Early relaparotomies after surgical treatment of cancer of the stomach

Based on the observation of 40 patients the authors consider that the greatest amount of postoperative complications in patients with gastric cancer make their appearance after reconstructive and palliative gastrectomies and combined operative interventions. Timely relaparotomy allowed saving 37.5% of the patients who had such complications as incompetence of anastomosis sutures, pancreanecrosis, peritonitis, intraabdominal abscesses. A retrospective analysis of causes of the complications allowed developing a prophylactic complex of measures which includes means of the operative technique and preparation of weakened organism of oncological patients to the foregoing operative trauma.     

Reasons for relaparotomies following operations on the biliary tract in nontumorous lesions

According to the authors' data the incidence of relaparotomies after 1500 operations for non-tumor diseases of bile ducts was 2.5%. Causes of relaparotomies at early and late terms of the postoperative period were different. The dependence of results of the treatment on the amount of relaparotomies and the presence of such complications as jaundice, cholangitis and pancreatitis has been established. In such complications and increased amount of relaparotomies lethality was considerably higher. General lethality after relaparotomies was 49%. Complex of prophylactic and curative measures of the complications resulting in relaparotomies has been developed.     

Planned relaparotomies in the surgical treatment of severe generalized peritonitis from intestinal origin

The evolution of the septic state and the mortality rate are analyzed in a group of 42 selected patients presenting with severe peritonitis from small or large intestinal origin. All patients presented in a septic state with signs of generalized peritonitis for at least 24 hours. Planned relaparotomies are preferable to the conventional surgical approach of peritoneal lavage which frequently must be followed by demand relaparotomies in patients with recurring peritonitis. The mortality rate in the planned relaparotomy group (29%) was significantly lower than in the conventional treatment group (73%). The poor prognosis of persistent or recurrent multisystem failure complicating septic shock is confirmed. The planned relaparotomy tactic should be considered a valuable alternative approach to the treatment of severe forms of peritonitis.     

Abdominal zippers for temporary abdominal closure in planned relaparotomies for peripancreatic sepsis: experience in a developing country

Background: Planned relaparotomies have generated renewed interest because of the high mortality rates associated with conventional management techniques in severe intraabdominal sepsis. The use of abdominal zippers for temporary abdominal closure was devised to facilitate repeated explorations, allowing daily cleansing of the peritoneal cavity and the detection and management of septic complications. Methods: In our institution, eight patients were managed in a 4-year period, using abdominal zippers for peripancreatic sepsis. Results: In all eight patients, subsequent laparotomies allowed the detection of progressive necrosis. Repeated explorations successfully controlled the sepsis in five patients. In three patients, the condition deteriorated, and they died of multiple organ failure. Conclusions: The technique warrants further prospective controlled trials in the local setting to ascertain its role in the management of severe intraabdominal sepsis, and in other patients who may require "second-look" operations. Received: May 11, 2001 / Accepted: August 1, 2001     

Emergency laparoscopy

Background: Laparoscopic diagnosis of intestinal ischemia is difficult. Dark-colored bowels are not a reliable indicator for infarction, because there is no correlation between color and oxygenation. The same picture is produced by intraluminal blood or feces. False diagnoses are described. Methods: We analyzed various techniques for assessing intestinal oxygenation and perfusion to support laparoscopic diagnosis.In this study laparoscopy was performed on eight pigs. A 10-cm segment of intestine was fixed to the abdominal wall and rendered ischemic. Measurements of the ischemic segment and normal intestine were taken using laser-Doppler, Doppler ultrasound, spectrophotometer, and pulse oximeter. Doppler ultrasound and pulse oximetry were unsuitable in our model, as was laser-Doppler flowmetry. Results: Only the spectrophotometer proved a highly sensitive means of assessing bowel oxygenation. Conclusions: This method provides the desired additional information about intestinal oxygenation, thus helping to interpret the laparoscopic picture of dark bowels.     

Emergency oesophagectomy

In the treatment of instrumental perforation of the obstructed thoracic oesophagus, relief of obstruction is one of the prerequisites of success. In some cases it is better to resect both the perforation and the original lesion rather than to rely on repair and drainage. The salient features of 19 cases of emergency oesophagectomy collected from the literature have been tabulated, and three new examples are here reported. The results are encouraging. The operation usually performed for malignant cases is a one-stage oesophagogastrectomy with oesophagogastrostomy; a two-stage procedure is recommended for benign lower-end strictures. The lacerated oesophagus and the stricture are resected at the emergency operation, and the fundus of the stomach, advanced into the chest, is anastomosed to the oesophagus. The whole of the stomach is thereby preserved for the elective reconstruction which constitutes the second stage.     

Emergency tracheostomy

On rare occasions, emergency tracheostomy is indicated to establish an airway. Using a large bore needle as a guide, tracheal intubation is assured with minimal damage to vital structures in the neck.