Risk factors for surgical site infection in Japanese patients with ulcerative colitis: a multicenter prospective study

Purpose

A prospective, multicenter, observational study was performed to investigate the risk factors of surgical site infection (SSI) in patients with ulcerative colitis (UC).

Methods

From 2009 to 2010, perioperative clinicopathological data were collected from patients who had undergone surgery for UC within the research period, for up to 6 consecutive months in 13 hospitals in Japan. The primary outcome was the development of SSI.

Results

A total of 195 patients with UC who underwent colorectal surgery were enrolled. SSI was diagnosed in 38 (19.5 %) patients, in the form of incisional infection in 23 (11.8 %), organ/space infection in 16 (8.2 %), and both in 1 (0.5 %). There were no significant risk factors associated with an increased risk of development of incisional SSI. An American Society of Anesthesiologists physical status of ≥ 3 was indicated as the only significant risk factor for organ/space SSI (P = 0.02) compared with other factors, such as a neutrophil count of >100 × 10²/mm³, albumin level of <3.5 g/dl, perioperative packed red blood cell transfusion, fair or poor colonic cleanliness, and therapeutic use of antibiotics.

Conclusion

Poor general physical status was the significant independent risk factor for organ/space SSI in patients with UC in Japan.     

Nutritional risk index as an independent predictive factor for the development of surgical site infection after pancreaticoduodenectomy

Purpose

Malnutrition has been considered a risk factor for the development of a surgical site infection (SSI). The aim of this study was to determine the relationship between preoperative nutritional screening scores and the development of SSI after pancreaticoduodenectomy.

Methods

We examined 64 patients who had undergone pancreaticoduodenectomy. Their clinical data, nutritional risk index (NRI), and nutritional risk screening 2002 (NRS-2002) score were recorded. SSIs were diagnosed according to the definitions of wound infection established by the Center for Disease Control and Prevention and were confirmed by a microbiological examination. Data were analyzed using the Fisher exact probability method and a multivariate logistic regression analysis.

Results

SSIs developed in 21 patients (33 %). Eleven patients had wound infections, and 14 patients had an intra-abdominal abscess. A univariate analysis of perioperative factors revealed that a pancreatic fistula, the NRS-2002, and the NRI were significantly associated with the development of SSI (p < 0.05). The multivariate logistic regression analysis revealed that a pancreatic fistula and the NRI were independent risk factors for SSI. By analyzing the pre- and intra-operative factors after excluding the 11 patients with pancreatic fistulas, the NRI was still an independent risk factor for SSI.

Conclusion

The present study showed the NRI to be an independent factor for predicting the risk of SSI after pancreaticoduodenectomy.     

Crohn’s Disease but not Diverticulitis Is an Independent Risk Factor for Surgical Site Infections in Colectomy

Introduction

Surgical site infections (SSIs) after colectomy for colon cancer (CC), Crohn’s disease (CD), and diverticulitis (DD) significantly impact both the immediate postoperative course and long-term disease-specific outcomes. We aim to profile the effect of diagnosis on SSI after segmental colectomy using the National Surgical Quality Improvement Program (NSQIP) data set.

Method

NSQIP data from 2006 to 2011 were investigated, and segmental colectomy procedures performed for the diagnoses of Crohn’s disease, DD, and colon malignancy were included. SSI complications were compared by diagnosis using univariate and multivariate analysis.

Result

We included 35,557 colectomy cases in the analysis. CD had the highest rate of postoperative SSI (17 vs. 13 % DD vs. 10 % CC; p?p?≤?0.001), deep incisional SSI (OR?=?1.85, p?=?0.03), and organ space SSI (OR?=?1.51, p?=?0.02).

Conclusion

For patients undergoing segmental colectomy in the NSQIP data set, statistically significant increases in SSI are seen in CD, but not DD, when compared to CC, thus confirming CD as an independent risk factor for SSI.     

Additional surgical procedure is a risk factor for surgical site infections after laparoscopic cholecystectomy

Purpose

Surgical site infections (SSI) are associated with increased costs and length of hospital stay, readmission rates, and mortality. The aim of this study was to identify risk factors for SSI in patients undergoing laparoscopic cholecystectomy.

Methods

Analysis of 35,432 laparoscopic cholecystectomies of a prospective multicenter database was performed. Risk factors for SSI were identified among demographic data, preoperative patients’ history, and operative data using multivariate analysis.

Results

SSIs after laparoscopic cholecystectomy were seen in 0.8 % (n?=?291) of the patients. Multivariate analysis identified the following parameters as risk factors for SSI: additional surgical procedure (odds ratio [OR] 4.0, 95 % confidence interval [CI] 2.2–7.5), age over 55 years (OR 2.4 [1.8–3.2]), conversion to open procedure (OR 2.6 [1.9–3.6]), postoperative hematoma (OR 1.9 [1.2–3.1]), duration of operation >60 min (OR 2.5 [1.7–3.6], cystic stump insufficiency (OR 12.5 [4.2–37.2]), gallbladder perforation (OR 6.2 [2.4–16.1]), gallbladder empyema (OR 1.7 [1.1–2.7]), and surgical revision (OR 15.7 [10.4–23.7]. SSIs were associated with a significantly prolonged hospital stay (p?<?0.001), higher postoperative mortality (p?<?0.001), and increased rate of surgical revision (p?<?0.001).

Conclusions

Additional surgical procedure was identified as a strong risk factor for SSI after laparoscopic cholecystectomy. Furthermore, operation time >60 min, age >55 years, conversion to open procedure, cystic stump insufficiency, postoperative hematoma, gallbladder perforation, gallbladder empyema, or surgical revision were identified as specific risk factors for SSI after laparoscopic cholecystectomy.     

The efficacy of active drainage for preventing postoperative organ/space surgical site infections in patients with Crohn’s disease

Purpose

Patients with Crohn’s disease (CD) show a higher incidence of surgical site infections (SSIs) after bowel resection in comparison to other patient populations because CD patients commonly suffer from anemia, malnutrition, and immunosuppression. In comparison to conventional passive drainage, active drainage using a closed-suction drain reportedly reduces postoperative wound-related complications in several diseases. In the present study, we aimed to investigate the incidence of SSI and to identify the risk factors for SSI in patients with CD.

Methods

We retrospectively analyzed the patient characteristics and perioperative data of 106 CD patients who underwent bowel resection at our institution between January 2000 and June 2016. We statistically analyzed the incidence of different types of SSI (overall, incisional, and organ/space) in relation to patient-related and surgery-related risk factors.

Results

Overall postoperative SSIs were diagnosed in 19 patients (17.9%), including incisional SSI (n = 16; 15.1%), organ/space SSI (n = 7; 6.6%), and both (n = 4; 3.8%). A long operative time (p = 0.036) and colonic involvement (p = 0.011) were significantly associated with the overall risk of developing an SSI. Active drainage significantly reduced the incidence of organ/space SSI (p = 0.037).

Conclusion

Intraabdominal active drainage was more useful than passive drainage for preventing organ/space SSI development.

     

Pancreatic Anastomotic Leakage after Pancreaticoduodenectomy. Risk factors, Clinical predictors, and Management (Single Center Experience)

Background

Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) remains a challenge even at high-volume centers.

Methods

This study was designed to analyze perioperative risk factors for POPF after PD and evaluate the factors that predict the extent and severity of leak. Demographic data, preoperative, intraoperative, and postoperative variables were collected.

Results

A total of 471 consecutive patients underwent PD in our center. Fifty-seven patients (12.1 %) developed a POPF of any type; 21 patients (4.5 %) had a fistula type A, 22 patients (4.7 %) had a fistula type B, and the remaining 14 patients (3 %) had a POPF type C. Cirrhotic liver (P = 0.05), BMI > 25 kg/m² (P = 0.0001), soft pancreas (P = 0.04), pancreatic duct diameter <3 mm (0.0001), pancreatic duct located <3 mm from the posterior border (P = 0.02) were significantly associated with POPF. With the multivariate analysis, both BMI and pancreatic duct diameter were demonstrated to be independent factors. The hospital mortality in this series was 11 patients (2.3 %), and the development of POPF type C was associated with a significantly increased mortality (7/14 patients). The following factors were predictors of clinically evident POPF: a postoperative day (POD) 1 and 5 drain amylase level >4,000 IU/L, WBC, pancreatic duct diameter <3 mm, and pancreatic texture.

Conclusions

Cirrhotic liver, BMI, soft pancreas, pancreatic duct diameter <3 mm, pancreatic duct near the posterior border are risk factors for development of POPF. In addition a drain amylase level >4,000 IU/L on POD 1 and 5, WBC, pancreatic duct diameter, pancreatic texture may be predictors of POPF B, C.     

Chronic kidney disease is associated with high abdominal incisional hernia rates and wound healing disturbances

Background and objectives

Incisional hernias are among the most frequent complications following abdominal surgery with impact on morbidity and mortality rates. Elevated uremia toxins may inhibit granulation tissue formation and impair wound healing, thereby promoting incisional hernia development. Here, we quantified the hazard ratio for incisional hernia prevalence in patients at risk undergoing abdominal reoperations with interrelationship to kidney function. In the same cohort, incidence rates for de novo wound healing disturbances within a 4-month follow-up period were determined.

Design, setting, participants and measurements

Upon hospitalization for elective abdominal surgery in a university hospital (tertiary medical center), past medical histories were recorded in 251 patients and incisional hernia prevalence rates were calculated. Known modifiers for hernia formation as well as laboratory values for estimated glomerular filtration rate (eGFR) were recorded. The status of wound healing was assessed by a blinded investigator 4 months postoperatively. Chronic kidney disease (CKD) was defined as eGFR < 60 ml/min/1.73 m². To identify independent risk factors for incisional hernia or postoperative wound healing disorder, multivariate regression analyses were performed.

Results

The incisional hernia prevalence was 24.3 % in the overall cohort. Patients with CKD (32/251; 12.8 %) were more likely to suffer from incisional hernias with an odds ratio (OR) of 2.8 ([95 % CI 1.2–6.1]; p = 0.014) than patients with eGFR > 60 ml/min (219/251; 88.2 %). In multivariate analyses, CKD proved to be an independent risk factor for incisional hernia development with an OR similar to obesity (BMI > 25; OR 2.6 [95 % CI 1.3–5.1]; p = 0.007). In the prospective analysis, disturbed wound healing occurred in 32 of 251 (12.8 %) patients undergoing abdominal operations. Frequency of wound healing was increased when CKD was present (8/32; 25 %; OR 2.3 [95 % CI 1.1–6.7]; p = 0.026) compared to patients with eGFR > 60 ml/min (24/219; 11 %).

Conclusions

Chronic kidney disease is associated with impaired wound healing and constitutes an independent risk factor for incisional hernia development.     

Is Perineural Invasion More Accurate Than Other Factors to Predict Early Recurrence after Pancreatoduodenectomy for Pancreatic Head Adenocarcinoma?

Background

Some patients operated by pancreaticoduodenectomy for resectable pancreatic head adenocarcinoma will present with a recurrence during the first year (early recurrence).

Objective

The aim of this study was to determine prognostic factors associated with early recurrence in a large retrospective study.

Methods

From January 1995 to November 2010, all patients operated by pancreaticoduodenectomy for pancreatic head adenocarcinoma in our institution were retrospectively included. Univariate and multivariate analyses were performed to determine factors associated with early recurrence.

Results

A total of 166 patients were included; 57 patients (34 %) developed early recurrence. In univariate analysis, factors associated with early recurrence were perineural invasion (p = 0.0002), preoperative bilirubin (p = 0.01), lymph node ratio (LNR) ≥0.2 (p = 0.009), and T stage (p = 0.02). In multivariate analysis, perineural invasion (odds ratio [OR] 3.31; 95 % confidence interval [CI] 1.42–7.72; p = 0.005), LNR ≥0.2 (OR 2.55; 95 % CI 1.17–5.52; p = 0.02), and preoperative bilirubin (OR 1.04; 95 % CI 1.01–1.07; p = 0.03) were independent factors associated with early recurrence. Perineural invasion was also associated with poor overall survival (p = 0.001) and poor disease-free survival (p = 0.07).

Conclusion

In our study, perineural invasion (OR 3.31) is more accurate than T stage and lymph node status (OR 2.55) to predict early recurrence after pancreatoduodenectomy for pancreatic head adenocarcinoma.     

Incisional hernia after laparoscopic colorectal surgery. Is there any factor associated?

Background

Laparoscopic approach is related to, among others, educing abdominal wall complications such as incisional hernia (IH). However, there are scarce data concerning laparoscopic colorectal surgery (LCRS). The aim of this study was to evaluate related factors and incidence of IH following this approach.

Methods

A retrospective analysis of consecutive patients who underwent colorectal surgery with laparoscopic approach in a single center was performed. Patients with a minimum follow-up of 6 months, and also converted to open surgery were included. Uni- and multi-variate analyses were performed using the following variables: age; gender; type of surgery (left, right, total, or segmental colectomy); comorbidities [diabetes and chronic pulmonary obstructive disease (COPD)]; previous surgery; colorectal disease (benign and malignant); operative time; surgical site infection (SSI); and body mass index (BMI). Midline incisions (right colectomy) and off-midline incisions (left colectomies and rectal resections) were also compared.

Results

During a period of 12 years, 1051 laparoscopic colorectal surgeries were performed. The incidence of IH was 6 % (n = 63). Univariate analysis showed that BMI > 30 kg/m² [p < 0.01, OR: 2.3 (1.3–4.7)], SSI [p < 0.01, OR: 6.5 (3.4–12.5)], operative time >180 min [p < 0.01, OR: 2.1 (1.2–3.6)] and conversion to open surgery (p = 0.01, OR: 2.4 [1.1–5.0]) were related to incisional hernias. BMI and SSI have a statistically significant relation with the incidence of IH in multivariate analysis (p < 0.01). No statistical difference between right and left colectomy was observed (6.6 vs. 6.4 %, respectively).

Conclusion

The incidence of IH after LCRS seems to be acceptable. BMI over 30 kg/m² and SSI are strongly associated to this complication.     

Pressurized Pulse Irrigation with Saline Reduces Surgical-site Infections following Major Hepatobiliary and Pancreatic Surgery: Randomized Controlled Trial

Background

Surgical site infections (SSI) are a significant cause of postoperative morbidity. Pressurized pulse irrigation of subcutaneous tissues may lower infection rates by aiding in the debridement of necrotic tissue and reducing bacterial counts compared to simply pouring saline into the wound.

Methods

A total of 128 patients undergoing laparotomy extending beyond 2 h were randomized to treatment of wounds by pressurized pulse lavage irrigation (<15 psi) with 2 L normal saline (pulse irrigation group), or to standard irrigation with 2 L normal saline poured into the wound, immediately prior to skin closure (standard group). Only elective cases were included, and all cases were performed within a specialized hepatobiliary and pancreatic surgery unit.

Results

There were 62 patients managed by standard irrigation and 68 were managed by pulse irrigation. The groups were comparable in most aspects. Overall there were 16 (13 %) SSI. Significantly fewer SSI occurred in the pulse irrigation group [4 (6 %) vs. 12 (19 %); p = 0.032]. On multivariate analysis, the use of pulse irrigation was the only factor associated with a reduction in SSI with an odds ratio (OR) of 0.3 [95 % confidence interval (95 % CI) 0.1–0.8; p = 0.031]. In contrast, hospital length of stay of greater than 14 days was associated with increased infections with an OR of 7.6 (95 % CI 2.4–24.9; p = 0.001).

Conclusions

Pulse irrigation of laparotomy wounds in operations exceeding 2 h duration reduced SSI after major hepatobiliary pancreatic surgery. (Australian New Zealand Clinical Trials Registry, ACTRN12612000170820).     

Statistical Analysis of Surgical Site Infection After Head and Neck Reconstructive Surgery

Background

Surgical site infections (SSIs) occur at a rate exceeding 40 % after head and neck reconstruction and are due in part to the clean-contaminated surgical field, in which cutaneous fields interact with oral or pharyngeal fields. The aim of this study was to clarify the most important risk factors for SSI and to identify effective strategies for preventing SSI.

Methods

In 2011 and 2012, 197 patients who underwent head and neck reconstructive surgery were studied at National Cancer Center Hospital East, Japan. The SSI rate, risk factors for SSI, and biological aspects of SSI were evaluated prospectively.

Results

A total of 42 patients (21.3 %) had SSIs, and 62 bacterial species were identified at infection sites. Significant risk factors for SSI identified with multivariate analysis were hypoalbuminemia [P = 0.002, odds ratio (OR) = 3.37], reconstruction with vascularized bone transfer (P = 0.006, OR = 3.99), and a poor American Society of Anesthesiologists Physical Status score (P = 0.041, OR = 3.00). Most bacteria identified were species that persist around cutaneous and pharyngeal fields, but multidrug-resistant bacteria were rare.

Conclusions

The SSI rate at our hospital is lower than rates in previous studies. To minimize SSI, intervention to improve the patient’s perisurgical nutritional status and a more appropriate mandible reconstructive strategy should be considered.     

Safety of postoperative thromboprophylaxis after major hepatobiliary–pancreatic surgery in Japanese patients

Background and purpose

Thromboprophylaxis is recommended for preventing postoperative venous thromboembolism (VTE) after abdominal surgery; however, its use after major hepatobiliary–pancreatic surgery is typically avoided as it increases the risk of bleeding. We conducted this study to evaluate the safety of thromboprophylaxis after major hepatobiliary–pancreatic surgery.

Methods

We analyzed the rates of postoperative bleeding, VTE, morbidity, and prolonged hospital stay in 349 patients who underwent major hepatobiliary–pancreatic surgery, such as pancreaticoduodenectomy, hemihepatectomy or greater, and hepatopancreaticoduodenectomy.

Results

Chemical thromboprophylaxis was associated with significantly increased rates and risks of overall bleeding events vs. no chemical thromboprophylaxis (26.6 vs. 8.5 %, respectively). The rate of minor hemorrhage was significantly higher in patients who received chemical thromboprophylaxis (21.7 vs. 3.5 %); however, there were no differences in the rate of major hemorrhage requiring blood transfusion or hemostatic intervention between the groups (4.8 vs. 4.9 %). The postoperative VTE rate was also significantly decreased by chemical thromboprophylaxis (2.9 vs. 7.7 %). However, chemical thromboprophylaxis did not affect the rate of SSI, severe morbidity, or duration of the postoperative hospital stay.

Conclusion

We consider that chemical thromboprophylaxis is beneficial and can be safely used even after major hepatobiliary–pancreatic surgery.     

Postoperative surgical site infections after ventral/incisional hernia repair: a comparison of open and laparoscopic outcomes

Background

The purpose of this study was to compare the incidence of postoperative surgical site infections (SSIs), operative times (OTs), and length of hospital stay (LOS) after open and laparoscopic ventral/incisional hernia repair (VIHR) using multicenter, prospectively collected data.

Methods

The incidence of postoperative SSIs, OTs, and LOS was determined for cases of VIHR in the American College of Surgeons’ National Surgical Quality Improvement Program database in 2009 and 2010. Open and laparoscopic techniques were compared using a propensity score model to adjust for differences in patient demographics, characteristics, comorbidities, and laboratory values.

Results

A total of 26,766 cases met the inclusion criteria; 21,463 cases were open procedures (reducible, n = 15,520 [72 %]; incarcerated/strangulated, n = 5,943 [28 %]), and 5,303 cases were laparoscopic procedures (reducible, n = 3,883 [73 %]; incarcerated/strangulated, n = 1,420 [27 %]). Propensity score adjusted odds ratios (ORs) were significantly different between open and laparoscopic VIHR for reducible and incarcerated/strangulated hernias with regard to superficial SSI (OR 5.5, p < 0.01 and OR 3.1, p < 0.01, respectively), deep SSI (OR 6.9, p < 0.01, and OR 8.0, p < 0.01, respectively) and wound disruption (OR 4.6, p < 0.01 and OR 9.3, p = 0.03, respectively). The risk for organ/space SSI was significantly greater for open operations among reducible hernias (OR 1.9, p = 0.02), but there was no significant difference between the open and laparoscopic repair groups for incarcerated/strangulated hernias (OR 0.8, p = 0.41). The OT was significantly longer for laparoscopic procedures, both for reducible (98.5 vs. 84.9 min, p < 0.01) and incarcerated/strangulated hernias (96.4 vs. 81.2 min, p < 0.01). LOS (mean, 95 % confidence interval) was significantly longer for open repairs for both reducible (open = 2.79, 2.59–3.00; laparoscopic = 2.39, 2.20–2.60; p < 0.01) and incarcerated/strangulated (open = 2.64, 2.55–2.73; laparoscopic = 2.17, 2.02–2.33; p < 0.01) hernias.

Conclusions

Laparoscopic VIHR for reducible and incarcerated/strangulated hernias is associated with shorter LOS and decreased risk for superficial SSI, deep SSI, and wound disruption, but longer OTs when compared to open repair.     

Volume of the excised specimen and prediction of surgical site infection in pilonidal sinus procedures (surgical site infection after pilonidal sinus surgery)

Purpose

In previous studies, a lack of antibiotic prophylaxis, smoking and obesity were described as factors that contribute to the development of a surgical site infection (SSI) after pilonidal disease (PD) surgery. In this study, we evaluated whether the volume of the excised specimen (VS) was a risk factor for SSI.

Methods

The patients who underwent surgical treatment for PD from January 2010 through December 2011 were retrospectively evaluated in terms of SSI, time off work and healing time. The single and multiple explanatory variable(s) logistic regression analyses were performed.

Results

One-hundred and sixty patients were included in the study. SSI occurred in 19 (11.9 %) patients. In the multiple explanatory variable logistic regression analysis, VS was emerged as a risk factor for SSI (OR 18.78, 95 % CI 2.38–148.10; P < 0.005). The healing time and time off work were longer when a SSI occurred (P < 0.001).

Conclusions

This study suggests that the rate of SSI after the surgical treatment of PD is higher in patients with a high VS. A SSI significantly prolongs the healing time. Surgeons can use this data for assessing the SSI risk. As a preventive measure, prolonged use of an empiric broad-spectrum antibiotic may be beneficial in patients with a high VS.     

Perioperative Outcomes of Pancreaticoduodenectomy Compared to Total Pancreatectomy for Neoplasia

Purpose

Total pancreatectomy (TP) eliminates the risk and morbidity of pancreatic leak after pancreaticoduodenectomy (PD). However, TP is a more extensive procedure with guaranteed endocrine and exocrine insufficiency. Previous studies conflict on the net benefit of TP.

Methodology

A comparison of patients undergoing non-emergent, curative-intent TP or PD for pancreatic neoplasia using the National Surgical Quality Improvement Project data from 2005–2011 was done. Main outcome measures were mortality and major and minor morbidities.

Results

Of the 6,314 (97 %) who underwent PD and the 198 (3 %) who underwent TP, malignancy was present in 84 % of patients. The two groups were comparable at baseline. Mortality was higher after TP (6.1 %) than DP (3.1 %), p?=?0.02. Adjusting for differences on multivariable analysis, TP carried increased mortality (OR 2.64, 95 % CI 1.3–5.2, p?=?0.005). TP was also associated with increased rates of major morbidity (38 vs. 30 %, p?=?0.02) and blood transfusion (16 vs. 10 %, p?=?0.01). Infectious and septic complications occurred equally in both groups.

Conclusion

The morbidity of a pancreatic fistula can be eliminated by TP. However, based on our findings, TP is associated with increased major morbidity and mortality. TP cannot be routinely recommended for to reduce perioperative morbidity when pancreaticoduodenectomy is an appropriate surgical option.     

Increased rate of clinically relevant pancreatic fistula after deep enucleation of small pancreatic tumors

Purpose

Only small, potentially benign pancreatic tumors located ≥3 mm distant from the main pancreatic duct (MPD) are considered good candidates for enucleation. This study evaluates the outcome of enucleations with regard to their distance to the MPD.

Methods

Clinical characteristics, complications, and outcomes of prospectively documented patients with small (≤30 mm), potentially benign pancreatic tumors, who underwent enucleation, were retrospectively analyzed. Patients were divided in two groups, either deep enucleation (DE, distance ≤3 mm) or standard enucleation (SE, distance >3 mm), as determined by intraoperative ultrasonography (IOUS).

Results

Sixty patients underwent DE (n?=?30) or SE (n?=?30) with IOUS. Both groups did not differ regarding age, tumor size, pathology, and operating time. Complications occurred in 24/30 (80 %) patients of the DE group compared to 15/30 (50 %) patients after SE (P?=?0.029). Mortality was nil. The most frequent complication was pancreatic fistula (POPF) occurring in 22/30 (73.3 %) patients after DE and 9/30 (30 %) patients undergoing SE (P?=?0.002). Especially, the rate of clinically significant POPF types B and C was higher after DE (21 of 30 patients) compared to SE (7 of 30 patients, P?=?0.0006). Univariate and multivariate analyses revealed DE as the only significant factor that negatively influenced the occurrence of POPF. Postoperative hospital stay tended to be longer after DE (15 vs. 11.5 days, P?=?0.050). All but two patients with metastatic gastrinoma and two patients, who died of unrelated causes, showed no evidence of disease after a median follow-up of 24 (3–235)?months.

Conclusions

Deep enucleation of small, potentially benign pancreatic tumors should be considered with caution given the high rate of clinically relevant POPF.     

Implantation of Prophylactic Nonabsorbable Intraperitoneal Mesh in Patients With Peritonitis Is Safe and Feasible

Background

Patients with peritonitis undergoing emergency laparotomy are at increased risk for postoperative open abdomen and incisional hernia. This study aimed to evaluate the outcome of prophylactic intraperitoneal mesh implantation compared with conventional abdominal wall closure in patients with peritonitis undergoing emergency laparotomy.

Method

A matched case-control study was performed. To analyze a high-risk population for incisional hernia formation, only patients with at least two of the following risk factors were included: male sex, body mass index (BMI) >25 kg/m², malignant tumor, or previous abdominal incision. In 63 patients with peritonitis, a prophylactic nonabsorbable mesh was implanted intraperitoneally between 2005 and 2010. These patients were compared with 70 patients with the same risk factors and peritonitis undergoing emergency laparotomy over a 1-year period (2008) who underwent conventional abdominal closure without mesh implantation.

Results

Demographic parameters, including sex, age, BMI, grade of intraabdominal infection, and operating time were comparable in the two groups. Incidence of surgical site infections (SSIs) was not different between groups (61.9 vs. 60.3 %; p = 0.603). Enterocutaneous fistula occurred in three patients in the mesh group (4.8 %) and in two patients in the control group (2.9 %; p = 0.667). The incidence of incisional hernia was significantly lower in the mesh group (2/63 patients) than in the control group (20/70 patients) (3.2 vs. 28.6 %; p < 0.001).

Conclusions

Prophylactic intraperitoneal mesh can be safely implanted in patients with peritonitis. It significantly reduces the incidence of incisional hernia. The incidences of SSI and enterocutaneous fistula formation were similar to those seen with conventional abdominal closure.     

Subcuticular Absorbable Suture with Subcutaneous Drainage System Prevents Incisional SSI after Hepatectomy for Hepatocellular Carcinoma

Background

The effectiveness of subcuticular absorbable suture with subcutaneous drainage to decrease the risk of postoperative incisional surgical site infection (SSI) in hepatocellular carcinoma (HCC) patients was evaluated.

Methods

A total of 149 patients with HCC who underwent hepatectomy (Hx) were retrospectively investigated. Patients were divided into two groups: the patients with subcuticular suture combined with subcutaneous drainage (the drainage group; 61 patients) and the patients with nylon suture without subcutaneous drainage (the nylon group; 88 patients). After the operations, the complication rate of postoperative incisional SSI was analyzed and compared between the two groups.

Results

In the drainage group the rate of incisional SSI was significantly lower compared to the nylon group: 14–3?% (p?=?0.033), respectively. Patients with incisional SSI needed significantly longer postoperative hospital care than the patients without incisional SSI: 28 versus 15?days (p?p?=?0.034).

Conclusions

We have demonstrated that the subcuticular suture with subcutaneous drainage is effective in preventing incisional SSI in patients undergoing Hx for HCC.