn
The aim of the present study was to explore whether preoperative white blood cell (WBC) count may predict 30-day mortality and long-term survival following surgery for abdominal aortic aneurysm (AAA). Secondarily, we wanted to assess the potential sex differences in WBC in these patients. The study was carried out as a retrospective cohort study. Patients undergoing surgery for intact and ruptured AAA (rAAA) at our institution consecutively in the time period 1994-2007 were included. Patients were either treated with open aneurysm repair or with endovascular aneurysm repair. Data were collected from the patients' medical records, including laboratory reports for WBC count prior to surgery. Mortality and long-term survival were extracted from The Patient Administrative System. A total of 988 patients were included, 712 (72%) patients were treated for intact AAA and 276 (28%) underwent surgery for rAAA. Patients with WBC ≥11 ×109/L had a 8.7-fold higher risk of 30-day mortality undergoing surgery for intact AAA compared to patients with WBC <11 ×109/L (95% confidence interval [CI]: 3.2-23.3, P < 0.001). Patients with a high WBC tended to have inferior long-term survival. However, when excluding 30-day mortality, no statistically significant difference was found (hazard ratio, 1.4; 95% CI: 0.9-2.0, P = 0.121). No association between WBC count and 30-day mortality or long-term survival was observed among patients treated for rAAA. We could not identify any sex differences in WBC, neither in intact AAA nor in rAAA. We were not able identify any association between WBC and specific causes of death. This study suggests that patients with WBC count ≥11 ×109/L prior to surgery for intact AAA have a higher 30-day mortality compared to patients with WBC <11 ×109/L. We could not identify any substantial difference in long-term survival when excluding 30-day mortality. We did not observe any association between preoperative WBC count and case fatality or long
Ogawa, Tomoko; Hanamura, Noriko
An abdominal advancement flap (AAF) is a flap that pulls the elevated abdominal skin up, creating the shape of the inferior portion of the breast by making a neo-inframammary fold. We used an AAF combined with volume displacement techniques to fill the defect left after breast-conserving surgery (BCS). Forty-one small- to medium-sized breast patients whose resection area included the lower portion of the breast underwent this procedure from October 2010 to December 2014. We evaluated efficacy of this procedure. The excision volume ranged from 10 to 35 %. Complications after surgery were observed in two patients (partial necrosis of the nipple-areola complex and partial necrosis of the breast skin in one patient each). There was no fat necrosis of the flap in any of the patients. The cosmetic results were found to be excellent in 7 cases, good in 23, fair in 9 and poor in 2. In 11 cases with an unacceptable outcome, 9 cases were in the inner portion. In patients with the tumor in the inner portion, the proportion of unacceptable cases was 50 %. In the cases other than the inner portion, the proportion of unacceptable cases was 8.7 % (p < 0.01). In the cases with larger breasts, unacceptable cases were more frequently observed (p < 0.05). We believe that an AAF combined with volume displacement techniques may be useful following BCS in the lower portion of a small- to medium-sized breast, except in cases where the tumors is located in the inner potion.
Rao, Keshav Govind; Misra, Shilpi; Shukla, Aparna
Regional anesthesia has emerged as one of the preferred and convenient modes for intra- and post-operative management owing to its advantage of not interfering with the metabolic functions, better tolerability, and decrease in reflex activity. In recent years, ropivacaine has increasingly replaced bupivacaine as a preferred local anesthetic because of its similar analgesic properties, lesser motor blockade, and decreased propensity of cardiotoxicity. Neuraxial adjuvant such as clonidine used in epidural anesthesia offers advantage by augmenting the local anesthetic effect and reducing the anesthetic and analgesic requirement. Comparison of onset, duration of sensory and motor block, and any adverse effects between 0.5% ropivacaine with normal saline versus 0.5% ropivacaine with clonidine (75 μg/kg). This prospective randomized study was carried out in 50 patients (25 in each group) of American Society of Anesthesiologist Grade 1 and 2 scheduled for abdominal hysterectomy under epidural block. Group-1 (ropivacaine-clonidine [RC]): Epidural ropivacaine 20 ml (0.5%) with 0.75 μg/kg clonidine. Group-2 (ropivacaine [R]): Epidural ropivacaine 20 ml (0.5%) with normal saline. Onset, duration of sensory-motor block, heart rate, blood pressure, oxygen saturation, and respiratory rate were recorded. The statistical analysis was done using Statistical Package for Social Sciences version 15.0. Chi-square test, ANOVA, Student's t-test, and paired t-test were used. Groups were comparable with regard to demographic data and hemodynamic stability. Onset of sensory and motor blockade was faster in RC group as compared to R group. Duration of postoperative analgesia was significantly prolonged in RC group. No potential side effect was seen in either group. On account of faster onset, hemodynamic stability, and prolonged postoperative analgesia, ropivacaine with clonidine is a better option than ropivacaine alone.
Full Text Available Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos es una actualización del resumen publicado en Noviembre de 2014, basado en 4 nuevas revisiones sistemáticas aparecidas con posterioridad. El íleo postoperatorio es una condición común que retrasa la recuperación luego de una cirugía abdominal. El uso precoz de goma de mascar, como método de alimentación fingida, estimularía la peristalsis permitiendo una alimentación más precoz. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 18 revisiones sistemáticas que en conjunto incluyen 81 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la goma de mascar probablemente disminuye el tiempo de hospitalización luego de una cirugía abdominal.
Full Text Available Hamid Reza Faiz,1 Poupak Rahimzadeh,1 Ognjen Visnjevac,2 Behzad Behzadi,1 Mohammad Reza Ghodraty,1 Nader D Nader2 1Iran University of Medical Sciences, Tehran, Iran; 2VA Western NY Healthcare System, University at Buffalo, Buffalo, NY, USA Background: In recent years, intravenously (IV administered acetaminophen has become one of the most common perioperative analgesics. Despite its now-routine use, IV acetaminophen's analgesic comparative efficacy has never been compared with that of ketamine, a decades-old analgesic familiar to obstetricians, gynecologists, and anesthesiologists alike. This double-blind clinical trial aimed to evaluate the analgesic effects of ketamine and IV acetaminophen on postoperative pain after abdominal hysterectomy. Methods: Eighty women aged 25–70 years old and meeting inclusion and exclusion criteria were randomly allocated into two groups of 40 to receive either IV acetaminophen or ketamine intraoperatively. Postoperatively, each patient had patient-controlled analgesia. Pain and sedation (Ramsay Sedation Scale were documented based on the visual analog scale in the recovery room and at 4 hours, 6 hours, 12 hours, and 24 hours after the surgery. Hemodynamic changes, adverse medication effects, and the need for breakthrough meperidine were also recorded for both groups. Data were analyzed by repeated-measures analysis of variance. Results: Visual analog scale scores were significantly lower in the IV acetaminophen group at each time point (P<0.05, and this group required significantly fewer doses of breakthrough analgesics compared with the ketamine group (P=0.039. The two groups had no significant differences in terms of adverse effects. Conclusion: Compared with ketamine, IV acetaminophen significantly improved postoperative pain after abdominal hysterectomy. Keywords: intravenous acetaminophen, abdominal hysterectomy, ketamine, analgesia, postoperative pain
Bang, J-Y; Lee, J B; Yoon, Y; Seo, H-S; Song, J-G; Hwang, G S
Although both Acute Kidney Injury Network (AKIN) and risk, injury, failure, loss, and end-stage (RIFLE) kidney disease criteria are frequently used to diagnose acute kidney injury (AKI), they have rarely been compared in the diagnosis of AKI in patients undergoing surgery for infrarenal abdominal aortic aneurysm (AAA). This study investigated the incidence of, and risk factors for, AKI, defined by AKIN and RIFLE criteria, and compared their ability to predict mortality after infrarenal AAA surgery. This study examined 444 patients who underwent infrarenal AAA surgery between January 1999 and December 2011. Risk factors for AKI were assessed by multivariable analyses, and the impact of AKI on overall mortality was assessed by a Cox's proportional hazard model with inverse probability of treatment weighting (IPTW). Net reclassification improvement (NRI) was used to assess the performance of AKIN and RIFLE criteria in predicting overall mortality. AKI based on AKIN and RIFLE criteria occurred in 82 (18.5%) and 55 (12.4%) patients, respectively. The independent risk factors for AKI were intraoperative red blood cell (RBC) transfusion and chronic kidney disease (CKD) by AKIN criteria, and age, intraoperative RBC transfusion, preoperative atrial fibrillation, and CKD by RIFLE criteria. After IPTW adjustment, AKI was related to 30 day mortality and overall mortality. NRI was 15.2% greater (P=0.04) for AKIN than for RIFLE criteria in assessing the risk of overall mortality. Although AKI defined by either AKIN or RIFLE criteria was associated with overall mortality, AKIN criteria showed better prediction of mortality in patients undergoing infrarenal AAA surgery. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Mahmood, A; Gosling, P; Vohra, R K
The optimal colloid for renal protection during abdominal aortic aneurysm (AAA) surgery is not known. This study compared the effects of two hydroxyethyl starch (HES) solutions and gelatine on perioperative renal function. Sixty-two patients undergoing AAA surgery were randomized to 6 per cent HES of molecular weight 200/0.62 kDa or 130/0.4 kDa, or 4 per cent gelatine for plasma expansion. Measurements were taken of serum urea and creatinine to mark glomerular filtration, urinary immunoglobulin G : creatinine ratio to mark glomerular membrane function and alpha(1)-microglobulin : creatinine ratio to mark tubular dysfunction before, and for 5 days after, surgery. Serum urea was lower in both HES groups than the gelatine group. Serum creatinine was lower with HES 130/0.4 compared with gelatine at days 1, 2 and 5 after surgery (P = 0.020, P = 0.045 and P = 0.045 respectively). Urinary alpha(1)-microglobulin : creatinine ratio was lower with HES 200/0.62 compared with gelatine at 4 and 8 h (P gelatine at 4 to 24 h, and on days 4 and 5 (P gelatine. There was no difference between the two starch groups. Compared with gelatine, volume expansion with both types of HES during AAA surgery improved renal function and reduced renal injury.
Zhao, Wen-Peng; Han, Zhi-Yu; Zhang, Jing; Yu, Xiao-Ling; Cheng, Zhi-Gang; Zhou, Xiang; Liang, Ping
The study was conducted to describe ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation in the treatment of intra-abdominal aggressive fibromatosis in seven patients who had failed surgery. We retrospectively investigated seven patients with pathologically proven intra-abdominal aggressive fibromatosis and surgical failure, who were treated with USgHIFU between June 2013 and February 2015. The main causes for surgical failure were a large tumour size or adjacent tissue invasion by the tumour. All of the patients were treated with palliative intent, to reduce symptoms of the diseases. The medical records were reviewed during the follow-up period, and the patients were asked to compare the symptoms of their disease as improved, unchanged or worsened, based on their levels before treatment. In addition, contrast-enhanced MRI was conducted to follow the size of the tumours before and after therapy. The procedure was successfully accomplished in all of the patients without severe side effects. The median diameter of the tumours was 10.3 cm (range, 7.6-13.6 cm) and the mean ablation rate (the percentage rate of the non-perfused volume compared with the tumour volume on enhanced MRI after treatment) was 92.5 ± 3.7% (range, 86.5-96.8%). One patient underwent two treatments for a large tumour size, and other patients received single-visit therapy. All of the patient clinical symptoms remitted significantly after 6 months. The regression rates of the tumours were 34.8 ± 8.2% (range, 22.4-46.1%) and 58.2 ± 12.7% (range, 43.8-70.3%), respectively, at 6 and 12 months after treatment. USgHIFU ablation could be an effective alternative minimally invasive therapy for the achievement of local control of intra-abdominal aggressive fibromatosis. The conclusions indicate that USgHIFU ablation could be a promising alternative treatment for the achievement of local control of intra-abdominal aggressive fibromatosis.
Wang, Weiming; Qin, Jing; Zhu, Lei; Ni, Dong; Chui, Yim-Pan; Heng, Pheng-Ann
Due to the characteristic artifacts of ultrasound images, e.g., speckle noise, shadows and intensity inhomogeneity, traditional intensity-based methods usually have limited success on the segmentation of fetal abdominal contour. This paper presents a novel approach to detect and measure the abdominal contour from fetal ultrasound images in two steps. First, a local phase-based measure called multiscale feature asymmetry (MSFA) is de ned from the monogenic signal to detect the boundaries of fetal abdomen. The MSFA measure is intensity invariant and provides an absolute measurement for the signi cance of features in the image. Second, in order to detect the ellipse that ts to the abdominal contour, the iterative randomized Hough transform is employed to exclude the interferences of the inner boundaries, after which the detected ellipse gradually converges to the outer boundaries of the abdomen. Experimental results in clinical ultrasound images demonstrate the high agreement between our approach and manual approach on the measurement of abdominal circumference (mean sign difference is 0.42% and correlation coef cient is 0.9973), which indicates that the proposed approach can be used as a reliable and accurate tool for obstetrical care and diagnosis.
Sillesen, H; Eldrup, N; Hultgren, R
BACKGROUND: Abdominal aortic aneurysm (AAA) is thought to develop as a result of inflammatory processes in the aortic wall. In particular, mast cells are believed to play a central role. The AORTA trial was undertaken to investigate whether the mast cell inhibitor, pemirolast, could retard...... surgery, diabetes mellitus, and severe concomitant disease with a life expectancy of less than 2 years. Included patients were treated with 10, 25 or 40 mg pemirolast, or matching placebo for 52 weeks. The primary endpoint was change in aortic diameter as measured from leading edge adventitia...
de Jonge, Wouter J.; The, Frans O.; van der Coelen, Dennis; Bennink, Roelof J.; Reitsma, Pieter H.; van Deventer, Sander J.; van den Wijngaard, René M.; Boeckxstaens, Guy E.
Background & Aims: Inflammation of the intestinal muscularis following manipulation during surgery plays a crucial role in the pathogenesis of postoperative ileus. Here, we evaluate the role of mast cell activation in the recruitment of infiltrates in a murine model. Methods: Twenty-four hours after
Jeanne, M; Clément, C; De Jonckheere, J; Logier, R; Tavernier, B
The analgesia nociception index (ANI) is an online heart rate variability analysis proposed for assessment of the antinociception/nociception balance. In this observational study, we compared ANI with heart rate (HR) and systolic blood pressure (SBP) during various noxious stimuli in anaesthetized patients. 15 adult patients undergoing laparoscopic appendectomy or cholecystectomy were studied. Patients received target controlled infusions of propofol (adjusted to maintain the Bispectral index in the range [40-60]) and remifentanil (with target increase in case of haemodynamic reactivity [increase in HR and/or SBP >20% of baseline]), and cisatracurium. Medical staff was blind to the ANI monitor. ANI and haemodynamic data were recorded at predefined times before and during surgery, including tetanic stimulation of the ulnar nerve before start of surgery. Anaesthesia induction decreased HR and SBP, while high ANI values (88 ) were recorded, indicating parasympathetic predominance. In 10 out of 11 patients, tetanic stimulation led to a transient (surgery, ANI decreased to 60 (39) and decreased further to 50 (15) after the pneumoperitoneum was inflated, while there was no significant change in HR or SBP. When haemodynamic reactivity occurred, ANI had further decreased to 40 (15). After completion of surgery, ANI returned to 90 (34). ANI seems more sensitive than HR and SBP to moderate nociceptive stimuli in propofol-anaesthetized patients. Whether ANI monitoring may allow preventing haemodynamic reactivity to noxious stimuli remains to be demonstrated.
Broek, R.P.G ten; Stommel, M.W.; Strik, C.; Laarhoven, C.J.H.M. van; Keus, F.; Goor, H. van
BACKGROUND: Formation of adhesions after peritoneal surgery results in high morbidity. Barriers to prevent adhesion are seldom applied, despite their ability to reduce the severity of adhesion formation. We evaluated the benefits and harms of four adhesion barriers that have been approved for
ten Broek, Richard P. G.; Stommel, Martijn W. J.; Strik, Chema; van Laarhoven, Cornelis J. H. M.; Keus, Frederik; van Goor, Harry
Background Formation of adhesions after peritoneal surgery results in high morbidity. Barriers to prevent adhesion are seldom applied, despite their ability to reduce the severity of adhesion formation. We evaluated the benefits and harms of four adhesion barriers that have been approved for
A randomised controlled pilot trial to evaluate and optimize the use of anti-platelet agents in the perioperative management in patients undergoing general and abdominal surgery--the APAP trial (ISRCTN45810007).
Antolovic, D; Rakow, A; Contin, P; Ulrich, A; Rahbari, N N; Büchler, M W; Weitz, J; Koch, M
Surgeons are increasingly confronted by patients on long-term low-dose acetylsalicylic acid (ASA). However, owing to a lack of evidence-based data, a widely accepted consensus on the perioperative management of these patients in the setting of non-cardiac surgery has not yet been reached. Primary objective was to evaluate the safety of continuous versus discontinuous use of ASA in the perioperative period in elective general or abdominal surgery. Fifty-two patients undergoing elective cholecystectomy, inguinal hernia repair or colonic/colorectal surgery were recruited to this pilot study. According to cardiological evaluation, non-high-risk patients who were on long-term treatment with low-dose ASA were eligible for inclusion. Patients were allocated randomly to continuous use of ASA or discontinuation of ASA intake for 5 days before until 5 days after surgery. The primary outcome was the incidence of major haemorrhagic and thromboembolic complications within 30 days after surgery. A total of 26 patients were allocated to each study group. One patient (3.8%) in the ASA continuation group required re-operation due to post-operative haemorrhage. In neither study group, further bleeding complications occurred. No clinically apparent thromboembolic events were reported in the ASA continuation and the ASA discontinuation group. Furthermore, there were no significant differences between both study groups in the secondary endpoints. Perioperative intake of ASA does not seem to influence the incidence of severe bleeding in non-high-risk patients undergoing elective general or abdominal surgery. Further, adequately powered trials are required to confirm the findings of this study.
Grebennikov, V A; Mishina, T P; Stepanenko, S M
Central hemodynamics was studied, using echocardiography and dopplercardiometry in 48 newborn operated on the abdominal organs. General regularities of hemodynamic changes in the first postoperative hours irrespective of the initial type of circulation have been established. Two types of cardiovascular system response to the operation stress are described; an increase and a drop in the cardiac output, which is extremely important for the diagnosis of impaired compensatory-adaptive mechanisms in the newborn. Special attention was paid to the assessment of the adequacy of the infusion therapy. Volume-load test facilitates the diagnosis of latent heart failure. Timely prescription of cardiotonic drugs and differential approach to infusion therapy prevent the onset of circulatory disturbances.
Risby, Kirsten; Pedersen, Mark Ellebæk; Jakobsen, Marianne S
PURPOSE: This study aims to investigate the safety and clinical implication of intraperitoneal microdialysis (MD) in newborns operated on for congenital abdominal wall defect. PATIENTS AND METHODS: 13 infants underwent intraperitoneal microdialysis (9 with gastroschisis and 4 with omphalocele). MD...... for high and low levels of intraperitoneal lactate, glycerol, and glucose and lactate/pyruvate ratio respectively. High and low levels were defined as above or below the median value on day one. RESULTS: Results from intraperitoneal MD showed a significantly higher mean lactate concentration in the group...... underwent primary closure. None of the infants with omphalocele received parenteral nutrition whereas all of the infants with gastroschisis did. There was no significant difference in duration of parenteral nutrition or tube feeding, respectively, when comparing the gastroschisis children with high versus...
Abd Elwahab, Sami Medani
Somatoform disorders (SD) or medically unexplained physical symptoms (MUPS) are a group of disorders that represent a group of symptoms that cannot be explained by an organic or physical pathology. These disorders are widely prevalent, and, if unrecognised, SD may lead medical professionals to embark on tests or procedures which may inflict unnecessary iatrogenic complications. Despite the high prevalence, they are only poorly included in medical training curricula, at both undergraduate and postgraduate levels. In this article, we review the literature and present two cases. The first one presented with a recurrent acute abdomen had an unnecessary CT abdomen. The second case had laparoscopy for acute right-sided abdominal pain which turned out to be normal, and was readmitted again after a short period with acute urine retention which resolved spontaneously following discussion with the patient and family. Both cases were referred for psychiatric assessment and their family doctors were informed.
Full Text Available Karl Rüdiger Wiebelitz, André-Michael BeerDepartment of True Naturopathy, Blankenstein Hospital, Hattingen, GermanyAbstract: A patient with pancreatic carcinoma diagnosed in 2005 suffered from chronic abdominal pain 6 years later that did not respond to conventional pain treatment according to guidelines. Furthermore, several complementary medical approaches remained ineffective. In the long run, only an Iberis amara drug combination relieved pain sufficiently. The drug is registered in Germany for the indications irritable bowel syndrome and dyspepsia. The multi-target approach of this combination drug may account for the effectiveness under these fundamentally different pathophysiological conditions. No serious undesired effects have been described in the use of this drug for other indications and none were observed in this case.Keywords: Iberis amara combination, early dumping syndrome, late dumping syndrome
Sinha, Amitasha; Afghani, Elham [Johns Hopkins Medical Institutions, Division of Gastroenterology, Baltimore, MD (United States); Singh, Vikesh K. [Johns Hopkins Medical Institutions, Division of Gastroenterology, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Pancreatitis Center, Baltimore, MD (United States); Cruise, Michael; Matsukuma, Karen [Johns Hopkins Medical Institutions, Department of Pathology, Baltimore, MD (United States); Ali, Sumera; Raman, Siva P.; Fishman, Elliot K. [Johns Hopkins Medical Institutions, The Russel H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Andersen, Dana K. [National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (United States); Makary, Martin A. [Johns Hopkins Medical Institutions, Department of Surgery, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Pancreatitis Center, Baltimore, MD (United States); Zaheer, Atif [Johns Hopkins Medical Institutions, The Russel H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Pancreatitis Center, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Baltimore, MD (United States)
To determine which abdominal CT findings predict severe fibrosis and post-operative pain relief in chronic pancreatitis (CP). Pre-operative abdominal CTs of 66 patients (mean age 52 ± 12 years, 53 % males) with painful CP who underwent the Whipple procedure (n = 32), Frey procedure (n = 32) or pancreatic head biopsy (n = 2), between 1/2003-3/2014, were evaluated. CT was evaluated for parenchymal calcifications, intraductal calculi, main pancreatic duct dilation (>5 mm), main pancreatic duct stricture, and abnormal side branch(es). The surgical histopathology was graded for fibrosis. CT findings were evaluated as predictors of severe fibrosis and post-operative pain relief using regression and area under receiver operating curve (AUC) analysis. Thirty-eight (58 %) patients had severe fibrosis. Parenchymal calcification(s) were an independent predictor of severe fibrosis (p = 0.03), and post-operative pain relief over a mean follow-up of 1-year (p = 0.04). Presence of >10 parenchymal calcifications had higher predictive accuracy for severe fibrosis than 1-10 parenchymal calcification(s) (AUC 0.88 vs. 0.59, p = 0.003). The predictive accuracy of >10 versus 1-10 parenchymal calcifications increased after adjusting for all other CT findings (AUC 0.89 vs. 0.63, p = 0.01). Parenchymal calcification(s) independently predict severe fibrosis and are significantly associated with post-operative pain relief in CP. The presence of >10 parenchymal calcifications is a better predictor of severe fibrosis than 1-10 parenchymal calcification(s). (orig.)
Martin, Robert C G; Brown, Russell; Puffer, Lisa; Block, Stacey; Callender, Glenda; Quillo, Amy; Scoggins, Charles R; McMasters, Kelly M
To prospectively evaluate predictive factors of hospital readmission rates in patients undergoing abdominal surgical procedures. Recommendations from MedPAC that the Centers for Medicare and Medicaid Services (CMS) report upon and determine payments based in part on readmission rates have led to an attendant interest by payers, hospital administrators and far-sighted physicians. Analysis of 266 prospective treated patients undergoing major abdominal surgical procedures from September 2009 to September 2010. All patients were prospectively evaluated for underlying comorbidities, number of preop meds, surgical procedure, incision type, complications, presence or absence of primary and/or secondary caregiver, their education level, discharge number of medications, and discharge location. Univariate and multivariate analyses were performed. Two hundred twenty-six patients were reviewed with 48 (18%) gastric-esophageal, 39(14%) gastrointestinal, 88 (34%) liver, 58 (22%) pancreas, and 33 (12%) other. Seventy-eight (30%) were readmitted for various diagnoses the most common being dehydration (26%). Certain preoperative and intraoperative factors were not found to be significant for readmission being, comorbidities, diagnosis, number of preoperative medications, patient education level, type of operation, blood loss, and complications. Significant predictive factors for readmission were age (≥69 years), number of discharged (DC) meds (≥9 medications), ≤50% oral intake (52% vs. 23%), and DC home with a home health agency (62% vs. 11%) Readmission rates for surgeons WILL become a quality indicator of performance. Quality parameters among Home Health agencies are nonexistent, but will reflect on surgeon’s performance. Greater awareness regarding predictors of readmission rates is necessary to demonstrate improved surgical quality.
Walczewski, Mayra da Rosa Martins; Justino, Ariane Zanetta; Walczewski, Eduardo André Bracci; Coan, Tatiane
To evaluate the results of the introduction of new measures to accelerate the postoperative recovery of patients undergoing elective abdominal surgery. We observed 162 patients and interviewed them on two distinct periods: the first between October to December 2009 (n = 81) comprised patients who underwent conventional perioperative monitoring (pre-intervention) and the second between March and May 2010 (n = 81), formed by a new group of patients, submitted to the new protocol of perioperative monitoring. Data collection in the two periods occurred without the knowledge of the professionals in the service. The variables were: indication for preoperative nutritional support, duration of fasting, post-operative volume of hydration, use of catheters and drains, length of stay and postoperative morbidity. when comparing the two periods we observed a decrease of 2.5 hours in the time of preoperative fasting (p = 0.0002) in the post-intervention group. As for the reintroduction of oral diet, there was no difference between the two periods (p = 0.0007). When considering the patients without postoperative complications, there was a significantly decreased length of stay (p = 0.001325). There was a reduction of approximately 50% in antibiotic use in the post-intervention group (p = 0.00001). The adoption of multidisciplinary perioperative measures is feasible within our reality, and although there was no statistically significant changes in the present study, it may improve morbidity and reduce length of stay in general surgery.
Full Text Available Jing Zhou,1 Hongying Pi,2 Yingying Zheng1 1General Surgery, 2Nursing Department, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China Background: Abdominal cavity drainage fluid can be used as an early diagnostic tool of postoperative complications, and observing its characteristics can help us to judge and handle postoperative complications. There is no accurate standard reference range on its characteristics after surgeries for gastrointestinal or retroperitoneal tumors. This research attempted to analyze its characteristics in Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors, and to offer an experimental basis for establishing a reliable standard reference range for abdominal cavity drainage fluid used to detect postoperative complications.Methods: This study enrolled 262 Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors.Results: All patients had a median age (range of 55 (19–72 years, and 150 (57.3% were men. There were 93 (35.5%, 115 (43.9%, and 54 (20.6% patients who underwent surgery for upper gastrointestinal tumors, lower gastrointestinal tumors, and retroperitoneal tumors, respectively. The total amount, density, and pH of the abdominal cavity drainage fluid were 204 (0–6,195 mL, 1.032 (1.011–1.047 kg/m3, and pH 7.0 (5.0–7.5, respectively. The total numbers of cells and white blood cells were 1.3×1011 (5.5×108–6.2×1012/L and 3.7×109 (1.0×107–5.0×1011/L, respectively. The levels of sugar and protein were 3 (0–37 mmol/L and 39 (1–272 g/L. The total amount of abdominal cavity drainage fluid, the total number of cells, the total number of white blood cells, the number of multinucleated cells, the number of monocytes, and the levels of sugar were statistically significantly different between the three groups (P<0.05 for all.Conclusion: This study
Janda, Monika; Gebski, Val; Davies, Lucy C; Forder, Peta; Brand, Alison; Hogg, Russell; Jobling, Thomas W; Land, Russell; Manolitsas, Tom; Nascimento, Marcelo; Neesham, Deborah; Nicklin, James L; Oehler, Martin K; Otton, Geoff; Perrin, Lewis; Salfinger, Stuart; Hammond, Ian; Leung, Yee; Sykes, Peter; Ngan, Hextan; Garrett, Andrea; Laney, Michael; Ng, Tong Yow; Tam, Karfai; Chan, Karen; Wrede, C David; Pather, Selvan; Simcock, Bryony; Farrell, Rhonda; Robertson, Gregory; Walker, Graeme; Armfield, Nigel R; Graves, Nick; McCartney, Anthony J; Obermair, Andreas
Standard treatment for endometrial cancer involves removal of the uterus, tubes, ovaries, and lymph nodes. Few randomized trials have compared disease-free survival outcomes for surgical approaches. To investigate whether total laparoscopic hysterectomy (TLH) is equivalent to total abdominal hysterectomy (TAH) in women with treatment-naive endometrial cancer. The Laparoscopic Approach to Cancer of the Endometrium (LACE) trial was a multinational, randomized equivalence trial conducted between October 7, 2005, and June 30, 2010, in which 27 surgeons from 20 tertiary gynecological cancer centers in Australia, New Zealand, and Hong Kong randomized 760 women with stage I endometrioid endometrial cancer to either TLH or TAH. Follow-up ended on March 3, 2016. Patients were randomly assigned to undergo TAH (n = 353) or TLH (n = 407). The primary outcome was disease-free survival, which was measured as the interval between surgery and the date of first recurrence, including disease progression or the development of a new primary cancer or death assessed at 4.5 years after randomization. The prespecified equivalence margin was 7% or less. Secondary outcomes included recurrence of endometrial cancer and overall survival. Patients were followed up for a median of 4.5 years. Of 760 patients who were randomized (mean age, 63 years), 679 (89%) completed the trial. At 4.5 years of follow-up, disease-free survival was 81.3% in the TAH group and 81.6% in the TLH group. The disease-free survival rate difference was 0.3% (favoring TLH; 95% CI, -5.5% to 6.1%; P = .007), meeting criteria for equivalence. There was no statistically significant between-group difference in recurrence of endometrial cancer (28/353 in TAH group [7.9%] vs 33/407 in TLH group [8.1%]; risk difference, 0.2% [95% CI, -3.7% to 4.0%]; P = .93) or in overall survival (24/353 in TAH group [6.8%] vs 30/407 in TLH group [7.4%]; risk difference, 0.6% [95% CI, -3.0% to 4.2%]; P = .76). Among women
This Data-in-Brief article contains a detailed method for the conduct of this survey and additional original data. In this survey, we also provided vascular surgery colleagues with contemporary epidemiologic and surgical outcome data. This was followed by a hypothetical scenario whereby a patient had just been diagnosed with a small (40 mm AAA and a novel biomarker predicted it to be fast growing in the coming years. We assessed the vascular professionals' perception of the patient's preference for management in this scenario, and their willingness to refer patients for a surgical trial that investigates the outcome of early versus late surgery in this setting. The survey then asked the vascular professionals to assume the role of the patient, and provided their own preferences in such a scenario.
Tammisto, T; Olkkola, K T
We studied the intensity of neuromuscular block that is adequate for surgical relaxation at different end-tidal levels of enflurane during N2O-O2-fentanyl anesthesia in 30 patients undergoing upper abdominal surgery. After induction of anesthesia with thiopental 4-6 mg/kg and vecuronium 0.07 mg/kg intravenously (i.v.), patients were randomly assigned to receive nitrous oxide-oxygen (2:1) and enflurane at 0.3% (Group I), 0.6% (Group II), or 1.2% (Group III) end-tidal level throughout anesthesia. The initial neuromuscular block was allowed to terminate and additional increments of 1 mg vecuronium were given when indicated by clinical signs or by spontaneous electromyography of neck muscles. In Group I additional vecuronium had to be given 62 times and in Groups II and III, 33, and 16 times, respectively. The mean (SD) neuromuscular block at the time of additional vecuronium was 75.9% +/- 20.7%, 62.5% +/- 20.1%, and 39.3% +/- 21.1% in Groups I to III, respectively. We conclude that there was a clear linear relationship between the end-tidal concentration of enflurane and the degree of neuromuscular block necessary to produce adequate surgical muscle relaxation (P < 0.001).
Lee, Ji Yeon; Park, Hee Yeon; Jung, Wol Seon; Jo, Youn Yi; Kwak, Hyun Jeong
We hypothesized that the 2 ventilation modes might have a different influence on the stroke volume variation (SVV). This study investigated the effect of the ventilation modes on SVV as a predictor of fluid responsiveness during major abdominal surgery. Sixty patients were randomly allocated to volume-controlled ventilation (VCV, n = 30) or pressure-controlled ventilation (PCV, n = 30) modes. After the induction of anesthesia, hemodynamic variables and SVV were measured before and after volume expansion (VE) with colloid solution of 10 mL/kg. The ability of SVV to predict the fluid responsiveness was tested by calculation of the area under a receiver operating characteristic curve for an increase in stroke volume index of at least 15% after VE. There were 10 and 16 responders in the VCV and PCV groups, respectively. The area under a receiver operating characteristic curve (95% confidence interval) for SVV before VE was 0.723 (0.538-0.907) and 0.799 (0.625-0.973) in the VCV and PCV groups, respectively. The optimal threshold value of SVV was 11% and 14% in the VCV and PCV groups, respectively. Stroke volume variation can predict fluid responsiveness during both VCV and PCV modes. However, the optimal threshold values of SVV may differ according to the ventilation modes. Copyright © 2012 Elsevier Inc. All rights reserved.
cholecystectomy, hysterectomy, gastric surgery, ventral hernlorrhaphy, bowel resection without ostomy , laparotomy). 3.) Patients with the following...and patterns Eliminative aids used at home Ostomies Diaphioresis Other excretions ACTIVITY AND REST Usual activitieS Ability to perform ADL Tolerance...pressuretemperature) Sensory aids Speechilanguage Orientation to pe~son. place. time Mental Status ROLES/ SEXUALITY Soc:a, roles Family/significant other support
K. M. Mylytsya
Full Text Available The aim of the study was to discuss the possibility and appropriateness of simultaneous operations in patients with metabolic syndrome (MS and obesity (O. Material and methods. The analysis of 50 simultaneous operations in patients with MS and O was performed. Gender, age, medical history and clinical-laboratory features were explored. Duration of operations, the number of complications, length of hospital stay were analyzed. Results and discussion. Body mass index ranged from 33 kg/m2 to 51 kg/m2. Skin and fat flaps weight ranged from 3 to 12 kg. Weight loss of patients in one week after surgery ranged from 5 to 14 kg. There were no complications in the early and late postoperative period. Analysis of carbohydrate metabolism showed no significant differences in pre- and post-operative period. Nevertheless simultaneous abdominoplasty as corrective surgery reduces weight, improves the self-perception of body image, physical and mental components of quality of life. Conclusion. The introduction of simultaneous operations will contribute: - for state: to increase and maintain the reproductive potential of the nation, to save the hospital beds, to save finances, to reduce the incidence of metabolic forms of cancer pathology; - for the patient: performing one operation instead of two ones, allowing to go through preoperative stress, anesthesia, postoperative period and the rehabilitation period once; during one operation to solve two-three issues; during surgical treatment of main disease to prevent oncological, cardio-vascular disease, diabetes, etc. Of course, the widespread adoption of the program of simultaneous gynecology, surgery requires the dissemination of knowledge and techniques refinement. simultaneous surgery; metabolic syndrome; obesity
Yang, Liu; Chong-Qi, Tu; Hai-Bo, Song; Lan, Zhang; Tian-Fu, Yang; Hong, Duan; Fu-Xing, Pei
To investigate the feasibilities of reducing intraoperative hemorrhage and improving the safety of pelvic and sacrum tumor surgery using sizing balloon occluding abdominal aorta. From May 2001 to May 2007, 18 patients were diagnosed as sacrum or pelvic tumor and underwent surgery in our institution. Balloon catheters were placed via femoral artery to occlude the abdominal aorta of pelvic tumor and sacrum region undergoing the sacrum resection or half pelvis resection and replacement operation in 12 patients. A sizing balloon was used to occlude the abdominal aorta for 60 min in assisting with resection of pelvic and sacral tumors. After the abdominal aorta was occluded, much less intraoperative hemorrhage was found, and the average blood loss was only 280 ml (range 200-600 ml). This procedure assisted the surgeon in identifying clearly the surgical margin and neurovascular structure surrounded by the tumors. The blood pressure remained stable during the operation. And the function of the kidney, the pelvis organs and the lower extremities were normal. Intraoperative abdominal aorta occluding may effectively control intraoperative hemorrhage, thus assisting the surgeon in the complete and safe resection of pelvic and sacrum tumors.
Treskatsch, Sascha; Klambeck, Michael; Mousa, Shaaban A; Kopf, Andreas; Schäfer, Michael
Human volunteer studies demonstrate ketamine-reversible opioid-induced hyperalgesia, consistent with reports of increased postoperative pain and analgesic consumption. However, recent clinical trials showed controversial results after intraoperative administration of high-dose remifentanil. To investigate in lower abdominal surgery patients whether postoperative pain intensity and analgesic consumption are increased following intraoperative high-dose vs. low-dose remifentanil, and whether this could be prevented by preoperative administration of the NMDA antagonist amantadine. Randomised, placebo-controlled, clinical study. University hospital. Sixty patients scheduled for elective major lower abdominal surgery. Patients were randomly assigned to one of three anaesthetic regimens. First, in the group 'low-dose remifentanil and preoperative isotonic saline' (n=15), a remifentanil infusion was maintained at a rate of 0.1 μg kg min throughout anaesthesia, and the end-tidal concentration of sevoflurane started at 0.5 minimum alveolar concentration (MAC) and was increased by 0.2% increments according to clinical demand. Preoperatively, 500 ml NaCl 0.9% were infused as study solution. Second, in the group 'high-dose remifentanil and preoperative saline' (n=17), the end-tidal concentration of sevoflurane was maintained at 0.5 MAC throughout anaesthesia. A remifentanil infusion was started at a rate of 0.2 μg kg min and subsequently increased by 0.05 μg kg min increments to clinical demand. Preoperatively, these patients also received a solution of 500 ml NaCl 0.9% as study solution. Third, the group 'high-dose remifentanil and preoperative amantadine' (n=16) received the same anaesthetic protocol as the second group, but the preoperative study solution was substituted by amantadine (200 mg/500 ml). Pain intensity measured by the numerical rating scale and cumulative morphine consumption. The remifentanil dose in both high-dose groups was significantly higher compared
Viscusi, Eugene R; Frenkl, Tara L; Hartrick, Craig T; Rawal, Narinder; Kehlet, Henrik; Papanicolaou, Dimitris; Gammaitoni, Arnold; Ko, Amy T; Morgan, Leslie M; Mehta, Anish; Curtis, Sean P; Peloso, Paul M
To evaluate the effects of two different doses of etoricoxib delivered perioperatively compared with placebo and standard pain management on pain at rest, pain with mobilization, and use of additional morphine/opioids postoperatively. In this double-blind, placebo-controlled, randomized clinical trial, we evaluated postoperative pain following total abdominal hysterectomy over 5 days in patients receiving placebo or etoricoxib administered 90 min prior to surgery and continuing postoperatively. Patients were randomly assigned to receive either placebo (n = 144), etoricoxib 90 mg/day (n = 142), or etoricoxib 120 mg/day (n = 144). Average Pain Intensity at Rest over days 1-3 (0- to 10-point numerical rating scale [NRS]) was the primary efficacy endpoint. Secondary endpoints included Average Pain Intensity upon Sitting, Standing, and Walking over days 1-3 (0- to 10-point NRS) as well as Average Total Daily Dose of Morphine over days 1-3. This trial is registered on www.clinicaltrials.gov (NCT00788710). The least squares (LS) means (95% CI) for the primary endpoint were 3.26 (2.96, 3.55); 2.46 (2.16, 2.76); and 2.40 (2.11, 2.69) for placebo, etoricoxib 90 mg, and etoricoxib 120 mg, respectively, significantly different for both etoricoxib doses versus placebo (p placebo (p placebo. A greater proportion of patients on etoricoxib (10-30% greater than placebo) achieved mild levels of pain with movement, defined as pain ≤3/10. A key limitation for this study was that movement-evoked pain measurements were not designated as primary endpoints. In patients undergoing total abdominal hysterectomy, etoricoxib 90 mg and 120 mg dosed preoperatively and then continued postoperatively significantly reduces both resting and movement-related pain, as well as reduced opioid (morphine) consumption that led to more rapid bowel recovery.
Juan Carlos Sánchez-García
Full Text Available Introduction. The woman presents during pregnancy a weight gain that, in most cases, does not carry risks associated with weight gain, but that if that gain is not lost adequately in the postpartum, it can be harmful to their health. Promoting physical exercise programs during the postpartum period can be an effective tool in the recovery of women's pregestational weight, in addition, it can also be associated with an improvement in the healthy habits of both the woman and her family. Aim. To analyze the results of a program of hipopressive abdominal physical activity in a sample of women, starting four months after birth, and its influence on the recovery of pregestational weight. Material and methods. A randomized clinical trial was performed of observational and longitudinal cut. The study included a behavioral intervention, starting at 16 weeks postpartum and ended 12 weeks later. A moderate-intensity exercise program was followed, according to the Low Pressure Fitness methodology. The evolution of weight gained during pregnancy was known through the personal interview between the weeks 14-16 postpartum. Weight retention was assessed during the postpartum period, and measured again at week 28 postpartum. Results. At the beginning of the intervention, the women did not present statistically significant gestational weight gains between the two groups, being recommended by the American College of Obstetrics and Gynecology (ACOG, which ranged from 8.05 kg to 11.63 kg. The total drop out rate for the trial was 7.8%. No statistically significant differences were found between the two groups in the evolution of the woman's weight from the beginning to the end of the intervention. Neither when comparing the weights at the beginning and at the end of the intervention of each group. The value of p was 0.751 for CG and 0.691 for EG. No statistically significant differences were found in the characteristics of the sample. Conclusion. Statistically, no
Güngördük, Kemal; Özdemir, İsa Aykut; Güngördük, Özgü; Gülseren, Varol; Gokçü, Mehmet; Sancı, Muzaffer
Paralytic ileus that develops after elective surgery is a common and uncomfortable complication and is considered inevitable after an intraperitoneal operation. The purpose of this study was to investigate whether coffee consumption accelerates the recovery of bowel function after complete staging surgery of gynecologic cancers. In this randomized controlled trial, 114 patients were allocated preoperatively to either postoperative coffee consumption with 3 times daily (n=58) or routine postoperative care without coffee consumption (n=56). Total abdominal hysterectomy and bilateral salpingo-oophorectomy with systematic pelvic and paraaortic lymphadenectomy were performed on all patients as part of complete staging surgery for endometrial, ovarian, cervical, or tubal cancer. The primary outcome measure was the time to the first passage of flatus after surgery. Secondary outcomes were the time to first defecation, time to first bowel movement, and time to tolerance of a solid diet. The mean time to flatus (30.2±8.0 vs 40.2±12.1 hours; Pcoffee compared with control subjects. Mild ileus symptoms were observed in 17 patients (30.4%) in the control group compared with 6 patients (10.3%) in the coffee group (P=.01). Coffee consumption was well-tolerated and well-accepted by patients, and no intervention-related side-effects were observed. Coffee consumption after total abdominal hysterectomy and systematic paraaortic lymphadenectomy expedites the time to bowel motility and the ability to tolerate food. This simple, cheap, and well-tolerated treatment should be added as an adjunct to the postoperative care of gynecologic oncology patients. Copyright © 2016 Elsevier Inc. All rights reserved.
Zhou, Zhou; Han, Xiaotong; Ning, Fengling; Wen, Hui; Fan, Maiying; Yuan, Xia; Luo, Jieying; Zhang, Yi
To investigate the clinical effect of pulmonary rehabilitation therapy including respiratory exercise and vibration expectoration on patients with pulmonary infection after abdominal surgery. A retrospective case control study was conducted. Seventy-six patients with pulmonary infection after abdominal surgery admitted to the First Affiliated Hospital of Hunan Normal University from September 2015 to September 2016 were enrolled. According to whether accept the pulmonary rehabilitation therapy or not, the patients were divided into two groups. In the control group (n = 35), the conventional expectoration method was adopted. The patients in pulmonary rehabilitation group (n = 41) received both methods of the control group and pulmonary rehabilitation treatment, including respiratory exercise (effective cough, lip reduction breathing), respiratory exercise device (respiratory exerciser tri-ball), and vibrated expectoration. The 24-hour sputum volume, degree of comfort, inflammatory and pulmonary function parameters, and recovery situation were recorded in the two groups. (1) There were no significant differences in the parameters of inflammation and pulmonary function before treatment between the two groups. After treatment, the white blood cell (WBC) and C-reactive protein (CRP) in both groups were significantly decreased, and the forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) were significantly increased. The above changes in pulmonary rehabilitation group were more significant than those of the control group [WBC (×109/L): 11.12±2.88 vs. 13.42±2.62 at 3 days, 8.22±1.48 vs. 9.27±1.92 at 5 days; CRP (mg/L): 13.47±4.77 vs. 16.03±4.94 at 3 days, 9.69±1.56 vs. 11.77±1.41 at 5 days; FEV1 (L): 2.48±0.14 vs. 2.29±0.16 at 3 days, FEV1/FVC: 0.78±0.04 vs. 0.75±0.04 at 3 days; all P rehabilitation group were significantly higher than that of the control group (mL: 30.51±4.15 vs. 18.30±3.64 at 1 day, 31.08±3.22 vs. 20.37±3
Padalino, Pietro; Dionigi, Gianlorenzo; Minoja, Giulio; Carcano, Giulio; Rovera, Francesca; Boni, Luigi; Dionigi, Renzo
Vacuum-assisted fascial closure (VAFC-KCI(®)) of an open abdomen is one of the latest methods. A prospective observational study was performed with medical records of nine patients who had been treated by abdominal VAFC-KCI(®) from March 2006 to October 2007 in the Department of Surgical Sciences, University of Insubria. The mean Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were 22.62 and 10.62, respectively. All patients had abdominal compartment syndrome and a sepsis source that was difficult to control. All patients survived. The mean duration of open abdomen was 22.7 days (range, 3-50 days). Primary fascial closure was possible in six patients (66%), with a closure rate of 100% when early control of the infectious source was possible (Group A) but only 40% in patients with difficult and delayed control of infection (Group B). The mean durations of open abdomen in the two groups were statistically different: 8.5 days for Group A vs. 34.2 days for Group B (p high fascial closure rate. The complexity of the management of abdominal source control has a role in the success of primary fascial closure. The VAFC-KCI(®) system seems to contribute positively in fascia-to-fascia abdominal closure in cases of severe abdominal infection, in particular when early surgical source control is obtained.
Comparison and Evaluation of the Effects of Administration of Postoperative Non-Invasive Mechanical Ventilation Methods (CPAP and BIPAP) on Respiratory Mechanics and Gas Exchange in Patients Undergoing Abdominal Surgery.
Yağlıoğlu, Hatice; Köksal, Güniz Meyancı; Erbabacan, Emre; Ekici, Birsel
The aim of our study is to investigate the effect of two different methods of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BIPAP) and oxygen support under spontaneous ventilation on respiration mechanics, gas exchange, dry mouth and face mask lesion during an early postoperative period in patients undergoing upper abdominal surgery. Eighty patients undergoing elective abdominal surgery with laparotomy, between the age of 25 and 75 years and American Society of Anesthesiologists Physical Status score (ASA) II-III with chronic obstructive pulmonary disease (COPD) diagnosis were included to the study. Subjects were randomly allocated in to four groups. During the first postoperative hour, the first group received BIPAP, second group received high-flow CPAP, third group received low-flow CPAP and fourth group received deep breathing exercises, respiratory physiotherapy and O2 therapy. Preoperative, postoperative before and after treatment PaO2, PaCO2, SpO2, tidal volume (TV), respiratory rate (RR) levels were recorded. Subjects with dry mouth or face mask lesion were recorded. In all groups, PaO2 and TV measurements were higher at the postoperative first hour than the postoperative zero hour. We found that low-flow CPAP increased PaO2 and SpO2 values more, and TV levels were higher in the postoperative period than the preoperative period. PaCO2 levels were elevated at the zero hour postoperatively and at the end of the first hour; they decreased approximately to preoperative values, except in the fourth group. Administration of prophylactic respiratory support can prevent the deterioration of pulmonary functions and hypoxia in patients with COPD undergoing upper abdominal surgery. In addition, we found that low-flow CPAP had better effects on PaO2, SpO2, TV compared to other techniques.
Vlieger, Arine M.; Menko-Frankenhuis, Carla; Wolfkamp, Simone C. S.; Tromp, Ellen; Benninga, Marc A.
BACKGROUND & AIMS: Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are highly prevalent in childhood. A substantial proportion of patients continues to experience long-lasting symptoms. Gut-directed hypnotherapy (HT) has been shown to be highly effective in the treatment of adult
Boden, Ianthe; Browning, Laura; Skinner, Elizabeth H; Reeve, Julie; El-Ansary, Doa; Robertson, Iain K; Denehy, Linda
Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing and coughing exercises. However, the evidence is inconclusive due to methodological limitations. No well-designed, adequately powered, randomised controlled trial has investigated the effect of pre-operative education and training on post-operative respiratory complications, hospital length of stay, and health-related quality of life following upper abdominal surgery. The Lung Infection Prevention Post Surgery - Major Abdominal- with Pre-Operative Physiotherapy (LIPPSMAck POP) trial is a pragmatic, investigator-initiated, bi-national, multi-centre, patient- and assessor-blinded, parallel group, randomised controlled trial, powered for superiority. Four hundred and forty-one patients scheduled for elective open upper abdominal surgery at two Australian and one New Zealand hospital will be randomised using concealed allocation to receive either i) an information booklet or ii) an information booklet, plus one additional pre-operative physiotherapy education and training session. The primary outcome is respiratory complication incidence using standardised diagnostic criteria. Secondary outcomes include hospital length of stay and costs, pneumonia diagnosis, intensive care unit readmission and length of stay, days/h to mobilise >1 min and >10 min, and, at 6 weeks post-surgery, patient reported complications, health-related quality of life, and physical capacity. The LIPPSMAck POP trial is a multi-centre randomised controlled trial powered and designed to investigate whether a single pre-operative physiotherapy session prevents post-operative respiratory complications. This trial standardises post-operative assisted ambulation and
Holte, K; Foss, N B; Andersen, J; Valentiner, L; Lund, C; Bie, P; Kehlet, H
Evidence-based guidelines on optimal perioperative fluid management have not been established, and recent randomized trials in major abdominal surgery suggest that large amounts of fluid may increase morbidity and hospital stay. However, no information is available on detailed functional outcomes or with fast-track surgery. Therefore, we investigated the effects of two regimens of intraoperative fluids with physiological recovery as the primary outcome measure after fast-track colonic surgery. In a double-blind study, 32 ASA I-III patients undergoing elective colonic surgery were randomized to 'restrictive' (Group 1) or 'liberal' (Group 2) perioperative fluid administration. Fluid algorithms were based on fixed rates of crystalloid infusions and a standardized volume of colloid. Pulmonary function (spirometry) was the primary outcome measure, with secondary outcomes of exercise capacity (submaximal exercise test), orthostatic tolerance, cardiovascular hormonal responses, postoperative ileus (transit of radio-opaque markers), postoperative nocturnal hypoxaemia, and overall recovery within a well-defined multimodal, fast-track recovery programme. Hospital stay and complications were also noted. 'Restrictive' (median 1640 ml, range 935-2250 ml) compared with 'liberal' fluid administration (median 5050 ml, range 3563-8050 ml) led to significant improvement in pulmonary function and postoperative hypoxaemia. In contrast, we found significantly reduced concentrations of cardiovascularly active hormones (renin, aldosterone, and angiotensin II) in Group 2. The number of patients with complications was not significantly different between the groups [1 ('liberal' group) [corrected] vs 6 ('restrictive' group) [corrected] patients, P = 0.08]. A 'restrictive' [corrected] fluid regimen led to a transient improvement in pulmonary function and postoperative hypoxaemia but no other differences in all-over physiological recovery compared with a 'liberal' [corrected] fluid regimen
Sikder, Tarifin; Maimon, Geva; Sourial, Nadia; Tahiri, Mehdi; Teasdale, Debby; Bernier, Paule; Fraser, Shannon A; Demyttenaere, Sebastian; Bergman, Simon
Malnutrition among elderly surgical patients has been associated with poor postoperative outcomes and reduced functional status. Although previous studies have shown that nutrition contributes to patient outcomes, its long-term impact on functional status requires better characterization. This study examines the effect of nutrition on postoperative upper body function over time in elderly patients undergoing elective surgery. This is a 2-year prospective study of elderly patients (≥70 years) undergoing elective abdominal surgery. Preoperative nutrition status was determined with the Subjective Global Assessment (SGA). The primary outcome was handgrip strength (HGS) at 1, 4, 12, and 24 weeks postsurgery. Repeated measures analysis was used to determine whether SGA status affects the trajectory of postoperative HGS. The cohort included 144 patients with a mean age of 77.8 ± 5.0 years and a mean body mass index of 27.7 ± 5.1 kg/m(2). The median (interquartile range) Charlson Comorbidity Index was 3 (2-6). Participants were categorized as well-nourished (86%) and mildly to moderately malnourished (14%), with mean preoperative HGS of 25.8 ± 9.2 kg and 19.6 ± 7.0 kg, respectively. At 24 weeks, 64% of well-nourished patients had recovered to baseline HGS, compared with 44% of mildly to moderately malnourished patients. Controlling for relevant covariates, SGA did not significantly affect the trajectory of postoperative HGS. While HGS values over the 24 weeks were consistently higher in the well-nourished SGA group than the mildly to moderately malnourished SGA group, no difference in the trajectories of HGS was detected between the groups.
Nielsen, Per Rotbøll; Jørgensen, Lars Damkjær; Dahl, Benny
To evaluate the outcome after spinal surgery when adding prehabilitation to the early rehabilitation.......To evaluate the outcome after spinal surgery when adding prehabilitation to the early rehabilitation....
Lilot, M; Ehrenfeld, J M; Lee, C; Harrington, B; Cannesson, M; Rinehart, J
Variation in clinical practice in the perioperative environment and intensive care unit is a major challenge facing modern medicine. The objective of the present study was to analyse intraoperative crystalloid administration practices at two academic medical centres in the USA. We extracted clinical data from patients undergoing intra-abdominal procedures performed at UC Irvine (UCI) and Vanderbilt University (VU) Medical Centres. Limiting data to uncomplicated elective surgery with minimal blood loss, we quantified variability in fluid administration within individual providers, between providers, and between types of procedures using a corrected coefficient of variation (cCOV). Regression was performed using a general linear model to determine factors most predictive of fluid administration. For provider analysis and model building, 1327 UCI and 4585 VU patients were used. The average corrected crystalloid infusion rate across all providers at both institutions was 7.1 (sd 4.9) ml kg(-1) h(-1), an overall cCOV of 70%. Individual providers ranged from 2.3 (sd 3.7) to 14 (sd 10) ml kg(-1) h(-1). The final regression model strongly favoured personnel as predictors over other patient predictors. Wide variability in crystalloid administration was observed both within and between individual anaesthesia providers, which might contribute to variability in surgical outcomes. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: email@example.com.
Macciò, Antonio; Kotsonis, Paraskevas; Chiappe, Giacomo; Melis, Luca; Zamboni, Fausto; Madeddu, Clelia
Uterine leiomyosarcoma (LMS) in some cases may disseminate through the abdominal cavity, without extra-abdominal spreading, determining a condition of abdominal sarcomatosis, which represents a peculiar situation. Only radical surgical removal offers a chance of long-term survival in such cases of LMS. Here we describe a case of diffuse abdominal sarcomatosis from uterine LMS in a 51-year-old perimenopausal woman who underwent laparoscopic radical hysterectomy, bilateral salpingo-oophorectomy, total pelvic peritonectomy, pelvic lymphadenectomy to the mesenteric inferior artery, and omentectomy. Then, given the high probability of disease recurrence, the patient underwent a close follow-up consisting of positron emission tomography (PET)/computed tomography every 3 months and diagnostic (and if necessary operative) laparoscopy every 6 months. To date, the patient had 11 laparoscopies; 5 of them were preceded by a PET indicative of the presence of disease with high metabolic activity, which was confirmed at surgery and each time completely removed laparoscopically with no evidence of residual disease. To date, 5 years from diagnosis the patient is alive and continues her follow-up. Our report brings to light the ability of laparoscopic surgery to obtain disease control in a case of LMS with abdominal dissemination. Moreover, laparoscopic surgery, as demonstrated in our case, may have an important role in the close follow-up of the disease and allow a timely and early radical surgical approach of relapses before they become extremely large and difficult to remove radically. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.
Schardey, H M
In surgery prophylaxis for infection is necessary, because patients are immunocompromised due to the underlying disease and the operation while at the same time being increasingly exposed to potentially pathogenic germs. Prophylaxis is based on the control of endogenous and exogenous microorganisms. For this purpose either systemic or locally active topical agents may be employed. Systemically active substances are applied with the aim to kill and eliminate invasive microorganisms in deep tissue levels, either by their own biological activity or by stimulating specific or unspecific host immune reactions. Local topical measures in contrast are to prevent the primary contact between microorganisms and host. The central pillar of systemic measures is the perioperative systemic antibiotic prophylaxis, immunonutrition is beginning to gain importance, and in the future possibly substances such as G-CSF, which directly stimulate the immune system, may be employed. Standard topical measures are sterilization and desinfection while decontamination of the digestive tract has until now not found a wide spread acceptance. For certain indications especially high risk surgical resections with anastomoses at the level of the oesophagus or the lower rectum it is possible to eliminate endogenous intestinal microorganisms effectively using topical decontamination in combination with systemic antibiotics and improve the surgical results, especially anastomotic healing.
Stavrou, George; Giamarellos-Bourboulis, Evangelos J; Kotzampassi, Katerina
Administration of probiotics has been proposed for various medical and surgical conditions. Their effect has been largely attributed to their ability to maintain the integrity of the intestinal mucosal barrier as well as to modulate the innate immune response. Multiple studies have demonstrated their effect in reducing infectious complications in critically ill patients, minimising bacterial translocation and increasing the secretion of anti-inflammatory cytokines. Furthermore, they have been shown to be effective in reducing infections following colorectal surgery, while at the same time preventing overgrowth of bacterial species such as Pseudomonas aeruginosa that has been implicated in the pathogenesis of anastomotic leak. Recent experimental studies have demonstrated that probiotics may decrease expression of the SOCS3 gene, which encodes the protein SOCS3 that suppresses cytokine production, implying a direct interaction of probiotics with the innate immune system. These results hold high promises for the development of new therapeutic strategies. Copyright © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
Jessurun, ER; Van Hemel, NM; Defauw, JJ; De La Riviere, AB; Stofmeel, MAM; Kingma, JH; Ernst, JMPG
Aim Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining
Afridi, Shahida Parveen; Siddiqui, Rameez Ahmed; Rajput, Akram; Alam, Shams Nadeem
The study highlights the spectrum of abdominal TB in emergency surgery and its outcome. A proforma based prospective cross sectional study was conducted from March 2008 - March 2014, at the Department of General Surgery, Dow University of Health Sciences & Civil Hospital Karachi, Pakistan. Total patients studied were hundred. Ninety percent patients presented through the emergency department. Mean age was 30 ± 7.29 years. Family history of TB was positive in 46 (46%) patients. Pulmonary TB was present in 22 (22%), and 52 (52%) - were already on Antitubercular Therapy-- Emergency exploratory laparotomy was performed in 85 (85%) patients with 61 (61%) having peritonitis. and 24 (24%) having acute intestinal obstruction. A total of 15 (15%) patients were kept on ATT under observation, Of these 7(7%) were diagnosed with Ileocaecal mass, 5 (5%) with enterocutaneous fistula, and 3(3%) had sub-acute intestinal obstruction. Ileum was the most common site for abdominal TB in 36(36%), followed by ileocaecal TB in 13 (13%) and jejunal TB in 12 (12%). Stoma and abdominal washout was the minimum procedure which was performed in 34 (34%) cases. Fourteen (14%) patients diagnosed with ileocaecal TB, received limited right hemi colectomy with two end stoma whereas 7(7%) patients were subjected to limited right hemi colectomy with primary anastomosis. Patients with multiple strictures and perforations were subjected to segmental resection with two end stoma. This was performed, in 12 (12%) cases and primary repair and anastomosis in 9 (9%). Only washouts and laparostomy was performed in 5 (5%) and adhenolysis in 4(4%) cases. Redo surgery was required in 44 (44%). The overall mortality was 18%. This study concludes that abdominal TB patients usually present late with complications in emergency surgery because of diagnostic delay, having a high morbidity and mortality.
Tanaka, Noriyoshi; Ohno, Yuko; Hori, Megumi; Utada, Mai; Ito, Kenji; Suzuki, Toshiyasu
We compared resistive heating (RH) and upper-body convective warming (CW) in 70 patients (RH 33, CW 31, 6 excluded) undergoing major abdominal surgery. The effect of RH was not inferior to that of CW for the time-weighted average core temperature, and the lower limit of 95% CW was greater than -0.5 degrees C. Resistive heating showed no inferiority in maintaining core temperature compared with convective warming.
Straatman, Jennifer; Cuesta, Miguel A; Gisbertz, Suzanne S; Van der Peet, Donald L
Postoperative complications frequently follow major abdominal surgery and are associated with increased morbidity and mortality. Early diagnosis and treatment of complications is associated with improved patient outcome. In this study we assessed the value of a step-up diagnosis plan by C-reactive protein and CT-scan (computed tomography-scan) imaging for detection of postoperative complications following major abdominal surgery.An observational cohort study was conducted of 399 consecutivepatients undergoing major abdominal surgery between January 2009 and January 2011. Indication for operation, type of surgery, postoperative morbidity, complications according to the Clavien-Dindo classification and mortality were recorded. Clinical parameters were recorded until 14 days postoperatively or until discharge. Regular C-reactive protein (CPR) measurements in peripheral blood and on indication -enhanced CT-scans were performed.Eighty-three out of 399 (20.6 %) patients developed a major complication in the postoperative course after a median of seven days (IQR 4-9 days). One hundred and thirty two patients received additional examination consisting of enhanced CT-scan imaging, and treatment by surgical reintervention or intensive care observation. CRP levels were significantly higher in patients with postoperative complications. On the second postoperative dayCRP levels were on average 197.4 mg/L in the uncomplicated group, 220.9 mg/L in patients with a minor complication and 280.1 mg/L in patients with major complications (p CT-scan imaging showed a sensitivity of 91.7 % and specificity of 100 % in diagnosis of major complications. Based on clinical deterioration and the increase of CRP, an additional enhanced CT-scan offered clear discrimination between patients with major abdominal complications and uncomplicated patients. Adequate treatment could then be accomplished.
Probst, Pascal; Grummich, Kathrin; Ulrich, Alexis; Büchler, Markus W; Knebel, Phillip; Diener, Markus K
Industry sponsorship has been identified as a factor correlating with positive research findings in several fields of medical science. To date, the influence of industry sponsorship in general and abdominal surgery has not been fully studied. This protocol describes the rationale and planned conduct of a systematic review to determine the association between industry sponsorship and positive outcome in randomised controlled trials in general and abdominal surgery. A literature search in the Cochrane Library, MEDLINE and EMBASE and additional hand searches in relevant citations will be conducted. In order to cover all relevant areas of general and abdominal surgery, a new literature search strategy called multi-PICO search strategy (MPSS) has been developed. No language restriction will be applied. The search will be limited to publications between January 1985 and July 2014. Information on funding source, outcome, study characteristics and methodological quality will be extracted.The association between industry sponsorship and positive outcome will be tested by a chi-squared test. A multivariate logistic regression analysis will be performed to control for possible confounders, such as number of study centres, multinational trials, methodological quality, journal impact factor and sample size. This study was designed to clarify whether industry-sponsored trials report more positive outcomes than non-industry trials. It will be the first study to evaluate this topic in general and abdominal surgery. The findings of this study will enable surgical societies, in particular, to give advice about cooperation with the industry and disclosure of funding source based on empirical evidence. PROSPERO CRD42014010802.
Full Text Available Postoperative complications frequently follow major abdominal surgery and are associated with increased morbidity and mortality. Early diagnosis and treatment of complications is associated with improved patient outcome. In this study we assessed the value of a step-up diagnosis plan by C-reactive protein and CT-scan (computed tomography-scan imaging for detection of postoperative complications following major abdominal surgery. An observational cohort study was conducted of 399 consecutive patients undergoing major abdominal surgery between January 2009 and January 2011. Indication for operation, type of surgery, postoperative morbidity, complications according to the Clavien-Dindo classification and mortality were recorded. Clinical parameters were recorded until 14 days postoperatively or until discharge. Regular C-reactive protein (CPR measurements in peripheral blood and on indication -enhanced CT-scans were performed. Eighty-three out of 399 (20.6 % patients developed a major complication in the postoperative course after a median of seven days (IQR 4-9 days. One hundred and thirty two patients received additional examination consisting of enhanced CT-scan imaging, and treatment by surgical reintervention or intensive care observation. CRP levels were significantly higher in patients with postoperative complications. On the second postoperative day CRP levels were on average 197.4 mg/L in the uncomplicated group, 220.9 mg/L in patients with a minor complication and 280.1 mg/L in patients with major complications (p < 0,001. CT-scan imaging showed a sensitivity of 91.7 % and specificity of 100 % in diagnosis of major complications. Based on clinical deterioration and the increase of CRP, an additional enhanced CT-scan offered clear discrimination between patients with major abdominal complications and uncomplicated patients. Adequate treatment could then be accomplished.
de Graauw, J A; Mihály, S; Deme, O; Hofker, H S; Baranski, A G; Gobée, O P; Krikke, C; Fehérvari, I; Langer, R M; Ploeg, R J; Marazuela, R; Domínguez-Gil, B; Haase-Kromwijk, B J J M; Font-Sala, C
Considering the growing organ demand worldwide, it is crucial to optimize organ retrieval and training of surgeons to reduce the risk of injury during the procedure and increase the quality of organs to be transplanted. In the Netherlands, a national complete trajectory from training of surgeons in procurement surgery to the quality assessment of the procured organs was implemented in 2010. This mandatory trajectory comprises training and certification modules: E-learning, training on the job, and a practical session. Thanks to the ACCORD (Achieving Comprehensive Coordination in Organ Donation) Joint Action coordinated by Spain and co-funded under the European Commission Health Programme, 3 twinning activities (led by France) were set to exchange best practices between countries. The Dutch trajectory is being adapted and implemented in Hungary as one of these twinning activities. The E-learning platform was modified, tested by a panel of Hungarian and UK surgeons, and was awarded in July 2013 by the European Accreditation Council for Continuing Medical Education of the European Union of Medical Specialists. As a pilot phase for future national training, 6 Hungarian surgeons from Semmelweis University are being trained; E-learning platform was fulfilled, and practical sessions, training-on-the-job activities, and evaluations of technical skills are ongoing. The first national practical session was recently organized in Budapest, and the new series of nationwide selected candidates completed the E-learning platform before the practical. There is great potential for sharing best practices and for direct transfer of expertise at the European level, and especially to export this standardized training in organ retrieval to other European countries and even broader. The final goal was to not only provide a national training to all countries lacking such a program but also to improve the quality and safety criteria of organs to be transplanted. Copyright © 2014 Elsevier
Penza, Veronica; Ortiz, Jesús; Mattos, Leonardo S; Forgione, Antonello; De Momi, Elena
Single-incision laparoscopic surgery decreases postoperative infections, but introduces limitations in the surgeon's maneuverability and in the surgical field of view. This work aims at enhancing intra-operative surgical visualization by exploiting the 3D information about the surgical site. An interactive guidance system is proposed wherein the pose of preoperative tissue models is updated online. A critical process involves the intra-operative acquisition of tissue surfaces. It can be achieved using stereoscopic imaging and 3D reconstruction techniques. This work contributes to this process by proposing new methods for improved dense 3D reconstruction of soft tissues, which allows a more accurate deformation identification and facilitates the registration process. Two methods for soft tissue 3D reconstruction are proposed: Method 1 follows the traditional approach of the block matching algorithm. Method 2 performs a nonparametric modified census transform to be more robust to illumination variation. The simple linear iterative clustering (SLIC) super-pixel algorithm is exploited for disparity refinement by filling holes in the disparity images. The methods were validated using two video datasets from the Hamlyn Centre, achieving an accuracy of 2.95 and 1.66 mm, respectively. A comparison with ground-truth data demonstrated the disparity refinement procedure: (1) increases the number of reconstructed points by up to 43 % and (2) does not affect the accuracy of the 3D reconstructions significantly. Both methods give results that compare favorably with the state-of-the-art methods. The computational time constraints their applicability in real time, but can be greatly improved by using a GPU implementation.
Francisco J. González-Álvarez
Full Text Available ABSTRACT Background Few studies have explored the effects of stretching techniques on diaphragm and spine kinematics. Objective To determine whether the application of diaphragm stretching resulted in changes in posterior chain muscle kinematics and ribcage and abdominal excursion in healthy subjects. Method Eighty healthy adults were included in this randomized clinical trial. Participants were randomized into two groups: the experimental group, which received a diaphragmatic stretching technique, or the placebo group, which received a sham-ultrasound procedure. The duration of the technique, the position of participants, and the therapist who applied the technique were the same for both treatments. Participant assessment (cervical range of movement, lumbar flexibility, flexibility of the posterior chain, and rib cage and abdominal excursion was performed at baseline and immediately after the intervention by a blinded assessor. Results The mean between-group difference [95% CI] for the ribcage excursion after technique at xiphoid level was 2.48 [0.97 to 3.99], which shows significant differences in this outcome. The remaining between-group analysis showed significant differences in cervical extension, right and left flexion, flexibility of the posterior chain, and ribcage excursion at xiphoid level (p<0.05 in favor of the experimental group. Conclusion Diaphragm stretching generates a significant improvement in cervical extension, right and left cervical flexion, flexibility of the posterior chain, and ribcage excursion at xiphoid level compared to a placebo technique in healthy adults.
Value of a step-up diagnosis plan: CRP and CT-scan to diagnose and manage postoperative complications after major abdominal surgery Value of a step-up diagnosis plan: CRP and CT-scan to diagnose and manage postoperative complications after major abdominal surgery
Straatman, Jennifer; Cuesta, Miguel A.; Gisbertz, Suzanne S.; van der Peet, Donald L.
Postoperative complications frequently follow major abdominal surgery and are associated with increased morbidity and mortality. Early diagnosis and treatment of complications is associated with improved patient outcome. In this study we assessed the value of a step-up diagnosis plan by C-reactive
Full Text Available ... appendicitis is the most common reason for emergency abdominal surgery. Ultrasound imaging can also: help a physician determine the source of abdominal pain, such as gallstones, kidney stones, abscesses or ...
Göransson, Katarina; Lundberg, Johan; Ljungqvist, Olle; Ohlsson, Elisabet; Sandblom, Gabriel
Poor communication between surgical and anesthesia unit personnel may jeopardize patient safety. Review reports from a national survey on patient safety performed at 17 units 2011-2013 were analyzed in order to identify strategies to reduce risks related to the interaction between surgery and anesthesia. The reports were reviewed in this study by an independent group in order to extract findings related to communication between anesthesia and surgical unit personnel. Suggested strategies to improve patient safety included: uniform national health declaration forms; consistent use of admission notes; uniform systems for documenting medical information; multidisciplinary forum for evaluation of high-risk patients; weekly and daily scheduling of surgical programs; application of the WHO check list; open dialog during surgery; oral and written reports from the surgeon to the postoperative unit; and combined mortality and morbidity conferences.
["Onlay" mesh provides significantly better results than "sublay" reconstruction. Prospective randomized multicenter study of abdominal wall reconstruction with sutures only, or with surgical mesh--results of a five-years follow-up].
Wéber, György; Baracs, József; Horváth, Ors Péter
There are several well-known procedures to treat abdominal wall hernias, but the results are quite controversial. The aim of study was to compare the results of different surgical modalities - mesh (onlay vs. sublay position) and suture repair - in the treatment of abdominal wall hernias. A five-year randomized, multicentric, internet-based, clinical trial was started in 2002. 953 patients were included in the study and divided into two groups according to the size of hernia orifice. In group 'A' ( n = 494) the surface of hernia orifice was between 5-25 cm 2 (small hernia), and in group 'B' ( n = 459) it was above 25 cm 2 (large hernia). Patients of these two groups were randomized according to surgery: group 'A' (suture vs. mesh) and in group 'B' (mesh in onlay vs. sublay position). In group 'A' suture repair was performed in 247, and sublay mesh implantation in 247 cases. In group 'B' sublay ( n = 235) and onlay ( n = 224) mesh reconstruction was performed. The patients were followed-up for five years. 734 patients - 77% of all randomized cases - have completed the study. In the small hernia group significantly ( p suture repair ( n = 50-27%) than in mesh repair ( n = 15-8%). In the large hernia group onlay mesh reconstruction provided significantly better ( p suture repair. In case of large hernias the recurrence rate is higher after sublay reconstruction. The randomized trial was registered on www.ClinicalTrials.gov - ID number: NCT01018524.
Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO): study protocol for a randomized controlled trial.
Mihaljevic, André L; Michalski, Christoph W; Erkan, Mert; Reiser-Erkan, Carolin; Jäger, Carsten; Schuster, Tibor; Schuhmacher, Christoph; Kleeff, Jörg; Friess, Helmut
Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided) and sample size (n = 258 per group) is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance.
Zahra Pourmoghaddas; Hossein Saneian; Hamidreza Roohafza; Ali Gholamrezaei
We evaluated the effectiveness of an antispasmodic, mebeverine, in the treatment of childhood functional abdominal pain (FAP). Children with FAP (n = 115, aged 6–18 years) received mebeverine (135 mg, twice daily) or placebo for 4 weeks. Response was defined as ≥2 point reduction in the 6-point pain scale or “no pain.” Physician-rated global severity was also evaluated. Patients were followed up for 12 weeks. Eighty-seven patients completed the trial (44 with mebeverine). Per-protocol and int...
Full Text Available History of present illness: A 69-year-old male with poorly controlled hypertension presented with 1 hour of severe low back pain that radiated to his abdomen. The patient was tachycardic and had an initial blood pressure of 70/40. He had a rigid and severely tender abdomen. The patient’s history of hypertension, abnormal vital signs, severity and location of his pain were suspicious for a ruptured abdominal aortic aneurysm (AAA. Therefore, a computed tomography angiogram (CTA was ordered. Significant findings: CTA demonstrated a ruptured 7.4 cm infrarenal abdominal aortic aneurysm with a large left retroperitoneal hematoma. Discussion: True abdominal aortic aneurysm is defined as at least a 3cm dilatation of all three layers of the arterial wall of the abdominal aorta.1 An estimated 15,000 people die per year in the US of this condition.2 Risk factors for AAA include males older than 65, tobacco use, and hypertension.1,3,4 There are also congenital, mechanical, traumatic, inflammatory, and infectious causes of AAA.3 Rupture is often the first manifestation of the disease. The classic triad of abdominal pain, pulsatile mass, and hypotension is seen in only 50% of ruptured AAAs.5 Pain (abdominal, groin, or back is the most common symptom. The most common misdiagnoses of ruptured AAAs are renal colic, diverticulitis, and gastrointestinal hemorrhage.6 Bedside ultrasonography is the fastest way to detect this condition and is nearly 100% sensitive.1 One study showed that bedside ultrasounds performed by emergency physicians had a sensitivity of .94 [95% CI = .86-1.0] and specificity of 1 [95% CI = .98-1.0] for detecting AAAs.7 CTA has excellent sensitivity (approximately 100% and yields the added benefit of facilitating surgical planning and management.1 Without surgical treatment, a ruptured AAA is almost uniformly fatal, and 50% of those who undergo surgery do not survive.1 Early resuscitation and coordination with vascular surgery should be
Heiselman, Jon S.; Collins, Jarrod A.; Clements, Logan W.; Weis, Jared A.; Simpson, Amber L.; Geevarghese, Sunil K.; Jarnagin, William R.; Miga, Michael I.
In order to rigorously validate techniques for image-guided liver surgery (IGLS), an accurate mock representation of the intraoperative surgical scene with quantifiable localization of subsurface targets would be highly desirable. However, many attempts to reproduce the laparoscopic environment have encountered limited success due to neglect of several crucial design aspects. The laparoscopic setting is complicated by factors such as gas insufflation of the abdomen, changes in patient orientation, incomplete organ mobilization from ligaments, and limited access to organ surface data. The ability to accurately represent the influences of anatomical changes and procedural limitations is critical for appropriate evaluation of IGLS methodologies such as registration and deformation correction. However, these influences have not yet been comprehensively integrated into a platform usable for assessment of methods in laparoscopic IGLS. In this work, a mock laparoscopic liver simulator was created with realistic ligamenture to emulate the complexities of this constrained surgical environment for the realization of laparoscopic IGLS. The mock surgical system reproduces an insufflated abdominal cavity with dissectible ligaments, variable levels of incline matching intraoperative patient positioning, and port locations in accordance with surgical protocol. True positions of targets embedded in a tissue-mimicking phantom are measured from CT images. Using this setup, image-to-physical registration accuracy was evaluated for simulations of laparoscopic right and left lobe mobilization to assess rigid registration performance under more realistic laparoscopic conditions. Preliminary results suggest that non-rigid organ deformations and the region of organ surface data collected affect the ability to attain highly accurate registrations in laparoscopic applications.
Moesgaard, F; Jensen, L S; Christiansen, P M
AND TREATMENT: One hundred and ninety-four consecutive patients undergoing acute colorectal surgery for perforated and/or obstructed large bowel were randomized in a double-blind fashion to receive ranitidine 100 mg i.v. twice a day commencing at induction of anesthesia and continued for five days (group I...... patients were withdrawn from the study (for reasons such as other diagnosis, refused to continue, medication not given as prescribed). MAIN OUTCOME MEASURES: Patients were observed for signs of infectious complications; such as wound infection, intra-abdominal abscess, septicemia, and pneumonia. RESULTS...
Full Text Available Aims: To study the effect of oral gabapentin used as preemptive analgesia to attenuate post operative pain in patients undergoing abdominal surgery under general anesthesia. Materials and Methods: In a randomized double blind study, 60 patients were divided into two groups. Group A received 600mg gabapentin and group B oral received placebo 1 h prior to surgery. Anesthesia was induced with Propofol 2 mg/kg and Vecuronium 0.1mg/kg and maintained with 60% N 2 O in O 2 and Vecuronium 0.02 mg/kg. All cases were given Fentanyl 2μg/kg as pre-medication and a repeat dose 1μg/kg at the end of the first hour. Assessment of post-operative pain was made with the visual analog score (VAS at extubation (0 h, 2, 4, 6, 12, and 24 h post-operatively. Post-operative analgesia was provided with intravenous Tramadol. The first dose was given in the Post Anesthesia Care Unit as 2mg/kg, and repeated at 8 and 16 h. Rescue analgesia was given with Diclofenac 1.5mg/kg, slow intravenous. The number of doses of rescue analgesia in both the groups was noted. Results: The VAS scores at 0, 2, 4, 6, 12, and 24 h were 1.9 vs. 2.4 (P=0.002, 2.3 vs. 3.0 (P=0.000, 3.2 vs. 3.7 (P=0.006, 2.9 vs. 4.4 (P=0.000, 3.6 vs. 4.6 (P=0.000, and 3.7 vs.4.6 (P=0.000, respectively. Numbers of patients requiring rescue analgesia with Diclofenac were 3 vs. 14 (P=0.004. Conclusion: A single oral dose of gabapentin given pre-operatively enhanced the analgesic effect of Tramadol as it also reduced the requirement of rescue analgesia with Diclofenac.
Conclusions: The early removal of an indwelling catheter after surgery was not associated with an increased rate of febrile events, UTI. Pain perception was also lower in early removal group. Although need of recatheterization was higher in early removal group, but not statistically significant.
Cruise, A. S.; Amonoo-Kuofi, K.; Srouji, I.; Kanagalingam, J.; Georgalas, C.; Patel, N. N.; Badia, L.; Lund, V. J.
OBJECTIVES: To compare Telfa with the Rapid Rhino Riemann nasal pack for use following endoscopic sinus surgery. DESIGN: Prospective, randomized, double-blind, paired trial. SETTING: Tertiary otolaryngology hospital. PARTICIPANTS: Forty-five adult patients undergoing bilateral endoscopic sinus
Amirkazem, Vejdan Seyyed; Malihe, Khosravi
Spleen is the most common organ damaged in cases of blunt abdominal trauma and splenectomy and splenorrhaphy are the main surgical procedures that are used in surgical treatment of such cases. In routine open splenectomy cases, after laparotomy, application of sutures in splenic vasculature is the most widely used procedure to cease the bleeding. This clinical trial evaluates the role and benefits of the Ligasure™ system in traumatic splenectomy without using any suture materials and compares the result with conventional method of splenectomy. After making decision for splenectomy secondary to a blunt abdominal trauma, patients in control group (39) underwent splenectomy using conventional method with silk suture ligation of splenic vasculature. In the interventional group (41) a Ligasure™ vascular sealing system was used for ligating of the splenic vein and artery. The results of operation time, volume of intra-operation bleeding and post-operative complications were compared in both groups. The mean operation times in control and interventional group were 21 and 12 min respectively (p splenectomy was 280 cc, but in the interventional group decreased significantly to 80 ml (p splenectomy not only can decrease the operation time but also can decrease the volume of bleeding during operation without any additional increase in post-operative complications. This method is recommendable in traumatic splenic injuries that require splenectomy in order to control the bleeding as opposed to use of traditional silk sutures. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel; Waldau, Tina; Møller, Ann Merete; Rosenberg, Jacob; Møller, Morten Hylander; Nystrup, Kristin Brønnum; Esbensen, Bente Appel
To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. Emergency abdominal surgery is common, but little is known about how patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating postoperative intermediate care after emergency abdominal surgery, the InCare trial. A qualitative study with individual semi-structured interviews. We analysed interviews using Systematic Text Condensation. Eighteen patients (nine intervention/nine controls) were strategically sampled from the InCare trial. Data analysis resulted in three distinct descriptions of intermediate care; two of standard surgical ward care. Intermediate care was described as 'luxury service' or 'a life saver.' The latter description was prevalent among patients with a perceived complicated disease course. Intermediate care patients felt constrained by continuous monitoring of vital signs as they recovered from surgery. Standard surgical ward care was described as either 'ok - no more, no less' or 'suboptimal'. Experiencing suboptimal care was related to patient perceptions of heavy staff workloads, lack of staff availability and subsequent concerns about the quality of care. Postoperative intermediate care enhanced perceptions of quality of care, specifically in patients with a perceived complicated disease course. Patients were eager to contribute actively to their recovery; however, intermediate care patients felt hindered in doing so by continuous monitoring of vital signs. Intermediate care may increase patient perceptions of quality and safety of care. © 2014 John Wiley & Sons Ltd.
Full Text Available Ovarian cancer remains one of the most aggressive gynecologic malignancies with high capacity to recur even in cases submitted to surgery with curative intent. However, even in these cases the best therapeutic option in order to achieve a good control of the disease remains radical surgery. We present the case of a 65-year-old patient diagnosed submitted to surgery for stage IIIC ovarian cancer five years before. At two years follow up she was diagnosed with an isolated recurrence at the level of the hepatic pedicle which was successfully removed. At 18 months follow up she was diagnosed with a large recurrence in the left superior abdominal quadrant and a liver metastasis which were resected. At 18 months follow up she is free of recurrent disease.
Vierhout, Bastiaan P.; Ott, Alewijn; Reijnen, Michel M. P. J.; Oskam, Jacques; Ott, Alewijn; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.
Background: Surgical site infections (SSI) after vascular surgery are related to substantial morbidity. Restriction of bacterial access to the site of surgery with a cyanoacrylate sealant is a new concept. We performed a randomized clinical trial to assess the effect of the sealing of skin with a
AWARD NUMBER: W81XWH-15-2-0030 TITLE: Robotic Surgery Readiness (RSR): A Prospective Randomized Skills Decay Recognition and Prevention Study...20164. TITLE AND SUBTITLE Robotic Surgery Readiness (RSR): A Prospective Randomized Skills Decay 5a. CONTRACT NUMBER R ognition and Prevention Study...design and skill decay model construction. Supply purchasing and acquisition for all four sites was also completed during this period. Working with
Hasselager, Rune; Gögenur, Ismail
PURPOSE: Risk stratification of patients prior to surgery is important for reduction of postoperative morbidity and mortality. The frailty concept has been put forward as a good predictor of surgical outcomes. Sarcopenia (depletion of muscle mass) can be used to measure frailty. We aimed to syste......PURPOSE: Risk stratification of patients prior to surgery is important for reduction of postoperative morbidity and mortality. The frailty concept has been put forward as a good predictor of surgical outcomes. Sarcopenia (depletion of muscle mass) can be used to measure frailty. We aimed...
Shulman, Robert J; Hollister, Emily B; Cain, Kevin; Czyzewski, Danita I; Self, Mariella M; Weidler, Erica M; Devaraj, Sridevi; Luna, Ruth Ann; Versalovic, James; Heitkemper, Margaret
We sought to determine the efficacy of psyllium fiber treatment on abdominal pain and stool patterns in children with irritable bowel syndrome (IBS). We evaluated effects on breath hydrogen and methane production, gut permeability, and microbiome composition. We also investigated whether psychological characteristics of children or parents affected the response to treatment. We performed a randomized, double-blind trial of 103 children (mean age, 13 ± 3 y) with IBS seen at primary or tertiary care settings. After 2 weeks on their habitual diet, children began an 8-day diet excluding carbohydrates thought to cause symptoms of IBS. Children with ≥75% improvement in abdominal pain were excluded (n = 17). Children were assigned randomly to groups given psyllium (n = 37) or placebo (maltodextrin, n = 47) for 6 weeks. Two-week pain and stool diaries were compared at baseline and during the final 2 weeks of treatment. We assessed breath hydrogen and methane production, intestinal permeability, and the composition of the microbiome before and after administration of psyllium or placebo. Psychological characteristics of children were measured at baseline. Children in the psyllium group had a greater reduction in the mean number of pain episodes than children in the placebo group (mean reduction of 8.2 ± 1.2 after receiving psyllium vs mean reduction of 4.1 ± 1.3 after receiving placebo; P = .03); the level of pain intensity did not differ between the groups. Psychological characteristics were not associated with response. At the end of the study period, the percentage of stools that were normal (Bristol scale scores, 3-5), breath hydrogen or methane production, intestinal permeability, and microbiome composition were similar between groups. Psyllium fiber reduced the number of abdominal pain episodes in children with IBS, independent of psychological factors. Psyllium did not alter breath hydrogen or methane production, gut permeability, or microbiome composition
Full Text Available A classification of intraoperative cardio-vascular complications (CVC was performed, based on data from 466 patients subjected to emergency surgery, due to severe abdominal surgical diseases or traumas, in accordance with the severe criteria of ACC/AHA for CVC in noncardiac surgery. There were 370 intraoperative CVC registered, distributed as follows: groups with low risk (148, moderate risk (200, and high risk (22. Patient groups were formed, according to the CVC risk level, during the intraoperative period, for which the determinant factor for the group distribution of patients was the complication with the highest risk. Individual data was collected for each patient, based on 65 indices: age, physical status, diseases, surgical interventions, anaesthesiological information, intra and postoperative cardio-vascular complications, disease outcome, causes of death, cardiovascular disease anamnesis, anamnesis of all other nonsurgical diseases present, laboratory results, results from all imaging and instrumental examinations, etc. On the basis of these indices, a new distribution of the risk factors was implemented, into groups with different levels of risk of CVC during intraoperative period. This result is a solid argument, substantiating the proposal to introduce these adjustments for determining the severity of CVC in the specific conditions of emergency abdominal surgery.
Vaajoki, Anne; Kankkunen, Päivi; Pietilä, Anna-Maija; Vehviläinen-Julkunen, Katri
Contradictory results have been presented on how music listening affects patients' blood pressure, heart rate, and respiratory rate. The aim of the present study was to evaluate the effects of music listening on blood pressure, heart rate, and respiratory rate on operation day, and on the first, second, and third postoperative days in abdominal surgery patients. Using a quasi-experimental pretest-post-test design, 168 abdominal surgery patients were assigned every second week to the music group (n=83) or to the control group (n=85) for 25 months. In the music group, the respiratory rate was significantly lower after intervention on both the first and second postoperative days compared with the control group. A significant reduction in systolic blood pressure was demonstrated in the group that received music compared with the control group on both the first and second postoperative days. Evaluation of the long-term effects of music on physiological factors showed that the respiratory rate in the music group was significantly lower compared with the control group. Nurses should offer music listening to surgery patients because of its potential benefit. © 2011 Blackwell Publishing Asia Pty Ltd.
Pourmoghaddas, Zahra; Saneian, Hossein; Roohafza, Hamidreza; Gholamrezaei, Ali
We evaluated the effectiveness of an antispasmodic, mebeverine, in the treatment of childhood functional abdominal pain (FAP). Children with FAP (n = 115, aged 6-18 years) received mebeverine (135 mg, twice daily) or placebo for 4 weeks. Response was defined as ≥ 2 point reduction in the 6-point pain scale or "no pain." Physician-rated global severity was also evaluated. Patients were followed up for 12 weeks. Eighty-seven patients completed the trial (44 with mebeverine). Per-protocol and intention-to-treat (ITT) analyses were conducted. Treatment response rate in the mebeverine and placebo groups based on per-protocol [ITT] analysis was 54.5% [40.6%] and 39.5% [30.3%] at week 4 (P = 0.117 [0.469]) and 72.7% [54.2%] and 53.4% [41.0] at week 12, respectively (P = 0.0503 [0.416]). There was no significant difference between the two groups in change of the physician-rated global severity score after 4 weeks (P = 0.723) or after 12 weeks (P = 0.870) in per-protocol analysis; the same results were obtained in ITT analysis. Mebeverine seems to be effective in the treatment of childhood FAP, but our study was not able to show its statistically significant effect over placebo. Further trials with larger sample of patients are warranted.
Full Text Available We evaluated the effectiveness of an antispasmodic, mebeverine, in the treatment of childhood functional abdominal pain (FAP. Children with FAP (n = 115, aged 6–18 years received mebeverine (135 mg, twice daily or placebo for 4 weeks. Response was defined as ≥2 point reduction in the 6-point pain scale or “no pain.” Physician-rated global severity was also evaluated. Patients were followed up for 12 weeks. Eighty-seven patients completed the trial (44 with mebeverine. Per-protocol and intention-to-treat (ITT analyses were conducted. Treatment response rate in the mebeverine and placebo groups based on per-protocol [ITT] analysis was 54.5% [40.6%] and 39.5% [30.3%] at week 4 (P = 0.117 [0.469] and 72.7% [54.2%] and 53.4% [41.0] at week 12, respectively (P = 0.0503 [0.416]. There was no significant difference between the two groups in change of the physician-rated global severity score after 4 weeks (P = 0.723 or after 12 weeks (P = 0.870 in per-protocol analysis; the same results were obtained in ITT analysis. Mebeverine seems to be effective in the treatment of childhood FAP, but our study was not able to show its statistically significant effect over placebo. Further trials with larger sample of patients are warranted.
Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N.
Background Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. Aim To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID
Full Text Available Objective: To assess whether honey can accelerate the wound healing in women undergoing cesarean section. Methods: This was a triple blinded randomized prospective clinical trial. Women with cesarean section were randomly designated as drug (37 cases and placebo (38 cases groups. The drug group