Intra-abdominal Abscess Research Articles

Adjunctive Azithromycin Prophylaxis for Prelabor Cesarean Birth.

To evaluate maternal postoperative infections before and after addition of adjunctive azithromycin to standard antibiotic prophylaxis for prelabor cesarean births. We conducted a retrospective cohort study of patients with singleton gestations at more than 23 weeks of gestation who underwent prelabor cesarean birth at a single tertiary care center. Deliveries were categorized as those before implementation of 500 mg intravenous azithromycin in addition to standard preoperative cephalosporin antibiotic prophylaxis (pre-AZI group; January 2013-September 2015) and those after implementation of adjunctive azithromycin (post-AZI group; January 2016-December 2018). Cesarean births from October to December 2015 were excluded as a washout period. The primary outcome was a composite of postcesarean infections (endometritis, superficial or deep wound infections, intra-abdominal abscess, urinary tract infections). Secondary outcomes included composite components, other wound or postoperative complications, and select neonatal morbidities. Outcomes were compared between groups, and adjusted odds ratios (aORs) and 95% CIs were calculated using multivariable analysis. Propensity score matching was performed to assess the robustness our analysis. Of 2,867 delivering patients included for analysis, 1,391 (48.5%) were in the pre-AZI group and 1,476 (51.5%) were in the post-AZI group. Patients in the post-AZI group were older and were more likely to have private insurance, use aspirin, and receive predelivery antibiotics within 2 weeks. There were significantly lower odds of composite infection after azithromycin implementation (3.3% vs 4.8%, aOR 0.60, 95% CI 0.40-0.89), driven by a reduction in wound infection odds (2.4% vs 3.5%, aOR 0.61, 95% CI 0.39-0.98). There were lower odds of other postpartum complications, including wound seroma (0.5% vs 0.9%, aOR 0.34, 95% CI 0.13-0.90) and dehiscence (0.5% vs 1.2%, aOR 0.32, 95% CI 0.13-0.79). There were no differences in select neonatal morbidities between groups. Of 1,138 matching sets in the propensity analysis, the primary outcome remained significantly lower in the post-AZI group (aOR 0.64, 95% CI 0.41-0.99). Adopting adjunctive azithromycin for prelabor cesarean deliveries was associated with lower odds of postpartum infection.

Disutility Study for Adult Patients with Moderate to Severe Crohn’s Disease

Background: Crohn’s disease (CD) treatments and associated adverse events (AEs) can be burdensome for patients. However, specific values which quantify the impact on health-related quality of life (HRQL) for economic evaluation are lacking. Objectives: This study aimed to elicit health utility values for AEs related to biologic treatment and surgical complications for CD in the UK. Methods: Health states were developed by literature review and interviews with CD patients (n=6) and gastroenterologists (n=3). Draft health states were validated in cognitive debrief interviews with patients (n=4) and gastroenterologists (n=2). Treatment AEs were described with moderate severe CD (reference state) and included hypersensitivity, injection site reactions, serious infection, lymphoma, and tuberculosis. Surgical complications were described following bowel surgery (reference state) and included anastomotic leak, wound infection, prolonged ileus/bowel obstruction, and intra-abdominal abscess. Health states were valued by 100 members of the general public who completed background questions, EQ-5D-3L, visual analogue scale rating task and time trade-off (TTO) interviews. Results: The mean TTO value for reference states ‘moderate to severe CD’ and ‘bowel surgery’ were 0.70 (SD=0.28) and 0.69 (SD=0.28). Participants rated lymphoma as the worst AE/surgical complication state (0.44, SD=0.37), followed by tuberculosis (0.47, SD=0.85) and anastomotic leak (0.48, SD=0.38). Values of other AE/surgical complication states ranged from 0.76 (hypersensitivity) to 0.56 (intra-abdominal abscess). Conclusions: This study provides utility estimates for AE and surgical complication health states not previously assessed in the context of CD. As new treatments are emerging, it is important to include these influences on quality of life in any economic evaluation of treatments.

Preoperative Hypoalbuminemia as a Predictor of Severe Postoperative Complications in Patients Undergoing Whipple Pancreatoduodenectomy.

Pancreaticoduodenectomy (PD) known as Whipple procedure is still one of the most complex abdominal surgeries used for treatment of periampullary tumors. PD is often followed with postoperative complications (pancreatic, biliar or intestinal fistula, haemorrhage, intraabdominal abscess, delayed gastric empting. Severe postoperative complications (SPC) can be reason for reoperation and reason of bad outcome of treatment and life treathening condition. To investigate predicitive value of preoperative hypoalbuminemia for severe postoperative complications (SPC) in patients who have undergone Whipple pancreaticoduodenetomy (PD). However, no similiar study has been ever reported from our country until now. In this retrospective-prospective study, 100 patients who have had Whipple pancreaticoduodenectomy for malignant periampullary tumors at the Department for Surgery of University Clinic Center Tuzla, Bosnia and Herzegovina were enrolled, from january of 2009 to decembre of 2021. All patients were preoperatively analysed according to serum albumine levels and presensce of hypolabuminemia (serum albumine levels <32g/l). Serum albumine biochemical test were done 1-2 days preoperatively. Clavien Dindo classification was used for determination patients with SPC. Patients who did not have SPC belonged to (I-II) Clavien Dindo group of patients while those who had SPC belonged to( III-V) Clavien Dindo group of patients. Out of 100 patients who have undergone pancreaticoduodenetomy, in 55 (55%) patients postoperative complications were noticed. Mortality rate was 18 (18%) and reoperation has been done in 20 cases (20%). SPC were noticed in 19 patients and most often were: delayed gastric emptying (20%), pancreatic fistula (13%) and intraabdominal collections (9%). Hypoalbuminemic patients had a significantly higher rate of severe postoperative complications ( p<0.05). Using hypoalbuminemia-SPC correlation analaysis, there is confirmed statistically significant correlation between hypoalbuminemia and SPC (ρ= 0.236; p<0.05). Preoperative hypoalbuminemia can be used as predictor and prognostic factor for severe postoperative complications after Whipple pancreaticoduodenectomy. Identification and optimization of serum albumin level prior to Whipple pancreatoduodenectomy may improve surgical outcomes.

FEATURES OF DIAGNOSIS AND TREATMENT OF CROHN’S DISEASE (CLINICAL CASE)

The exact reason for the occurrence of Crohn’s disease remains unknown. It is believed that pathology can be carried out by infectious and viral pathogens, deviations from the norm of natural balance of the microflora of the gastrointestinal tract (hereinafter – the gastrointestinal tract). Many researchers indicate an abnormal autoimmune response of the body on food stimuli – in favor of such an assertion indicates the systematic impression of the internal organs. However, for the emergence and development of this disease, there are significant impacts with harmful habits, such as: smoking, alcoholic beverages and medicines, unbalanced nutrition and the presence of chronic inflammatory gastroids. The inflammatory process begins in the mucous membrane, gradually affects all layers of the wall of the gastrointestinal wall, leads to its destruction and fibrosis and the formation of fistish and stenoses. Therefore, early diagnosis and timely treatment prevents the development of complications, including such severe such as bleeding, perforation of the intestinal wall, intra-abdominal abscesses, internal and external fists, adhesions of the intestine with the development of obstruction. Purpose: on the basis of a specific case of HC to investigate and analyze the features of diagnosis and treatment of these patients using an analytical method and a systematic approach. Materials and methods: The material was a clinical case of HC, methods of instrumental diagnosis and objective analysis. The results: The concrete case of HC is investigated, features of inspection and diagnostics are defined. Conclusions: A feature of the diagnosis and treatment of patients with HC is a constant vigilance about the occurrence of complications, the key to the prevention of which is a multidisciplinary approach in the tactics of diagnosis and treatment of these patients. Key words: Crohn’s disease, features of examination and diagnosis.

Leiomyomatosis peritonealisis disseminata resembling intra-abdominal malignancy

Leiomyomatosis peritonealisis disseminata (LPD) is a rare benign tumor characterized by the dissemination of smooth muscle-like cell nodules within the peritoneal cavity. Diagnosing LPD is challenging for clinicians due to its nonspecific clinical presentation and its dissemination throughout the peritoneal cavity, which mimics intra-abdominal malignancy. In the present study, we present the case of a 47-year-old woman with severe abdominal pain and fever initially diagnosed with intra-abdominal abscess or peritoneal carcinomatosis. Exploratory laparotomy was performed to resect several leiomyoma-like tumors in the subperitoneal space. LPD was confirmed histopathologically.

Perforated appendicitis treated with laparoscopic appendicectomy or open appendicectomy: A meta-analysis.

This analysis compared the impact of laparoscopic appendicectomy (LA) and open appendicectomy (OA) on treating adult perforated appendicitis (PA). Articles relating to LA and OA in treating PA were retrieved from databases including PubMed, Cochrane Library and Embase since their founding to January 2022. These articles were independently filtered based on the inclusion and exclusion criteria by two investigators. The quality of these articles was assessed and article data were extracted. Dichotomous data were presented in the form of odd's ratio (OR), whereas continuous data were in the form of weighted mean difference (WMD). The included articles reported at least one of the following outcomes: intra-abdominal abscess (IAA), wound infection, operative time, hospital stay and complications. Three randomised control trials (198 LA cases vs. 205 OA cases) and 12 case - control trials (914 LA cases vs. 2192 OA cases) were included. This analysis revealed that although the IAA formation rate was similar in the LA and OA groups (OR: 1.28, 95% confidence interval [CI]: 0.87-1.88), the wound infection rate was lower in the LA group (OR: 0.38, 95% CI: 0.28-0.51). Furthermore, LA was associated with shorter hospital stay (WMD: -1.43 days, 95% CI: -2.33--0.52) and fewer complications than OA (OR: 0.40, 95% CI: 0.28-0.57). LA has significant benefits in treating PA and is associated with better post-operative outcomes such as shorter hospital stay, lower incidence of wound infection and other complications. However, more studies with randomised and large-sample populations are still required to determine the clinical benefit of LA in treating PA.

MICROBIOLOGICAL ANALYSIS OF ABDOMINAL CAVITY EXUDATE, BLOOD AND AFFECTED TISSUES SAMPLES FROM PATIENTS WITH INTRA-ABDOMINAL ABSCESSES IN COMPLICATED INFECTION OF ABDOMINAL CAVITY.

The aim: To conduct an analysis of the results of a microbiological examination of biological samples taken from patients with intra-abdominal abscesses. Materials and methods: Material for microbiological examination was collected from 60 patients during surgery and transported to laboratory at the same day. Isolation and identification of microbial pure cultures were performed by standard microbiological methods. Statistical analysis was performed using Statistica software. Results: Analyzing the microbiological research results indicated importance of the sample collecting time (first or repeated surgery). In pa¬tient's blood taken during first surgery it was found a statistically significant predominance of no growth of microflora. In abdominal cav¬ity exudates anaerobic cultures increased statistically significantly in repeated surgery. It was noted that in samples taken during first sur¬gery mixed pathogens were represented mainly by facultative anaerobic cocci, then in repeated surgery anaerobic microorganisms were predominant. Examination of liver abscess content found that monoculture was isolated in 85.7 %. Blood and affected tissue samples in such patients were sterile. Investigation of samples from patients with multiple abdominal cavity abscesses revealed anaerobic microorganisms in 16.7 %. Blood samples of that patients in 40 % were sterile. Conclusions: An analysis showed that in appendicular abscesses content gram-negatives were predominant. Gram-positive bacteria dominated in paravesical abscesses with 65 % isolates from gallbladder and 66.7 % from the affected tissue samples. In liver abscesses gram-positive cocci were isolated in 57.1 %. In multiple abdominal abscesses due to bowel perforation rod-shaped microflora was predominant (76 %) and represented by either obligate aerobes or obligate and facultative anaerobes.

Trocar-assisted percutaneous abscess drainage: A better way to treat intra-abdominal abscess

Objective: This study aimed to introduce trocar-assisted percutaneous abscess drainage (TA-PAD) and compare it to the Seldinger puncture with pigtail drain (SPD) in the clinical treatment of intra-abdominal abscess. Materials and Methods: The clinical data of 23 patients with abdominal abscess treated with TA-PAD from 2017 to 2019 were retrospectively analyzed. Moreover, 18 patients with abdominal abscess treated with SPD from 2014 to 2016 were taken as the control. The therapeutic effects were compared between the two groups. Results: No death or surgery-related complications were observed in either group. There were significant differences between the two groups in the drainage rate of open surgery, the complete healing time of abscess, the time of inflammation relief, the recurrence rate of abscess, and the hospitalization cost (P &lt; 0. 05). There was no significant difference in the duration of antibiotic use between the two groups (P &gt; 0. 05). Conclusions: TA-PAD can optimize the treatment of abdominal abscesses with significantly lower surgical drainage rates, shorter hospital stays, lower recurrence rates, and lower hospital costs.

Giant porta hepatis cystic lymphangioma mimicking intra-abdominal abscess

Background: Intra-abdominal lymphangiomas are very rare benign tumors in adults. Here we demonstrate a 22-year-old male who presented with abdominal pain and fevers. He underwent a CT of the abdomen and pelvis which showed multiple, large loculated fluid density lesions extending from the porta hepatis into the entire right hemi-abdomen and into the left upper quadrant. The largest cyst measured 10.4 cm by 1.9 by 26.4 cm. Due to ongoing fevers and concern for infection, the patient underwent percutaneous aspiration of the fluid for concern of intra-abdominal abscess. From the sampled fluid, cultures were negative for growth, cytology was negative for malignant cells, and cell count was within normal limits. The triglyceride level of the fluid was 2739 mg/dL. The patient had moderate relief, but the following day again developed abdominal distension, discomfort, and anorexia. Due to the symptomatic nature of the mass, the patient underwent an exploratory laparotomy with resection of the mass. 4.6 liters of chylous ascites were removed from within the cystic mass. The mass was noted to extend from the porta hepatis into the right retroperitoneum and extend to the left upper quadrant, abutting the pancreas and spleen. The pathology report was consistent with lymphangioma with marked acute fibrinopurulent inflammation and no evidence of malignancy. The patient had immediate relief postoperatively and recovered well from surgery.

Case report of 58-year-old psychiatric male with neglected complicated acute appendicitis

Background: Studies revealed people with psychiatric conditions have a higher risk of complicated appendicitis. Patients with acute appendicitis classically present with acute pain in the right iliac fossa, fever, and vomiting. In complicated acute appendicitis, patients present with a palpable mass, appendix phlegm, or abscess. Commonly, appendicular abscesses are treated conservatively with ultrasound-guided percutaneous drainage and antibiotic therapy. Case Presentation: We demonstrate a case of a 58-year-old with neglected appendicitis in a psychiatric patient. The patient presents with multiple intraabdominal abscesses and septic shock, requiring open drainage and intensive care unit admission. Conclusion: To stop the progression of the disease and the emergence of complications, our study highlights the significance of careful assessment, early diagnosis, and treatment with attention to adherence for the psychiatric population.

An Adolescent Girl with Acute-on-Chronic Abdominal Pain.

We present an 11-year-old pediatric patient with acute-on-chronic abdominal pain found to have a large intra-abdominal abscess with a concomitant dermoid cyst. Acute-on-chronic abdominal pain has one of the broadest and, in our case, ever-changing differential diagnoses. Exploratory laparoscopy revealed a severe pelvic inflammatory process with a large abscess and extensive omental and bowel adhesions, a left ovarian cyst, a shortened appendix with thickened tip, and purulent fluid in the cul-de-sac. These findings suggested a ruptured appendix leading to a large abscess with adjacent ovarian dermoid cyst, and an appendectomy was performed. Our patient responded well to continued intravenous antibiotics, and her drain was removed on the day of discharge. She was sent home with an additional 2 weeks of oral cefdinir and metronidazole. Follow-up ultrasound showed dramatic cyst resolution, and no further intervention was needed. [Pediatr Ann. 2023;52(1):e36-e38.].

Single-incision versus multi-port laparoscopic ileocolic resections for Crohn's disease: Systematic review and meta-analysis.

The aim of this systematic review and meta-analysis is to compare the outcomes of single-incision laparoscopic surgery (SILS) versus multi-port laparoscopy for ileocolic resection in patients with Crohn's disease (CD). A systematic search of multiple electronic databases was conducted. The peri- and post-operative outcomes were evaluated between Crohn's patients undergoing SILS versus multi-port laparoscopy for ileocolic resection. The primary outcomes included operative time, anastomotic leak rate, post-operative wound infections and length of hospital stay. Analysed secondary outcomes were conversion rates, ileus occurrence, intra-abdominal abscess formation, return to theatre and re-admissions. Revman 5.3 was used to perform the statistical analysis. Five observational studies with 521 patients (SILS: 211; multi-port: 310) were included in the data synthesis. Patients undergoing SILS had a reduced total operative time compared to multi-port laparoscopy (mean difference [MD]: -16.14, 95% confidence interval: [CI] -27.23 - 5.05, P = 0.004). Post-operative hospital stay was also found to be significantly less in the SILS group (MD: -0.57, 95% CI: -0.73--0.42, P < 0.0001). No significant difference was seen in the anastomotic leak rate (MD: -16.14, 95% CI: 0.18-1.71, P = 0.004) or post-operative wound infections (odds ratio: 0.78, 95% CI: 0.24 - 2.47, P = 0.67) between the two groups. Moreover, all the measured secondary outcomes were comparable. SILS seems to be a feasible alternative to multi-port laparoscopic surgery for ileocolic resection in patients with CD. Improved outcomes in terms of total operative time and length of hospital stay were observed in patients undergoing SILS surgery. Adopting this procedure into routine clinical practice constitutes the next step in the development of minimally invasive surgery.

Intra-abdominal packing does not increase infection risk or mandate longer presumptive antibiotic therapy.

Damage control laparotomy allows for resuscitation and reversal of coagulopathy with improved mortality. In-tra-abdominal packing is often used to limit hemorrhage. Temporary abdominal closure is associated with increased rates of subse-quent intra-abdominal infection. The effect of increased duration of antibiotics is unknown on these infection rates. We sought to determine the role of antibiotics in damage control surgery. A retrospective analysis of all trauma patients requiring damage control laparotomy on admission to an ACS verified level one trauma center from 2011 to 2016 was performed. Demographic and clinical data including ability and time to attain primary fascial closure, as well as complication rates, were recorded. The primary outcome measure was intra-abdominal abscess formation following damage control laparotomy. Two-hundred and thirty-nine patients underwent DCS during the study period. A majority were packed (141/239, 59.0%). No differences existed in demographics or injury severity between groups, and infection rates were similar (30.5% vs. 38.8%, P=0.18). Patients with infection were more likely to have suffered gastric injury (23.3% vs. 6.1%, P=0.003) than those without complication. There was no significant association between gram negative and anaerobic (Odds Radio [OR] 0.96, 95% confidence interval [CI] 0.87-1.05) or antifungal therapy (OR 0.98, 95% CI 0.74-1.31) and infection rate, regardless of duration on multivariate regression CONCLUSION: Our study offers the first review of the effect of antibiotic duration on intra-abdominal complications following DCS. Gastric injury was more commonly identified in patients who developed intra-abdominal infection. Duration of antimicrobial therapy does not affect infection rate in patients who are packed following DCS.

STAPLED VERSUS HANDSEWN INTESTINAL ANASTOMOSIS IN EMERGENCY SURGERY

Introduction The major problem following bowel anastomoses is the anastomotic failure leading to leakage peritonitis, fistula, abscess, sepsis, necrosis, stricture etc. adding to the morbidity and mortality. (e.g., 22% mortality in patients with a leak vs. 7.2% mortality in those without leak).The present study compares the complication rates of sutured and stapled anastomotic techniques in an emergency setting of a tertiary care institute in Kerala. Methodology The study evaluates the complications (leak /intra-abdominal abscess) of both stapled and hand-sewn techniques of intestinal anastomosis in emergency setting. The study is conducted in a tertiary care centre in Kerala and the data is collected from the medical records and emergency register. A total of 112 cases that meet the inclusion and exclusion criteria are included during the period from 2017 to 2021 Results Among the 61 patients who had undergone hand sewn anastomosis 7 (11.5%) had anastomotic leak and 54 (88.5%) patients had no leak. Among the 51 patients underwent stapled anastomosis, 6 (11.8%) had anastomotic leak and 45 (88.2%) patients developed no leak. This data is statistically analyzed using Chi Squared test and found that there is no significant difference between the occurrence of anastomotic leak between the two study groups irrespective of whether the anastomosis is hand sewn or stapled. The average time taken for surgery in the hand sewn group is about 192.1 minutes and in stapled group is 162.5 minutes. This difference in the average duration of surgery is analyzed statistically and it showed that the difference in of the duration of surgery is statistically significant. Conclusion There is no significant difference between the complication rates of both type of anastomosis is identified in the emergency setting. But there is a clear advantage of less operating time for stapled anastomosis.

Peritoneal antiseptic irrigation to prevent surgical site infection after laparotomy for hepatobiliary or gastrointestinal surgery (PAISI)—protocol for a randomized controlled study

BackgroundPostoperative surgical site infections (SSIs) remain common after laparotomy for resections of the gastrointestinal or hepatobiliary tract. Especially organ/space infections (CDC class III SSI) can be life-threatening, require relaparotomy, intensive care or interventional drainage of intraabdominal abscesses. The PAISI study aims to investigate whether the use of prophylactic peritoneal irrigation with NaOCl/HOCl solution can reduce the SSI rates following laparotomy for resections of the gastrointestinal or hepatobiliary tract, compared to standard irrigation with physiological electrolyte solution (Ringer’s solution). Secondarily, to evaluate whether the use of prophylactic peritoneal irrigation with NaOCl/HOCl solution can reduce postoperative morbidity and mortality as well as the rate of re-operations and length of hospital stay.MethodsPAISI is a prospective, randomized, observer- and patient-blinded, monocentric, two-arm surgical study in an adaptive parallel groups design, comparing peritoneal and wound irrigation with NaOCl/HOCl (50/50ppm) solution to irrigation with Ringer’s solution. The primary endpoint of the study is the SSI rate within 30 days postoperatively. Since there is no data on incidence rates from randomized clinical trials, the rates for sample size calculation were estimated according to the clinical experience at our institution. Therefore, the study design includes one unblinded look at the data by a second statistician, which will be performed after half of the patients reached the primary endpoint. This interim information will be used to check the assumptions and if needed, the sample size will be adjusted. The O’Brien-Fleming spending function is used to determine the efficacy test boundary and the non-binding futility boundary. The one-sided z-test (Group sequential test of two proportions) at the 2.5% significance level with a total of two looks at the data will have overall 80% power.DiscussionThe results of this study will provide high-level evidence for future research and clinical recommendations regarding the use of NaOCl/HOCl solution in abdominal surgery and provide the participating patients the opportunity of a potentially improved treatment.Trial registrationGerman Clinical Trials Register (DRKS) DRKS00028037. Registered on 27 May 2022.

Anti-TNF Treatment in Crohn’s Disease Complicated by Intra-abdominal Abscess

Excess production of TNF-α leads to chronic inflammation and tissue damage in immune-mediated inflammatory diseases (IMID) such as Crohn’s Disease (CD), rheumatoid arthritis, and psoriasis. The introduction of anti-TNF agents revolutionised therapy for patients with IMIDs, and two anti-TNFs are currently approved for use in CD in Europe: infliximab and adalimumab. The chronic transmural inflammation associated with CD commonly leads to intestinal complications such as intra-abdominal abscesses, which present a challenge to a multidisciplinary medical team. While surgical management may ultimately be required in some patients, it is associated with a risk of morbidity and loss of function, particularly in a patient who requires immunosuppression to address their underlying CD. This mini review summarises the current evidence surrounding the use of anti-TNFs in CD complicated by intra-abdominal abscess, including current treatment guidelines, the use of anti-TNFs in combination with conservative (non-surgical) management, and the impact of anti-TNFs on post-operative complications and abscess recurrence.

Prolonged Survival Following Intra-abdominal Mycobacterium abscessus Infection Without Antimicrobial Therapy or Surgical Intervention.

Management of Mycobacterium abscessus infection involves prolonged multidrug antibiotic therapy with surgical resection indicated in extensive disease and abscesses. We report a case of post-surgical intra-abdominal M. abscessus infection with prolonged survival and radiographic resolution without intervention. A 51-year-old female who had a prolonged hospital stay with multiple surgeries following a complicated laparoscopic sleeve gastrectomy developed multiple M. abscessus intra-abdominal and abdominal wall abscesses with cutaneous fistulae. She was started on a multidrug antibiotic regimen. However, the patient terminated the regimen after 4weeks due to intolerable side effects and was transitioned to hospice care. She showed steady clinical improvement with radiographic resolution of the abscesses over the next year. In the context of the limited understanding of these infections, our finding is notable, given that in this period, she avoided potential hospitalizations, life altering side effects of prolonged antimicrobial therapy, and complications from more surgeries.

Three-year outcomes of robotic gastrectomy versus laparoscopic gastrectomy for the treatment of clinical stage I/II gastric cancer: a multi-institutional retrospective comparative study.

Oncological benefits of robotic gastrectomy (RG) remain unclear. We aimed to determine and compare the 3-year outcomes of RG and laparoscopic gastrectomy (LG) for the treatment of gastric cancer. This was a multi-institutional retrospective study of patients who prospectively underwent RG in a previous study (UMIN000015388) and historical controls who underwent LG. Operable patients with cStage I/II primary gastric cancer were enrolled. The inverse probability of treatment weighting method based on propensity scores was used to balance patient demographic factors and surgeon volume between the RG and LG groups. The primary outcome measure was the 3-year overall survival rate (3yOS). Of the 1,127 patients in the previous study, 326 and 752 patients in the RG and LG groups, respectively, completed the study. The standardized difference of all confounding factors was reduced to 0.09 or less after weighting. In the weighted population, 3yOS was 96.3% and 89.6% in the RG and LG groups, respectively (hazard ratio [HR] 0.34 [0.15, 0.76]; p = 0.009), whereas there was no difference in 3-year recurrence-free survival rate (3yRFS) between the two groups (HR 0.58 [0.32, 1.05]; p = 0.073). Sub-analyses showed that RG improved 3yOS (HR 0.05 [0.01, 0.38]; p = 0.004) and 3yRFS (HR 0.05 [0.01, 0.34]; p = 0.003) in patients with pStage IA disease. Recurrence rates and patterns were similar between the RG and LG groups. RG did not improve the morbidity rate, however, it attenuated some of the adverse events, including anastomotic leakage and intra-abdominal abscess. RG improved estimated blood loss and duration of postoperative hospitalization. This study showed surgical and oncological safety of RG for cStage I/II gastric cancer considering the 3-year outcomes, compared with those of LG.

Comparison of Microbiological Profile of Drained Intra-Abdominal Abscess in Patients with Crohn’s Disease and Colonic Diverticulitis

Comparison of Microbiological Profile of Drained Intra-Abdominal Abscess in Patients with Crohn’s Disease and Colonic Diverticulitis

S123 Maternal and Fetal Outcomes After IBD Surgery During Pregnancy

Background: Inflammatory bowel disease (IBD) incidence peaks in the reproductive years. Despite advances in medical treatment, approximately 20% of ulcerative colitis (UC) and 80% of Crohn’s disease (CD) patients require surgical intervention during their lifetime. Active disease during pregnancy increases the risk of negative pregnancy outcomes, such as spontaneous abortion, low birth weight, prematurity and deformities. Achieving remission prior to conception and maintaining it throughout the pregnancy remain of utmost importance. However, surgery during pregnancy may be required for medically refractory disease or for disease-related complications such as intraabdominal abscess, perforation, or toxic megacolon. Literature pertaining to the maternal and fetal outcomes after IBD surgery during pregnancy remains scarce. Methods: This is a case series of 3 patients who underwent surgery for IBD during pregnancy and subsequently delivered at our quaternary IBD referral center. Results: Case 1: A 34-year-old female with recently diagnosed indeterminate colitis presented with disease exacerbation during her fifth gestational week. Despite treatment with mesalamine, methylprednisolone, and infliximab, she had persistent hematochezia, abdominal pain, and distention. On 11w6d of pregnancy, she underwent an open subtotal colectomy with end ileostomy for severe colitis. Postoperative period was uncomplicated. She then underwent a C-section at 38w5d of gestation. Baby weighed 2.9 kg, Apgar scores 9-9. The newborn had a cleft in the posterior soft palate, micrognathia, tongue tie, and laryngomalacia resulting in dyspnea and dysphagia, which required operative intervention during infancy. The mother ultimately underwent completion proctectomy with IPAA and ileostomy closure at 5- and 7-months following delivery, respectively. Postoperative pouch function was normal. During routine follow-up, pouchoscopy revealed cuffitis, which responded to mesalamine suppository. Case 2: A 28-year-old female with an 8-year history of UC previously treated with prednisone and azathioprine developed disease exacerbation during her 11th gestational week. During 25th week of pregnancy, she underwent an open subtotal colectomy with end ileostomy for acute severe ulcerative colitis. Postoperative period was uncomplicated. She underwent C-section at 39th week of gestation. Baby weighed 3.7 kg, Apgar scores 3-3-8. The newborn developed dyspnea which was resolved following positive pressure ventilation in the NICU for 30 hours. The mother underwent completion proctectomy with IPAA and ileostomy closure 2 years after delivery. Four years following pouch creation, she developed pouchitis, which was controlled with vedolizumab. Case 3: A 20-year-old female with recently diagnosed Crohn’s disease had disease exacerbation at 4 weeks gestation despite treatment with adalimumab and prednisone. A pelvic abscess was identified via ultrasound requiring percutaneous drainage twice. During the ninth week of pregnancy, she underwent a laparoscopic converted to open ileocecectomy due to recurrent abscess and abdominal pain. Postoperative period was uncomplicated. The pregnancy was complicated by pre-eclampsia in the third trimester. The patient had a vaginal delivery at 37w6d of gestation. Baby weighed 2.7 kg, Apgar scores 8-9. The post-delivery course of the mother and infant was uncomplicated. Conclusions: IBD affects females during their childbearing ages. IBD surgery at times needs to be done urgently/emergently; acceptable maternal and fetal outcomes can be achieved.