Treatment Of Common Complications Research Articles

The guideline for prevention and treatment of common complications after pancreatic surgery (2022)

In order to further standardize the prevention and treatment of postoperative complications of pancreatic surgery, the editorial board of the Chinese Journal of Surgery organized relevant experts to formulate this guideline under the promotion of the Study Group of Pancreatic Surgery in China Society of Surgery of Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association. According to the grading of recommendations assessment, development, and evaluation system, this guide discusses the hot issues on postoperative complications such as pancreatic fistula, biliary fistula, chylous fistula, post-pancreatectomy hemorrhage, abdominal infection, delayed gastric emptying, etc., quantitatively evaluates the level of evidence in clinical studies, and forms recommendations after repeatedly consulting. It is hoped to provide reference for pancreatic surgeons in the prevention and treatment of postoperative complications.

Antecolic versus retrocolic reconstruction after partial pancreaticoduodenectomy.

Pancreatic cancer remains one of the five leading causes of cancer deaths in industrialised nations. For adenocarcinomas in the head of the gland and premalignant lesions, partial pancreaticoduodenectomy represents the standard treatment for resectable tumours. The gastro- or duodenojejunostomy after partial pancreaticoduodenectomy can be reestablished via either an antecolic or retrocolic route. The debate about the more favourable technique for bowel reconstruction is ongoing. To compare the effectiveness and safety of antecolic and retrocolic gastro- or duodenojejunostomy after partial pancreaticoduodenectomy. In this updated version, we conducted a systematic literature search up to 6 July 2021 to identify all randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library 2021, Issue 6, MEDLINE (1946 to 6 July 2021), and Embase (1974 to 6 July 2021). We applied no language restrictions. We handsearched reference lists of identified trials to identify further relevant trials, and searched the trial registries clinicaltrials.govand World Health Organization International Clinical Trials Registry Platform for ongoing trials. We considered all RCTs comparing antecolic with retrocolic reconstruction of bowel continuity after partial pancreaticoduodenectomy for any given indication to be eligible. Two review authors independently screened the identified references and extracted data from the included trials. The same two review authors independently assessed risk of bias of included trials, according to standard Cochrane methodology. We used a random-effects model to pool the results of the individual trials in a meta-analysis. We used odds ratios (OR) to compare binary outcomes and mean differences (MD) for continuous outcomes. Of a total of 287 citations identified by the systematic literature search, we included eight randomised controlled trials (reported in 11 publications), with a total of 818 participants. There was high risk of bias in all of the trials in regard to blinding of participants and/or outcome assessors and unclear risk for selective reporting in six of the trials. There was little or no difference in the frequency of delayed gastric emptying (OR 0.67; 95% confidence interval (CI) 0.41 to 1.09; eight trials, 818 participants, low-certainty evidence) with relevant heterogeneity between trials (I2=40%). There was little or no difference in postoperative mortality (risk difference (RD) -0.00; 95% CI -0.02 to 0.01; eight trials, 818 participants, high-certainty evidence); postoperative pancreatic fistula (OR 1.01; 95% CI 0.73 to 1.40; eight trials, 818 participants, low-certainty evidence); postoperative haemorrhage (OR 0.87; 95% CI 0.47 to 1.59; six trials, 742 participants, low-certainty evidence); intra-abdominal abscess (OR 1.11; 95% CI 0.71 to 1.74; seven trials, 788 participants, low-certainty evidence); bile leakage (OR 0.82; 95% CI 0.35 to 1.91; seven trials, 606 participants, low-certainty evidence); reoperation rate (OR 0.68; 95% CI 0.34 to 1.36; five trials, 682 participants, low-certainty evidence); and length of hospital stay (MD -0.21; 95% CI -1.41 to 0.99; eight trials, 818 participants, low-certainty evidence). Only one trial reported quality of life, on a subgroup of 73 participants, also without a relevant difference between the two groups at any time point. The overall certainty of the evidence was low to moderate, due to some degree of heterogeneity, inconsistency and risk of bias in the included trials. There was low- to moderate-certainty evidence suggesting that antecolic reconstruction after partial pancreaticoduodenectomy results in little to no difference in morbidity, mortality, length of hospital stay, or quality of life. Due to heterogeneity in definitions of the endpoints between trials, and differences in postoperative management, future research should be based on clearly defined endpoints and standardised perioperative management, to potentially elucidate differences between these two procedures. Novel strategies should be evaluated for prophylaxis and treatment of common complications, such as delayed gastric emptying.

Acute Lymphoblastic Leukemia in the Elderly: Trends in Mortality Rates, Hospital Cost, Lengthof Stay, and Complication Rates in Patients Aged 60 and Older

Background: Adult Acute Lymphoblastic Leukemia (ALL) is associated with a high mortality. Advanced age is a risk factor associated with an increased rate of chemotherapy-related complications and precarious prognosis in these patients. We endeavored to evaluate trends in inpatient mortality, hospital cost, length of stay, and complication rates in patients aged 60 years and older who were admitted with active ALL. We also aimed to clarify differences in these outcomes in teaching versus nonteaching institutions.Methods: We analyzed the Nationwide Inpatient Sample between 1999 and 2014 using the ICD-9 codes 204 and 204.02 for acute lymphoblastic and acute lymphocytic leukemia in the primary diagnosis domain. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. Admission data pertinent to inpatient mortality, hospital cost, length of stay (LOS), and complication rates were derived. Chi square analysis was performed to examine differences in candidiasis, pneumonia, neutropenia, genitourinary infection, venous thromboembolism (VTE), sepsis, and clostridium difficile infection (CDI). Catalogued over a 16-year interval, the data was further compared between teaching and nonteaching institutions for patients greater than 60 years of age.Results: Between 1999 and 2014 a total of 2,548 (weighted N=12,518) admissions for ALL. Most of these admission aged 60 and older occurred at teaching institutions (p<0.05). Inpatient mortality decreased by more than 50% during the 16 year interval (p<0.0001), 34.2% in 1999 down to 15.2% in 2014. Furthermore, there was no statistical difference when both institutional settings were compared (p=0.19). Hospital cost for ALL admissions increased significantly between these years from $35,497 in 1999 to $142,270 in 2014, or $99,928 when adjusted for inflation (p<0.0001). By analyzing the mean cost in this period, higher charges were found in teaching institutions, $107,329, versus nonteaching, $58,507 (p<0.0001). LOS increased from 11.9 days in 1999 to 12.9 days in 2014 (p<0.01). Teaching institutions had significantly longer stays at 14.9 days compared to nonteaching at 9.7 days (p<0.001). Comparing the aforementioned complications in the elderly patients during the 16-year interval, there was no statistical significance. However, the majority of the complications were higher in teaching institutions compared to nonteaching institutions with statistical significance: neutropenia (p<0.0001), VTE (p<0.0003), sepsis (p<0.04), and CDI (p< 0.002). There was no statistical difference noted in the two settings for pneumonia and genitourinary tract infections.Conclusions: As previously thought, elderly patients admitted with a primary diagnosis of active ALL have a precarious prognosis. Intriguingly, overall inpatient mortality decreased conclusively during this 16-year interval. Many factors can be proposed to elucidate the decrease in mortality including the use of less-aggressive cytotoxic chemotherapy, improved recognition and treatment of complications of therapy, and use of tyrosine kinase inhibitors in selected patients. In this senior population, total cost and LOS were more pronounced in teaching institutions, though inpatient mortality was comparable. This may be due to the increased intricacy of cases at teaching institutions, escalating resource demand. In-hospital complications were more prevalent in teaching versus nonteaching institutions. This demonstrates that though we have established therapeutic guidelines and have made significant advancements in surveillance, prevention and treatment of common complications, there is still a discrepancy noted by unchanged rates during this time interval. Additional investigation is essential in determining the optimum course in improving these trends. DisclosuresNo relevant conflicts of interest to declare.

Diabetes and Cardiovascular Risk in Renal Transplant Patients.

End-stage kidney disease (ESKD) is a main public health problem, the prevalence of which is continuously increasing worldwide. Due to adverse effects of renal replacement therapies, kidney transplantation seems to be the optimal form of therapy with significantly improved survival, quality of life and diminished overall costs compared with dialysis. However, post-transplant patients frequently suffer from post-transplant diabetes mellitus (PTDM) which an important risk factor for cardiovascular and cardiovascular-related deaths after transplantation. The management of post-transplant diabetes resembles that of diabetes in the general population as it is based on strict glycemic control as well as screening and treatment of common complications. Lifestyle interventions accompanied by the tailoring of immunosuppressive regimen may be of key importance to mitigate PTDM-associated complications in kidney transplant patients. More transplant-specific approach can include the exchange of tacrolimus with an alternative immunosuppressant (cyclosporine or mammalian target of rapamycin (mTOR) inhibitor), the decrease or cessation of corticosteroid therapy and caution in the prescribing of diuretics since they are independently connected with post-transplant diabetes. Early identification of high-risk patients for cardiovascular diseases enables timely introduction of appropriate therapeutic strategy and results in higher survival rates for patients with a transplanted kidney.

Updates and analyzation of postoperative pancreatic fistula system of consensus statement on the diagnosis, treatment, and prevention of common complications after pancreatic surgery(2017)

In 2017, following many thorough discussions, considering Chinese actual situation, more than 20 distinguished pancreatic surgeons brought about an update of the previous 2010 Chinese experts' consensus on the prevention and treatment of common complications after pancreatic surgery. Referred to the latest update of the postoperative pancreatic fistula consensus statement by the International Study Group of Pancreatic Surgery, the postoperative pancreatic fistula system of 2017 version Chinese consensus divided pancreatic fistula into pure fistula and mixed fistula based on whether other digestive fluid is mixed or not. The new version also presents key points of pancreatic fistula prevention and surgical strategy. In the paper, the authors analyzed the necessity, essentials and controversy of the update.

A consensus statement on the diagnosis, treatment, and prevention of common complications after pancreatic surgery (2017)

Based on the latest update of the consensus statement by the International Study Group of Pancreatic Surgery, combined with China's actual situation, an update of the previous 2010 consensus on the Chinese experts of the prevention and treatment of common complications after pancreatic surgery was developed, with more than 20 extinguished experts to participate in, following many thorough discussions.This statement included pancreatic fistula, biliary fistula, postoperative bleeding, intraperitoneal infection and gastric emptying delay, and a new chapter of chyle leak. Each chapter is defined in terms of definition, grade, classification, prevention and treatment. In the end, the long-term postoperative complications of pancreatic surgery were emphasized, and the application of Clavien-Dindo classification in the evaluation of postoperative complications of pancreatic surgery was highly-recommended.

Antecolic versus retrocolic reconstruction after partial pancreaticoduodenectomy.

Pancreatic cancer remains one of the five leading causes of cancer deaths in industrialized nations. For adenocarcinomas in the head of the gland and premalignant lesions, partial pancreaticoduodenectomy represents the standard treatment for resectable tumours. The gastro- or duodenojejunostomy after partial pancreaticoduodenectomy can be reestablished via either an antecolic or a retrocolic route. The debate about the more favourable technique for bowel reconstruction is ongoing. To compare the effectiveness and safety of antecolic and retrocolic gastro- or duodenojejunostomy after partial pancreaticoduodenectomy. We conducted a systematic literature search on 29 September 2015 to identify all randomised controlled trials in the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library 2015, issue 9, MEDLINE (1946 to September 2015), and EMBASE (1974 to September 2015). We applied no language restrictions. We handsearched reference lists of identified trials to identify further relevant trials, and searched the trial registry clinicaltrials.gov for ongoing trials. We considered all randomised controlled trials that compared antecolic versus retrocolic reconstruction of bowel continuity after partial pancreaticoduodenectomy for any given indication to be eligible. Two review authors independently screened the identified references and extracted data from the included trials. The same two review authors independently assessed risk of bias of included trials, according to standard Cochrane methodology. We used a random-effects model to pool the results of the individual trials in a meta-analysis. We used odds ratios to compare binary outcomes and mean differences for continuous outcomes. Of a total of 216 citations identified by the systematic literature search, we included six randomised controlled trials (reported in nine publications), with a total of 576 participants. We identified a moderate heterogeneity of methodological quality and risk of bias of the included trials. None of the pooled results for our main outcomes of interest showed significant differences: delayed gastric emptying (OR 0.60; 95% CI 0.31 to 1.18; P = 0.14), mortality (RD -0.01; 95% CI -0.03 to 0.02; P = 0.72), postoperative pancreatic fistula (OR 0.98; 95% CI 0.65 to 1.47; P = 0.92), postoperative haemorrhage (OR 0.79; 95% CI 0.38 to 1.65; P = 0.53), intra-abdominal abscess (OR 0.93; 95% CI 0.52 to 1.67; P = 0.82), bile leakage (OR 0.89; 95% CI 0.36 to 2.15; P = 0.79), reoperation rate (OR 0.59; 95% CI 0.27 to 1.31; P = 0.20), and length of hospital stay (MD -0.67; 95%CI -2.85 to 1.51; P = 0.55). Furthermore, the perioperative outcomes duration of operation, intraoperative blood loss and time to NGT removal showed no relevant differences. Only one trial reported quality of life, on a subgroup of participants, also without a significant difference between the two groups at any time point. The overall quality of the evidence was only low to moderate, due to heterogeneity, some inconsistency and risk of bias in the included trials. There was low to moderate quality evidence suggesting no significant differences in morbidity, mortality, length of hospital stay, or quality of life between antecolic and retrocolic reconstruction routes for gastro- or duodenojejunostomy. Due to heterogeneity in definitions of the endpoints between trials, and differences in postoperative management, future research should be based on clearly defined endpoints and standardised perioperative management, to potentially elucidate differences between these two procedures. Novel strategies should be evaluated for prophylaxis and treatment of common complications, such as delayed gastric emptying.

Complications of endoscopic third ventriculostomy for hydrocephalus

To explore the complications of endoscopic third ventriculostomy (ETV) for hydrocephalus and examine their preventions. From September 2008 to September 2013, ETV was offered for obstructive hydrocephalus (n=15) and communicating hydrocephalus (n=5). And the prevention and treatment of common complications were analyzed. All had achieved satisfactory outcomes. For 16 cases, their symptoms and signs disappeared, ventricle returned to normal and interstitial edema resolved; for another 4 cases, there were improvements of symptoms and (or) signs, ventricular shrinking and/or interstitial edema lessening. And the postoperative complications included fever (n=5), poor healing of incision (n=2), scalp hydrops (n=2) and intracranial infection (n=1). The indications of ETV should be selected strictly according to the specific anatomical characteristics of bottom of third ventricle. And individualized methods of stoma are necessary. And early postoperative lumbar puncture and drainage may obviously reduce complications and improve surgical outcomes.

VERTEBRAL OSTEOPOROTIC COMPLICATIONS

Modern concepts of pathogenesis, current approaches of diagnosis and treatment of common complications of vertebral osteoporosis are considered on the basis of clinical cases.

To investigate the prevention and treatment of common complications of replacement therapy with pulmonary surfactant in neonates

Objective To investigate the clinical characteristic and prophylactic -therapeutic measures of common complications of pulmonary surfactant(PS) replacement therapy in neonates. Methods We analyzed the clinical data of 65 cases preterm neonates treated with PS replacement therapy in neonatal intensive care unit(NICU) of our hospital. Results In 65 cases,32 cases had one to five complications,totally 60 times. Those included 14 times pneumonia (21.5%), 10 times (15.4%)pneumorrhagia, 8times(12.3%) apnoea, intraventricular hemorrhage and bronchopulmonary dysplasia respectively 6 times(9.2%), patent ductus arteriosus, 3 times(4.6%), atelectasis and retinopathy of prematurity respectively 11 times(16.9%). 18 cases Of 32 xtremely low birth weight infants (56.3%) had different degree complications, and as that of 6 cases of 8 very low birth weight infants.54 cases after complex treatment were survival (survival rate 83.1%) and 11 cases died (mortality 16.9%). Conclusion Active precaution and early discovery and treatment all kinds of complications immediately could improve the effect of PS replacement therapy and reduce the mortality of the preterms. Key words: Pulmonary surfactant; Respiratory distress syndrome; Complication; Newborn Infant

Reoperation following Minimally Invasive Surgery: Are the “Rules” Different?

This article discusses various indications for reoperation and how employing laparoscopy at primary operation might affect the incidence, presentation, and treatment of common complications. The abdomen is likely to be far less hostile after laparoscopic surgery than after laparotomy. Adhesions to the anterior abdominal wall are minimal or absent. As a result, relaparoscopy is a reasonable diagnostic and often successful treatment modality in patients suspected of having intra-abdominal complications following laparoscopic operation. Laparoscopic success in dealing with acute bowel obstruction after laparoscopic surgery is related to the paucity of adhesions and unique mechanisms of obstruction that are localized and amenable to minimal dissection. The same mechanisms are also responsible for the increased risk of bowel necrosis associated with bowel obstruction after laparoscopic surgery. Limited experience with successful laparoscopic management of bleeding and anastomotic leak has been reported with the caveat that if the bleeding or contamination is excessive, cannot be identified and controlled quickly, or is unresponsive to a reasonable and brief effort using laparoscopy, a prompt laparotomy is indicated. Based on the current literature, it is reasonable to conclude that laparoscopic approaches to primary Crohn's disease and relaparoscopy for recurrence are an appropriate (perhaps the most appropriate) management strategy. Also, laparoscopic restorative proctocolectomy and ileal pouch-anal anastomosis after laparoscopic subtotal colectomy is the preferred treatment for toxic ulcerative colitis. We conclude that laparoscopic reoperative surgery is feasible for the treatment of many complications following laparoscopic major abdominal surgery and bowel resection.

Clinical competence statement on thoracic endovascular aortic repair (TEVAR)—multispecialty consensus recommendations: A Report of the SVS/SIR/SCAI/SVMB Writing Committee to Develop a Clinical Competence Standard for TEVAR

Clinical competence statement on thoracic endovascular aortic repair (TEVAR)—multispecialty consensus recommendations: A Report of the SVS/SIR/SCAI/SVMB Writing Committee to Develop a Clinical Competence Standard for TEVAR