Planned Reoperation for Trauma

Hydatid disease of the liver is still a major cause of morbidity in Greece. Beside the common complications of rupture and suppuration, calcification of the hepatic cysts represent a not well studied, less frequent and sometimes difficult surgical problem. In the present study 75 cases with calcified symptomatic liver echinococcosis were operated on in the 1st Propedeutic Surgical Clinic between 1964 to 1996. Twenty-eight patients were male and 47 female with ages from 23 to 78 years. The diagnosis was based mainly on the clinical picture and radiological studies. In 5 cases the operative method was cystopericystectomy. We performed evacuation of the cystic cavity and partial pericystectomy and primary closure of the residual cavity in 6 cases, omentoplasty or filling of the residual cavity with a piece of muscle of the diaphragm in 4 cases and external drainage by closed tube, in 60 cases. In 12 of those with drainage, after a period of time, a second operation with easy, removal of most of the calcareous wall plaques was performed. The mortality rate was 2%.Our results could be considered satisfactory. In the calcified parasitic cysts of the liver the proposed technique is cystopericystectomy. An alternative procedure is pericystectomy and drainage with a “planned” reoperation with a bloodless, due to intervening inflammation, chiseling of the calcification.

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Planned Reoperation for Severe Trauma

Annals of Surgery ◽

10.1097/00000658-199507000-00002 ◽

1995 ◽

Vol 222 (1) ◽

pp. 3-8 ◽

Cited By ~ 100

Author(s):

Asher Hirshberg ◽

Kenneth L Mattox

Keyword(s):

Severe Trauma ◽

Planned Reoperation

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War liver injuries

Vojnosanitetski pregled ◽

10.2298/vsp0501003s ◽

2005 ◽

Vol 62 (1) ◽

pp. 3-10 ◽

Cited By ~ 1

Author(s):

Nebojsa Stankovic

Keyword(s):

Mortality Rate ◽

Total Mortality ◽

Primary Treatment ◽

Severe Bleeding ◽

Peritoneal Drainage ◽

Life Saving ◽

Liver Injuries ◽

Planned Reoperation ◽

Abdominal Packing ◽

Grade Iii

Aim. To provide a retrospective analysis of our results and experience in primary surgical treatment of subjects with war liver injuries. Methods. From July 1991 to December 1999, 204 subjects with war liver injuries were treated. A total of 82.8% of the injured were with the liver injuries combined with the injuries of other organs. In 93.7%, the injuries were caused by fragments of explosive devices or bullets of various calibers. In 140 (68.6%) of the injured there were minor lesions (grade I to II), treated with simple repair or drainage. There were complex injuries of the liver (grade III-V) in 64 (31.4%) of the injured. Those injuries required complex repair (hepatorrhaphy, hepatotomy, resection debridement, resection, packing alone). The technique of perihepatic packing and planned reoperation had a crucial and life-saving role when severe bleeding was present. Routine peritoneal drainage was applied in all of the injured. Primary management of 74.0% of the injured was performed in war hospitals. Results. After primary treatment, 72 (35.3%) of the injured were with postoperative complications. Reoperation was done in 66 injured. Total mortality rate in 204 injured was 18.1%. All the deceased had significant combined injuries. Mortality rates due to the liver injury of the grade III, IV and V were 16.6%, 70.0% and 83.3%, respectively. Conclusion. Complex liver injuries caused very high mortality rate and the management of the injured was delicate under war circumstances (if the injured reached the hospital alive). Our experience under war circumstances and with war surgeons of limited knowledge of the liver surgery and war surgery, confirmed that it was necessary to apply compressive abdominal packing alone or in combination with other techniques for hemostasis in the treatment of liver injuries grade III-V, resuscitation and rapid transportation to specialized hospitals.

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Indications for the Appropriate Use of Damage Control Surgery and Damage Control Interventions in Civilian Trauma Patients

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v5i1.168 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Derek Jason Roberts ◽

Juan Duchesne ◽

Megan L. Brenner ◽

Bruno Pereira ◽

Bryan A. Cotton ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Damage Control ◽

Damage Control Surgery ◽

Healthcare Resource Utilization ◽

Trauma Patients ◽

Appropriate Use ◽

Initial Surgery ◽

Civilian Trauma ◽

Planned Reoperation

In patients undergoing emergent operation for trauma, surgeons must decide whether to perform a definitive or damage control (DC) procedure. DC surgery (abbreviated initial surgery followed by planned reoperation after a period of resuscitation in the intensive care unit) has been suggested to most benefit patients more likely to succumb from the “vicious cycle” of hypothermia, acidosis, and coagulopathy and/or postoperative abdominal compartment syndrome (ACS) than the failure to complete organ repairs. However, there currently exists no unbiased evidence to support that DC surgery benefits injured patients. Further, the procedure is associated with substantial morbidity, long lengths of intensive care unit and hospital stay, increased healthcare resource utilization, and possibly a reduced quality of life among survivors. Therefore, it is important to ensure that DC laparotomy is only utilized in situations where the expected procedural benefits are expected to outweigh the expected procedural harms. In this manuscript, we review the comparative effectiveness and safety of DC surgery when used for different procedural indications. We also review recent studies suggesting variation in use of DC surgery between trauma centers and the potential harms associated with overuse of the procedure. We also review published consensus indications for the appropriate use of DC surgery and specific abdominal, pelvic, and vascular DC interventions in civilian trauma patients. We conclude by providing recommendations as to how the above list of published appropriateness indications may be used to guide medical and surgical education, quality improvement, and surgical practice.

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Cytokine clearance in serum and peritoneal fluid of patients undergoing damage control surgery with abdominal negative pressure therapy for abdominal sepsis

Pleura and Peritoneum ◽

10.1515/pp-2020-0122 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Seraina Faes ◽

Martin Hübner ◽

Nicolas Demartines ◽

Dieter Hahnloser

Keyword(s):

Pilot Study ◽

Negative Pressure ◽

Peritoneal Fluid ◽

Damage Control ◽

Damage Control Surgery ◽

Abdominal Sepsis ◽

Negative Pressure Therapy ◽

Pressure Therapy ◽

Wide Range ◽

Planned Reoperation

AbstractObjectivesOpen abdomen technique with negative pressure therapy (NPT) is widely used in patients with severe abdominal sepsis. The aim of this study was to evaluate cytokine clearance in serum and peritoneal fluid during NPT.MethodsThis prospective pilot study included six patients with severe abdominal sepsis requiring discontinuity resection and NPT for 48 h followed by planned reoperation. Cytokines (IL6, IL8, IL10, TNFalpha, and IL1beta) were measured in the serum and peritoneal fluid during index operation, on postoperative days 0, 1, and 2.ResultsConcentrations of cytokines in peritoneal fluid were higher than in serum. IL10 showed a clearance both in serum (to 16.6%, p=0.019) and peritoneal fluid (to 40.9%, p=0.014). IL6 cleared only in serum (to 24.7%, p=0.001) with persistently high levels in peritoneal fluid. IL8 remained high in both serum and peritoneal fluid. TNFalpha and IL1beta were both low in serum with wide range of high peritoneal concentrations. Only TNFalpha in peritoneal fluid showed significant differences between patients with ischemia vs. perforation (p=0.006).ConclusionsThe present pilot study suggests that cytokines display distinct patterns of clearance or persistence in the peritoneal fluid and serum over the first 48 h of treatment in severe abdominal sepsis with NPT.

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The rationale for planned reoperation after unplanned total excision of soft-tissue sarcomas.

Journal of Clinical Oncology ◽

10.1200/jco.1985.3.10.1344 ◽

1985 ◽

Vol 3 (10) ◽

pp. 1344-1348 ◽

Cited By ~ 151

Author(s):

A E Giuliano ◽

F R Eilber

Keyword(s):

Soft Tissue ◽

Residual Disease ◽

Soft Tissue Sarcomas ◽

Residual Tumor ◽

Total Excision ◽

Histologic Diagnosis ◽

Definitive Therapy ◽

High Incidence ◽

Soft Tissue Masses ◽

Planned Reoperation

Multimodality management of soft-tissue sarcomas of the extremity is often based on the presence or absence of residual primary disease. Reoperation is warranted or radiotherapy doses altered if the physician is aware that the tumor was incompletely excised. Most patients with soft-tissue masses undergo an initial excision before definitive therapy. These initial unplanned total excisions are usually excisional biopsies for presumably benign disease. Ninety patients were reviewed to evaluate the adequacy of unplanned total excision. All patients underwent unplanned supposed total excisions. Most patients were then treated with preoperative intraarterial Adriamycin (Adria Laboratories, Columbus, Ohio) and radiation therapy, followed by wide reexcision of the prior operative field. Forty-six patients (51.1%) had no gross residual tumor in the reoperative specimen. In two patients, there was microscopic but not macroscopic disease. Forty-four patients (48.9%) had identifiable macroscopic residual disease in the reoperative specimen. When comparing these 44 patients with visible (macroscopic) residual tumor to the remaining 46, no differences were seen in age, sex, stage, histologic type, time from excision to reoperation, or size of initial lesion. This previously unrecognized high incidence of gross residual disease must be considered when planning definitive therapy. Unplanned total excisions are inadequate to remove local disease and, despite multimodality therapy, may result in local failure. Reoperation should be a planned part of definitive management for patients with soft-tissue sarcoma of the extremity whenever the initial surgical procedure was done without a histologic diagnosis or was not planned to be a wide excision. If reoperation cannot be performed, radiotherapy doses to treat gross residual disease should be used.

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