Surgical treatment of complications after operations on the biliary tract

Causes of relaparotomies after operations for cholelithiasis are analyzed. The frequency of relaparotomies after cholecystectomies was 2.1%. Technical defects in performing operations were the cause of postoperative complications in 52.4% of the cases. Of 63 patients subjected to relaparotomy 23 patients died (36.5%). Prophylactics of complications after operations on bile ducts should be directed first of all to careful observation of the cholecystectomy technique.     

Surgical morbidity after mastectomy operations

The records of 146 consecutive patients with mastectomy operations over a three year period were reviewed. Of these, ninety-three (63.6 per cent) had one or more complications secondary to surgery. There were 175 complications, of which complications, of which 107 (73.2 per cent) were wound-related. Seroma formation occurred most frequently but was of minor consequence. The incidence of flap necrosis was 19.1 per cent, with cellulitis or suppurative infection appearing in thirteen patients. Immediate postoperative edema of the arm was fairly rare (2.7 per cent) and appeared related to delayed wound healing. Postoperative complications after total, modified radical, and radical mastectomy present problems unique from those seen after other major surgery, in that local complications predominate. The very nature of the procedure, with the creation of large thin skin flaps, extensive axillary dissection, and an open wound for a prolonged period of time, predisposes to wound morbidity.     

Certain principles of prevention of recurrences after surgical treatment of tongue cancer]

Based on the analysis of late results, obtained in the combined treatment for cancer of the tongue in 138 patients, the materials of studying intra- and extraorganic lymphatic bed on 119 anatomical preparations of the tongue and bottom of the oral cavity, as well as the data of an acute experiment on 12 dogs, the authors offer reasonable grounds for some principles of prophylaxis against local recurrences in surgical removal of the tongue and bottom of the oral cavity for cancer. The suggested technic of surgical intervention can be used practically both by specialists of oncology and surgery, who are well experienced in the face and jaw surgery.     

Surgical treatment of peptic ulcer after gastroenterostomy]

Based on a comparison of the immediate and late results of treatment in patients with peptic ulcers following gastroenterostomy by means of gastric resection (24 patients) and by vagotomy, it is concluded that vagotomy in most cases results in a complete cure of patients, thus this procedure is felt to be more advantageous than gastric resection due to its technical feasibility and small operative risk.     

Surgical treatment of local recurrence after mastectomy]

This paper deals only with local recurrence of a mammary carcinoma, not with all locoregional recurrences. The surgical treatment of a true local recurrence depends on the freedom from metastases, on the type of the primary operation, whereas the localisation and the size of the recurrence are of minor importance. If no metastases can be found, the operative treatment of the recurrence is the method of choice leading to cure of part of the patient. Simple excision of the tumor is insufficient; the second operation must be radical. When a segmentectomy or a lumpectomy was performed as primary operation, the recurrence must be treated with a modified mastectomy. The status after modified mastectomy with or without primary reconstruction must be converted into a radical mastectomy. A local recurrence after radical mastectomy must be removed by chest wall resection.     

Surgical treatment for bleeding ileal varices: A case report

Introduction and importanceBleeding from ileal varices is a rare and a life-threatening situation. Its management is difficult and includes endoscopic, surgical and interventional radiology treatment.Here we report a successful emergency surgery for bleeding ileal varices in a patient with cirrhosis due to autoimmune hepatitis.Presentation of a caseA 60-year-old woman was admitted for rectal bleeding. She had a history of autoimmune hepatitis. She was treated by endoscopic ligation for oesophageal varices.Eso-gastro-duodenal fibroscopy and colonoscopy failed to reveal the bleeding site.CT scan was then performed showing ileal varices due to a portocaval shunt, there was a communication between the superior mesenteric vein and the right internal iliac vein.As the embolization was not feasible and the bleeding did not stop, an exploratory laparotomy was performed showing two dilated veins on the surface of the ileal wall, communicating with the right internal iliac vein. We performed a ligation of the vessels. Postoperative course was uneventful.DiscussionEctopic varices are a rare case of gastrointestinal bleeding. Most of those patients have portal hypertension and liver cirrhosis.Diagnosing bleeding ileal varices is difficult because endoscopic examination can't always reveal the bleeding site.Interventional radiology is a good option for patients having bleeding ileal varices knowing that they often have advanced liver cirrhosis making them poor candidates for surgery.Haemostasis by endoscopy is often temporary and bleeding frequently recurs.Surgery should be considered if non-invasive treatments failed to ensure the haemostasis.ConclusionBleeding ileal varices is a rare situation. Interventional radiology and endoscopy can be good options. If not feasible, surgical treatment should not be delayed.     

Osteoarthritis and recurrences after Putti-Platt and Eden-Hybbinette operations for recurrent dislocation of the shoulder

Summary. Thirty-five patients who had operations for recurrent anterior dislocation of the shoulder were reviewed, with a further 26 answering a questionnaire; the results were not as good as reported by others. The mean follow up was 26.9 years. Ten out of 43 patients had recurrent dislocations after the Putti-Platt and 6 out of 18 after the Eden-Hybbinette operation. Osteoarthritis developed in 15 shoulders of 26 patients who were followed-up after the former procedure and in 8 out of 9 shoulders after the latter. These sequelae depend on the age at the first dislocation rather than the number of dislocations. The overall satisfaction rate was acceptable for both procedures.

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Résumé. Notre étude à long terme (sur 61 patients, 35 suivis avec une moyenne de 26,9 ans) montre que les résultats des opérations de Putti-Platt et Eden-Hybbinette pour luxation récidivante de l’épaule ne sont pas, en considérant les récidives et le développement de l’arthrose, aussi bons que ceux rapportés dans la littérature [5, 8, 14, 18]. Dans notre série, 10 patients sur 43 ont eu une luxation récidivante après une intervention de Putti-Platt et 6 sur 18 après une opération de Eden-Hybbinette. Une omarthrose était présente chez 8 sur 9 patients du groupe Eden-Hybbinette et chez 15 sur 26 patients du groupe Putti-Platt. Nous pensons que le développement de l’omarthrose dépend plus de l’age du patient lors de la première luxation que du nombre de luxation avant l’intervention. Cependant, le taux de succès après une période d’observation moyenne de 26,9 ans était acceptable pour les 2 types de traitement.

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Accepted: 10 May 1996     

Surgical management after failed antireflux operations

From 1973 to 1989, 117 (28%) patients underwent re-operation for failed antireflux surgery from a total of 413 esophagogastric operations for gastro-esophageal reflux disease. Seventy-eight patients who underwent re-operation before 1984 were reviewed in detail for classification and long-term outcome. Forty re-operations followed a failed Nissen fundoplication, while no other procedure was the most recent prior operation in more than 10 patients. Re-operation rates were 3% following prior surgery in our clinic for reflux disease other than stricture and 9.6% if the prior operation was done for stricture. There was no difference in re-operation rates for the Belsey Mark IV or Nissen fundoplication, the 2 most commonly used repairs. In each case, complete pre-operative evaluations included symptom score, radiography, endoscopy, and esophageal function tests. Based on the results, the 78 patients were classified as pure sphincter mechanism failure to stop reflux (n=14), pure esophageal clearance failure (n=12), combined sphincter mechanism failure and clearance failure (n=29), alkaline reflux (n=9), or no reflux but another condition found (n=14). Patients having symptoms following a prior Nissen fundoplication or Angelchik prosthesis insertion were more likely to have esophageal clearance failure than those having other repairs. The classification proved to be a useful guide to the need for and types of re-operation chosen. Among the 117 patients undergoing re-operation, there were 2 (1.7%) deaths within 3 months of surgery and 25 (21%) complications. Long-term results were directly related to the number of previous operations, with resection and intestinal interposition being the preferred procedure in patients having had 2 or more previous attempts at antireflux surgery.

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Resumen Entre 1973 y 1989, 117 (28%) pacientes fueron sometidos a reoperación por falla de cirugía antirreflujo de un total de 413 operaciones esofagogástricas para enfermedad por reflujo; 78 pacientes sometidos a reoperación antes de 1984 y fueron revisados en detalle para clasificación y estudio del resultado a largo plazo. En cuarenta reoperaciones el procedimiento previo fue una fundoplicación de Nissen, pero ningún otro procedimiento individual antecedió la reoperación en más de 10 casos. Las tasas de reoperación en nuestra institución son de 3% después de cirugía por reflujo sin estrechez y 9.6% si la operación previa fue realizada por estrechez. No se halló diferencia entre las tasas de reoperación después de los procedimientos de Belsey Mark IV o de Nissen, que fueron los dos tipos más frecuentes de reparación. En cada paciente se debe efectuar una valoración preoperatoria completa que incluya gradación de la sintomatología, radiografía, endoscopia y pruebas de función esofágica. Con base en los resultados, los 78 pacientes flueron clasificados como falla pura del mecanismo esfinteriano en cuanto a impedir el reflujo (n=14), falla pura del vaciamiento esofágico (n=12), falla combinada del mecanismo esfinteriano y del vaciamiento (n=29) reflujo alcalino (n=9) y no reflujo y otra condición presente (n=14). Los pacientes sintomáticos después de una fundoplicación de Nissen o de la inserción de una prótesis de Angelchik exhibieron falla de vaciamiento con más frecuencia que aquellos con otros tipos de reparación. La clasificación probó ser una guía útil para determinar la necesidad y el tipo de reoperación. Se presentaron dos muertes (1.7%) entre los 117 pacientes sometidos a reoperación y 25 (21%) complicaciones, en los primeros tres meses después de la cirugía. Los resultados a largo plazo aparecieron directamente relacionados con el número de operaciones previas; la resección y la interposición intestinal fueron los procedimientos preferidos en los pacientes que tuvieron dos o más intentos previos de cirugía antirreflujo.

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Résumé Entre 1973 et 1985, 117 parmi 413 patients opérés d'un reflux gastro-oesophagien (28%) ont eu une réintervention pour un échec de la chirurgie anti-reflux. Soixante dix huit patients, qui ont été opérés avant 1984, ont été évalués en vue d'une classification. Il y a eu 40 réinterventions pour échec de l'opération de Nissen. Cette technique était la seule â être utilisée chez plus de 10 patients. Le taux de réintervention était de 3% dans notre service lorsqu'il n'y avait pas de sténose, et de 9.6% lorsqu'il existait une sténose. Il n'y avait pas de différence entre les taux de réintervention après Nissen ou Belsey Mark IV, les deux procédés utilisés le plus souvent. Dans chaque cas, l'évaluation comprennait un score des symptomes, une radiographie, une endoscopie, et des tests fonctionnels. Au vu de ces résultats, les 78 patients classés comme un échec étaient répartis selon qu'il s'agissait de défaut du mécanisme sphinctérien (n=14), de la clairance oesophagienne (n=12), des deux (n=29), d'un reflux alcalin (n=9) ou autres (n=14). L'échec par défaut de clairance était plus fréquent après Nissen ou insertion d'une prothèse d'Angelchik, qu'après les autres procédés chirurgicaux. La classification a été utile pour décider d'une réintervention et du type d'opération à faire. Des 117 patients réopérés, on a compté deux décès (1.7%) et 25 complications (21%) dans les 3 mois postopératoires. Les résultats à long-terme étaient en rapport direct avec le nombre de réinterventions. La résection et l'interposition intestinale était le procédé de choix chez le patient ayant eu deux opérations ou plus pour corriger son reflux.

     

Surgical treatment of stomal recurrences in cancer of the larynx

A study of 124 cases of cancer of the larynx treated by surgery in a general hospital revealed nine cases of stomal recurrence, that is, a recurrence at the junction of the amputated trachea and skin. Our studies suggest that the following factors may play a role in the development of this problem: preliminary tracheostomy or laryngofissure or the use of the endotracheal tube and possible tumor implantation, and inadequate initial surgery for large tumors of the vocal cords or subglottic lesions. Laryngectomy and routine radical neck dissection should be employed. If laryngectomy alone is performed, the hemithyroid should be removed on the side of the lesion in cases of small lesions. Our studies also suggest that there is a possible multicentricity of the primary lesion as indicated by the high incidence of larynx and lung cancers occurring as multiple primary lesions, and that similar etiologic factors may play a role in reducing the host resistance and allowing the stomal recurrence to develop.     

Surgical treatment of patients with local recurrences of rectal cancer

Local recurrences (LR) of cancer recti are revealed in 10-40% of patients, in 22-50% they are considered nonresectable. Surgical interventions--most effective method of treatment in patients, suffering resectable LR of cancer recti. The experience adduced concerning surgical treatment of 40 patients with LR of cancer recti in 1988-2004 yrs. In 82.5% of them LR have occurred after performance of sphincterpreserving operations. All the patients were operated for the second time. In 60% of them the rectal stump and the transplant extirpation, as in Kenu operation, was performed, in 15%--peritoneoanal resection of cancer recti. The postoperative complications rate had constituted 7.5%, in secondary LR of cancer recti--25%. The three-year and five-year survival had constituted accordingly (38.9 +/- 8.1) and (20.4 +/- 7.2)%.