Intra-abdominal Complications Research Articles

Implementing the Robotic deep inferior epigastric perforator Flap in daily practice: A series of 10 cases.

The deep inferior epigastric perforator (DIEP) flap is the workhorse in microvascular breast reconstruction. Rectus muscle sacrifice or denervation and inappropriate rectus sheath closure are the main causes of abdominal wall morbidity. Robotic vessel dissection may limit fascial incision length below the arcuate line and rectus denervation. This study describes and focuses on the implementation and feasibility of this technique in daily surgical practice. A retrospective data collection of all robotic DIEP flap reconstructions between August 2020 and October 2021 was conducted at our university hospital. Primary outcome variables were flap success and intraoperative complications. Secondary variables included timing of the different robot-assisted stages, total operating time, and postoperative complications within 6 weeks. In total, 10 robotic DIEPs were performed using a multiport robotic system through the transabdominal preperitoneal approach. Nine short intramuscular (SIM) and 1 subfascial (SF) perforators were selected based on the preoperative imaging. There were no perioperative intra-abdominal complications or flap losses. Robotic installation ranges from 16 to 40min. Mean robot-assisted operating time was 86min, and mean operative time was 479min. We present the largest case series of robotic DIEP flap reconstructions for delayed and immediate autologous breast reconstruction through a transabdominal preperitoneal approach. This technique is safe, reproducible, and feasible in a daily hospital setting. We have observed a steep learning curve associated with robotic vessel dissection. Future research may optimize surgical technique, assess possible benefit on abdominal wall morbidity, and evaluate cost-effectiveness.

The clinical impact of preoperative biliary drainage on isolated infectious complications (iiC) after pancreatic head resection\u2014a retrospective study

BackgroundThe perioperative morbidity after pancreatoduodenectomy (PD) is mostly influenced by intraabdominal complications which are often associated with infections. In patients with preoperative biliary drainage (PBD), the risk for postoperative infections may be even elevated. The aim of this study is to explore if isolated infectious complications without intraabdominal focus (iiC) can be observed after PD and if they are associated to PBD and antibiotic prophylaxis with potential conclusions for their treatment.MethodsDuring a 10-year period from 2009 to 2019, all consecutive PD were enrolled prospectively in a database and analyzed retrospectively. Bacteriobilia (BB) and Fungibilia (FB) were examined by intraoperatively acquired smears. A perioperative antibiotic prophylaxis was performed by Ampicillin/Sulbactam. For this study, iiC were defined as postoperative infections like surgical site infection (SSI), pneumonia, unknown origin etc. Statistics were performed by Fisher’s exact test and Mann Whitney U test.ResultsA total of 426 PD were performed at the Vivantes Humboldt-hospital. The morbidity was 56% (n = 238). iiC occurred in 93 patients (22%) and accounted for 38% in the subgroup of patients with postoperative complications. They were not significantly related to BB and PBD but to FB. The subgroup of SSI, however, had a significant relationship to BB and FB with a poly microbial profile and an accumulation of E. faecalis, E. faecium, Enterobacter, and Candida. BB was significantly more frequent in longer lay of PBD. Resistance to standard PAP and co-existing resistance to broad spectrum antibiotics is frequently found in patients with iiC. The clinical severity of iiC was mostly low and non-invasive therapy was adequate. Their treatment led to a significant prolongation of the hospital stay.ConclusionsiiC are a frequent problem after PD, but only in SSI a significant association to BB and FB can be found in our data. Therefore, the higher resistance of the bacterial species to routine PAP, does not justify broad spectrum prophylaxis. However, the identification of high-risk patients with BB and PBD (length of lay) is recommended. In case of postoperative infections, an early application of broad-spectrum antibiotics and adaption to microbiological findings from intraoperatively smears may be advantageous.

SURGICAL TREATMENT OF ACUTE SMALL BOWEL OBSTRUCTION: INDICATIONS ASSOCIATED WITH STRANGULATION AND EARLY MORTALITY AFTER SURGERY. PRELIMINARY DATA FROM A RETROSPECTIVE STUDY

Acute small bowel obstruction (ASBO) continues to be one of the most difficult problems of emergency abdominal surgery.
 Materials and methods. The results of treatment of 123 patients aged 18–80 years with ASBO were evaluated. Patients were divided into two groups: 1st - with a positive result (survivors, n = 101), 2nd — with an unfavourable result (non-survivors, n = 22).
 Results. All these patients underwent emergency surgery: the adhesive disease was the main cause in 101 (82.1 %) patients with ASBO, small bowel obstruction in gallstones was in 2 (1.6 %) and volvulus was the cause in 20 (16.3 %) ) patients. Small bowel ischemia developed in 49 (39.8 %) patients: reversible in 21 (42.9 %) and irreversible in 28 (57.1 %) patients; generalized peritonitis was present in 24 (19.5 %) patients, in 18 (75 %) of them abdominal sepsis was presented according to the criteria of Sepsis-3. After the operation, 22 patients (17.9 %) died, which were analyzed: in the early stages (first 72 hours), seventeen patients (77.3 %) and others (22.7 %) - from the third to the seventh day of the postoperative period. Studies have shown that only three laboratory parameters (blood leukocytes, lactate and C-reactive protein) and one instrumental (involving the mesentery of the small intestine, free fluid in the abdomen during CT) with a probability of 80 % or more were significantly associated with strangulated ASBO, as well as six indicators with the same probability were associated with early mortality after surgery. In both groups, the main operation in 95 (77.2 %) patients was adhesiolysis, transnasal tube of the small intestine and drainage of the abdominal cavity. The choice of access for surgery (laparoscopy or laparotomy) (P = 0.000), as well as the duration of surgery (P = 0.038), affected the results of the treatment in patients under analysis, although the types of operations performed did not significantly affect the results in these groups patients (P = 1.000). Immediate results in patients depended on the development of intra-abdominal complications after surgery (P = 0.024) and the need for early re-operation (P = 0.006). The development of postoperative complications, such as cardiovascular dysfunction (P = 0.000) and respiratory dysfunction (P = 0.000), also affected the treatment outcomes in these patients.
 Conclusion. It was confirmed that three laboratories and one instrumental parameter were indicated of strangulated ASBO before surgery and the six parameters studied were predictors of early mortality before surgery with a probability of 80 % or more.

Less Severe Intra-Abdominal Infections in Robotic Surgery for Gastric Cancer Compared with Conventional Laparoscopic Surgery: A Propensity Score-matched Analysis.

The impact of robotic gastrectomy (RG) for gastric cancer (GC) on the incidence of postoperative complication is debatable and unclear. This study enrolled 200 patients with GC who were surgically treated and consisted of 100 RG and 100 laparoscopic gastrectomy (LG) cases using an ultrasonic scalpel. The short-term outcomes were compared between the two groups. These outcomes were compared using a 1:1 propensity score (PS)-matching analysis. After PS matching, 76 cases in each group were well matched. Mean surgical time was significantly longer in the RG group than in the LG group (393 vs. 342min, p<0.005), whereas mean blood loss during surgery was significantly lower in the RG group than in the LG group (30.1 vs. 50.1mL, p=0.023). The median number of surgeons who attend the main part of the surgery was significantly less in the RG group than in the LG group (2.0 vs. 3.0, p=0.01). The rate of severe intra-abdominal infectious complication was significantly lower in the RG group than in the LG group (0% vs. 9.2%, p=0.014). The duration from surgery to adjuvant chemotherapy was significantly shorter in the RG group than in the LG group (29.6±11.0 vs. 45.2±27.8days, p=0.046). RG using an ultrasonic scalpel may be a viable alternative to LG because of the improvement in the rate of postoperative intra-abdominal infectious complications after curative surgery for GC.

The Management of Intra-abdominal Complications Following Peritoneal Flap Vaginoplasty

To describe the authors' experience diagnosing and managing intra-abdominal complications following robotic peritoneal flap vaginoplasty. The peritoneal flap vaginoplasty is a technique used to achieve consistent vaginal depth regardless of available natal tissue. Intra-abdominal complications following robotic peritoneal flap creation are rare but prompt diagnosis and management is critical to preventing patient harm. Given the infancy of the technique there is limited data on associated complications and their management. Retrospective chart review identified patients undergoing robotically assisted peritoneal flap vaginoplasty by the senior authors between 2017 and 2020 who subsequently developed intra-abdominal complications requiring readmission and/or return to the operating room. Patient charts were analyzed for preoperative demographics, medical comorbidities, intraoperative details, postoperative complication presentation, diagnosis, management, and long-term outcomes. Out of 274 patients undergoing peritoneal flap vaginoplasty during the study period, six patients were identified who developed intra-abdominal complications (2.2%). One patient developed a postoperative hematoma requiring return to the operating room for diagnostic laparoscopy and hematoma evacuation. Two patients developed intraabdominal abscesses requiring diagnostic laparoscopy and abscess drainage. One patient developed recurrent episodes of small bowel obstructions that resolved with bowel rest. Two patients developed incarcerated internal hernias requiring diagnostic laparoscopy and internal hernia reduction. In one case, the hernia occurred at the peritoneal flap closure site, and in the other case the hernia occurred at the peritoneal flap donor site. Intra-abdominal complications following robot assisted peritoneal flap vaginoplasty are rare. In addition to hematoma and abscess, small bowel incarceration and internal hernias are potential complications of peritoneal flap vaginoplasty that require prompt attention.

CROHN’S DISEASE COMPLICATED BY ILEOSIGMOID FISTULA: ASSESSMENT AND MANAGEMENT UPDATE

Abstract BACKGROUND The preoperative evaluation of Crohn’s-related ileosigmoid fistula (ISF) is complex with multiple preoperative diagnostic modalities available. Intraoperative management is also complicated when deciding whether to repair the fistula or resect the involved sigmoid. How these choices impact outcomes is not clear. We aim to evaluate the impact of sigmoid resection versus conservative fistula repair on postoperative complications when treating ISF. METHODS Patients with Crohn’s disease (CD) undergoing ileocolic resection in the setting of an ISF between January 1, 2007 and December 31, 2017 were identified. A retrospective chart review was conducted to collect data on preoperative workup, intra-operative technique, and 30-day complications. Intra-abdominal sepsis was defined as the presence of an intra-abdominal abscess or anastomotic leak from the sigmoid colon postoperatively. Univariate comparisons were performed between those undergoing primary repair versus sigmoid resection with primary anastomosis. RESULTS 61 patients (62.3% female) with a median age of 37 years (range, 18-73)were included. Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) each had a sensitivity of 100% versus 42% sensitivity for colonoscopy. When accounting for pre-operative endoscopy results, patients with endoscopic sigmoidal mucosal CD more often underwent sigmoid resection than patients with a normal sigmoidal mucosa or only a solitary fistulous opening in the sigmoid colon (p&amp;lt;0.001). When comparing primary repair vs sigmoid resection there was no difference in the occurrence of intra-abdominal septic complications (p=0.342) or anastomotic leak complication (p=0.239). CONCLUSION In summary, our study shows that conservative repair of the fistula is a safe option. Appropriate patient assessment and preoperative identification of the fistula is critical so that the management strategies for ISF and the potential implications can be discussed with the patient. CTE and MRE are the modalities of choice to diagnose ISF, while colonoscopy has a role in staging the burden of mucosal disease in the sigmoid colon. These tests help guide surgical decision-making with respect to resection versus primary repair of the sigmoid colon and will allow patients in whom the sigmoid colon is an innocent bystander to undergo a less extensive operation.

Nonmetastatic ypt0 rectal cancer after neoadjuvant treatment and total mesorectal excision: Lessons from a retrospective multicentric cohort of 383 patients

BackgroundA better understanding of pathological features and oncological survival in ypT0 rectal cancer after neoadjuvant chemoradiotherapy is required to improve patient selection criteria for rectal-preserving approach by local excision. Our aim was to define risk of lymph node metastasis and oncological outcomes in ypT0 rectal cancer after chemoradiotherapy and total mesorectal excision. MethodsAll consecutive patients who underwent total mesorectal excision for a nonmetastatic rectal adenocarcinoma classified ypT0 after neoadjuvant chemoradiotherapy, with or without locoregional lymph node involvement (ypN+ or ypN-), in 14 French academic centers between 2002 and 2015 were included. Data were collected retrospectively. Overall and disease-free survival were explored. ResultsAmong the 383 ypT0 patients, 6% were ypN+ (23/283). Before chemoradiotherapy, 86% (327/380) were staged cT3-T4 and 41% (156/378) were staged cN+. The risk of ypN+ did not differ between cT3-T4 and cT1-T2 patients (P = .345) or between cN+ and cN- patients (P = .384). After a median follow-up of 61.1 months, we observed 95% confidence interval (92%–97%) of 5-year overall survival and 93% confidence interval (91%–96%) of 5-year disease-free survival. In Cox multivariate analysis, overall survival was altered by intra-abdominal septic complications (hazard ratio = 2.53, confidence interval [1.11–5.78], P = .028). Regarding disease-free survival, ypN+ status and administration of adjuvant chemotherapy were associated with a reduced disease-free survival (P = .001 for both). cT3/T4 staging and cN+ staging did not modify overall survival (P = .332 and P = .450) nor disease-free survival (P = .862 and P = .124). ConclusionThe risk of lymph node metastasis and the oncological survival do not depend on the initial cT or cN staging in cases of ypT0 complete rectal tumor regression.

P399 C-Reactive Protein Values After Surgery for Inflammatory Bowel Disease: Is It Still A Good Marker For Intra-Abdominal Complication? A Retrospective Cohort Study of, 347 procedures

Abstract Background C-reactive protein (CRP) is a useful predictive test to early detect abdominal complication after colorectal surgery. Inflammatory bowel disease (IBD) is responsible of chronic inflammation and abnormal basal CRP that could influence the interest of its management after abdominal surgery. The aim of this study was to evaluate CRP as an indicator of postoperative complication in a specific IBD population. Methods Retrospective study of patients undergoing ileocolic resection or ileal pouch-anal anastomosis for IBD between, 2012 and 2019. Intra-abdominal complication was defined as any intra-abdominal event, infectious or otherwise, occurring during the immediate postoperative period. The early postoperative period was defined as post-operative days (POD), 1 and, 2 and late postoperative period as POD, 3 and 4. Results Ileocolic resection represented, 242 patients and ileal pouch-anal anastomosis, 105 patients. Intra-abdominal complications occured in, 18.1% of patients (ICR=40, 16.5% and IPAA=23, 21.9%). Pre-operative CRP (48 hours before surgery) was available for, 96 patients (29.8%). Among them, 64 had an abnormal CRP value (median:, 13±45.4). No relation was found between a preoperative abnormal CRP value and post-operative intra-abdominal complications. CRP was significantly higher at an early (105.2±56.0 vs, 128.1±69.8; p=0.008) and late stage (112.9±72.8 vs, 185.3±111.5; p &amp;lt;, 0.0001) for patients having an intra-abdominal complication. The best sensitivity and specificity values were obtained at POD, 3–4 with a CRP cut-off of, 75 with an area under the curve of, 0.71. The ability to rule out an intra-abdominal complication with a CRP Value &amp;lt;75 mg/L was good with, at POD, 1–2 NPV=86.4% and PPV=19.9% and, at POD, 3 an NPV=90.3% and PPV=22.2%. A BMI &amp;gt;25kg/m2 (p=0.04) and an open surgical approach (p=0.009) were associated with higher CRP levels in the first POD. In multivariate analysis, pre-operative steroid use (p=0.03), CRP at POD, 3 &amp;gt;, 100mg/L (p=0.002) and a rise between CRP values more than, 50 mg/L (p=0.005) or, 100 mg/L (p &amp;lt;, 0.0001) at, 48 hours were significantly associated with intra-abdominal complication. A CRP at POD, 1 &amp;lt;75mg/L was associated with a lower rate of intra-abdominal complication (p=0.01). A score using these, 4 independent factors was created and showed significant differences in intra-abdominal complication, anastomotic leakage and readmission rate. Conclusion CRP is a useful predictive marker to detect abdominal complication after surgery in IBD population. Measurement of CRP can help to reduce hospitalization stay and orientate towards complementary examinations.

P538 Implementation of Kono-S anastomosis as a new standard of surgical care

Abstract Background The Kono-S ileocolic anastomosis is thought to reduce the risk of clinical and surgical recurrence in Crohn’s disease patients. The Kono-S anastomosis was established as a new standard of care at our institution in 2018, however, it was not performed in all patients. The present study describes the learning curve and reasons for hesitation to use the new technique. Methods Consecutive patients undergoing bowel resection with formation of ileocolic anastomosis since starting to use Kono-S technique were included in the present retrospective analysis. Intraabdominal septic complications (IASC) were peritonitis, anastomotic leak, intraabdominal fistula and abscess. Results Since starting to use Kono-S anastomosis, 90 patients underwent ileocolic resection (45M, 45F). However, during this period, conventional side-to-side ileocolic anastomosis was still performed in 26 patients (29%). Kono-S anastomosis was performed in 46% of cases during the first 6 months, in 76% during the next 6 months and in 82% of cases after the first year since implementation (p=0.005). There was no difference in postoperative IASC rate between patients with or without Kono-S anastomosis (2% vs. 4%, p=0.5). Also, postoperative overall complication rate, incidence of postoperative small bowel obstruction and length of postoperative hospital stay did not differ between groups. There were no anastomotic leaks. By the multivariate analysis, the presence of intraabdominal abscess or fistula (Hazard ratio 0.25, p=0.037) was the main reason to perform the conventional hand S/S anastomosis instead of new technique. Conclusion Some hesitation to use Kono-S anastomosis could be observed after the implementation of the new standard of care, especially during the first six months and in patients presenting with more complex intraabdominal findings. However, the learning curve has no impact on postoperative morbidity.

CROHN’S DISEASE COMPLICATED BY ILEOSIGMOID FISTULA: ASSESSMENT AND MANAGEMENT UPDATE

The preoperative evaluation of Crohn’s-related ileosigmoid fistula (ISF) is complex with multiple preoperative diagnostic modalities available. Intraoperative management is also complicated when deciding whether to repair the fistula or resect the involved sigmoid. How these choices impact outcomes is not clear. We aim to evaluate the impact of sigmoid resection versus conservative fistula repair on postoperative complications when treating ISF. Patients with Crohn’s disease (CD) undergoing ileocolic resection in the setting of an ISF between January 1, 2007 and December 31, 2017 were identified. A retrospective chart review was conducted to collect data on preoperative workup, intra-operative technique, and 30-day complications. Intra-abdominal sepsis was defined as the presence of an intra-abdominal abscess or anastomotic leak from the sigmoid colon postoperatively. Univariate comparisons were performed between those undergoing primary repair versus sigmoid resection with primary anastomosis. 61 patients (62.3% female) with a median age of 37 years (range, 18-73)were included. Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) each had a sensitivity of 100% versus 42% sensitivity for colonoscopy. When accounting for pre-operative endoscopy results, patients with endoscopic sigmoidal mucosal CD more often underwent sigmoid resection than patients with a normal sigmoidal mucosa or only a solitary fistulous opening in the sigmoid colon (p<0.001). When comparing primary repair vs sigmoid resection there was no difference in the occurrence of intra-abdominal septic complications (p=0.342) or anastomotic leak complication (p=0.239). In summary, our study shows that conservative repair of the fistula is a safe option. Appropriate patient assessment and preoperative identification of the fistula is critical so that the management strategies for ISF and the potential implications can be discussed with the patient. CTE and MRE are the modalities of choice to diagnose ISF, while colonoscopy has a role in staging the burden of mucosal disease in the sigmoid colon. These tests help guide surgical decision-making with respect to resection versus primary repair of the sigmoid colon and will allow patients in whom the sigmoid colon is an innocent bystander to undergo a less extensive operation.Table 1Descriptive analysisView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Postoperative Safety Profile of Minimally Invasive Ileocolonic Resections for Crohn's Disease in the Era of Biologic Therapy.

There is controversy regarding the postoperative outcomes in Crohn's disease [CD] patients exposed to vedolizumab [VDZ] or ustekinumab [UST]. We aimed to describe our surgical outcomes in patients who underwent minimally invasive ileocolonic resection [MIS-ICR] for CD who had preoperative biologic therapy. All consecutive adult patients who had MIS-ICR for CD between 2014 and 2021 at our institution were included. Patients were divided into four groups: VDZ, UST, anti-tumour necrosis factor [anti-TNF], and no biologic group. Timing between the last dose of biologics and surgery was per surgeon's discretion. The primary outcome was intra-abdominal septic complications. Secondary outcomes included all 30-day complications. A total of 274 patients were identified. Of these, 113 [41.2%] patients had received anti-TNF, 52 [19%] had received UST, and 19 [7%] had received VDZ. There was no difference between the four groups regarding baseline risk factors. There was no difference between the four groups regarding intra-abdominal septic complications [4.4% for no biologic, 5.3% for anti-TNF, 5.8% for UST, and 5.3% for VDZ; p = 0.987], surgical site infection rate, overall 30-day morbidity, overall 30-day readmission, overall surgical and medical complications, urinary tract infection, pulmonary infections, or length of stay. Those results were consistent after a subgroup analysis based on complexity of the disease. This retrospective analysis demonstrates an equivalent postoperative safety profile for patients treated with preoperative anti-TNF, VDZ, or UST versus no biologic therapy within 3 months of MIS-ICR for Crohn's disease. Preoperative biologic therapy may not increase complications after minimally invasive ileocolonic resection in Crohn's disease. Further studies with larger sample sizes are needed to confirm results.

Early diagnosis of postoperative intraperitoneal purulent complications in peritonitis in children

Early diagnosis of postoperative complications leads to timely surgical interventions, on which the outcome of the disease depends. This also applies to postoperative intra-abdominal complications, especially in childhood, when the progression of peritonitis is fleeting, and many defense mechanisms are immature and depressed. Timely evacuation of pus from the abdominal cavity leads to a decrease in endotoxicosis, the main component in the pathogenesis of the toxic-septic process, and to a significant improvement in the results of treatment of the disease.

Диагностика и лечение ранних внутрибрюшных осложнений после холецистэктомии

In the RNCEMP for the period 2001 to 2019 10218 surgeries were performed for acute and complicatedforms of cholelithiasis (GSD), after which clinically significant early intra-abdominal complications (ERBO),requiring repeated endobiliary, laparoscopic or open interventions, were noted in 260 (2.5%) patients. Thefrequency of RVBO after emergency cholecystectomy averages 2.5% with a range from 1.8% (after LCE) to3.3% (after conventional CE) and 4.6% (after minilaparotomic CE). With cholecystectomy, the frequency ofiatrogenic damage to hepaticocholedochus ranges from 0.7-0.8%. In the structure of RVBO requiring repeatedinterventions, complications associated with a violation of the integrity of the ductal system prevail: in 41.9%of cases, there is an external (23.8%) or intra-abdominal (18.1%) bile leakage, in 26.2% of cases - damage to themain extrahepatic bile ducts; followed by intra-abdominal bleeding (16.2%) and abdominal abscesses (15.8%).In RVBO after operations on the bile ducts, in 63.1% of cases, the existing complications can be eliminatedusing endobiliary interventions (19.7%), endovideosurgical techniques (35.2%) and a hybrid application oftwo endoscopic technologies - videolaparoscopy and endoscopic transpapillary stenting of the choledochus(8.2%).

Pancreas Transplantation with Duodeno-Duodenal Anastomosis: A Single-Center Experience

Introduction: Techniques such as retroperitoneal graft placement have further improved the ability to reproduce the physiology of the “native” pancreas. We herein present our experience of a technique for pancreatic transplant, with the organ placed into a fully retroperitoneal position with systemic venous and enteric drainage of the graft by duodenoduodenostomy. Methods: All pancreas transplantations performed between May 2016 and July 2021 were prospectively entered into our transplant database and retrospectively analyzed. Results: A total of 81 transplants were performed using the duodenoduodenostomy (43 men: median age of 42 years [IQR 36-50]). Median cold ischemia times was 9 hours [IQR 7-10.4]. The preservation solution used was Celsior (n=19), IGL-1 (n=49), and UW (n=13). Regarding morbidity, 43.2% of patients presented pancreas related complications: abdominal hemorrhage (n=8, 9.9%); graft pancreatitis (n=5, 6.2%); fluid collections (n=9, 11.1%); and vascular thrombosis (n=20, 24.7%). Intestinal complications (n=7, 8.6%) were: intestinal obstruction (n=2); paralytic ileus (n=2); dehiscence in duodenum after pancreas transplantectomy (n=1); dehiscence of duodeno-duodenostomy (n=2). Of these, four cases required relaparotomy: adhesiolysis (n=2); transplantectomy (n=1); primary leak closure (n=1). According to the Clavien-Dindo classification, pancreas complications were: Grade I: 3.7 %, Grade-II: 13.6 %, and Grade IIIa:4.9%, Grade IIIb: 21%. The median hospital stay was 13.5 days. After a median follow-up of 30.7 months [IQR 18.1-44], the 1 and 3-year graft survival was 89.5%, respectively, with no patient mortality. Conclusions: Retroperitoneal graft placement with duodenoduodenostomy is safe and feasible, with a low rate of intra-abdominal complications, providing competitive results in terms of graft/patient survival.

PROGRAMMED LAPAROSCOPY IN THE OF DIFFUSE APPENDICULAR PERITONITIS TREATMENT OF CHILDREN.

The aim: To analyze the implementation of programmed laparoscopy with the criteria definition for its termination in the treatment of diffuse appendicular peritonitis in children. Materials and methods: Since 2017, the programmed laparoscopy in the treatment of diffuse appendicular peritonitis has been used in 28 children aged 1 to 16 years. Results: The programmed laparoscopy allows assessing the dynamics of the intra-abdominal infectious-inflammatory process and monitoring the treatment effectiveness. The modified abdominal index (AI) was determined based on integrated assessment of degree and nature of abdominal organs` damage during the first and repeated surgeries, the modified abdominal index (AI) was determined. AI identified during the primary laparoscopic intervention ranged from 14 up to 22 points and on average it was 17.5 ± 1.3 points, during the programmed laparoscopy AI was from 3 to 11 points, on average it was 9.15 ± 1.48 points. Conclusions: The programmed laparoscopy for diffuse peritonitis in children allows controlling the pathological process in the abdominal cavity and promptly eliminate intra-abdominal complications. Determination of AI allows objectifying the nature of the lesion and the dynamics of changes in the abdominal cavity.

Early intraabdominal complications after laparoscopic appendectomy: the status quo and the prospects for prevention

<h3></h3> Острый аппендицит (ОА) — наиболее частая причина острой боли в животе у пациентов во всем мире. Несмотря на десятилетия практики, независимо от хирургической техники и доступа аппендэктомия (АЭ) по-прежнему связана с относительно высоким риском развития инфекций в области хирургического вмешательства (далее ИОХВ), общая частота которых составляет 7%, варьируя от 0 до 37,4%. По данным разных авторов, факторами риска развития ИОХВ являются конверсия, недостаточный опыт хирурга, форма воспаления отростка и сроки заболевания, а также степень выраженности системного воспаления, выполнение операции в ночное время, некоторые характеристики отростка по данным компьютерной томографии (КТ), особенности хирургической техники и даже COVID-19. Однако ни один автор не характеризует лапароскопический доступ как независимый фактор риска развития ИОХВ, при этом некоторые высказывают предположение, что карбоксиперитонеум и термическое воздействие хирургической энергией может приводить к повреждению мезотелия и способствовать транслокации микроорганизмов. В обзоре подробно рассмотрены современные методы диагностики и оценки ИОХВ поле АЭ, а именно КТ и магнитно-резонансная томография, а также ультразвуковая диагностика, в том числе с применением эластографии. Тщательное соблюдение общепринятых рекомендаций по профилактике ИОХВ позволяет снизить распространенность последней, однако мировой опыт показывает, что список мероприятий, позволяющих уменьшить риск развития ИОХВ, этим не ограничивается. Хирургическому сообществу еще предстоит выработать четкие руководства по профилактике ранних ИОХВ после АЭ.

COMPLICATIONS OF INTRA ABDOMINAL DRAINS: A SINGLE CENTER EXPERIENCE

Objective: To compare frequency of intra-abdominal complications in drainage and non-drainage group among patents who underwent intra-abdominal surgeries.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Department of Surgery, Pakistan Ordinance Factory, Wah Cantt, from Mar 2018 to Jul 2018.&#x0D; Methodology: There were 32 patients, 16 in each group. Patients were selected through the process of consecutive sampling. Patients were randomly divided into two groups (random number table method); group A patients underwent intra-abdominal drain while group B was non-drainage group. Patients were followed up for 7 days and observed for complications.&#x0D; Results: Total 32 patients were included in the study. There were 14 (43.8%) males and 18 (56.3%) females. Mean age of patients was 43.2 ± 9.5 years. Drain group showed significantly low anastomosis leakage (p=0.02), wound infection (p=0.05), mortality (p=0.04), pulmonary complications (p=0.05) and bleeding (p=0.03) as compared to the non-drain group.&#x0D; Conclusion: Intra-abdominal drains are associated with several complications. Anastomosis leakage is the most common complication following pulmonary complications and bleeding. However, drains help in early detection of complications and timely management of such complications leads to better outcome of a surgical procedure.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ОСТРОГО АППЕНДИЦИТА: ЛАПАРОСКОПИЧЕСКАЯ ИЛИ ОТКРЫТАЯ АППЕНДЭКТОМИЯ?

The results of laparoscopic and "traditional" open appendectomy for acute appendicitis were studied, and postoperative complications were analyzed. The retrospective analysis of surgical treatment of 518 patients with acute appendicitis was carried out. In 433 (83.6%) cases laparoscopic appendectomy was performed, in 84 (16.2%) – open appendectomy. In laparoscopic surgery the ligature method of appendectomy was used, in open surgery invagination method was used. Indications for drainage of the abdominal cavity during laparoscopic and open appendectomy did not fundamentally differ. According to the results of a morphological study phlegmonous appendicitis was observed in 463 (89.4%) cases, gangrenous – in 55 (10.6%). After open appendectomies complications were detected in 11 patients, the overall incidence of postoperative complications was 13.1%. After laparoscopic appendectomies complications were detected in 4 patients, the overall incidence of postoperative complications was 0.9%. The rate of postoperative complications after laparoscopic appendectomy was statistically significantly lower than after open appendectomy. The nature of complications in laparoscopic and open appendectomy differs. In open appendectomy infectious complications of the surgical wound are observed, which do not require surgical treatment. In laparoscopic appendectomy intra-abdominal complications are observed, which in some cases require repeated surgical interventions. During laparoscopic appendectomy, there were such complications as stump leaks with peritonitis and inflammatory infiltrates of the abdominal cavity.

SURGICAL TREATMENT OF ACUTE SMALL BOWEL OBSTRUCTION: CLINICAL AND LABORATORY PARAMETERS ASSOCIATED WITH STRANGULATION AND EARLY MORTALITY AFTER SURGERY

The aim: The study aimed to evaluate some criteria for preoperative diagnosis of strangulation and significant indicators of the prognosis of short-term outcomes in patients with small bowel obstruction. Materials and methods: The results of the treatment of 123 patients aged 18-70 years with SBO were evaluated. Results: All of these patients underwent emergency surgery, and 22 patients (17.9%) have died. It has been shown that four lab parameters (blood leukocytes, lactate, intestinal fatty acid-binding protein, and C-reactive protein levels) and one instrumental (involving the mesentery of the small intestine, free fluid in the abdomen during CT) with 80% probability or more were associated with the strangulation type of SBO (Λ=0.276, p = 0.000). Three lab indicators (WBC count, serum lactate, and intestinal fatty acid-binding protein levels) and two clinical parameters (abdominal perfusion pressure level and the presence of abdominal sepsis) were associated with early mortality after surgery (Λ=0.626, p = 0.000) with the same probability. Immediate results of the treatment in these patients depended on the development of intra-abdominal complications after surgery (P = 0.024) and the need for early reoperation (P = 0.006) as well as the development of cardiovascular dysfunction (P = 0.000) and respiratory dysfunction (P = 0.000). Conclusions: There were confirmed parameters that were significantly associated with strangulation before surgery and short-term in-hospital mortality with an 80% probability or more. This made it possible to develop new mathematical models for the diagnosis of strangulated bowel obstruction and early postoperative mortality with an accuracy of 84.5% and 84.2%, respectively.

The impact of hiatal hernia on survival outcomes in patients with gastroesophageal junction adenocarcinoma.

AimA hiatal hernia (HH) complicates the diagnosis and surgical treatment of gastroesophageal junction (GEJ) cancer. This study aimed to investigate the effect of HH on the survival outcomes of GEJ cancer patients.MethodsThis single‐center study reviewed clinical data of 78 patients with GEJ adenocarcinoma who underwent R0 resection from 2008 to 2017. The patients were divided into two groups according to whether they presented with or without HH: the HH (+) group (n = 46) and the HH (−) group (n = 32).ResultsPatients in the HH (+) group were older than those in the HH (−) group (69.0 vs 67.5 years, P = .018). Regarding surgical outcomes, intra‐abdominal infectious complications was more common in the HH (+) group than in the HH (−) group (23.9% vs 9.4%, respectively; P = .089), particularly abscess formation (17.4% vs 3.1%, respectively; P = .036). Neither overall survival (OS) nor relapse‐free survival (RFS) differed between the two groups. However, survival rates were significantly worse in a subset of patients with T3‐4 disease (OS: log‐rank, P = .036) (RFS: log‐rank, P = .040) in the HH (+) group. In a multivariate analysis for OS in this cohort, HH was an independent prognostic factor (hazard ratio 3.60; 95% confidence interval 1.06‐11.9, P = .032).ConclusionHiatal hernia may adversely affect surgical and survival outcomes in patients with GEJ cancer. Thus, surgical strategy must be carefully considered in these patients.