Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
-
J. Gastrointest. Surg. · Feb 2012
Surgical Apgar score predicts perioperative morbidity in patients undergoing pancreaticoduodenectomy at a high-volume center.
Pancreaticoduodenectomy (PD) remains a procedure that carries considerable morbidity. Numerous studies have evaluated factors to predict patients at risk. The aim of this study was to determine whether the surgical Apgar score (SAS) predicts perioperative morbidity and mortality. ⋯ We demonstrate that the SAS is a significant predictor of perioperative morbidity for patients undergoing PD. This score should be used to identify patients at higher risk in order to prioritize use of postoperative critical care beds and hospital resources.
-
J. Gastrointest. Surg. · Feb 2012
Randomized Controlled TrialColorectal Infraperitoneal anastomosis: the effects of perioperative supplemental oxygen administration on the anastomotic dehiscence.
The role of supplemental oxygen therapy in the healing of colorectal anastomosis is still very much at an experimental stage. The aim of the present study, prospective randomized, was to assess the effect of administration of perioperative supplemental oxygen therapy on infraperitoneal anastomosis, where the risk of leakage is higher. ⋯ Therefore, supplemental 80% FiO2 during and for 6 h after major rectal cancer surgery, reducing postoperative anastomotic dehiscence, should be considered part of ongoing quality improvement activities related to surgical care, with few risks to the patient and little associated cost.
-
J. Gastrointest. Surg. · Feb 2012
Randomized Controlled TrialP.O.P.A. study: prevention of postoperative abdominal adhesions by icodextrin 4% solution after laparotomy for adhesive small bowel obstruction. A prospective randomized controlled trial.
Adhesive small bowel obstruction (ASBO) is an important cause of hospital admission, is associated with significant morbidity and mortality, and therefore is a substantial burden for healthcare systems worldwide. Icodextrin 4% solution (Adept, Shire Pharmaceuticals, UK) is a high-molecular-weight a-1,4 glucose polymer approved in Europe for use as intraoperative lavage and postoperative instillation to reduce the occurrence of post-surgery intra-abdominal adhesions. The present clinical study aimed to evaluate the safety and effectiveness of icodextrin 4% in decreasing the incidence, extent, and severity of adhesions in patients after abdominal surgery for ASBO. ⋯ The data resulting from this RCT showed that the use of icodextrin 4% solution in ASBO is safe and reduces intra-abdominal adhesion formation and the risk of re-obstruction.
-
J. Gastrointest. Surg. · Feb 2012
The influence of staple size on fistula formation following distal pancreatectomy.
Pancreatic fistula continues to be a source of significant morbidity following distal pancreatic resections. The technique of pancreatic division varies widely among surgeons, and there is no evidence that identifies a single method as superior. In our practice, the technique of distal pancreatic resection has evolved from cut-and-sew to stapled technique with green and recently white cartridge. The aim of our study was to evaluate the rate of clinically significant fistulas [International Study Group on Pancreatic Fistula (ISGPF) grade B or C] following distal pancreatectomy and to identify variables associated with a low rate of fistula development. ⋯ The optimal technique of pancreatic division has not been conclusively established. Dividing the pancreas utilizing vascular (2.5 mm) staple cartridges significantly decreased the rate of clinically significant pancreatic fistula and we have changed our practice accordingly. A prospective randomized trial is necessary to validate these results.
-
Nonagenarians are the fastest growing sector of population across Western Europe. Although prevalence of gallstone disease is high, elective cholecystectomy is still controversial in this age group. ⋯ Our study demonstrates that in unselected nonagenarians,cholecystectomy is safe with acceptable perioperative morbidity and mortality even as an emergency procedure. However, our data also suggests that cholecystitis appears to be a neglected condition in this age group.