Exploratory Laparotomy Surgery Research Articles

Transtorno do apetite depravado (Síndrome de Pica) em um felino

The psychological disorder of allotriophagy, also known as pica syndrome, can affect humans and animals. This eating disorder is characterized by chewing and ingesting objects without nutritional background, such as plastic, paper, fabrics, toys, wires, cables, among others. The present work aims to report the case of a feline affected by pica, having undergone exploratory laparotomy surgery to remove the foreign body. This behavior occurs more frequently in canines; however, it can occur in domestic cats, but in neither case is it considered a natural behavior and may be associated with clinical and behavioral causes. Although it is still little investigated by science, this behavioral disorder may be linked to nutritional deficiency, gastrointestinal problems, anxiety, stress, emotional dependence, separation anxiety, among others. Therefore, there is a need to diagnose pica syndrome in order to determine the ideal method of treatment.

Comparison of Preemptive Post-Intubation 15 Mg/KgBW Paracetamol to 0.35 Mg/KgBW Meperidine in Incidence of Post-Anesthetic Shivering

Post anesthesia shivering (PAS) is a repetitive involuntary movement of one or more muscle groups as a result of a decrease in core body temperature. Pharmacological therapy in preventing PAS may include meperidine and paracetamol. This study compared the effectiveness of paracetamol to meperidine in reducing the incidence of post-anesthesia shivering. This study used an experimental randomized double-blind comparative analytic design on patients underwent exploratory laparotomy surgery under general anesthesia at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from September 2021 to August 2022. Patients with 50 ASA 1-2 physical status were included and divided into two groups. One group received 15 mg/kg group paracetamol and the other received 0.35 mg/kg meperidine. Data on tympanic membrane temperature and hemodynamics before and after induction and after extubating were collected. Furthermore, data on the results of the assessment of the incidence and grade of shivering in each treatment group were also collected. The results of this study showed that there was a decrease in the frequency of PAS in patients receiving intravenous 15 mg/kg paracetamol (p<0.05), as well as less side effects in the form of nausea and vomiting (p < 0.05). The incidence and degree of shivering after general anesthesia using intravenous 15 mg/kg paracetamol was lower compared to the use of 0.35 mg/kg meperidine. In the meperidine group, the decrease in body temperature was lower than in the paracetamol group, while the incidence of nausea and vomiting in the paracetamol group was lower than in the meperidine group. In conclusion, paracetamol reduces the incidence of post-anesthesia shivering better than meperidine.

Intraoperative FoCUS: Training Practices and Views on Feasibility

To investigate whether resident anesthesiologists perceive intraoperative focused cardiac ultrasonography (FoCUS) as feasible, the self-reported confidence of residents performing intraoperative FoCUS, and United States graduate medical education resident ultrasound training practices. A cross-sectional survey. The United States Accreditation Council for Graduate Medical Education-listed anesthesiology programs over a 3-month period between June 2022 to September 2022. United States anesthesiology residents. A survey. Reported training practices were as follows: 87.3% of respondents reported formal FoCUS training, and the most commonly reported training was "lectures+live-model training under 5 hours annually" at 31%. Most respondents (82%) stated that faculty never or rarely performed bedside FoCUS, and most respondents (69%) reported no intraoperative FoCUS education exposure. The proportion of residents who reported a positive view on the perceived feasibility of intraoperative FoCUS was 53.2% for extremity surgery, 19.8% for laparoscopic surgery, 18.6% for exploratory laparotomy surgery, and 7.9% for robotic surgery. Most respondents (78.6%) indicated a lack of confidence in performing intraoperative FoCUS independently. The authors found no statistical difference in views on feasibility or reported confidence independently performing FoCUS across training years. Training that included "lectures+simulation" or "live-model" for more than 5 hours annually, faculty routinely using bedside FoCUS, and frequent exposure to intraoperative FoCUS increased the odds of reporting confidence. The misconception that intraoperative FoCUS is infeasible appears prevalent, and most of the authors' respondents expressed a lack of comfort independently performing intraoperative FoCUS. Alterations of training practices, including increasing faculty usage of bedside ultrasonography, increasing trainee time performing FoCUS, and incorporating specific intraoperative ultrasound into the ultrasound curriculum, may address these deficiencies.

Ultrasonographic appearance of retained surgical sponges and gauzes in the acute postoperative period: a phantom and cadaveric study.

Retained surgical sponges or gauzes (RSS) are an uncommon complication of exploratory laparotomy surgery and pose a clinically significant risk to the patient. The purpose of this two-part, prospective, descriptive study was to describe the previously uncharacterized ultrasonographic appearance of RSS in phantom and cadaveric models of the acute postoperative period (24-48h). For the first part of the study, a gelatin phantom containing a woven gauze with a radiopaque marker (radiopaque gauze), a woven gauze with no marker (nonradiopaque gauze), and a laparotomy sponge with a radiopaque marker (radiopaque sponge) was evaluated with ultrasonography. For the second part of the study, a total of 23 gauzes and sponges (of the aforementioned three types) were placed within the peritoneal cavity of 20 cadavers in one of three randomized locations during an exploratory laparotomy laboratory. The cadavers were imaged with ultrasonography 17h later and still images and video clips were reviewed. The retained surgical sponges and gauzes in the gelatin phantom displayed multiple hyperechoic layers and variable degrees of distal acoustic shadowing. In cadavers, 100% (23/23) of the retained surgical sponges and gauzes displayed a single hyperechoic layer of variable thickness and distal acoustic shadowing. In 95.6% (22/23) retained sponges and gauzes, there was a thin hypoechoic layer noted superficially to the hyperechoic layer. An improved understanding of the ultrasonographic appearance of retained sponges or gauzes in the acute postoperative period may assist in the identification of these objects.

Primary small bowel volvulus in adult: an unusual case report

Small bowel volvulus (SBV) is an uncommon case which the small intestine rotates around its own mesenteric axis. SBV generally occurs in newborns. We report the case of a 69-year-old man who has been coming with complaints of pain all over his abdomen, vomiting, no bowel movement, and flatus since 2 days ago. The patient underwent plain abdominal radiography and was found to have a high-lying obstructive ileus. The patient was treated with exploratory laparotomy surgery and found to have necrotic bowel sections. During the 5 days postoperative, the complaints improved.

Acute Gastric Dilatation due to Pyloric Band, with Acute Appendicitis and IleoIleal Intussusception in a 4-Year-Old Girl: Case Report

Acute gastric dilatation (AGD) is caused by mechanical and non-mechanical stomach processes. Acute appendicitis affects children and is treated with surgery. Intussusception is proximal bowel invagination against the distal bowel. Clinical findings of intussusception in the form of intermittent abdominal pain, a palpable mass in the abdomen, accompanied by wine-red stools. Due to significant morbidity and mortality, multiple-problem surgical emergencies require accurate diagnosis and treatment. A 4-year-old girl complained of a full stomach, abdominal discomfort, inability to flatus, vomiting, and fever, suggesting appendix perforation and widespread peritonitis. Radiographs show an intra-abdominal mass. Exploratory laparotomy surgery revealed gastric dilatation due to the pyloric band, acute appendicitis, ileoileal intussusception, grade 3 adhesions, and generalized peritonitis. Laparoscopic surgery revealed significant issues. The procedure was followed by partial gastrectomy, milking procedures, appendectomy, omentectomy and release of adhesions. Gastric histopathological examination showed the results of acute suppurative gastritis. Postoperatively the patient was hospitalized for nine days with improved condition. The complex pathogenesis is related to multiple cases in these patients. A continuous process is thought to occur between acute appendicitis and ER through the mechanism of intra-abdominal infection involving the omentum according to the anatomical location. Then hypertrophy of the lymphoid tissue of Peyer's plaque due to acute appendicitis is thought to contribute to intussusception. Clinical evaluation and appropriate management of surgical emergency cases with multiple problems are important to prevent further deterioration and complications.

Perioperative Management of Chronic Kidney Disease Patients with Bowel Perforation

<p><strong>Background</strong>: Anesthesia management applied during surgery in patients with chronic kidney disease (CKD) is different from ordinary anesthetic management. It is known that currently, there are not many case reports discussing anesthetic management in patients with CKD.</p><p><strong>Case Illustration</strong>: A 70-year-old patient with abdominal colic et causa abdominal perforation complained of abdominal pain accompanied by heavy bowel movements and flatus throughout the abdominal area. The patient was anesthetized by regional anesthesia with local agent bupivacaine and treated with laparotomy. Bupivacaine is the first local anesthetic drug with an acceptable onset of action, long duration of action, and a tendency for the sensory block to be greater than its motor block.</p><p><strong>Conclusion</strong>: This case report explains the novelty of anesthetic management of CKD patients undergoing exploratory laparotomy surgery using the reported patient cases. Operations in patients with CKD are preferable to regional anesthesia.</p>

Machine Learning to Predict Fascial Dehiscence after Exploratory Laparotomy Surgery

Fascial dehiscence following exploratory laparotomy is associated with significant morbidity and increased mortality. Previously published risk prediction models for fascial dehiscence are dated and limit a surgeon's ability to perform reliable risk assessment intraoperatively. We sought to determine if machine learning can predict fascial dehiscence after exploratory laparotomy. A retrospective cohort study was conducted of 93,024 patients undergoing exploratory laparotomy from the 2011-2018 ACS NSQIP data files. Data were divided into training (2011-2016, n=69,969) and temporal validation (2017-2018, n=23,055) cohorts. A clinical decision support tool was developed using the model generated via machine learning techniques. 1,332 (1.9%) patients in the training cohort and 390 (1.7%) patients in the temporal validation cohort developed fascial dehiscence. The area under the receiver operating characteristic curve was 0.69 (95% CI 0.66 to 0.72) in the validation cohort. Model predictions demonstrated excellent probability calibration. Decision curve analysis calculates net clinical benefit within a threshold range of 0.8%-4.5%. Operative time, surgical site and deep space infections, and body mass index were among the most important features for model predictions. Finally, operative time, sodium level, and hematocrit demonstrated non-linear relationships with predicted risk. A clinical decision support tool for predicting fascial dehiscence after exploratory laparotomy was created and validated on a contemporary, national patient cohort using machine learning. The tool calculates net clinical benefit and can be used at the point of care. Some identified risk factor relationships were found to be complex and non-linear, highlighting the ability of some machine learning applications to capture nuanced, patient-specific risk profiles.

Infant appendicitis with perforation: a case report

Appendicitis is one of the most common surgical emergencies in children. In the USA, there are 70,000 cases are diagnosed each year. Acute appendicitis is a rare case, barely considered in the diagnoses, and probably causes acute abdominal sepsis in neonates. It affects males generally 75% of the time and 25%-50% of all reported cases occur in premature infant. Almost 50 cases have been reported over the last 30 years. We reported a 5 month-old baby girl whom transferred to our hospital from a peripheral hospital. Previously, the baby diagnosis was low-type obstruction. At the time of admission to our hospital, the baby presented with a history of abdominal distension and did not pass stools after 48 h. Oxygen and oral gastric tube were administered. Exploratory laparotomy surgery was performed through a transverse incision. This report is a retrospective review of one patient with appendicitis perforation presented in our hospital.

Hernioplasty with Laparoscopy Mesh Application in Equine with Incisional Hernia

Background: Incisional hernia in the midline can be a consequence of abdominal surgeries, which incidence is around 5.7-18%. Surgical indication occurs in cases of large hernias, and the most common techniques used involve the closing of the musculature in a primary way, with sutures, and the implantation of a mesh on the abdominal wall. Laparoscopic hernioplasty emerged as a less invasive option, showing superiority when compared with open surgical techniques in human medicine, however there are few reports describing this technique in equines. So, the aim of this paper is to report a case of hernioplasty, using laparoscopic mesh, in a horse with midline incisional hernia.Case: A 13-year-old castrated male Brasileiro de Hipismo horse, weighing 415 kg, practitioner of classic equestrian, presented an incisional hernia after 14 days from an exploratory laparotomy surgery realized to treat colic syndrome. After 6 months, the patient was referred to a Veterinary Medicine Teaching Hospital for the correction of the defect in the abdominal wall. During palpation, the animal did not present local pain or other sign of inflammation, and the hernia measured approximately 20 cm in diameter. The animal was submitted to general anesthesia and placed in dorsal decubitus for the hernioplasty surgical procedure. An incision was made in cranial region of the midline, close to the xiphoid to introduce a single port; the abdomen was inflated with CO2 gas (12 mmHg) and the operating table was tilted in order to displace the organs cranially, facilitating the laparoscopic procedure. The abdomen was inspected and the presence of a single adherence could be observed, which was disrupted with endoscopic forceps. The mesh was introduced through the single port incision and anchored to the musculature, using polypropylene 2 following the marking points previously performed on the implant, covering the defect in the abdominal musculature. In the postoperative period, analgesia was instituted with non-steroidal anti-inflammatory drugs, antibiotic therapy with intravenous benzylpenicillin potassium+gentamicin sulfate, and daily dressings. The animal showed pain responsive to the instituted analgesia in the first 24-72 h after surgery. The discharge was established after 18 days of hospitalization with the recommendation of daily dressings and use of compressive bandage until the complete healing of the wound. Postoperative complications resulting from the laparoscopic hernioplasty technique was not observed in this case.The hernia reduction was satisfactory, with a good aesthetic result after five months, when the animal resumed its athletic activities.Discussion: Laparoscopy hernioplasty is poorly described in equine medicine, and there are no reports of this procedure performed in Brazil, however, it is widely used in human medicine with results superior to open hernioplasty techniques. In the present case and in others reported in the literature, the laparoscopic technique proved to be effective in reducing incisional hernias in horses. The animals had good regression of the hernia sac and the aesthetic result was satisfactory, with few post-surgical complications. In studies in which the open hernioplasty technique was used, there was a higher occurrence of complications, in addition to more intense pain resulting from the procedure and later return to athletic activity, demonstrating that the minimally invasive technique by video surgery can be advantageous.

Auricular vagus nerve stimulation protects against postoperative cognitive dysfunction by attenuating neuroinflammation and neurodegeneration in aged rats

Postoperative cognitive dysfunction (POCD) has been increasingly recognized as a significant complication after surgery, especially in senior patients. Vagus nerve stimulation (VNS) reportedly provides beneficial effects against various brain disorders, supporting a hypothesis of its protective role in POCD. However, direct stimulation of the vagus nerve is invasive, as it requires a surgical incision in the neck. Thus, we employed a non-invasive VNS method by stimulating the dermatome in the external ear, which is innervated by the vagus nerve (auricular vagus nerve stimulation; aVNS) and sought to investigate the efficacy of this method in treating surgery-induced cognitive dysfunction in an aged rat model of POCD. We observed that the treatment of aVNS alleviated postoperative memory impairment after exploratory laparotomy surgery, as demonstrated by the shorter swimming latency and distance in Morris water maze tests. Moreover, aVNS also reduced postoperative apoptosis in the hippocampus of the aged rats. Concomitant with these beneficial effects, we found that treatment with aVNS attenuated postoperative neuroinflammation (i.e., the protein level of interleukin-1β and tumor necrosis factor-α, along with the nuclear protein expression of NF-κB) and Alzheimer’s-related pathology (tau phosphorylation at AT-8 and Ser396, as well as the levels of Aβ40 and Aβ42) in the hippocampus of the aged rats. In conclusion, our study is the first to reveal the neuroprotective effect of aVNS against POCD. This effect might be attributed to the inhibition of neuroinflammation and Alzheimer’s-related pathology. This study suggests non-invasive aVNS may serve as a promising method for clinical treatment of POCD.

Intraoperative ultrasonography in nine dogs with intra-abdominal neoplasm suspect

ABSTRACT: Intraoperative ultrasonography (IOUS) is used in medicine for diagnosis and guidance during oncologic surgery. The aims of this study were to assess the performance, feasibility, advantages and difficulties of the IOUS technique in dogs with suspected intra-abdominal tumors. The study included nine client-owed dogs that had suspected intra-abdominal tumors (spleen, liver or bowel) based on transabdominal ultrasound examination and that were subsequently referred for exploratory laparotomy surgery. During surgery, IOUS was performed; results of preoperative transabdominal ultrasonography, inspection by the surgeon and IOUS were compared on a case-by-case basis. IOUS was helpful in determining lesion resection in all cases. Lesions detected solely by the use of IOUS were observed in seven out of nine cases. Analysis of these cases demonstrated that IOUS can be a tool to assist during oncology surgery on the liver, spleen or bowel. Dogs with hepatic tumors can have small non-palpable intraparenchymal nodules, which may be visible by IOUS.

Abstract 1377: Guided imagery use in the peri-operative period of gynecologic oncology surgery.

Abstract Objective: To assess the feasibility of using guided imagery therapy in the peri-operative period at the time of Gynecologic Oncology surgery. Methods: IRB approval was obtained for this randomized control trial. Patients were recruited based on having an exploratory laparotomy surgery with the gynecologic oncology group. Research staff performed a phone interview and obtained written consent. Patients were randomized to standard of care therapy, blank CD which was to simulate noise reduction headphones, or a validated guided imagery CD. The intervention would be used in pre op waiting area, during surgery, and after surgery. VAS scores, amount of narcotics used, amount of anti-emetics used, FACT G and POMS surveys were collected. Results: 12 patients were attempted to be recruited for the study from April 2012 to the present. Prior to study enrollment, all patients were excited about the study and willing participants. All 12 pre op nurses were a barrier to discuss the study with the patients in the pre op area. 2 patients were unable to be consented due to the pre-operative nursing staff baring the research staff from consenting. 3 of the 10 RNAs stated that the player was dysfunctional, though the players were tested prior to delivery to the pre-operative area. 7 of the 12 patients stated that they ‘forgot’ to listen to the CD prior to surgery, or that the nurses did not let them take the time to listen. Only 2 of the 12 patients actually listened to the CD prior to surgery; only 2 of the 12 had the CD played during surgery. 4 of the 12 never received the CD player and surveys after surgery on the surgical oncology floor. Only 1 of the 12 actually listened to the CD throughout the entire hospital stay. 5 patients were told that it was “too busy” to listen to the CD by the floor nursing staff. 6 CD players were lost or stolen during the course of the study. To date, only 1 patient in the control group completed all surveys. However, 3 patients voiced excitement and satisfaction when using the intervention CD during their immediate peri-operative time, and were documented by external observers to have resolution of their anxiety while using the intervention CD. Conclusions: While subjectively beneficial for patients to decrease stress responses peri-operatively, integrative medicine techniques such as guided imagery will be difficult to implement until the culture of medicine embraces this novel modality. Citation Format: Elizabeth L. Dickson, Matt Gerber, Amy L. Jonson. Guided imagery use in the peri-operative period of gynecologic oncology surgery. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1377. doi:10.1158/1538-7445.AM2013-1377