Treatment Of Postoperative Complications Research Articles

Mycobacterium avium pelvic abscess with vaginocutaneous fistula after transobturatory sling surgery

This study presents a rare case of abscess associated with vaginocutaneous fistula due to atypical mycobacterial infection after sling surgery, which was successfully treated. Abscesses and fistulas are rare postoperative complications in treatment of stress urinary incontinence by transobturatory sling surgery, due to its high rate of positive outcomes in the treatment of urinary incontinence in women. These complications are considered to be related to the composition of the mesh and bacterial infection. We report a case of a 50-year-old patient who developed, in the 7th postoperative year of perineoplasty with sling placement, pelvic abscess and cutaneous fistula in the left thigh. Microbiological examination of the lesion revealed infection by Mycobacterium avium. Antibiotic therapy plus abscess drainage surgery and surgical correction of the fistulous pathway were the treatment of choice. During the surgery, a vaginal opening of the cutaneous fistula was evidenced, originating from the sling mesh, which was removed and later proved to be colonized by M. avium. The patient became asymptomatic after 1 year of postoperative follow-up.

From theory to practice: immunotherapy of purulent-inflammatory diseases and purulent-septic complications

Lack of anti-infective protection is one of the reasons for the occurrence of purulent-inflammatory diseases of the skin, soft tissues and purulent-septic complications in the postoperative period. Immunocorrective therapy is extremely relevant in surgical practice, and it can be used both for the prevention and treatment of postoperative complications. In this regard, special attention should be paid to low molecular weight fragments of peptidoglycan of cellular bacteria muramyl peptides.
 The study included 65 patients with purulent inflammatory diseases, of which 35 men aged 2355 years with chronic recurrent pyoderma (ostiofolliculitis, folliculitis, sycosis, furunculosis), and 30 patients aged 18 to 65 years with purulent inflammatory diseases of soft tissues, mainly abscesses and phlegmons of various localization without pronounced concomitant pathology. The examination included 26 patients with purulent-septic complications in the postoperative period. The patients included in the study were divided into 2 equal groups: 1 is the main group, in which patients received intramuscularly Polimuramil 200 mg daily for 5 days in addition to treatment; Comparison group 2, in which patients received only standard treatment. The clinical symptoms of pyoderma were assessed from day 0 to day 7, then on day 14, after 1 and 6 months of the study. Blood samples were taken from all patients for hematological and immunological studies. The timing of the appearance of granulations was monitored daily.
 The inclusion of Polimuramil in the complex treatment of pyoderma accelerated the regression of the main clinical manifestations of the disease and promoted the induction of stable remission. In patients with soft tissue infections, Polimuramil increased the degree of regression of the depth and area of the wound and accelerated the appearance of granulations. The clinical efficacy of Polimuramil in patients with purulent-septic complications in the postoperative period correlated with a decrease in CRP and procalcitonin levels. The study confirms the effectiveness of Polimuramil in the treatment of purulent-inflammatory diseases and purulent-septic complications in the postoperative period and its high immunomodulatory potential (8 figs, 2 tables, bibliography: 5 refs).

The prevention and management of approach-specific complications of abdominal aortic balloon occlusion in pelvic and sacral surgery

Objective: To investigate the causes,prevention and treatment of femoral artery puncture related complications caused by the application of resuscitative endovascular balloon occlusion of the aorta (REBOA) in the resection of pelvic and sacral tumors. Methods: Clinical data of 23 patients with femoral artery puncture related complications who received REBOA in the resection of pelvic and sacral tumors from August 2010 to August 2018 at the Musculoskeletal Tumor Center,Peking University People's Hospital were retrospectively analyzed.There were 8 males and 15 females,with the an age of (37.0±16.2) years (range:15 to 65 years).Arterial access via the Seldinger technique for REBOA was obtained in the right common femoral artery of 18 cases,and in the left of 6 cases.An arterial sheath with a diameter of 11 to 12 F(1 F≈0.33 mm) was used for the patient.The occurrence and treatment of postoperative complications were analyzed. Results: Acute femoral arterial thrombosis occurred in 18 patients,which was managed by open repair 48 hours postoperatively.Among the 349 patients admitted before 2015 who received hemostasis by compression after femoral artery sheath removal,12 patients (3.4%) developed acute femoral artery thrombosis.While the 476 patients admitted after 2015 who used a vascular stapler to close the femoral artery wound,6 patients (1.3%) developed acute femoral artery thrombosis.One case of retroperitoneal hematoma and 1 case of femoral pseudoaneurysm were found and surgically fixed.Postoperative follow-up was (40±18) months (range:13 to 108 months).Three cases with chronic lower extremity ischemia were confirmed by Doppler ultrasonography during 1 to 5 years follow-up.Two of them had minimal symptoms and denied further treatment,while the other one received femoral-femoral artery bypass surgery to restore distal flow for pain and numbness relief. Conclusions: Acute femoral arterial thrombosis was the most common femoral artery puncture.Technique refinement of REBOA,the use of percutaneous suture device and close follow-up can reduce the approach-specific complications,and help to detect and treat the complications timely,which may popularize the clinical application of REBOA.

Influence of disposable relaparotomy and programmed sanation on the expression and dynamics of clusters determinations on immunocompetent cells of patients with abdominal sepsis caused by severe peritonitis

Relaparotomy in the treatment of postoperative complications of abdominal surgery remains a difficult problem of modern surgery.To evaluate the prognostic value of expression clusters of determination on immunocompetent cells of patients, the dynamics of HLA-DR + molecules and cytokines in the blood of patients with abdominal sepsis caused by severe peritonitis, as well as abscesses and phlegmons for postoperative period.Materials and methods.The study was conducted in 40 patients diagnosed with abdominal sepsis in the period from 2017-2020, which was treated in medical institutions of Chernivtsi and Ternopil in Ukraine, and which were divided into control and research groups. The control group consisted of 17 patients without signs of abdominal sepsis and acute surgical pathology. Determination of the expression of determination clusters such as CD11a, CD162, CD95, CD16 on immunocompetent cells, and the study of the dynamics of expression of HLA-DR + molecules and the content of cytokines IL-2, IL-4, IL-6 in the blood of patients was performed in the postoperative period. Both groups were representative by age, sex, comorbidities, risk factors. Determination of experimental parameters in the blood of patients was performed in the postoperative period (the results were evaluated before surgery, on the first, third, seventh, and on the fourteenth day of the postoperative period).Research results and their discussionIn patients with abdominal sepsis caused by severe peritonitis, the expression of HLA-DR + molecules on immunocompetent cells increases, which to some extent indicates an intensification of γ-interferon synthesis. At the same time, there is a sharp decrease in the content of IL-2 in the blood - the main regulator of a specific immune response.

Immediate and long-term results of treatment of abdominal complications after gynecological operations using endoscopic technologies

The objective: to give a comparative assessment of the immediate and long-term results of laparoscopic treatment of postoperative abdominal complications in patients with gynecological pathology.Materials and methods. We carried out a comparative study of the immediate results after repeated laparoscopies and relaparotomies in gynecological patients with postoperative intra-abdominal complications, during which 2 clinical groups of patients were identified. Group I (main) consisted of 62 patients (50,82%) with early postoperative complications who underwent video endoscopic interventions. Group II (control) included 60 (49,18%) patients who underwent traditional «open» laparotomy. The criteria for the course of the early postoperative period were chosen traditionally. At the same time, it was taken into account that after the repeated interventions, the patients of both the main and the control groups received similar intensive therapy aimed at correcting the main symptom complex of the disease.All patients were comprehensively examined using clinical, instrumental and laboratory research methods. The groups were homogeneous in age and structure of operations performed on the pelvic organs, and were statistically comparable.Long-term results were studied among 28 (45,1%) patients of the main group and 21 women from the comparison group (35%) in terms of one to five years after gynecological intervention.Results. In the patients of the control group, the pain syndrome persisted statistically significantly longer and required prescription of anesthetic drugs on average 2 days more. The use of laparoscopy in the treatment of postoperative complications most often (51,7%) made it possible to refuse analgesics, and non-steroidal anti-inflammatory drugs were used on demand only in the first 2–3 days. The average duration of inpatient treatment for patients of group I with postoperative intra-abdominal gynecological complications averaged 10±2,5 days versus 16±2,9 in II (control) (p>0,05). The average duration of inpatient treatment after open surgery was on average 6±1,9 days longer (p<0,05).Long-term results were assessed using a three-point system (the result is good, satisfactory, unsatisfactory) based on the data of clinical and instrumental examination. Good long-term results were found in 13 (46,4%) patients of the main group and in 6 (28,5%) patients from the control group. Satisfactory results in group I were found in 13 (46,4%) patients, in group II – in 13, which amounted to 61,9%. In 2 patients, the results were found unsatisfactory after relaparoscopic manipulations (7,2%), and in 2 (9,5%) – after relaparotomy. One patient, due to frequent, recurrent cramping pains, was operated on as planned (abdominal adhesions were dissected).The study revealed a direct relationship during the early postoperative period and long-term results in women operated traditionally and with the use of laparoscopy. Based on the study of the results of surgical treatment of early postoperative intraperitoneal complications, the high efficiency of the video-laparoscopic method was proved in comparison with the traditional one. Thus, the implementation of the proposed treatment tactics can significantly improve the quality of life of this category of patients. The study of long-term results of laparoscopic operations has shown that the use of diagnostic methods of surgical techniques in the practice of medical institutions will contribute to the improvement of the results of complex treatment of sick women with pathology of the pelvic organs.

Compliance with D2 lymph node dissection in reduced-port totally laparoscopic distal gastrectomy in patients with gastric cancer

This phase II clinical trial was performed to determine whether reduced-port laparoscopic surgery with complete D2 lymph node (LN) dissection for gastric cancer is a safe and feasible surgical technique. The prospectively enrolled 65 gastric cancer patients underwent reduced-port surgery (i.e., triple-incision totally laparoscopic distal gastrectomy [Duet TLDG] with D2 lymphadenectomy). Compliance rate was the primary outcome, which was defined as cases in which there was no more than one missing LN station during D2 LN dissection. The secondary outcomes were the numbers of dissected and retrieved LNs in each station and other short-term surgical outcomes and postoperative course. The compliance rate was 58.5%. The total number of retrieved LNs was 41 (range: 14–83 LNs). The most common station missing from LN retrieval was station no. 5 (35/65; 53.8%), followed by station no. 1 (24/65; 36.9%). The overall postoperative complication rate was 20.0% (13/65). One patient underwent surgical treatment for postoperative complications. There was no instances of mortality. Duet TLDG is an oncologically and technically safe surgical method of gastrectomy and D2 lymphadenectomy.

Профилактика уретродермальных фистул после балапениальной неоуретропластики

AIM To compare the results of treatment of postoperative complications in children with hypospadias. MATERIALS AND METHODS A total of 123 patients aged 6 months to 16 years were included in the study. An evaluation of the level of reactive oxygen species (ROS) and the state of the antiperoxide system in the eluate was carried out. RESULTS In the tissues of patients with glandular and midshaft hypospadias after urethroplasty the generation of ROS was enhanced. The products of their interaction with lipid and protein macromolecules can result in the formation of urethrocutaneous fistulas. The use of urethral catheter which allowed to obstruct and rinse the neourethra by a water-soluble antioxidant solution had a good effect on the tissue regeneration and significantly reduced the frequency of urethrocutaneous fistulas. CONCLUSIONS The proposed method of rinsing the neourethra after urethroplasty in patients with glandular and midshaft hypospadias with a water-soluble antioxidant dibunol allowed to reduce the generation of ROS in the eluate, which resulted in a decrease in the content of SMDA in the eluate by 1.88, an increase in APA by 11.1 and to decrease the frequency of urethrocutaneous fistulas by 2.6 times due to an increase in local regeneration.

Survival in adult lung transplantation: where are we in 2020?

In this article, an overview of the survival after lung transplantation will be given, with a focus on factors affecting outcome and differences in survival determined by underlying disease. Lung transplantation is an established treatment modality for patients with various end-stage lung diseases. The most recent International Society for Heart and Lung Transplantation Registry reports a 1 and 5-year survival of 85 and 59%, respectively, for adult lung transplant recipients transplanted since 2010. Over the past decades, significant improvements in patient outcomes have been achieved related to changes in donor selection, organ preservation, perioperative management and better treatment of postoperative complications. However, long-term graft and patient outcomes still lag behind that of other solid organ transplantations. Chronic lung allograft dysfunction (CLAD) a condition which develops in about 50% of recipients 5 year after lung transplantation, remains the major barrier for long-term survival, although development of solid organ cancer is nowadays also an increasing cause of late mortality. Lung transplantation offers a survival benefit in well chosen patients with end-stage lung diseases. However, CLAD, side effects of immunosuppressive therapy and solid organ cancer remain important challenges impairing long-term survival. Advances in prevention and treatment of chronic rejection are critical to further improve outcome.

Prevention and Treatment of Postoperative Complications in Equines

Colic surgery is one of the most expensive procedures in equine clinics throughout the world. Although costs of surgery and anesthesia can be standardized to some extent, the cost of aftercare is less predictable. It can be altered considerably by the development of complications, such as surgical site infection, postoperative ileus, and formation of post-operative hernias, among others. Colic surgery places enormous demands on personnel, time, and resources. Nevertheless, it is a life-saving procedure. Complications increase cost through prolonged nursing care, technician salaries, extended treatment with antibiotics and other drugs, repeated laboratory analysis, and high-volume fluid therapy. Additional surgery, such as repeat celiotomy or repair of incisional complications, increases the costs considerably. Because none of these can be anticipated in most cases, a critical part of case management is a complete evaluation of expected and probable unexpected costs for the owner

Complex approach in the treatment of postoperative complications of gastrectomy

Relevance. At the present stage of development of on-cology, the level of locally advanced and metastatic can-cer of the stomach is high, in total according to 2017 year stage III and IV were diagnosed with 63.7% of all newly diagnosed cases of gastric cancer. The surgical method is basic in the treatment of stomach cancer. Complications of the surgical treatment of gastric cancer, leading to the impossibility or delay of adjuvant treatment, significantly worsen the rates of relapse-free and overall survival. Due to the large difference in the frequency of complications (from 9% to 32%) with surgical aids, the development of combined methods for their treatment is relevant. Ob-jective. In this clinical case, demonstrated a stepwise ap-proach in the treatment of postoperative complications of gastrectomy using conservative and active surgical meth-ods, including minimally invasive endoscopic technolo-gies. Research materials. A case study of the treatment of complications of combined gastrectomy using a variety of approaches is presented. Research methods. Evalua-tion of treatment tactics for postoperative complications of gastrectomy using conservative, endoscopic and active surgical approaches, in comparison with published data. Results. Using a wide arsenal of therapeutic measures, it was possible to stop severe complications after gastrecto-my. Conclusion. Surgical tactics using minimally invasive technologies in combination with intensive care made it possible to timely eliminate the purulent-septic compli-cations. This clinical case demonstrates the applicability of the simultaneous and sequential use of conservative treatment, active surgical tactics and minimally invasive endoscopic technologies in the treatment of severe com-plications of gastrectomy. The choice of tactics in each specific case of the development of postoperative com-plications should be individual, while the use of only con-servative treatment is associated with less efficiency and greater mortality compared to the combined approach.

Complex assessment of complications in operated patients with Fallot's tetrad at the hospital stage

Fallo's tetrad - one of the most often found congenital heart disease. The relevance of a problem of complications after cardiac operations at the Fallo's tetrad remains acute for today. The analysis of results of expeditious treatment and complications will allow to solve problems of timely diagnostics, treatment and prevention of the reasons of an unsatisfactory clinical condition of patients at all stages of postoperative maintaining. Objective: Studying the structure of postoperative complications, determination of the causes of postoperative complications at a hospital stage at patients after a definitive and palliative repair of Fallo's tetrad definition of diagnostic and medical tactics in the postoperative period. Material and methods: The studied patients with Fallo's tetrad (126 children aged from 2 days till 9 years, from them boys - 64, girls - 62) were distributed on 2 main groups: after the definitive repair of defect (DRD) and after the palliative correction of defect (PCD). The complex assessment of postoperative complications at patients with TF was carried out with use of clinical-laboratory research methods. Results: Complications at a hospital stage arose in 38 (45.2%) cases from 84 (100%) patients after a definitive repair and in 17 (50%) cases from 34 (100%) – after palliative correction of Fallo's tetrad. The structure of complications after a definitive and palliative repair of defect is defined. The reasons and risk factors of development of postoperative complications after surgical correction of Fallo's tetrad are defined. Features of a clinical current of complications after a definitive and palliative repair of Fallo's tetrad are noted. Optimum tactics in treatment of postoperative complications at a hospital stage after a definitive and palliative repair of Fallo's tetrad is defined.

Role of the Interventional Radiologist in Pancreatic Whole Organ and Islet Cell Transplantation

AbstractPancreas transplantation is an exciting therapy which has been used for several decades in the treatment of diabetes mellitus. It can be performed as either a whole organ or islet cell transplant. The role of interventional radiologists in the management of whole organ transplants is evolving and includes treatment of postoperative complications and graft biopsy to evaluate for rejection. An in-depth understanding of the transplant anatomy and variations is a fundamental tool in performing these interventions successfully. Islet cell transplantation entails delivery of purified donor pancreatic islet cells into the recipient portal vein. Because of their expertise in image-guided access to the portal system, interventional radiologists play a crucial role in this procedure. The purpose of this article is to review the indications, anatomy, complications, and outcomes of both whole organ and islet cell pancreas transplants, followed by a discussion of the role of interventional radiologists in each procedure.

Indications, complications, and outcomes associated with subdermal plexus skin flap procedures in dogs and cats: 92 cases (2000-2017).

To describe indications, complications, and outcomes associated with subdermal plexus skin flap (SPSF) procedures in dogs and cats. 53 dogs and 20 cats that received SPSFs for reconstruction of skin defects from 2000 to 2017. Medical record data were collected and summarized regarding patient signalment, indication for the SPSF procedure, type and location of SPSF, complications, and outcome. 92 SPSF procedures (64 in dogs and 28 in cats) were included. Indications for the procedures included tumor excision (n = 37 [40%]), acute wound (14 [15%]) or chronic wound (28 [30%]) reconstruction, surgical scar revision (7 [8%]), and other reasons (6 [7%]). Types of SPSFs included advancement (31 [34%]), axillary fold (20 [22%]), inguinal fold (20 [22%]), rotation (16 [17%]), transposition (3 [3%]), and distant direct (2 [2%]). Complications were noted for 47 (51%) procedures at a mean ± SD of 6.9 ± 4.0 days after surgery and were classified as minor (34 [37%]) or major (13 [14%]). Outcome was considered excellent for 44 (48%) procedures, good for 33 (36%), fair for 13 (14%), and poor for 2 (2%). Results suggested that approximately half of SPSF procedures in dogs and cats can be expected to be followed by a complication, occurring at a mean of 1 week after surgery, and yet with appropriate management of these complications, a good to excellent outcome was possible. Owners should be counseled about the likely need for additional visits and costs associated with treatment of postoperative complications.

Research advance on postoperative complications of diabetics with cataract

With the development of cataract surgery technology and intraocular lens, great progress has been made in the prevention and treatment of postoperative complications of cataract.The risk of complications after cataract surgery in diabetic patients is significantly higher than that in non-diabetic patients. This article reviews the progress in prevention and treatment of macular edema, diabetic retinopathy, corneal and ocular surface abnormalities after cataract surgery in diabetic patients. Key words: Cataract; Diabetics; Conplication

Failure to Rescue as a Surgical Quality Indicator: Current Concepts and Future Directions for Improving Surgical Outcomes.

Over the past decade, failure to rescue-defined as the death of a patient after one or more potentially treatable complications-has received increased attention as a surgical quality indicator. Failure to rescue is an appealing quality target because it implicitly accounts for the fact that postoperative complications may not always be preventable and is based on the premise that prompt recognition and treatment of complications is a critical, actionable point during a patient's postoperative course. Although numerous patient and macrosystem factors have been associated with failure to rescue, there is an increasing appreciation of the key role of microsystem factors. Although failure to rescue is believed to contribute to observed hospital-level variation in both surgical outcomes and costs, further work is needed to delineate the underlying patient-level and system-level factors preventing the timely identification and treatment of postoperative complications. Therefore, the goals of this narrative review are to provide a conceptual framework for understanding failure to rescue, to discuss various associated patient- and system-level factors, to delineate the reasons it has become recognized as an important quality indicator, and to propose future directions of scientific inquiry for developing effective interventions that can be broadly implemented to improve postoperative outcomes across all hospitals.

Prevention and Treatment of Postoperative Complications of ERCP

经内镜逆行胰胆管造影术（ERCP）已从单纯的诊断技术发展为胆胰疾病的首选治疗措施，但其并发症在一定程度上不可避免，严格掌握ERCP适应证和禁忌证、加强术者的操作技术和术中的准确判断与处理，以及相关药物的合理使用是术后并发症预防和治疗的关键。

PS01.088: CERVICOSTERNOTOMY COMBINED WITH LAPAROSCOPY FOR RESECTION OF UPPER THORACIC ESOPHAGUS: AN INSTITUTIONAL EXPERIENCE

Abstract Background Access to the cervicothoracic junction, whether by lower anterior cervical or transthoracic approach, is particularly difficult. It has been found that the cervicosternotomy allows exposure of the upper thoracic esophagus to the level of the carina. Our goal in this study is to summarize the experience in resection of the upper segment of the esophagus through cervicosternal splitting approach combined with laparoscopy and to discuss the choice of surgical approach, the clearance of lymph node and the treatment of postoperative complications. Methods From January 2016 to February 2018, 7 patients with esophageal disease underwent cervicosternotomy as part of a larger procedure. The lesion of the upper esophagus was resected by the direct anterior approach and the lower segmeat of the thoracic esophagus was freed by laparoscopic transesophageal hiatus. The stomach was taken up to the neck through the bed of esophagus and anastomoted between the stomach and esophagus. We analyzed these patients to determine the utility of this means, the ability to achieve complete resection and the outcomes. Results Of the 7 patients, 4 patients underwent radical resection for esophageal squamous cell carcinoma, 2 for esophagectomy and laryngectomy, 1 for benign stricture of the esophagus, 6 for cervical and mediastinal node dissection.The lesion of esophagus was resected in all cases. Recurrent laryngeal nerve injury in one patient with carcinoma, the only major postoperative complication in this group. There was no operative death. Conclusion The cervicosternal splitting approach can offer good exposure, high rate of resectability and low incidence of postoperative complications for the pathology of the upper segment of esophagus. Careful evaluation of the patient, focusing on the type, extent, and location of the abnormality relative to the level of the carina, often indicates that cervicosternotomy combined with laparoscopy is a safe and effective method of upper thoracic esophagectomy. Disclosure All authors have declared no conflicts of interest.

Updates in version 2.2018 of the NCCN guidelines for esophageal and esophagogastric junction cancers

Comment Preferred Regimens provide by expert group were adjusted: (1) Fluorouracil and cisplatin was no longer the Preferred Regimen for Preoperative Chemoradiation and Perioperative Chemotherapy (recommended as the other regimens); (2) DCF modifications were no longer the Preferred Regimens for First-Line Therapy (recommended as the other regimens); (3) Pembrolizumab (For second-line or subsequent therapy for MSI-H or dMMR tumors) was recommended as the Preferred Regimen for Second-Line or Subsequent Therapy; (4) Ramucirumab for adenocarcinoma (category 1 for EGJ adenocarcinoma; category 2A for esophageal adenocarcinoma) was no longer the Preferred Regimen for Second-Line or Subsequent Therapy. Survivors who underwent esophagectomy are at particular risk for clinically relevant long-term health issues, especially GI-related issues, such as malnutrition, dysphagia, dumping syndrome, delayed gastric emptying, reflux, and fatigue, which have been shown to negatively impact survivors' quality of life. This update proposes the following specific management and monitoring solutions for esophageal cancer survivors: Weight monitoring and the nutritional status in patients with esophageal cancer who underwent surgery are important. Intervention by nutrition specialists is recommended. Treatment of postoperative complications, such as delayed gastric emptying, dumping syndrome, esophageal bile reflux, and dysphagia should be carefully considered, and nursing advice should also be provided. In patients who previously had hypertension, the blood pressure condition may be improved after weight loss. Therefore, blood pressure should be monitored, and the original antihypertensive regimen adjusted as appropriate. Patients who previously had diabetes and hyperlipidemia may also need similar adjustments. Complications caused by chemoradiotherapy, such as radiation-induced heart injuries and chemotherapy-induced neuropathy, should be managed. Patient's psychological and physical states should be evaluated. Healthy lifestyle: Specific advice on dietary habits, living habits, physical activities, smoking cessation, and alcohol abstinence is necessary.

Perioperative management of thyroid ambulatory surgery

The incidence rate of thyroid cancer and thyroid nodule in China are rising and surgical operation is the main treatment for thyroid nodule and thyroid carcinoma. It has been controversial whether thyroid surgery is suitable for day surgery. Perfect preoperative examination and anesthesia assessment, selection of an appropriate of patients and minimally invasive surgery , good postoperative analgesia and the prevention and treatment of postoperative nausea and vomiting, recognition and treatment of postoperative complications timely, postoperative follow-up, can ensure safety of patient with thyroid ambulatory surgery, and made the same medical quality as the surgery in hospital. Under certain criteria, thyroid ambulatory surgery is safety , high efficient, economy and time-efficient.It is a reasonable surgical management mode which can reduce days of hospitalization and hospitalization cost. But it still need further study on the inclusion and exclusion criteria of patients, anesthesia techniques and perioperative management. Key words: Thyroid diseases/SU; Ambulatory surgery; Anesthesia; Perioperative care

Stomal construction: Technical tricks for difficult situations, prevention and treatment of post-operative complications

The creation of a digestive stoma, whether it is a lateral stoma or a terminal stoma, is an essential gesture in colorectal surgery, but that may result in post-operative complications in 35% of patients. Surgeons are aware of the situations at the origin of complications, although there is little factual data in the literature to discriminate them. They are related to patient-specific factors (obesity, cirrhosis, portal hypertension) or to the underlying pathology (colon obstruction) or the conditions under which the intervention is performed (emergency). The aim of this review is to describe these different situations and the data from the literature that may allow reduction of the risk of an unsatisfactory or even complicated stoma.