Intra-abdominal Complications Research Articles

Postoperative peritonitis diagnosis features in abdominal sepsis

Introduction: Despite significant advances in modern medicine, postoperative peritonitis is the cause of death in 50-86 % of patients. Postoperative peritonitis remains one of the most common causes of relaparotomy, accounting for 35 %-56 % of all intraabdominal complications. The diagnosis of postoperative peritonitis is based on clinical and biochemical examinations, the informative value of which is insufficient. One of the most informative methods of diagnosis of postoperative peritonitis with abdominal sepsis is a study of indices of endogenous intoxication and immune response of the body, such as medium-mass molecules, IgA, IgM, IgG, and complement activity. Objective: The objective of the research is to study the changes in immune response in patients with postoperative peritonitis with abdominal sepsis.

Ileocolic resection for Crohn's disease: robotic intracorporeal compared to laparoscopic extracorporeal anastomosis.

Laparoscopy is the first-line approach in ileocolic resection for Crohn's disease. Emerging data has shown better short-term outcomes with robotic right colectomy for cancer when compared to laparoscopic approach. However, robotic ileocolic resection for Crohn's disease has only shown faster return to bowel function. We aimed to evaluate short-term outcomes of ileocolic resection for Crohn's disease between robotic intracorporeal anastomosis (RICA) and laparoscopic extracorporeal anastomosis (LECA). Patients undergoing minimally invasive ileocolic resections for Crohn's disease were retrospectively identified using a prospectively maintained database between 2014 and 2021 in two referral centers. Among the 239 patients, 70 (29%) underwent RICA while 169 (71%) LECA. Both groups were similar according to baseline and preoperative characteristics. RICA was associated with more intraoperative adhesiolysis and longer operative time [RICA: 238 ± 79min vs. LECA: 143 ± 52min; p < 0.001]. 30-day postoperative complications were not different between the two groups [RICA: 17/70(24%) vs. LECA: 54/169(32%); p = 0.238]. Surgical site infections [RICA: 0/70 vs. LECA: 16/169(10%); p = 0.004], intra-abdominal septic complications [RICA: 0/70 vs. LECA: 14/169(8%); p = 0.012], and Clavien-Dindo ≥ III complications [RICA: 1/70(1%) vs. LECA: 15/169(9%); p = 0.044] were less frequent in RICA. Return to bowel function [RICA: 2.1 ± 1.1 vs. LECA: 2.6 ± 1.2days; p = 0.002] and length of stay [RICA: 3.4 ± 2.2 vs. LECA: 4.2 ± 2.5days; p = 0.015] were shorter after RICA, with similar readmission rates. RICA demonstrated better short-term postoperative outcomes than LECA, with reduced Clavien-Dindo ≥ III complications, surgical site infections, intra-abdominal septic complications, shorter length of stay, and faster return to bowel function, despite the longer operative time.

V-035 TRANSVAGINAL EVISCERATION, LAPAROSCOPIC APPROACH

Abstract Aim We present the laparoscopic approach of a case of transvaginal evisceration after hysterectomy. Material &amp; Methods 50 yo Female, with a history of bilateral ovaric and endometrial endometroid carcinoma, for which bilateral laparoscopic anexectomy and subsequent hysterectomy and cytoreduction surgery were performed two months earlier. She consulted to emergency department for metrorrhagia and abdominal discomfort of one week's evolution. Physical examination revealed a dehisced vaginal vault with evisceration of small bowel loops. Abdominal CT scan was performed in which other intra-abdominal complications were ruled out. Urgent surgical intervention was decided and a minimally invasive approach was proposed. During the operation, dehiscence of the vaginal vault was observed without other findings. The separated edges are refreshed and a running suture is performed with a barbed suture. As reinforcement, a titanized polypropylene mesh was placed and fixed with cyanoacrylate. Results The patient was discharged on the 2nd postoperative day without incident. Conclusions Transvaginal evisceration is a rare complication that usually occurs after hysterectomies. If it is not possible to reduce the contents, it can cause suffering of the herniated structures. The treatment consists of closing the defect and acting on the complications it may cause. The minimally invasive approach provides the already known benefits for the patient and a better vision and surgical field for the surgeon.

Hemobiochemical profile and multiple organ dysfunction syndrome: a paradigm for objective assessment of small bowel fistula treatment

When organizing the treatment process for small bowel fistula, timely diagnosis of significant pathophysiological changes arising from intra-abdominal complications is relevant. We studied the results of the treatment of 41 patients with an unformed small bowel fistula, caused by the failure of the intestinal suture placed in connection with the violation of the integrity of the enteral wall in technically difficult viscerolysis,against the background of diffuse peritonitis, as well as the suture failure after bowel resection in open and closed abdominal trauma and in a strangulated hernia. At three stages of the study (initial — 1–2, intermediate — 5–7, and final — 28 days from the start of treatment), the functional state of vital organs and systems and electrolyte imbalance were assessed by monitoring 10 biochemical blood parameters (total protein and bilirubin, alkaline phosphomonoesterase, alanine and aspartate aminotransferase, urea,creatinine, glucose, amylase and potassium), thereby objectifying the nature of multiple organ dysfunction in its three-stage gradation. It has been found that in the presence of an unformed small bowel fistula at the time of its occurrence, there are multisystem disorders of varying severity. Against the background of the traditional complex of therapeutic measures, including conservative treatment and surgical technologies, there are changes in the evaluated criteria, which become especially clear within the framework of the concept of hemobiochemical profile in its graphical presentation. At the final time interval of follow-up, a third of patients have a critical level of the main clinical and laboratory parameters, including hemobiochemical parameters. Preservation of severe forms of multiple organ dysfunction — sub- and decompensation (from 47 to 69 % of patients), in the process of implementing a three-stage follow-up model, as well as a high level of mortality (41.46 %) indicate the low effectiveness of traditional tactics for the treatment of an unformed small bowel fistula.

Original pancreas transplant teohnique in terms of prevention of intra-abdominal purulent complications

A clinical case of pancreas transplantation (PTx) based on an original technique is presented. The applied technique made it possible to prevent the spread and involvement of the abdominal organs in an inflammatory process caused by postoperative graft pancreatitis, and to preserve the pancreas graft.

Early Postoperative Outcomes of Retroperitoneal Partial Nephrectomy of Anterior and Posterior Renal Tumors: A 5-Year Experience in A Single Center.

Objective: Partial nephrectomy (PN) is one of the surgical treatment options for renal tumors. Therefore, the aim of this study was to compare the surgical outcomes of retroperitoneal PN for anterior and posterior tumors. Materials and Methods: This study enrolled 177 patients who had renal tumors that were detected on abdominal computed tomography and underwent PN between January 2017 and April 2021. Tumor position was defined by the anatomic avascular Brodel's line. Surgical outcomes were compared between approaches using the chi-squared Student's t-tests, logistic regression analysis, and stratification analysis. Results: Of the 177 patients, 97 (54.8%) patients had anterior renal tumors and 80 (45.2%) had posterior renal tumors. On comparing the surgical results between the two groups, the anterior group had higher levels of hemoglobin (Hb) reduction (-1.92 vs -1.54 g/dL, p = 0.0444), but the estimated blood loss showed no significant difference between the two groups (497.6 vs 433.2 mL, p = 0.4149). In addition, the alteration in estimated glomerular filtration rate at postoperative 1st day (p = 0.5616), 6th month (p = 0.5046), and at postoperative 1st year (p = 0.7085) was not significantly different between the two groups. Other surgical outcomes, such as blood transfusion rate, complications, and lengths of stay, also had no significant difference. Stratified analysis revealed the anterior renal tumors had a 3.76 times risk (p = 0.0186) than the posterior tumors for decreasing Hb >10% under laparoscopic PN. No postoperative gastrointestinal-related complications were reported. Conclusions: This study demonstrated retroperitoneal surgical access to renal tumors and revealed equivalent surgical outcomes for both anterior and posterior renal tumors. Moreover, anterior renal tumors had benefits under robotic PN for bleeding control. Retroperitoneal PN can be considered as a good approach for both anterior and posterior renal tumors with few intra-abdominal complications.

Pancreatic thickness as a predictor of postoperative pancreatic fistula after laparoscopic or robotic gastrectomy.

Despite technical advances in minimally invasive gastrectomy for gastric cancer, an increased incidence of postoperative pancreatic fistula (POPF) has been reported. POPF can cause infectious and bleeding complications, which could lead to surgery-related death; therefore, reduction of the post-gastrectomy POPF risk is crucial. This study aimed to investigate the importance of pancreatic anatomy as a predictor of POPF in patients undergoing laparoscopic or robotic gastrectomy. Data were collected from 331 consecutive patients who underwent laparoscopic or robotic gastrectomy for gastric cancer. The thickness of the pancreas anterior to the most ventral level of the splenic artery (TPS) was measured. The correlation between TPS and POPF incidence was investigated using univariate and multivariate analyses. The cutoff value of TPS was 11.8mm, which predicted a high drain amylase concentration on postoperative day 1, and patients were categorized into thin (Tn group) and thick TPS groups (Tk group). There was no significant difference in the background characteristics between the two groups, except for sex (P = 0.009) and body mass index (P < 0.001). The incidences of POPF grade B or higher (2% vs. 16%, P < 0.001), all postoperative complications of grade II or higher (12% vs. 28%, P = 0.004), and postoperative intra-abdominal infections of grade II or higher (4% vs. 17%, P = 0.001) were significantly higher in the Tk group. Multivariable analysis identified that high TPS was the only independent risk factor for grade B or higher POPF and grade II or higher postoperative intra-abdominal infectious complications. The TPS is a specific predictive factor for POPF and postoperative intra-abdominal infectious complications in patients undergoing laparoscopic or robotic gastrectomy. Careful pancreatic manipulation during suprapancreatic lymphadenectomy is necessary for patients with increased TPS (> 11.8mm) to avoid postoperative complications.

Factors affecting the development of complications in Crohn's disease in patients undergoing intestinal resection.

Surgery is a common form of management for Crohn disease (CD) in the presence of intra-abdominal complications. In this study, we investigated the effect of various factors on the development of postoperative complications in patients who underwent surgery for complicated CD. Patients who underwent surgery between 2011 and 2018 were included in this study. Information on age, sex, presence of extraintestinal findings, operation indications, operation type, and postoperative complications was obtained. Groups with and without postoperative complications were compared according to body mass index, American Society of Anesthesiologists score, comorbidities, smoking status, preoperative drug use, presence of perianal disease, presence of a stoma, synchronous small intestine resection surgery, duration of hospital stay, and preoperative biochemical parameters. A total of 192 patients were included, of which 53.1% were female and 46.9% were male. Patients were indicated for surgery for reasons such as stricture, abscess, fistula, and tumor development. As the surgical method, patients were operated on by open or laparoscopic method (86% and 14%, respectively). Postoperative complications occurred in 30 female and 33 male patients (15.6% and 17.1%, respectively). Patient age, smoking status, steroid use, perianal disease, presence of stoma, and presence of extra intestinal findings were significantly higher in the complicated group. Surgery may be inevitable for CD in the presence of complications. In cases of patient age, smoking, steroid use, perianal disease, stoma opening, and presence of extra intestinal findings, patients with CD who undergo surgery should be followed up closely in terms of the development of complications.

Abdominal emergencies in surgical oncology.

In general, abdominal emergencies are urgent situations that require a prompt and correct diagnosis and treatment. They involve a broad spectrum of diagnoses and can occur in all age groups. The situation is often modified in oncologic patients according to the extent and level of progression of the primary oncological disease. A retrospective study was conducted to analyze the group of adult patients with abdominal emergencies treated in Masaryk Memorial Cancer Institute between 2011-2017. In total, 601 patients underwent emergency surgery during the 7-year period. The causes included gastrointestinal obstruction (43%), intra-abdominal inflammatory complications (33%) and bleeding (17%). Acute appendicitis or cholecystitis was the cause in only less than 4% of all patients. The problems of acute abdominal emergencies in oncologic patients are substantially different from those in the general population, particularly in terms of the causes where gastrointestinal obstruction is the leading cause.

Risk factors and therapeutic options for postoperative intra-abdominal septic complication in Crohn’s disease

Background: Approximately 70% of patients suffering from Crohns disease require surgery in their lifetime. The postoperative course is complex, with higher complication rates compared to major colorectal surgery and with a high incidence of Intra Abdominal Septic Complications (IASC).

Short-term outcomes of robotic gastrectomy vs laparoscopic gastrectomy for patients with gastric cancer: A randomized clinical trial.

344 Background: Robotic gastrectomy (RG) procedure for gastric cancer (GC) patients may be associated with decreased incidence of intra-abdominal infectious complications. Prospective randomized controlled trials (RCTs) comparing laparoscopic gastrectomy (LG) and RG are required, however. We completed an RCT to compare short-term surgical outcomes of LG and RG for GC patients. Methods: This was a randomized, two-center clinical trial. All included patients are adults with primary carcinoma of the stomach, in whom the tumor is considered surgically resectable (cStage I-III). Included in this trial were 240 patients with GC. The primary endpoint was to assess the incidence of postoperative intra-abdominal infectious complications including pancreatic fistula, intra-abdominal abscess, and anastomotic leakage. Secondary endpoints included incidence of postoperative complications, surgical results, postoperative course, and oncological outcomes. Lymphadenectomy without touching the pancreas was basically performed during robotic gastrectomy using assisting articulating forceps. Results: A total of 241 patients were randomly assigned to the LG group (n = 122) or the RG group (n = 119), and 236 patients (LG119 RG117) were analyzed for ITT population. Overall incidence of intra-opereative infectious complications higher than Clavien-Dindo grade II were not significantly different (LG 8.4%, RG 6%). However, overall incidence of any complications higher than grade II were significantly lower in the RG group (19.3 vs 8.5% P = .019). In RG group, postoperative pancreatic fistula was not found. Amylase levels in drainage fluid on POD 1 were significantly lower in the RG group (893IU/L) than in the LG group (438 IU/L) ( P = 0.039). Conclusions: Regarding short-term surgical outcomes, RG is feasible, safe and ideal treatment procedure for GC. Our RG procedure without touching the pancreas may be associated with decreased incidence of postoperative pancreatic fistula. Clinical trial information: UMIN000031536 .

P187 Intestinal ultrasound is accurate for detecting intra-abdominal complications in Crohn’s disease: a meta-analysis

Abstract Background The clinical course of Crohn’s disease (CD) is associated with development of complications including strictures and penetrating lesions such as fistulas and abscesses. Close disease monitoring and optimizing therapy can prevent these complications. Intestinal ultrasound (IUS) is a non-invasive cross-sectional imaging method ideal for frequent assessment of disease activity and intra-abdominal complications. In this meta-analysis we provide an updated assessment of the diagnostic accuracy of IUS and its advanced modalities in the detection of intra-abdominal complications in CD compared to endoscopy, MRI/CT, surgery and pathology. Methods We conducted a literature search in Pubmed/MEDLINE and EMBASE databases from 01-01-1970 up to and including 17-10-2022 for studies describing diagnostic accuracy of IUS in adult patients with CD related intra-abdominal complications. Quality of the included studies was assessed with the QUADAS-2 tool. A univariate random-effects model was used to calculate the diagnostic test accuracy variables, including the log diagnostic odds ratio and area under the pooled ROC (AUC for SROC). All data were calculated with 95% confidence intervals (CIs). Chi-squared (χ²) test was used to assess study heterogeneity with p &amp;lt; 0.05 indicating significant heterogeneity. Funnel plots were created to assess publication bias. All meta-analysis were performed using the R-package mada. We calculated pooled sensitivity and specificity in Meta-DiSc. Results We identified 1506 studies of which 68 were used for the systematic review. Twenty-three studies with 3863 patients were included in this meta-analysis with an overall moderate to high risk of bias. In total 6 meta-analyses were performed, both for conventional IUS (B-mode) and oral contrast IUS (SICUS) for diagnosing CD-related complications. Pooled overall log diagnostic odds ratio for strictures, fistulas and inflammatory masses by B-mode IUS were 3.56 (2,90-4.21), 3.84 (3.28-4.41) and 3.97 (3.30-4.64) and the AUC were 0.926, 0.896 and 0.960 respectively. Pooled overall diagnostic odds ratio for the diagnosis of strictures, fistulas and inflammatory masses by SICUS were 4.51 (3.28-5.73), 4.80 (3.46-6.14) and 5.46 (3.61-7.30) and the AUC were 0.955, 0.982 and 0.985, respectively. Significant heterogeneity was seen between studies reporting data on diagnosing strictures by B-mode IUS. Conclusion These results indicate that IUS is an accurate tool for the diagnosis of intra-abdominal complications related to CD. IUS as a non-invasive, point-of-care modality is recommended as the first-line imaging tool if there is a suspicion of CD-related intra-abdominal complications.

DOP89 Impact of biologics on the risk of early postoperative complications in Crohn’s disease: a French nationwide study

Abstract Background While the effect of anti-TNFs on postoperative outcomes in patients with Crohn’s disease (CD) has been widely studied, the impact of vedolizumab and ustekinumab on the risk of postoperative complications remains poorly known. Methods All consecutive patients who underwent intestinal resection for CD between July 2014 and April 2022 within 22 French centers were included in a retrospective cohort. The risk of early post-operative complications (≤30days) in patients exposed to biologics was compared to patients not exposed by logistic regression and propensity score-matched analysis adjusted for age, previous intestinal resection, corticosteroids or immunosuppressants exposure, disease activity, presence of abscess, urgent surgery and initial stoma (preoperative contra-indication to anastomosis). Results Among the 1201 patients included, respectively 491 (41%), 76 (6.3%) and 57 (4.7%) were exposed to anti-TNFs, ustekinumab, or vedolizumab within six months before surgery. A total of 317 (26.4%) patients had at least one complication of which 123 (38%) were considered as severe (DINDO III/IV). New surgery was necessary in 69 (5.7%) patients and secondary stoma in 23 (1.9%). Three deaths were observed (0.25%). The rates of overall complications in patients not exposed to biologics, exposed to anti-TNFs, ustekinumab or vedolizumab were respectively 26.1%, 25.1%, 34.7% and 29.8%. The risks of intra-abdominal infectious complications in these four groups were respectively 13.5%, 11.1%, 13.3% and 8.8%. In multivariate analysis, age [OR, 1.02 (1.01-1.04); p=0.004], disease activity [OR, 8.36 (1.79 – 149); p=0.037], the presence of an abscess [OR, 2.01 (1.25-3.20); p=0.004] and initial stoma [OR, 1.70 (1.10 –2.61); p=0.016] were significantly associated with intra-abdominal infectious complications. Conversely, preoperative enteral nutrition [OR, 0.12 (0.01 -0.59); p=0.040] was associated with a reduction in this risk. Exposure to anti-TNFs [OR, 0.80 (0.51-1.24); p=0.31], ustekinumab [OR, 1.17 (0.39-3.51); p=0.78] and vedolizumab [OR, 1.28 (0.32-5.17); p=0.72] within the 3 months before surgery were not associated with the risk of intra-abdominal infectious complications. Similar results were observed in patients exposed to these treatments in the month before surgery. Conclusion In this large cohort, a quarter of patients operated on for CD presented an early postoperative complication and 10% a severe complication. Preoperative exposure to anti-TNFs, vedolizumab or ustekinumab was not associated with an increased risk of early postoperative complications. Preoperative enteral nutrition was associated with a reduced risk of intra-abdominal infectious complication.

P216 Oral Budesonide and low serum albumin levels at surgery are associated with a higher risk of postoperative intra-abdominal septic complications after primary ileocecal resection for Crohn’s disease: a retrospective analysis of 853 consecutive patients treated in a tertiary centre.

Abstract Background Patients undergoing ileocecal resection for Crohn’s disease (CD) are at high risk of postoperative intra-abdominal septic complications (IASC). The associated risk factors are still debated. The aim of the study was to identify the variables associated with IASC in patients treated for primary CD of the terminal ileum. Methods Retrospective single-centre study including consecutive patients undergoing ileocecal resection for CD between 2004-2021 and managed before surgery in a multidisciplinary IBD unit. Outcomes to identify the variables associated with IASC (primary aim) and severe complications, classified as Clavien-Dindo grade 3 and higher (secondary aim). The potential independent predictors of each outcome were evaluated using logistic regression. To reduce overfitting, all models were built including only the variables that were significant at univariate analyses, except for age, gender and history of cardiovascular diseases, that were included a priori. Standard diagnostic procedures were adopted to check all models validity: influential observation analysis (Dbeta, change in Pearson chi-square), Hosmer-Lemeshow test for the goodness of fit and C statistic (area under the Receiving Operator Curve). Results A total of 853 patients were included. Overall sample characteristics are shown in Table 1. Table 2 and Table 3 reported the comparison according to the primary (IASC) and secondary (severe complications) outcomes, respectively. Table 4 showed the multivariate analyses of the potential predictors of IASC and severe complications. The onset of IASC was associated with lower serum albumin level (OR 1.81, 95% CI 1.15-2.94, p=0.011) and the use of oral budesonide at time of surgery (OR 2.07, 95% CI 1.12-3.83, p= 0.021). The risk of severe complications was associated with a history of cardiovascular disease (OR 2.91, 95% CI 1.08-7.84, p=0.03) and lower serum albumin level (OR 1.58, 95% CI 1.02-2.50, p=0.04). Conclusion The present study analysed a large population of patients affected by CD of the terminal ileum who were treated homogeneously before surgery in a multidisciplinary setting and confirmed the significant impact of preoperative nutritional status on the risk of severe postoperative complications and IASC. The latter, however, was also associated with the use of oral budesonide at the time of surgery. This finding has not been previously reported in the literature. Based on the present evidence, oral budesonide should be discontinued or tapered to the lowest dose before surgery.

P489 Surgery for enterocutaneous fistula: the strongest predictor of postoperative mortality in Crohn’s disease patients

Abstract Background To access the risk of bowel resection in Crohn’s disease patients with enterocutaneous fistulae. Methods Consecutive patients undergoing intestinal resections for Crohn’ disease between 1992 and 2021 were included in the present prospective observational study. Exclusion criteria were: a) abdominoperineal resections for perianal disease, b) surgery for colorectal cancer complicating Crohn’s disease, c) abdominal surgery without intestinal resection (e.g. stoma formation or closure, mere adhesiolysis etc. Enterocutaneous fistulae occurring after previous bowel resection were named “postresection fistulae”, all other – “non-postresection fistulae”. Results 750 patients were included. At all, 70 patients (9%) underwent intestinal resections due to enterocutaneous fistulae. The frequency of surgery for enterocutaneous fistula decreased significantly during the last decade of the study (1992-2000: 13% of surgeries, 2001-2010: 12% of surgeries, 2011-2021: 6% of surgeries; p=0.05). The postoperative intraabdominal septic complication rate was 15% (n=111), six patients (0.8%) died. The mortality rate was 7% (5 of 79%) in patients with enterocutaneous fistulae. All latter death occurred only in patients with postresection fistulae. By multivariate analysis, surgery for enterocutaneous fistula (Hazard ratio 27.4, 95% CI: 2.9 – 255.6; p=0.004), age of 50 years and older (Hazard ratio 13.2; 95% CI: 2.0 – 87.7; p=0.008) and presence of intraabdominal abscess (Hazard ratio 11.8; 95% CI: 1.2 – 116.5; p=0.035) were associated with an increased risk of postoperative death. Age over 50 years was associated with an increased risk of death in patients with enterocutaneous fistulae (mortality rate 20% vs. 3.6%, Hazard ratio 16.61; 95% CI: 1.28 – 216.07; p=0.032). Conclusion Surgery for enteroctunaeous fistulae still poses significant risks, specially, when they occurred after bowel resection and in older patients.

Is the use of nonsteroidal anti-inflammatories after bowel anastomosis in trauma safe?

With an increasing interest in multimodal and opioid-reducing pain strategies, nonsteroidal anti-inflammatory drugs (NSAIDs) have become common place in the care of injured patients. Long-standing concerns of increased anastomotic leak (AL) rate with the use of NSAIDs, however, have persisted. We hypothesized that there would be no significant risk associated with NSAID use after bowel anastomosis in trauma patients. All patients presenting to a level 1 trauma center who required intestinal resection and anastomosis from 2011 to 2017 were reviewed. Patients receiving NSAIDs were compared with those managed without NSAIDs. Primary outcome of interest was anastomosis-related complications (AL, intra-abdominal abscess, anastomotic bleed, fascial dehiscence, fascial dehiscence, and enterocutaneous fistula). Multivariable logistic regression analyses were performed with propensity adjustment for inverse probability of NSAID treatment weights. A total of 295 patients met the inclusion criteria with 192 receiving NSAIDs. Patients receiving NSAIDs had lower abdominal Abbreviated Injury Scale and Injury Severity Score ( p < 0.046). Arrival systolic blood pressure, diastolic blood pressure, and Glasgow Coma Scale were higher in the NSAID group ( p < 0.013). After propensity weighting, NSAID use was not a major predictor of anastomotic complication ( p = 0.39). There was an increased risk of AL with perioperative vasopressor exposure (odds ratio [OR], 3.33; 95% confidence interval [CI], 1.17-9.05; p < 0.001). Increasing red blood cell transfusions in the first 24 hours were associated with intra-abdominal complications (OR, 1.02; 95% CI, 1.00-1.04; p = 0.05). Nonsteroidal anti-inflammatory drug exposure demonstrated a weak association with AL (OR, 1.92; 95% CI, 0.97-3.90; p = 0.06). Consistent with previous studies, perioperative vasopressor exposure and increased number of red blood cell transfusions are risk factors for ALs and intra-abdominal complications, respectively. Nonsteroidal anti-inflammatory drug use in trauma patients with multiple risk factors may be associated with an increased risk of AL and should be used with caution in the setting of other established risk factors. Therapeutic/Care Management; Level III.

EXPERIMENTAL STUDY OF THE POSSIBILITY OF DETERMINING THE OPTICAL DENSITY OF PLASMA OF VENOUS BLOOD TO MONITOR THE COURSE OF THE INTRA -ABDOMINAL INFLAMMATORY PROCESS

Early diagnosis of postoperative inflammatory intra-abdominal complications is an urgent issue due to the lack of sufficiently informative methods. Our previous studies revealed that measurement of venous blood plasma optical density parameters (ODVBP) at a wavelength of l = 310 nm is an informative criterion for the presence of inflammatory and destructive pathology of abdominal organs. Therefore, it would be logical to assume that such an indicator can be used to assess the activity of the intra-abdominal inflammatory process after surgery.&#x0D; The purpose of the study: to assess the possibility of determining the ODVBP at a wavelength of l = 310 nm to assess the activity of the intra-abdominal inflammatory process after surgery in the experiment.&#x0D; Materials and methods. 50 white non-linear rats with models of acute peritonitis, which was modeled by intra-abdominal puncture injection of a 20% autofecal mixture at a dose of 1 ml per 100 g of weight. 12 hours after the initiation of peritonitis, a laparotomy was performed, the peritoneal cavity was washed with a decamethoxin solution. After 6, 12, 24 and 48 hours, a relaparotomy was performed, the parietal peritoneum was taken for histological examination and blood from the jugular vein. The study of ODVBP was carried out on an Agilent Cary 100/300 Series UV-Vis spectrophotometer. Animals were removed from the experiment by decapitation. Inhalational sevoflurane anesthesia was used to anesthetize the animals. Statistical calculation of research results was carried out using Microsoft® Office Excel spreadsheets (build 11.5612.5703). Testing of the law of distribution of samples for normality was carried out using the Shapiro-Wilk test. The Wilcoxon test was used to test the hypothesis of equality of means.&#x0D; Results. 12 days after laparotomy, animals showed signs of purulent peritonitis. 6 hours after washing, the animals showed peritoneal edema, desquamation of the mesothelium, a small number of polymorphonuclear leukocytes (PLL) and lymphocytes. After 12 hours, the growth of peritoneal edema was observed, the desquamation of the mesothelium was maintained, and the infiltration of the peritoneal cavity of the peritoneal cavity increased. In the future, signs of subsidence of the inflammatory process in the peritoneum were observed.&#x0D; Against the background of the regression of inflammation 6 hours after washing the peritoneal cavity, the parameters of ODVBP decreased statistically significantly. After 12 hours, against the background of some increase in signs of inflammation, the indicators of ODVBP increased slightly. After 24 hours, against the background of signs of a moderate decrease in the activity of inflammation, the indicators of ODVBP decreased slightly. After 48 hours, against the background of a significant regression of signs of inflammation and the appearance of signs of regeneration processes, the indicators of ODVBP statistically significantly decreased, almost to the limits of normal values.&#x0D; The obtained data indicate that the determination of ODVBP is promising for use under clinical conditions for the purpose of control in the postoperative period. A decrease in parameters will indicate the absence of inflammatory complications, while an increase will indicate their possible development. However, this issue requires clinical research.&#x0D; Conclusions:&#x0D; &#x0D; According to experimental data, in rats with models of acute peritonitis, after washing the peritoneal cavity against the background of regression of inflammation of the peritoneum, ODVBP indicators at the wavelength l = 310 nm decrease statistically significantly.&#x0D; In case of activation of the inflammatory process, indicators of ODVBP increase.&#x0D; The obtained data indicate the prospects of clinical application of such an indicator for evaluating the activity of the inflammatory process and the prospects of relevant clinical studies.&#x0D;

Intra-abdominal cystic lesions after ventriculoperitoneal shunting

Objectives: Definitive diagnosis is essential for the medical and surgical management of pediatric patients with ventriculoperitoneal (VP) shunt. In patients with a VP shunt, abdominal complications have been well described, among which abdominal pseudo cysts are uncommon. In this report, we present our experience in terms of the multi-disciplinary management of intra-abdominal cystic lesions associated with the VP shunt procedure. Methods: From 2016 to 2021, 245 VP shunt procedures were performed in our institution. Intra-abdominal cystic lesions were recorded as intra-abdominal complications (abdominal pseudocyst, intestinal subserosal bowel cyst, and scrotal cyst) in 3 patients. For these patients we retrospectively collected data on medical history, complaints, diagnosis, treatment procedure, and postoperative results. The study was performed on 2 male and 1 female patients. The average patient age was 11.6 months (5 months to 1.5 years). The most common complaint was that of abdominal distention with ileus symptoms. The average time of admission after the catheterization of VP shunt was 1 month; laparotomy was performed for 2 patients in whom treatment was needed for high ligation. Results: A VP shunt operation is followed by abdominal complications in about 5%-47% of all cases. These complications are manifested as ileus symptoms, such as vomiting, abdominal distension, and abdominal pain with intestinal obstruction. Conclusions: In pediatric patients with VP shunts, a shunt catheter-induced abdominal cystic formation should always be considered a complication. Management of these cystic lesions requires the use of a multi-disciplinary approach with neurosurgery and pediatric surgery for treatment.

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.

Novel Clean End-to-End Anastomosis Method, Without Opening the Stomach Lumen, in Totally Laparoscopic or Robotic Pylorus-Preserving Gastrectomy.

Intra-abdominal infection is a common postoperative complication of laparoscopic pylorus-preserving gastrectomies (PPGs). Many studies have reported that intra-abdominal infectious complications after gastrectomy adversely affect patient survival outcomes. To prevent gastric fluid leakage into the abdominal cavity, we developed a novel anastomosis method in which the stomach lumen is not opened (termed the non-opened clean end-to-end anastomosis method [NoCEAM]) and evaluated its feasibility. Subsequent to lymphadenectomy, the oral and anal resection lines were sutured using an intraoperative endoscope. After closing the stomach circumferentially with clips, the specimen was rolled outward like a "donut." We resected the specimen circumferentially using a linear stapler, and anastomosis was completed simultaneously. We examined the feasibility of this procedure ex vivo, using three porcine stomachs, and in vivo, using one pig. Subsequently, we applied the procedure to 13 consecutive patients with middle-third early gastric cancer utilizing laparotomic, laparoscopic, and robotic PPG. NoCEAM was completed in all porcine models and human cases. In the human cases, the mean operation time (±standard deviation) was 279±51 minutes, and mean blood loss volume was 22±45 mL. The mean number of linear staples used was 5.06±0.76. None of the patients had complications, and all were discharged on the eighth postoperative. The serum total protein, serum albumin, and hemoglobin levels did not change significantly after surgery. NoCEAM is feasible and safe for performing totally laparoscopic or robotic PPG. It may reduce postoperative complications, such as intra-abdominal infections.