Postoperative Gastrointestinal Complications Research Articles

Use of Computed Tomography in Diagnosis of Major Postoperative Gastrointestinal Complications of Laparoscopic Roux-en-Y Gastric Bypass Surgery

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is becoming a frequently performed procedure for the treatment of morbid obesity. It is important for all general surgeons to be able to diagnose correctly and treat its complications. It is the purpose of this study to determine whether computed tomography (CT) is useful in correctly diagnosing these complications. The medical records of all patients that underwent LRYGB between March 2000 and December 2002 (n = 574) at Huntington Memorial Hospital were reviewed. Major abdominal complications defined as anastomotic leaks or small bowel obstruction were noted. Results of CT scans in these patients were reviewed by both a radiologist and an attending surgeon. CT scan findings were then compared to intraoperative findings. Postoperatively, 18 patients were found to have small bowel obstruction/herniation and anastomotic leaks. CT scan correctly diagnosed anastomotic leaks and small bowel obstruction in 71 per cent and 100 per cent of patients, respectively. Complication following LRYGB are rare but potentially life-threatening. CT scans are helpful in predicting the pathology and directing the surgical management of these patients. CT scan findings, however, can be subtle and therefore be missed by those not intimately familiar with post gastric bypass anatomy.

Normal anatomy and complications after gastric bypass surgery: helical CT findings.

To determine the usefulness and potential pitfalls of helical computed tomography (CT) for depiction of normal anatomy and diagnosis of complications after gastric bypass surgery. From March 1998 to July 2002, 100 abdominal and pelvic CT examinations were performed in 72 patients after gastric bypass surgery for treatment of morbid obesity. Two of four attending abdominal radiologists retrospectively assessed the CT images in consensus for normal postoperative gastrointestinal anatomy and complications such as leaks, staple line dehiscence, bowel obstruction, abscess, hepatic or splenic infarction, and hernia. CT findings were compared with clinical, surgical, and other imaging findings. The gastric pouch, excluded stomach, proximal efferent loop, oversewn jejunal loop, and distal jejunojejunal anastomosis were identified in 96 (96%) of 100 studies and 69 (96%) of 72 patients, 100 (100%) of 100 studies and 72 (100%) of 72 patients, 99 (99%) of 100 studies and 71 (99%) of 72 patients, 88 (88%) of 100 studies and 61 (85%) of 72 patients, and 67 (67%) of 100 studies and 46 (64%) of 72 patients, respectively. The fundus of the excluded stomach was filled with a combination of air, fluid, and contrast material, which mimicked a loculated fluid collection in 15 (15%) of 100 studies and 13 (18%) of 72 patients. Sixty-two abnormalities, detected in 41 patients, included leak (n = 12), loculated fluid collection unrelated to leak (n = 9), markedly distended excluded stomach (n = 6), small-bowel obstruction (n = 6), gastric staple line dehiscence (n = 6), splenic infarction (n = 5), hematoma (n = 5), left hepatic lobe infarction (n = 3), and hernia related to gastric bypass (n = 10, including three internal hernias, three incisional hernias, and four nonincisional ventral hernias). Seventeen patients required a total of 21 CT-guided interventional procedures. Helical CT is useful for identifying normal postoperative anatomy and complications after gastric bypass surgery.

Gastrointestinal complications following infrarenal endovascular aneurysm repair.

Gastrointestinal complications are known to occur after open elective aortic aneurysm repair. This leads to increased morbidity, mortality, length of stay, and hospital costs. The authors hypothesize a change in the character and/or frequency of early postoperative gastrointestinal complications after endovascular aneurysm repair as compared to open abdominal aortic repair. This is a retrospective cohort study in which the medical records of 153 consecutive patients who underwent endovascular infrarenal aneurysm repair from November 1998 to August 2001 were reviewed for gastrointestinal complications. Of these 153 patients, 9 (5.9%) had postoperative gastrointestinal complications. Three patients (1.9%) underwent exploratory laparotomy for small bowel obstruction. One patient had had a right hemicolectomy for cancer 2 years before stent graft placement. This patient needed a partial small bowel resection. One patient had had a right hemicolectomy 4 months before stent graft placement; he had lysis of adhesions with no bowel resection. A third patient underwent operative repair of an incarcerated inguinal hernia. Six patients (3.9%) had paralytic ileus that was treated by nasogastric tube or observation resulting in an extended hospital length of stay. All cases of ileus resolved without any operative intervention. No patients in this series developed any intestinal ischemia, pancreatitis, cholecystitis, or gastrointestinal bleeding. After endovascular aneurysm repair, gastrointestinal complications such as ileus and postoperative small bowel obstruction are seen with a similar frequency as after open aortic repair. This occurs despite the absence of a laparotomy with mesenteric dissection and evisceration. In this series, these complications are associated with longer hospital length of stay but no increased mortality rate. No instances of colonic ischemia, pancreatitis, cholecystitis, or gastrointestinal bleeding were seen in this series.

Routine Nasogastric Tubes Are Not Required Following Cystectomy With Urinary Diversion: A Comparative Analysis of 430 Patients

Postoperative nasogastric tube (NGT) use has been shown to increase postoperative morbidity in patients undergoing nonurological abdominal surgery. We examine the omission of NGTs as a method of decreasing postoperative gastrointestinal complications and hospital stay in patients undergoing cystectomy with urinary diversion. Between January 1983 and December 2001, 430 patients underwent cystectomy with urinary diversion at our institution. We retrospectively compared patients who received postoperative NGTs with those who did not with regard to gastrointestinal recovery time, gastrointestinal complications and hospital stay. After correcting for confounding factors using ANCOVA the time to first bowel sounds, time to first flatus and the duration of hospitalization were shorter in patients not receiving NGTs (p = 0.006, 0.001 and 0.032, respectively). Omitting NGTs did not increase the risk of ileus, bowel obstruction, wound dehiscence, anastomotic leakage or aspiration pneumonia and it did not result in more frequent postoperative NGT placement. The results of the current study suggest that gastric decompression with NGTs following cystectomy with urinary diversion may prolong gastrointestinal recovery, which may be a factor leading to increased duration of hospitalization. We propose that postoperative NGTs should not be used routinely in the management of cystectomy cases.

Predictors of gastrointestinal complications after conventional and beating heart coronary surgery

Gastrointestinal complications after cardiac surgery remain a significant problem despite improvements in pre-operative, operative and post-operative care. The pathophysiology is uncertain, and their prevention remains suboptimal. This prospective, randomised study was designed to define the role of cardiopulmonary bypass (CPB) and cardioplegic arrest in the pathogenesis of gastrointestinal complications following coronary artery surgery. Three hundred patients were prospectively randomised to (1) on-pump conventional coronary artery surgery [150 patients, 114 men, mean age 64 (45-75 years)] with mild hypothermic (32c) CPB and cardioplegic arrest of the heart or (2) off-pump surgery [150 patients, 113 men, mean age 64 (38-66) years] on the beating heart. The association of perioperative factors with gastrointestinal complications was investigated by univariate analysis. Significant variables were then included into a stepwise logistic regression model to ascertain their independent influence on the occurrence of gastrointestinal complications. There were no significant baseline differences between the groups. Eleven patients in the on-pump group and one patient in the off-pump group had post-operative gastrointestinal complications. Univariate analysis showed that CPB inclusive of cardioplegic arrest, left ventricular ejection fraction <50%, emergency surgery, prolonged aortic cross clamp and CPB time, post-operative low cardiac output syndrome, post-operative inotropic requirement, new onset atrial fibrillation (AF), excessive post-operative blood loss and redo thoracotomy <24 hours were predictors of gastrointestinal complications after coronary artery surgery (all p<0.05). However, stepwise multivariate regression analysis identified CPB inclusive of cardioplegic arrest as the only predictor of post-operative gastrointestinal complications (OR7.4; CI 3.4-17.9). Cardiopulmonary bypass, inclusive of cardioplegic arrest, is the main independent predictor of post-operative gastrointestinal complications in patients undergoing coronary revascularisation.

Gastrointestinal Complications after Ruptured Aortic Aneurysm Repair

Gastrointestinal complications after ruptured aortic abdominal aneurysm (AAA) repair are not well defined and are limited to descriptions of ischemic colitis. We sought to delineate risk factors predicting gastrointestinal complications after ruptured AAA repair. Data from 100 consecutive patients after ruptured AAA repair between July 1980 and June 2000 were gathered for multiple preoperative, intraoperative, and postoperative factors. These variables were analyzed relative to postoperative gastrointestinal complications and resulting mortality. Overall mortality was 48 per cent. Gastrointestinal complications were encountered 29 times in 27 patients of 100 total patients (27%). Complications included prolonged adynamic ileus (three), acute pancreatitis (four) and cholecystitis (two), perforated duodenal ulcer (one), bowel obstruction (three), antibiotic-associated colitis (six), ischemic colitis (three), bowel infarction (four), and liver failure (three). Comparison of patients with and without gastrointestinal complications showed no predictive preoperative or intraoperative variables. Gastrointestinal complications are common in ruptured aortic aneurysm repair and carry increased mortality and morbidity. Surgeons must maintain a high level of suspicion to anticipate possible gastrointestinal complications.

Off-pump coronary artery bypass surgery does not reduce gastrointestinal complications.

Gastrointestinal (GI) complications following on-pump coronary artery bypass grafting (CABG) are rare, but carry a high mortality rate. Prolonged cardiopulmonary bypass (CPB) has been associated with a higher incidence of such complications. Little is known about the effect of avoiding CPB on GI complications. Our hypothesis was that off-pump CABG might reduce such complications. A total of 2327 consecutive cases undergoing isolated CABG between April 1997 and May 2001 were identified from four consultants' practice at the two cardiothoracic centres involved in this study. We performed a multivariable logistic regression analysis to identify the risk factors for development of post-operative GI complications. Potential risk factors considered in the logistic model were age, sex, angina, ejection fraction, peripheral vascular disease, renal dysfunction, redo operations, previous GI complications, priority of surgery and the use of CPB. A total of 1210 cases were performed on CPB, compared to 1117 off-pump. The incidence of GI complications was 1.2% (n = 14) in the on-pump group and 1.6% (n = 18) in the off-pump group (P = 0.347). The incidence of in-hospital mortality, in the patients who had a GI complication, was 28.6% (n = 4) and 22.2% (n = 4), respectively (P = 0.681). The results of the logistic regression analysis showed that renal dysfunction, advancing age and previous history of GI surgery are significant risk factors for GI complications after coronary bypass surgery whether CPB is used or not. Our study suggests that off-pump and on-pump techniques are similar in the rates of GI complications. We suggest that a properly designed randomized control trial is needed to verify our findings.

Complications of Methylprednisolone Sodium Succinate Therapy in Dachshunds with Surgically Treated Intervertebral Disc Disease

Abstract Objective: To compare the incidence of clinically evident post‐operative complications, financial cost and length of hospital stay for Dachshunds with acute intervertebral disc disease treated with decompressive surgery with and without the use of methylprednisolone sodium succinate (MPSS). Design: Retrospective clinical study Setting: Veterinary Teaching Hospital Animals: Dachshunds that presented to the Veterinary Hospital of the University of Pennsylvania between January 1994 and December 1999 with acute intervertebral disc disease that were treated with decompressive surgery. Intervention: None Measurements and Main Results: Dogs were divided into 2 groups dependent upon whether they had received MPSS. Medical records were examined for evidence of post‐operative complications. Other parameters recorded included details of drugs administered (principally corticosteroids and gastrointestinal protectant drugs), length and cost of hospital stay and neurological status at 24 hours post‐operatively and at suture removal. Compared to other corticosteroids, dogs receiving MPSS had a significantly higher incidence of clinically evident post‐operative gastrointestinal complications, an increased use of gastrointestinal protectant drugs, and an increased cost for hospital stay (p&lt;0.01). Conclusions: The use of MPSS inDachshunds with acute intervertebral disc disease is associated with an increased post‐operative complication rate and an increased financial cost to the client. The use of MPSS should be carefully evaluated for each patient.

Midline retroperitoneal versus midline transperitoneal approach for abdominal aortic aneurysm repair

Purpose: The purpose of this study was to compare the midline retroperitoneal approach with the midline transperitoneal approach for abdominal aortic aneurysm (AAA) repair with respect to operative details, gastrointestinal complications, and wound complications. Methods: From January 1990 through January 1998, 128 patients underwent elective aortic reconstruction for infrarenal AAA. Of these, 64 patients (the transperitoneal group) underwent conventional transperitoneal midline aortic exposure, whereas the remaining 64 patients (the retroperitoneal group) underwent retroperitoneal midline exposure of the aneurysm. Results: Preclamp time, that is, the time from skin incision to aortic clamping, was significantly shorter in the transperitoneal group than in the retroperitoneal group (P <.001). However, the midline retroperitoneal approach was associated with decreased incidence of ileus (P <.01), earlier resumption of oral intake (P <.01), and decreased wound pain (P <.01), in comparison with the transperitoneal approach. Furthermore, there was no incidence of wound complications such as abdominal bulge or wound pain in any of the patients in the postoperative period or over the long term. Conclusions: The midline retroperitoneal approach for AAA was associated with fewer postoperative gastrointestinal and wound complications than the midline transperitoneal approach. Over the long term, there was no wound complication such as abdominal bulge and wound pain in any of the patients. (J Vasc Surg 2000;32:219-23.)

Acute Gastrointestinal Complications after Open Heart Surgery

Retrospective analysis revealed that 24 of 4401 adult patients (0.5%) developed severe gastrointestinal complications after open heart surgery during a 3-year period from January 1995. There were 4 women (17%) and 20 men (83%). Mean age was 61.7 ± 2.02 years. Gastrointestinal bleeding (33.3%), mesenteric ischemia (20.8%), pancreatitis (20.8%), hepatic dysfunction (16.7%), and cholecystitis (16.7%) were the most common complications. Mortality was 41.7% (10 patients). During the same period, mortality in the patients who did not develop gastrointestinal complications was 1.89% (p &lt; 0.0001). Emergency basis, reoperation, combined operations, peripheral vascular disease, diabetes mellitus, chronic lung disease, and impaired left ventricle function were found to be risk factors for the development of postoperative gastrointestinal complications.

Postoperative gastrointestinal complications after lung volume reduction operations

Background. Lung volume reduction operations have been shown to improve the quality of life and functional status of some patients with end-stage emphysema. Methods. Because of a perceived increase in the occurrence of postoperative gastrointestinal (GI) complications, we reviewed our experience in 287 patients who had lung volume reduction operations to determine the frequency of GI complications and to identify risk factors. Results. Using a broad definition of postoperative GI complications (nausea, vomiting, abdominal distension, gastroesophageal reflux, diarrhea, constipation) there were 137 complications in 67 patients (23%). More severe GI complications (bowel ischemia, GI bleeding, perforation, ulceration, ileus, colitis, cholecystitis, pancreatitis) occurred 49 times in 27 patients (9.4%). Seven of the 27 patients required abdominal operations. Risk factors identified as predictive of severe complications include diabetes ( p = 0.0003), lower preoperative hematocrit ( p = 0.01), steroid use ( p = 0.02), and use of parenteral meperidine analgesic ( p = 0.002). Stepwise logistic regression demonstrated that diabetes was 7.02 times more likely to produce severe complications. Other risk factors included steroids (2.81), number of different pain medications (2.59), hematocrit decrease of 5% (1.96), and hematocrit decrease of 1% (1.14). In the patients with severe GI complications there were six of 27 (22%) hospital deaths compared with five of 260 (2%) in those without GI complications ( p = 0.0001). Conclusions. Severe GI complications in patients with emphysema who had lung volume reduction operations are not uncommon (9.4%) and influence the perioperative mortality rate. Heightened awareness to identified risk factors will allow earlier recognition, prevention, and perhaps decrease morbidity and mortality rates in these high-risk patients.

Gastrointestinal complications following cardiac surgery

This study sought to determine which factors influence the mortality rate in patients developing gastrointestinal complications following cardiac surgery. Between July 1988 and January 1992, 2054 patients underwent cardiac surgical procedures at the Boston University Medical Center. Of these, 29 (1.4%) developed postoperative gastrointestinal complications. The overall mortality rate among these patients was 27% ( 8 29 ). Those who died following such complications had a higher incidence of New York Heart Association (NYHA) class IV and unstable symptoms ( 8 8 , 100% versus 3 21 , 14%; P < 0.0001), and an increased need for preoperative intra-aortic balloon pump support ( 4 8 . 50% versus 1 21 , 5%; P < 0.004). The need for gastrointestinal surgical intervention increased the mortality rate significantly compared with patients managed medically ( 8 18 , 44% versus 0/11, 0%; P < 0.01). Patients with ischemic bowel also had a significantly higher mortality ( 5 5 , 100% versus 3 24 , 12%; P < 0.001). It is concluded that most patients with gastrointestinal complications following cardiac surgery can be treated, and with acceptable mortality rates. The presence of unstable symptoms, preoperative intra-aortic balloon pump support, ischemic bowel and the need for gastrointestinal surgical intervention adversely affect mortality.

Imaging of abdominal complications following cardiac surgery.

Ten thousand seven hundred fifty-six patients underwent cardiac bypass surgery at the Mater Hospital national cardiac unit between September 1979 and April 1993. Of this group, 49 patients were identified who had developed postoperative gastrointestinal complications leading to 16 deaths. Twenty-five patients developed gastrointestinal hemorrhage, eight patients developed gallbladder disease, five patients developed phlegmonous pancreatitis, eight patients developed bowel perforations, and three patients developed intestinal pseudoobstruction. The particular radiological features that lead to diagnosis in each case are discussed and relevant literature is briefly reviewed.

Postoperative Visceral Hypotension the Common Cause for Gastrointestinal Complications after Cardiac Surgery

In order to identify peroperative risk factors and to evaluate different etiological factors in developing postoperative gastrointestinal complications, clinical variables were studied in 3493 patients undergoing adult cardiac surgery. There were 86 gastrointestinal complications, 2.9%, with an overall morality among these of 22.1%: the mortality rate was 3.9% for all patients undergoing cardiac surgery at our institution (p < 0.001). Paralytic ileus, intestinal ischemia, and acute cholecystitis were the most frequently seen complications. Arterial hypertension, smoking and poor preoperative cardiac function, clinical instability, and the need for an emergency operation were distinct clinical risk factors. Cardiopulmonary bypass time was, by itself, not an important factor. Embolic etiology was also ruled out. The incidence of peroperative myocardial infarction, low postoperative cardiac output necessitating massive use of vasopressor substances and/or intraaortic balloon pumping were significantly more often observed in patients who subsequently developed gastrointestinal complications. The common etiological factor in developing gastrointestinal complications of any kind, after cardiac surgery, seems to be postoperative splanchnic hypoperfusion with visceral ischemia. In order to reduce postoperative morbidity and mortality it is essential to identify patients at risk, support preoperative poor cardiac function, and to carefully monitor these patients postoperatively for abdominal complications to reach an early diagnosis.

Creation of a neo-aortoiliac system from lower extremity deep and superficial veins.

This study evaluated the morbidity, mortality, and intermediate term follow-up of patients undergoing replacement of their aortoiliac-femoral systems with lower extremity deep and superficial veins. The most commonly used treatment for aortic prosthetic infection is ectopic bypass and removal of the prosthesis. The overall mortality rate with this approach is approximately 20%, with an amputation rate of 10% to 14%. Other limitations include thrombosis of the ectopic bypass leading to limb loss, reinfection of the ectopic bypass, and aortic stump blowout. Dissatisfaction with this approach has led the authors to develop the following. A neo-aortoiliac system (NAIS) was fashioned from lower extremity deep veins (DV), greater saphenous veins (GSV), or both in patients with infected aortobifemoral prosthesis (n = 17) and other complex aortic problems (n = 3). Removal of infected prosthetic material, harvest of vein, and creation of NAIS was performed as a single-staged procedure. The in-hospital mortality and amputation rates were 10% each. The mean (+/- standard deviation [SD]) operative time was 6.5 +/- 1.8 hours and the blood transfusion requirement was 4 +/- 3 units. Four patients experienced postoperative gastrointestinal complications with peritonitis and sepsis; NAIS vein graft resisted infection and remained intact. The mean follow-up time was 22.5 +/- 16 months. NAISs constructed from GSVs were prone to the development of focal stenoses requiring intervention or diffuse neointimal hyperplasia leading to occlusion. In contrast, all NAISs from larger caliber DVs have remained widely patent. The failure rate of GSV NAISs was 64%, compared to 0% for DV NAISs (p = 0.006). Despite the high failure rate in patients with GSV NAISs, none has required amputation. In patients who had DVs harvested for NAIS reconstruction, limb edema and other signs of venous hypertension have been minimal. NAIS reconstruction from lower extremity veins is a successful option in patients with extensive aortic prosthetic infection and other complex aortic problems.

Post-operative gastrointestinal complications

The drugs and procedures involved in anaesthesia inevitably involve all systems of the body, and the gastrointestinal system is one of the most conspicuously affected. General anaesthesia has been notorious since its inception for causing sickness, and since the problem has not been eliminated it is worth discussion again. In addition, gastrointestinal motility may be affected by stasis, spasm or cramps. All these problems have secondary effects on a gastrointestinal anastomosis, on surgical wounds, on respiration and on general well-being. Consequently, the anaesthetist must be aware of potential gastrointestinal complications, even if some are due to surgery rather than to anaesthesia, and must try to reduce the adverse effects of anaesthesia to a minimum. There is a full review of anaesthesia and the gastrointestinal system by Aitkenhead.1

The ileoanal reservoir

One hundred nine men and 71 women with a mean age of 31 years had construction of 164 S, 2 J, and 14 other ileoanal reservoirs. Postoperative gastrointestinal complications included small bowel obstruction in 11 percent and ileus, hemorrhage, and sepsis in 6 percent, 5 percent, and 11 percent, respectively. There was a 13 percent incidence of miscellaneous postoperative complications. Pouch perianal fistulas developed in 5 percent of patients, and pouch vaginal and other pouch fistulas developed in an additional 4 percent. During long-term follow-up, small bowel obstruction developed in 27 percent of patients, and enterolysis or enterectomy was required in 15 percent of patients. One hundred fourteen patients who were followed for a mean length of 5 years after ileostomy closure (range 16 to 88 months) were evaluated for functional outcome. Function improved with time in 63 percent of patients and remained stable in another 33 percent; only 4 percent had long-term deterioration. Ninety-five percent of patients would again choose an ileoanal reservoir over a permanent ileostomy. This long-term assessment shows that although the ileoanal reservoir is a viable option in the management of mucosal ulcerative colitis, it should not be recommended to every patient.

Factors influencing the development of gastrointestinal complications after neurosurgery: results of multivariate analysis.

A retrospective review of 526 patients who underwent neurosurgery for nontraumatic conditions over a 5-year period revealed 36 (6.8%) patients with endoscopically and or surgically documented postoperative gastrointestinal (GI) complications. Two patients had GI bleeding and perforation, and the remaining patients had bleeding only. Multivariate analysis indicated 5 factors that were of independent significance in predicting the development of postoperative GI complications. These factors included 1) inappropriate secretion of antidiuretic hormone, 2) preoperative coma (Glasgow Coma Score less than 9), 3) the presence of postoperative complications, 4) age greater than or equal to 60 years, and 5) pyogenic infection of the central nervous system. Further analysis of the 36 patients with GI complications revealed that they could be divided into three groups with different clinical courses. In Group I (n = 10), all patients died as a result of their neurological conditions; GI complications were just preterminal events and did not require treatment. In Groups II (n = 11) and III (n = 15), GI complications were symptomatic and life-threatening events, respectively. Eleven patients from Group III died as a direct result of the GI complications. Separate multivariate analyses based on the patients in Groups II and III revealed that preoperative coma was the only significant factor that predicted the occurrence of life-threatening complications. Patients who are at high risk of developing postoperative GI complications can thus be identified, and intensive prophylaxis may be instituted.

Factors Influencing the Development of Gastrointestinal Complications after Neurosurgery: Results of Multivariate Analysis

A retrospective review of 526 patients who underwent neurosurgery for nontraumatic conditions over a 5-year period revealed 36 (6.8%) patients with endoscopically and or surgically documented postoperative gastrointestinal (GI) complications. Two patients had GI bleeding and perforation, and the remaining patients had bleeding only. Multivariate analysis indicated 5 factors that were of independent significance in predicting the development of postoperative GI complications. These factors included 1) inappropriate secretion of antidiuretic hormone, 2) preoperative coma (Glasgow Coma Score <9), 3) the presence of postoperative complications, 4) age ≥60 years, and 5) pyogenic infection of the central nervous system. Further analysis of the 36 patients with GI complications revealed that they could be divided into three groups with different clinical courses. In Group I (n = 10), all patients died as a result of their neurological conditions; GI complications were just preterminal events and did not require treatment. In Groups II (n = 11) and III (n = 15), GI complications were symptomatic and life-threatening events, respectively. Eleven patients from Group III died as a direct result of the GI complications. Separate multivariate analyses based on the patients in Groups II and III revealed that preoperative coma was the only significant factor that predicted the occurrence of life-threatening complications. Patients who are at high risk of developing postoperative GI complications can thus be identified, and intensive prophylaxis may be instituted. (Neurosurgery 25:378-382, 1989)

Combined gastrointestinal and abdominal aortic aneurysm operations.

Experience with gastrointestinal surgical conditions in 154 consecutive aneurysm operations at St Vincent's Hospital, Sydney, over 5 years (1982-86) is reported. Seventeen patients (11%) had coincidental gallstones, and six patients had other gastrointestinal conditions. Postoperative gastrointestinal complications occurred in eight patients. The overall in-hospital mortality rate was 7.8%. Four of the 12 deaths were associated with gastrointestinal problems, but these complications first developed after aneurysm surgery in three patients and could not have been avoided by a concurrent operation. The management of gastrointestinal pathology in association with the treatment of abdominal aneurysm is reviewed. The coincidence of these disorders is not sufficiently frequent to allow valid comment on the probability of successful outcomes, but the risks posed by surgically untreated gastrointestinal conditions are low, so that secondary gastrointestinal procedures should be avoided in most aneurysm operations.