Hepato Gastroenterol
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Hepato Gastroenterol · Nov 2008
Case ReportsThe abdominal compartment syndrome (ACS) in general surgery.
The abdominal compartment syndrome is a life threatening clinical entity which can develop within the first 12 hours of intensive care unit admission in high-risk surgical patients. The aim of this paper is to show the definitions, ethiology, pathophysiology, diagnosis and treatment of this serious, not only surgical problem. ⋯ Intraabdominal hypertension and abdominal compartment syndrome are frequent clinical findings among acute general surgical patients. Patients with comparable demographics and acute severity of illness are more likely to die if intraabdominal hypertension or abdominal compartment syndrome is present. We conclude that the early recognition and surgical decompression is urgent.
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Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (HIPEC) is an aggressive treatment for patients with peritoneal malignancies. While promising, this therapeutic approach is still associated with significant morbidity and mortality. Surgical risk in elderly patients is even higher, since these people suffer from frequent comorbidities, resulting in poorer performance status. Whether this type of major cancer surgery is feasible in elderly patients is an ongoing question. ⋯ Incorporating new strategies to reduce morbidity makes aggressive cytoreduction procedure feasible in the majority of elderly patients. Age and advanced peritoneal malignancy should not preclude patients from the maximal surgical effort.
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Hepato Gastroenterol · Nov 2008
Management of sigmoid diverticulitis: a retrospective study of 268 patients.
The therapeutic management of acute diverticulitis has evolved over the last years in favour of an initial conservative approach with laparoscopy rather than a primary anastomosis. We studied the management of sigmoid diverticulitis in the Digestive Surgical Unit to assess it in comparison to actual practice. ⋯ Based on our study and published reviews, we recommend elective colectomy after 2 recurrent episodes of acute diverticulitis, one episode of complicated acute diverticulitis managed conservatively, or if the patient is younger than 50 years-old. This approach would reduce the number of acute operations, which are associated with high morbidity and mortality.
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Hepato Gastroenterol · Sep 2008
Strategies to reduce perioperative morbidity in cytoreductive surgery.
Peritoneal carcinoma has been regarded as a uniformly lethal clinical entity. Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (HIPEC) is an aggressive treatment for patients with peritoneal malignancies. While promising, this therapeutic regimen has been associated with significant morbidity, long hospital stay and an increased risk for perioperative mortality. The purpose of this study was to evaluate the possibility to reduce morbidity by use of strategy aiming to reduce inflammatory response associated with cytoreductive surgery plus HIPEC. ⋯ The results of this study demonstrate the possibility to reduce the perioperative risk of cytoreductive surgery plus IPHC. The described strategy aiming the reduction of inflammatory response was able to reach a morbidity level which stands in line with other major oncologic operations.
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Hepato Gastroenterol · Sep 2008
Prolonged antibiotic prophylaxis longer than 24 hours does not decrease surgical site infection after elective gastric and colorectal surgery.
Prophylactic administration of antibiotics can decrease postoperative morbidity, shorten hospitalization, and reduce overall costs. In Western countries, it is stressed that antimicrobial prophylaxis was discontinued within 24 hrs after surgery in currently published guidelines. However, it is unclear how long we need to continue perioperative prophylaxis for gastrointestinal surgery. In this manuscript, we analyzed surgical site infection (SSI) in gastric and colorectal surgery according to the duration of antibiotics prophylaxis and discuss the duration of an antibiotic prophylaxis, and its relation to SSI. ⋯ From our findings, SSI rate did not decrease with longer duration of antimicrobial prophylaxis. We concluded that we must recognize that the cause of postoperative wound infection is multimodal, and should not rely on antibiotics to prevent postoperative SSI but that surgeons should reduce the risk for postoperative SSI.