scholarly journals Anastomotic leakage with abscess after laparoscopic sleeve gastrectomy for obesity: report of a series and review of literature

2020 ◽  
Vol 13 ◽  
pp. 263177452092596
Author(s):  
Yang Liu ◽  
Ning-Ning Yang ◽  
Yong-Song Guan ◽  
Qing He
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Abdominal Pain ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Percutaneous Drainage ◽  
Treatment Strategies ◽  
Postoperative Hospital Stay ◽  
Severe Complication ◽  
The Mean

Anastomotic leakage with abscess is a rare but severe complication of bariatric surgery. However, there is currently a lack of attention regarding this complication. This study aimed to investigate the risk factors for this complication and relevant treatment strategies to call attention to this severe complication. We retrospectively reviewed the patients who were rehospitalized for anastomotic leakage with abscess after bariatric surgeries in West China Hospital of Sichuan University from November 2017 to November 2018. The clinical profiles analyzed included body mass index, body weight before and after surgery, postoperative hospital stay, diet prescriptions, treatment strategies, and outcomes. A total of six patients (two men and four women) were included. The mean baseline body mass index was 37.52 (29.84–43.37), and the mean weight was 104.95 kg (74.5–127.5). The chief complaints leading to rehospitalization were fever and dull abdominal pain. The average postoperative hospital stay was 3.3 (3–4) days, and the onset time ranged from 7 to 15 days. Finally, revision surgeries were performed in two of the six patients (33%), and they were all cured by percutaneous drainage-based treatments. The postoperative fever and abdominal pain were the signs of leakage and abscess. Similar patients should be followed up once a week for 3 weeks after bariatric surgery to facilitate the early recognition of this complication. A longer hospital stay and sufficient parenteral nutrition plus a later implementation of diet should be helpful to minimize this severe complication. Percutaneous drainage played a significant role in the treatment of these patients.

scholarly journals Early oral feeding is safe and useful after rectosigmoid resection with anastomosis during cytoreductive surgery for primary ovarian cancer

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Kazuyoshi Kato ◽  
Kohei Omatsu ◽  
Sanshiro Okamoto ◽  
Maki Matoda ◽  
Hidetaka Nomura ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Cytoreductive Surgery ◽  
Group Versus ◽  
Postoperative Hospital Stay ◽  
Oral Feeding ◽  
Early Oral Feeding ◽  
Rectosigmoid Resection ◽  
Primary Ovarian Cancer

Abstract Background The aim of this study was to investigate the safety and clinical usefulness of early oral feeding (EOF) after rectosigmoid resection with anastomosis for the treatment of primary ovarian cancer. Methods We performed a retrospective review of all consecutive patients who had undergone rectosigmoid resection with anastomosis for primary ovarian, tubal, or peritoneal cancer between April 2012 and March 2019 in a single institution. Patient-related, disease-related, and surgery-related data including the incidence of anastomotic leakage and postoperative hospital stay were collected. EOF was introduced as a postoperative oral feeding protocol in September 2016. Before the introduction of EOF, conventional oral feeding (COF) had been used. Results Two hundred and one patients who underwent rectosigmoid resection with anastomosis, comprised of 95 patients in the COF group and 106 patients in the EOF group, were included in this study. The median number of postoperative days until the start of diet intake was 5 (range 2–8) in the COF group and 2 (range 2–8) in the EOF group (P < 0.001). Postoperative morbidity was equivalent between the groups. The incidence of anastomotic leakage was similar (1%) in both groups. The median length of the postoperative hospital stay was reduced by 6 days for the EOF group: 17 (range 9–67) days for the COF group versus 11 (8–49) days for the EOF group (P < 0.001). Conclusion EOF provides a significant reduction in the length of the postoperative hospital stay without an increased complication risk after rectosigmoid resection with anastomosis as a part of cytoreductive surgery for primary ovarian cancer.

scholarly journals Dorsal approach with Glissonian approach for laparoscopic right anatomic liver resections

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shaohe Wang ◽  
Yang Yue ◽  
Wenjie Zhang ◽  
Qiaoyu Liu ◽  
Beicheng Sun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Hepatic Vein ◽  
Pringle Maneuver ◽  
Caudate Lobe ◽  
Postoperative Hospital Stay ◽  
Dorsal Approach ◽  
Glissonian Approach ◽  
The Mean ◽  
Major Hepatic Vein

Abstract Background Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. However, how to expose the whole hepatic vein and avoid the hepatic vein laceration is still a challenge because of the caudate lobe, particularly in right hepatectomy. We adopted a dorsal approach combined with Glissionian appraoch to perform laparoscopic right anatomic hepatectomy (LRAH). Methods Twenty patients who underwent LRAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). The paracaval portion of caudate lobe could be transected firstly through dorsal approach and the corresponding major hepatic vein could be exposed from its root to the peripheral branches safely. Due to exposure along the major hepatic vein trunk, the remaining liver parenchyma could be quickly transected from dorsal to cranial side. Results The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05). Conclusions Dorsal approach combined with Glissonian approach for right lobe is feasible and effective in laparoscopic right anatomic liver resections.

scholarly journals ACUTE CHOLECYSTITIS

2010 ◽  
Vol 17 (02) ◽  
pp. 185-192
Author(s):  
TARIQ HASSAN CH ◽  
ASGHAR ALI ◽  
MUNAWAR JAMIL
Keyword(s):  
Hospital Stay ◽  
Wound Dehiscence ◽  
Biliary Tree ◽  
Postoperative Hospital Stay ◽  
Total Hospital ◽  
Acute Calculous Cholecystitis ◽  
Total Hospital Stay ◽  
Group A ◽  
The Mean ◽  
Group B

Introduction: Gallstones are common biliary pathology. The Vast majority of subjects are asymptomatic. About 0.2% of the population suffering from gallstones develop acute cholecystitis every year. In case of acute calculous cholecystitis, cholecystectomy can be performed early i.e during the same admission or interval i.e after 6 weeks of conservative management. Objective: To compare the early and interval cholecystectomy in acute calculous cholecystitis for morbidity, postoperative hospital stay, total hospital stay and complications. Study Design: Quasi-experimental study. Setting: Department of Surgery Bahawal Victoria Hospital Bahawalpur. Duration of Study: Two year study from December 2007 to December 2009. Subject and Methods: Sixty patients fulfilling the inclusion criteria were selected for this study. The patients were divided into two groups. Group A patients were managed by early cholecystectomy and group B patients by intervalcholecystectomy. Postoperatively patients were evaluated for postoperative hospital stay, total hospital stay and postoperative complications. Results: The mean age of the patients in group A was 42.2 + 10.7 years and in group B was 42.2+ 10.7 years. The Male to female ratio was 1:4 in both groups. The mean postoperative hospital stay in group A was 4.0+ 1.8days and in group B was 3.8+ 1.4 days. The mean total hospital stayin group A was 6.5 + 1.7 days and in group B was 10.2 + 1.3 days. The P value was less than 0.001, which was significant. In distribution of postoperative complications, in group A there were 1(3.3%) injury to biliary tree, 4(13.3%) wound infection,1(3.3%) wound haematoma, 3 (10%) seroma and 1(3.3%) wound dehiscence. While in group B there were 1(3.3%) injury to biliary tree, 3(10%) wound infection,2 (6.7%) wound haematoma, 2(6.7%) & no patient of wound dehiscence. Conclusion: Our study suggests that early cholecystectomy is a better treatment option than interval cholecystectomy because it has less total hospital stay, needs single hospital visit and has no risk of developing complications during wait for surgery.

PS01.148: UTILITY OF GASTROSTOMY VIA GASTRIC TUBE AFTER ESOPHAGEAL CANCER SURGERY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 91-91
Author(s):  
Yoshihisa Matsumoto
Keyword(s):  
Esophageal Cancer ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Postoperative Hospital Stay ◽  
Cancer Surgery ◽  
Recurrent Nerve ◽  
Clinicopathological Factors ◽  
Respiratory Complications ◽  
Postoperative Results

Abstract Background Esophageal cancer patients often suffer from preoperative malnutrition. It is very important for them to improve their perioperative nutrition status. In our department, we have adopted jejunostomy after esophageal cancer surgery in almost all cases. However, sometimes we have experienced catheter related complications via jejunostomy. Recently, several studies reported that gastrostomy via gastric tube might reduce the catheter related complications. In this study, we compared gastrostomy with jejunostomy as postoperative results and catheter related complications. Methods From January 2010 to November 2016, we performed 215 consecutive esophagectomy for esophageal cancer. It was divided into 133 cases of gastrostomy group (group G) and 82 cases of jejunostomy group (group J). We analyzed clinicopathological factors (age, sex, tumor localization, tumor progression degree and preoperative chemotherapy), postoperative results (anastomotic leakage, respiratory complications, recurrent nerve palsy and postoperative hospital stay) and correlation of catheter related complications retrospectively. Results There were no significant differences between the two groups in clinicopathological factors and postoperative outcomes such as anastomotic leakage, recurrent nerve paralysis and postoperative hospital stay. Respiratory complications were occurred in 12 cases (8.0%)/25 cases (31.0%) (P < 0.001). Catheter related complications were occurred in 17 cases (5 in group G (3.0%), 12 in group J (9.8%) (P = 0.005) and it was significantly less in group G. The details of catheter related complications were classified into group G (duodenal perforation and dislocation) and group J (intestinal perforation, intestinal obstruction and intestinal fluid leakage). Conclusion The rate of catheter related complications after esophagectomy via gastrostomy in this study were lower than that via jejunostomy in previous reports. We suggest the route of enteral nutrition via gastric tube is more effective than that via jejunostomy with regard to catheter related complications. Disclosure All authors have declared no conflicts of interest.

scholarly journals Perioperative outcome of severe rigid idiopathic scoliosis: Single-staged posterior spinal fusion utilizing a dual attending surgeon strategy. A report of 41 patients

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902093600
Author(s):  
Chris Yin Wei Chan ◽  
Weng Hong Chung ◽  
Yuki Mihara ◽  
Sin Ying Lee ◽  
Pei Ying Ch’ng ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Hospital Stay ◽  
Cobb Angle ◽  
Perioperative Complications ◽  
Postoperative Hospital Stay ◽  
Transfusion Rate ◽  
Perioperative Outcome ◽  
Correction Rate ◽  
Operation Duration ◽  
The Mean

Purpose: Various surgical strategies including combined approach and spinal osteotomies in severe rigid scoliosis had been reported with significant perioperative complication rates. The use of single-staged posterior spinal fusion (PSF) utilizing a dual attending surgeon strategy for severe rigid scoliosis has not been widely reported. Methods: This was a retrospective study aimed to evaluate the perioperative outcome of single-staged PSF in severe rigid idiopathic scoliosis patients (Cobb angle ≥90° and ≤30% flexibility). Forty-one patients with severe rigid idiopathic scoliosis who underwent single-staged PSF were included. The perioperative outcome parameters were operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, preoperative and postoperative hemoglobin, transfusion rate, patient-controlled anesthesia morphine usage, length of postoperative hospital stay, and perioperative complications. Radiological parameters included preoperative and postoperative Cobb angle, correction rate, side-bending flexibility, and side-bending correction index. Results: The mean age was 16.9 ± 5.6 years. The mean preoperative Cobb angle was 110.8 ± 12.1° with mean flexibility of 23.1 ± 6.3%. The mean operation duration was 215.5 ± 45.2 min with mean blood loss of 1752.6 ± 830.5 mL. The allogeneic blood transfusion rate was 24.4%. The mean postoperative hospital stay was 76.9 ± 26.7 h. The mean postoperative Cobb angle and correction rate were 54.4 ± 12.8° and 50.9 ± 10.1%, respectively. The readmission rate in this cohort was 2.4%. Four perioperative complications were documented (9.8%), one somatosensory evoke potential signal loss, one superficial infection, one lung collapse, and one superior mesenteric artery syndrome. Conclusions: Severe rigid idiopathic scoliosis treated with single-staged PSF utilizing a dual attending surgeon strategy demonstrated an average correction rate of 50.9%, operation duration of 215.5 min, and postoperative hospital stay of 76.9 h with a 9.8% perioperative complication rate.

Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial

2019 ◽  
Vol 30 (5) ◽  
pp. 615-622 ◽  
Author(s):  
Xiaoguang Han ◽  
Wei Tian ◽  
Yajun Liu ◽  
Bo Liu ◽  
Da He ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Radiation Exposure ◽  
Pedicle Screw ◽  
Spinal Surgery ◽  
Facet Joint ◽  
Postoperative Hospital Stay ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
The Mean

OBJECTIVEThe object of this study was to compare the safety and accuracy of pedicle screw placement using the TiRobot system versus conventional fluoroscopy in thoracolumbar spinal surgery.METHODSPatients with degenerative or traumatic thoracolumbar spinal disorders requiring spinal instrumentation were randomly assigned to either the TiRobot-assisted group (RG) or the freehand fluoroscopy-assisted group (FG) at a 1:1 ratio. The primary outcome measure was the accuracy of screw placement according to the Gertzbein-Robbins scale; grades A and B (pedicle breach < 2 mm) were considered clinically acceptable. In the RG, discrepancies between the planned and actual screw placements were measured by merging postoperative CT images with the trajectory planning images. Secondary outcome parameters included proximal facet joint violation, duration of surgery, intraoperative blood loss, conversion to freehand approach in the RG, postoperative hospital stay, and radiation exposure.RESULTSA total of 1116 pedicle screws were implanted in 234 patients (119 in the FG, and 115 in the RG). In the RG, 95.3% of the screws were perfectly positioned (grade A); the remaining screws were graded B (3.4%), C (0.9%), and D (0.4%). In the FG, 86.1% screws were perfectly positioned (grade A); the remaining screws were graded B (7.4%), C (4.6%), D (1.4%), and E (0.5%). The proportion of clinically acceptable screws was significantly greater in the RG than in the FG (p < 0.01). In the RG, the mean deviation was 1.5 ± 0.8 mm for each screw. The most common direction of screw deviation was lateral in the RG and medial in the FG. Two misplaced screws in the FG required revision surgery, whereas no revision was required in the RG. None of the screws in the RG violated the proximal facet joint, whereas 12 screws (2.1%) in the FG violated the proximal facet joint (p < 0.01). The RG had significantly less blood loss (186.0 ± 255.3 ml) than the FG (217.0 ± 174.3 ml; p < 0.05). There were no significant differences between the two groups in terms of surgical time and postoperative hospital stay. The mean cumulative radiation time was 81.5 ± 38.6 seconds in the RG and 71.5 ± 44.2 seconds in the FG (p = 0.07). Surgeon radiation exposure was significantly less in the RG (21.7 ± 11.5 μSv) than in the FG (70.5 ± 42.0 μSv; p < 0.01).CONCLUSIONSTiRobot-guided pedicle screw placement is safe and useful in thoracolumbar spinal surgery.Clinical trial registration no.: NCT02890043 (clinicaltrials.gov)

scholarly journals A Pilot Study of Nutritional Status Prior to Bariatric Surgery in South China

2021 ◽  
Vol 8 ◽  
Author(s):  
Linli Sun ◽  
Chunxia Wang ◽  
Wei Sun ◽  
Chunjiang Wang
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Pilot Study ◽  
Nutritional Status ◽  
South China ◽  
High Body Mass Index ◽  
Nutritional Deficiencies ◽  
Bariatric Patients ◽  
The Mean ◽  
25 Oh Vitamin D

Objective: The was a pilot study to assess the biochemical and historical information about bariatric patients before undergoing the surgery in the aim of identifying nutritional deficiencies and their prevalence from 2015 to 2020.Methods: Clinical data of 247 patients (105 males and 142 females) were included. Vitamins, trace elements, electrolytes, albumin, globulin, hemoglobin, folate, ferritin, microalbuminuria (MAU), and parathyroid hormone (PTH) levels were determined to explore the nutritional status according to gender, age, high body mass index (BMI), and waist circumstance (WC).Results: The mean age, mean BMI, and mean WC of the candidates were 32.95 ± 10.46 years, 38.01 ± 7.11 kg/m2, and 117.04 ± 16.18 cm, respectively. The prevalence of preoperative nutritional deficiencies was 76.88% for 25 (OH) vitamin D, 19.84% for globulin, 11.74% for albumin, 11.02% for sodium, 8.33% for folic acid, 10.48% (male) and 6.34% (female) for chloride, 4.05% for calcium, 3.07% (male) and 0.70%(female) for ferritin, 11.90% for elevated PTH, and 44.96% for MAU. Males exhibited increased prevalence of globulin and MAU relative to females (P &lt; 0.05). Older groups are more likely to exhibit albumin deficiency (P = 0.007), globulin deficiency (P = 0.003), and zinc deficiency (P = 0.015). In addition, 25 (OH) D deficiency and albumin deficiency were more common in patients with BMI ≥ 47.5 kg/m2 (P = 0.049 and 0.015, respectively). Wider WC (≥150 cm) exhibited higher rates of albumin deficiencies (P = 0.011).Conclusion: Electrolyte and nutritional deficiencies were common in patients prior to bariatric surgery in South China. Routine evaluation of electrolyte and nutritional levels should be carried out in this population.

scholarly journals The Role of Sleeve Gastrectomy on Preventing Type 2 Diabetes Mellitus

2017 ◽  
Vol 5 (3) ◽  
pp. 316-318 ◽  
Author(s):  
Serdar Olt ◽  
Sabri ÖzdaÅŸ ◽  
Mehmet Åžirik
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Body Mass Index ◽  
Type 2 Diabetes Mellitus ◽  
Body Mass ◽  
P Value ◽  
Obese Patients ◽  
The Mean

AIM: To investigate the effect of bariatric surgery on HbA1c and serum cortisol levels in morbidly obese patients without type 2 diabetes mellitus.MATERIALS AND METHODS: Twenty-nine patients who underwent sleeve gastrectomy and whose body mass index was> 40 were included in the present study. Patients' files were reviewed retrospectively. Those with diabetes mellitus and those with age <18 were excluded from the study. Pre-operative and 1-year post operative data were documented. The obtained data were analysed by SPSS statistical program.RESULTS: The mean age of the patients was 27.4 ± 8.4. 5 of the patients were male, and 24 were female. The mean body mass index of the patients was 44 ± 2.3. 1 patient [3.4%] had hypertension. Four patients [13.7%] had gastroesophageal reflux disease. The number of smokers was 7 [24.1%], and the number of alcohol users was 3 [10.3%]. There was a statistically significant decrease in HbA1c, body mass index values after operation [p value <0.01], but cortisol was not different [p value = 0.72].CONCLUSION: In this present study we found that bariatric surgery caused a significant decrease in HbA1c levels in non-diabetic patients, suggesting that bariatric surgery may prevent Type 2 Diabetes Mellitus in obese patients.

scholarly journals ASSESSMENT OF BODY FAT IN OBESE PATIENTS PREOPERATIVELY FOR BARIATRIC SURGERY

2016 ◽  
Vol 29 (suppl 1) ◽  
pp. 59-61 ◽  
Author(s):  
Mônica FERNANDEZ ◽  
Rosana Farah TOIMIL ◽  
Zied RASSLAN ◽  
Elias Jirjoss ILIAS ◽  
Ana Lúcia Torloni GRADINAR ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Waist Circumference ◽  
Body Mass ◽  
Body Fat ◽  
Significant Relationship ◽  
Bioelectrical Impedance ◽  
The Body ◽  
Anthropometric Indicators ◽  
The Mean

ABSTRACT Background: The study of body composition in patient candidates for bariatric surgery is directly related to the increase and distribution of body fat in the development of cardiovascular disease. Aim: To correlate anthropometric indicators and bioelectrical impedance in the assessment of body fat in female candidates for bariatric surgery. Methods: Cross-sectional, observational study of 88 women. The weight, height, body mass index and waist circumference data were evaluated in the anthropometric analysis. The body fat was determinate by bioelectrical impedance conducted according to the manufacturer´s recommended technique with a specific severe obesity formula. The patients were divided into two subgroups according to the average waist circumference and body mass index for better analysis of the results. Results: The group had a mean age of 39.7 years (±7.2), average weight of 125.6 kg (±16.2), mean body mass index of 48.7 kg/m2 (±6.4) and the mean waist circumference 137.6 cm (±12.4). Negative and significant relationship between BMI values waist circumference and resistance obtained by bioelectrical impedance were found. By analyzing the two groups the mean BMI and waist circumference, a significant relationship was observed, ie, the higher the degree of obesity less resistance was obtained by bioelectrical impedance. The higher is the obesity the lower is value found for resistance. Conclusion: The increase of anthropometric indicators (BMI and waist circumference) determined reduction in resistance and reactance obtained by bioelectrical impedance analysis in obese women candidates to bariatric surgery.

scholarly journals Pyomyositis and Infectious Myositis: A Comprehensive, Single-Center Retrospective Study

2021 ◽  
Author(s):  
Christopher Radcliffe ◽  
Savanah Gisriel ◽  
Yu Si Niu ◽  
David Peaper ◽  
Santiago Delgado ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Percutaneous Drainage ◽  
Treatment Success ◽  
Tertiary Care ◽  
Treatment Strategies ◽  
Altered Mental Status ◽  
Gram Positive Bacteria ◽  
Tertiary Care Institution ◽  
The Mean ◽  
Days Open

Abstract Background Pyomyositis is a bacterial infection of skeletal muscle which classically leads to abscess formation. A related, but distinct, entity is infectious myositis. The epidemiology of these infections has changed in recent years. Methods To better characterize both pyomyositis and infectious myositis, we conducted a retrospective study at our tertiary care institution. We identified 43 cases of pyomyositis and 18 cases of infectious myositis treated between January 2012 and May 2020. Results The mean age of patients was 48 years, and 66% were male. Diabetes mellitus affected one-third of patients, and 16% had other immunocompromising comorbidities. Staphylococcal species accounted for 46% of all infections, and common symptoms included muscle pain (95%) and subjective fever (49%). Altered mental status was a presenting symptom in 16% of cases. Roughly half of all patients received &gt;1 class of antibiotic, and the median length of antimicrobial therapy was 18 days. Open and percutaneous drainage procedures figured prominently in the management of these infections, with 28% of patients requiring multiple procedures. Pathology specimens were available for 12 of 61 cases. Overall, the treatment success rate was 84%. Conclusions Gram-positive bacteria accounted for most infections at our institution, and management commonly involved open or percutaneous drainage procedures. Future studies which prospectively evaluate treatment strategies for pyomyositis and infectious myositis are warranted.

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