Development Of Intra-abdominal Abscess Research Articles

Association between bacterial resistance profile and the development of intra-abdominal abscesses in pediatric patients with perforated appendicitis: cohort study

PurposeThe objective of this study was to determine the association between the presence of a microorganism resistant to the antibiotic used in empirical therapy and the development of intra-abdominal abscesses in children with perforated appendicitis.MethodsA prospective cohort study was conducted in patients under 18 years of age who underwent laparoscopic appendectomy between November 1, 2019, and September 30, 2020, in whom perforated appendicitis was documented intraoperatively. Peritoneal fluid samples were taken for bacteria culture purposes, and clinical and microbiological data were collected from all patients.ResultsA total of 232 patients were included in the study. The most isolated microorganisms were Escherichia coli (80.14%) and Pseudomonas aeruginosa (7.45%). In addition, 5.31% of E. coli isolates were classified as ESBL-producing organisms. No association was found between a germ resistant to empiric antimicrobial therapy and the development of a postoperative intra-abdominal abscess. Multivariate analysis showed that being a high-risk patient on admission (OR 2.89 (p = 0.01)) was associated with the development of intra-abdominal abscesses postoperatively.ConclusionE. coli was the most commonly isolated microorganism, with a low rate of ESBL-producing isolates. No association between resistance and risk of postoperative intra-abdominal abscess was found. However, it was identified that being a high-risk patient on admission was associated with this complication.Type of studyPrognosis study.Level of evidenceLevel I.

Primary Repair Versus Resection for AAST Grade I and II Colon Injuries: Does the Type of Repair Matter?

IntroductionThe management of traumatic colon injuries has evolved over the past two decades. Recent evidence suggests that primary repair or resection over colostomy may decrease morbidity and mortality. Data comparing patients undergoing primary repair versus resection are lacking. We sought to compare the outcomes of patients undergoing primary repair versus resection for low-grade colon injuries. MethodsA retrospective review of all patients who presented with American Association for the Surgery of Trauma grade I and II traumatic colon injuries to our Level I trauma center between 2011 and 2021 was performed. Patients were further dichotomized based on whether they underwent primary repair or resection with anastomosis. Outcome measures included length of stay data, infectious complications, and mortality. ResultsA total of 120 patients met inclusion criteria. The majority of patients (76.7%) were male, and the average age was 35.6 ± 13.1 y. Most patients also underwent primary repair (80.8%). There were no statistically significant differences between the groups in arrival physiology or in injury severity score. Length of stay data including hospital length of stay, intensive care unit length of stay, and ventilator days were similar between groups. Postoperative complications including pneumonia, surgical site infections, fascial dehiscence, the development of enterocutaneous fistulas, and unplanned returns to the operating room were also all found to be similar between groups. The group who underwent resection with anastomosis did demonstrate a higher rate of intra-abdominal abscess development (3.1% versus 26.1%, P < 0001). Mortality between both groups was not found to be statistically significant (7.2% versus 4.3%, P = 0.4) ConclusionsFor low-grade (American Association for the Surgery of Trauma I and II) traumatic colon injuries, patients undergoing primary repair demonstrated a decreased rate of intra-abdominal abscess development when compared to patients who underwent resection with anastomosis.

Validation of the American Association for the Surgery of Trauma Organ Injury Scale for Penetrating Colon Injuries.

In 2020, the American Association for the Surgery of Trauma (AAST) published a revision of the organ injury scale (OIS) for bowel injuries. The update included for the first time a separate OIS for penetrating colon injuries as well as imaging criteria. To validate the new OIS and its correlation with outcomes, we performed a retrospective review of patients with penetrating colon injuries (AIS<3 in other body regions) between 2016 and 2020 at a single institution. Sixty-six patients met inclusion criteria. Most were young (29years median) and male (90%). All underwent operative intervention and 23 (34%) had pre-operative imaging. Imaging grade was higher than operative grade in 11 patients (48%). Higher AAST operative grade was associated with a higher likelihood of resection and anastomosis or colostomy, need for damage control laparotomy, and development of intra-abdominal abscess and acute kidney injury. A multicenter study is underway to confirm these findings.

Significance of granulomas in the outcomes of Crohn's disease patients.

BackgroundThe presence of granulomas in the gastrointestinal (GI) tract is one of the characteristic histologic features of Crohn’s disease (CD). The clinical significance of granulomas remains unclear. In this study, we aimed to determine whether the presence of granulomas on endoscopic pinch biopsy or surgical resection from the upper or lower GI tract is associated with worse outcomes among patients with CD.MethodsThis was a retrospective chart review of patients with CD evaluated at a tertiary care center between 1996 and 2019. Patients were divided into 2 groups based on the presence or absence of granulomas on GI histology. Clinical and laboratory data, and outcomes of interest, were obtained from the electronic medical records. Patients’ characteristics and outcomes were compared between the 2 groups.ResultsA total of 237 patients were included in our study; 41 (17.3%) had granulomas on their biopsy/resection specimen. The presence of granulomas in the GI tract was significantly associated with the development of intra-abdominal abscesses and/or fistulas (P=0.037), greater utilization of immunomodulators (P=0.029), and greater use of immunosuppressive medications (immunomodulator and/or biologic therapy) (P=0.015). No significant differences were found between the 2 groups in terms of number of hospitalizations, presence of perianal disease, intestinal resection, mean age, mean age at initial diagnosis of CD, duration of disease, sex, or smoking history.ConclusionsThe presence of granulomas in the GI tract of CD patients may serve as a prognostic biomarker of worse disease severity. Larger studies are needed to better validate this finding.

Should the severity of acute cholecystitis (Tokyo 2018 guideline) affect the decision of early or delayed cholecystectomy?

In our study, we aimed to compare the complication rates of patients presenting with acute cholecystitis and undergoing surgery at the time of hospitalization (early cholecystectomy) and delayed cholecystectomy and also to examine whether the severity of cholecystitis has an effect on the timing of cholecystectomy. The study was planned retrospectively and the approval of the ethics committee of our hospital was obtained. The patient files of the patients who were admitted to our tertiary hospital with acute cholecystitis were accessed through the hospital archive system. The patients were divided into two groups, those who were admitted to the emergency department for acute chole-cystitis and who underwent early cholecystectomy and delayed cholecystectomy. The Tokyo 2018 acute cholecystitis guideline was used to determine the severity of acute cholecystitis. Pre-operative and post-operative data of the patients were examined and their complications were evaluated. The data of 158 patients who met the inclusion criteria were retrospectively analyzed. Compared with delayed chole-cystectomy, complication rates increased in patients who underwent early cholecystectomy (8.1% and 32.2%, respectively, p<0.001). According to the Tokyo 2018 guideline, patients with acute cholecystitis were grouped as Tokyo 1, 2, and 3; and of Tokyo 1 patients, more complications were observed in those who underwent early cholecystectomy (22.6% and 4.2%, respectively, p=0.004). When the complications were examined, it was observed that pulmonary embolism, pneumonia, intra-abdominal abscess development, sepsis, and wound infection were significantly higher in those who were operated early. When the factors affecting complications are examined, having a Tokyo score of 2 and above (OR: 4.161), high creatinine levels (OR: 5.496), and presence of additional disease (OR: 4.238) increase the risk of developing complications. More complications occur after cholecystectomy in patients with Tokyo 2 and above, when compared with patients with Tokyo 1. It was observed that more complications developed in patients with Tokyo 1 cholecystitis who were operated in the early period. Further studies are needed to determine the effect of acute cholecystitis severity in determining the timing of cholecystectomy.

Multi-Center Prospective Study of Restrictive Post-Operative Antibiotic Treatment of Children with Complicated Appendicitis.

Background: No consensus has been reached regarding the most advantageous duration of antibiotic prophylaxis to decrease post-operative infection complications of appendectomy for acute complex appendicitis. This study aimed to determine the efficacy of short-term antibiotic treatment on post-operative complications in children with complex appendicitis. Methods: A multi-center, parallel group, randomized study was conducted in patients younger than 14 years of age with complicated appendicitis at three hospitals in China. The qualified patients were randomized prospectively to either the restrictive 72-hour short-term antibiotic strategy or the standard antibiotic usage. A comparison of the complications within 24 months, including infectious complications and long-term results, were conducted between the two groups. This trial is registered with the Chinese Clinical Trial Registry (ChiCTR), number ChiCTR1900023941 and is complete. Results: A shorter duration of antibiotic treatment had no effect on intestinal function recovery, antibiotic-associated diarrhea, and health-care-associated Clostridium difficile infection and infectious complication, including intra-abdominal abscess development (17.9% vs. 18.0%, p = 0.52). Furthermore, no substantial difference for re-admission requirement and re-operation were found between the two treatment strategies. A sizeable decrease in total duration of hospitalization (p < 0.001) and average total antibiotic duration (p < 0.001) were observed for the restrictive antibiotic strategy group. Conclusion: In complicated appendicitis, the restrictive antibiotic usage was equivalent to standard antibiotic usage in terms of short- and long-term outcomes, but with shorter hospital stays and fewer antibiotic agents.

2438. Using Artificial Neural Networks to Predict Intra-Abdominal Abscess Risk Post-Appendectomy

BackgroundApplying Artificial Intelligence techniques to healthcare data are gaining momentum. Early identification of patients at risk of surgical site infections is a major clinical goal. Our objective for this study was to determine whether deep learning AI techniques could identify patients at risk of intra-abdominal abscess development post-appendectomy using clinical data for pediatric patients undergoing appendectomy.MethodsA dataset of 1,574 patients classified by surgeons as negative (1,328) or positive (246) for Intra-Abdominal Abscess Post-Appendectomy for Appendicitis were selected from a database containing 6,127 patients less than 19 years-old who had appendectomy at our institution between 2009–2018. Demographic, clinical, and surgical information were extracted. 34 Independent variables were identified to be useful for the study. Using Random Forest methodology 12 variables with the highest influence on the outcome were selected for the final dataset. Data imputation (MICE algorithm) was used to replace missing data points. Two “Reproducible” Artificial Neural Networks with different architectures were developed to predict the risk of developing Intra-Abdominal Abscess Post- Appendectomy: Model (1) 12 Inputs, 3 hidden layers with 12 Neurons each, and 1 Output. Model (2) 12 Inputs, 2 hidden layers with 18 Neurons each, and 1 Output.ResultsFor the 1,574 patients (80%-20% used as training and test sets), Model (1) achieved Accuracy of 89.84%, Sensitivity of ~ 70%, and Specificity of 93.61% on the test set while Model (2) achieved Accuracy of 84.13%, Sensitivity of 81.63%, and Specificity of 84.6%. The difference between the models is that in Model (2) we over sampled the minority class (using SMOTE algorithm) to balance both classes which helped the model to learn both classes without bias and improved sensitivity over Model (1).ConclusionDeep learning algorithms applied to enough clinical variables can identify patients with high probability for the risk of developing intra-abdominal abscess post-appendectomy. While further test sets are necessary to validate the models, Artificial Neural Networks can be an important addition to current post-surgical care guidelines to personalize and optimize care to reduce infections following appendectomy. Disclosures All authors: No reported disclosures.

Are Preoperative CT Findings Useful for Predicting Postoperative Intraabdominal Abscess in the Patients with Acute Appendicitis?

Background and objective: In patients with acute appendicitis (AA), preoperative computed tomography (CT) findings suggesting development of intraabdominal abscess (IAA) had not been widely used. The aim of this study was to investigate the preoperative clinical and radiological factors that predict the development of a postoperative IAA in patients with AA who were treated by laparoscopic appendectomy (LA). Methods: Two hundred and sixteen patients with pathologically proven AA underwent LA between January 2013 and March 2018 in our department. Medical records and preoperative CT images of these 216 patients were retrospectively reviewed and the predictive factors of postoperative IAA were investigated. In addition, patients were divided into complicated appendicitis (CA) and simple appendicitis (SA) and perioperative factors of two groups were compared. Results: One hundred and forty-seven patients were diagnosed with CA, while the other 69 patients were diagnosed with SA. Sixteen patients developed postoperative IAA in the CA group, while no patients in the SA group did. The univariate analysis revealed that time from onset to surgery more than 3 days (p = 0.011), the preoperative CT finding of periappendiceal fluid (p = 0.003), abscess (p < 0.001), and free air (p < 0.001), operation time more than 120 min (p = 0.023) and placement of a drainage tube (p < 0.001) were significantly associated with the development of IAA. Multivariate analysis revealed that the preoperative CT finding of free air was independently associated with the development of IAA (p = 0.007, odds ratio = 5.427, 95% CI: 1.586–18.57). Conclusions: IAA developed predominantly in patients with CA. Preoperative CT findings of free air was found to be an independent predictor for the development of IAA. Surgeons should be meticulous in managing the postoperative course of patients with this finding.

Laparoscopic Procedure is Not Independently Associated With the Development of Intra-Abdominal Abscess After Appendectomy: A Multicenter Cohort Study With Propensity Score Matching Analysis.

The aim of this study was to identify independent risk factors for postoperative intra-abdominal abscess (IAA) after appendectomy for patients with acute appendicitis. Although laparoscopic appendectomy (LA) has been performed universally, whether LA is associated with an increased incidence of postoperative IAA compared with open appendectomy (OA) remains controversial, which causes some surgeons' increasing concerns. We retrospectively analyzed 6805 consecutive adult patients with acute appendicitis who underwent LA or OA at 7 general hospitals in China. Patient characteristics, operative variables, and surgical outcomes were collected and compared between patients who underwent LA and OA. Propensity score matching analysis was used to minimize the bias in patient selection differing from various procedure of appendectomy. Independent risk factors associated with the development of postoperative IAA after appendectomy were identified by univariate and multivariate logistic regression analysis in the propensity matched cohort. Over a 3-year period, 2710 (39.8%) and 4095 (60.2%) patients underwent LA and OA respectively. Patients who underwent OA had more males, American Society of Anesthesiologists score 2-3, preoperative systemic inflammatory response syndrome, and perforated appendicitis than those who underwent LA (all P<0.01). Propensity score matched analysis created 2542 pairs of patients. Univariate analysis revealed that patients who underwent LA had a higher incidence of postoperative IAA than patients who underwent OA (6.7% vs. 5.3%; P=0.039). However, multivariate logistic regression analysis identified LA not to be an independent risk factor associated with the development of postoperative IAA (odds ratio, 1.053; 95% confidence interval, 0.922-1.657; P=0.216). The present study identified that laparoscopic procedure was not an independent risk factor associated with the development of postoperative IAA after appendectomy of acute appendicitis. Therefore, concerns of increased incidence of IAA because of laparoscopic procedure are unwarranted.

Antibiotic Duration After Laparoscopic Appendectomy for Acute Complicated Appendicitis.

Optimal duration of antibiotic treatment to reduce infectious complications after an appendectomy for acute complicated appendicitis remains unclear. To investigate the effect of antibiotic duration on infectious complications after laparoscopic appendectomy for acute complicated appendicitis. National multicenter prospective, observational, surgical resident-led cohort study conducted in June and July 2014. This study involved academic teaching hospitals (n = 8), community teaching hospitals (n = 38), and community nonteaching hospitals (n = 16), and all consecutive patients (n = 1975) who underwent surgery for suspected acute appendicitis. Patients treated laparoscopically for whom the antibiotic regimens were prolonged postoperatively because of complicated appendicitis. Receiving either 3 or 5 days of antibiotic treatment as planned and additional variables were explored as risk factors for infectious complications using regression analyses. A total of 1975 patients were included in 62 participating Dutch hospitals; 1901 (96.3%) of these underwent an appendectomy for acute appendicitis and laparoscopy was used in 74.4% of these patients (n = 1415). In 415 laparoscopically treated patients, antibiotic treatment was continued for more than 24 hours because of acute complicated appendicitis (29.3%). The prescribed antibiotic duration varied between 2 and 6 days in all of these patients. In 123 patients (29.6%), the length of treatment was adjusted. A shorter duration of antibiotic treatment (3 days instead of 5) had no significant effect on any infectious complication (odds ratio [OR], 0.93; 95% CI, 0.38-2.32; P = .88) or on intra-abdominal abscess development (OR, 0.89; 95% CI, 0.34-2.35; P = .81). Perforation of the appendix was the only independent risk factor for the development of an infectious complication (OR, 4.90; 95% CI, 1.41-17.06; P = .01) and intra-abdominal abscess (OR, 7.46; 95% CI, 1.65-33.66; P = .009) in multivariable regression analysis. Lengthening of postoperative antibiotic treatment to 5 days was not associated with a reduction in infectious complications. Further restriction of antibiotic treatment can be considered in nonperforated complicated appendicitis.

Nonsurgical management of multiple splenic abscesses in an obese patient that underwent laparoscopic sleeve gastrectomy: case report and review of literature

Key Clinical MessageSleeve gastrectomy (SG) is a surgical weight-loss procedure. Splenic abscess is a rare complication of SG. Four cases of splenic abscess after SG have been reported, all managed by surgical intervention. We report the first documented case of multiple splenic abscesses following SG managed conservatively by an integrated medical treatment.

Laparoscopic appendectomy for perforated appendicitis in children: Is intraperitoneal drainage necessary?

Objective: In this study, our aim is to evaluate the necessity of intraperitoneal drainage in perforated appendicitis. Methods: 510 pediatric patients [246 laparoscopic (LA) and 264 open (OA)] underwent appendectomy between 2007 and 2014. 275 of them were perforated appendicitis (106 LA, 169 OA). The patients were retrospectively evaluated in terms of age, sex, symptoms, length of hospital stay (LOHS), antibiotherapy, postoperative nasogastric tube placement and intraperitoneal drainage, follow-up period, intraoperative and postoperative complications. Results: Statistically significant differences were observed between laparoscopic perforated appendicitis (71 male, 35 female; median 9.5 years) and open perforated appendicitis (108 male, 61 female; median 9 years) groups in terms of placement of nasogastric tube (102/106 vs.169/169) (p=0.021), length of hospital stay (1.67± 0.11 days vs. 2.34± 0.09 days) (p<0.001), intraperitoneal drainage (32/106 vs. 138/169), (p<0.001), duration of intraperitoneal drainage (1.66± 0.28 vs. 4.21± 0.2 days) and LOHS (5.82± 0.3 vs. 4.23± 0.6 days) respectively (p <0.001). There was no significant difference between the two groups in terms of development of intra-abdominal abscess (10/106 vs. 9/169), (p=0.144), surgical site infection (2/106 vs. 8/169), (p=0.187) and development of adhesive intestinal obstruction (1/106 vs. 9/169) (p=0.053). Conclusion: Laparoscopic access reduces the necessity for drainage and shortens duration of nasogastric tube and length of hospital stay. J Clin Exp Invest 2015; 6 (3): 224-227 Key words: Laparoscopic appendectomy, perforated appendicitis, intraperitoneal drainage

A 15-Year-Old Girl with Fever and Abdominal Pain

We present a case of a previously healthy 15-year-old girl with fever, right lower quadrant pain, and hip pain. Her history was notable for a recent laparoscopic appendectomy that was complicated by the development of intraabdominal abscesses. She reported normal bowel movements and good appetite on a regular diet, although she did endorse a recent 5-kg weight loss. Further investigation and examination revealed a diagnosis of Crohn's disease with recurrent psoas muscle abscess as the etiology of her pain and fevers. Psoas abscess is a rare complication of Crohn's disease, and vague presenting symptoms may complicate its diagnosis. This case demonstrates the importance of maintaining a broad differential diagnosis when treating a child presenting with abdominal pain and fever.

Impact of bacterial culture positivity of the drainage fluid during the early postoperative period on the development of intra-abdominal abscesses after gastrectomy

The aim of this study was to evaluate the impact of positive bacterial cultures of the drainage fluid (D-cultures) during the early postoperative period on the incidence of intra-abdominal abscess formation following gastrectomy. From January 2012 to June 2013, we prospectively performed D-cultures on postoperative day (POD) 1 in consecutive gastric cancer patients who underwent gastrectomy. The univariate and multivariate analyses were performed to identify the risk factors for intra-abdominal abscess formation without anastomotic leakage. The rate of positive D-cultures was 6.4 % on POD 1. According to a univariate analysis, the use of combined organ resection (P = 0.011), the drain amylase level on POD 1 (P = 0.016) and the D-culture status on POD 1 (P = 0.004) were found to be significantly associated with the incidence of intra-abdominal abscesses. A multivariate analysis demonstrated that D-culture positivity on POD 1 was the only independent predictor of intra-abdominal abscess formation (P = 0.011). The present study demonstrated that bacterial culture positivity of drainage fluid during the early postoperative period has a significant impact on the development of intra-abdominal abscesses after gastrectomy.

Right Upper Quadrant Abdominal Pain Ten Years Post-laparoscopic Cholecystectomy

Purpose: A 72-year-old woman with past history of laparoscopic cholecystectomy 10 years ago presented with a 6-month history of intermittent right upper quadrant abdominal and flank pain without association with food intake. She denied fever and weight loss. Physical examination revealed erythema and tenderness in the right lateral aspect of the upper abdomen. Labs were unremarkable. Computed tomography (CT) of the abdomen showed a complex 21 x 5.8 x 8.8 cm perihepatic fluid collection with internal septations, which fistulized through the abdominal wall and formed a 5.6 x 2 cm subcutaneous fluid collection in the right flank. HIDA scan and MRCP ruled out bile leak. Ultrasound guided drainage of the abscess drained thick, greenish fluid. The patient was empirically started on ceftriaxone and metronidazole. Bacterial and fungal cultures as well as PPD, Echinococcus, and Entamoeba serology were all negative. Cytology revealed proteinaceous material with few inflammatory cells and many degenerated structures, suspicious for, yet not definitive of, Echinococcus cyst. Patient received a 6-week course of albendazole, and PAIR procedure (puncture, aspiration, injection, and re-aspiration) was performed with no improvement in symptoms. Repeat CT scan showed persistence of the abscess. An exploratory laparotomy was performed with 500 ml of fluid drained and evacuated 28 gallstones, confirmed by pathology, from the cavity. The fluid cultures were again negative. Repeat CT scan performed a month after the surgery showed near complete resolution of the abscess. Gallbladder perforation during laparoscopy cholecystectomy can result in spillage of gallstones into the peritoneal cavity, which may lead to the development of intra-abdominal abscesses that are easily misidentified as tumors or parasitic infections on radiography due to their similar appearance. The rarity and chronicity of this problem makes the diagnosis very challenging. Treatment requires exploratory laparotomy to remove all dropped gallstones. Less invasive procedures such as percutaneous drainage are effective for resolving acute symptoms, but allow recurrence of abscess. Most patients get a short course of antibiotics based on fluid cultures that typically reveal E. coli, Klebsiella pneumoniae, and Enterococcus. Interestingly, in our patient, the cultures were negative, suggesting that the development of the abscess was secondary to foreign body reaction to the dropped gallstones. Our case illustrates the importance of considering dropped gallstones in the differential diagnosis of intra- or extraperitoneal abscesses in any patient with a history of laparoscopic cholecystectomy, regardless of the time elapsed since surgery.

Abscess rate of patients with penetrating abdominal injury in Zaria

Background: Penetrating abdominal injury occurs when a foreign object pierces the skin. The morbidity and mortality associated with penetrating abdominal trauma is related to the intra-abdominal complications. This study is, therefore, intended to determine the abscess rate resulting from penetrating abdominal trauma in Ahmadu Bello University Teaching Hospital Zaria. Method: A 6-year (January 2006-December 2011) retrospective study of penetrating abdominal trauma emphasizing on the rate of development of intra-abdominal abscess. Information was obtained from patients’ case notes, operating room log books and surgical audit data. Information extracted included cases of penetrating abdominal trauma, intra-operative findings and cases of intra-abdominal abscesses. Results: A total of 39 cases of penetrating abdominal trauma were treated within this period of six years. 3 (7.7%) were treated in 2006, 6 (15.4%) in 2007, 3 (7.7%) in 2008 and 11 (28.2%) in 2009, 8 (20.5%) in 2010, 9 (23.1%) in 2011. 26 (66.7%) were adult while 13 (33.3%) were paediatric cases. The male were 37 (94.9%) and the female were 2 (5.1%), with a sex ratio of 18.5:1 (male to female). The age range was 5 -60 years (39.92 mean). The commonest cause of injury was road traffic accident. At exploration, 13 (33.3%) had organ injury only, 17 (43.6%) suffer from both organ injury and intra-peritoneal emorrhage, 9 (23.1%) had retroperitoneal haemorrhage only. The intra-abdominal abscess rate of penetrating abdominal injury in Zaria was found to be 2.6%. Conclusion: Contamination from either foreign object or organ injury is found to increase the risk of post-operative intra-abdominal abscess. In this center, the abscess rate of penetrating abdominal trauma is comparatively low.

Pancreaticoduodenectomy can be safely performed in the elderly

Although pancreaticoduodenectomy has been recognized in the past for its severe complications, improvements in operative methods and perioperative management have made it a safe procedure. Therefore, pancreaticoduodenectomy can be performed in elderly patients, and our experience and outcomes are described in this report. We retrospectively investigated 142 patients in whom pancreaticoduodenectomy was performed without stenting tubes during pancreaticojejunostomy. The patients were classified into two groups: (A) those older and (B) younger than 75 years. The outcomes, including preoperative characteristics, intraoperative characteristics, postoperative complications and mortality, are herein reported. Continuous variables were compared using Student's t test and the Chi-square test. There were no differences between groups A and B in terms of sex, operative time, amount of blood loss, performance status, soft pancreas rate, disease distribution and operative procedure. Comorbidities in groups A and B were statistically different. Regarding the preoperative status, the elderly patients exhibited lower serum albumin and hemoglobin levels than the younger patients. There were no differences in mortality (0 vs. 0 %), morbidity (24.3 vs. 29.5 %, p = 0.362), postoperative hospital days or major complications such as pancreatic fistula development, delayed gastric emptying, intra-abdominal abscess development, biliary fistula formation and postpancreatectomy hemorrhage. Pancreaticoduodenectomy can be safely performed in elderly as well as younger patients.

Risk Factors for the Development of Intra-Abdominal Abscess Following Splenectomy for Trauma

Risk Factors for the Development of Intra-Abdominal Abscess Following Splenectomy for Trauma

Pancreaticojejunostomy (PJ) after pancreatico-duodenectomy (Duct to mucosa versus invaginating end to side anastomosis)

Aim: This prospective randomized trial compares the results of pancreaticoduodenectomy with duct to mucosa pancreaticojejunostomy with external stent versus pancreatico-duodenectomy with invaginating (dunking) end to side pancreaticojejunostomy Methods: This study included 40 patients who underwent surgical therapy for cancer head of pancreas, between Sep. 2009 and March 2011 at Ain Shams University Hospitals. Patients were randomly assigned to surgical procedures. Patients in group 1 (n 20) underwent pancreaticoduodenectomy with end to side duct to mucosa pancreatico-jejunostomy and external stent, and patients in group 2 (n 20) underwent pancreatico-duodenectomy with invaginating (dunking) end to side pancreaticojejunostomy. Results: In group 1 two patients (10%) developed pancreatic fistula compared to five patients (25%) in group 2.As regards development of intra-abdominal abscess, one patient in group 1 developed that complication while two patients (10%) in group 2 developed intra-abdominal abscess. One patient (5%) in group 2 had postoperative bleeding.One patient in group 1 (5%) developed septicemia compared to three patients (15%) in group 2. Two patients in group 2 needed reoperation. Conclusion: Duct to mucosa pancreaticojejunostomy has less post-operative morbidity as pancreatic fistula, intra-abdominal abscess and septcemia than invaginating (dunking) pancreaticojejunostomy.

Middle Pancreatectomy - Own Experience

The aim of the study was to analyse early results after middle pancreatectomy based on our experience. During the period between 2008 and 2009, 154 pancreatic resections were performed at the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice. The following procedures were performed: 109 (70.78%) pancreatoduodenectomies, 32 (20.78%) distal pancreatectomies, 9 (5.84%) middle pancreatectomies, 3 (1.94%) total pancreatic resections, and 1 (0.65%) subtotal pancreatic resection. Early results in case of nine middle pancreatectomies were subject to analysis. Average hospitalization period amounted to 24.28 days (ranging between 8 and 57 days). Mean hospitalization period after surgery amounted to 20.71 days (ranging between 6 and 54 days). Average duration of the surgical procedure amounted to 3.6 hours (ranging between 2.25 and 4 hours). Wirsung's duct required drainage in 4 (44.4%) patients. Pancreatoenterostomy was performed in 5 (55.5%) patients. Early postoperative complications were observed in three (33.3%) patients. The most common complications included wound suppuration and intra-abdominal abscess development observed in two (22.2%) patients. Pancreatic fistula development during the postoperative period was observed in case of one (11.1%) patient. Other early postoperative complications included peritoneal cavity hemorrhage (1-11.1%) and pancreatic necrosis (1-11.1%). Two (2.22%) reoperations were required. Early postoperative mortality amounted to 0%. Middle pancreatectomy operations performed in experienced centers are considered as safe procedures with a low rate of complications. The most common indication for middle pancreatectomy is the diagnosis of a benign pancreatic tumor.