Complication Of Previous Surgery Research Articles

Predictive factors of admission in outpatient laparoscopic surgery

IntroductionThe aim of the study is to analyze the rate of unplanned hospitalization after ambulatory surgical procedures by laparoscopy, and identify associated risk factors to failure in the ambulatory manage of this patients. MethodsA prospective observational study was performed during 18 months and included 297 patients treated with ambulatory laparoscopies performed at University Hospital La Fe of Valencia. The need for hospital admission, same day after surgery, was considered the main variable. Variables were recorded for preoperative, intraoperative or postoperative factors. To identify risk factors and variables associated with complications, statistical analyses were calculated with logistic regression models. ResultsAfter laparoscopic surgery, 8.1% of patients required hospitalization. This rate was significantly superior in gynecologic surgery, patients with previous surgery complications, superior ASA score (II and III) and smokers. Likewise, patients with pneumoperitoneum time over 45minutes presented a higher hospitalization rate, also found in patients with anesthetic or surgery complications (including conversion to laparotomy). Finally, the rate of hospitalization was significantly superior in relation with postoperative nausea and vomiting (PONV). ConclusionThe rate of patients who need hospitalization after ambulatory laparoscopic surgery was 8.1%, of which 5.5% were general surgeries and 12.1% were gynecologic surgeries. The most frequently related factors with failed ambulatory management, analyzed with multiple regression, were the appearance of surgery complications, pneumoperitoneum time over 100minutes and PONV.

Surgical treatment for secondary aortoesophageal fistula

BackgroundAortoesophageal fistula (AEF) is a relatively rare condition that is often life-threatening. Secondary AEF is a complication of previous surgery, which can be more critical and challenging than primary AEF. The number of secondary AEF is increasing due to increase in the number of thoracic endovascular aortic repair (TEVAR). Although TEVAR has become a successful alternative surgical strategy for thoracic aortic aneurysms, secondary AEF after TEVAR might be critical than other secondary AEF because of severe adhesion between the esophagus and residual thoracic aortic wall.MethodsThis study analyzed six patients with secondary AEF who were treated at Tokyo Medical University Hospital between 2011 and 2016. These participants included four patients who had undergone TEVAR and two who had undergone total arch replacement.ResultsAlthough they were subsequently hospitalized for a long period, open surgical repair was completed in two patients who had undergone total arch replacement. TEVAR alone was performed in two patients who had undergone TEVAR and they were discharged without major complications shortly. Combined repair of TEVAR as a bridge to open surgery was planned for two patients who had undergone TEVAR. However, reconstruction of the aorta and esophagus could not be completed in these patients due to severe adhesions, and they died during hospitalization.ConclusionsDefinitive open repair was successfully performed in patients with secondary AEF after total arch replacement. However, in the patients with secondary AEF after TEVAR, severe adhesion between the aorta and esophagus led to difficulty in performing a successful definitive open repair. The strategy for secondary AEF should, therefore, be decided considering the etiology of secondary AEF. In secondary AEF after TEVAR, definitive open repair is difficult to complete because of catastrophic complication, and palliative treatment using TEVAR without reconstruction of aorta and esophagus can be an alternative.

Factores con valor predictivo de ingreso en cirugía laparoscópica ambulatoria

IntroductionThe aim of the study is to analyze the rate of no planificated hospitalization after ambulatory surgical procedures by laparoscopy, and identify associated risk factors to failure in the ambulatory manage of this patients. MethodsA prospective observational study was performed during 18 months and included 297 patients treated with ambulatory laparoscopies performed at University Hospital La Fe of Valencia. The need for hospital admission, same day after surgery, was considered the main variable. Variables were recorded for preoperatives, intraoperatives o postoperatives factors. To identify risk factors and variables associated with complications, statistical analyses were calculated with logistic regression models. ResultsAfter laparoscopic surgery, the 8.1% of patients required hospitalization. This rate was significantly superior in gynecologic surgery, patients with previous surgery complications, superior ASA classified (II and III) and smokers. Likewise, patients with pneumoperitoneum time over 45minutes presented a higher hospitalization rate; also founded in patients with anesthetic or surgery complications (including conversion to laparotomy). At least, the rate of hospitalization was significantly superior in relation with postoperative nausea and vomiting (PONV). ConclusionThe rate of patients who need hospitalization after ambulatory laparoscopic surgery was 8.1%, of which 5.5% were general surgeries and 12.1% were gynecologic surgeries. The mots relationated factors with ambulatory manage failure, analyzed with multiple regression, were the appearance of surgery complications, the pneumoperitoneum time over 100minutes and the PONV.

Recurrent intestinal fistulation after porcine acellular dermal matrix reinforcement in enteric fistula takedown and simultaneous abdominal wall reconstruction.

Porcine acellular dermal matrix (PADM) has been promoted as a suitable material for the reinforcement of the abdominal wall in Ventral Hernia Working Group (VHWG) Grade 3/4 wounds by Ventral Hernia Working Group et al. (Surgery 148(3):544-548). We describe our experience of, and assess the mechanisms for the failure of PADM (PermacolTM) in intestinal and abdominal wall reconstruction (AWR) for enterocutaneous fistulation (ECF). All patients referred to our unit who had PADM used for AWR and ECF were studied from a prospectively maintained database. Follow-up data until 31/12/2018 were analysed. PADM was explanted at further surgery and examined histologically. 13 patients, (median age-58.5years) underwent AWR with PADM reinforcement. Twelve of these (92%) patients had developed abdominal wall defects (AWD) and ECF following complications of previous surgery. Six patients underwent fistula takedown and AWR with PADM, of which 5(83%) refistulated. Seven patients referred to us had already undergone similar procedures in their referring hospitals and had also refistulated. Median (range) time to fistulation after AWR with PADM was 17 (7-240) days. In all cases, PADM had been used to bridge the defect and placed in direct contact with bowel. At reconstructive surgery for refistulation, PADM was inseparable from multiple segments of small intestine, necessitating extensive bowel resection. Histological examination confirmed that the PADM almost completely integrated with the seromuscular layer of the small intestine. PADM may become inseparable from serosa of the human small intestinal serosa when it is left in the abdomen during reconstructive surgery. This technique is associated with recurrent intestinal fistulation and intestinal failure and should be avoided if at all possible.

Jejunogastric intussusception presented with hematemesis: A case presentation and review of the literature

SummaryJejunogastric intussusception (JGI) is a rare but life‐threatening complication of gastrectomy. It is a complication of previous surgery on the stomach, such as Billroth II gastrectomy, Roux‐en‐Y anastomosis, and gastrojejunostomy. Early diagnosis is important but difficult in acute JGI. Emergency surgical intervention is necessary in most cases and can prevent clinical deterioration. We report such a case that presented with hematemesis.Copyright © 2017, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.

PWE-416 Does a general surgery dual-specialty consultant on-call system improve emergency access to appropriate specialist surgery?

Introduction Subspecialisation within general surgery has resulted in concerns over the provision of emergency surgical care. Outcomes after some elective surgery have been shown to be better when performed by a surgeons of an appropriate subspeciality.1Some advocate emergency surgery should be considered in the same way, and performed by appropriately trained specialists. A dual consultant on-call system has been proposed as a means of ensuring this occur. This study aims to identify whether patients receive subspecialty emergency surgical intervention using an in-hours dual consultant on-call system. Method A prospective review of all emergency laparotomies performed at a single centre from 11/01/2014 to 12/01/2015. Data was collected on indication for surgery, operative findings, subspecialty interest of operating surgeon, and the timeliness of surgery compared to CEPOD operative urgency grading. Operations were classified as General: suitable for any surgeon (GEN); Upper Gastrointestinal (UGI); and Colorectal (COL). Our centre operated a dual consultant on call system within normal working hours, and single consultant outside hours. Results 306 emergency laparotomies were identified. 169 (55%) were classified as GEN; 22 (7%), UGI; 115 (38%), COL by procedure. The most senior surgeon present was consultant in 281 (92%) of cases, Specialist Trainee in 24 (8%), and unknown in 1. (36) 12% of cases were due to a complication of previous surgery. 20% of cases were performed out-of-hours. Within normal working hours, 90 of 103 (87.4%) operations of a specialist nature were performed by a consultant surgeon of that specialty. Outside of these hours, this figure was 15 out of 27 (55.6%). 95% of cases were performed within the NCEPOD operative timing classification. Conclusion A dual consultant on-call system does result in the majority of patients receiving emergency care by a surgeon with the appropriate subspeciality interest, and allows this to occur in a timely fashion. Disclosure of interest None Declared. Reference Anwar S, Fraser S, Hill J. Surgical specialization and training – its relation to clinical outcome for colorectal cancer surgery. J Eval Clin Pract. 2012 Feb;18(1):5–11

Le carpe bossu

Fiolle reported the first description of a "carpal boss". The "hump" is cosmetically disturbing and sometimes painful. It has to be distinguished from a ganglion. A lateral X-Ray with 30 degrees of supination reveals a spur or a styloid bone (12.5%). In a series of 44 patients, treated over a period of 7 years, 21 needed operation for pain or a complication of previous surgery. The technique described by Cuono and Watson was successfully used without recurrence of deformity but in 2 cases some pain remained during strenuous efforts.

Clinical Features of the Failed-Back Syndrome

This study comprises 78 patients who were treated for chronic back pain at a multidisciplinary, multimodal pain treatment center. These patients were selected from 494 patients examined by the authors because all of their previous medical records, operative notes, and imaging studies were available for review. The records and imaging studies were reviewed independently by a neurosurgeon and an orthopedist, and a retrospective decision was made concerning the historical and physical findings correlated with imaging studies in order to provide justification for the intervention. At the time of admission to the pain treatment center, 16 patients had no physical abnormalities that would explain their back complaint and 16 patients exhibited minor postoperative changes insufficient to cause disabling pain. Twenty-seven patients suffered from a complication of previous surgery, 13 had spondylotic disease, and in six a new diagnosis was established. Comprehensive psychiatric evaluation of the 78 patients revealed that 10 patients had a definitive psychiatric diagnosis, 34 were diagnosed as having a maladaptive personality disorder, and 34 had a normal pre-pain personality. Sixty-seven patients suffered from reactive depression. Fifty-four patients were taking medications at doses higher than usually prescribed, 58 misused narcotics, nine had drug addiction, and 54 were suffering withdrawal symptoms. Of the 78 patients, 64 underwent a total of 171 operations, an average of 2.6 per patient. The authors applied the clinical criteria approved by the American Association of Neurological Surgeons and the American Academy of Orthopedic Surgeons for selection of surgery or chemonucleolysis in the treatment of the herniated disc to these patients. Preoperative imaging studies were normal or demonstrated nonspecific degenerative disc disease in 52 patients. Twenty-six patients had a diagnosis based on radiological findings that warranted surgery. Clinical criteria justifying intervention were met in 25 patients and not met in 53. Imaging and clinical criteria for a second operation were met in 18 (40%) of the patients. After the second operation all patients met the criteria: subsequent surgery was necessary to treat effects of an earlier operation in 73%. These data indicate that many of these patients with failed-back syndrome underwent an original operation based on a persistent complaint of pain, frequently coupled with an underlying psychiatric abnormality, although they did not meet the criteria generally accepted by neurosurgeons for intervention at the time of first surgery.

Clinical features of the failed-back syndrome

This study comprises 78 patients who were treated for chronic back pain at a multidisciplinary, multimodal pain treatment center. These patients were selected from 494 patients examined by the authors because all of their previous medical records, operative notes, and imaging studies were available for review. The records and imaging studies were reviewed independently by a neurosurgeon and an orthopedist, and a retrospective decision was made concerning the historical and physical findings correlated with imaging studies in order to provide justification for the intervention. At the time of admission to the pain treatment center, 16 patients had no physical abnormalities that would explain their back complaint and 16 patients exhibited minor postoperative changes insufficient to cause disabling pain. Twenty-seven patients suffered from a complication of previous surgery, 13 had spondylotic disease, and in six a new diagnosis was established. Comprehensive psychiatric evaluation of the 78 patients revealed that 10 patients had a definitive psychiatric diagnosis, 34 were diagnosed as having a maladaptive personality disorder, and 34 had a normal pre-pain personality. Sixty-seven patients suffered from reactive depression. Fifty-four patients were taking medications at doses higher than usually prescribed, 58 misused narcotics, nine had drug addiction, and 54 were suffering withdrawal symptoms. Of the 78 patients, 64 underwent a total of 171 operations, an average of 2.6 per patient. The authors applied the clinical criteria approved by the American Association of Neurological Surgeons and the American Academy of Orthopedic Surgeons for selection of surgery or chemonucleolysis in the treatment of the herniated disc to these patients. Preoperative imaging studies were normal or demonstrated nonspecific degenerative disc disease in 52 patients. Twenty-six patients had a diagnosis based on radiological findings that warranted surgery. Clinical criteria justifying intervention were met in 25 patients and not met in 53. Imaging and clinical criteria for a second operation were met in 18 (40%) of the patients. After the second operation all patients met the criteria: subsequent surgery was necessary to treat effects of an earlier operation in 73%. These data indicate that many of these patients with failed-back syndrome underwent an original operation based on a persistent complaint of pain, frequently coupled with an underlying psychiatric abnormality, although they did not meet the criteria generally accepted by neurosurgeons for intervention at the time of first surgery.