Effect of Surgical Approach on 30-Day Mortality and Morbidity After Elective Colectomy: a NSQIP Study

We reviewed 739 cases of surgery for pulmonary infection between 1970 and 1990 at the Persahabatan Hospital, Jakarta. In 32 cases (13.61%) surgery was performed for pulmonary mycosis. There were 20 males and 12 females; the majority were between 31 and 50 years of age and all were symptomatic. Primary mycosis infection was found in only 1 case (3%) with a diagnosis of coccidioidomycosis; the other 31 patients had aspergillosis secondary to tuberculosis. Pneumonectomy was performed in 2 cases (6%), lobectomy in 28 cases (88%), and cavernoplasty in 2 cases (6%). Four operations were performed on an emergency basis, 15 were regarded as semi-emergencies, and 13 were carried out electively. Postoperative complications consisted of 2 cases of bronchopleural fistula, one of which was self-healing and the other needed a muscle plombage. There was 1 death (mortality 3%) from septic shock 3 weeks after the operation. The low mortality and morbidity support a surgical approach to the treatment of pulmonary mycosis in symptomatic patients.

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Self-Expandable Metal Stents for Left Sided Colon Obstruction from Diverticulitis. A Single Center Retrospective Series

Medicina ◽

10.3390/medicina57030299 ◽

2021 ◽

Vol 57 (3) ◽

pp. 299

Author(s):

Antonietta Lamazza ◽

Maria Vittoria Carati ◽

Anna Guzzo ◽

Anna Maria Pronio ◽

Virgilio Nicolanti ◽

...

Keyword(s):

Postoperative Mortality ◽

Complicated Diverticulitis ◽

Metal Stents ◽

Colonic Diverticulitis ◽

Sems Placement ◽

Major Morbidity ◽

Mortality And Morbidity ◽

Segmental Colectomy ◽

Elective Colectomy ◽

Definitive Form

Background and Objectives: The incidence of diverticulitis is increasing in western countries. Complicated diverticulitis is defined as diverticulitis associated with localized or generalized perforation, localized or distant abscess, fistula, stricture or obstruction. Colonic symptomatic strictures are often treated with segmental colectomy. The aim of our study is to report our experience with Self Expandable Metal Stents (SEMS) placement to relieve sigmoid obstruction secondary to diverticulitis, either as a permanent solution or as a bridge to elective colectomy. Material and Methods: From January 2016 to December 2018, 21 patients underwent SEMS placement for sigmoid obstruction secondary to diverticulitis at our institution. In four patients with poor general conditions, SEMS was considered the definitive form of treatment. In 17 patients, the stent was placed as bridge to elective colectomy. Data were prospectively collected and retrospectively analyzed. Primary outcomes were postoperative mortality and morbidity after SEMS and subsequent elective colectomy. Results: There was no mortality or major morbidity after SEMS placement or subsequent elective colectomy. No stoma was performed. Conclusions: Placement of Colorectal Self Expandable Stent represents a useful tool to relieve obstruction in patients with left-sided colonic diverticulitis. SEMS placement makes it possible to transform an emergency clinical condition into an elective condition, giving time to resolve the inflammation and the infection inevitably associated with complicated diverticulitis.

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Comparison between PeRcutanEous and surgical femoral aCcess for endovascuLar aOrtic repair in patientS with typE III aortic Dissection (PRECLOSE Trial)

Vascular ◽

10.1177/1708538120965310 ◽

2020 ◽

pp. 170853812096531

Author(s):

Ahmet A Sahin ◽

Ahmet Guner ◽

Ali R Demir ◽

Nedim Uzun ◽

Burak Onan ◽

...

Keyword(s):

Aortic Dissection ◽

Femoral Artery ◽

Surgical Approach ◽

Femoral Access ◽

Percutaneous Approach ◽

Mortality And Morbidity ◽

Type Iii ◽

Significant Difference ◽

Sheath Insertion ◽

Aortic Dissections

Objectives Aortic dissections are cardiovascular events with high mortality and morbidity rates. Management might be either with medical or interventional approach. Recently, thoracic endovascular intervention (TEVAR) becomes the first treatment of choice because of its better results and lower rates of complications in patients with type III aortic dissections. The intervention might be performed via femoral artery either with percutaneous or with surgical approach. Because of large sheath insertion to femoral artery, Pre-close technique is described in literature. The aim of this study was to investigate and compare the outcomes and safety of ‘Pre-close technique’ to surgical approach in patients with type III aortic dissections who underwent TEVAR with femoral access ≥22 F. Methods A total of 96 patients whom had type III aortic dissection and was performed TEVAR were retrospectively included in the study. Fifty-six patients had TEVAR with percutaneous approach and these patients are named as P-TEVAR group, and 40 patients had TEVAR with surgical approach and these patients are named as S-TEVAR group. Pre- and post-procedural data with complications and procedural data during TEVAR were evaluated for both groups and compared in between. Results The main finding was that there was no significant difference between S-TEVAR and P-TEVAR groups in terms of complications and technical success. Operating room time was significantly decreased in P-TEVAR group ( P < 0.001). Overall success rate for femoral approach in patients with Pre-close technique was 94.6% and was 100% for surgical approach. P-TEVAR group had post-operative complications in three patients and S-TEVAR group had in four patients. Conclusions Total percutaneous approach with Pre-close technique using Pro-Glide device is a safe and feasible method of femoral access in patients with type III aortic dissections.

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