Relaparotomy Rate Research Articles

Surgical complications and technical failure of simultaneous pancreas-kidney transplantation: A 22-year experience from a single center.

Simultaneous pancreas-kidney transplantation (SPKT) is the best treatment for selected individuals with type 1 diabetes mellitus and end-stage renal disease. Despite advances in surgical techniques, donor and recipient selection, and immunosuppressive therapies, SPKT remains a complex procedure with associated surgical complications and adverse consequences. We conducted a retrospective study that included 263 SPKT procedures performed between May 2000, and December 2022. A total of 65 patients (25%) required at least one relaparotomy, resulting in an all-cause relaparotomy rate of 2.04 events per 100 in-hospital days. Lower donor body mass index was identified as an independent factor associated with reoperation (OR.815; 95% CI: .725-.917, p=.001). Technical failure (TF) occurred in 9.9% of cases, primarily attributed to pancreas graft thrombosis, intra-abdominal infections, bleeding, and anastomotic leaks. Independent predictors of TF at 90 days included donor age above 36 years (HR 2.513; 95% CI 1.162-5.434), previous peritoneal dialysis (HR 2.503; 95% CI 1.149-5.451), and specific pancreas graft reinterventions. The findings highlight the importance of carefully considering donor and recipient factors in SPKT. The incidence of TF in our study population aligns with the recent series. Continuous efforts should focus on identifying and mitigating potential risk factors to enhance SPKT outcomes, thereby reducing post-transplant complications.

Outcomes of cesarean delivery in placenta accreta: conservative delivery vs. cesarean hysterectomy.

To compare delivery outcomes of pregnancies diagnosed with placenta-accreta-syndrome (PAS) who underwent conservative treatment to patients who underwent cesarean hysterectomy. A retrospective study of all women diagnosed with PAS treated in one tertiary medical center between 03/2011 and 11/2020 was performed. Comparison was madebetween conservative management during cesarean delivery and cesarean hysterectomy. Conservative management included leaving uterus in situ with/without placenta and with/without myometrial resection. A total of 249 pregnancies (0.25 % of all deliveries) were diagnosed with PAS, 208 underwent conservative cesarean delivery and 41 had cesarean hysterectomy, 31 ofthem were unplanned (75.6 %). The median number of previous cesarean deliveries was significantly higher in thecesarean hysterectomy group. There was no difference in the duration from the last cesarean delivery, the presence of placenta previa, pre-operative hemoglobin or platelets levels between the pregnancies with conservative management and the cesarean hysterectomy. Significantly more pregnancies with sonographic suspicion of placenta percreta and bladder invasion had cesarean hysterectomy. Cesarean hysterectomy was significantly associated with earlier delivery, with bleeding and required significantly more blood products. There was no statistically significant difference in the rate of relaparotomy following cesarean delivery or the rate of infections. Multivariable-regression-analysis revealed a significant odds ratio of 3.38 of blood loss of >3,000 mL following cesarean hysterectomy. Conservative management in delivery of PAS pregnancies is associated with less bleeding complications during surgery compared to cesarean hysterectomy.

Endovascular Management of Postoperative Hemorrhage after Pancreaticoduodenectomy

Abstract Objective The aim of the study was to assess the safety and efficacy of endovascular management for postpancreaticoduodenectomy hemorrhage. Materials and Methods A retrospective analysis of patients who underwent endovascular management for hemorrhage after pancreatic surgery between January 2015 to December 2020 was performed. Patient demographics, clinical presentation, angiography findings, endovascular procedure, technical success, clinical success, and complications were assessed. Results Seventeen patients, comprising 14 (82.4%) males and 3 (17.6%) females, aged 37 to 68 years underwent endovascular management for postpancreatectomy hemorrhage. Patients presented with hemorrhage on their postoperative days 4 to 22 (mean: 9.8th day; median: 8th day); the presentation was with extraluminal hemorrhage in 11 patients (64.7%) and intraluminal hemorrhage in 6 patients (35.2%). The gastroduodenal artery (GDA) stump (10 patients, 58.8%) was the most commonly involved artery. The majority of cases were treated using coils as embolizing agents (13/17 patients, 76.5%). The technical and clinical success rates were 100%. The complication rate was 5.9% (1/17) and the mortality rate was 11.8% (2/17). The relaparotomy rate was 23.5% (4/17); however, none of the relaparotomy was for hemorrhage. Conclusion Endovascular treatment provides a minimally invasive, safe, and effective method for the management of pancreaticoduodenectomy hemorrhage.

Does dialysis modality or duration influence outcomes in simultaneous pancreas-kidney transplant recipients? Single center experience and review of the literature.

The influence of dialysis modality and duration on outcomes following simultaneous pancreas-kidney transplantation (SPKT) remains uncertain. We performed a single-center retrospective review in 255 SPKT recipients according to dialysis modality (55 preemptive/no dialysis-ND, 70 peritoneal dialysis-PD, 130 hemodialysis-HD) and duration (55 none, 137<2 years, 41 2-4 years, 22>4 years). Mean follow-up was 9.4 years (median 9.2 years). Early (3-month) relaparotomy rate (20% ND vs. 36% PD/HD, p=.03) was lower in ND patients. There were no differences in early graft loss, patient survival, overall or death-censored kidney or pancreas graft survival rates (GSR) at 1 or 10 years follow-up. When analyzing dialysis duration, there were no differences in rates of pancreas thrombosis or early pancreas graft loss. Kidney delayed graft function (DGF) was lower in the ND/short dialysis groups combined (1.0%), compared to the intermediate/long dialysis groups combined (9.5%, p=.003). Early relaparotomy rates were higher with longer duration of dialysis (p=.045 between ND and >4 years of dialysis). Patient survival in the long dialysis group was 50% compared to 69.5% in the other three groups combined (p=.09). However, both overall and death-censored kidney and pancreas GSR were comparable. Preemptively transplanted patients had a lower incidence of kidney DGF and relaparotomy whereas patient survival was slightly lower with longer dialysis vintage prior to SPKT. Dialysis modality and duration did not influence either overall or death-censored pancreas or kidney GSR in patients with short waiting times, low KDPI donor organs, and dialysis duration up to 4 years.

Influence of donor and recipient sex on outcomes following simultaneous pancreas-kidney transplantation in the new millennium: Single-center experience and review of the literature.

The influence of sex on outcomes following simultaneous pancreas-kidney transplantation (SPKT) in the modern era is uncertain. We retrospectively studied 255 patients undergoing SPKT from 11/2001 to 8/2020. Cases were stratified according to donor (D) sex, recipient (R) sex, 4 D/R sex categories, and D/R sex-matched versus mismatched. D-male was associated with slightly higher patient (p=.08) and kidney (p=.002) but not pancreas (p=.23) graft survival rates (GSR) compared to D-female. There were no differences in recipient outcomes other than slightly higher pancreas thrombosis (8% R-female vs. 4.2% R-male, p=.28) and early relaparotomy rates in female recipients (38% R-female vs. 29% R-male, p=.14). When analyzing the 4 D/R sex categories, the two D-male groups had higher kidney GSRs compared to the two D-female groups (p=.01) whereas early relaparotomy and pancreas thrombosis rates were numerically higher in the D-female/R-female group compared to the other three groups. Finally, there were no significant differences in outcomes between sex-matched and sex-mismatched groups although overall survival outcomes were lower with female donors irrespective of recipient sex. The influence of D/R sex following SPKT is subject to multiple confounding issues but survival rates appear to be higher in D-male/R-male and lower in D-female/R-male categories.

P-139 THE EFFECTS OF THE INCISION TYPE ON INCISIONAL HERNIA RESULTS OF LIVING DONOR LIVER TRANSPLANT; SINGLE CENTER EXPERIENCE

Abstract Aim We aimed to assess the effects of the chosen incision type on postoperative hernia rates of liver transplantation in this paper. Material-Methods During the period between the 5th September 2018 and 31st March 2022, total 210 liver transplantations were performed in the Liver Transplantation Center of Koç University Hospital. 96 pediatric and 10 deceased donor transplantations were excluded. Living donor liver transplantation (LDLT) cases in only adults were included in the trial. Total 104 patients were included. Patients divided into two groups in the manner of chosen laparotomy incision during the operation. Reverse T incisions (Group A, n=68) and Makuuchi incisions (Group B, n=36) were performed in our center during the trial period. Minimum 3 month-follow up period was performed. Results Demographic data (Table 1) was similar in both groups. Operation and warm ischemia durations were longer in Group B (Table 2). Postoperative immunosuppressive regimens were same protocols contains tacrolimus and prednisolone. Surgical site infection rates, relaparotomy rates, postoperative blood transfusion rates, biliar, vascular and pulmonary complication rates were also similar in both groups (Table 3). While 11 patients diagnosed with incisional hernia in Group A (%16,2), 2 patients diagnosed with incisional hernia in Group B (%5,6, p=0,212). Conclusion Although Makuuchi incision seems to be safer in manner of hernia rates, this couldn't be proved by statistically significance as a result of this retrospective analysis of a single center. The necessity of prospective designed trials is obvious in order to obtain more reliable results.

Improved surgical outcomes following simultaneous pancreas-kidney transplantation in the contemporary era.

Complications leading to early technical failure have been the Achilles' heel of simultaneous pancreas-kidney transplantation (SPKT). The study purpose was to analyze longitudinally our experience with early surgical complications following SPKT with an emphasis on changes in practice that improved outcomes in the most recent era. Single center retrospective review of all SPKTs from 11/1/01 to 8/12/20 with enteric drainage. Early relaparotomy was defined as occurring within 3 months of SPKT. Patients were stratified into two sequential eras: Era 1 (E1): 11/1/01-5/30/13; Era 2 (E2) 6/1/13-8/12/20 based on changes in practice that occurred pursuant to donor age and pancreas cold ischemia time (CIT). 255 consecutive SPKTs were analyzed (E1, n=165; E2, n=90). E1 patients received organs from older donors (mean E1 27.3vs. E2 23.1 years) with longer pancreas cold CITs) (mean E1 16.1vs. E2 13.3h, both p<.05). E1 patients had a higher early relaparotomy rate (E1 43.0%vs. E2 14.4%) and were more likely to require allograft pancreatectomy (E1 9.1%vs. E2 2.2%, both p<.05). E2 patients underwent systemic venous drainage more frequently (E1 8%vs. E2 29%) but pancreas venous drainage did not influence either relaparotomy or allograft pancreatectomy rates. The most common indications for early relaparotomy in E1 were allograft thrombosis (11.5%) and peri-pancreatic phlegmon/abscess (8.5%) whereas in E2 were thrombosis, pancreatitis/infection, and bowel obstruction (each 3%). Maximizing donor quality (younger donors) and minimizing pancreas CIT are paramount for reducing early surgical complications following SPKT.

Management of spontaneous portosystemic shunts at the time of liver transplantation: treatment or observation? Results of a systematic review.

Optimal treatment of spontaneous portosystemic shunts (SPSS) during liver transplantation (LT) remains debated. We systematically reviewed the literature on definitions, treatment and outcomes of patients presenting SPSS undergoing LT. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we used PubMed to retrieve all studies dealing with SPSS and LT between January 1987 and January 2020. The primary endpoints were definitions and outcomes according to the management of SPSS (treatment vs observation). Thirteen studies detailing the management of 962 SPSS were retrieved. Hemodynamically significant SPSS were defined as those having diameter ≥ 10mm in 41% (n = 395) of patients. SPSS were splenorenal (42%), cavo-gastric (15.2%), umbilical (7.4%), mesenterico-caval (n = 31; 3.2%), mesenterico-renal (0.1%) and unreported (31.9%), respectively. At the time of LT 372 shunts (38.7%) were treated while 590 were observed (61.3%). During a follow-up time ranging from 4months to 5years, the reported overall survival (OS) at 1year was not significantly different except for one study. Portal vein anastomosis complications (i.e. reduced flow, stenosis or thrombosis) were similarly reported in observed [n = 26 (4%)] and ligated SPSS [n = 10 (2%)] (p = 0.22) but the rate of relaparotomy was significantly higher in observed SPPS (16 vs 2; p = 0.01) to rescue post LT portal vein thrombosis (n = 6) and reduced portal flow and graft dysfunction (n = 10). There was a heterogeneous management of SPSS during LT in the literature. Ligation of SPPS did not reduce vascular complications neither improved survival. A randomized prospective study might contribute to identify best management of SPSS at time of LT.

Solid pancreas transplant outcomes with increased donor and recipient ages compared with reference ages: a systematic review.

Increased recipient and donor age are associated with worse solid organ pancreas transplant outcomes. However, donor and recipient age criteria vary between jurisdictions. We systematically reviewed studies reporting the association between transplanting older recipients and donors beyond current Transplantation Society of Australia and New Zealand (TSANZ) limits with solid pancreas transplant outcomes. To review current outcomes of solid pancreas transplantation in recipients and donors over the TSANZ reference ages. Studies comparing transplant outcomes between a reference-age and an older-age donor (>45 years) or recipient (≥50 years) cohort for solid pancreas transplantation were included. Primary outcomes were pancreas/kidney graft and patient survival at 1 and 5 years. Secondary outcomes were post-transplant complications (graft thrombosis, acute rejection and relaparotomy rates). Eleven studies were included (two studies assessing solid pancreas outcomes between older vs reference-aged donors and nine studies assessing outcomes between older vs reference-aged recipients). Seven of 11 studies were judged to be at high risk of bias. Primary and secondary outcomes were not significantly different between recipient age groups in nine studies. A sensitivity analysis of older versus reference-aged studies excluding studies at high risk of bias also showed non-inferior primary and secondary outcomes at 1year. Two studies comparing outcomes by donor age showed worse graft survival but non-inferior patient survival with older donors. Increased donor or recipient age alone should not absolutely contraindicate solid pancreas transplantation, especially if other risk predictors are minimised.

Relaparotomy post-cesarean delivery: characteristics and risk factors.

Relaparotomy following cesarean delivery (CD) is performed at a rate of 0.2-1% of CD. The objective of the present study was to identify risk factors for relaparotomy following CD, and to examine whether there is a difference in the risk of relaparotomy between CD performed during different hours of the day. A retrospective study on all CD over 10years compared pregnancies that underwent laparotomy within 1week following CD to those that did not. Sixty-four patients underwent relaparotomy out of 24,239 CDs (0.26%). In univariate analysis, relaparotomy was significantly associated with pregnancies following assisted-reproductive-technologies odds ratio (OR) 95% confidence interval (CI) 3.15 (1.90-5.22), hypertensive disorders of pregnancy OR 3.05 (1.62-5.72), twin pregnancies OR 95% CI 3.78 (2.21-6.48), preterm deliveries OR 95% CI 2.44 (1.46-4.10), placenta previa OR 95% CI 6.41(2.55-16.09) and urgent CD 1.74 (1.06-2.86), especially during the second-stage of labor OR 95% CI 2.73 (1.34-5.54). The time of day of CD did not influence the rate of relaparotomy. In a multivariable-regression analysis, the adjusted odds ratio for relaparotomy was 10.24 in CD due to placenta previa, and 5.28 in CD performed at the second-stage of delivery. At relaparotomy, active bleeding was found in 50 patients (78.1%), nearly half received packed cells, 12.5% developed consumptive coagulopathy, and 17.2% needed hospitalization in the intensive care unit. 6.3% underwent a second relaparotomy, mainly due to bleeding. Placenta previa, and urgent CDs mainly those performed at the second stage of labor are risk factors for relaparotomy after CD.

Is open abdominal management useful in nontrauma emergency surgery for older adults? A single-center retrospective study.

Open abdominal management (OAM) is being adopted increasingly frequently in nontrauma patients. This study assessed the effectiveness of OAM in nontrauma older adults. We retrospectively reviewed all adults who underwent nontrauma emergency laparotomy requiring postoperative intensive care unit (ICU) management between September 2012 and August 2017 at our hospital. Patients ≥ 80years old, who underwent OAM, were compared with those < 80years old. The primary outcome was the 90-day mortality. Secondary outcomes were the 30-day mortality, unplanned relaparotomy, and the ICU length of stay (LOS). The OAM group comprised 58 patients, including 27 who were ≥ 80years old. The patients ≥ 80years old in the OAM group had a significantly higher 90-day mortality rate (33% vs. 10%; p = 0.027) than those < 80years old. There were no significant differences in the 30-day mortality rate, patients' unplanned relaparotomy rate, or ICU LOS between the patients ≥ 80years old and those < 80 in the OAM group. Older adults who underwent OAM had a significantly higher mortality rate than younger patients. However, the OAM strategy for older nontrauma patients may still be useful and reasonable considering the severe condition of these patients.

Management of Postpancreatectomy Hemorrhage Following Pancreaticoduodenectomy at a Tertiary Care Center in Nepal

Introduction Postpancreatectomy hemorrhage (PPH) is an important complication which significantly increases morbidity and mortality following pancreaticoduodenectomy (PD). This study aims to find the incidence, classification, management, and mortality associated with PPH following PD. This study also describes the changes in management and outcomes between the period of 2004-2014 and 2015-2019 in our institute as in the later time period there was use of CT angiography and interventional radiology (IR) to identify and control the bleeding site.&#x0D; MethodsThis is a retrospective study in which medical records of patients having PPH following PD between 2004-2019 were analyzed. The grading and classification were done according to the International Study Group of Pancreatic Surgery (ISGPS). Management and outcomes were analyzed using standard descriptive statistics.&#x0D; ResultsA total of 43 patients developed PPH out of 336 PDs. Out of 43 patients, 4 (9.3%) had Grade A, 16 (37.2%) had Grade B and 23 (53.5%) had Grade C PPH. Fifteen (35%) patients were managed conservatively, seven (16.2%) with IR procedure and 21 (48.8%) were reexplored. There were 16 (37.2%) mortalities, out of different factors- intraoperative blood loss &gt;500 ml showed the predictability for mortality (p= 0.01). On comparing two time periods it was seen that the PPH rate was almost similar but the mortality decreased from 58.8% to 23.07%.&#x0D; ConclusionPPH following PD is associated with high mortality. Increased use of IR procedure and CT angiography can decrease the relaparotomy rates and eventually decrease mortality.

Management of Postpancreatectomy Hemorrhage Following Pancreaticoduodenectomy at a Tertiary Care Center in Nepal

Introduction: Postpancreatectomy hemorrhage (PPH) is an important complication which significantly increases morbidity and mortality following pancreaticoduodenectomy (PD). This study aims to find the incidence, classification, management, and mortality associated with PPH following PD. This study also describes the changes in management and outcomes between the period of 2004-2014 and 2015-2019 in our institute as in the later time period there was use of CT angiography and interventional radiology (IR) to identify and control the bleeding site. Methods: This is a retrospective study in which medical records of patients having PPH following PD between 2004-2019 were analyzed. The grading and classification were done according to the International Study Group of Pancreatic Surgery (ISGPS). Management and outcomes were analyzed using standard descriptive statistics. Results: A total of 43 patients developed PPH out of 336 PDs. Out of 43 patients, 4 (9.3%) had Grade A, 16 (37.2%) had Grade B and 23 (53.5%) had Grade C PPH. Fifteen (35%) patients were managed conservatively, seven (16.2%) with IR procedure and 21 (48.8%) were reexplored. There were 16 (37.2%) mortalities, out of different factors- intraoperative blood loss &gt;500 ml showed the predictability for mortality (p= 0.01). On comparing two time periods it was seen that the PPH rate was almost similar but the mortality decreased from 58.8% to 23.07%. Conclusion: PPH following PD is associated with high mortality. Increased use of IR procedure and CT angiography can decrease the relaparotomy rates and eventually decrease mortality.

Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience

The impact of high-volume care in total pancreatectomy (TP) is barely explored since annual numbers are mostly low. This study evaluated surgical outcomes after TP over time in a high-volume center. All adult patients (age ≥ 18years) who underwent an elective single-stage TP at Karolinska University Hospital were retrospectively analysed (2008-2017). High volume was defined as > 20 TPs/year. Overall, 145 patients after TP were included, including 86 (59.3%) extended resections. Major morbidity was 34.5% (50/145) and 90-day mortality 5.5% (8/145). The relative use of TP within all pancreatectomies increased from 5.4% (63/1175) in 2008-2015 to 17.3% (82/473) in 2016-2017 (p < 0.001). Over time, TP was more often performed to achieve radicality (n = 11, 17.5% to n = 31, 37.8%; p = 0.007). In multivariable logistic regression analysis, an annual TP-volume of > 20 was associated with reduced major morbidity (odds ratio [OR] = 0.225, 95% confidence interval [CI], 0.097-0.521; p < 0.001). In the high-volume years (2016-2017), major morbidity (n = 31, 49.2% to n = 19, 23.2%; p = 0.001) and relaparotomy rate (n = 13, 20.6% to n = 5, 6.1%; p = 0.009) improved. Improvements occurred mainly after extended TP, including lower major morbidity (n = 22, 57.9% to n = 12, 25.0%; p = 0.002) and in-hospital mortality (n = 3, 7.9% to n = 0, 0%; p = 0.082). In a single, high-volume center study, an increase in surgical volume of TP was associated with improved perioperative outcomes, especially for extended resections.

Patient's characteristics, management practices and outcome of re-laparotomies in a tertiary hospital in Tanzania

BackgroundRelaparotomy is an important indicator of the safety and quality of laparotomy in any surgical setting. Despite this, its measure in many low- and middle-income countries is scarce, Tanzania included. Understanding its existence will help curb it and mitigate its adverse outcomes by systematic improvement strategies. This study, therefore, aimed to examine characteristics of patients undergoing on-demand relaparotomy and their management outcomes at a tertiary level hospital in Tanzania. MethodsA cross-sectional descriptive study was carried out in the department of surgery of Muhimbili National Hospital for one year in 2017–2018. All patients (of all ages and sex) who required an on-demand relaparotomy within 60 days of their index laparotomy were identified for inclusion into the study. Data were collected regarding patient's demography, clinical characteristics, index surgical procedure, indication for relaparotomy, number of re-laparotomies, complications during re-laparotomy, ICU admission, and mortality. Data were entered into SPSS version 23 for analysis where continuous variables were summarized as means with standard deviations and categorical variables summarized as the frequency with proportions. Ethical approval for the audit was obtained from the Muhimbili University of Health IRB. ResultsA total of 101 patients had undergone relaparotomy, with a relaparotomy rate among those primarily operated at our hospital of 7.6%. Their mean age was 37 years with equal sex distribution. The leading primary procedure had involved bowel resection and anastomosis (47.5%) with anastomotic leak being the leading reason for relaparotomy (37.6%) followed by intra-abdominal collection (29.7%), bowel fistula (19.8%) and wound dehiscence (18.8%). Electrolyte imbalance was the leading complication among the patients (22.9%) followed by anemia (21.5%), wound infection (18.9%) and Septicemia (11%). The overall mortality of rate was 39.6%. ConclusionOn-demand relaparotomy carries a high mortality and morbidity at Muhimbili National Hospital in Tanzania. Addressing predictors and improving post-operative services are urgently needed.

Emergency endovascular treatments for delayed hemorrhage after pancreaticobiliary surgery: indications, outcomes, and follow-up of a retrospective cohort.

To evaluate the outcomes of emergency endovascular treatments for delayed bleeding after pancreaticobiliary surgery. We retrospectively evaluated 21 patients (M:F = 13:8, median age = 64years) undergoing 23 endovascular treatments, performed from 2010 to 2017 in a single center. Data collected were patient characteristics; surgery; pathology; incidence of postoperative pancreatic fistulas (POPF); bleeding signs on CT and angiography; damaged artery; endovascular tools used; technical and clinical success; intervals between surgery, endovascular treatment, and discharge; survival rates. Sixteen patients had pancreatoduodenectomy, three hepaticojejunostomy, two distal pancreatectomy. Indications for surgery were mainly biliary (33%), pancreatic (19%), or duodenal (10%) malignancies. Seventeen patients had "grade C" POPF, three suffered a biliary leak, one had no POPF. Active bleeding was present in 17/23 CTs and in 22/23 angiographies, mostly from hepatic (43%), gastroduodenal (22%), and splenic (13%) arteries. The endovascular treatments were performed with coils (26%), glue (22%), stent-graft (22%), and their combinations (30%). Sixteen patients had a single endovascular treatment, one underwent a second embolization, three had subsequent surgery, one had repeat embolization followed by surgery. Relaparotomy rate was 19%. Median hospital stay was 37days (range 12-75); median intervals among pancreaticobiliary surgery, endovascular treatment, and discharge were 21 (2-36) and 12 (8-47) days, respectively. We observed 4/21 intrahospital deaths (median: 31days from endovascular treatment, 4-53); 1-year survival rate of discharged patients was 71%. Endovascular treatment using embolization and/or stent-graft placement is a useful first-line intervention to halt postoperative hemorrhage after pancreaticobiliary surgery and decreases the need for urgent relaparotomy.

Risk factors for relaparotomy after cesarean section due to hemorrhage: a tertiary center experience

Aim: This study aimed to examine the risk factors for relaparotomy after cesarean section (RLACS) due to bleeding.Material and methods: In this retrospective descriptive case-control study, women who underwent RLACS only for bleeding between 2008 and 2019 at a single tertiary center were examined (the center oversees approximately 25,000 deliveries per year). Maternal characteristics, postoperative findings, and surgical features were compared with a control group that included non-complicated cesarean sections (CS). Multivariable logistic regression analysis was used to identify the risk factors for relaparotomy.Results: Relaparotomy complicated 0.07% (n = 40) of CS during the study period (n = 58,095). When compared with the control group, age, parity, estimated blood loss (EBL), postoperative pulse, blood replacement, and length of hospital stay were statistically higher in patients undergoing relaparotomy, whereas their postoperative systolic and diastolic blood pressure were found to be low. A history of pelvic surgery, the need for intensive care, and complications were more frequent in patients undergoing relaparotomy. When CSs were grouped according to 8-h periods of the day, it emerged that relaparotomies were mostly performed on the patients who underwent CS after working hours. Time interval during the day of the CS [OR: 2.59 (1.10–6.12)] and high postoperative pulse rate [OR: 1.58 (1.28–1.96)] were found to be independent risk indicators for RLACS (AUC: 0.97).Conclusions: Monitoring vital signs in the postoperative period and increasing the number of physicians and nurses during off-hours in hospitals working with on-call duty procedures as determined by the Ministry of Health will reduce the incidence rate of relaparotomy, maternal morbidity, and mortality due to hemorrhage.

Surgical management of the grade C pancreatic fistula after pancreatoduodenectomy

BackgroundSurgical management of severe pancreatic fistula after pancreatoduodenectomy remains challenging, and carries high mortality. The aim of this retrospective study was to compare different surgical techniques used at relaparotomy for pancreatic fistula after pancreatoduodenectomy, and to identify factors predictive of failure to rescue. MethodsA total of 43 patients after pancreatoduodenectomy developed a pancreatic fistula requiring relaparotomy. The perioperative data and outcomes were reviewed retrospectively. ResultsCompletion pancreatectomy, simple drainage of the pancreatic anastomosis and external wirsungostomy were performed in 17, 16, and 10 cases, respectively. The mortality rate for completion pancreatectomy was 47.1%, compared with 56.3% for simple drainage (p = 0.598) and 50.0% for external wirsungostomy (p = 0.883). Simple drainage was associated with a higher rate of further relaparotomies (56.3%) in comparison with completion pancreatectomy (23.5%, p = 0.055) and external wirsungostomy (0%, p = 0.003). A rescue resection of the pancreatic remnant after failed simple drainage resulted invariably in death. On multivariate analysis, the factors predictive of mortality after relaparotomy for pancreatic fistula were organ failure on the day of reoperation (p = 0.001) and need of further surgical reintervention (p = 0.007). ConclusionTimely reintervention and appropriate surgical technique are essential for reducing mortality after reoperation for pancreatic fistula after pancreatoduodenectomy.

A comparative analysis of stapler versus harmonic scalpel in major liver resections

Background: Many techniques have been used for liver parenchymal transection. It remains unknown which technique is superior with regards to perioperative outcomes. Vascular staplers have been used to perform liver parenchymal transection; however, evidence of their performance is still lacking. Methods: This is a single center, retrospective, comparative analysis of surgical outcomes of utilizing the stapler technique versus the harmonic scalpel for parenchymal transection during major hepatectomy. Results: Between 2011 and 2016, 176 patients with an otherwise healthy liver underwent right hepatectomy. A vascular stapler was used for parenchymal transection in 82 patients and the harmonic scalpel in 94 patients (control group). Morbidity, relaparotomy rate, and mortality were similar between groups. Median parenchymal transection time was shorter for patients undergoing stapled hepatectomy (7 vs 39 minutes, p<0.001). Median total operative time was also shorter (205 vs 255 minutes, p<0.001) Conclusion: Stapled parenchymal transection during major hepatectomy is feasible and safe. Transection and total operative times are significantly shorter when the stapler technique is employed. Morbidity and mortality rate are comparable between the two group. The stapler technique should be considered a standard method for liver parenchymal transection.

A Comparative Analysis Of Stapler Versus Harmonic Scalpel In Major Liver Resections

Background: Many techniques have been used for liver parenchymal transection. It remains unknown which technique is superior with regards to perioperative outcomes. Vascular staplers have been used to perform liver parenchymal transection; however, evidence of their performance is still lacking. Methods: This is a single center, retrospective, comparative analysis of surgical outcomes of utilizing the stapler technique versus the harmonic scalpel for parenchymal transection during major hepatectomy. Results: Between 2011 and 2016, 176 patients with an otherwise healthy liver underwent right hepatectomy. A vascular stapler was used for parenchymal transection in 82 patients and the harmonic scalpel in 94 patients (control group). Morbidity, relaparotomy rate, and mortality were similar between groups. Median parenchymal transection time was shorter for patients undergoing stapled hepatectomy (7 vs 39 minutes, p<0.001). Median total operative time was also shorter (205 vs 255 minutes, p<0.001). Conclusion: Stapled parenchymal transection during major hepatectomy is feasible and safe. Transection and total operative times are significantly shorter when the stapler technique is employed. Morbidity and mortality rate are comparable between the two group. The stapler technique should be considered a standard method for liver parenchymal transection.