Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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Surgery on the pancreas is a major abdominal procedure leading to a number of pathophysiological alterations during the early post-operative period. Novel approaches to perioperative care including shortened pre-operative starving periods, pre-operative glucose load, sophisticated pain management and early enteral feeding have resulted in major improvements of surgical results after major colorectal surgery. These alterations of perioperative care have been introduced to visceral surgery as so-called fast track surgery or multimodal rehabilitation (multimodal rehabilitation, ERAS = enhanced recovery after surgery). So far it is not known whether or not these approaches can also be applied in pancreatic cancer surgery. ⋯ While routine laboratory parameters showed similar changes during the postoperative course after pancreatic surgery, the clinical outcome parameters clearly indicated that the concept of fast track rehabilitation can be even beneficially applied to these high-risk patients undergoing elective surgery for pancreatic cancer.
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Urgent abdominal disorders are a daily work routine at surgical departments. Therefore, all surgeons are familiar with the problematics, including all its pitfalls, e.g. high morbidity rates and mortality rates of the patients managed. The authors record urgent abdominal disorders mortality rates as well as rates of serious surgical complications requiring re-operations and their effect on the patients' prognosis. ⋯ Peritonitis in some form (50%), dehiscence of the laparotomy (31.2%), necrosis of the intestine, ileus, bleeding and some less frequent complications, were the most frequent indications for re-laparotomies. The thirty-day mortality rate in patients, operated for urgent abdominal disorders, was 4.8%. In the re-operated group, the mortality rate reached 19.4%.