Intra-abdominal Complications Research Articles

The development and validation of risk-stratification models for short-term outcomes following contaminated complex abdominal wall reconstruction.

Short-term outcomes for patients undergoing contaminated complex abdominal wall reconstruction (CCAWR), including risk stratification, have not been studied in sufficiently high numbers. This study aims to develop and validate risk-stratification models for Clavien-Dindo (CD) grade ≥ 3 complications in patients undergoing CCAWR. A consecutive cohort of patients who underwent CCAWR in two European national intestinal failure centers, from January 2004 to December 2015, was identified. Data were collected retrospectively for short-term outcomes and used to develop risk models using logistic regression. A further cohort, from January 2016 to December 2017, was used to validate the models. The development cohort consisted of 272 procedures performed in 254 patients. The validation cohort consisted of 114 patients. The cohorts were comparable in baseline demographics (mean age 58.0 vs 58.1; sex 58.8% male vs 54.4%, respectively). A multi-variate model including the presence of intestinal failure (p < 0.01) and operative time (p < 0.01) demonstrated good discrimination and calibration on validation. Models for wound and intra-abdominal complications were also developed, including pre-operative immunosuppression (p = 0.05), intestinal failure (p = 0.02), increasing operative time (p = 0.04), increasing number of anastomoses (p = 0.01) and the number of previous abdominal operations (p = 0.02). While these models showed reasonable ability to discriminate patients on internal assessment, they were not found to be accurate on external validation. Acceptable short-term outcomes after CCAWR are demonstrated. A robust model for the prediction of CD ≥ grade 3 complications has been developed and validated. This model is available online at www.smbari.co.uk/smjconv2.

P557 Increased risk of anastomotic leak in Crohn’s disease patients unable to complete preoperative mechanical bowel preparation

Abstract Background To assess the risk of postoperative anastomotic leak in Crohn’s disease patients unable to complete the preoperative mechanical bowel preparation (MBP): a prospective observational study from two referral centres in Germany and the Czech Republic. Methods Preoperative MBP was used routinely in all Crohn’s disease patients undergoing elective ileocolic or colorectal resections completed by the formation of an anastomosis since 6/2016. The MBP consisted of 2 L Polyethyleneglycol (PEG) solution combined with two doses of oral antibiotics Metronidazole and Paromomycin. The MBP was defined as incomplete when patients were not able to drink the whole amount of PEG solution due to side effects or complications. The primary endpoint was occurrence of anastomotic leak. The secondary endpoint was the incidence of postoperative intraabdominal septic complications (IASC) which were defined as an anastomotic leak, intraabdominal abscess or fistula and peritonitis. Results Between 6/2016 and 11/2019, 96 Crohn’s disease patients underwent elective ileocolic or colorectal resections after receiving preoperative MBP and oral antibiotics. Twenty-four (25%) developed complications of MBP, mostly vomiting; 17 patients (18%) were not able to complete MBP. The presence of extraintestinal disease manifestations (Hazard Ratio 4.8, p = 0.029), preoperative weight loss (HR 5.7, p = 0.019) and female sex (HR 13.3, p = 0.005) were associated with an increased probability not to be able to complete MBP. Postoperative anastomotic leak occurred in 2 patients (2%). The risk of anastomotic leak was significantly higher in patients unable to complete MBP (12%) as compared with patients with complete MBP (0%, p = 0.03). Postoperative IASC occurred in 7 patients (7%). Patient unable to complete preoperative MBP were at higher risk to develop IASC; however, the difference was not statistically significant (18% vs. 5%, p = 0.10) Conclusion The anastomotic leak rate is very low when preoperative mechanical bowel preparation and oral antibiotics have been used. However, patients not able to complete MBP might be at an increased risk.

Delayed Gastric Emptying as a Complication of Whipple's Procedure: Could it be Much Less Frequent than Anticipated? Could the Definition Be Revised? A Single Center Experience.

ObjectiveWhipple’s procedure for periampullary tumors has significant risks and complications. Delayed gastric emptying has the highest rate. Although the International Study Group of Pancreatic Surgery defined (ISGPS) this entity, multiple definitions still exist among authors. This study aims to revise the definition.MethodSeventy-three consecutive patients were analyzed for complications, particularly delayed gastric emptying. All patients underwent a standardized surgery. Procedures used for total pancreatectomies and benign diseases were excluded.ResultsA total of 73 patients were included in the study. Intra-abdominal complications were observed in 15 (20.6%) patients. Grade C delayed gastric emptying was observed in only one (1.4%) patient. Grade A and B disease were observed in three (4.1%) patients. However, they responded well to conservative methods, causing no extra morbidity.ConclusionGrade A and B delayed gastric emptying can be observed after any gastrointestinal surgery. These patients respond well to simple conservative methods with nasogastric intubation. Drainage of the intra-abdominal collection resolves the emptying problem (if any). Only grade C disease without other intra-abdominal complications can be accepted as a complication of this procedure. ISGPS definition does not include the cause. Thus, the definition and grading can be revised.

Fast Track Protocol for Early Intraabdominal Drain Removal After Colorectal Cancer Surgery Was Not Associated With Surgical Site Infection and Readmission Rate

Background: Nowadays, surgical resection was still the option for resectable colorectal cancer patients, curative resection associated with better clinical outcome and survival rate. Surgical site infection was one of the most common problem during this procedure, fast tract protocols was announced for several years to enhanced recovery after surgery. In many centre, for some other reasons, intra abdominal drain placement was still needed, according to ERAS protocols, early drain removal was recommended for those cases. Methods: We would evaluated the resectable colorectal cancer cases with advanced stage (stage III and IV) whose already been done resection for the tumor. 30 days follow up was done to evaluated the presense of surgical site infection after surgery, the readmission rate associated with post operative infection would be recorded. Unresectable colorectal cancer cases were excluded. Results: 14 cases of colorectal cancer patients were evaluated on this study. 1 patient was 50 years old. The most common case was rectal cancer (8 patients, 57 %), left sided colon cancer was found in 3 cases. Early drain removal (the 3rd post operative days) was done for those cases. We found superficial surgical site infection on 1 case but was not associated with further readmission and was not associated with other intraabdominal complication. Those surgical site infection could be managed conservatively and was suggested with elderly and emergency operation. Conclusion: fast track protocols for early intraabdominal drain removal was safe and not associated with increased risk of surgical site infection and readmission rate.

Rectal Cancer Surgery in Patients Older Than 80 Years: Is Hartmann's Procedure Safe?

The current study aimed to identify the safety and efficacy of Hartmann's procedure (HP) among elderly patients (age ≥80 years) with rectal cancer. Data on surgical outcome, survival rate, and incidence of stoma reversal were retrospectively compared between patients aged over 80 years who underwent anterior resection (AR) and HP. In total, 79 elderly patients underwent rectal cancer surgery. Of these patients, 54 (68.4%) underwent AR and 25 (31.6%) HP. The two groups did not differ significantly in terms of age, nutrient status, and tumor characteristics. Eight (14.8%) patients who underwent AR and six (24.0%) who underwent HP presented with intra-abdominal complications (p=0.35). The overall survival and recurrent-free survival rates between the two groups did not differ. HP for elderly patients with rectal cancer has similar complication rates to AR, and achieved similar oncological outcomes.

Risk factors for postoperative complications after elective ileocolic resection for Crohn's disease: a retrospective study.

BackgroundThe incidence of postoperative complications (POC) in patients with Crohn’s disease (CD) who undergo intestinal resection is high. The literature provides conflicting data about the risk factors for POC, especially regarding preoperative immunosuppressive medications. The purpose of this study was to evaluate the impact of anti-tumor necrosis factor (TNF) agents on the postoperative course and identify other predictors for POC after ileocolic resection (ICR).MethodsThis was a single-center retrospective study that included 153 CD patients who underwent elective ICR in a Greek tertiary center between January 2010 and December 2018. Risk factors for overall POC and intra-abdominal septic complications (IASC) were assessed with univariate and multivariate analyses.ResultsOverall POC and IASC occurred in 35 (22.9%) and 19 (12.4%) patients, respectively. In multivariate analysis, anti-TNF agents (n=61), as either monotherapy or combination treatment, were not associated with an increased risk for overall POC (21.3% vs. 23.9%, P=0.71) or IASC (13.1% vs. 12.0%, P=0.83). Similarly, no combined immunosuppressive regimen significantly correlated with POC. Patients with perianal disease, disease duration >10 years, or previous intestinal resections had significantly higher rates of both overall POC and IASC. In multivariate analysis, previous resection was the only independent risk factor for overall POC (odds ratio [OR] 3.90, 95% confidence interval [CI] 1.38-11.06; P=0.010) and IASC (OR 4.56, 95%CI 1.51-13.77; P=0.007).ConclusionsPreoperative administration of anti-TNF agents or other immunosuppressive regimens was not a risk factor for total POC or IASC. A history of previous resection independently correlated with both overall POC and IASC.

Fast-track recovery for perforated duodenal ulcer

To study the outcomes of fast-track recovery in patients with perforated duodenal ulcer (PDU). There were 138 patients with PDU who underwent surgical treatment for the period from January 1, 2015 to December 31, 2019. Patients were divided into 3 groups: main group, control group 1 (CG-1) and control group 2 (CG-2). The main group (fast-track group, FT-group) included 51 patients who underwent laparoscopic suturing of PDU followed by enhanced recovery (fast-track). CG-1 comprised 44 patients who underwent open suturing of PDU and conventional perioperative treatment. CG-2 consisted of 43 patients who underwent laparoscopic suturing and conventional perioperative treatment. Complications were assessed using Clavien-Dindo grading system. In the FT group, postoperative complications were observed in 2 patients (3.92%). Anemia of mixed genesis (Clavien-Dindo grade II) was diagnosed in 1 patient and left-sided lower lobe pneumonia in another one (grade II). There were no deaths. Mean length of hospital-stay was 3.86 days. In the 1st control group, the largest number of complications was observed (n=12, 27.27%) including 9 extra-abdominal complications (pulmonary disorders (II) - 7 patients (15.9%); sepsis (IVB) - 1 (2.27%), delirium (IVA) - 1 patient (2.27%), postoperative wound seroma (IIIA) - 1 (2.27%) patient). Intra-abdominal complications consisted of compensated pyloroduodenal stenosis (II) in 1 (2.27%) case, recurrent bleeding from acute gastric and duodenal ulcers (IIIB) in 1 (2.27%) patient. Mortality rate was 4.54% (n=2) in this group (progressive multiple organ failure). Mean length of hospital-stay was 7.56 days. In the 2nd control group, postoperative complications included extra-abdominal (pulmonary disorders (II) - pneumonia in 4 (9.3%) cases, spontaneous pneumothorax (IIIA) in 1 (2.32%) case) and intra-abdominal events (duodenitis (II) in 1 (2.32%) patient and compensated pyloroduodenal stenosis (II) in another 1 (2.32%) patient). There were no lethal outcomes in this group. Mean length of hospital-stay was 6.7 days. Treatment outcomes in patients with perforated duodenal ulcer confirmed an effectiveness of laparoscopic suturing and complete abdominal sanitation. These measures create the prerequisites for fast track recovery in urgent surgical practice. FT-protocol of inpatient management is followed by reduced hospital-stay and less incidence of postoperative complications. Moreover, this approach promotes early and safe discharge of patients.

Abdominal Drainage in the Prevention and Management of Major Intra-Abdominal Complications after Total Gastrectomy for Gastric Carcinoma.

PurposeThe role of prophylactic abdominal drainage in total gastrectomy is not well-established. This study aimed to evaluate the efficacy of abdominal drainage in the prevention and management of major intra-abdominal complications after total gastrectomy for gastric carcinoma.Materials and MethodsWe retrospectively reviewed the data of 499 patients who underwent total gastrectomy for gastric carcinoma in a high-volume institution. The patients were divided into drainage and non-drainage groups and compared for the development and management of major intra-abdominal complications, including anastomotic leak, abdominal bleeding, abdominal infection, and pancreatic fistulas.ResultsThe drainage group included 388 patients and the non-drainage group included 111 patients. The 2 groups showed no significant differences in clinicopathological characteristics or operative procedures, except for more frequent D2 lymphadenectomies in the drainage group. After surgery, the overall morbidity (drainage group vs. non-drainage group: 24.7% vs. 28.8%, P=0.385) and incidence of major intra-abdominal complications (6.4% vs. 6.3%, P=0.959) did not significantly differ between the two groups. The non-drainage group showed no significant increase in the incidence rate of major intra-abdominal complications in the subgroups divided by age, sex, comorbidity, operative approach, body mass index, extent of lymphadenectomy, and pathological stage. Abdominal drainage had no significant impact on early diagnosis, secondary intervention or reoperation, or recovery from major intra-abdominal complications.ConclusionsProphylactic abdominal drainage showed little demonstrable benefit in the prevention and management of major intra-abdominal complications of total gastrectomy for gastric carcinoma.

Appendectomy technique: paradigm shift or a well-forgotten old one? The role of mesoappendectomy in prevention of infectious intra-abdominal complications (announcement of RCT)

To analyze the role of mesoappendixectomy in the development of intra-abdominal surgical site infection (IAB SSI) after LAE. A prospective randomized non-blind multiple-center registered (ClinicalTrials.gov NCT03754777) study has been performed for the period from 2016 to 2018. The study was devoted to effectiveness and safety of the modified enhanced recovery protocol in LAE. In the main group, this protocol (n=56) included routine mesoappendixectomy, restrictive strategy for abdominal drainage and postoperative antibiotic prevention. In the control group (n=71), mesoappendixectomy was performed only in case of necrotic changes. Both groups were comparable by demographic parameters and severity of comorbidities. In the main group, significant decrease in the incidence of IAB SSI was found (0% versus 9.8%). Moreover, the main group was characterized by reduced length of hospital-stay (1.43±1.34 d versus 2.94±2, 43 days). Mesoappendixectomy should be evaluated in further research as a potential factor in prevention of IAB SSI.

Dulucq's technique for laparoscopic totally extraperitoneal hernioplasty.

Background:Inguinal hernia repair has been a controversial area in surgical practice. Its complexity is reflected by the fact that numerous different procedures including both open and laparoscopic techniques are in use today. Laparoscopic totally extraperitoneal (TEP) repair is preferred over transabdominal pre-peritoneal repair as the peritoneum is not breached and also due to fewer intra-abdominal complications. This is the most elegant technique but rather difficult to perform.Aim:The purpose of this study was to describe Dulucq's technique for inguinal hernia repair and the use of three-dimensional mesh without fixation in laparoscopic TEP inguinal hernioplasty.Methods:Surgical technique of laparoscopic TEP inguinal hernia repair is detailed in the text.Results:A total of 945 hernia repairs were included in the study. The hernias were repaired by Dulucq's technique. Mean operative time was 45 min in unilateral hernia and 65 min in bilateral hernia. There were no serious complications.Conclusion:The laparoscopic TEP hernioplasty by Dulucq's technique is feasible with fewer intra-abdominal complications. The dissection must always be done with the same stages with minimal monopolar diathermy and patient in a slight Trendelenburg position.

MR scan evaluation of pelvic organ prolapse mesh complications and agreement with intra-operative findings

IntroductionAn increasing number of women are presenting with symptoms after the placement of mesh implants for prolapse which may be attributable to a mesh implant complication. MRI imaging can be used to evaluate abdominally placed mesh but there is no published research evaluating the use of MRI in this group of women. The objective of our study was to report our experience as a tertiary centre in evaluating abdominal mesh with MR imaging and the agreement of MR reports with surgical findings.Study designA retrospective observational cohort study (Canadian Task Force classification II-2) of all women referred to our tertiary unit who underwent an MR scan for investigation of symptoms of mesh complication following an abdominally placed mesh implant between June 2006 and September 2018 was performed. The reports of MR images were compared with the findings at surgery.ResultsMR scan was performed in 87 with suspected mesh complications. MR scan detected mesh failure in 42.1% of women (37/87), infection in 12.6% (11/87), compression in 2.3% (2/87), exposure in 12.6% (11/88), bowel extrusion in 2.3% (2/87) and inflammation in 11.5% (10/87). Agreement between MR scan report and surgical diagnosis was almost perfect for mesh failure, infection and compression, whilst agreement was only moderate for mesh erosion and signs of inflammation (failure κ = 0.97, infection κ = 0.94, compression κ = 1.0, exposure κ = 0.58 and inflammation κ = 0.24).ConclusionThese data provide information on the role of MR imaging in the investigation of women presenting with suspected intra-abdominal POP mesh complications including recurrence.

Incidence and Risk Factors for Severity of Postoperative Ileus After Colorectal Surgery: A Prospective Registry Data Analysis.

Defining severe postoperative ileus in terms of consequences could help physicians standardize the management of this condition. The recently described classification based on consequences requires further investigation. The aim of this study was to obtain a snapshot of postoperative ileus in patients undergoing colorectal surgery within enhanced recovery programs and to identify factors associated with non-severe and severe postoperative ileus. This prospective registry data analysis was conducted in 40 centers in five different countries. A total of 786 patients scheduled for colorectal surgery within enhanced recovery programs were included. The primary endpoint was the incidence rate of postoperative ileus as defined by Vather et al. RESULTS: A total of 121 patients experienced postoperative ileus (15.4%). Non-severe POI occurred in 48 patients (6.1%), and severe postoperative ileus occurred in 73 patients (9.3%). In multivariate analysis, the male gender and intra-abdominal complications were associated with severe postoperative ileus: odd ratio (OR) = 2.03 [95% confidence interval (CI) 1.14-3.59], p = 0.01 and OR = 3.60[95% CI 1.75-7.40], p < 0.0001, respectively. Conversely, open laparotomy and urinary retention were associated with non-severe POI: OR = 3.03[95% CI 1.37-6.72], p = 0.006 and OR = 2.70 [95% CI 0.89-8.23], p = 0.08, respectively. Postoperative ileus occurred in 15% of patients after colorectal surgery within enhanced recovery programs. For 60% of patients, this was considered severe. The physiopathology of these two entities could be different, severe POI being linked to intraabdominal complication, while non-severe POI being linked with risk factors for "primary" POI. The physician should pay attention to male patients having POI after colorectal surgery and look for features evocating intraabdominal complications.

228. Early Recurrent Postoperative Bloodstream infections in Living-Donor Liver Transplant Recipients

BackgroundBloodstream infections (BSIs) represent a poor prognosis in living-donor liver transplant recipients (LDLT-Rs). Some patients develop recurrent BSIs. We evaluated the impacts of ER-BSIs on outcomes in LDLT-Rs.MethodsAll LDLT-Rs with follow-up data between January 2008 and December 2016 were included. Early BSIs (E-BSIs) defined as BSI events within 2 months after LDLT. ER-BSI was defined as new-onset BSI within 2 months due to another pathogen ≥48-hour interval, or relapse of BSI by the same pathogen ≥1-week interval with negative cultures in between. Logistic regression model was used to analyze risk factors for 1-year mortality. An associated factor of E-BSI and ER-BSI were also evaluated.ResultsAmong 727 LDLT-Rs, 108 patients had 149 events with 170 isolated pathogens of E-BSI. Twenty-eight patients (25.9%, 28/108) experienced ER-BSI. Enterococcus (37.6%) was the most common pathogen. Intra-abdominal infection was the most common focus in the first episode of E-BSI and even significantly more common in ≥ second (59.3% vs. 82.9%, P = 0.007). Intra-abdominal and/or biliary complications were risk factors for both E-BSI and ER-BSI. Whereas high MELD score, longer cold ischemic time and longer recipient operative time were associated with E-BSI, longer post-transplant intensive care unit stay and longer donor operative time was associated with ER-BSI. 1-year survival rates of patients with or without single event of E-BSI were 81.3% and 92.4%, respectively. Patients having ER-BSI showed significantly low 1-year survival rates of 28.6% (Figure 1). ER-BSI was the most relevant risk factor for 1-year mortality (adjusted OR = 8.26; 95% CI = 4.30–15.88).ConclusionLDLT-Rs with ER-BSI showed very low survival rates accompanying with intra-abdominal and/or biliary complications. Clinicians should aware to prevent recurrence of BSI focusing on intra-abdominal complications in order to improve clinical outcomes of LDLT-R. Disclosures All authors: No reported disclosures.

Neonatal Abdominal Surgery, Our Experiences of 179 Cases

This is a retrospective study carried out in the Department of Pediatric Surgery, Faridpur Medical College Hospital and in Dr. Zahed Children Hospital at Faridpur, during the period of May 2002 to may 2016. Total 179 neonates were treated by laparotomy for intestinal obstruction after clinical diagnosis and resuscitation. The male to female ratio was 4:5. Most of the patients presented within 02 -25 days of age. In all cases diagnosis was done on history, clinical examination and investigations. The investigations were plain x-ray abdomen in all cases and contrast x-ray upper GIT in 10 cases and enema x-ray in 11 cases and sonogram in 15 cases. Serum electrolytes were not estimated in all patients. There were 34 postoperative mortality. We did loop diversion for 81 cases those who were in potential risk to develop septicemia. Oral feeding started at 3rd postoperative day in diversion cases and 4th postoperative day in resection and end to end anastomosis cases. Superficial wound infection was encountered in 39 cases. Anorectal malformation, IHPS, Exomphaious, Gastroschisis were not included in this study. Long term survival of neonatal abdominal surgery are excellent, however patients have substantial risk to develop intra-abdominal complications. Faridpur Med. Coll. J. Jul 2018;13(2): 82-84

The Impact of Anti-Tumor Necrosis Factor Alpha Therapy on Postoperative Complications in Pediatric Crohn's Disease.

The incidence of Crohn's disease (CD) within the pediatric population is increasing worldwide. Despite a growing number of these patients receiving anti-tumor necrosis factor α therapy (anti-TNF-α), one-third of them still require surgery. There is limited data as to whether anti-TNF-α influences postoperative complications. We evaluated postoperative complications in patients who were or were not exposed to anti-TNF-α therapy in our institutional cohort. A retrospective review of CD patients who underwent abdominal surgery between September 2013 and September 2018 was performed. The patients were divided into two groups based on whether they were treated with anti-TNF-α within 90 days before surgery. Thirty-day postoperative complications were assessed using Clavien-Dindo classification (D-C); this examination included surgical site infections (SSIs), stoma complications, intra-abdominal septic complications, non-SSIs, bleeding, ileus, readmission rate, and return to the operating room. Mann-Whitney U-test, Fisher's exact test, and multivariate logistic regression analyses were used for statistical analysis. Sixty-five patients (41 males) with a median age of 16 years (range: 7-19) at the time of operation were identified. The most common surgery was ileocecal resection in 49 (75%) patients. Forty-three (66.2%) patients were treated with anti-TNF-α preoperatively. Seven patients (11%) experienced postoperative complications. There was no statistically significant difference in postoperative complication in patients who did or did not receive anti-TNF-α before surgery (D-C minor 2.3% vs. 4.6%, p = 1; D-C major 7% vs. 9.1%, p = 1). The use of anti-TNF-α in pediatric CD patients within the 90 days prior to their abdominal surgery was not associated with an increased risk of 30-day postoperative complications.

AN UNSUTURED MESENTERY DEFECT AFTER COLON GRAFT FORMATION IN ESOPHAGOPLASTY IN CHILDREN

Purpose. To decrease the number of complications at the intra-abdominal stage of total esophagoplasty in children by leaving a mesentery defect unsutured after the graft formation. Material and methods. 27 children with atresia (4) and scar contraction (23) of the esophagus had esophagoplasty with a colon left-side graft on a vascular pedicle including a. colicamed; a.colicasin and the arcade between the first sigmoid artery were ligated and cut. The graft was placed behind the sternum in the antiperistaltic position. A “window” in the mesentary of the transverse colon was left unsutured after the graft formation. Basic techniques for examination - X-ray and endoscopy. An anastomosis “end of the esophagus to the side of the colon graft” was always formed at the neck level. Results. Due to the unsutured mesentary of the transverse colon, surgeons avoided all intra-abdominal complications which may develop, if the mesentary is sutured. The right side of the colon remained intact ; neck-anastomosis fistulas were seen only in 2 (9%) patients.

Antegrade lithoextraction as perspective rechnique for mechanical jaundice radical treatment

Material and methods From 2014 to 2017 in our hospital 1158 patients with cholelithiasis complicated by mechanical jaundice have been treated. The group consisted of 59 (5.1%) patients with initially predicted difficulties for endoscopic lithoextraction. In 12 of that group antegrade decompression was the only surgical method for completing treatment. In 2 cases the ‘rendezvous’ technique was used, and in 23 patients the antegrade decompression it was complemented with laparotomy and choledocholithotomy. In 22 patients for verification the nature of the bile-excreting ducts and the cholelithic occlusion revealed at the same time the first stage included an antegrade decompression that allowed to finish surgical treatment by an endoscopic transpapillary lithoextraction.Results In the main group of clinical observations for 59 patients the surgical treatment complemented with an antegrade decompression was without fatal outcomes. All patients were cured of cholelithic occlusion and recovered. In the study group with 1099 patients that were treated with only an endoscopic lithoextraction 8 patients died that showed 0.7±0.2% of operational mortality. Complications, in the form of operational wounds in the main group of observations were found in 7 patients and it was 11.8±4.2%. Other postoperative complications in the main group were not observed. In the control group similar wound complications were seen in 13 patients (1.2%). In the control group with 57 patients we observed intraabdominal complications which resulted in mortality (5.2±0.7%). Of those postoperative reversible pancreatitis was found in 34 patients, 3 patients had fulminant pancreonecrosis, in 4 cases there was profuse bleeding from a papillosphincterotomy area, in 3 cases we observed insertion of Dormia basket at lithoextraction, septic cholangitis was in 11 and duodenum perforation with retroperitoneal phlegmon was in 3 cases.Conclusion Mortality in the group with antegrade treatment application for choledocholithiasis was not found. On the contrary, rather higher rate of complications in the control group testifies in advantage of the antegrade techniques for choledocholithiasis treatment in the shown cases.

Incisional Complications and Cosmetic Evaluation After Hand-assisted Retroperitoneoscopic Donor Nephrectomy

PurposeHand-assisted retroperitoneoscopic (HARP) donor nephrectomy prevents major complications, but incision site complications may be more frequent in hand-assisted approach. We evaluated long-term incisional complication rates and cosmetic outcomes after HARP donor nephrectomy in our series. Materials and MethodsA total of 609 donors who underwent nephrectomy between February 2009 and June 2016 were invited for physical examination and face-to-face interview. A total of 209 donors (35.3%) participated to the study. Sex, age, body mass index (BMI), mean follow-up period, incision-related outcomes of cosmesis, and postoperative complications were evaluated. Body image scale (BIS) and cosmetic scale (CS) (scar test) questionnaires were applied. Higher cosmesis and body image scores indicated greater satisfaction. ResultsA total of 191 donors had paramedian (91.4%), and 18 donors had Pfannenstiel incision (8.6%); 121 donors were female (57.9%). The donor mean age and BMI were 49.1 (SD, 1.8) years and 29.7 (SD, 5.1), respectively. Body mass index was significantly lower in the Pfannenstiel group (P < .001). The mean BIS score was 18.9 (SD, 1.8), and the CS questionnaire score was 19.3 (SD, 4,7). The BIS score was significantly better in donors with Pfannenstiel incisions (P < .001), but there was no statistical significance in CS score. The total rate of wound infection was 4.8%, and rate of incisional hernia was 4.8%. The rate of incisional hernia was more frequent in donors with paramedian incision (5.2%), but there was no statistical significance. Six donors (2.9%) required rehospitalization because of incision site complications. ConclusionHand-assisted retroperitoneoscopic donor nephrectomy avoids intra-abdominal complications, but rate of incision site complications can be higher in hand-assisted procedure. The donors were convinced from the cosmetic outcome after HARP donor nephrectomy. The ones who had Pfannenstiel incision had better satisfaction according to BIS score.

A STUDY OF UTILITY OF DRAIN FLUID PH FOR RAPID DETECTION OF INFECTIOUS COMPLICATION AFTER ABDOMINAL SURGERY

Background: The onset of infectious complications following abdominal surgery may be insidious, their presence obscure and the diagnosis difficult.&#x0D; Methods: A prospective study of patient in whom emergency laprotomy was performed and post operative abdominal drain fluid analysis was done by ph for rapid detection of infectious complications.&#x0D; Results: In our study those patients who developed intraabdominal complications (Failure) there 65.3% of samples have pH &lt;7.1 and 34% samples have pH &gt;7.1.While in patients who considered cured &amp; improved 76.62% samples have pH &gt;7.1 &amp; 23.37% have pH &lt;7.1&#x0D; Conclusion: The pH during the postoperative follow-up period to evaluate the potential for rapid, simple, and early detection of infectious complications following abdominal surgery.&#x0D; Keywords: PH, Infection, Drain, Fluid.

A positive proximal resection margin is associated with anastomotic complications following primary ileocaecal resection for Crohn's disease.

Bowel resection in patients with Crohn's disease (CD) has a high reported rate of postoperative complications and surgical recurrence. A macroscopically normal resection margin is recommended in CD surgery as wider margins do not translate in reduced recurrence rates. The aim of this study was to evaluate the association between resection margin status and anastomotic complications following ileocaecal resection for primary CD. All patients treated with ileocaecal resection for primary CD from 2010 to 2018 were included in this retrospective observational study. Emergency operations and recurrent CD were excluded. Patients in whom an anastomosis was not fashioned at the time of the surgery were also excluded. Histopathology data collected included macroscopic description, presence of macroscopic and microscopic involvement of the proximal and distal resection margins. The primary outcome was the rate of positive resection margin in patients who developed anastomotic complications(anastomotic leaks and intra-abdominal collections), and the secondary outcomes were overall complications rate, length of hospital stay, reoperations and rehospitalisation within 30days. A total of 104 patients were included. The proximal resection margin was microscopically involved in 19 patients (18.2%). Ten patients (9.6%) developed intra-abdominal anastomotic related complications, with 5 patients out of 10 (50%) in the group of postoperative anastomotic complications having a positive microscopic proximal margin at histology, compared to 14 patients (14.9%) in the group that did not develop anastomotic complications (p < 0.0001). Microscopic involvement of the proximal resection margin is more frequent in patients who develop postoperative anastomotic complications following elective ileocaecal resection for primary CD.