scholarly journals COMPLICATED DIVERTICULITIS: MANAGEMENT, DIAGNOSIS, TREATMENT

2018 ◽  
pp. 68-72
Author(s):  
O. Yu. Karpukhin ◽  
Yu. S. Pankratova ◽  
M. I. Cherkashina ◽  
A. F. Shakurov ◽  
M. I. Ziganshin
Keyword(s):  
Postoperative Complications ◽  
Diverticular Disease ◽  
Bowel Resection ◽  
Wide Spectrum ◽  
Postoperative Mortality ◽  
Complicated Diverticulitis ◽  
Intestinal Tube ◽  
Results Of Treatment ◽  
Secondary Resection ◽  
Colostomy Reversal

AIM. To analyze the results of treatment of patients with diverticular disease in Coloproctology Department. MATERIALS AND METHODS. During the periodfrom 2001 to 2017, 223 patients with diverticular colon disease were treated in the hospital. RESULTS. 191 (85,7%) were treated conservatively, 32 (14,3%) patients were operated on. One-stage procedure was performed in 21 (67,7%) patients, in 10 (32,3%) bowel resection has been completed by stoma. Postoperative complications developed in 25% of cases. Postoperative mortality was 3,1%. Operations reconstructive the length of the intestinal tube were performed in 24 previously operated patients. Colostomy reversal was combined with secondary resection in 9 (37,5%) patients CONCLUSION. Diverticular disease of the colon is a widespread condition with a wide spectrum of severe complications requiring surgical correction. In work with this pathology it is necessary to strictly observe uniform standards of diagnostics and treatment.

scholarly journals Complicated Diverticular Disease

2020 ◽  
Author(s):  
Kathleen M. Coakley ◽  
Bradley R. Davis ◽  
Kevin R. Kasten
Keyword(s):  
Postoperative Complications ◽  
Diverticular Disease ◽  
Surgical Intervention ◽  
Management Strategies ◽  
Significant Risk ◽  
Complicated Diverticulitis ◽  
Careful Attention ◽  
Correct Treatment ◽  
Treatment Paradigm ◽  
Colonic Diverticular Disease

AbstractThe modern management of colonic diverticular disease involves grouping patients into uncomplicated or complicated diverticulitis, after which the correct treatment paradigm is instituted. Recent controversies suggest overlap in management strategies between these two groups. While most reports still support surgical intervention for the treatment of complicated diverticular disease, more data are forthcoming suggesting complicated diverticulitis does not merit surgical resection in all scenarios. Given the significant risk for complication in surgery for diverticulitis, careful attention should be paid to patient and procedure selection. Here, we define complicated diverticulitis, discuss options for surgical intervention, and explain strategies for avoiding operative pitfalls that result in early and late postoperative complications.

scholarly journals ELECTROSURGICAL AND ULTRASOUND DISSECTION AND COAGULATION TISSUE EFFECT FEATURES DURING OPERATIONS ON STOMACH AND INTESTINES

2018 ◽  
Keyword(s):  
Gastrointestinal Tract ◽  
Postoperative Complications ◽  
Blood Vessels ◽  
Postoperative Mortality ◽  
Main Group ◽  
Ultrasound Scanning ◽  
Results Of Treatment ◽  
Tissue Effect ◽  
Ultrasound Dissection

The work is devoted to the problem of reducing intra- and postoperative complications in patients with surgical gastrointestinal tract pathology. The aim of the study is to comprehensively investigate electrosurgical and ultrasound dissection and coagulation features to prevent intra- and postoperative complications, improve the results of treatment of patients with surgical gastrointestinal tract pathology. The study included experimental and clinical parts. The use of ultrasound scanning in the main group of patients revealed significant advantages of this method compared to MES. This device allowed not only to carry out the dissection of the gastrointestinal tract organs, but also to mobilize them, thereby simplifying and speeding up the operation. Intersection of vessels of both omenta, small and large intestines mesentery vessels was carried out with alternating regimes of coagulation and cutting, while ligating only large blood vessels. The study showed that thanks to the use of ultrasound scanning it was possible to reduce the number of postoperative complications from 16.2% to 6.7%, postoperative mortality decreased from 6.11% to 1.55%, and postoperative bed-day decreased from an average of 17.5+ 3.75 to 12.5 + 2.58, which in the complex allowed to improve the parameters of treatment and rehabilitation of patients.

scholarly journals Diagnosis and Treatment of Obturator Hernia: Retrospective Analysis of 86 Clinical Cases at a Single Institution.

2020 ◽  
Author(s):  
ZHENGZHENG LI ◽  
Chaoyang Gu ◽  
Mingtian Wei ◽  
Xing Yuan ◽  
Ziqiang Wang
Keyword(s):  
Postoperative Complications ◽  
Emergency Surgery ◽  
Bowel Resection ◽  
Elective Surgery ◽  
Gastrointestinal Surgery ◽  
Intestinal Resection ◽  
Postoperative Mortality ◽  
Obturator Hernia ◽  
Diagnosis And Treatment ◽  
Surgery Group

Abstract Background: To explore the clinical characteristics, diagnosis and treatment of obturator hernia.Methods: Eighty-six patients who were diagnosed as obturator hernia by abdominal CT in the Department of Gastrointestinal Surgery of our hospital between 2009 and 2019 were enrolled in this study. Patient characteristics, surgical method, postoperative complications and mortalities were retrospectively reviewed, and the patients were followed by telephone or clinic visit to check for the recurrence.Results: 30 days mortality rate of 5.5% and 46.1% were observed in surgery group and non-surgery group, respectively. Surgery was performed as an emergency procedure in 59 cases and elective procedure in 14 cases depending on different hernia contents, intestinal necrosis and signs of peritonitis. In the emergency surgery group, segmental intestinal resection with anastomosis was performed in 24 patients(24/59, 40.7%). There were 4 deaths(4/59, 6.8%) in this group ,all of which occurred in patients undergoing SI resections. In contrast, no bowel resection, postoperative complications, or death occurred in the elective surgery group. 3 -year recurrence rates of 5.1% (3/59)and 7.1%(1/14) were observed in the emergency surgery and the elective surgery group, respectively. Conclusions: CT examination plays an important role in improving the diagnostic rate of obturator hernia. In elderly people with comorbidities, timely surgical treatment is the key to improve the efficacy of obturator hernia and prevent the deterioration of the condition. In addition, postoperative mortality is significantly associated with bowel resection and postoperative complications.

scholarly journals PREVENTION OF EARLY POSTOPERATIVE COMPLICATIONS OF INTESTINAL SURGERY USING IMMUNOMODULATING THERAPY

2020 ◽  
pp. 37-45
Author(s):  
M. Tymchenko
Keyword(s):  
Small Intestine ◽  
Postoperative Complications ◽  
Lipoic Acid ◽  
Comparison Group ◽  
Intestinal Anastomosis ◽  
Interleukin 2 ◽  
Postoperative Mortality ◽  
Main Group ◽  
Immunomodulating Therapy ◽  
Results Of Treatment

Summary. The aim of the study is to develop a method of immunocorrection, which improves the results of treatment of patients with developed peritonitis against the background of the small intestine anastomosis leakege by stopping the cascade of SIRS and MOF. Materials and methods. The work was clinical in nature, was performed in the clinic of the SI «ZIGUS NAMSU» in the period from 2016 to 2019. We examined 58 patients with various diseases of the abdominal organs complicated by peritonitis, in which sections of the small intestine were resected. The Comparison Group included patients who received traditional therapy, patients of the Main Group, the complex of drug therapy included recombinant interleukin-2, galavit and α-lipoic acid. The results of surgical treatment were evaluated according to the classification of D. Dindo, N. Demartinesta, P.-A. Clavien (2004). Statistical analysis was removed from the Statistica 6.0 software (StatSoft, Inc. 2001) and SPSS 7.5 on Apple PC. Results and Discussion. Thus, the results of the use of a comprehensive immunomodulation scheme using IL-2, galavit and α-lipoic acid in the complex treatment of patients with widespread peritonitis against the background of intestinal anastomosis failure suggest that the developed scheme has a targeted immunoregulatory effect and prevents the excess production of inflammatory mediators in the early postoperative the period of the disease, helps to eliminate the cytokine imbalance and prevents the development of secondary immune deficiency. A comparative analysis of the incidence of complications revealed that in patients of the Main Group the average number of complications per patient was 0.53, while in the Comparison Group this indicator was 1.36. Conclusions. The use of a combination of IL-2, galavit and α-lipoic acid in the complex of treatment of common peritonitis helps to reduce the level of systemic and local postoperative complications, as well as the level of postoperative mortality.

scholarly journals Combined Surgical Tactics with Step-up Approach in the Treatment of Infected Acute Pancreatitis

2020 ◽  
Vol 87 (3-4) ◽  
pp. 3-9
Author(s):  
I. A. Kryvoruchko ◽  
V. V. Boyko ◽  
K. Yu. Parkhomenko ◽  
A. G. Drozdova ◽  
S. A. Andreieshchev
Keyword(s):  
Acute Pancreatitis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Postoperative Mortality ◽  
Multiple Organ ◽  
Percutaneous Catheter Drainage ◽  
Results Of Treatment ◽  
Surgical Tactics ◽  
Open Necrosectomy

Objective. To evaluate the results of treatment using minimally invasive interventions and open necrectomy in patients with infected acute pancreatitis. Materials and methods. A retrospective cohort two-centered analysis was performed in 211 patients with infected acute pancreatitis who divided into two groups: the first included 101 patients, in the treatment of which used open surgery; the second included 110 patients, in the treatment of which used treatment tactic step-up approach. Results. In the first group used open necrosectomy with drainage for postoperative lavage (75 patients, 74.3%), including open packing with planned re-laparotomy (8 patients, 7.9%), and omentobursostomy for necrosectomy after surgery (18 patients, 17.8%). Postoperative complications occurred in 58 (57.4%), after the surgery 34 (33.7%) patients was died: 30 had a thirty-day mortality, and 4 had a ninety-day mortality. In the second group group, 72 (65.5%) patients were treated by percutaneous catheter drainage, 6 (5.5%) by video-assisted retroperitoneal debridement and drainage, 5 (4.5%) by through the wall of the stomach or duodenum in the infected pseudocyst and open necrosectomy was performed on 27 (24.5%) patients. Postoperative complications occurred in 37 (33.6%) patients, after the surgery 19 (17.3%) was died: 15 had a thirty -day mortality and 4 had a ninety-day mortality. In the regression analysis, only the presence of multiple organ dysfunction before (AUC = 0.867) and after surgery (AUC = 0.930) significantly affected postoperative mortality, but the effect of the prevalence of pancreatic necrosis (AUC = 0.693) on mortality was limited. Differences were likely between groups (χ2=7.282, p=0.026). Conclusion. The surgical treatment should be initiated with a minimally invasive procedures and combination these operations with open surgery was able to reduce complications and mortality in the patients with infected acute pancreatitis.

Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

2021 ◽  
pp. 000313482199506
Author(s):  
Youngbae Jeon ◽  
Kyoung-Won Han ◽  
Won-Suk Lee ◽  
Jeong-Heum Baek
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Postoperative Mortality ◽  
Nonsurgical Treatment ◽  
Perioperative Outcomes ◽  
Rank Test ◽  
Kaplan Meier ◽  
Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

Impact of bowel resection on postoperative mortality in patients with obturator hernias

Hernia ◽  
2018 ◽  
Vol 23 (2) ◽  
pp. 317-322 ◽  
Author(s):  
Y. Hisamatsu ◽  
M. Yamagata ◽  
M. Miyazaki ◽  
H. Wang ◽  
S. Tanaka ◽  
...  
Keyword(s):  
Bowel Resection ◽  
Postoperative Mortality

scholarly journals LYMPHOCYTE COUNT AND PLATELET VOLUME PREDICTS POSTOPERATIVE COMPLICATIONS IN ESOPHAGECTOMY FOR CANCER: A COHORT STUDY

2019 ◽  
Vol 56 (4) ◽  
pp. 377-385 ◽  
Author(s):  
Francisco TUSTUMI ◽  
Flávio Roberto TAKEDA ◽  
Antonio Adolfo Guerra Soares BRANDÃO ◽  
Rubens Antonio Aissar SALLUM ◽  
Ulysses RIBEIRO JUNIOR ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Count ◽  
Univariate Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Platelet Volume ◽  
Curative Intent ◽  
Trimodal Therapy ◽  
Esophagectomy For Cancer ◽  
Cellular Components

ABSTRACT BACKGROUND: Biomarkers from routine complete blood count are known predictive factors of long-term outcomes in cancer patients. The value of these biomarkers in the setting of trimodal therapy for esophageal cancer in predicting early postoperative outcomes is not studied. OBJECTIVE: The present study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by curative intent esophagectomy for cancer in predicting postoperative mortality and morbidity. METHODS: A cohort of 149 consecutive patients that underwent chemoradiotherapy using platinum- and taxane-based regimens followed by esophagectomy was analyzed. Cellular components of blood collected before neoadjuvant therapy (period A) and before surgery (period B) were assessed for postoperative mortality and complications. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. RESULTS: Postoperative morbidity was present in 46% of the patients. On multiple regression analysis platelet volume (B) (OR: 1.53; 95% CI: 1.2-2.33) was an independent predictor of general complications. Severe postoperative surgical complications were present in 17% of the patients. On multiple regression analysis, lymphocyte decrease between B-A periods (OR: 0.992; 95% CI: 0.990-0.997) was related to higher risk for severe complications. Cervical anastomotic leakage was present in 25.6% of the patients. On univariate analysis eosinophil count in A and B periods was related to cervical anastomotic leakage. For this outcome, multivariate joint model could not identify independent risk variables of cellular components of blood. The 30-day mortality rate was 7.4%. On univariate analysis, platelet count in period B was associated to higher risk for mortality. The multivariate joint model could not accurately predict mortality due to the few number of patients in the mortality group. CONCLUSION: This is the first study to assess the relationship between peripheral blood count variables changes during neoadjuvant chemoradiotherapy using a platinum- and taxane-based regimen followed by curative intent esophagectomy for cancer in predicting postoperative complications. The platelet volume prior to surgery is related to postoperative complications and the lymphocyte count change prior to surgery predicts severe postoperative complications in the setting of trimodal therapy for esophageal cancer.

scholarly journals BOTULINUM TOXIN TYPE A AND LATERAL SUBCUTANEOUS SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE WITH THE SPHINCTER SPASM. WHAT TO CHOOSE? (systematic literature review and meta-analysis)

2020 ◽  
Vol 19 (2) ◽  
pp. 113-128 ◽  
Author(s):  
R. Yu. Khryukin ◽  
I. V. Kostarev ◽  
K. I. Arslanbekova ◽  
M. A. Nagudov ◽  
E. E. Zharkov
Keyword(s):  
Botulinum Toxin ◽  
Postoperative Complications ◽  
Anal Fissure ◽  
Anal Incontinence ◽  
Chronic Anal Fissure ◽  
Meta Analysis ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Results Of Treatment

INTRODUCTION: for the treatment of chronic anal fissure, various surgical techniques are used, the main difference between which is the method of eliminating the anal sphincter spasm. One of the most serious postoperative complications is the development of anal incontinence. To date, there are a number of methods for drug-induced relaxation of the internal sphincter, which can significantly reduce the risk of developing anal incontinence after surgery.AIM: to evaluate the safety and effectiveness of botulinum toxin type A (BTA) and lateral subcutaneous sphincterotomy (LSS) in the treatment of chronic anal fissure with sphincter spasm.METHODS: a systematic review and meta-analysis of 7 selected randomized clinical trials comparing the results of treatment of chronic anal fissure using BTA and LSS was performed. The results of treatment of 489 patients were analyzed with an assessment of the following indicators: the incidence of epithelization of fissures, postoperative complications, development of anal incontinence and the disease recurrence. RESULTS: In the BTA group, the incidence of fissure epithelization is 0.88 times lower than in the LSS group (OR=0.12; CI=0.06;0.22; p<0.00001). There were no statistical differences in the rate of postoperative complications in both groups (OR=1.07; CI=0.50;2.30; p=0.85). The risk of developing postoperative anal incontinence is 0.86 times lower in the BTA group than in the LSS group (OR=0.14; CI=0.03;0.64; p=0.01). The risk of relapse after lateral subcutaneous sphincterotomy is 6.06 times lower than when using botulinum toxin type A (OR=6.06; CI=3.52;10.42; p<0.00001).CONCLUSION The use of botulinum toxin type A in the treatment of chronic anal fissure reduces the risk of developing postoperative anal incontinence, but this method is significantly inferior to lateral subcutaneous sphincterotomy in terms of the rate of chronic anal fissure epithelization.

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