Validation of peritoneal adhesion index as a standardized classification to universalize peritoneal adhesions definition

Peritoneal adhesion index (PAI) is a score based on appearance and distribution of peritoneal adhesions. The study aims to assess the validity of PAI in order to standardize the definition of peritoneal adhesions. The study includes an expert survey to assess the feasibility of the score and a prospective observational and multicenter trial to assess its validity. 96% of surgeons of the survey consider PAI a useful tool. From January 2013 to March 2015, 205 patients were enrolled to undergo a surgical intervention for bowel obstruction caused by peritoneal adhesions in 21 centers. PAI was significantly higher in the population with previous surgery (P=0.043) and in patients who underwent two previous surgical interventions, if compared to those with only one previous intervention (P=0.012). Length of surgery was significantly longer in patients with higher PAI (P<0.001). Patients with a higher PAI showed a clinically higher risk for early bowel re-obstruction and for early re-intervention. The AUC of the ROC curve for early re-occlusion is 0.8. PAI can be considered a feasible and useful score.

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Su2069 ELECTIVE VS UNPLANNED SURGICAL INTERVENTIONS FOR BOWEL OBSTRUCTION IN CROHN'S DISEASE: IS THERE A ROLE FOR PREEMPTIVE SURGICAL INTERVENTION?

Gastroenterology ◽

10.1016/s0016-5085(20)34606-0 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-1570

Author(s):

David Koller ◽

Kenneth D. Allen ◽

Sean Maroney ◽

Alan Harzman ◽

mark arnold ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Obstruction ◽

Surgical Intervention ◽

Surgical Interventions

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Peritoneal Adhesions as a Cause of Mechanical Small Bowel Obstruction Based on Own Experience

Polish Journal of Surgery ◽

10.2478/pjs-2014-0093 ◽

2015 ◽

Vol 86 (11) ◽

Cited By ~ 1

Author(s):

Bartłomiej Morawski ◽

Ireneusz Nawrot ◽

Włodzimierz Klonowski ◽

Marek Mądrecki ◽

Wiesław Tarnowski

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Age Of Onset ◽

Adhesive Small Bowel Obstruction ◽

Emergency Rooms ◽

Peritoneal Adhesions ◽

Surgical Interventions ◽

Number Of Patients ◽

The Mean

AbstractBowel obstruction is a condition which has been known for many years. As time goes by, the problem is still often encountered at surgical emergency rooms. More than 20% of emergency surgical interventions are performed because of symptoms of digestive tract obstruction with the disease mostly situated in the small bowel. Rates of causative factors of the disease have changed over recent years and there have been increasingly more cases of small bowel obstruction caused by peritoneal adhesions, i.e., adhesive small bowel obstruction (ASBO).to analyse the reasons and incidence of adhesive small bowel obstruction during two periods of time (1990-1995 and 2005-2010).We performed a retrospective analysis of medical records of patients hospitalized at the 1We found that the incidence of adhesive small bowel obstruction increased from 58 cases in the first period to 215 cases in the second one, and the outcomes improved. The proportion of patients who underwent surgery diminished from 38% to 13%. The mean hospitalization time shortened and was 11.3 days and 6.95 days during 1990-1995 and 2005-2010 periods of time, respectively. In the first group, patients who had a surgery were hospitalized for 17.8 days and those who were treated conservatively for 8.08 days. In the second group, the mean hospital stay decreased to 15.6 days and 5.7 days in the case of surgical and conservative treatment, respectively. The age of onset declined from 56.63 years in the first period to 52.54 years in the other one.Analysed data show an increasing number of patients with adhesive small bowel obstruction. The highest risk of the disease was associated with operations on the large bowel and gynaecological procedures.

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Bowel obstruction in obturator hernia: a challenging diagnosis

International Surgery Journal ◽

10.18203/2349-2902.isj20212740 ◽

2021 ◽

Vol 8 (7) ◽

pp. 2212

Author(s):

Nimisha Ramachandran Chemmangattuvalappil ◽

Babu John Pulluvelil ◽

Ravindran Chirukandath ◽

Santosh Vijayan Thekoot ◽

Bobby Sebastian

Keyword(s):

Bowel Obstruction ◽

Clinical Case ◽

Surgical Intervention ◽

Exploratory Laparotomy ◽

Obturator Hernia ◽

Rare Type ◽

Obturator Foramen ◽

Surgical Interventions ◽

Emergency Surgical Intervention ◽

Specific Symptoms

The obturator hernia is a rare pelvic hernia that presents as bowel obstruction caused by the presence of an intestinal segment, more often ileum passing through obturator foramen. This type of hernia accounts for 0.5-1.4% of all hernias. We reported the clinical case of a 74 year old woman with no previous surgical interventions, presented to ER with abdominal pain and distension, features of intestinal obstruction, which she had experienced for previous three days. A CT scan revealed a right jejunal, obstructed obturator hernia. The patient underwent an emergency surgical intervention with emergency exploratory laparotomy and repair. This case was presented as obturator hernia was a rare type of hernia due to its diagnosis, which is often unclear with non-specific pain radiating to legs mimicking neurological symptoms. A prompt suspect based for the non-specific symptoms is crucial for the diagnosis. Surgical management depends on early diagnosis and it is the only possible treatment for this pathology.

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Peritoneal adhesion: state of issue and modern methods of prevention

Perm Medical Journal ◽

10.17816/pmj36372-90 ◽

2019 ◽

Vol 36 (3) ◽

pp. 72-90

Author(s):

V. A. Samartsev ◽

V. A. Gavrilov ◽

B. S. Pushkarev ◽

A. A. Parshakov ◽

M. P. Kuznetsova ◽

...

Keyword(s):

Surgical Treatment ◽

Intestinal Obstruction ◽

Surgical Intervention ◽

Modern State ◽

Peritoneal Adhesion ◽

Peritoneal Adhesions ◽

Modern Methods ◽

Prevention And Treatment ◽

Therapeutic Measures ◽

Adhesive Intestinal Obstruction

Peritoneal adhesion (PA) is still an actual surgical issue. It is known that any surgical intervention causes abdominal adhesion that, in its turn, induces a number of complications such as adhesive intestinal obstruction. There is registered a high lethality among patients with the developed acute adhesive intestinal obstruction. Adhesive intestinal obstruction hurts health of patients, leading to eight (on average) days of hospitalization and intrahospital lethality of 3 % per episode. The cause of the development of a significant number of lethal cases is imperfection of preventive, diagnostic, therapeutic measures; 20 to 30 % of patients with adhesive intestinal obstruction need surgical treatment. Heavy expenses in the system of healthcare are required for treatment of peritoneal adhesions. The review presents the data regarding modern state of the problem, advanced tendencies in diagnosis, prevention and treatment of patients with peritoneal adhesions, their use in practical studies.

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HOSPITAL INFECTION IN SURGICAL DEPARTMENTS AT HUE UNIVERSITY HOSPITAL IN 2015

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.5.6 ◽

2016 ◽

pp. 39-43

Author(s):

Dinh Binh Tran ◽

Dinh Tan Tran

Keyword(s):

Surgical Site Infection ◽

Surgical Intervention ◽

University Hospital ◽

Hospital Infections ◽

Site Infection ◽

Cross Sectional ◽

Surgical Interventions ◽

Hospital Acquired Infections ◽

Tract Infections ◽

Hospital Acquired

Objective: To study nosocomial infections and identify the main agents causing hospital infections at Hue University Hospital. Subjects and Methods: A cross-sectional descriptive study of 385 patients with surgical interventions. Results: The prevalence of hospital infections was 5.2%, surgical site infection was the most common (60%), followed by skin and soft tissue infections (35%), urinary tract infections (5%). Surgical site infection (11.6%) in dirty surgery. There were 3 bacterial pathogens isolated, including Staphylococcus aureus (50%), Pseudomonas aeruginosa and Enterococcusspp (25%). Conclusion: Surgical site infection was high in hospital-acquired infections. Key words: hospital infections, surgical intervention, surgical site infection, bacteria

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Do People Trust in Robot-Assisted Surgery? Evidence from Europe (Preprint)

10.2196/preprints.23791 ◽

2020 ◽

Author(s):

Joan Torrent-Sellens ◽

Ana Jiménez-Zarco ◽

Francesc Saigí-Rubió

Keyword(s):

Technology Acceptance ◽

Surgical Intervention ◽

Negative Relationship ◽

Predictor Variable ◽

Major Change ◽

Ease Of Use ◽

The European Union ◽

Robot Assisted ◽

Surgical Interventions ◽

Robot Assisted Surgery

BACKGROUND Increasingly intelligent and autonomous robots are destined to have a huge impact on our society. Their adoption, however, represents a major change to the healthcare sector’s traditional practices, which, in turn, poses certain challenges. To what extent is it possible to foresee a near-future scenario in which minor routine surgery is directed by robots? And what are the patients’ or general public’s perceptions of having surgical procedures performed on them by robots, be it totally or partially? A patient’s trust in robots and AI may facilitate the spread and use of such technologies. OBJECTIVE The goal of our study was to establish the factors that influence how people feel about having a medical operation performed on them by a robot. METHODS We used data from a 2017 Flash Eurobarometer (number 460) of European Commission with 27,901 citizens aged 15 years and over in the 28 countries of the European Union. The research designs and tests a technology acceptance model (TAM). Logistic regression (odds ratios, OR) to model the predictors of trust in robot-assisted surgery was calculated through motivational factors, robots using experience and sociodemographic independent variables. RESULTS The negative relationship between most of the predictors of ease of use, expected benefits and attitude towards robots, and confidence in robot-assisted surgery was contrasted. The only non-sociodemographic predictor variable that has a positive relationship with trust in robots participating in a surgical intervention is previous experience in the use of robots. In this context, we analyze the confidence predictors for three different levels of robot use experience (zero use, average use, and high use). The results obtained indicate that, as the experience of using robots increases, the predictive coefficients related to information, attitude and perception of robots become more negative. Research results also determined that variables of a sociodemographic nature played an important predictive role. It was confirmed that the effect of experience on trust in robots for surgical interventions was greater among men, people between 40 and 54 years old, and those with higher educational levels. CONCLUSIONS Despite the considerable benefits for the patient that the use of robots can bring in a surgical intervention, the results obtained show that trust in robots goes beyond rational decision-making. By contrasting the reasons that generate trust and mistrust in robots, especially by highlighting the experience of use as a key element, the research makes a new contribution to the state of the art and draws practical implications of the use of robots for health policy and practice.

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Small Bowel Obstruction Induced by Concurrent Postoperative Intra-Abdominal Adhesions and Small Bowel Fecal Materials in a Young Dog

Veterinary Sciences ◽

10.3390/vetsci8050083 ◽

2021 ◽

Vol 8 (5) ◽

pp. 83

Author(s):

Jae-Eun Hyun ◽

Hyun-Jung Han

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Surgical Intervention ◽

Gastrointestinal Symptoms ◽

Exploratory Laparotomy ◽

Abdominal Adhesions ◽

Abdominal Radiography ◽

Foreign Body Removal ◽

Small Intestinal

A 7-month-old neutered male poodle dog presented with general deterioration and gastrointestinal symptoms after two separate operations: a jejunotomy for small-intestinal foreign body removal and an exploratory laparotomy for diagnosis and treatment of the gastrointestinal symptoms that occurred 1 month after the first surgery. The dog was diagnosed as having small-bowel obstruction (SBO) due to intra-abdominal adhesions and small-bowel fecal material (SBFM) by using abdominal radiography, ultrasonography, computed tomography, and laparotomy. We removed the obstructive adhesive lesion and SBFM through enterotomies and applied an autologous peritoneal graft to the released jejunum to prevent re-adhesion. After the surgical intervention, the dog recovered quickly and was healthy at 1 year after the surgery without gastrointestinal signs. To our knowledge, this study is the first report of a successful treatment of SBO induced by postoperative intra-abdominal adhesions and SBFM after laparotomies in a dog.

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The Long-Term Follow-Up of Patients with Cystine Stones: A Single-Center Experience for 13 Years

Journal of Clinical Medicine ◽

10.3390/jcm10071336 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1336

Author(s):

Toshifumi Takahashi ◽

Shinya Somiya ◽

Katsuhiro Ito ◽

Toru Kanno ◽

Yoshihito Higashi ◽

...

Keyword(s):

Surgical Intervention ◽

Median Number ◽

Small Sample ◽

Age At Diagnosis ◽

Surgical Interventions ◽

Significant Difference ◽

Long Term Follow Up ◽

Cystine Stones

Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center. Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019. Results: The median follow-up was 160 (range 6–340) months, and the median patient age at diagnosis was 46 (range 12–82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0–2.6) and 0.19 (range 0–1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis (p = 0.02, 0.04, respectively). Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.

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Safety and effectiveness of surgical fixation versus non-surgical methods for the treatment of flail chest in adult populations: a systematic review and meta-analysis

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01606-2 ◽

2021 ◽

Cited By ~ 1

Author(s):

Ayobobola A. Apampa ◽

Ayesha Ali ◽

Bryar Kadir ◽

Zubair Ahmed

Keyword(s):

Systematic Review ◽

Surgical Intervention ◽

Meta Analysis ◽

Adult Population ◽

Flail Chest ◽

Surgical Interventions ◽

Surgical Methods ◽

Surgical Fixation ◽

Randomised Controlled ◽

Pulmonary Status

Abstract Purpose The objective of this systematic review is to compare the safety and efficacy of surgical fixation of rib fractures against non-surgical interventions for the treatment of flail chest in the adult population. Methods A search was performed on the 22nd of July 2020 to identify articles comparing surgical fixation versus clinical management for flail chest in adults, with a description of the outcome parameters (resource utility, mortality, adverse effects of the intervention and adverse progression in pulmonary status). Relevant randomised controlled trials were selected, their risk of bias assessed, and the data then extracted and analysed. Results 157 patients were included from four studies in the analyses, with 79 and 78 patients in the surgical and non-surgical groups, respectively. The pooled effects of all outcomes tended towards favouring surgical intervention. Surgical intervention was associated with lower rates of pneumonia (I2 = 46%, Tau2 = 0.16, p = 0.16), significantly lower rates of tracheostomy (I2 = 76%, Tau2 = 0.67, p = 0.02), and a significantly lower duration of mechanical ventilation (I2 = 88%, Tau2 = 33.7, p < 0.01) in comparison to the non-surgical management methods. Conclusion Our results suggest that surgical intervention reduces the need for tracheostomy, reduces the time spent in the intensive care unit following a traumatic flail chest injury and could reduce the risk of acquiring pneumonia after such an event. There is a need for further well-designed studies with sufficient sample sizes to confirm the results of this study and also detect other possible effects of surgical intervention in the treatment of traumatic flail chest in adults.

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Plasma Levels of t-PA and PAI-1 Correlate With the Formation of Experimental Post-Surgical Peritoneal Adhesions

Mediators of Inflammation ◽

10.1155/mi/2006/13901 ◽

2006 ◽

Vol 2006 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Clara Di Filippo ◽

Alessandro Falsetto ◽

Vito De Pascale ◽

Elisabetta Tufariello ◽

Domenico De Lucia ◽

...

Keyword(s):

Plasminogen Activator ◽

Adhesion Formation ◽

Plasminogen Activator Inhibitor ◽

Lavage Fluid ◽

Plasminogen Activator Inhibitor 1 ◽

Peritoneal Adhesion ◽

Peritoneal Adhesions ◽

Risk Patients ◽

Activator Inhibitor ◽

Pai 1

This study has evaluated whether systemic changes of plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) parallel the adhesions development and whether they could be used as predictors of adhesion risk. This has been studied in an animal model of post-surgical peritoneal adhesion by monitoring for 10 days the plasma and tissue levels of t-PA and PAI-1. The results showed that both tissular and plasmatic levels of t-PA were decreased in concomitance with the development of peritoneal adhesions. In contrast, PAI-1 was found increased into the tissue and into the plasma samples of the rats taken at 5 and 10 days time points. Inflammatory mediators such as ICAM-1, VCAM-1, and IL-6 within the peritoneal lavage fluid also correlated with the adhesion formation process. In conclusion, post-surgical peritoneal adhesions provide alterations of local inflammatory components and local and systemic fibrinolytic components, possibly with PAI-1 quenching t-PA. This may have potential for the identification of high-risk patients.

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