Acute Abdominal Surgery Research Articles

Akut Batın Operasyonu ve Ehlers-Danlos Sendromu: Anestezi Yönetimi

Akut Batın Operasyonu ve Ehlers-Danlos Sendromu: Anestezi Yönetimi

Major abdominal surgery in a patient with a metallic heart valve—balancing risks of thromboembolic events and perioperative bleeding

Surgical patients with mechanical valves are challenging, as their need for anticoagulation to reduce thromboembolic events is weighed against the risk for postoperative hemorrhage. Timing and bridging method for anticoagulation presents a great challenge for the surgeon. There is no protocol and consensus to our knowledge of managing acute major abdominal surgery in patients with metallic valves. We share our experience and review the current literature on this topic.

Laparoscopic Acute Care Surgery in Liver Disease: A Regression Analysis of the Nationwide Inpatient Sample

Introduction: Patients with liver disease are being more frequently undergoing urgent and emergent surgery. There is sparse literature comparing outcomes based on modality of surgery (laparoscopic versus open) in this important cohort of patients. Our study examines surgical outcomes by liver disease status and surgical modality in acute care surgery setting. Methods: This is a retrospective cohort study of patients undergoing acute care abdominal surgery between 2006 and 2010 extracted from the National Inpatient Sample database. Surgical outcomes examined were in-hospital mortality, surgical, and medical complications, length of stay, and total hospital charges. Sequential multivariable generalized linear regression models were used to compare the outcomes across surgical modality and type of liver disease. Results: Unadjusted and adjusted analyses revealed that laparoscopic surgery was associated with marked reduction in mortality (92%) and surgical complications (86%) compared to open surgery, as well as a moderate yet significant reduction (60%) for medical complications, length of stay and total hospital charges. Patients with cirrhotic liver disease fared worse compared to those with non-cirrhotic and no liver disease, as expected. Conclusion: Laparoscopic surgery provides a feasible alternative for patients with liver disease undergoing acute care surgery. You can submit your Manuscripts at: https://symbiosisonlinepublishing.com/submitManuscript.php

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

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. 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-dose antibiotics, surgery within 6 h, perioperative stroke volume-guided haemodynamic optimization, intermediate level of care for the first 24 h after surgery, standardized analgesic treatment, early postoperative ambulation and early enteral nutrition. The primary outcome was 30-day mortality. Six hundred patients were included in the study and compared with 600 historical controls. The unadjusted 30-day mortality rate was 21·8 per cent in the control cohort compared with 15·5 per cent in the intervention cohort (P = 0·005). The 180-day mortality rates were 29·5 and 22·2 per cent respectively (P = 0·004). The introduction of a multidisciplinary perioperative protocol was associated with a significant reduction in postoperative mortality in patients undergoing AHA surgery. NCT01899885 (http://www.clinicaltrials.gov).

Morbidity and mortality rates after emergency abdominal surgery: an analysis of 4346 patients scheduled for emergency laparotomy or laparoscopy

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. 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. A total of 4,346 patients underwent emergency surgery, of whom 14% had surgical complications and 23% medical complications. The overall 30-day mortality was 8% with 50% of those in this group over 80years of age. The 30-day mortality rates were 0.8% (95% CI 0.5-1.1) and 17% (95% CI 15.5-18.9), respectively, for the laparoscopy and the laparotomy groups. The overall death rate within 24h of surgery was 21%. Several risk factors for 30- and 90-day mortality were identified: age, ASA ≥3 (American Society of Anaesthesiologists physical status classification), performance score (Zubroed/WHOclassification), cirrhosis of the liver, chronic nephropathy, several medical conditions, and malignancy. Almost one in five patients died after emergency laparotomy, of whom one in five died within 24h of surgery. Predictors for poor outcome were identified.

Elder-friendly Approaches To The Surgical Environment

Current hospital procedures are based around cautious exercise prescriptions, especially in the frail elderly population. While activity restrictions are placed for patient safety, there is currently no consensus on the level of restriction necessary or what activities should be restricted in the frail surgical patient. Exercise is a key component to a healthy lifestyle and is recognized in its role in managing symptoms and reducing the functional decline in aging. Therefore, it should be administered as a component of the treatment plan in order to reduce the muscular atrophy that occurs upon the stress of surgery and hospitalization in the elderly. PURPOSE: To compare the functional status of elderly abdominal surgery patients post surgery and to determine how a regularly performed reconditioning program will affect the functional decline associated with bed rest. METHODS: 30 patients over the age of 65 performed 30-Second Sit-To-Stands (STS) on day 2 post-operation (POD2) and immediately prior to discharge in our control group. The intervention group will receive the reconditioning program and will perform the exercises between the two STS trials. Patients are prescribed exercise programs based on frailty level upon hospital admission. RESULTS: The STS data from the control group demonstrates that only 4 of the 30 patients were able to achieve the STS score required for independent living, despite the majority of patients discharged home without support of additional medical care. Results for the intervention group are currently being analyzed. CONCLUSION: Current surgical bed rest practices may be exacerbating the functional decline in our elderly surgical patients. Patients are leaving the hospital in a reduced functional state due to long periods of inactivity following emergency abdominal surgery. A reconditioning intervention to address the deconditioning effects of bed rest following acute abdominal surgery is currently being implemented. Preliminary findings will be presented. Supported by the SCN Surgical Network Grant through Alberta Health Services as well as the PRIHS Grant through Alberta Innovates Health Solutions.

Re-Operation after abdominal procedures lessons learnt from our two years experience

Objective: The objective of the study are to audit our experience of the management of cases presenting with operative complications requiring acute re operation and to identify the factors resulting in the first operation failure requiring re-exploration. Study Design: A prospective observational/analytical study. Place and duration: Acute re-operative abdominal surgery during two years period 2002-2003 in surgical Unit 1 Allied hospital, Faisalabad. Patient and methods: All the cases which were re-explored after abdominal surgery admitted in surgical unit 1, Allied hospital, Faisalabad are included in the study. Results: The cases fall in three categories, trauma cases (29) 33.71%, non trauma emergency cases (32) 37.25 and elective surgery cases (25) 29.1%. The incidence of our own unit cases subjected to re-operation is 21.9% (24). The presenting pathologies after first operation are in 6 groups; Gastrointestinal fistulas (38 cases) 41.8%, bowel obstruction (7 cases) 8.15%, abdominal abscesses (12 cases) 13.9%, bleeding (18 cases) 20.9%, miscellaneous (biliary and G.U.) (8 cases) 9.35, abdominal wound dehiscence and evisceration (3 cases) 3.6%. Total of 136 complications are in 70 cases. Mortality of 7 cases (8.14) is shared by the semi-trained surgeons, Medical officer operators(6 cases) and the trainee surgeons(1 case).Incidence of mortality in elective surgery cases is 4% in trauma cases 10.34%,non trauma emergency cases 9.4%. Intensive resuscitation including nutritional support, team of senior consultants doing the re-operation, intraoperative and post operative monitoring are the hallmarks of the management. Conclusion: Training and retraining (continuous medical education) of surgeons and regionalization of trauma cases are recommended. The facilities for less invasive procedures blessed with low morbidity and very low mortality will shrink this list of re-operations.

Transumbilical Laparoscopic Assisted Appendectomy Compared with Transumbilical Laparoscopic Appendectomy in Acute Appendicitis- Analysis of 1000 Cases

Background: Acute appendicitis (AA) is the most common cause of acute abdominal surgery. The available scientific evidence does not show consensus of opinion about the best access route for the treatment of AA. Aim: To compare the techniques Laparoscopic Appendectomy (LA) and Transumbilical Laparoscpoic Assisted Appendectomy (TULAA). Methods: This is a retrospective study comparing two series with 1000 patients. Variables were: operative time, hospital stay, postoperative complications, postoperative pain, earlier return to daily activities, conversion in relation to the type of operation and motive of the conversion. Results: The averaged surgical time was 75.5 minutes in LA and 51.7 minutes in TULAA. The incidence of postoperative pain showed no statistically significant difference. General complications had incidence of 9.6% in LA and 7.6% in TULAA. Regarding to wound infection the incidence was 2.7% and 2.4% to LA group and TULAA group respectively. The earlier return to daily activities and short hospital stay were observed in both groups. When conversion was necessary in TULAA group, the techniques were laparotomic appendectomy (59.4%), LA (17.4%) and TULAA with a second incision (23.2%). The patients submitted to LA who needed conversion were treated by laparotomic technique. Conclusion: The effectiveness and safety of trans-umbilical laparoscopic appendectomy can make this technique the preferred choice in the initial management of patients with acute appendicitis.

Emergency Abdominal Operations in the Elderly: A Multivariate Regression Analysis of 430 Consecutive Patients with Acute Abdomen.

This study is intended to ascertain if outcome of acute abdominal surgery among elderly patients with acute abdominal pain have improved. Altogether 456 patients aged >65 years underwent emergency abdominal surgery between the years 2007 and 2009 in our hospital. After excluding emergency reoperations of elective surgery, a total of 430 consecutive patients were included in this retrospective audit. The key factors under analysis in this study were the occurrence of major complications and death from any cause within 30 days after the operation. In addition, we compared our results to our previously published data some 20 years ago. The most common diagnoses were cholecystitis (n = 139, 32.3 %, incidence of 125 per 100,000 elderly persons), incarcerated hernia (n = 60, 13.9 %, 54/100,000), malignancy related (n = 50, 11.6 %, 45/100,000), or acute appendicitis (n = 46, 10.7 %, 41/100,000). The majority of operations (80.7 %) were performed using open technique. Of all 112 laparoscopic procedures, 25.9 % were converted to open surgery. Reoperations were rare and postoperative surgical complications were not associated with statistically significant increase in mortality, even if reoperation was needed. The 30-day mortality and morbidity rates were 14.2 and 31.9 %, respectively. Logistic regression analysis showed that patient's age (p = 0.014), atrial fibrillation (p = 0.017), low body mass index (p = 0.001), open surgery (p = 0.029), ASA grade III or more (p < 0.001), and previous history of malignancies (p = 0.010) were likely to increase mortality. Despite modern diagnostics and improved surgical techniques, the results of emergency abdominal surgery still have relatively high morbidity and mortality as reported in earlier studies.

Apendicectomia videoassistida por acesso único transumbilical comparada à via laparoscópica e laparotômica na apendicite aguda

Acute appendicitis is the most common cause of acute abdominal surgery. Despite nearly three decades comparing laparoscopic with laparotomic appendectomy, the available scientific evidence does not show consensus of opinion about the best access for the treatment of acute appendicitis. The transumbilical laparoscopic assisted appendectomy combines the advantages of laparoscopic access to the simplicity of the laparotomic technique. To compare the three technical advantages showing possible tendency to transumbilical laparoscopic assisted appendectomy. This is a retrospective study comparing three series with 1232 patients. Variables were: operative time, hospital stay, early and late postoperative complications, postoperative pain and earlier return to daily activities. The averaged surgical time was 59.8 min in laparotomic appendectomy, 75.5 min in laparoscopic appendectomy and 51,7 min in transumbilical laparoscopic assisted appendectomy with significant difference. The incidence of postoperative pain, general complications and wound infection were greater in the group submitted to laparotomic appendectomy. The earlier return to daily activities and short hospital stay were observed in groups laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy. The effectiveness and safety of transumbilical laparoscopic assisted appendectomy can make this technique the preferred choice in the initial management of patients with acute appendicitis.

血液凝固異常(含DIC)を有する患者の腹部救急手術と管理

血液凝固異常(含DIC)を有する患者の腹部救急手術と管理

Critical Illness Outcomes in Specialty versus General Intensive Care Units

General intensive care units (ICUs) provide care across a wide range of diagnoses, whereas specialty ICUs provide diagnosis-specific care. Risk-adjusted outcome differences across such units are unknown. To determine the association between specialty ICU care and the outcome of critical illness. We conducted a retrospective cohort study design analyzing patients admitted to 124 ICUs participating in the Acute Physiology and Chronic Health Evaluation IV from January 2002 to December 2005. We examined 84,182 patients admitted to specialty and general ICUs with an admitting diagnosis or procedure of acute coronary syndrome, ischemic stroke, intracranial hemorrhage, pneumonia, abdominal surgery, or coronary-artery bypass graft surgery. ICU type was determined by a local data coordinator at each site. Patients were classified by admission to a general ICU, a diagnosis-appropriate ("ideal") specialty ICU, or a diagnosis-inappropriate ("non-ideal") specialty ICU. The primary outcomes were in-hospital mortality and ICU length of stay. After adjusting for important confounders, there were no significant differences in risk-adjusted mortality between general versus ideal specialty ICUs for all conditions other than pneumonia. Risk-adjusted mortality was significantly greater for patients admitted to non-ideal specialty ICUs. There was no consistent effect of specialization on length of stay for all patients or for ICU survivors. Ideal specialty ICU care appears to offer no survival benefit over general ICU care for select common diagnoses. Non-ideal specialty ICU care (i.e., "boarding") is associated with increased risk-adjusted mortality.

Are specialized ICUs so special?

Subjects: 84,182 patients admitted to specialty and general ICUs with an admitting diagnosis or procedure of acute coronary syndrome, ischemic stroke, intracranial hemorrhage, pneumonia, abdominal surgery, or coronaryartery bypass graft surgery. ICU type was determined by a local data coordinator at each site. Patients were classified by admission to a general ICU, a diagnosis-appropriate (“ideal”) specialty ICU, or a diagnosis-inappropriate (“nonideal”) specialty ICU.

Subhepatically located appendicitis due to adhesions: a case report.

IntroductionAcute appendicitis occurs frequently and is a major indication for acute abdominal surgery. Subhepatic appendicitis has rarely been reported and is more difficult to diagnose.Case presentationA 71-year-old man with multiple medical comorbidities presented with undifferentiated right abdominal pain. Diagnostic difficulty was encountered due to subhepatic mal-location of the appendix and subsequently atypical presentation for acute appendicitis.ConclusionSubhepatic anatomical location of the appendix makes it more difficult to diagnose acute appendicitis at any age, including in older adults.

Dihydropiridine calcium-channel blockers and perioperative mortality in aortic aneurysm surgery

BackgroundDihydropiridine calcium-channel blockers are often used as an alternative to beta-blockers for the treatment of hypertension in patients undergoing aortic aneurysm surgery. We studied the relation between dihydropiridine calcium-channel blocker use and perioperative mortality in patients undergoing aortic aneurysm surgery. MethodsWe studied 1000 patients [mean (range) age, 69 (22–95) yr; males 810] who underwent acute or elective abdominal or thoracoabdominal aortic aneurysm surgery between January 1999 and April 2007, at Semmelweis Medical University (Budapest, Hungary). Patients were evaluated for clinical risk factors, chronic medication use, and surgical characteristics. Propensity score analysis was used to adjust for the potential bias in dihydropiridine calcium-channel blocker use. Multivariable logistic regression analyses were applied to study the association between the likelihood of dihydropiridine calcium-channel blocker use and mortality occurring within 30 days of surgery. ResultsPerioperative mortality occurred in 85 (8.5%) patients. Thirty-day mortality was significantly higher in dihydropiridine calcium-channel blocker users compared with non-users, 14.0% vs 6.0%; crude odds ratio (OR) 2.6, 95% confidence interval (CI): 1.6–4.0, P<0.0001. Even after correcting for other baseline covariates and propensity for these agents dihydropiridine calcium-channel blocker use was associated with increased 30-day mortality, OR (95% CI) 2.5(1.3–4.6), P=0.003. ConclusionsDihydropiridine calcium-channel blocker use in patients with acute or elective aortic aneurysm surgery is independently associated with an increased incidence of perioperative mortality.

The Contribution of Acute Cholecystitis, Obesity, and Previous Abdominal Surgery on the Outcome of Laparoscopic Cholecystectomy

The Contribution of Acute Cholecystitis, Obesity, and Previous Abdominal Surgery on the Outcome of Laparoscopic Cholecystectomy

Abdominal Surgery in Nonagenarians: Short-Term Results

To determine the short-term results of abdominal surgery in nonagenarians. Retrospective analyses of 193 patients aged 90 and older operated on for abdominal complaints during a 15-year period (1990-2004) in a 500-bed tertiary care institutional hospital and 100-bed rural institutional hospital in Spain. The factors analyzed included the following: perioperative risk, diagnosis, operative procedures, timing of operation (elective or emergency), morbidity, mortality, and length of hospital stay. The most common diagnoses were hernia in 69 cases, colorectal cancer in 39, and biliary lithiasis in 24. One hundred and thirty-seven patients (71%) were operated on on an emergency basis. Forty-seven patients died (24%), with mortality rates of 9% (5/56) and 31% (42/137) respectively, for elective and emergency surgery. None of the 15 patients classified as grade I according to the criteria of the American Society of Anesthesiologists (ASA) died and only 3 out of 63 (5%) died who were ASA grade II. Eighty patients (41%) had postoperative complications. Local morbidity was 16% (n = 30), and systemic morbidity was 30% (n = 58). Our results support the notion that elective and acute abdominal surgery in nonagenarians can be performed with acceptable rates of mortality and morbidity. Mortality for surgery in nonagenarians is strongly related to the perianesthetic risk (ASA grade), emergency operation, and seriousness of the disease in question.

The Contribution of Acute Cholecystitis, Obesity, and Previous Abdominal Surgery on the Outcome of Laparoscopic Cholecystectomy

The aim of this study was to evaluate the impact of acute cholecystitis (AC), obesity, and previous abdominal surgery on laparoscopic cholecystectomy (LC) outcomes. Records of 1940 patients undergoing LC in 1992 and 2004 were reviewed in order to assess the independent and joint effects of the above risk factors on conversion, morbidity, operation time, and hospital stay. In multivariate regression analysis, adjusting for sex and age, AC alone and in combination with obesity or previous abdominal surgery increased the risk of conversion and complications and was associated with prolonged operation time and hospital stay compared with the patients without any of the risk factors (reference group). The independent and joint effects of obesity and previous abdominal surgery were significant only on operation time. On the contrary, previous upper abdominal surgery alone and in combination with AC was associated with 3- and 17-fold relative odds of conversion, respectively. The combined presence of AC, obesity, and previous abdominal surgery yielded an odds ratio for conversion of 7.5 and for complications of 10.7, as well as a longer operation time and hospital stay. The presence of previous upper abdominal surgery with AC and obesity had a substantial effect on conversion, with an odds ratio of 87.1 compared with the reference group. LC is safe in patients with AC, previous abdominal surgery, or obesity. However, the presence of inflammation alone or in combination with obesity and/or previous (especially upper) abdominal surgery is the main factor that influences the adverse outcomes of LC.

A Rare Cause Of Acute Abdomen: Stump Appendicitis

We report a stump appendicitis case of a 18-years-old man two mounts after laparoscopic appendectomy diagnosed by CT scan and succesfully treated by laparoscopically. Although the signs and symptoms do not differ from acute appendicitis, the diagnosis is often not considered because of the past surgical history. This clinical condition should considered in differential diagnosis of acute abdominal pain and surgery should not be delayed.

Pioneers in acute abdominal surgery. By Zachary Cope, B.A., M.D., M.S. Lond., F.R.C.S. Eng., Surgeon to St. Mary's Hospital, Paddington; Senior Surgeon to the Bolingbroke Hospital, Wandsworth Common. 7 3/8 × 4 7/8 in. Pp. 134 + xii, with 38 illustrations. 1939. London: Oxford University Press. 7s. 6d. net

Pioneers in acute abdominal surgery. By Zachary Cope, B.A., M.D., M.S. Lond., F.R.C.S. Eng., Surgeon to St. Mary's Hospital, Paddington; Senior Surgeon to the Bolingbroke Hospital, Wandsworth Common. 7 3/8 × 4 7/8 in. Pp. 134 + xii, with 38 illustrations. 1939. London: Oxford University Press. 7s. 6d. net Pioneers in Acute Abdominal Surgery. By Zachary Cope, B.A., M.D., M.S. Lond., F.R.C.S. Eng., Surgeon to St. Mary's Hospital, Paddington; Senior Surgeon to the Bolingbroke Hospital, Wandsworth Common. 7 3/8 × 4 7/8 in. Pp. 134 + xii, with 38 illustrations. 1939. London: Oxford University Press. 7s. 6d. net. British Journal of Surgery, Volume 27, Issue 107, January 1940, Page 623, https://doi.org/10.1002/bjs.18002710740 Published: 06 December 2005