Relaparotomy in acute hemorrhage after operations on the abdominal organs]

In the paper, an analysis of acute postoperative hemorrhages in 30 patients after operations on the abdomen is presented. In these patients 42 relaparatomies have been performed with lethal issues in 16.7%. The causes of this complication are analysed, and recommendations how to prevent them are given.     

Transarterial embolization for postoperative hemorrhage after abdominal surgery

The study goal was to evaluate the efficacy, safety, and clinical outcome of transarterial embolization for postoperative hemorrhage after abdominal surgery. Thirty-three patients were referred for angiography because of gastrointestinal or intra-abdominal bleeding after abdominal surgery. Urgent angiography and transarterial embolization was performed in all 33 patients. The clinical and angiographic features were retrospectively reviewed. Angiography revealed a discrete bleeding focus in 26 (79%) of 33 patients. Transarterial embolization was technically successful in 24 (92%) of 26 patients with a discrete bleeding focus. Rebleeding occurred in four (17%) of 24 patients. They were successfully managed with repeat embolization. There was no procedure-related complication during follow-up period. Angiography has a high detection rate of bleeding site in patients with postoperative hemorrhage after abdominal surgery. Transarterial embolization is considered to be an effective and safe means in the management of postoperative hemorrhage.     

Intraabdominal cholerrhea after cholecystectomy]

Cholecystectomy (CE) was performed in 2303 patients with cholelithiasis and its complications. Cholerrhea (CR) after operation was in 31 (1.34%) patients: after laparoscopic CE (1425 patients)--in 18 (1.26%), after open CE (878 patients)--in 13 (1.48%). Source of CR was not found in 21 patients, CR from gall bladder bed was revealed in 7, from cystic duct stump--in 2, from hepaticojejunoanastomosis--in 1 patient. Ultrasonic examination, endoscopic retrograde pancreatocholangiography, laparoscopy were used for diagnosis of this complication. CR stopped spontaneously in 19, after endoscopic papillosphincterotomy--in 4 patients. Spread of bile in abdominal cavity was revealed in 6 patients, 4 of them underwent laparoscopic operations, 2--open operations. Infrahepatic encapsulated bile clumps were in 2 patients, they underwent ultrasonic-assisted drainage.     

Intraabdominal pressure as a mortality predictor in abdominal surgery

A case control study concerning intraabdominal pressure (IAP) in relation with mortality was developed in postoperative patients admitted in the intensive care unit of the Holguin General University Hospital V I Lenin in Cuba from March 1998 to March 2002. A total of 207 patients were included. The most frequently affected age groups were 16-35 years of age and 36-55 years of age. Sex distribution was similar. Mean IAP of diseased patients was 13.138333, S=5.8248008; meanwhile, patients who survived had 11.453299, S=4.9293458. There was a statistically significant difference between both groups (ANOVA) F=4.4726752). Proportion of diseased/alive patients also increased with greater values of IAP. There was specificity of 97.95% for predicting mortality when IAP was >21 cm of H2O and negative predictive value of 91.66% if IAP was <5 cm of H2O. We conclude that IAP is a good predictor of mortality for postoperative patients admitted to the intensive care unit. There is a very high probability of death if IAP is >21 cm of H2O and low probability if IAP is >5 cm of H2O.     

Electroanalgesia after operations on the abdominal organs

Electroanalgesia was used in 102 patients operated on the gastro-intestinal tract for postoperative anesthesia. The analgetic effect was obtained in 2/3 of the patients. The indicators of respiration increased and those of blood circulation remained practically the same against the background of electroanalgesia. At the same time the use of non-narcotic analgetics resulted in a reliably decreased minute volume of blood circulation below the normal limits. The authors recommend electroanalgesia in the postoperative period for patients with initial disorders of the cardio-vascular and respiratory systems.     

Correction of disorders of phosphorus metabolism after operations on the abdominal organs]

Hypophosphatemia and decreased content of ATP, 2,3-DPG in erythrocytes were found in 147 patients operated upon organs of the abdominal cavity. Hypophosphatemia was more pronounced after operations for ulcer disease of the stomach and duodenum, acute pancreatitis and commissural ileus. An intravenous injection of potassium dihydrogen phosphate++ prevents the development of hypophosphatemia and concomitant decrease of the content of nonorganic phosphorus, ATP, 2,3-DPG in erythrocytes and may improve the postoperative period in these patients.     

Analysis of early relaparotomy after lower gastrointestinal system surgery

Purpose To evaluate the complications after lower gastrointestinal system (GIS) operations, and to investigate the reasons for and outcomes of relaparotomy (RL), and the factors influencing its mortality rate. Methods The subjects of this retrospective study were 38 patients who underwent early RL for complications of lower GIS surgery. We analyzed the demographic features and initial diagnoses of the patients, the reasons for their initial surgery and their postoperative complications, and the number, duration, and outcome of early RLs. Results The average patient age was 54.8 ± 16.2 years and the male:female ratio was 30:8. Early RL was performed for the following complications: leakage of an intestinal repair or anastomosis (n = 17, 44.7%); intraabdominal infection or abscess (n = 8, 21%); stomal complications (n = 5, 13.2%); necrosis caused by mesenteric arterial thrombosis (n = 4, 10.5%); hemorrhage (n = 2, 5.3%); and intestinal rupture (n = 2, 5.3%). A mortality rate of 36.8% (n = 14) was attributed mainly to infections (n = 27, 71.4%). The average interval between the first laparotomy and RL was 5.5 ± 3.5 days, and the average hospital stay was 27.1 ± 19.4 days. Conclusions Relaparotomy performed soon after major lower GIS surgery is associated with a high mortality rate. Thus, to decrease both the RL and mortality rates, complicated surgery should ideally be performed by experienced surgeons in fully equipped facilities.     

Prophylaxis and treatment of eventration after relaparotomy]

A method of prophylaxis and treatment of eventrations after relaparotomy using apparatus of transtissue fixation was fested clinically. The apparatus was used in 24 patients with acute abdominal surgical disease subjected to relaparotomy. The apparatus of transtissue fixation permits to shorten time of operation, to make easier the work of surgeon and assistants, to minimize damage to sutured inflamed tissues. Lethality was 16.7%. There were no eventrations.