Amount Of Bleeding In Operation Research Articles

Vaginal Vault Infiltration With Bupivacaine for Postoperative Pain Control After Total Laparoscopic Hysterectomy: A Randomized Control Trial

ABSTRACT A viable alternative to total abdominal hysterectomy is total laparoscopic hysterectomy (TLH), which offers abdominal route advantages for women in need of total hysterectomy for benign diseases. Fewer complications, faster recovery, and less pain are ensured by laparoscopy, although this method is not entirely devoid of pain. Reports from various authors indicate that up to 80% of laparoscopic surgery patients require opioid analgesia, which could increase hospital-stay duration and delay mobilization/recovery. Because of these statistics, opioid analgesic usages ought to be minimized, for the aforementioned reasons and also to prevent additional adverse effects. This study was performed to evaluate efficacy of reducing postoperative pain by infiltration of bupivacaine, a long-acting anesthetic agent, into the vaginal vault after TLH. This study was a randomized control trial designed as a 2-arm double-blinded study conducted at a North-Indian Apical Center in the Department of Obstetrics and Gynecology. After written informed consent from all patients, computer-generated randomization software placed them in 1 of 2 groups: group 1, the intervention group (received the infiltration of bupivacaine in the vaginal vault following TLH), or group 2 (the control group). The inclusion criteria were a uterine size of ≤12 weeks' pregnancy and patients requiring TLH with or without bilateral salpingo-oophorectomy for uterine size and benign conditions. Exclusion criteria were contraindication to any medication used by the study, presence of malignancy, history of multiple surgeries, and history of inflammatory disease. Postoperative pain outcome measured in both groups at 1, 3, 6, 12, and 24 hours via a visual analog score was the primary outcome. The secondary outcome was the need for rescue analgesia. A complete profile of each patient was created, using eligibility criteria, body mass index, and demographic profile, and a complete gynecological and physical examination was performed, along with preoperative investigations for fitness to general anesthesia. Per standard protocol, general anesthesia was administered for all surgeries. After vault closure, a fine-tipped aspiration needle was used to administer 10 mL of bupivacaine, which was infiltrated laparoscopically at 2 different locations, approximately 2–4 cm apart. The control group omitted this step. In the first 24 hours after operation, pain was treated using 1 g intravenous paracetamol every 6 hours. For the next 5 days, patients were given nonsteroidal anti-inflammatory drugs (diclofenac) 3 times daily for 5 days. Participants scaled their pain using the visual analog scale (VAS) score at the 1, 2, 6, 12, and 24 hours intervals postsurgery. Scores greater than 4 initiated the distribution of tramadol 50 mg intramuscular. Also recorded were the uterine weight, the operative time, complications, and the amount of operative bleeding. Group 1 patients exhibited VAS scores of less than 4 at 1 hour postsurgery (100%), 3 hours postsurgery (100%), 6 hours postsurgery (97%), 12 hours postsurgery (96.7%), and 24 hours postsurgery (36.7%). The control group VAS scores of less than 4 for the respective times were as follows: 1 hour (93%), 3 hours (86.6%), 6 hours (30%), 12 hours (10%), and 24 hours (3.3%). From these data, it is clear that the infiltration with a local analgesia was effective in reducing postoperative pain. Overall, a feasible and safe option for postoperative pain relief is vaginal cuff infiltration with local anesthetic. A significant increase in the number of women experiencing minimal postoperative pain for 24 hours after laparoscopic hysterectomy took place due to infiltration of the vaginal vault with 10 mL of 0.25% bupivacaine (with no complications). Furthermore, this method reduces requirements of additional opioid/analgesia usage. The beneficial use of local vault infiltration with bupivacaine after TLH within the first 24 postoperative hours is highlighted by this study.

A Retrospective Study of Chemotherapy and 3D-Image-Guided Afterloading Intracavitary Radiotherapy in Locally Advanced Cervical Cancer.

Aim To investigate the value of neoadjuvant chemotherapy combined with 3D-image-guided afterloading intracavitary radiotherapy in locally advanced cervical cancer (LACC). Methods Patients with cervical cancer admitted to our hospital from January 1, 2020 to January 1, 2021 were retrieved and analyzed. Cases treated with neoadjuvant chemotherapy and 3D-image-guided afterloading intracavitary radiotherapy were assigned into the observation group (OG), while cases with neoadjuvant chemotherapy alone were assigned into the control group (CG). The short-term effects were determined by RECIST 1.1. Total effective rate (TR) = complete remission (CR) + partial remission (PR). The serum levels of squamous epithelial cell carcinoma antigen (SCC-Ag), glycoantigen 125 (CA125), carcinoembryonic antigen (CEA), and vascular endothelial growth factor (VEGF) were assessed. In view of the difference between tumor markers and diameters before and after treatment, the correlation between them was analyzed by Pearson test. The adverse events were compared, and the amount of operative bleeding and operation time were evaluated. Cox regression analysis was conducted to assess the influencing factors of 1-year disease-free survival time. Results Sixty-seven patients were retrieved, including 30 cases in the OG and 37 cases in the CG. There were no significant differences in age, pathological type, tumor size, FIGO stage, past medical history, or smoking history between the two groups (P > 0.05). The TR of patients in the OG was higher than that in the CG (P < 0.05). The SCC-Ag, CA125, CEA, and VEGF levels in the OG decreased markedly after treatment (P < 0.001). The difference in SCC-Ag, CA125, CEA, and VEGF was positively correlated with the difference in tumor diameter before and after treatment (P < 0.05). The incidence of adverse events revealed no obvious difference between the OG and CG (P > 0.05). Cox regression analysis showed that FIGO stage and treatment regimens were independent prognostic factors for 1-year disease-free survival (P < 0.05). Conclusion Neoadjuvant chemotherapy combined with 3D-image-guided afterloading intracavitary radiotherapy can improve the TR rate and 1-year disease-free survival of LACC patients without increasing the incidence of adverse events.

Adrenal kitlelerde laparaskopik ve açık cerrahi tekniklerin sonuç açısından karşılaştırılması

Purpose: The aim of this study was to compare the results of conventional and laparoscopic adrenalectomy in adrenal mass cases operated on during a 9-year period.Materials and Methods: A total of 81 patients who underwent adrenalectomy were included in the study. Patients were divided into two groups as; Group 1 - conventional surgery and Group 2 - laparoscopic surgery. Two groups were compared retrospectively on characteristics such as; age, sex, body mass index (BMI), American Society of Anesthesiologists' score (ASA), mass localization, mass size and hormonal activity of the mass, duration of operation, amount of bleeding in operation, duration of hospitalization, duration until food intake, perioperative mortality, early complications and readmission to hospital within 90 days. Results: There were 22 patients in Group 1 and 59 patients in Group 2. No statistically significant difference was found between the groups in terms of age, sex, BMI, ASA score, tumor localization, indications for operation, postoperative complication, perioperative mortality and re-admittance within 90 days. The hormonal activity of the mass was higher and the mass was smaller in size in Group 2. The duration of operation (min), the amount of bleeding in the operation (ml), the duration until oral intake (days) and the length of hospital stay (days) were found to be statistically significantly higher in Group 1.Conclusion: Laparoscopic adrenalectomy should be the preferred surgical method because of its short duration of operation, low blood loss, early onset of oral food intake and shorter hospital stay, as well as its safety.

Clinical comparative study of metaphyseal locking intramedullary nail and locking plate in the treatment of humeral surgical neck fracture

Objective To investigate the difference of clinical efficacy between metaphyseal locking intramedullary nail and locking plate in the treatment of humeral surgical neck fracture. Methods 64 patients with Neer II humeral surgical neck fracture who were treated in our hospital from January 2010 to December 2015 were selected. According to the operation plan, the patients were divided into epiphyseal locking intramedullary nail fixation group (observation group, n=42) and locking plate fixation group (control group, n=22). The differences of clinical data (sex, age, time from injury to operation, number of injured cases, follow-up time), clinical indicators (neck-trunk angle, last neck-trunk angle, number of complications, amount of operative bleeding, amount of operative blood transfusion, operation time, fracture healing time): Neer shoulder function score and Constant shoulder score were compared between the two groups. Results There was no significant difference in gender, age, time from injury to operation, number of cases of injury and follow-up time between the two groups, and the subjects were comparable (P>0.05). There was no significant difference in the neck-trunk angle, the last neck-trunk angle and the number of complications between the two groups (P>0.05); the observation group had longer operation time, less operation bleeding volume and blood transfusion volume, shorter fracture healing time (P 0.05). The Constant score, external rotation, abduction and flexion in the observation group were significantly higher than those in the control group (P<0.05). Conclusions The use of metaphyseal locking intramedullary nail in the treatment of humeral surgical neck fracture has a definite clinical effect and a low incidence of complications, which is worthy of clinical application. Key words: Humeral fractures; Shoulder fractures; Fracture fixation, intramedullary; Bone nails; Bone plates

Clinical effectiveness of postoperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma

Objective: To investigate the clinical effectiveness of postoperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma (HCC). Methods: A total of 379 HCC patients who received partial hepatectomy from January 2010 to December 2013 in Department of Hepatobiliary Surgery of Cancer Hospital, Chinese Academy of Medical Sciences were selected. Based on the nutritional method, all of the enrolled patients were divided into two group: 142 patients who received early enteral nutrition (EEN) combined with parenteral nutrition (PN) were identified as EEN+ PN group; 237 patients who received total parenteral nutrition (TPN) were identified as TPN group. These two groups were even divided into two subgroups, centrally located HCC (cl-HCC) and non-centrally located HCC (ncl-HCC). The clinical effectiveness of different groups was assessed and compared. Results: The age, gender, body mass index (BMI), the maximum diameter of the tumor, the amount of operative bleeding and postoperative infective rate did not show statistically significant differences between EEN+ PN group and TPN group (P>0.05). On the seventh postoperative day (7(th) POD), aspartate transaminase (AST) of EEN+ PN group and TPN group were (41.6±2.0) IU/L and (50.4±3.2) IU/L respectively, and the difference was statistically significant (P<0.05). Alkaline phosphatase (ALP) of these two groups were (80.8±2.4) IU/L and (90.2±2.3) IU/L, respectively, and the difference was statistically significant (P<0.05). Total bilirubin (TBIL) of these two groups were (15.8±0.7) μmol/L and (19.1±0.7) μmol/L, respectively, and the difference was statistically significant (P<0.05). On the 7(th) POD, AST in cl-HCC subgroups of EEN+ PN group and TPN group were (39.6±2.6) IU/L and (61.0±7.0) IU/L, respectively, and the difference was statistically significant (P<0.05). TBIL in cl-HCC subgroups of these two groups were (14.4±0.9) μmol/L and (20.7±1.3) μmol/L, respectively, and the difference was statistically significant (P<0.05). On the 7(th) POD, ALP in ncl-HCC subgroups of these two groups were (79.3±3.0) IU/L and (89.9±3.1) IU/L, respectively, and the difference was statistically significant (P<0.05). The total length of stay (t-LOS) of these two groups were (15.8±0.4) days and (17.1±0.4) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) of these two groups were (8.6±0.2) days and (10.1±0.3) days, respectively, and the difference was statistically significant (P<0.05). Total length of stay (t-LOS) in ncl-HCC subgroups of these two groups were (15.1±0.5) days and (16.6±0.3) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) in ncl-HCC subgroups of these two groups were (8.4±0.2) days and (9.5±0.2) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) in cl-HCC subgroups of these two groups were (8.7±0.2) days and (11.0±0.8) days, respectively, and the difference was statistically significant (P<0.05). Postoperative hospitalization expenses of these two groups were (20 855.0±549.8) yuan and (23 373.0±715.5) yuan, respectively, and the difference was statistically significant (P<0.05). Postoperative hospitalization expenses in cl-HCC subgroups of these two groups were (21 012.0±748.5) yuan and (24 697.0±1 409.0) yuan, respectively, and the difference was statistically significant (P<0.05). Conclusion: EEN+ PN can improve the liver function, shorten the postoperative hospitalization time and reduce the postoperative hospitalization expenses of HCC patients in need of nutritional support.

Complications analysis of adenoidectomy and tonsillectomy assisted with ablation on children

Objective:To analyze the complications of adenotonsilectomy assisted with coblation in children. Method:Complications of 2 089 cases of children with adenoid and tonsil surgery assisted with coblation, in our hospital nearly 10 years, were analyzed by epidemiological methods through the method of retrospective analysis. Result:①the sex ratio of male to female was 2.08：1, average age (5.87±3.12) years old, and most of 2 089 cases 76.35% (1 595/2 089) were 3-7 years old; ②all cases underwent adenoidectomy. Different surgery methods of tonsil consisted of three groups as partial resection associated with ablation was 69.17% (1 445/2 089), ablation (channeling) alone was 22.26% (465/2 089) and total resection was 8.57% (179/208). The amount of bleeding in operation was (8.52±3.18)ml, average operation time was (30.15±8.26) minutes, the postoperative pain score was (3.77±1.61); ③The incidence of postoperative complications: postoperative bleeding (all were secondary bleeding cases) rate was 0.24% (5/2 089), recurrence rate was 0.14% (3/2 089), prevertebral lymphadenitis was 0.96% (20/2 089), the other was 0.29% (torus hyperplasia in 2 cases, dyspnea in 2 cases, 1 cases of angle of mouth burned, nasopharyngeal adhesion in 1 cases). Postoperative fever rate was 9.81% (205/2 089). Conclusion:coblation technique is a good method for the treatment of children's adenoids and tonsil diseases with high efficiency and low complications. But improving the operation procedure proficiency level and skills of operation is an important link to reduce complications.

Comparison of the effect of proximal femoral nail anti-rotation and dynamic hip screw internal fixation in the treatment of intertrochanteric fracture

Objective To compare the clinical effect of proximal femoral nail anti-rotation(PFNA) and dynamic hip screw(DHS) internal fixation in the treatment of femoral intertrochanteric fracture. Methods 80 patients with femoral intertrochanteric fracture were selected as research subjects.They were divided into PFNA group and DHS group by random number table, 40 cases in each group.The operation time, intraoperative blood loss, postoperative wound drainage, postoperative weight-bearing time, healing time, complication rate, Harris hip function score between two groups were compared. Results The operation time of the PFNA group was lower than that of DHS group(t=22.66, P<0.05), the amount of bleeding in operation was less than that in the DHS group(t=54.85, P<0.05), the postoperative wound drainage volume was less than that of the DHS group(t=16.85, P<0.05), the weight-bearing time after operation was shorter than that in the DHS group(t=20.18, P<0.05), and the healing time was shorter than that in the DHS group(t=22.00, P<0.05). The excellence rate of Harris hip function score in the PFNA group was 95.00%, which was significantly higher than 80.00% in the DHS group, the difference was statistically significant(χ2=4.11, P<0.05). The incidence rate of complication of the PFNA group was 7.50%, which was significantly lower than 25.00% of the DHS group(χ2=4.50, P<0.05). Conclusion Compared with DHS, PFNA internal fixation has the advantages of less operation time, less intraoperative blood loss, shorter healing time and low complication rate in the treatment of femoral intertrochanteric fracture.It is worthy to be promoted clinically. Key words: Femoral fractures; Fracture fixation, internal; Fracture fixation, intramedullary; Bone wires

Rigid choledochoscopy via biliary fistula tracts to remove bile duct stones

Objective To study the indications, feasibility and efficacy of rigid choledochoscopy via biliary fistula tracts to remove bile duct stones. Methods A retrospective analysis was performed on the clinical data of 86 patients with bile duct stones treated with rigid choledochoscopy via biliary fistula tracts at our hospital between November 2011 and July 2016. Patients with bile duct stones were divided into the percutaneous transhepatic cholangio drainage (PTCD) group and the T tube tract group. There were 40 patients who underwent lithotomy using rigid choledochoscopy via the PTCD tract and 46 patients who underwent choledocholithotomy using rigid choledochoscopy via the T-tube tract. A comparison was conducted to compare the duration of the procedures, the amount of perioperative bleeding, the postoperative complication rates and residual stone rates between the two groups. Results In the PTCD group, the average operation time was (77.0±36.5) min, the amount of perioperative bleeding was (26.5±54.1) ml, and the postoperative complication rate was 37.5% (15/40). Complete lithotomy in one-stage was successful in 33 patients, and in two-stages in 1 patient. The residual stone rate was 15.0% (6/40). In the T tube tract group, the average operation time was (82.5±44.1) min, the amount of perioperative bleeding was (14.8±21.0) ml, and the postoperative complication rate was 32.6% (15/46). Complete lithotomy in one-stage was successful in 34 patients, and two-stages in 2 patients. The residual stone rate was 21.7% (10/46). There were no significant differences in the residual stone rates, complication rates and operation time between the two groups (P>0.05). The amount of operative bleeding was significantly better in the T tube tract group than the PTCD group, (P<0.05). Conclusions There was no significant differences in the clinical efficacy in the treatment of bile duct stones using choledochoscopy either via the PTCD tract or the T tube tract group. Both approaches can be used for bile duct stones. Key words: Rigid choledochoscopy; Percutaneous transhepatic cholangio drainage (PTCD); Bile duct stones; Cholelithiasis; T-tube; Fistula

Evaluation of the Effect of the Blood Stopper; Ankaferd in Management of Post Laparoscopic Cholecystectomy Liver Bed Bleeding

Introduction: The incidence of bleeding complications during laparoscopic cholecystectomy remains a frequent reason for conversion. Ankaferd Blood Stopper is a unique medicinal plant extract that has historically been used as a hemostatic agent and has been approved for the management of external hemorrhage and dental surgery bleeding. The aim of this study was to evaluate the effect of Ankaferd as a blooding stopper; in the management of liver bed bleeding in post laparoscopic cholecystectomy. Patients and Methods: A total of 120 patients; 60 for each group; group A (laparoscopic cholecystectomy with cauterization of gallbladder bed of the liver) and group B (laparoscopic cholecystectomy with application of Ankaferd drops by laparoscopic injector into gallbladder bed). End points: The primary end point of the study was measurement of the intraoperative bleeding as a result of application of both techniques; ankaferd instillation and cauterization of gallbladder bed of the liver. The secondary end points were estimation of the amount and characteristics of postoperative discharge till removal of drains, length of hospital stay and postoperative wound infection. Results: The operative time in group A was 85±34.5 minutes while in group B, it was 56±20.5 minutes. The mean amount of intraoperative bleeding was 58.1±29.97 ml and 37±14.47 ml in group A&B respectively. The mean amount of postoperative fluid drainage was 41.75±12.9 ml in group A while in group B was 30±6.75 ml and the hospital stay, It was 51.6±15.35 hours for patients of group A versus 31.8 ±8.5 hours for patients of group B respectively with significant distribution {P ≤ 0.001}. Conclusion: Ankaferd rapidly achieves hemostasis allowing surgeon to control bleeding properly and therefore the amount of operative bleeding, the operative time and the amount of postoperative fluid discharge on using ankaferd is statistically reduced.

Robot-assisted versus endoscopic submandibular gland resection via retroauricular approach: a prospective nonrandomized study

The aim of this study was to compare the short-term clinicopathological results of robot-assisted and endoscopic resection of the submandibular gland by the retroauricular approach.We present a prospective, non-random, study of 35 patients who had endoscope-assisted (n=22), or robot-assisted (n=13), resection of the submandibular gland using a retroauricular approach. Patients selected one of the two methods, and short-term clinical outcomes were then compared, including maximum diameter of the tumour and gland, length of incision, total operating time, amount of operative bleeding, amount and duration of drainage, duration of hospital stay, cosmesis, and complications. The operation was feasible in all patients with no appreciable operative complications or need to convert to a conventional open operation. The operating time of the robot-assisted group (63.4 (6.3)min) was comparable with that of the endoscopic group (66.5 (9.1)min) (p=0.15). There were no differences in the other clinical outcomes between the 2 groups. Both groups of patients were extremely satisfied with their postoperative cosmesis, and did not differ significantly (p=0.89). Robotic and endoscopic resection of the submandibular gland gave comparable early surgical outcomes and excellent cosmetic results. Despite the technical convenience for the surgeon, the robot gave no apparent clinical benefit over the endoscope in this series.

Huneral greater tubercle fracture treated with minimal incision combined with absorbable screws

Objective To investigate the effect of the humeral greater tubercle fracture treated with minimal incision combined with absorbable screws. Methods Totally 41 cases accepted by our department from 10 of 2002 to 11 of 2005 were treated with minimal incision combined with absorbable screws. Results The patients were followed up for an average of 9 months( ranged from 6 to 14 months). According to the Neer functional index,the outcome was excellent in 36 patients, good in 3 effective in 2, the excellent and good rate was 95.12%. Conclusion This operative method of minimal incision combined with absorbable screws has the advantages of stable fixation, less operative time, less amount of operative bleeding, minimum tissue trauma and quicker bone union. Key words: Humeral greater tubercle; Absorbable screws; Minimal incision; Fracture

VIDEO-ASSISTED NECK SURGERY (VANS) IN THE FIELD OF ENDOCRINE SURGERY

For the purpose of minimization of operative scar on the neck from a cosmetic viewpoint, we performed an endoscopic resection for 21 thyroid tumors and a parathyroid tumor out of 20 cases using an anterior neck-lift method which we exploited and named Video-Assisted Neck Surgery (VANS). The approach to the thyroid is made mainly through the chest wall 1.5cm below the clavicle where is completely covered by neck-opened cloths. A prophylactic lymph node dissection of the pre- and paratracheal lymph nodes was added to the patients whose preoperative cytology revealed class 3b. The resected tumors were 17-53mm (mean: 34.7mm) in size and. 2.5-32.6g (mean: 14.3g) in weight. The amount of operative bleeding ranged from 5 to 360ml (mean: 111.3ml), the operating time from 1 hours and 2 minutes to 3 hours and 54 minutes (mean: 2 hours 14 minutes), and postoperative hospital stay from 3 to 8 days (mean: 5.1 days). The operating time and amount of bleeding in VANS varied from case to case depending upon location, size of tumor and operative procedure. Those disadvantages, however, are considered to be improved in accordance with further experience. We are convinced that VANS will become a surgical procedure which is preferably selected by patient in terms of both cosmetic advantages and excellent result.

POSTOPERATIVE COURSE AND HEPATIC REGENERATION AFTER HEPATOPANCREATODUODENECTOMY FOR BILIARY TRACT CARCINOMA

Hepatopancreatoduodenectomy (HPD) with hepatectomy has been widely employed for advanced biliary tract carcinomas. In this paper 10 patients with biliary tract carcinoma undergoing HPD with hepatectomy were compared with control groups for operative stress, hepatic regeneration, and postoperative complications. These 10 patients were divided into 2 groups, namely 6 undergoing resection of more than 2 segments and 4, less than 2 segments. Another each 10 patients undergoing extended hepatectomy or HPD were severed as control. HPD patients with hepatectomy of more than 2 segments showed significantly greater values in operative bleeding amount, operating time, and postoperative complications than those of other 3 groups. Postoperative total serum bilirubin significantly increased in HPD with hepatectomy (more than 2 segments) group. There were no differences in restoration of remnant hepatic volume after extended hepatic lobectomy with or without pancreatoduodenectomy. Median survival after HPD was 12 months. According to a questionnaire survey reported at the 16th Japan Pancreatectomy Society, the commonest cause of hospital deaths in HPD patients was hepatic failure, followed by preoperative T. Bil. level of 3mg/dl or more, age of over 60, hepatectomy of more than 2 segments, and association of vascular reconstruction, in this order (with significant difference). It is thought that an increase in total bilirubin well expresses a significantly severe operative stress with HPD than that with usual hepatectomy. Accordingly, HPD can escape associating with postoperative hepatic failure and other complications by an appropriate selection of operative candidates preceded by sufficient reduction of serum bilirubin; careful vascular reconstruction; and good nutritional management.

CLINICAL STUDY OF OPERATED CASES OF ACUTE CHOLECYSTITIS WITH SPECIAL REFERENCE TO THE CLINICAL CHARACTERISTICS AND THERAPEUTIC PROBLEMS IN AGED PATIENTS

For the purpose of making clear the clinical characteristics and therapeutic problems in aged patients over 70 years old undergoing surgery for acute cholecystitis, 64 patients treated at the department during a recent fiveyear.1986-1990 were retrospectively studied by comparing with younger age group (under 69 years old). In the aged group 52.6% (30 cases) of all patients undergoing cholecystectomy had acute cholecystitis. Stones in the choledocus were found in 46.7% of the aged patients. It was 1.8 times higher than that of the youngers. Only 4 cases of the aged group had sepsis. Patients in the aged group had some underlying disease preoperatively in a significantly high rate compared to that of younger patients. The longest delay from the onset to the operation was noted in aged patients with preoperative underlying disease. There was no significant difference in operating time between both groups, however, aged patients tended to show more operative bleeding amount. The degree of inflammation was also severer in aged patients than the others. No significant difference in the frequency of postoperative complications was noted between both groups, but gastrointestinal bleeding was observed in only aged patients. There was no significant difference in postoperative hospital stay between them. No deaths were noted. Further efforts to make inflammation disappear as soon as possible, to perform safe and early operation under an appropriate control of the underlying disease, and to shorten the hospital stay are important.