Complication Of Abdominal Surgery Research Articles

Fluid therapy and pulmonary complications in abdominal surgeries: randomized controlled trial

BackgroundThere is no consensus on the most effective strategy for Postoperative Pulmonary Complication (PPC) reduction. This study hypothesized that a Goal-Directed Fluid Therapy (GDFT) protocol of infusion of predetermined boluses reduces the occurrence of PPC in patients undergoing elective open abdominal surgeries when compared with Standard of Care (SOC) strategy. MethodsRandomized, prospective, controlled study, conducted from May 2012 to December 2014, with ASA I, II or III patients undergoing open abdominal surgeries, lasting at least 120 min, under general anesthesia, randomized into the SOC and the GDFT group. In the SOC, fluid administration was according to the anesthesiologist's discretion. In the GDFT, the intervention protocol, based on bolus infusion according to blood pressure and delta pulse pressure, was applied. Patients were postoperatively evaluated by an anesthesiologist blinded to the group allocation regarding PPC incidence, mortality, and Length of Hospital Stay (LOHS). ResultsForty-two patients in the SOC group and 43 in the GDFT group. Nineteen patients (45%) in the SOC and 6 in the GDFT (14%) had at least one PPC (p = 0.003). There was no difference in mortality or LOHS between the groups. Among the patients with PPC, four died (25%), compared to two deaths in patients without PPC (3%) (p = 0.001). The LOHS had a median of 14.5 days in the group with PPC and 9 days in the group without PPC (p = 0.001). ConclusionThe GDFT protocol resulted in a lower rate of PPC; however, the LOHS and mortality did not reduce.

Stepwise treatment of complex intestinal fistulas and strategies of nutritional support treatment

Intestinal fistula is one of the common diseases and complications in abdominal surgery. It does not only cause severe abdominal infections but also leads to obstruction, bleeding, malnutrition, and may develop into complex intestinal fistulas, resulting in increased challenges in treatment, elevated treatment costs, and increased risk of patient mortality. At present, the treatment of intestinal fistula mainly adopts a three-stage approach: (1) early diagnosis, (2) mid-term nutritional support treatment, and (3) definitive surgical treatment. Nutritional support treatment can significantly reduce patient mortality and improve recovery. Due to the difficulty, complexity, and diversity of intestinal fistula treatment, and the fact that complex intestinal fistulas are currently a challenge in the treatment of intestinal fistulas, this article will introduce the progress and difficulties at different stages, and explore the future treatment direction of intestinal fistulas from the perspective of interdisciplinary cooperation.

Serial monitoring of pancreatic stone protein for the detection of sepsis in intensive care unit patients with complicated abdominal surgery: A prospective, longitudinal cohort study

PurposeThe objective of this study was to assess the performance of pancreatic stone protein (PSP) monitoring for the detection of sepsis, prediction of outcome and distinction between bacterial and fungal infections in intensive care unit (ICU) patients with complicated abdominal surgery. Materials and methodsIn this prospective multicenter cohort study, patients with complicated abdominal surgery had serial PSP measurements during their ICU stay. Infectious episodes were classified as bacterial, fungal or mixed. PSPmax (maximal PSP value within 48 h of the diagnosis of infection) and ΔPSP (difference between PSPmax and the preceding PSP value) were used for analyses. ResultsPSPmax was obtained for 118 infectious episodes (68 patients). ΔPSP was available for 73 episodes (48 patients). Both PSPmax and ΔPSP were significantly higher in patients with sepsis and in patients with a fatal outcome. A PSPmax ≥124 ng/ml and a ΔPSP ≥34 ng/ml could detect sepsis with a sensitivity/specificity of 84%/54% and 69%/76%, respectively. There was no significant difference of PSPmax or ΔPSP between patients with bacterial/mixed versus fungal infections. ConclusionsSerial PSP monitoring may be an additional tool for the early detection of sepsis in patients with complicated abdominal surgery who are at high risk of severe infections.

Adhesive Nanoparticle-in-Microgel System with ROS Scavenging Capability and Hemostatic Activity for Postoperative Adhesion Prevention.

Postoperative adhesion is a noteworthy clinical complication in abdominal surgery due to the existing physical barriers are unsatisfactory and inefficient in preventing its occurrence. In this work, an elaborate nanoparticle-in-microgel system (nMGel) is presented for postoperative adhesion prevention. nMGel is facilely formed by crosslinking manganese dioxide (MnO2 ) nanoparticles-loaded gelatin microspheres with polydopamine using a modified emulsification-chemical crosslinking method, generating a nano-micron spherical hydrogel. After drying, powdery nMGel with sprayability can perfectly cover irregular wounds and maintains robust tissue adhesiveness even in a wet environment. Additionally, nMGel possesses prominent antioxidant and free radical scavenging activity, which protects cell viability and preserves cell biological functions in an oxidative microenvironment. Furthermore, nMGel displays superior hemostatic property as demonstrated in mouse tail amputation models and liver trauma models. Importantly, nMGel can be conveniently administrated in a mouse cecal defect model to prevent adhesion between the injured cecum and the peritoneum by reducing inflammation, oxidative stress, collagen synthesis, and angiogenesis. Thus, the bioactive nMGel offers a practical and efficient approach for ameliorating postsurgical adhesion.

The Effect of ACE Inhibitors/ARBs Withdrawal on the Risk of Postoperative Complications in Abdominal Surgery

A significant proportion of patients undergoing non-cardiac surgery receive therapy with angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), which are usually prescribed for treatment of arterial hypertension and CHF. Current guidelines fail to provide clear consensus on whether it is worth discontinuing ACEi/ARBs before non-cardiac surgery. The aim of this research was to assess the contribution of pre-op ACEi/ARBs withdrawal to the development of postoperative complications in patients after abdominal surgery using data from STOPRISK database.Materials and methods. Data of 1945 patients from of the STOPRISK database was used for the analysis. Patients were retrospectively divided into two groups: first group (N=471, 24.2%) included patients subjected to ACEi/ARBs withdrawal 24 hours before surgery, second group (N=1474, 75.8%) included patients continuing on ACEi/ARBs therapy. The 30-day outcomes were analyzed — postoperative complications (acute kidney injury, acute respiratory distress syndrome, anastomosis failure, arrhythmias, circulatory arrest, cardiogenic pulmonary edema, postoperative delirium, myocardial infarction, pneumonia, ileus, postoperative bleeding, pulmonary embolism, acute cerebrovascular accident, wound infection) and mortality. We were not evaluating intraoperative and postoperative arterial hypotension and hypertension, we analyzed the use of vasopressors as a surrogate marker. ACEi/ARBs re-initiation after surgery was not evaluated.Results. One or more post-operative complications were documented in 113 patients (5.8%). Only postoperative delirium was more common in patients (1.06% vs. 0.27%, P=0.027) after ACEi/ARBs withdrawal 24 hours before surgery, the difference reached statistical significance. Sub-analysis in the group of patients with arterial hypertension as the only comorbidity showed no statistically significant differences in the outcomes. Sub-analysis in the group of patients with CFH showed higher incidence of postoperative delirium after ACEi/ARBs withdrawal (2.68% vs. 0.6%, P=0.023). The logistic regression analysis showed that the risk of developing postoperative delirium is influenced by age, vasopressor support, and ACEi/ARBs withdrawal (the area under the curve for the model was 0.92 (0.90–0.93).Conclusion. Rates of pre-op ACEi/ARBs withdrawal (24.2%) are consistent with published data. In the entire cohort, ACEi/ARBs withdrawal resulted in higher incidence of postoperative delirium, as well as in the subgroup of patients with CHF, while ACEi/ARBs withdrawal in the subgroup of patients with arterial hypertension had no influence on postop complications.ACEi/ARBs withdrawal, along with hemodynamic instability and older age, contributes to the development of postoperative delirium, which is the subject of future research.

Incisional herniae following lower segment caesarean section: A 20-year chart review

Introduction: The rates of caesarean delivery is increasing worldwide as well as in Sri Lanka. Incisional hernia is a known complication of abdominal surgery. To our knowledge there has been no study to assess the incidence of incisional hernia following caesarean section in Sri Lanka. This study was to assess the incidence of incisional hernia requiring surgical repair after lower segment caesarean section (LSCS) in a cohort during a 20-year period.Methods: This was a chart review based on tertiary care private sector hospital in Sri Lanka. Hernia repairs performed during 2002 to 2022 were identified. The data was retrieved from computer based data base and previous bed head tickets. The main inclusion criterion was a caesarean delivery from the 01st of January 2002 to 31st of December 2022 in women with no history of previous abdominal surgery. The cohort was assessed from their first caesarean delivery until 20 years in the inclusion period for an event of hernia repair. The following exclusion criteria for the hernia repairs were used: Diastasis rectiwithout hernia, hernia not in the caesarean incision, and no hernia. The study was approved by the Research and Ethical Committee of Nawaloka Hospital Sri Lanka. The patient records and the data-set were anonymized before analysis. No conflict of interest.Results: There were 2675 records retrieved. The mean age of the patients was 28±7.5 years. There were 10/2675 (0.37%) patients were found to incisional herniae following LSCS. The majority (7/10) of patients with incisional hernia had lower midline incisions for their LSCS. The average time duration of the occurrence of incisional hernia following a single LSCS was 19.5±2.3 months and it was 14.3±1.6 and 12.3±1.5 months for following second and third LSCS respectively. Majority of the incisional herniae were done as routine cases. Following the incisional hernia repair one patient had a recurrence after year.Conclusion: The overall incidence of having an incisional hernia requiring repair of a caesarean delivery was 0.37%. Most herniae appeared within the first two years and associated with the lower midline incisions.

Application of metagenomic sequencing of drainage fluid in rapid and accurate diagnosis of postoperative intra-abdominal infection: a diagnostic study.

Postoperative intra-abdominal infection (PIAI) is one of the most serious complications of abdominal surgery, increasing the risk of postoperative morbidity and mortality and prolonging hospital stay. Rapid diagnosis of PIAI is of great clinical value. Unfortunately, the current diagnostic methods of PIAI are not fast and accurate enough. We performed an exploratory study to establish a rapid and accurate diagnostic method of PIAI. We explored the turnaround time and accuracy of metagenomic next-generation sequencing (mNGS) in diagnosing PIAI. Patients who underwent elective abdominal surgery and routine abdominal drainage with suspected PIAI were enrolled in the study. The fresh midstream abdominal drainage fluid was collected for mNGS and culturing. We found that the median sample-to-answer turnaround time of mNGS was dramatically decreased than that of culture-based methods (less than 24h vs. 59.5 to 111h). The detection coverage of mNGS was much broader than culture-based methods. We found 26 species from 15 genera could only be detected by mNGS. The accuracy of mNGS was not inferior to culture-based methods in the 8 most common pathogens detected from abdominal drainage fluid (sensitivity ranged from 75% to 100%, specificity ranged from 83.3% to 100%, and kappa values were higher than 0.5). Moreover, the composition of the microbial spectrum established by mNGS varied between upper and lower gastrointestinal surgery, enhancing the understanding of PIAI pathogenesis. This study preliminarily revealed the clinical value of mNGS in the rapid diagnosis of PIAI and provided a rationale for further research.

Crohn's Disease as a Possible Risk Factor for Failed Healing in Ileocolic Anastomoses.

Anastomotic leakage (AL) after colorectal resections is a serious complication in abdominal surgery. Especially in patients with Crohn's disease (CD), devastating courses are observed. Various risk factors for the failure of anastomotic healing have been identified; however, whether CD itself is independently associated with anastomotic complications still remains to be validated. A retrospective analysis of a single-institution inflammatory bowel disease (IBD) database was conducted. Only patients with elective surgery and ileocolic anastomoses were included. Patients with emergency surgery, more than one anastomosis, or protective ileostomies were excluded. For the investigation of the effect of CD on AL 141, patients with CD-type L1, B1-3 were compared to 141 patients with ileocolic anastomoses for other indications. Univariate statistics and multivariate analysis with logistic regression and backward stepwise elimination were performed. CD patients had a non-significant higher percentage of AL compared to non-IBD patients (12% vs. 5%, p = 0.053); although, the two samples differed in terms of age, body mass index (BMI), Charlson comorbidity index (CCI), and other clinical variables. However, Akaike information criterion (AIC)-based stepwise logistic regression identified CD as a factor for impaired anastomotic healing (final model: p = 0.027, OR: 17.043, CI: 1.703-257.992). Additionally, a CCI ≥ 2 (p = 0.010) and abscesses (p = 0.038) increased the disease risk. The alternative point estimate for CD as a risk factor for AL based on propensity score weighting also resulted in an increased risk, albeit lower (p = 0.005, OR 7.36, CI 1.82-29.71). CD might bear a disease-specific risk for the impaired healing of ileocolic anastomoses. CD patients are prone to postoperative complications, even in absence of other risk factors, and might benefit from treatment in dedicated centers.

Risk factors for small-bowel obstruction after colectomy for colorectal cancer: a retrospective study.

Postoperative adhesions are a concerning complication of abdominal surgery with major implications on quality of life. This study aimed to investigate the risk factors for postoperative small-bowel obstruction (SBO) after colectomy for colorectal cancer. We reviewed the clinicopathological variables of 1646 patients who underwent colectomy for colorectal cancer between 2009 and 2018. SBO occurred following primary tumor resection for colorectal cancer in 67 (4.1%) of the 1646 patients. The median observation period was 7.5 (range: 3.0-12.0) years. Multivariate analysis revealed that rectal tumors, anastomotic leakages, previous abdominal surgeries, and longer operating times were all correlated with postoperative SBO, but there were no differences in the incidence of SBO between laparoscopic vs. open surgery. The use of adhesion prevention material had no effect on SBO. Our data showed that the onset of SBO tended to be relatively early, within a year after surgery (89.5%). Tumor localization in the rectum is associated with several problems, including a wide resection area, prolonged operative duration, and high risk of anastomotic leakage, which may increase the risk of SBO. Laparoscopic surgery and adhesion prevention material did not demonstrate a clear preventive effect against SBO.

Results of repeat operation for early adhesive intestinal obstruction

Introduction and Aim: One of the formidable complications in abdominal surgery is early intestinal obstruction, which quickly leads to the development of severe endotoxicosis, and intra-abdominal hypertension. The objective of this study is to present the results of repeat operation of early adhesive intestinal obstruction. Methodology: There were 27 patients (13 men and 14 women) aged 17-73 years under observation, who were re-operated for early intestinal obstruction that occurred after operations on abdominal organs. Twenty-four operations were performed by laparotomic access and three by laparoscopic access. Eighteen were operated on an emergency basis and nine were operated on as per plan. Results: After diagnosis, all patients were operated on under endotracheal anesthesia with median laparotomy access, with the timing of the intervention being different. So, on the first day after the obstruction was detected, five patients were operated on, 15 patients from 24-72 hours, six patients from 3-5 days, and one patient was operated on after five days. This study shows the severity of the condition of patients with early intestinal obstruction and the complexity of treatment. Conclusion: After surgery, treatment should be comprehensive and aimed at etiopathogenesis and affect intra-abdominal pressure, endotoxicosis, and nutritional support.

S2468 Stop, Drop, and Roll: One Woman’s Pelvic Floor Disease Journey

Introduction: Pelvic floor disease includes symptoms of the anterior (urinary, vaginal) and posterior (anorectal) pelvic floor. This case describes a woman who developed dyssynergic defecation after surgical management of urinary incontinence. The diagnostic route taken to reveal the unusual cause of her symptoms is a lesson in how to evaluate ambiguous gastrointestinal(GI)/genitourinary symptoms. Case Description/Methods: A 69-year-old woman presents with bloating and difficulty defecating for 2 years. She senses incomplete evacuation, passing 1-2 thin stools per day despite an extensive bowel regimen (e.g. posturing, straining). Two years ago, she underwent sacrocolpopexy and mesh placement to treat pelvic organ prolapse. Her urinary incontinence improved but constipation worsened. She was thus evaluated by GI- many CTs showed nonspecific sigmoid (SC) thickening. A colonoscopy noted SC narrowing; mucosa pathology was normal. She came to our clinic to investigate further. Digital rectal exam had a normal tone with widening of the vault with strain. Anorectal manometry (ARM) showed dyssynergic defecation and unsuccessful balloon expulsion, consistent with mechanical obstruction. A flexible sigmoidoscopy showed benign-appearing extrinsic compression at the rectosigmoid junction. The SC also had a large stool burden despite 2 pre-procedure enemas. Given a concern for mass effect of the mesh into the colon, an exploratory laparoscopy was performed, showing a redundant SC with scarred, edematous mesentery. A partial sigmoidectomy was performed and adhesions at the anterior rectal wall (near the sacrocolpopexy mesh) were lysed. In just 3 months, the patient’s symptoms resolved. Repeat ARM had a normal defecation pattern and balloon expulsion (Figure). Discussion: Postoperative adhesions are present after 63-97% of open abdominal surgeries. The most common complication of such adhesions is bowel obstruction, occurring in 15% of patients within 1 month of surgery. Our patient had an even more unique complication- constipation and dyssynergic defecation. Literature on post-op adhesions and defecation dysfunction mainly describes surgery of the rectal sphincter. In contrast, the sacrocolpopexy did not involve the rectum or surrounding peritoneum, but caused adhesions with a mass effect on the rectum. Given the morbidity associated with lower abdominal adhesions, suspicion must remain high in populations with a history of complicated abdominal surgery- especially for treatment of anterior pelvic floor disease.Figure 1.: A. Flexible sigmoidoscopy: Very narrowed lumen in the sigmoid colon. B. CT abdomen and pelvis: Coronal view showing sharp angulation in the sigmoid colon (due to the mass effect of the mesh and adhesions) C.Anorectal manometry: The Y-axis notes length (cm) from anal sphincter (0cm) into sigmoid. The X-axis shows time (in seconds). The color of the data points denotes pressure exerted. Here, the top horizontal line in green shows rectal pressure. The same amount of pressure is shows in the bottom “green” areas, indicating that anal tone faily to appropriately relax. This increase in anal pressure with a good push, indicating dyssynergic defecation pattern.

Activating SIRT3 in peritoneal mesothelial cells alleviates postsurgical peritoneal adhesion formation by decreasing oxidative stress and inhibiting the NLRP3 inflammasome

Peritoneal adhesions (PAs) are a serious complication of abdominal surgery and negatively affect the quality of life of millions of people worldwide. However, a clear molecular mechanism and a standard therapeutic strategy for PAs have not been established. Here, we developed a standardized method to mimic the pathological changes in PAs and found that sirtuin 3 (SIRT3) expression was severely decreased in adhesion tissues, which was consistent with our bioinformatics analysis and patient adhesion tissue analysis. Thus, we hypothesized that activating SIRT3 could alleviate postsurgical PAs. Sirt3-deficient (Sirt3−/−) mice exhibited many more PAs after standardized abdominal surgery. Furthermore, compared with wild-type (Sirt3+/+) mice, Sirt3-deficient (Sirt3−/−) mice showed more prominent reactive oxygen species (ROS) accumulation, increased levels of inflammatory factors, and exacerbated mitochondrial damage and fragmentation. In addition, we observed NLRP3 inflammasome activation in the adhesion tissues of Sirt3−/− but, not Sirt3+/+ mice. Furthermore, mesothelial cells sorted from Sirt3−/− mice exhibited impaired mitochondrial bioenergetics and redox homeostasis. Honokiol (HKL), a natural compound found in several species of the genus Magnolia, could activate SIRT3 in vitro. Then, we demonstrated that treatment with HKL could reduce oxidative stress and the levels of inflammatory factors and suppress NLRP3 activation in vivo, reducing the occurrence of postsurgical PAs. In vitro treatment with HKL also restored mitochondrial bioenergetics and promoted mesothelial cell viability under oxidative stress conditions. Taken together, our findings show that the rescue of SIRT3 by HKL may be a new therapeutic strategy to alleviate and block postsurgical PA formation.

Ventral incisional hernia with herniation of the left hepatic lobe: A case report

Incisional hernias are a very common complication of abdominal surgery, reaching form 5–20% to around 69% in the case of high-risk patients with prospective long-term follow-up. Herniation of the liver, however, is extremely rare and there are only a handful of cases reported. Here we present a case concerning a complex incisional defect of the abdominal wall involving liver herniation with mild ischemia that required extensive surgery to repair in a patient with previous history of ovarian cancer with incomplete resection surgery. The treatment choice was manual reduction of the hernia at the moment of presentation and delayed elective surgery for definite correction, aiming at full functional recovery of the abdominal wall muscles and to a better outcome regarding quality of life when compared to mesh repair without closure of the defect. As hernias involving left hepatic lobe are rare and mostly occur in patients with comorbidities, conservative management should be considered. However, depending on the effect they have in quality of life, preoperative conditions should be optimized aiming for a successful abdominal wall reconstruction, despite the patient’s comorbidities.

INSPIRA: study protocol for a randomized-controlled trial about the effect of spirometry-assisted preoperative inspiratory muscle training on postoperative complications in abdominal surgery

BackgroundRehabilitation strategies after abdominal surgery enhance recovery and improve outcome. A cornerstone of rehabilitation is respiratory physiotherapy with inspiratory muscle training to enhance pulmonary function.Pre-habilitation is the process of enhancing functional capacity before surgery in order to compensate for the stress of surgery and postoperative recovery. There is growing interest in deploying pre-habilitation interventions prior to surgery.The aim of this study is to assess the impact of preoperative inspiratory muscle training on postoperative overall morbidity. The question is, whether inspiratory muscle training prior to elective abdominal surgery reduces the number of postoperative complications and their severity grade.MethodsWe describe a prospective randomized-controlled single-centre trial in a tertiary referral centre. The primary outcome is the Comprehensive Complication Index (CCI) at 90 days after surgery. The CCI expresses morbidity on a continuous numeric scale from 0 (no complication) to 100 (death) by weighing all postoperative complications according to the Clavien-Dindo classification for their respective severity.In the intervention group, patients will be instructed by physiotherapists to perform inspiratory muscle training containing of 30 breaths twice a day for at least 2 weeks before surgery using Power®Breathe KHP2. Depending on the surgical schedule, training can be extended up to 6 weeks. In the control group, no preoperative inspiratory muscle training will be performed. After the operation, both groups receive the same physiotherapeutic support.DiscussionExisting data about preoperative inspiratory muscle training on postoperative complications are ambiguous and study protocols are often lacking a clear design and a clearly defined endpoint. Most studies consist of multi-stage concepts, comprehensively supervised and long-term interventions, whose implementation in clinical practice is hardly possible. There is a clear need for randomized-controlled studies with a simple protocol that can be easily transferred into clinical practice. This study examines the effortless adjustment of the common respiratory physiotherapy from currently postoperative to preoperative. The external measurement by the device eliminates the diary listing of patients’ performances and allows the exercise adherence and thus the effect to be objectively recorded.Trial registrationClinicalTrials.govNCT04558151. Registered on September 15, 2020.

Enteral nutrition provides favorable postoperative outcomes for patients with pseudomyxoma peritonei: a retrospective study.

Pseudomyxoma peritonei (PMP) is a rare malignancy, and many uncertainties regarding its treatment and prognosis still remain. The main treatment for PMP is cytoreductive surgery (CRS) combined with heated intraperitoneal chemotherapy (HIPEC), which can lead to intra-abdominal trauma and systemic reactions. Enteral nutrition (EN) is an important and beneficial perioperative option for major complicated abdominal surgery compared with total parenteral nutrition (TPN). However, the role of EN in PMP after surgery is still unknown. The purpose of this study was to analyze the effects of EN on postoperative outcomes in PMP patients. The perioperative clinical data of PMP patients from Xiangya Hospital of Central South University who accepted CRS plus HIPEC from January 2011 to December 2018 were collected and analyzed. The effects of EN on the nutritional status, postoperative complications, and hospital stay time of patients with PMP were studied. We further analyzed the risk factors affecting hospital stay and complications in PMP patients after surgery. A total of 51 PMP patients accepted CRS and were enrolled in this study, including 25 cases in the EN group and 26 patients in the TPN group. The baseline demographic characteristics and preoperative nutritional status were not significantly different between the two groups. The postoperative absolute lymphocyte count (P<0.001), hemoglobin (P=0.016), and albumin (P<0.001) levels of the EN group were higher than those of the TPN group, but the postoperative hospital stay time (P=0.008) and the complication rate (P=0.03) in the EN group were less than those in the TPN group. Logistic regression analysis showed that age (P=0.031), American Society of Anesthesiologists (ASA) score (P=0.008), and EN (P=0.024) were independent risk factors for postoperative hospital stay in PMP patients. ASA score (P=0.006), number of prior operations (P=0.021), and EN (P=0.035) were independent risk factors for postoperative complications in PMP patients. EN support results in better outcomes and is an independent protective factor for the postoperative hospital stay time and complications of PMP patients.

Incisional Hernia following Abdominal Surgery in Children: A Single Centre Experience

Background: Although uncommon, incisional hernia is a well-known complication of abdominal surgery in children and data on incisional hernia in the pediatric age group are sparse. The aim of this study was to evaluate a single center’s experience with regards to the incidence and outcome of incisional hernia in children. Materials and Methods: This was a retrospective study of children aged 15 years and younger who developed incisional hernia following abdominal surgery, between January 2013 and December 2017, at the pediatric surgery unit of a tertiary hospital in Enugu, Nigeria. Results: During the study period, a total of 1004 pediatric abdominal surgeries were performed. Out of this number, 31 patients developed incisional hernia: This accounted for an incidence rate of 3.1%. There was male predominance and the mean age at diagnosis of incisional hernia was 24 months. All the patients presented with a protrusion at or around the site of a previous surgical scar. Non-operative treatment (serial bandaging) was effective in most of the patients. There was no mortality. Conclusion: Incisional hernia is a well-known complication of abdominal surgery. This study recorded the incisional hernia incidence rate of 3.1%. Non-operative treatment was successful in majority of the patients. Future studies should emphasis on the specific risk factors (surgeon/patient) that may predispose to incisional hernia.

Gastric Ulcer Bleeding associated with a Left Gastric Artery Pseudoaneurysm

A left gastric artery (LGA) pseudoaneurysm is known to occur as a complication of abdominal surgery, trauma, or pancreatitis. However, an LGA pseudoaneurysm presenting with gastrointestinal bleeding is rare. A 77-year-old man complained of dizziness and three episodes of melena in the last 24 hours. He did not have a history of surgery, trauma, or pancreatitis. He underwent primary coronary intervention for unstable angina and started dual antiplatelet therapy 1 month prior. Esophagogastroduodenoscopy (EGD) revealed a 3-cm ulcer in the lesser curvature of the gastric high body with a pulsating subepithelial tumor-like lesion in the ulcer. Hemostasis was achieved endoscopically. Three days after the endoscopic hemostasis, hematemesis and hypovolemic shock occurred. Emergent angiography of the superior mesenteric artery revealed an LGA pseudoaneurysm with extravasation. Coil embolization was successfully performed. Three days after the angiographic embolization, EGD revealed improvement of the gastric ulcer, which was covered with exudate, and disappearance of the subepithelial tumor-like lesion. At the 2-month follow-up, EGD showed that the ulcer was in the healing stage.

Oncologic colorectal surgical site infection: oral or not oral antibiotic preparation, that is the question.

Surgical wound infection is the most frequent postoperative complication in abdominal surgery, especially at the colorectal level. The aim of this study is analysing the results of mechanical colon preparation combined with oral antibiotic versus mechanical colon preparation without antibiotic therapy in patients with colorectal cancer undergoing elective surgery. This retrospective cohort study had been developed from November 2017 to February 2020. We have included a total of 281 consecutive patients undergoing elective colon and rectal oncological surgeries by the same surgical group using laparoscopic and open approaches. Transanal minimally invasive surgery (TAMIS) and transanal total mesorectal excision (TaTME) approaches were excluded. Exposed patients undergoing colon and rectal cancer surgery received mechanical bowel preparation and oral antibiotics with three doses of neomycin 1g and erythromycin 500mg the day before surgery. The primary outcome was reduction in surgical wound infection rates before and after starting the oral antibiotic therapy from 17 to 6% (p < 0.05). As a secondary analysis, we evaluated the anastomotic dehiscence rate, corresponding with a decrease from 12 to 3% (p < 0.05). Mechanical bowel preparation combined with oral antibiotic therapy is still not unanimously carried out in all the medical hospitals. In this report, we show that mechanical bowel preparation in combination with oral antibiotic reduces the risk of surgical wound infection and anastomotic leakage in patients undergoing colon and rectal cancer surgery.

A rare type of postoperative abdominal herniation

Resume. Postoperative abdominal hernia is considered the most common complication in abdominal surgery. Aim. To acquaint medical practitioners with the clinical case of diagnosis and treatment of impaired postoperative contraperture true abdominal hernia on the background of a closed abdominal injury. Materials and methods. We present a clinical case of our own observation of the clinical course, diagnosis and treatment of impaired postoperative contraperture true abdominal hernia with necrosis of the loop of the small intestine and necrosis of the large omentum, acute strangulation small intestinal obstruction, general serous-fibrinous peritonitis, adhesive peritoneal disease of the 2nd degree at patient with closed abdominal trauma. Results. The patient with a closed abdominal injury, the results of the examination and treatment of which are given in the article, in the anamnesis - cholecystoectomy 39 years ago. The preliminary diagnosis: closed abdominal trauma, peritonitis. Intraoperatively, a case of true postoperative abdominal hernia of rare localization - contraperture hernia. It was taking into account the patient's complaints, medical history, results of physical examination, the results of laboratory and instrumental methods of research available at the time of examination. The clinical interest is not only the rarity of the birth of this pathology, but also the history of the disease, diagnostic search, clinical picture and treatment tactic. Conclusions. In this case, the patient was probably a hernia carrier for many years, and the injury only provoked the infringement. The patient sought medical help late, as result of which the picture of peritonitis was obvious. This made it possible to quickly decide on the need for surgical treatment. Otherwise, the likelihood of a tactical error is not excluded. We believe this case is interesting because one should always remember about the possible surgical pathology against the background of a closed abdominal trauma.

Complications of Intraperitoneal Mesh Techniques for Incisional Hernia - A Systematic Review.

Incisional hernia is considered to be one of the most frequent complication of abdominal surgery, with an incidence up to 20% or 35-50%. Given the latest focus on laparoscopic approach of any surgical pathology, there is a tendency in managing the incisional hernias in this particular manner, which impose intraperitoneal onlay mesh placement (IPOM). The aim of this review is to gather more information regarding the possible complications that can be associated with this technique. The study was conducted based on a bibliographic research using the databases: PubMed, Scopus and Web of Science. The work was reported in line with PRISMA guidelines. The study conducted shows that the short-term risks of intraperitoneal mesh placement for incisional hernia repair are not life-threatening and are comparable to other prosthetic surgical techniques. The most frequent complications can be devided in minor: seroma, hematoma and recurrent pain, and major: enterocutaneous fistula, mesh infection and Adhesions-Bowel obstruction. The high rate of unavailability for follow-up, especially regarding major complications that usually occur after a significant period of time, limits the results of the studies documented and they lack the quality-of-life assessment.