Open Abdominal Surgery Research Articles

Reliability of Bioreactance and Pulse-Power Analysis in Measuring Cardiac Index During Open Abdominal Aortic Surgery

To investigate the accuracy, precision, and trending ability of noninvasive bioreactance-based Starling SV and the mini invasive pulse-power device LiDCOrapid as compared to thermodilution cardiac output (TDCO) as measured by pulmonary artery catheter when assessing cardiac index (CIx) in the setting of elective open abdominal aortic (AA) surgery. A prospective method-comparison study. Oulu University Hospital, Finland. Forty patients undergoing elective open abdominal aortic surgery. Intraoperative CI measurements were obtained simultaneously with TDCO and the study monitors, resulting in 627 measurement pairs with Starling SV and 497 with LiDCOrapid. The Bland-Altman method was used to investigate the agreement among the devices, and four-quadrant plots with error grids were used to assess trending ability. The agreement between TDCO and Starling SV was associated with a bias of 0.18 L/min/m2 (95% confidence interval [CI] = 0.13 to 0.23), wide limits of agreement (LOA = -1.12 to 1.47 L/min/m2), and a percentage error (PE) of 63.7 (95% CI = 52.4-71.0). The agreement between TDCO and LiDCOrapid was associated with a bias of -0.15 L/min/m2 (95% CI = -0.21 to -0.09), wide LOA (-1.56 to 1.37), and a PE of 68.7 (95% CI = 54.9-79.6). The trending ability of neither device was sufficient. The CI measurements achieved with Starling SV and LiDCOrapid were not interchangeable with TDCO, and the ability to track changes in CI was poor. These results do not support the use of either study device in monitoring CI during open AA surgery.

A comparative study of endotracheal tube cuff pressure changes in patients undergoing open abdominal and laparoscopic surgeries

Background: Laparoscopic surgeries are routinely performed because it’s minimally invasive and early recovery for patients. The preferred mode of anesthesia is general anesthesia with an endotracheal tube (ETT). The creation of the pneumoperitoneum and various positions cause cuff pressure (CP) changes. Aims and Objectives: We aim to study the CP changes and post-operative complications related to it. The secondary objective was to observe the post-operative complications such as sore throat, hoarseness of voice, and blood-streaked expectoration after extubation at 12 h, and at the time of discharge from the post-anesthesia care unit. Materials and Methods: One hundred and fifty patients undergoing elective open abdominal and laparoscopic surgeries were enrolled. Three groups (open abdominal [group A], n=50; lap head up [group B], n=50; and lap head down [group C], n=50) were compared for CP changes before and after pneumoperitoneum and position change. CP changes and post-operative complications were recorded and analyzed with Statistical Package for the Social Sciences version 19. Results: Mean differences in CP after intubation at 5 min were similar in all three groups. At 45 min onward, the mean CP in group C was found to be elevated and continued to increase till the end of surgery. However, at 90 min, group B also showed some increase in CP. There was a mild increase in CP in groups B and A. The mean difference between groups was found to be remarkable. During the post-operative period, there were 0.7% and 3.3% of cases with throat pain in group B and group C, and 2% of patients in group C had blood streak expectoration. Conclusion: In laparoscopic surgery, especially in a head-down position, a considerable increase in CP is associated with postoperative complications.

Visual Evaluation of Plethysmographic Waveforms: Introducing the Simple Systolic Ratio as an Indicator of Fluid Responsiveness.

For patient safety, maintaining hemodynamic stability during surgical procedures is critical. Dynamic indices [such as systolic pressure variation (SPV) and pulse pressure variation (PPV)], have recently seen an increase in use. Given the risks associated with such invasive techniques, there is growing interest in non-invasive monitoring methods-and plethysmographic waveform analysis. However, many such non-invasive methods involve intricate calculations or brand-specific monitors. This study introduces the simple systolic ratio (SSR), derived from pulse oximetry tracings, as a non-invasive method to assess fluid responsiveness. This prospective observational study included 25 adult patients whose SPV, PPV, and SSR values were collected at 30-min intervals during open abdominal surgery. The SSR was defined as the ratio of the tallest waveform to the shortest waveform within pulse tracings. The correlations among SSR, SPV, and PPV were analyzed. Additionally, anaesthesia specialists visually assessed pulse oximetry tracings to determine fluid responsiveness using the SSR method. Strong correlations were observed between SSR and both SPV (r = 0.715, P < 0.001) and PPV (r = 0.702, P < 0.001). Receiver operator curve analysis identified optimal SSR thresholds for predicting fluid responsiveness at 1.47 for SPV and 1.50 for PPV. A survey of anaesthesia specialists using the SSR method to visually assess fluid responsiveness produced an accuracy rate of 83%. Based on the strong correlations it exhibits with traditional markers, SSR has great potential as a clinical tool, especially in resource-limited settings. However, further research is needed to establish its role, especially as it pertains to its universal applicability across monitoring devices.

Evaluating the effectiveness of proactive perioperative nursing strategies on the prevention of surgical site infections and the enhancement of skin healing in paediatric abdominal surgery

AbstractThe present study aimed to investigate the comparative efficacy of proactive perioperative nursing interventions versus conventional perioperative nursing care in improving wound healing, reducing the incidence of surgical site infections (SSIs) and enhancing patient satisfaction among paediatric patients undergoing elective open abdominal surgery. A total of 100 paediatric patients were enrolled in a randomised controlled trial at our hospital between January 2021 and December 2022. Inclusion criteria were patients aged &lt;18 years who met the requirements for surgical intervention and had no contraindications to surgery or anaesthesia. Patients were randomly assigned to either an observation group receiving proactive perioperative nursing care, or a control group subjected to conventional care. Primary outcome measures included surgical incision healing grades (A, B, C), infection rates confirmed by bacterial culture within 30 days post‐surgery, patient satisfaction scores and length of hospital stay. Comprehensive statistical analyses were performed using IBM's SPSS software (version 27.0). Both groups demonstrated statistically similar baseline demographics and surgical parameters. However, the observation group showed significant improvement in wound healing outcomes (Grade A) and decreased incidence of complications (Grade C) and infections compared to the control group (P &lt; 0.05). Patient satisfaction was significantly higher in the observation group, with 80% of patients reporting satisfaction as opposed to 20% in the control group (p &lt; 0.05). The distribution of pathogenic bacteria in SSIs predominantly included Escherichia coli (E. coli), Pseudomonas aeruginosa, Enterococcus spp., Staphylococcus aureus and Klebsiella pneumoniae. Proactive perioperative nursing interventions demonstrate considerable benefits in improving wound healing, reducing surgical site infection rates and enhancing patient satisfaction in elective open abdominal surgery settings. However, these results require validation through large‐scale trials.

Differences in the association between epidural analgesia and length of stay by surgery type: an observational study

IntroductionDespite a decline in the use of thoracic epidural analgesia related in part to concerns for delayed discharge, it is unknown whether changes in length of stay (LOS) associated with...

Effects of Early Mobilisation on Post Operative Pulmonary Complication in Patients with Open Abdominal Surgery

Background: Patients undergoing open abdominal surgery are the focus of this research, namely the effect of earlymobilisation on postoperative pulmonary problems. Early mobilization is proposed as a potential intervention toenhance respiratory function and reduce the risk of PPCs.Purpose: The purpose of this study is to evaluate the impact of pre-operative mobilisation on the incidence ofpulmonary complications in patients undergoing open abdominal surgery.Materials and Methods: This quasi-experimental study included 50 subjects who underwent open abdominalsurgery at Saveetha Medical Hospital, SIMTS. Convenient sampling was used to select the participants. Measuresof oxygen saturation (SPO2) and pulmonary function (FEV1) from a spirometer were employed as functionaloutcome indicators. After two weeks, participants were given a post-test to record their progress.Results: Data collected before and after early mobilisation exercise were analysed using a paired t-test. Theexperimental group showed significant improvements in SPO2, FIM, and FEV1 (P&lt;0.0001), indicating highervalues post-intervention. Post-test demonstrated higher statistical significance compared to pre-test.Conclusion: As a result, it was shown that early mobilisation Exercise is beneficial for reducing pulmonarycomplications after surgery.

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Uterine sarcoma post laparoscopic myomectomy using morcellation; systematic review

The Food and Drug Administration released a safety communication in 2014 advising physicians not to do laparoscopic power morcellation for myomectomy, hysterectomies, or the removal of uterine fibroids. The purpose of this study was to ascertain how morcellation affected the survival rates of patients with uterine sarcoma who had myomectomy or hysterectomy. The Web of Science, PubMed, Embase, and Scopus databases were searched for publications that had been published between the years 2003 and 2024. It aimed to find all original English-language studies comparing the outcomes between patients with uterine morcellation following laparoscopic myomectomy or hysterectomy and those without. A total of seven studies were included in this review. In most of the included studies, the group that underwent morcellation included patients undergoing laparoscopic, open abdominal, vaginal, and hysteroscopic surgery. In contrast, the group without morcellation consisted of all patients undergoing open abdominal surgery. Patients who had uterine morcellation were more likely to experience tumor metastases than those in the group without morcellation. The rate of reoperations was higher in patients who had morcellation than those who did not. Overall, five studies found that morcellation deteriorating outcomes, whereas the other two found no significant difference between morcellation and non-morcellation. The available evidence indicated that in patients with uterine sarcomas, morcellation increases the risk of intra-abdominal and total recurrences but not the risk of extra-abdominal recurrences. Nevertheless, a link was found between morcellation and reduced survival rates.

Acute kidney injury after surgical treatment of failed endovascular aneurysm repair.

This study aims to report the incidence of acute kidney injury following surgical reconstruction after a failed endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms. This retrospective study included 44 patients (39 males, 5 females; mean age: 70±11.3 years; range, 35 to 84 years) who underwent emergency or elective surgical reconstruction after failed EVAR between February 2015 and January 2019. Patients were divided into two groups: acute kidney injury group and no acute kidney injury group. The primary end-point of the study was to evaluate the development of acute kidney injury following surgery. The secondary end-points included the 30-day and one-year mortality rates. Surgical reconstruction of the abdominal aorta was performed electively in 29 (65.9%) patients and urgently in 15 (34.1%) patients. Acute kidney injury occurred in 12 (27.3%) patients. The interval from endovascular aneurysm repair to surgical reconstruction was statistically significantly higher in the no acute kidney injury group than in the acute kidney injury group (24.6±11.5 and 18.1±13.3 months, respectively; p=0.145). The mean abdominal aortic aneurysm diameter, neck angulation, and neck diameter were statistically significantly higher in the acute kidney injury group than in the no acute kidney injury group (p=0.001, p=0.009, and p<0.001, respectively). No statistically significant difference was observed between the acute kidney injury and no acute kidney injury groups for the overall 30-day mortality (p=0.185) and oneyear mortality (p=0.999). Acute kidney injury is not uncommon after the surgical reconstruction of a failed EVAR. Aneurysm-related anatomical factors may have an impact on the development of postoperative acute kidney injury. Comprehensive surgical planning should be performed for open abdominal aortic surgery after a failed EVAR.

Laparoscopic surgery for advanced peritonitis

To determine the criteria for choosing surgical access in patients with advanced peritonitis considering its local and general manifestations. We analyzed treatment outcomes in 588 patients with advanced peritonitis. The most common causes of peritonitis were destructive forms of acute appendicitis (273 cases), perforated gastroduodenal ulcers (165 cases), acute cholecystitis (59 cases). To determine the criteria for choosing surgical access in advanced peritonitis, we analyzed treatment outcomes considering MPI, SPP and WSES SSS score. The choice of surgical access in advanced peritonitis can only symbolically be standardized according to modern scoring systems (MPI, SPP, WSES SSS). Laparotomy is necessary for MPI score ≥30 and SPP score > 10 (WSES SSS score > 8). Regardless of MPI, SPP, WSES SSS scores, the absolute contraindications for laparoscopic surgery are dense non-removable fibrin deposits, interintestinal abscesses, purulent recesses, intra-abdominal pressure > 20 mm Hg or small intestine dilation> 3 cm, sepsis or septic shock (qSOFA score 2-3), previous open abdominal surgery, unstable hemodynamics, technical difficulties. Conversion should be used at any doubt. Careful patient selection, surgical experience and training in laparoscopic technique are decisive factors for wider use of laparoscopic approach in patients undergoing emergency abdominal surgery.

Comparison of Doppler Guided Seldinger Technique Versus Classic Palpatory Seldinger Technique for Radial Artery Cannulation-an Open Label Randomized Controlled Trial

Objective: Radial artery cannulation is commonly performed by the conventional palpatory technique. However, in circumstances where the cannulation is difficult, other methods such as Doppler or ultrasound are used to guide the cannulation. Incorporating the Seldinger technique can further improve the successful cannulation. The aim of the study was to compare the first attempt success rate of radial artery cannulation between conventional palpatory Seldinger technique and Doppler guided Seldinger technique. Methods: Ninety patients undergoing major open abdominal surgeries were divided into two groups -the Classic palpatory and the Doppler guided radial artery cannulation. The Seldinger Technique was used in both the groups. First attempt success rate of radial artery cannulation and time to cannulation were noted by both the techniques. Results: The number of attempts and the time to cannulation were significantly less in the palpatory Seldinger group as compared with the Doppler Seldinger group. Complication rates were similar in both the groups but there were 4 failure in palpatory Seldinger group. Conclusion: The classic palpatory technique along with the Seldinger technique for radial artery cannulation is better in terms of first attempt cannulation rate and duration of cannulation than the Doppler guided Seldinger technique in patients undergoing elective surgeries. However, Doppler method had no failures and can be a useful rescue method in failed cannulation.

The role of Tranexamic acid in the Reduction of Bleeding in Abdominal Aortic Aneurysm Surgery

Objective: To determine the effects of Tranexamic acid on intraoperative blood loss. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jun to Oct 2021. Methodology: A total of 96 patients from both genders undergoing elective open abdominal aortic aneurysm surgery under general anaesthesia enrolled in the study after random distribution to Drug and Control Groups. The primary determinant was intraoperative blood loss. Additionally, determining variables were intraoperative and postoperative blood transfusions, thromboembolic episodes, and postoperative mortality rate. Results: A total of 96 patients enrolled in the study, out of which 90(93%) were males, whereas 6(7%) were females, with a mean age of 65.37±7.01 (55–75 years). Of 96 participants, 52(54%) patients were from ASA Class II and 44(46%) were from ASA Class III. There was no significant correlation between surgical time (p-value 0.45), clamping time (p-value 0.34), and intraoperative and postoperative transfusions (p-value 0.56 and 0.28, respectively). However, a statistically significant reduction in intraoperative and postoperative blood loss was recorded (p-value &lt;0.001). Conclusion: Tranexamic acid significantly impacts the reduction of intraoperative and postoperative bleeding in elective open abdominal aortic aneurysm surgeries under general anaesthesia.

Safety and Feasibility of Intraoperative High PEEP Titrated to the Lowest Driving Pressure (ΔP)-Interim Analysis of DESIGNATION.

Uncertainty remains about the best level of intraoperative positive end-expiratory pressure (PEEP). An ongoing RCT ('DESIGNATION') compares an 'individualized high PEEP' strategy ('iPEEP')-titrated to the lowest driving pressure (ΔP) with recruitment maneuvers (RM), with a 'standard low PEEP' strategy ('low PEEP')-using 5 cm H2O without RMs with respect to the incidence of postoperative pulmonary complications. This report is an interim analysis of safety and feasibility. From September 2018 to July 2022, we enrolled 743 patients. Data of 698 patients were available for this analysis. Hypotension occurred more often in 'iPEEP' vs. 'low PEEP' (54.7 vs. 44.1%; RR, 1.24 (95% CI 1.07 to 1.44); p < 0.01). Investigators were compliant with the study protocol 285/344 patients (82.8%) in 'iPEEP', and 345/354 patients (97.5%) in 'low PEEP' (p < 0.01). Most frequent protocol violation was missing the final RM at the end of anesthesia before extubation; PEEP titration was performed in 99.4 vs. 0%; PEEP was set correctly in 89.8 vs. 98.9%. Compared to 'low PEEP', the 'iPEEP' group was ventilated with higher PEEP (10.0 (8.0-12.0) vs. 5.0 (5.0-5.0) cm H2O; p < 0.01). Thus, in patients undergoing general anesthesia for open abdominal surgery, an individualized high PEEP ventilation strategy is associated with hypotension. The protocol is feasible and results in clear contrast in PEEP. DESIGNATION is expected to finish in late 2023.

Long-Term Bowel Vaginoplasty With a Single Yang-Monti Tube.

The bowel remains the favored tissue for neo-vaginoplasty (NeoVP) in pediatric patients with vaginal agenesis. In 2001, the first description of NeoVP using the Yang-Monti technique with a sigmoid double tubular flap was published. We present our experience of NeoVP with a single Yang-Monti tube (SYMT) flap and report on the use of different segments of colon. We conducted a retrospective review of patients who underwent NeoVP using a bowel SYMT between 2009 and 2021. The procedure was performed under open abdominal surgery by isolating 8 to 12 cm from the rectosigmoid, cecum, or ascending colon. Subsequently, this segment was detubularized near the mesenteric border, folded, and retubularized transversally, leaving the mesentery in a cephalic position. A channel was dissected in the pelvis to accommodate the NeoVP. Seventeen patients were identified. The median age was 16 years old. The principal diagnosis was Mayer-Rokitansky's syndrome (47.1%). The median follow-up was 50 months. The mean harvested bowel length was 9 cm, and the sigmoid was the preferred site (65%). The cecum-ascending colon was used in 3 (17.6%) patients. Complications were recorded in 6 patients (35%). Of these 6 patients, 4 had introital stenosis. There was 1 case of urethrovaginal fistula and another of left hematometrocolpos. Satisfactory sexual function has been reported in sexually active individuals. We described our experience in NeoVP using a large bowel SYMT as a safe and effective technique. It allows decreased tension on the vascular pedicle and the use of shorter colon segments.

Enhancing predictive accuracy of the cardiac risk score in open abdominal aortic surgery: the role of left ventricular wall motion abnormalities.

Open abdominal aortic surgery carries many potential complications, with cardiac adverse events being the most significant concern. The Vascular Study Group Cardiac Risk Index (VSG-CRI) is a commonly used tool for predicting severe cardiac complications and guiding clinical decision-making. However, despite the potential prognostic significance of left ventricular wall motion abnormalities (LVWMAs) and reduced LV ejection fraction (LVEF) for adverse outcomes, the VSG-CRI model has not accounted for them. Hence, the main objective of this study was to analyze the added value of LV wall motion on the discriminatory power of the modified VSG-CRI in predicting major postoperative cardiac complications. A prospective study was conducted involving 271 patients who underwent elective abdominal aortic surgery between 2019 and 2021. VSG-CRI scores were calculated, and preoperative transthoracic echocardiography was conducted for all patients. Subsequently, a modified version of the VSG-CRI, accounting for reduced LVEF and LVWMAs, was developed and incorporated into the dataset. The postoperative incidence of the composite endpoint of major adverse cardiac events (MACEs), including myocardial infarction, clinically relevant arrhythmias treated with medicaments or by cardioversion, or congestive heart failure, was assessed at discharge from the index hospitalization, with adjudicators blinded to events. The predictive accuracy of both the original and modified VSG-CRI was assessed using C-Statistics. In total, 61 patients (22.5%) experienced MACEs. Among these patients, a significantly higher proportion had preoperative LVWMAs compared to those without (62.3% vs. 32.9%, p < 0.001). Multivariable regression analysis revealed the VSG-CRI [odds ratio (OR) 1.46, 95% confidence interval (CI) 1.21-1.77; p < 0.001] and LVWMA (OR 2.76; 95% CI 1.46-5.23; p = 0.002) as independent predictors of MACEs. Additionally, the modified VSG-CRI model demonstrated superior predictability compared to the baseline VSG-CRI model, suggesting an improved predictive performance for anticipating MACEs following abdominal aortic surgery [area under the curve (AUC) 0.74; 95% CI 0.68-0.81 vs. AUC 0.70; 95% CI 0.63-0.77; respectively]. The findings of this study suggest that incorporating preoperative echocardiography can enhance the predictive accuracy of the VSG-CRI for predicting MACEs after open abdominal aortic surgery. Before its implementation in clinical settings, external validation is necessary to confirm the generalizability of this newly developed predictive model across different populations.

Implementation of mandatory blood alcohol screening in trauma patients: A retrospective study from a tertiary trauma center in a Middle Eastern country

BackgroundAlcohol consumption is a significant risk factor for several types of injuries and trauma recidivism and remains an important public health concern worldwide. We aimed to describe the implementation of mandatory alcohol screening and the AUDIT tool among trauma patients admitted to a level 1 trauma center in a country with a partial ban on alcohol consumption. MethodsThis was a retrospective analysis of trauma patients (>12 years old) who required hospital admission and underwent blood alcohol concentration (BAC) screening between 2014 and 2019. This was achieved via an enzymatic method using alcohol dehydrogenase for ethanol detection in the plasma and serum samples. Trauma patients with a BAC <2.2 mmol/L were referred to as “negative”, and BAC >2.2 mmol/L was referred to as “BAC positive”. A comparative analysis was performed between the two BAC groups. Alcohol Screening, Brief Intervention, Referral for Treatment [ASBIRT] program, and AUDIT were applied. ResultsA total of 7326 BAC screening tests were performed on 7284 patients during the study period. With slight variation over the years, the compliance rate was 77% (70.4%–85.3%), and the test positivity rate was 10% (8.6%–12.5%). There were 42 repeated admissions, of which seven patients were BAC positive at every admission. Young age and non-Arab patients were more likely to test positive, and the main mechanism of injury (MOI) was road traffic-related trauma (p < 0.05). Assault and self-inflicted injuries were significantly higher in BAC-positive patients than in BAC-negative patients (18% vs. 4% and 2.7% vs. 1.3%, respectively; p = 0.001). The injury severity score (ISS) and mortality rate were comparable between the study groups. Patients with a positive BAC were significantly more likely to undergo pan-CT scan in the emergency department, intubation, and exploratory laparotomy than those with a negative BAC. In patients who sustained injuries due to assault, all-terrain vehicles, or motorcycle crashes, there was a significant association between the positivity of BAC tests and the patient's ISS. ConclusionDespite improvements in BAC screening in trauma admissions over the years, almost 20% of cases were missed. Although the mortality rates were comparable, alcohol consumption burdens resources in terms of excess imaging, intubation, open abdominal surgery, and possible disability. Further studies are needed to understand the key obstacles and challenges to achieving optimum compliance for screening in trauma settings.

Intraoperative hypotension affects postoperative acute kidney injury depending on the invasiveness of abdominal surgery: A retrospective cohort study.

Intraoperative hypotension (IOH) or highly invasive surgery adversely affects postoperative clinical outcomes. It is, however, unclear whether IOH affects postoperative acute kidney injury (AKI) depending on the invasiveness of abdominal surgery. We speculated that IOH in highly invasive abdominal surgery is a significant risk factor for postoperative AKI. We retrospectively reviewed the data of 448 patients who underwent abdominal surgery. Patients were divided into 3 groups: highly (such as pancreaticoduodenectomy and hepatectomy), moderately (open abdominal surgery), and minimally (laparoscopic surgery) invasive surgeries. The association between the time-weighted average (TWA) of mean arterial pressure (MAP) values (≤60 and ≤ 55 mm Hg) and AKI occurrences in each group was assessed. Postoperative AKI occurred after highly, moderately, and minimally invasive surgeries in 33 of 222 (14.9%), 14 of 110 (12.7%), and 12 of 116 (10.3%) cases, respectively (P = .526). The median [interquartile range] of TWA-MAP ≤ 60 mm Hg, as an IOH parameter, was 0.94 [0.33-2.08] mm Hg in highly, 0.54 [0.16-1.46] mm Hg in moderately, and 0.14 [0.03-0.57] mm Hg in minimally invasive surgeries (P < 0001). In addition, there was a significant association between TWA-MAP and AKI in highly invasive surgery, unlike in moderately and minimally invasive surgery, with adjusted odds ratios (95% confidence interval) for TWA-MAP ≤ 60 and ≤ 55 mm Hg associated with AKI of 1.23 [1.00-1.52] (P = .049) and 1.55 [1.02-2.36] (P = .041), respectively. Intraoperative MAP ≤ 60 mm Hg in highly invasive abdominal surgery is associated with postoperative AKI, compared to moderately and minimally invasive surgeries. Additionally, low MAP thresholds in highly invasive surgery increase postoperative AKI risk.

Surgical site infection following abdominal cancer surgery: a retrospective study in a tertiary care cancer hospital

Background: Surgical site infections (SSIs) are significant complications following abdominal cancer surgery, resulting in patient discomfort, prolonged hospitalization, and increased healthcare costs. Despite efforts to mitigate their occurrence, SSIs remain a challenge in healthcare settings, particularly in low- and middle-income countries. Materials and Methods: This retrospective cross-sectional study aimed to determine the incidence, risk factors, microbiological patterns, and impact of SSIs in patients undergoing open abdominal cancer surgery at a tertiary cancer hospital in Nepal. Results: A total of 206 patients were included in the study, with an SSI incidence of 35.4%. Superficial SSIs accounted for 87.7% of cases, while 12.2% were deep or organ/space infections. The study explored various risk factors, including patient demographics, wound classification, surgical type, and preoperative conditions, and although certain factors showed associations, none reached statistical significance. Notably, longer surgical duration was linked to a higher risk of SSIs. Patients with SSIs experienced significantly longer hospital stays compared to those without SSIs. The predominant pathogens isolated were Escherichia coli, Staphylococcus aureus, and Citrobacter freundii, many of which displayed multidrug resistance. Conclusions: These findings highlight the need for tailored prevention strategies, prudent antibiotic use, and enhanced infection control measures in this high-risk population undergoing abdominal cancer surgery.

Is there a role for warm humidified carbon dioxide insufflation in open abdominal surgery?

Is there a role for warm humidified carbon dioxide insufflation in open abdominal surgery?

Viral load of SARS-CoV-2 in surgical smoke in minimally invasive and open surgery: a single-center prospective clinical trial

At the beginning of the COVID-19 pandemic, it was assumed that SARS-CoV-2 could be transmitted through surgical smoke generated by electrocauterization. Minimally invasive surgery (MIS) was targeted due to potentially higher concentrations of the SARS-CoV-2 particles in the pneumoperitoneum. Some surgical societies even recommended open surgery instead of MIS to prevent the potential spread of SARS-CoV-2 from the pneumoperitoneum. This study aimed to detect SARS-CoV-2 in surgical smoke during open and MIS. Patients with SARS-CoV-2 infection who underwent open surgery or MIS at Heidelberg University Hospital were included in the study. A control group of patients without SARS-CoV-2 infection undergoing MIS or open surgery was included for comparison. The trial was approved by the Ethics Committee of Heidelberg University Medical School (S-098/2021). The following samples were collected: nasopharyngeal and intraabdominal swabs, blood, urine, surgical smoke, and air samples from the operating room. An SKC BioSampler was used to sample the surgical smoke from the pneumoperitoneum during MIS and the approximate surgical field during open surgery in 15 ml of sterilized phosphate-buffered saline. An RT-PCR test was performed on all collected samples to detect SARS-CoV-2 viral particles. Twelve patients with proven SARS-CoV-2 infection underwent open abdominal surgery. Two SARS-CoV-2-positive patients underwent an MIS procedure. The control group included 24 patients: 12 underwent open surgery and 12 MIS. One intraabdominal swab in a patient with SARS-CoV-2 infection was positive for SARS-CoV-2. However, during both open surgery and MIS, none of the surgical smoke samples showed any detectable viral particles of SARS-CoV-2. The air samples collected at the end of the surgical procedure showed no viral particles of SARS-CoV-2. Major complications (CD ≥ IIIa) were more often observed in SARS-CoV-2 positive patients (10 vs. 4, p = 0.001). This study showed no detectable viral particles of SARS-CoV-2 in surgical smoke sampled during MIS and open surgery. Thus, the discussed risk of transmission of SARS-CoV-2 via surgical smoke could not be confirmed in the present study.