Abdominal Surgical Incision Research Articles

Biomechanical and tissue reaction: the effects of varying sutures size on canine abdominal wall stitching.

Larger diameter sutures can provide sufficient tensile strength to surgical incisions but may exacerbate the inflammatory response caused by the amount of implanted foreign material. This experiment aims to investigate the differences in biomechanical stability and tissue reactivity after suturing canine midline abdominal incisions with different suture sizes. Assessing the biomechanical differences between USP 2-0, 3-0, and 4-0 PGA sutures using uniaxial tensile testing on ex vivo canine midline skin and fascial muscle tissues using either a simple continuous or simple interrupted technique. mRNA and protein expression levels of inflammatory factors were measured through RT-PCR and ELISA. Tissue reactivity was evaluated using a semi-quantitative scoring system. For strains below 30% in skin and below 50% in muscle, there were no significant differences among groups. The results of skin biomechanical testing showed that the USP 4-0 PGA suture group demonstrated significantly lower maximum tensile strength compared to the USP 2-0 PGA or USP 3-0 PGA suture groups. However, it remained capable of providing at least 56.3 N (1.03 MPa) tensile strength for canine skin incisions, matching the tensile strength requirements of general canine abdominal wall surgical incisions. In addition, there were no statistically significant differences observed in the maximum tensile strength among different size of sutures according to the data of biomechanical testing in muscle. Larger diameter sutures led to increased levels of inflammatory factors (IL-1β, IL-6, TNF-ɑ) and tissue reactivity. Simple interrupted sutures caused higher levels of inflammatory factors in muscular tissue compared to simple continuous sutures. USP 4-0 PGA sutures provide sufficient biomechanical stability for suturing canine abdominal skin and linea alba. Suture size significantly influences tissue reactivity after suturing, with smaller gauge sutures reducing early tissue inflammatory response. Thus, USP 4-0 PGA suture has more advantages to suturing canine abdominal surgical incisions.

144. OPTIMIZING MEDIASTINAL ACCESS FOR RADICAL ESOPHAGECTOMY: A BILATERAL CERVICAL AND TRANSHIATAL APPROACH TO RESECT ESOPHAGEAL CANCER

Abstract Background Major medical centers have gradually attempted and promoted esophagectomy via mediastinal approach. However, this operation is challenging and requires a high level of technical proficiency from surgeons because of the limited space and restricted visibility of the mediastinum. The current surgical method limits its application in patients with locally advanced esophageal cancer, which underscores an urgent need for optimization to facilitate its refinement and dissemination. Methods We have implemented the following enhancements to the surgical procedure: 1. The cervical level was chosen for transecting the esophagus, and then the proximal esophageal stump was pulled down and invaginated. 2. Bilateral cervical incisions were made, with a small 0.5 cm incision at the anterior edge of the right sternocleidomastoid muscle. 3. The position of abdominal surgical incisions was adjusted so that all incisions were located on the left side of the abdominal midline. 4. A portion of the left diaphragm was dissected. 5. During the superior mediastinum procedure, gauze was positioned within the expanded superior mediastinum. Results 1. The surgical field was fully exposed, expanding the operative space for upper mediastinal surgery. 2. The difficulty of this surgery was reduced, and it was easier to expose both RLNs and completely remove the mediastinal lymph nodes. 3. The 106recR could be completely removed under endoscopy. 4. The thoracic duct could be fully exposed and freed. 5. During surgery, gauze is placed in the upper mediastinum to aid in hemostasis and improve visibility. 6. Even if the tumor was slightly larger or locally invaded surrounding tissues, it could be completely resected. 7.Complete resection of the esophageal mesorectum was successfully achieved. Conclusion Esophagectomy for esophageal cancer via bilateral cervical and transhiatal approach can achieve radical resection and can be applied to patients with locally advanced esophageal cancer. This surgical method expands the surgical indications, reduces the surgical difficulty for surgeons, and facilitates the promotion and popularization of the mediastinal approach surgery.

175. OPTIMIZING MEDIASTINAL ACCESS FOR RADICAL ESOPHAGECTOMY: A BILATERAL CERVICAL AND TRANSHIATAL APPROACH TO RESECT ESOPHAGEAL CANCER

Abstract Background Major medical centers have gradually attempted and promoted esophagectomy via mediastinal approach. However, this operation is challenging and requires a high level of technical proficiency from surgeons because of the limited space and restricted visibility of the mediastinum. The current surgical method limits its application in patients with locally advanced esophageal cancer, which underscores an urgent need for optimization to facilitate its refinement and dissemination. Methods We have implemented the following enhancements to the surgical procedure: 1. The cervical level was chosen for transecting the esophagus, and then the proximal esophageal stump was pulled down and invaginated. 2. Bilateral cervical incisions were made, with a small 0.5 cm incision at the anterior edge of the right sternocleidomastoid muscle. 3. The position of abdominal surgical incisions was adjusted so that all incisions were located on the left side of the abdominal midline. 4. A portion of the left diaphragm was dissected. 5. During the superior mediastinum procedure, gauze was positioned within the expanded superior mediastinum. Results 1. The surgical field was fully exposed, expanding the operative space for upper mediastinal surgery. 2. The difficulty of this surgery was reduced, and it was easier to expose both RLNs and completely remove the mediastinal lymph nodes. 3. The 106recR could be completely removed under endoscopy. 4. The thoracic duct could be fully exposed and freed. 5. During surgery, gauze is placed in the upper mediastinum to aid in hemostasis and improve visibility. 6. Even if the tumor was slightly larger or locally invaded surrounding tissues, it could be completely resected. 7.Complete resection of the esophageal mesorectum was successfully achieved. Conclusion Esophagectomy for esophageal cancer via bilateral cervical and transhiatal approach can achieve radical resection and can be applied to patients with locally advanced esophageal cancer. This surgical method expands the surgical indications, reduces the surgical difficulty for surgeons, and facilitates the promotion and popularization of the mediastinal approach surgery. Video address: https://www.icloud.com.cn/iclouddrive/085wyZDN6Qqm6Ou06fhOsi-Rw#2023_ISDE_abstract_video

Application of laparoscopic modified Bacon operation in patients with low rectal cancer and analysis of the changes in anal function: A retrospective single-center study.

To investigate the value of modified Bacon operation in patients with low rectal cancer. Retrospective analysis of 60 patients treated with laparoscopic surgery for low rectal cancer in the Department of Colorectal and Anal Surgery, Jingzhou Hospital affiliated to Yangtze University, from 2019 to 2022, divided into observation and control groups based on the method of the operation (laparoscopic modified Bacon operation group and laparoscopic Dixon operation with prophylactic ileostomy group). We compared the variations between the two groups. The length of the abdominal surgical incision was shorter in the observation group than in the control group(P<0.05). In the observation group, the length of hospital stay after the first operation was shorter(P<0.05), the both operations time and the second intraoperative bleeding were less(P<0.05), the DET score at one week after the first operation and the VAS after both operations were fewer than in the control group(P<0.05), the postoperative rate of ischemic necrosis of the exposed bowel was higher(P<0.05), and the anal function was poorer in the short term after the second operation compared with the control group(P<0.05), but there was no significant difference between the anal function at 6 months after the second operation compared with the control group(P>0.05).12 months after the second operation, the anal function has recovered to the preoperative level in the observation group(P>0.05). The laparoscopic modified Bacon operation has smaller abdominal wounds, which reduces postoperative pain; it does not require the use of staplers, which reduces the patient's financial burden; no postoperative anastomotic leakage occurs, and a more satisfactory anal function can be obtained.

Abdominal Orta Hat İnsizyonlarda Elektrokoter ile Bistüri Kullanım Sonuçlarının Karşılaştırılması

Objective: Scalpel is the conventional instrument for laparotomy incisions. Electrocautery, on the other hand, can offer potential advantages such as blood loss, incision time, postoperative pain. In this study, we aimed to compare the clinical results of electrocautery and scalpel in abdominal midline surgical incisions.&#x0D; Method: 146 cases who underwent elective abdominal midline incision between January 2020 – December 2021 were included in the study. The patients were divided into two randomized groups as electrocautery (n: 78) and scalpel (n: 68). The incision dimensions, incision time and blood loss during incision were noted intraoperatively. Postoperative pain and wound infection were recorded.&#x0D; Results: The age and sex distribution was similar in the two groups. Incision time(seconds) in the electrocautery group (35.4±18.1) (57.6±25.3) was significantly shorter compared with the time in the scalpel group(p

Risk Factors and Bacterial Profile of Abdominal Surgical Incisions- Changing Trends

Introduction: Surgical Site Infections (SSIs) remain a significant postoperative complication after abdominal surgeries, even with the advancement of infection control practices. The emergence of drug resistance to routine antibiotics was a challenge to infected wound management. Aim: To analyse the host risk factors and bacterial flora associated with abdominal surgical site infections and to evaluate the changes in the prevalence and antibiotic susceptibility pattern over the years. Materials and Methods: A cross-sectional study was done among 150 abdominal surgery cases admitted to a Government Medical College Thrissur, (referral hospital) in Kerala, India for one year, from September 2010 to August 2011. Host risk factors were analysed by clinical details and preoperative investigations. Samples were collected from the wound site on the third day of surgery using sterile swabs for bacteriological analysis. Repeated samples were taken in case of suspected wound infection to identify the types of pathogen if any. Statistical analysis was done using Microsoft excel and open Epi software. The results were compared with the similar studies conducted in this institution during 2015-2016 and 2016-2017 to know the changes in prevalence and antimicrobial sensitivity. Result: Out of 150 cases higher infection rate was found in patients &gt;60 years 5 (17.2%), emergency surgeries 16 (21.6%), large intestinal surgeries 4 (44.4%), with diabetes 5 (26.32%), patients on steroids and obese 3 (37.5%). Colonisers were present in 34.7% abdominal surgical wounds. Infection rate of 14.7% in abdominal surgeries was reduced to 11.2% and 10% between the years 2015-16 and 2016-17 respectively. Higher infection rate was noticed in patients with premorbid risk factors. When compared with the similar studies conducted in the same institute, Pseudomonas and Acinetobacter with E. coli and S. aureus were found to be most common wound pathogens and resistance to ciprofloxacin and ceftriaxone were increased. Amikacin, piperacillin tazobactam and imipenem were useful but decreasing in sensitivity were noticed. Conclusion: Bacterial colonisation with endogenous flora was the primary source of SSIs. Good infection control practices, early identification of the pathogen and treatment with an appropriate antibiotics can reduce the development of resistant organisms and cross infection. The use of antimicrobials for prophylaxis and treatment needed to be modified according to the antimicrobial sensitivity report and local susceptibility pattern.

The advantage of hyaluronidase in rectus sheath block for pain control in laparoscopic cholecystectomy

ABSTRACT Background: Rectus sheath block (RSB) had been proven to reduce the pain associated with ventral abdominal surgical incisions and laparoscopic surgery. We hypothesized that the addition of hyaluronidase could increase the effectiveness of the (RSB) technique by improving the local anesthetic (LA) spread. Objective of the study: effectiveness of adding the hyaluronidase as an adjuvant to bupivacaine in ultrasound-guided rectus sheath block (RSB) in those patients planning for laparoscopic cholecystectomy (LC). Patients and methods: Eighty patients, their ages range from 20-60 years old, ASA physical statuses I to III, and planning for elective (LC): were assigned in this study and allocated randomly into two equivalent groups. Group (R) had given rectus sheath block with 19 ml of bupivacaine 0.25%+1ml of hyaluronate 1500 IU, and control group (B) received rectus sheath block 19 ml of bupivacaine 0.25%+1ml of normal saline on each side after standardized induction sequence. Results: mean intraoperative fentanyl consumption exhibit a significant decline in Group H (167.75±20.6) compared to Group B (186.25±20.57) p < 0.001. Numerical Rating Score (NRS) was significantly less in the H group than in the B group at 0 hour, 2 hours, 4 hours, 6hours, postoperatively with A significant p-value. There was a significant decrease in the total dose of analgesia in 24hrs (P<0.001) in Group H (55.75±14.66) compared to Group B (82.50±36.57). Conclusion: Preoperative RSB by adding hyaluronidase to bupivacaine reduced the need for analgesia during the intraoperative time and 24 hours postoperatively in patients planning for LC, versus the preoperative RSB without hyaluronidase.

Role of Subcutaneous Negative Suction versus Simple Subcutaneous Drain Closure in Contaminated Abdominal Surgeries in Pediatric Age Group

Introduction: Contaminated abdominal surgical laparotomy incisions and their care are basic principles in the field of surgery. In emergency or trauma laparotomy, the primary surgeon's pivotal role is to optimize the untoward incision wound response, excise or debride viable/nonviable tissues, and alleviate the process of wound healing near to normal function. In contaminated abdominal surgeries, wound contamination is unavoidable that occurs at the time of surgery, and several methods are used to prevent wound complications. Material and Methods: To assess the impact of subcutaneous negative suction versus simple subcutaneous drains on the outcome of surgical wound infection, we conducted an observational study involving patients with contaminated abdominal surgical laparotomy wounds. The study was conducted in the Department of Pediatric Surgery at Liaquat University Hospital Hyderabad. Over five years from January 2015 to December 2020 about 300 patients underwent emergency or trauma laparotomy. Patients were divided into two groups A and B 150 each group by random sampling. Results: In our study, negative suction drain versus simple subcutaneous drain without suction during the closure of the contaminated abdominal surgical wound in emergency or trauma laparotomy, the negative suction drain is highly suggestive to decrease postoperative wound infection, seroma formation, and wound disruption. Compared to a simple subcutaneous drain, the utilization of a subcutaneous suction drain following the closure of the abdominal sheath result in effective wound drainage, reducing the risk of wound infection and disruption. Conclusion: Subcutaneous suction drain has a better outcome as compared with simple subcutaneous without suction in the management of contaminated surgical laparotomy wounds. Keywords: Negative suction drain, simple drain, seroma, wound disruption.

Ultrasound-guided Spinal Needle Localization for Resection of Abdominal Wall Endometrioma

A 47-year-old patient with 2 previous cesarean sections presented with 2 years of right lower quadrant spasm-inducing pain. The pain began with menses and lasted for 15 days each month. Magnetic resonance imaging revealed a 3.3 × 1.9 × 6.0-cm lesion in the medial aspect of the right rectus abdominis muscle, consistent with abdominal wall endometrioma (Fig. 1A). No fascial involvement was identified. At the time of surgery, intraoperative ultrasound was used to map the endometrioma (Fig. 1B). Under ultrasound guidance, the endometrioma borders were marked using 3.5-cm 20 gauge needles through the anterior abdominal wall (Fig. 2). During robotic-assisted excision of the endometrioma, the needles were intermittently advanced and withdrawn from the peritoneal cavity by the bedside assistant to delineate the limits of necessary dissection (Fig. 3). This technique contributed to efficient and complete excision. Postoperatively, the patient reported complete resolution of right lower quadrant pain. Final pathologic evaluation confirmed extensive endometriosis. Abdominal wall endometriosis (AWE) is most often found in previous abdominal surgical incisions. In women undergoing surgical excision of endometriosis, AWE was noted in 1.34% [1Khan Z Zanfagnin V El-Nashar SA Famuyide AO Daftary GS Hopkins MR. Risk factors, clinical presentation, and outcomes for abdominal wall endometriosis.J Minim Invasive Gynecol. 2017; 24: 478-484Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar]. The most common procedure before AWE is cesarean section with a higher risk reported with Pfannenstiel incision vs vertical midline incision [1Khan Z Zanfagnin V El-Nashar SA Famuyide AO Daftary GS Hopkins MR. Risk factors, clinical presentation, and outcomes for abdominal wall endometriosis.J Minim Invasive Gynecol. 2017; 24: 478-484Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 2Horton JD Dezee KJ Ahnfeldt EP Wagner M. Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases.Am J Surg. 2008; 196: 207-212Abstract Full Text Full Text PDF PubMed Scopus (184) Google Scholar, 3Zhang P Sun Y Zhang C et al.Cesarean scar endometriosis: presentation of 198 cases and literature review.BMC Womens Health. 2019; 19: 14Crossref PubMed Scopus (23) Google Scholar]. Cesarean scar endometriosis is likely secondary to direct implantation of endometrial tissue in the incision [2Horton JD Dezee KJ Ahnfeldt EP Wagner M. Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases.Am J Surg. 2008; 196: 207-212Abstract Full Text Full Text PDF PubMed Scopus (184) Google Scholar]. Surgical excision allows pathologic evaluation and therapeutic resection [4Karapolat B Kucuk H. A rare cause of abdominal pain: scar endometriosis.Emerg Med Int. 2019; 20192584652Crossref PubMed Google Scholar,5Behbehani S Magtibay P Chen L Wasson M. Clear cell carcinoma of the anterior abdominal wall secondary to iatrogenic endometriosis.J Minim Invasive Gynecol. 2020; 27: 1230-1231Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. Excision is often planned with preoperative ultrasound or magnetic resonance imaging. Previously reported surgical approaches to AWE include ablative techniques such as percutaneous cryoablation or ethanol injection [6Welch BT Ehman EC VanBuren WM et al.Percutaneous cryoablation of abdominal wall endometriosis: the Mayo Clinic approach.Abdom Radiol (NY). 2020; 45: 1813-1817Crossref PubMed Scopus (6) Google Scholar]. If AWE involves the fascia, surgical excision can still be performed by a minimally invasive approach with endoscopic mesh placement and fascial repair by general surgery. Intraoperative techniques to assist with excision include injecting the lesion with methylene blue or ultrasound-guided wire localization [7Lee MMH Robson NK Carpenter TT. Ultrasound-guided wired localisation for resection of impalpable anterior abdominal wall scar endometriomas.Gynecol Surg. 2012; 9: 103-105Crossref Scopus (2) Google Scholar,8Takmaz T Kiran G Ozcan P Sahin N Tanoglu B. Total surgical excision by ultrasound–guided wire localization for spontaneous abdominal-wall endometriosis.J Gynecol Surg. 2020; 36: 76-79Crossref Scopus (1) Google Scholar]. Ultrasound-guided localization with spinal needles is a simple, practical technique that can assist with complete excision of abdominal wall endometriomas.

Serratus intercostal interfascial plane block in supraumbilical surgery: a prospective randomized comparison.

Upper abdominal wall surgical incisions may lead to a severe postoperative pain. Therefore, adequate analgesia is important. Here we investigate whether the low serratus-intercostal interfascial plane block (SIPB) achieves an effective analgesia, considering opioids consumption, pain control and recovery quality in upper abdominal surgeries. This blinded, randomized controlled study was conducted on 102 patients undergoing open upper abdominal wall surgery under general anesthesia. All patients who received serratus-intercostal plane block at the eighth rib as analgesic technique were included in SIPB group and in control group those who received continuous intravenous morphine analgesia. Pain scores in numeric verbal scale (NVS) and opioids consumption at 0, 6, 12, 24 and 48 hours postoperatively were assessed. The quality of the postoperative recovery was evaluated using the QoR-15 questionnaire at 24 hours. This study showed lower postoperative opioid consumption at 24 hours (P<0.0001; 4.17 mg vs. 41.52 mg of morphine) and better pain control (P<0.005) with mean pain scores (NVS 1.8±1.5 vs. 4.8±1.6) in group 0 (SIPB). The global QoR-15 scores 24 hours postoperatively were higher (better quality) in the SIPB group (122 vs. 100). The low serratus-intercostal interfascial plane block (SIPB) provides efficient analgesia leading to a saving of opioids and improvement of the recovery quality in patients undergoing upper abdominal wall surgeries.

Precision functional sphincter-preserving surgery (PPS) for ultralow rectal cancer: a natural orifice specimen extraction (NOSE) surgery technique.

In patients with ultralow rectal cancer, surgical resection of the tumor without impairing sphincter function remains a technical challenge. The purpose of this study was to describe a new technique of transanal natural orifice specimen extraction (NOSE) surgery using our independently developed devices, aiming to achieve precise cancer resection and preserve sphincter function in patients with ultralow rectal cancer. Precision functional sphincter-preserving surgery (PPS) was performed on nineteen patients with ultralow rectal cancer between June 2019 and April 2020. With the help of our independently developed devices, surgeons directly and accurately removed the lower edge of the tumor and retained healthy rectal tissue on the nontumorous side. Hand-sewn anastomosis with a mattress suture was used to achieve sturdy anastomosis. Preoperative baseline characteristics, operative details, 90-day postoperative complications, costs, and analfunctionscore at 6 months after surgery were documented. Nineteen ultralow rectal cancer patients with a median distance to the dentate line of 2.0 cm successfully underwent PPS without serious postoperative complications. Six out of nineteen patients (31.6%) received a prophylactic stoma. The average cost was 62164.1 yuan. At 6 months after surgery, the average Wexner anal function score and the average Vaizey score were both 3 points. PPS can be employed to precisely resect rectal tumors and preserve sphincter function in ultralow rectal cancer patients. The use of our devices enhanced surgical efficiency, reduced the need for prophylactic stoma, reduced surgery-related costs, and prevented abdominal surgical incisions.

Intrathecal baclofen pump replacements under local anaesthetic: rapid pathway implementation under COVID-19

Intrathecal baclofen pump replacements under local anaesthetic: rapid pathway implementation under COVID-19

Comparison of efficacy of thoracic paravertebral block with oblique subcostal transversus abdominis plane block in open cholecystectomy.

Background and Aims:Sensory afferent nerve branches of lower six thoracic and upper lumbar nerves innervate the anterior abdominal wall and are the therapeutic focus of local anesthetics to provide analgesia for the abdominal surgical incision. Central neuraxial and regional analgesia can provide better control of pain due to right subcostal incision used in open cholecystectomy and attenuate the need for opioids. The earlier studies which showed the benefit of the thoracic paravertebral block (TPVB) for analgesia after upper abdominal surgeries did not compare TPVB with oblique subcostal transversus abdominis plane (OSTAP) block. Therefore, the current study compares the analgesic efficacy of TPVB and OSTAP block in open cholecystectomy.Material and Methods:Seventy consenting adults scheduled for open cholecystectomy were allocated to one of the two groups: ultrasound-guided TPVB (Group I) and ultrasound-guided OSTAP block (Group II). The primary objective of this study is to assess and compare tramadol consumption in 48 h in both the groups along with VAS in post anesthesia care unit, and then at 2, 4, 6, 8, 12, 24, and 48 h. The secondary objective of the study is to assess the incidence of PONV.Results:The number of doses of rescue analgesia required was less in Group I when compared with Group II (P < 0.001). Patients in Group I had significantly lower pain scores than Group II. Although in the initial 8 h, both groups had comparable pain scores, after 8 h, these scores were significantly lower in patients in Group I. Less postoperative nausea and vomiting was seen in Group I patients (11.7%) in comparison to Group II (18.1%).Conclusion:Ultrasound-guided TPVB is superior to OSTAP block because of its association with decreased postoperative opioid consumption, lower VAS score, and reduction in opioid-related side effects. Thus, it should be strongly considered as a part of multimodal analgesia regimen in upper abdominal surgeries.

Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study

BackgroundPostoperative pulmonary complications (PPCs) contribute significantly to overall postoperative morbidity and mortality. In abdominal surgery, PPCs remain frequent. The study aimed to analyze the profile and outcomes of PPCs in patients submitted to abdominal surgery and admitted in a Portuguese polyvalent intensive care unit.MethodsFrom January to December 2017 in the polyvalent intensive care unit of Hospital Garcia de Orta, Almada, Portugal, we conducted a retrospective, observational study of inpatients submitted to urgent or elective abdominal surgery who had severe PPCs. We evaluated the perioperative risk factors and associated mortality. Logistic regression was performed to find which perioperative risk factors were most important in the occurrence of PPCs.ResultsSixty patients (75% male) with a median age of 64.5 [47–81] years who were submitted to urgent or elective abdominal surgery were included in the analysis. Thirty-six patients (60%) developed PPCs within 48 h and twenty-four developed PPCs after 48 h. Pneumonia was the most frequent PPC in this sample. In this cohort, 48 patients developed acute respiratory failure and needed mechanical ventilation. In the emergency setting, peritonitis had the highest rate of PPCs. Electively operated patients who developed PPCs were mostly carriers of digestive malignancies. Thirty-day mortality was 21.7%. The risk of PPCs development in the first 48 h was related to the need for neuromuscular blocking drugs several times during surgery and preoperative abnormal arterial blood gases. Median abdominal surgical incision, long surgery duration, and high body mass index were associated with PPCs that occurred more than 48 h after surgery. The American Society of Anesthesiologists physical status score 4 and COPD/Asthma determined less mechanical ventilation needs since they were preoperatively optimized. Malnutrition (low albumin) before surgery was associated with 30-day mortality.ConclusionPPCs after abdominal surgery are still a major problem since they have profound effects on outcomes. Our results suggest that programs before surgery, involve preoperative lifestyle changes, such as nutritional supplementation, exercise, stress reduction, and smoking cessation, were an effective strategy in mitigating postoperative complications by decreasing mortality.

P206 EVALUATION OF PREEMPTIVE MULTIMODAL ANALGESIA IN IVOR LEWIS ESOPHAGECTOMY

Abstract Aim of the study is the evaluation of preemptive multimodal analgesia vs established technique of single epidural, in Ivor Lewis esophagectomy, perioperatively. Background &amp; Methods In a randomized prospective trial, 25 patients were randomly assigned to two groups (A=12: preemptive multimodal analgesia, and B=13: epidural analgesia) after informed consent. Patients with coagulative disorders, and renal or hepatic impairment were excluded from study. In all patients a thoracic epidural (T5 – T7) was placed before anesthesia induction. Anesthetic protocol was the same, according body weight, in both groups, apart from analgesic drugs. Group A patients received morphine 1.5-3mg and ropivacaine 0.25% 10-12 ml epidurally (ed), and paracetamol 1gr, parecoxib 40mg, clonidine 150mcg, dexamethasone 8mg, lidocaine 1mg/kg, and magnesium sulfate 25% 10 ml iv, at least 20 min before surgical incision, while in group B same doses of ed morphine and ropivacaine were administered post-incision and iv paracetamol and parecoxib were administered 1hr before end of surgery. Surgical incision infiltration in both wounds with ropivacaine 0.375% 20ml was performed jn both groups’ patients. Intraoperative opioid doses were titrated accordingly. Analgesic needs intra- and postoperatively, as well as vital signs stability and side effects such as postoperative nausea or vomiting (PONV), dizziness, sleepiness, and respiratory suppression were recorded. Results Group A patients received significantly lower opioid doses intraoperatively (p&lt;0.001), 2 (17%) of them did not need extra opioids at all, and in 8 (67%), operation was completed with only one low dose of fentanyl (2-3mcg/kg) before abdominal surgical incision. Group A patients had stable heart rate (HR) and blood pressure (BP) during whole operation, while 11 (84.6%) from group B (p&lt;0.001) demonstrated HR and BP raising in certain surgical times. All both groups’ patients were transferred to ICU awake. 5 (38.46%) group B patients (p&gt;0.005) required rescue amalgesic post-awakening. None of both groups’patients demonstrated any drugs’ side effects. Conclusion Preemptive multimodal analgesia seems to be more efficient, reducing needs for opioids intraoperatively, rescue analgesics postoperatively and providing better hemodynamic stability, than single epidural. Further studies are needed to support this conclusion.

Secondary Versus Tertiary Wound Closure in High Risk Gynecologic Abdominal Surgical Incisions

Secondary Versus Tertiary Wound Closure in High Risk Gynecologic Abdominal Surgical Incisions

Scar endometriosis: A case report and literature review

Introduction:Surgical scar endometrioma is defined as the presence of an endometrial tissue near or inside an abdominal surgical incision. This is a rare clinical event that can occur in women after gynecological or obstetric surgery, with a global prevalence estimated at 0.01%–1%. The most prevalent clinical feature includes a painful mass with a cyclic pain that exacerbates with menstruation. The aim of this work is to facilitate the identification and support the diagnosis of abdominal wall endometrioma associated with the cesarean section scar, with basis on a case study of a tumor in the cesarean surgical scar of a patient who also complains of dyspareunia and menorrhagia.Case report:A 43-year-old female patient, G4PC4A0, with a single, rounded and painful subcutaneous nodule in the right inguinal region, on the cesarean section scar, which had progressively grown for two years. Patient also reported increased nodule size during menstrual period, associated with pain and menorrhagia. In February 2016, a surgical procedure was performed and by the post-surgical evaluation, the patient had already presented a menstrual cycle and reported decrease in symptoms. Biopsy report brought findings compatible with endometriosis.Conclusion:According to the literature, the clinical picture of the patient confirms the suspected endometrioma. The set of signals and symptoms associated with well-specified additional tests allowed an early and efficient diagnosis. The knowledge of the disease and the adoption of these criteria may mean a reduced burden on health services, but mainly, improve the quality of life of patients.

V09-05 SIX-WEEK-OLD INFANT ROBOTIC PYELOPLASTY: KEY POINTS FOR SAFETY AND PROFICIENCY

You have accessJournal of UrologyPediatric Urology1 Apr 2018V09-05 SIX-WEEK-OLD INFANT ROBOTIC PYELOPLASTY: KEY POINTS FOR SAFETY AND PROFICIENCY Maria Veronica Rodriguez, Nimrod Barashi, Joseph Rodriguez, and Mohan S Gundeti Maria Veronica RodriguezMaria Veronica Rodriguez More articles by this author , Nimrod BarashiNimrod Barashi More articles by this author , Joseph RodriguezJoseph Rodriguez More articles by this author , and Mohan S GundetiMohan S Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2177AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteropelvic junction obstruction (UPJO) is one of the most common pediatric urologic congenital anomalies. Anderson-Hynes dismembered pyeloplasty has been the gold standard for the intervention of this pathology. Nowadays, robotic surgery has provided a safe alternative to manage these patients with minimally invasive surgery and, even though the procedure is frequently performed by pediatric urologists across the US, there is still a steep learning curve to perform infant robotic pyeloplasty. We aim to describe a robotic-assisted laparoscopic pyeloplasty in a 6-week-old patient with grade 4 hydronephrosis and UPJO in addition to key technical points for safety and proficiency. METHODS The crucial points are patient positioning, proper port placement; particularly the inferior working ports, given the close proximity to the bladder, instrumentation and docking and the inherent bowel distension that children usually have. We present a robotic pyeloplasty in a 6-week old infant with UPJO. The patient was placed in a lateral position, close to the edge of the table. With an open Hassan technique approach, a 12-mm umbilical camera port and two 8-mm ports were placed in the midline in addition to a 5-mm assistant port that was positioned on the lower midclavicular line. There was a distended bowel, therefore an orogastric tube was placed to improve visualization and avoid bowel injury. The Gerota's fascia was incised and the pelvis was hitched with a subcutaneous suture. Then, the narrow ureteropelvic junction was recognized and the pelvis was transected just below the renal hilum vessels, which was followed by ureter spatulation. Ultimately, the anastomosis of the posterior wall with the spatulated ureter was performed in a continuous fashion and subsequently, a double J stent was placed percutaneously to complete the anterior wall anastomosis. RESULTS The patient tolerated the procedure well and was discharged on postoperative day 2 without any complications. Operative time was 143 minutes and, estimated blood loss was found to be less than 5 mL. The Foley catheter was removed prior to discharge. At 1 month follow-up, the patient had well healed abdominal surgical incisions, the double J stent was removed and, his renal bladder ultrasound scan showed improvement of the hydronephrosis. CONCLUSIONS We emphasize the key points for safety and proficiency when performing a robotic infant pyeloplasty, given our long-term institutional experience doing robotic surgery in such young patients to optimize outcomes and prevent complications. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e904 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Maria Veronica Rodriguez More articles by this author Nimrod Barashi More articles by this author Joseph Rodriguez More articles by this author Mohan S Gundeti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Analysis of related factors of incision infection in abdominal surgical operation

Objective To explore the abdomen surgical incision infection risk factors, and to put forward prevention countermeasures. Methods 1 854 patients with abdominal surgery were selected as subjects.According to whether had surgical incision infection, they were divided into the infection group(76 cases) and the non-infection group(1 778 cases). Single factor analysis and Pearson correlation analysis were used to summarize abdominal surgical incision infection risk factors. Results Single factor analysis results showed that age, BMI, category of incision, operation timing, operation time, diabetes mellitus, drainage tube placement, summer were risk factors for abdominal surgery incision infection (t or χ2=8.925, 5.840, 5.376, 5.445, 5.846, 19.674, 5.846, 19.674, all P<0.05). Pearson correlation analysis showed that age, BMI, category of incision, operation timing, operation time, diabetes mellitus, drainage tube placement and summer surgery were risk factors for abdominal surgery incision infection (r=0.746, 0.689, 0.746, 0.689, 0.691, 0.548, 0.760, 0.548, all P<0.05). Conclusion Abdominal surgery incision infection is associated with many factors.It is necessary for all kinds of risk factors for targeted intervention to reduce incision infection rate. Key words: Surgical Procedures, Operation; Abdomen; Wound infection; Risk factors

Clinical anatomy of the inferior epigastric artery with special relevance to invasive procedures of the anterior abdominal wall.

INTRODUCTION:Injury to the inferior epigastric artery (IEA) has been reported following lower abdominal wall surgical incisions, abdominal peritoneocentesis and trocar placements at laparoscopic port sites, resulting in the formation of abdominal wall haematomas that may expand considerably due to lack of tissue resistance. The aim of this study was to localise its course in relation to standard anatomic landmarks and suggest safe areas for performance of invasive procedures.MATERIALS AND METHODS:Sixty IEAs of 30 adult cadavers (male = 19; female = 11) were dissected and the course of the IEA noted in relation to the mid-inguinal point, anterior superior iliac spine (ASIS) and umbilicus.RESULTS:The mean distance of the IEA from the midline was 4.45 ± 1.42 cm at the level of the mid-inguinal point, 4.10 ± 1.15 cm at the level of ASIS and 4.49 ± 1.15 cm at the level of umbilicus. There was an average of 3.3 branches per IEA with more branches arising from its lateral aspect. The IEA was situated within one-third (32%) of the distance between the midline and the sagittal plane through ASIS at all levels.CONCLUSION:To avoid injury to IEA, trocars can be safely inserted 5.5 cm [mean + 1 standard deviation (SD)] away from the midline (or) slightly more than one-third of the distance between the midline and a sagittal plane running through ASIS. These findings may be useful not only for laparoscopic procedures but also for image-guided biopsy, abdominal paracentesis, and placement of abdominal drains.