Elective Closure Research Articles

Incisional Negative Pressure Wound Therapy Versus Primary Wound Suturing after Intestinal Ostomy Closure: A Systematic Review and Meta-Analysis.

Objective: Wound infection after intestinal ostomy closure is a very common postoperative complication. An alternative to primary wound suturing by single sutures or purse string sutures (PSS) is applying incisional negative pressure wound therapy (iNPWT). The aim of the following systematic review and meta-analysis was to assess and compare clinical outcomes in patients after PSS and iNPWT use. Approach: The aim of the study was to find relevant clinical data comparing outcomes of iNPWT and primary wound closure after intestinal ostomy closure. The search was conducted using the MEDLINE/PubMed, ScienceDirect, EMBASE, Scopus, Cochrane Controlled Register of Trials, SciELO, and Web of Science databases and took place up to November 12, 2022. The authors did not use date or language filters. Statistical analysis was performed using Review Manager 5.4 (The Cochrane Collaboration, 2020, London, UK). The authors conducted a meta-analysis of the following four parameters: wound healing time (WHT), surgical site infections (SSIs), complications, and length of hospital stay (LOS). Odds ratios (OR) and inverse variance (IV) were generated with 95% confidence intervals (CI). The meta-analysis was registered in the International Prospective Register of Systematic Reviews database under registration number CRD42023391640. Results: The analysis revealed that the iNPWT group and the control group did not differ significantly with regard to the WHT parameter (Z = 2,73; p = 0.006; χ2 = 0.37, df = 1, p = 0.54, I2 = 0%). Meta-analysis of SSI incidence revealed a significant difference favoring the iNPWT group over the observational group (OR = 0.42; 95% CI = 0.25-0.72; p = 0.002; I2 = 14%). Patients included in the iNPWT group had a significantly lower pooled incidence of overall complications than the observational group (OR = 0.52; 95% CI = 0.35-0.77; p = 0.001, I2 = 71%). Subgroup analysis limited to randomized studies also presented significant differences favoring the iNPWT group over the observational group (OR = 0.27; 95% CI = 0.14-0.52; p < 0.001, I2 = 67%). Our analysis showed that LOS did not differ significantly between the groups treated with and without iNPWT (IV = 0.19; 95% CI = -0.66 -1,04; p = 0.76, I2 = 0%). In addition, subgroup analysis of randomized studies also did not present a significant difference (IV = 0.25; 95% CI = -0.80 -1,30; p = 0.33, I2 = 10%). Innovation: This study shows that the use of iNPWT can reduce the risk of SSIs with other complications, such as wound hematomas, wound seromas, wound dehiscence, fistulas, and ileus, in patients undergoing intestinal ostomy closure without extended hospital stay. Conclusions: Use of iNPWT can be considered in postoperative care after elective ostomy closure to decrease the rate of the most common complications after ostomy closure.

A Prospective Study of Sutured Versus Non-sutured Subcutaneous Fat Tissue in Laparotomy Wound Closure.

Background This study was conducted to determine the wound-related complications, such as wound dehiscence, delayed post-operative stay, and reinterventions in both groups, and compare the incidence of surgical site infection in elective laparotomy wounds in two groups - those with closing subcutaneous fat tissue and those without. Methods At the Government Medical College, Thrissur, 248 patients undergoing elective abdominal surgeries during the period from August 2019 to August 2020 participated in this one-year prospective cross-sectional study. The institutional ethics committee approved the study, and participants provided written informed consent. Patients were randomly assigned to the subcutaneous closure group (S) and the non-closure group (N). Post-operative events were then systematically documented. Results The group with no subcutaneous suture (N) had a considerably greater percentage of patients with seromas (12 patients, 9%), hematomas (13 patients, 10.5%), superficial surgical site infection and total wound dehiscence as compared to the subcutaneous tissue closure group (S). Groups N and S displayed comparable numbers of suture sinus developments and partial wound dehiscence. Group N and Group S had similarhospital stays, according to the overall length of stay displayed. Conclusion Subcutaneous suturingduring elective laparotomy wound closure significantly reduced superficial surgical site infection, hematoma, seroma, and total wound dehiscence; in the remaining categories, subcutaneous and non-subcutaneous sutures did not differ significantly. It also did not help to reduce hospital stays.

Three-year follow-up analysis of the short-stitch versus long-stitch technique for elective midline abdominal closure randomized-controlled (ESTOIH) trial

BackgroundClinical trials have shown reduced incisional hernia rates 1 year after elective median laparotomy closure using a short-stitch technique. With hernia development continuing beyond the first postoperative year, we aimed to compare incisional hernias 3 years after midline closure using short or long stitches in patients from the ESTOIH trial.MethodsThe ESTOIH trial was a prospective, multicenter, parallel-group, double-blind, randomized-controlled study of primary elective midline closure. Patients were randomized to fascia closure using a short- or long-stitch technique with a poly-4-hydroxybutyrate-based suture. A predefined 3-year follow-up analysis was performed with the radiological imaging-verified incisional hernia rate as the primary endpoint.ResultsThe 3-year intention-to-treat follow-up cohort consisted of 414 patients (210 short-stitch and 204 long-stitch technique) for analysis. Compared with 1 year postoperatively, incisional hernias increased from 4.83% (20/414 patients) to 9.02% (36/399 patients, p = 0.0183). The difference between the treatment groups at 3 years (short vs. long stitches, 15/198 patients (7.58%) vs. 21/201 (10.45%)) was not significant (OR, 1.4233; 95% CI [0.7112–2.8485]; p = 0.31).ConclusionHernia rates increased significantly between one and 3 years postoperatively. The short-stitch technique using a poly-4-hydroxybutyrate-based suture is safe in the long term, while no significant advantage was found at 3 years postoperatively compared with the standard long-stitch technique.Trial registryNCT01965249, registered on 18 October 2013.

Original Article--Clinical and Procedural Characteristics of Successful Transcatheter Device Closure of Ostium Secundum Atrial Septal Defect in Symptomatic Children Weighing

This retrospective study sought to determine the feasibility of transcatheter atrial septal defect device closure in patients less than 15 kg, as well as to assess complication rates and the reasons for unsuccessful device closure. In general, the risks associated with transcatheter atrial septal defect device closure are believed and reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend atrial defect closure in device closure in children <15 kg, due to limited data available for feasibility and safety of device closure in this group of patients. Retrospective review of all patients who underwent elective transcatheter closure of ostium secundum atrial septal defect between September 2013 to February 2022. We excluded all children above 15 kg, as well as those with complex congenital heart defects. Major and minor complications were predefined and indications for referral were evaluated. We identified 81 patients meeting criteria with a median procedural age of 3 years (1 year-8 years), and median weight of 12 kg (4-15 kg). Successful device closure was achieved in 95.1% (77/81) and in 4.9% (4/81), the procedure was aborted. There was 1 major (1.2%) and 1 minor (1.2%) complication, total complication rate (2.4%). 100% of the referrals had right heart enlargement and exertional dyspnoea, 18.5% had recurrent lower respiratory tract infection and 9.9% had failure to thrive. Rate of resolution of residual shunt was 95.1%. at post-procedure day 1 and 98.8% at post-procedure 3 and 6 months respectively. Percutaneous atrial septal defect closure can be done effectively and safely in symptomatic children weighing less than 15 kg in experienced centres. However, deferral for closure until the historically established timeline of around 4-5 years of age should be strongly considered in asymptomatic children.

Same-day discharge after elective percutaneous closure of patent foramen ovale.

Percutaneous closure of the patent foramen ovale (PFO) is increasingly performed in specific patients with cryptogenic stroke or clinical evidence of a paradoxical embolism. This study was performed to determine the safety of same-day discharge (SDD) following such procedures. This is a prospective, observational study of patients undergoing elective percutaneous PFO closure in a single tertiary center in Portugal between January 2020 and July 2023. AmplatzerTM devices (St. Jude Medical, St. Paul, MN, USA) and NobblestichTM EL (HeartStitch, Inc., Fountain Valley, CA, USA) were used. After 6 months, the following events were looked at: post-procedural paroxysmal atrial fibrillation, stroke, unplanned cardiac re-hospitalization, urgent cardiac surgery, major vascular complications, pericardial effusions, device embolization, and death. We studied 122 consecutive patients (52% female, 68; 48±12 years old) who had elective percutaneous closure with success and no complications. Forty-nine (40%) had SDD. AmplatzerTM devices were used more frequently in the SDD group, while NobblestichTM EL was more common in the overnight group. During the overnight group's follow-up period, there was one non-cardiovascular death; there were no further events. SDD after elective percutaneous closure of PFO was shown to be a safe and successful patient management method, including NobblestichTM, which we describe for the first time. Our results prove the safety of this same-day discharge strategy. We hypothesize that in the near future, in selected cases, PFO closure might become an ambulatory procedure.

Clinical Value of Echocardiographic Screening and Dynamic Observations for Ductus Arteriosus Closure in Newborns

Objective: To explore and analyze the clinical value of echocardiography screening and dynamic observation for ductus arteriosus closure in newborns. Methods: The study was conducted from August 2022 to December 2023. 500 newborns who were admitted to our hospital were selected as research subjects for this study (Kunming Tongren Hospital). All subjects underwent echocardiography to determine the severity of patent ductus arteriosus (PDA). The inner diameter of the pulmonary artery was measured, and the pulmonary artery pressure was estimated through tricuspid regurgitation. If the patient had high pulmonary artery pressure, elective closure surgery was performed. Results: Among the 500 subjects, 448 cases of ductus arteriosus closure and 52 cases of PDA were detected by echocardiography, including 23 cases of simple PDA, 15 cases with patent foramen ovale, 11 cases with atrial septal defect, 1 case with muscular ventricular septal defect, 1 case with tricuspid valve prolapse, and 1 case with tricuspid valve chordae tendineae rupture. After symptomatic treatment and intervention, their echocardiogram results were reviewed and no abnormalities were found. All measurement results of children with PDA combined with pulmonary hypertension were better than before treatment (P &lt; 0.05). Conclusion: Echocardiography is a fast, accurate, and reliable non-invasive imaging examination technology. It can significantly improve congenital heart disease detection rate in infants and young children. Early intervention based on the examination results can dramatically improve the quality of life of infants and young children with PDA.

Abstract 16504: Hospital Frailty Risk Score (HFRS) Predicts Adverse Events in Patients Undergoing Elective Percutaneous Left Atrial Appendage Closure (LAAC) With WATCHMAN Device

Introduction: Frailty and its association with adverse events are well-known in transcatheter aortic valve replacement. However, this association has not been well-studied in patients undergoing Left Atrial Appendage Closure (LAAC). Hypothesis: Frailty predicts adverse events in patients undergoing elective LAAC with WATCHMAN device. Methods: Patients aged ≥65 years who underwent elective LAAC with WATCHMAN device were identified using ICD-10 procedure code 02L73DK from the 2016-2018 HCUP-NIS Database. Hospital Frailty Risk Score (HFRS) was calculated for each patient based on 109 ICD-10 diagnosis codes and classified into non-frail (HFRS &lt; 5) and frail (HFRS score ≥ 5) groups. In-hospital major adverse event (MAE) was defined as the composite of mortality, stroke (ischemic or hemorrhagic) or TIA, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery. Multivariate regression and receiver operating characteristic (ROC) analyses were used to assess the relationship between the HFRS and MAE. Results: 28,050 patients (Age = 77.3 ± 6.4 years; Female = 42.6%) were included, and 4.7% experienced in-hospital MAE. Frail patients (HFRS score ≥ 5) constituted 12.5% of the cohort. Frail patients were older and had a more significant proportion of women. Rates of MAE were significantly greater in frail patients (4% vs. 9.7%; p&lt;0.001). Increasing Hospital Frailty Risk Score was associated with a greater risk of in-hospital MAE. The AUC - ROC was 0.63 (Figures: A and B). Conclusions: HFRS predicts adverse events after LAAC. HFRS could be implemented in hospital information systems to facilitate the identification of at-risk patients.

Abstract 17596: Association of Racial-Ethnic Disparities and Frailty on Adverse Outcomes in Geriatric Patients Undergoing Elective Percutaneous Left Atrial Appendage Closure With Watchman Device

Introduction: Use of left atrial appendage closure (LAAC) has become more widespread in the geriatric population. Frailty, a geriatric syndrome, is associated with significant morbidity and mortality. Hypothesis: Race/Ethnicity influences frailty status and may differentially impact adverse outcomes in elective LAAC procedure. Methods: Patients aged ≥65 years who underwent elective LAAC were identified using ICD-10 procedure code 02L73DK from 2016-2018 HCUP-NIS Database. Hospital Frailty Risk Score (HFRS) was calculated for each patient based on 109 ICD-10 diagnosis codes and classified into non-frail (HFRS &lt; 5) and frail (HFRS score ≥ 5) groups. Charlson comorbidity index (CCI) was used to assess comorbidity burden. In-hospital major adverse event (MAE) was defined as the composite of mortality, stroke (ischemic or hemorrhagic) or TIA, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery. Outcome was in-hospital MAE. Multivariate regression analysis was used to assess the association of race/ethnicity and frailty on MAE. Results: 27,155 patients (Age = 77.3 ± 6.4 years; Female = 42.4%, White: 88%, Black: 3.4%, Hispanic:5.2%, Other: 3.4%) were included. Overall, the prevalence of frailty was 12.5% (White:12.4%, Black: 13.7%, Hispanic: 11.8%, Other: 13%). Overall, in-hospital MAE was 4.7%, with increased rates in frail patients (4% vs.9.6%; p&lt;0.001). Rates of in-hospital MAE were frail-White: 9.3%, frail-Black: 8%, frail-Hispanic:20.6%, and frail-Other: 4.2% (p&lt;0.001). On multivariate analysis, frail-White and frail-Hispanic patients were at increased risk of in-hospital MAE compared to non-frail patients (Figure). Conclusion: Further research is needed to highlight disparities by race/ethnicity and to identify potentially modifiable factors to mitigate adverse events in frail geriatric population undergoing LAAC.

Transcatheter closure of large ostium secundum atrial septal defects in symptomatic small children: A single-center retrospective study.

In general, the risks associated with transcatheter atrial septal defect (ASD) device closure are reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend ASD device closure in children with defect sizes >20 mm due to limited data available in this group of patients. This retrospective study sought to determine the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects and assess the complication rates and reasons for unsuccessful device closure. We retrospectively reviewed the data of all patients who underwent elective transcatheter closure of ostium secundum ASD in our department between September 2013 and February 2022. All children weighing <20 kg, requiring a device of size 20 mm or greater, were included. Major and minor complications were predefined and indications for referral were evaluated. Echocardiogram reports were reviewed from the time of referral, postcatheterization day 1, and at 1-year follow-up. We identified 40 patients meeting inclusion criteria with a median (interquartile range [IQR]) procedural age of 5 (4-7) years and median (IQR) weight of 14 (12-18) kg. Successful device closure was achieved in 39 patients with a success rate of 97.5%. The total complication rate was 2.5% (95% confidence interval: 0.44%- I2.8%) with only 1 major complication. All children had right heart enlargement and exertional dyspnea, 30% of patients had recurrent lower respiratory tract infections, and 10% had failure to thrive. At 1-year follow-up, a transthoracic echocardiogram showed a well-endothelialized device in a stable position in all the patients, and none of the patients had a residual shunt. In experienced centers, percutaneous ASD closure of large defects in symptomatic small children can be done effectively and safely with a great degree of predictability and a low complication rate.

WTP5.5 A 6 year Review of Pilonidal Operations in a DGH

Abstract Aims Pilonidal Disease can be difficult to manage and operative management carries well known risk. We aimed to review all pilonidal operations from a 6 year period in our DGH, especially complications and reoperations. Methods An excel database was created and hospital coding data pulled for any pilonidal operation including elective and emergency over a 6 year period from 2015-2020. Hospital electronic and paper notes were used to cross reference coding data with op notes and discharge paperwork. Complications were then categorised as “Major” or “Minor” and type of complication documented. Number of reoperations was counted. Results 183 operations were carried out on 151 individual patients (103 male and 48 female). There were 33 reoperations on 21 patients. 78 formal elective operations were done with 68 primary closure and 10 laid open. Of primary closure there were only 13 complications – 5 major and 8 minor. Major complications included return to theatre for wound dehiscence, and wound sepsis. Those with major complications mainly had pre-existing complicated disease and all had previous emergency I&amp;D. All patients who had primary closure had ongoing symptomatic disease prior to operation with 29 having previous emergency I&amp;D. Conclusions Most patients with ongoing symptomatic disease benefit from definitive management in the form of elective primary closure eg Bascom procedure. Despite the well recognised risks of this surgery, most complications are minor and major complications are often reflective of a history of problematic pilonidal disease.

Natural history of anastomotic leakage after elective stoma closure.

Elective stoma closure (ESC) is a common procedure. The main complication of ESC is anastomotic leakage, which can be revealed by peritonitis or an enterocutaneous fistula (ECF). The objective of the present study was to describe the natural history of AL after ESC. Between January 2015 and March 2020, all patients having undergone AL after loop or double-barreled ESC were included in a retrospective, single-center study. The rate of ECF and peritonitis at presentation, the success rate of a conservative treatment and the factors associated with the success of healing of ECF were evaluated. From January 2015 to March 2020, 619 patients underwent a loop or double-barreled ESC in our department. The AL rate was 6.3% (n=39). The leakage was revealed by an ECF in 72% of cases (n=28). The mean±standard deviation time between the stoma closure and the diagnosis of the AL was 6±4 days. Conservative treatment was successful in 24 (85%) of the 28 patients with ECF, with a mean±SD time to recovery of 6.6±9.4 months. In a univariate analysis, none of the conservative treatments was significantly associated with healing of the ECF. AL is not rare and is mainly revealed by an ECF. Although the fistula heals in most cases, both the surgeon and the patient must be aware that the time to recovery is long.

Renal dysfunction occurs following ileostomy formation and is independent of readmission.

Ileostomy formation may be permanent or intended as temporary to defunction a high-risk pelvic anastomosis to reduce the risk of septic consequences of anastomotic leak. However, these procedures have a high rate of readmission, most commonly due to dehydration and associated with acute kidney injury (AKI). A single centre retrospective cohort study of patients who underwent ileostomy formation from 2015 to 2020 and analysed in two groups: those who needed readmission within 60 days and those who did not. Data collected included demographics and renal function and electrolytes at baseline (ileostomy formation) and at elective ileostomy closure. A total of 171 patients were included in the analysis, with a readmission rate 38% within 60 days of discharge. There was a significant increase in creatinine from baseline blood tests compared to date of elective ileostomy closure in both the readmission and no readmission arms. There was a significant decrease in eGFR from baseline blood tests compared with date of ileostomy closure in both readmission and no readmission arms. There was no significant difference in creatinine or eGFR between readmission and no readmission arms at date of ileostomy closure. Baseline serum sodium levels were lower in the readmission arm compared to no readmission arm. Ileostomy formation is associated with a deterioration in renal function, which occurs independent of whether the patient requires readmission to hospital. Low serum sodium may be used as a predictor for patients with an increased risk of readmission.

Device Closure of Left Circumflex Coronary Artery to Coronary Sinus Fistula

A coronary artery fistula (CAF) is defined as a direct connection between a coronary artery with right heart chambers including the right atrium, right ventricle, coronary sinus, superior vena cava, or pulmonary arteries. Elective closure of coronary artery fistula by surgery or percutaneous transcatheter technique is generally accepted in the presence of symptoms. We report a case of successful percutaneous transcatheter device closure of coronary fistula, originating from the circumflex artery and draining into the coronary sinus.

767 NEVER TOO LATE TO SHOW-UP: A RARE CASE OF PLATYPNEA-ORTHODEOXIA SYNDROME

Abstract Patient presentation. We present the case of an 85-years old woman, hypercholesterolemic, with a previous history of microvascular angina treated with nitrates, ASA and ranolazine. She presented in our emergency department for repeated episodes of seizure and “drop attacks” and she underwent neurological and cardiological evaluation. ECG showed sinus tachycardia, 110/min, left anterior hemiblock. Transthoracic echocardiogram was normal. Head CT-scan and cerebral magnetic resonance documented mild hyperintense areas in the subcortical part of white matter suggestive for chronic cerebrovascular disease. Carotid Doppler was negative for significant stenosis. Thus, suspecting an unexplained syncope, she underwent loop recorder implantation. One month later she was admitted to the emergency room for dysarthria, left hemiparesis and ataxia, that completely regressed after 24-hours, posing the diagnosis of transient ischemic stroke. Physical examination was normal. During in-hospital stay, the patient progressively developed dyspnoea and oxygen desaturation (SpO2 &amp;lt; 90%). Initial work-up. Due to oxygen desaturation non-invasive ventilation with Venturi mask (60%) was started. Blood tests were normal. The arterial blood gas analysis in Venturi mask showed: pH 7.47, pCO2 48 mmHg, pO2 136 mmHg, P/F 226. Despite non-invasive ventilation with Venturi mask, P/F remained low and so continuous positive airway pressure (CPAP) was started. A repeated echocardiogram showed a mild reduction of ejection fraction (45-50%) due to hypokinesia of the septum, secondary to right ventricular overload and compression. Pulmonary embolism was excluded by angio-CT. Medical management with vasodilators and diuretics finally allowed to wean off the non-invasive ventilation, still maintaining oxygen support with nasal cannulas. However, surprisingly, the mobilization of the patient in a sitting position resulted impossible, due to the occurrence of sudden desaturation. Diagnosis and Management. Suspecting a manifestation of platypnea-orthodeoxia syndrome (POS) a transoesophageal echocardiogram was performed. It revealed a wide patent foramen ovale (PFO), maximum diameter 1.5 cm, with a baseline mild right-to-left shunt, confirmed with sonicated contrast, that increased in the sitting position. Therefore, the diagnosis of POS syndrome and paradoxical cerebral embolization was posed. Elective PFO closure with the percutaneous positioning of an atrial septal defect (ASD) Occluder n.15 was successfully performed. Conclusions The platypnea-orthodeoxia syndrome is a rare cause of hypoxemia. The most common structural abnormality associated with this syndrome is the PFO, which can remain asymptomatic for decades. A shift in the relationship between right-and left intra-cardiac pressures, a change in the anatomy of the adjoining structures with age, stretching the atrial septum and favouring the blood inflow into the PFO (as ascending aorta dilatation or Thoracic Kyphosis) can lead to POS. The closure of the atrial defect is generally resolutive. However, the heterogeneous clinical presentations, the rarity of the disease and the confounding role of comorbidities can often result misleading, especially in advanced age.

A Comparative Study Between Conventional Sutures, Staples, and Adhesive Glue for Clean Elective Surgical Skin Closure.

As long as medicine has subsisted, wound closure has existed.When assessing a surgical wound, physicians are more than ever confronted with various sutures and other closure materials. The surgeon must choose the most appropriate material for that specific closure because not one substance is perfect in all circumstances. The history of suturing wounds is intertwined with the history of surgery. Wound suturing is a critical component of wound therapy, including suturing materials and techniques. Suturing has been practiced for thousands of years. Although suture materials and techniques have changed, the goals like closing dead space, supporting and strengthening wounds until healing increases their tensile strength, approximating skin edges for an aesthetically pleasing and functional result, and reducing the risk of bleeding and infection remain the same. Traditional skin closure with sutures requires time and effort, creates an unsightly scar, and requires infection removal. In this modern era, patientsfind it appealing when the operated location has a decent cosmetic appearance. The quicker, more comfortable, and most aesthetically pleasing method of skin closure is what surgeons are searching for. Assessing whether newer methods are superior to sutures and staples is necessary. Better cosmesis, flexibility, water resistance, painless sealed skin closure, and ease of application are all advantages of 2-octyl cyanoacrylate. This article aims to provide an overview of the critical characteristics of traditional sutures, common suture materials, sticky glue, and staples, as well as additional closure materials.

Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter, single-blinded, randomized controlled trial

IntroductionThe objective of this study was to evaluate the impact of preoperative bowel stimulation on the development of postoperative ileus (POI) after loop ileostomy closure.MethodsThis was a multicenter, randomized controlled trial (NCT025596350) including adult (≥ 18 years old) patients who underwent elective loop ileostomy closure at 7 participating hospitals. Participants were randomly assigned (1:1) using a centralized computer-generated sequence with block randomization to either preoperative bowel stimulation or no stimulation (control group). Bowel stimulation consisted of 10 outpatient sessions within the 3 weeks prior to ileostomy closure and was performed by trained Enterostomal Therapy nurses. The primary outcome was POI, defined as an intolerance to oral food in the absence of clinical or radiological signs of obstruction, on or after postoperative day 3, that either (a) required nasogastric tube insertion; or (b) was associated with two of the following: nausea/vomiting, abdominal distension, or the absence of flatus.ResultsBetween January 2017 and November 2020, 101 patients were randomized, and 5 patients never underwent ileostomy closure; thus, 96 patients (47 stimulated vs. 49 control) were analyzed according to a modified intention-to-treat protocol. Baseline characteristics were well balanced in both groups. The incidence of POI was lower among patients randomized to stimulation (6.4% vs. 24.5%, p = 0.034; unadjusted RR: 0.26, 95% CI 0.078–0.87). Stimulated patients also had earlier median time to first flatus (2.0 days (1.0–2.0) vs. 2.0 days (2.0–3.0), p = 0.025), were more likely to pass flatus on postoperative day 1 (46.8% vs. 22.4%, p = 0.022), and had a shorter median postoperative hospital stay (3.0 days (2.0–3.5) vs. 4.0 days (2.0–6.0), p = 0.003).ConclusionsPreoperative bowel stimulation via the efferent limb of the ileostomy reduced POI after elective loop ileostomy closure.

Early inflammatory reaction and thrombus formation post Gore® Septal Occluder Device insertion for an atrial septal defect

A 40-year-old man with an incidental large secundum atrial septal defect (sASD) with left to right shunt (Qp:Qs 2.7:1) and right ventricular dilatation presented for elective percutaneous closure with a 44mm Gore® Septal Occluder (GSO) device. Single dose cephazolin was given peri-procedurally. Implantation was uncomplicated and the patient was commenced on aspirin and clopidogrel post-operatively.

Zanimljiv slučaj koronarno-kameralne fistule sa anginom pektoris

Introduction: Coronary-cameral fistula (CCF) is an anomalous connection between a coronary artery and a cardiac chamber. Most CCFs are discovered incidentally during angiographic evaluation of coronary vascular disorders. We report a case of CCF with angina pectoris. Case report: A 67-year-old woman presented with chest pain and dyspnea upon exertion. Coronary angiography showed atherosclerotic lesions in the two major coronary arteries, but also communication between three arteries and the cavity of the right ventricle (RV) through many small, diffuse fistulas. Angiography also showed a fistula between the proximal left anterior descending artery (LAD) (first septal branch) and the right ventricle, as well as between the proximal right coronary artery (RCA) (acute marginal branch) and the right ventricle. The patient qualified to undergo coronary artery bypass graft surgery (CABG) and surgical closing of the fistulas, which is why we performed, on a beating heart, double vessel revascularization by autovein graft between the ascending aorta and the RCA and between the ascending aorta and the LAD, as well as closing of the fistulas with hemoclips and polypropylene suture, with a teflon pledget. Conclusion: Hemodynamically insignificant fistulas, which are clinically silent and not associated with other abnormal findings, most commonly do not require further treatment. Large, hemodynamically significant fistulas should be closed by ligation. However, smaller fistulas tend to get larger with age and it is recommended that early elective closure is performed in patients experiencing symptoms or in asymptomatic patients with a continuous murmur or a systolic murmur with an early diastolic component.

Abstract 13609: Impact of Frailty on Hospital-Related Outcomes of Elective Left Atrial Appendage Closure

Introduction: Atrial fibrillation as the most common arrhythmia worldwide results in a significantly elevated risk of cardioembolic stroke. Left atrial appendage (LAA) closure has been advocated and supported by randomized clinical trials as an alternative treatment in patients with atrial fibrillation who have contraindications for anticoagulation. The safety of this procedure in patients who are considered frail remains unknown since they have been underrepresented in most clinical studies. Our study aims to investigate the impact of frailty on hospital-related outcomes in patients undergoing elective LAA closure. Methods: We reviewed the National Inpatient Sample database from January 2016 to December 2017 to identify patients that underwent elective percutaneous LAA closure using the ICD-10 code 02L73DK for the procedure. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. An individual is considered frail if they present &gt;=1 diagnosis within the indicator. The outcomes include in-hospital mortality, hemorrhage requiring blood transfusion, respiratory failure, sepsis, length of stay, and total hospitalization cost. Multivariate logistic or linear regression was adopted to determine the impact of frailty on the outcomes while reducing the effect of possible confounding baseline characteristics. Results: From the period of January 2016 to December 2017, a total of 14795 patients underwent elective LAA closure. Of those patients, 830 were determined to meet the criteria for frailty, while 13965 were considered non-frail. The frail group is older than the non-frail group with a mean age of 78.77 years old than 75.53 years old. Frailty was associated with an increased risk of hemorrhage requiring transfusion (odds ratio 2.82, p=0.030) and a longer length of stay (2.10 vs 1.30 days, p=0.003). The frail group appears to have higher hospitalization costs, but the result was not statistically significant ($122668.2 vs $114295.3, p=0.091). Conclusions: The presence of frailty was associated with an increased risk of hemorrhage requiring transfusion and a longer length of hospital stay after elective left atrial appendage closure.

Abstract 13987: Efficacy and Safety of Surgical Repair of Atrial Septal Defect in Asymptomatic Children Less Than 3 Years of Age

Background: Elective surgical closure of atrial septal defect (ASD) in asymptomatic children is commonly performed at 3 to 6 years of age when catheter-guided closure is not feasible. However, a recommended timing of surgical closure is not based on recent evidence. Hypothesis: Surgical ASD closure can be done safely in any age group. Methods: Asymptomatic patients with surgically closed isolated ASDs who were not indicated for catheter-guided closure in our cardiac center from 2002 to 2019 were studied. The patients were divided into 4 groups based on the age at surgery (&lt;3 years, ≥3 to &lt;6 years, ≥ 6 to &gt;10 years, and ≥ 10 years). Demographic data, type of ASD, cardiopulmonary bypass time (CPBT), intensive care unit (ICU) stay, total hospitalization days, post-operative adverse events, and readmission rate were studied. Effects of creation of pericardial window (PW) was also examined. Data are shown as mean ± standard deviation. Results: Total 163 patients were studied (Table). There was no statistically significant difference in CPBT, ICU stay, or total hospitalization days among the 4 groups. There were no mortalities. Incidence of adverse events during hospitalization was low in &lt; 6 years (1.9 to 4.2%) but higher in older ages (10.8 to 13.5%). Readmission rate was higher in younger groups: 18.6% in &lt; 3 years old, 13.2% in ≥ 3 and &lt; 6 years old, 8.0% in ≥ 6 and &lt; 10 years, and 10.8% in ≥ 10 years, which was mainly due to pericardial effusion (PE). Total 18 patients developed PE postoperatively, 14 of whom were readmitted for treatment. With the creation of PW at the time of initial surgery, the incidence of PE and readmission rate were significantly reduced compared with without PW, especially in younger children. There was no complication due to PW. Conclusion: Surgical ASD closure can be performed safely even in younger children with ages &lt;3 years, especially with creation of PW. Routine application of PW markedly reduced postoperative adverse events in surgical ASD closure.