Laparoscopy and re-laparoscopy in the diagnosis and treatment of postoperative complications

Experience of repeated laparoscopic surgeries in early and late postoperative period in 112 patients is analyzed. In early postoperative period repeated laparoscopy was performed in 75 patients for prevention, diagnosis and treatment of postoperative complications. In 54 patients repeated laparoscopy was carried out for programmed control for pathologic process. Laparoscopic surgery for diagnosis and treatment of postoperative complications was performed in 27 patients. In this group complications were seen in 2 patients. Technical features of repeated laparoscopy are demonstrated. Laparoscopic surgeries after laparotomic and laparoscopic operations are a good component of complex treatment and prophylaxis of severe complications in abdominal surgery. Prior performed abdominal operation is not contraindication for laparoscopy.     

Pulmonary complications after subtotal oesophagectomy

The postoperative pulmonary complications in 25 patients undergoing subtotal oesophagectomy for intrathoracic oesophageal carcinoma during the 3-year period 1981-1983 were compared with those of 25 patients undergoing surgery from 1984 to 1986. Although more extensive lymphadenectomies were performed from 1984, the mortality rate caused by the postoperative pulmonary complications was zero in the later period (1984-1986) compared with a rate of 16 per cent in the earlier period (1981-1983). The incidence of postoperative pulmonary complications was lower in the later series but the difference was not statistically significant. Factors which may have contributed to the decrease in critical pulmonary complications after surgery during the later period were the selection of the posterior mediastinal route for reconstruction, the introduction of selective endobronchial intubation by a double lumen tube with combined epidural anaesthesia, fluid restriction during and after surgery, postoperative mobilization and the administration of an expectorant.     

Cardiac troponin I is reliable with immediate but not medium-term cardiac complications after abdominal aortic repair

BACKGROUND: The diagnosis of cardiac complications is particularly challenging in the postoperative course of non-cardiac surgery. Follow-up of patients suggests that silent or symptomatic postoperative myocardial infarction have similar short-term outcomes. Cardiac troponin I (cTnI) has been reported as being a sensitive and specific marker of these complications. METHODS: We conducted a prospective study to determine the cut-off values of cTnI which may predict cardiac complications, i: in the postoperative period until discharge, and ii: during a 1-year period after aortic surgery. Three hundred and twenty-nine consecutive patients undergoing infrarenal aortic surgery were included over a 2-year period in a single center. cTnI was measured at recovery and on the 1st, 2nd and 3rd postoperative days. The presence or absence of cardiac complications was classified by reviewers who had no knowledge of cTnI. For evaluation of the ideal discrimination value of cTnI between the complicated and uncomplicated patient groups, we calculated receiver-operator characteristics for the mean values of the peak of cTnI. RESULTS: Thirteen patients (4%) developed 19 postoperative cardiac complications. Thirteen patients (4%) died in the postoperative period. Nine patients (3%) developed 10 cardiac complications during the 1-year follow-up in 316 patients. In 280 patients, cTnI was below 0.5 ng/ml, in 22 patients between 0.5 and 1.5 ng/ml and the 27 remaining patients had a cTnI higher than 1.5 ng/ml. The area under the curve for postoperative cardiac complications was 0.84 (SD=0.21). A limit value of 0.54 ng/ml yielded a sensitivity of 75% and a specificity of 89%. The area under the curve for late cardiac complications was 0.45 (SD= 0.13). CONCLUSION: A cTnI level greater than 0.54 ng/ml appears to be correlated with the occurrence of cardiac complications in the period until discharge, but no value of cTnI is predictive of late cardiac complications occurring in the 1st year after aortic surgery.     

Predicting purulent complications in surgery by determining antibody affinity]

Blood serum of 153 operated patients was studied, 133 of them had uncomplicated postoperative period, 20 patients had postoperative infectious complications. Control group consisted of 23 healthy donors. Coefficient of antibodies affinity was deduced mathematically. If this coefficient didn't exceed 15%, probability of complications development was 90%; if this coefficient ranged from 15 to 30%, probability of complications was 50%; if coefficient exceeded 30%, complications in postoperative period were the least probable. This method can be used for humoral immunity evaluation in surgical patients, bearing in mind its prognostic and diagnostic significance.     

原位肝移植术后并发症的影像学评价

目的：对评价原位肝移植(orthotopic liver transplantation，OLT)术后并发症的影像学检查方法进行评价。方法：对OLT术后并发症的影像学检查结果进行分析，并对各类并发症的相关影像学表现加以总结。结果：B超可用作OLT术后并发症的早期筛查；彩色多谱勒超声能早期发现血管性并发症；螺旋CT和MRI对术后血管性和(或)胆管性并发症、肝实质本身异常以及肝外转移性并发症有很高的诊断价值；对排斥反应．目前影像学检查还无特征性表现。结论：影像学检查(特别是超声、螺旋CT和MRD在OLT术后各类并发症的诊断中具有重要的作用。     

Significance of endovideosurgery in treatment of surgical infections

Results of treatment of 186 patients treated in the clinic in the period from 2000 through 2005 for infectious complications after severe combined injuries who underwent 264 operations have been studied. It was established that the endovideosurgical method of sanitation of the infection focus was used in 50% of cases at an average. The investigation of surgical treatment of infectious complications in patients with severe surgical pathology has shown high efficiency of endovideosurgical method for treatment of such complications in the third period of wound dystrophy. The proposed endovideosurgical methods of sanitation of the infection focus have a number of advantages over open ones--low traumatism, less number of postoperative infectious complications, less duration of the postoperative period.     

Correction of fatty acid metabolism in stomach surgery patients by the infusion of a fatty emulsion

The method of gas-liquid chromatography was used for studying the content of high molecular weight fatty acids in blood serum of 48 patients after operations on the stomach. It was established that in the early postoperative period the level of high molecular weight fatty acids including essential ones was considerably lower which deteriorated the course of the postoperative period and caused complications. The inclusion of fat emulsions in the programme of parenteral feeding in the early postoperative period is an effective measure of correction of the disturbed fatty acid metabolism resulting in the improvement of immediate results of the operation and less amount of postoperative complications.     

Early surgical complications of corrective operations in congenital hydronephrosis in children

The analysis of immediate results of 271 correcting operations for congenital hydronephrosis in children has shown that the operations may be followed by such complications at the early postoperative period as aggravation of pyelonephritis (10 patients), urinal fistulas (8 patients), urinary leakage (4 patients), paraureteral abscesses (3 cases) as well as postoperative bleedings (5 cases) and suppuration of the operative wound (4 cases). The exact performance of plastic operations according to the elaborated method, strict observation of indications and contraindications, complex therapy in the postoperative period were found to reduce the amount of complications.     

Correction of immunological status of patients with cholelithiasis for the prevention of postoperative complications]

An investigation of immune status of patients with chronic calculous cholecystitis prior to operation and in the postoperative period has proved the development of a pronounced secondary immune deficiency involving T and B-systems of the immune control as well as factors of nonspecific resistance. These changes may be considered as risk factors of the development of infectious complications in the postoperative period. Prophylactics of the secondary immune deficiency by administration of Contrical is indicated which permitted the amount of postoperative complications and the period of stay at the hospital to be decreased.     

Postoperative complications after femoral neck fracture in advanced elderly patients

BACKGROUND: We studied the prevalence of postoperative complications and the predictor for the occurrence of postoperative delirium in patients who had received surgery for femoral neck fracture. METHODS: A retrospective study, covering the period between January 1, 2005 and March 31, 2006, was carried out 50 in patients of advanced age treated for femoral neck fracture. We investigated main symptoms of postoperative complications. We also compared postoperative delirium group (D group) with no delirium group (ND group). RESULTS: The following results were obtained. Main postoperative complications were delirium, hypotension and hypoxia. And only one death case was included. In postoperative delirium, there was not a wide difference between the two groups except for hearing loss. CONCLUSIONS: Our results indicate that it might be possible to prevent postoperative complications by careful perioperative management. Hearing loss preoperatively was a risk factor of postoperative delirium in advanced elderly patients.     

多发性硬化并发痔的手术治疗

为探讨多发性硬化患者并发痔在手术治疗时应注意的问题及术后并发症的处理,对人院的多发性硬化并发痔6例患者资料进行回顾性分析。结果显示,6例患者均平稳度过围手术期,术后平均住院7d,有效率100％。结果表明,对并发痔的多发性硬化患者,只要术前严把手术适应症;术中严密观察病情变化并及时处理,手术操作时轻。准、快,术后严格防治并发症,如减轻术后疼痛、防止创面感染,患者就能安全度过围手术期,提高生活质量。     

Enterosorption in the preparation of patients for surgery of the large intestine

Enterosorption was used in the preparation of 30 patients for operations for carcinoma of the colon in order to make detoxication of the organism and to reduce the amount of postoperative pyo-inflammatory complications. The effectiveness of detoxication was confirmed by laboratory analysis. The amount of postoperative complications were reduced from 40% to 17.6%, the duration of the postoperative period at the hospital became shorter - 19.3 days instead of 26.7.     

The effect of corticosteroids on postoperative course after esophageal resection for carcinoma

BACKGROUND: The effect of steroids against inflammatory mediators is well known, but its benefit and adverse effect on the postoperative clinical course are uncertain after esophageal resection for carcinoma. METHODS: Forty-three cases undergoing esophageal resection for carcinoma were studied retrospectively. Twenty-six cases, given corticosteroids during operation or first postoperative day, were classified as the steroid group, and the other 17 cases were defined as the control group. Postoperative courses, complications, and outcomes were compared between these 2 groups. RESULTS: In the steroid group, heart rate, body temperature and C-response protein were depressed during the postoperative period, and duration of systemic inflammatory response syndrome was 1.2 +/- 1.1 days compared with 2.7 +/- 1.4 days in the control group (P < 0.001). Although the duration of mechanical ventilation and ICU stay was unchanged, morbidity rate of postoperative anastomotic leakage was 15% in the steroid group compared with 47% in the control group (P < 0.05). The other morbidity rates of pulmonary complications, postoperative infection, arrhythmia, and liver dysfunction as well as mortality rate were similar between the 2 groups. CONCLUSIONS: Corticosteroids given in the early postoperative period depress systemic inflammatory response and attenuate the rate of postoperative anastomotic leakage after esophageal resection for carcinoma.     

Characteristics of immunologic disorders in patients with acute destructive pancreatitis

Examination of immunological status in patients with acute destructive pancreatitis with uncomplicated (14 patients) and complicated (infectious-inflammatory processes--18 patients) postoperative period illustrated depression of T- and B-links of immunity, reduction of absolute and relative number of TFU- and TFC-lymphocytes. All the patients demonstrated reliable elevation of phagocytic rate, phagocytic index and number of circulating immune complexes. These changes were more significant in patients with complicated postoperative period. Level of lactoferrin in patients with complicated period was by 10% higher than in patients without complications. Significant elevation of tumor necrosis factor Ia in blood was registered in patients of both groups. During all the periods of examination the level of interleukin-8 was higher in patients with complicated postoperative period than in the patients with favorable postoperative period. This interleukin-8 is a reliable marker of postoperative complications in acute destructive pancreatitis.     

Hyperglycemic syndrome at the early postoperative period

An analysis of treatment of 141 patients with hyperglycemic syndrome at the early postoperative period was made, which was 1.3% of all the patients operated on during this period. Inflammatory postoperative complications took place in 30 (21.3%) patients in the group of patients with hyperglycemic syndrome. It suggests that hyperglycemia at the early postoperative period should be considered not simply as criterion of a severe state, but also as a factor having a direct influence on the course of the pathological process. So, these patients should be given sugar-decreasing therapy with monitoring of the glucose level.     

On-line monitoring of mixed venous oxygen saturation after cardiothoracic surgery.

On-line monitoring of MVo2 sat. in vivo by means of fibreoptic reflectometry was studied in 19 patients as to its predictive value during the postoperative course after thoracotomy for periods up to 60 hours. In all but one of the 10 patients with MVo2 sat. less than 65% for at least one hour complications occurred. A fall of MVo2 sat. of more than 5% or a value below 60% predicted a period of hypotension in six patients. In two of them this coincided with a period of ventricular arrhythmias. In those with MVo2 sat. greater than 65% no postoperative complications such as arrhythmias, shock, respiratory dysfunction or oliguria took place.     

Placement of Inferior Vena Cava Filters in Bariatric Surgical Patients – Possible Indications and Technical Considerations

Background: Surgical treatment of the morbidly obese has assumed an increasingly important role in both the academic and community setting, while postoperative pulmonary embolism remains a devastating complication. Since the overall incidence remains low, the role for vena cava filter placement in this group is not yet well defined. In addition, the technical challenges and techniques for insertion have not been well-described. We present our experience with filter placment among patients with gastric bypass and the evolution of technique to facilitate safe placement in this group. Methods: From 1995 to August 2003, 586 patients underwent gastric bypass for morbid obesity. Review of registries and records from this period was accomplished to identify patients at MUSC who underwent both the gastric bypass and placement of an inferior vena cava filter. 12 patients were identified by this method. Results: Technical challenges with venous access and imaging are described. 6 patients were identified as potential high risk for thromboembolic complications and had a filter placed preoperatively with a mean postoperative stay of 5.3 days. The 6 patients who required filter placement in the postoperative period as part of the management of postoperative complications had a mean hospital stay of 24.5 days. There were no long-term complications associated with filter placement at a mean follow-up interval of 19 months. Conclusion: Inferior vena cava filter placement is not only feasible and safe for the morbidly obese individual undergoing gastric bypass, but should be strongly considered for patients with risk factors for thromboembolic complications or who experience postoperative complications requiring ICU stay or prolonged immobility.     

Lack of utility of postoperative chest radiograph in pediatric tracheotomy.

OBJECTIVE: To assess the incidence of pulmonary complications after nonemergent pediatric tracheotomy and to determine whether obtaining a routine postoperative chest radiograph is warranted. STUDY DESIGN: Retrospective review of the records of 107 consecutive patients (age 1 month to 18 years) who underwent tracheotomy from October 1994 to June 2000. Main outcome measures included frequency of pulmonary complications and use of information obtained from postoperative chest radiograph for intervention. SETTING: Tertiary care university children's hospital. RESULTS: No pneumothoraces or significant pulmonary complications were detected in the immediate postoperative period. No management changes were undertaken as a result of information obtained from any chest radiograph in this period. CONCLUSIONS: The incidence of significant pulmonary complications after pediatric tracheotomy is low. Little information is obtained from chest radiograph after tracheotomy, and this information does not change management. SIGNIFICANCE: Routine postoperative chest radiograph after pediatric tracheotomy is not indicated in all patients.     

Phagocytic link of immunity in patients surgically treated for chronic calculous cholecystitis]

Twenty-two females, 38 to 75 years of age, who underwent planned operation for chronic uncomplicated calculous cholecystitis were examined in the pre- and postoperative period. Postoperative pneumonia developed in 4 (13.4%) patients, no other complications occurred. Functional neutrophil activity was studied according to the following parameters: spontaneous and induced NBT test, myeloperoxidase activity, amount of cationic proteins, expression of Fc receptors, spontaneous and induced luminol-dependent chemiluminescence, neutrophil bactericidal action against H-thymidine-labelled Staphylococcus aureus (strain 209), amount of blood immunoglobulins, and the modulating effect of serum of patients on the chemiluminescence of neutrophils of healthy donors. The control group consisted of 35 volunteers whose ages ranged from 18 to 50 years. Basic differences were revealed between the indices of neutrophil activity in patients with an uneventful postoperative period and those of patients with infectious complications in the preoperative period which became much graver in the early postoperative period. This suggests that neutrophilic dysfunctions play a significant role in the development of postoperative infectious complications in this category of patients.