Comparative Analysis of Immediate Postoperative Complications Following Total Gastrectomy

2017 ◽  
Vol 89 (3) ◽  
pp. 1-6
Author(s):  
S. M. Stancu ◽  
B. A. Popescu
Keyword(s):  
Postoperative Complications ◽  
Gastric Carcinoma ◽  
Total Gastrectomy ◽  
Statistical Significance ◽  
Hemodynamic Instability ◽  
Postoperative Risk ◽  
Complex Procedure ◽  
Life Threatening ◽  
Manual Anastomosis ◽  
Surgery Department

Introduction: Total gastrectomy (TG), despite disrupting the continuity of the alimentary tract and accounting for significant postoperative complications, is the procedure of choice for curative resection of gastric carcinoma. The objectives of this study were to report the rate of postoperative complications following TG, to analyze adverse postoperative outcomes, and to determine the safer technique between Roux –en-Y Esophagojejunostomy and Omega Braun TG. Materials and Methods: A retrospective, observational study was conducted among patients diagnosed with gastric carcinoma who underwent TG between January 1st, 2010 and December 31st, 2012 in the Surgery Department of the Bucharest Clinical Emergency Hospital. Descriptive and analytical statistical analysis with parametric and non-parametric tests was carried out using GraphPad, with statistical significance set at p <0.05. Results: Seventy-seven patients, aged 37-91 years (average age 64.1 ± 11.59 years), were enrolled in this study. A total of 84 immediate postoperative complications were encountered in 35 patients (47.5%), classified into local (n=21, 25%) and general complications (n=63, 75%). Reoperation was necessary in five cases (6.2%), all after Roux-en-Y end-side esophagojejunostomy. Two deaths (n=2, 2.5%), one after Roux-en-Y and one after Omega-Braun TG, were reported. Discussion: The Roux-en-Y technique had the higher number of complications, both local and general. Omega-Braun TG was associated with a lower number of local complications; however, it was associated with life-threatening complications including hemodynamic instability and multisystem organ failure. A statistically significant correlation between manual anastomosis and mortality was observed. Conclusion: The study deemed Roux-en-Y Esophagojejunostomy the overall safer procedure. A statistically significant correlation between manual anostomosis and mortality was observed. Total Gastrectomy is a complex procedure with numerous potential complications which calls for an improved surgical technique to reduce postoperative risk.

OPERATIONS FOR ANEURISM OF THE ABDOMINAL AORTIC DEPARTMENT - RESECTION WITH THE FOLLOWING PROSTHETICS AND ENDOPROSTHETICS: A COMPARATIVE ANALYSIS OF COMPLICATIONS

2020 ◽  
pp. 43-49
Author(s):  
Андрей Анатольевич Иванов ◽  
Александр Иванович Жданов ◽  
Максим Сергеевич Шевелин ◽  
Александр Сергеевич Брежнев
Keyword(s):  
Comparative Analysis ◽  
Postoperative Complications ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Surgical Interventions ◽  
Vein Thrombosis ◽  
Scientific Hypothesis ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
High Level

В статье представлены данные оригинального исследования по улучшению хирургического лечения аневризм брюшного отдела аорты. С этой целью произведен сравнительный анализ двух альтернативных друг другу операций: 1) резекции аневризмы с последующим протезированием аорты; 2) эндопротезирования аорты. Сформулировано научное предположение о том, что замена «классических» операций резекции аневризмы на «альтернативные» операции эндопротезирования приведет к принципиальному снижению уровня послеоперационных осложнений. В независимых группах пациентов с использованием сравниваемых хирургических вмешательств произведена точная качественная и количественная оценка послеоперационных осложнений: нетромботических - кардиальных, пульмональных, ренальных и тромботических - тромбозов глубоких вен и тромбозов браншей протеза. После реализации исследования было установлено, что замена «классических» операций на «альтернативные» достоверно приводит к принципиальному снижению уровня наиболее жизнеопасных осложнений - кардиальных (острых форм ишемической болезни сердца, нарушений сердечного ритма), пульмональных (пневмоний, тромбоэмболии легочной артерии, респираторного дистресс-синдрома взрослых) и ренальных (острой почечной недостаточности). Некоторое исключение составили менее жизнеопасные тромботические осложнения. Полученные результаты имеют высокий уровень статистической значимости, что позволяет рекомендовать их к рассмотрению к использованию в практике сосудистой хирургии The article presents data from an original study to improve the surgical treatment of abdominal aortic aneurysms. For this purpose, a comparative analysis of two alternate operations was performed: 1) aneurysm resection followed by aortic prosthetics; 2) aortic endoprosthetics. The scientific hypothesis is formulated that the replacement of the «classical» operations of resection of the aneurysm with «alternative» operations of endoprosthetics will lead to a fundamental decrease in the level of postoperative complications. In independent groups of patients using the compared surgical interventions, an accurate qualitative and quantitative assessment of postoperative complications was made: non-thrombotic - cardiac, pulmonary, renal and thrombotic - deep vein thrombosis and prosthetic jaw thrombosis. After the study was completed, it was found that the fundamental replacement of «classical» operations with «alternative» reliably leads to a fundamental decrease in the level of the most life-threatening complications - cardiac (acute forms of coronary heart disease, cardiac arrhythmias), pulmonary (pneumonia, pulmonary thromboembolism, respiratory distress syndrome of adults) and renal (acute renal failure). Some exceptions were less life-threatening thrombotic complications. The results obtained have a high level of statistical significance, which allows us to recommend them for consideration in the practice of vascular surgery

scholarly journals P034 STRANGULATED DIAPHRAGMATIC HERNIA: TEN CASES REPORTS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Mehmet Gunay ◽  
gorkem uzunyolcu ◽  
yalın iscan ◽  
kaan gok ◽  
hakan yanar ◽  
...  
Keyword(s):  
Total Gastrectomy ◽  
Diaphragmatic Hernia ◽  
Emergency Surgery ◽  
Penetrating Trauma ◽  
Abdominal Symptoms ◽  
Threatening Condition ◽  
Segmental Bowel Resection ◽  
Life Threatening ◽  
Surgery Department ◽  
Laparoscopic Techniques

Abstract Aim A diaphragmatic hernia (DH) is a protrusion of abdominal contents into the thoracic cavity as a result of a defect within diaphragm. It is most common as a congenital phenomenon; however, there have also been cases where it can be acquired. DH can be life-threatening, resulting in incarceration and strangulation. Material and Methods From June 2009 to April 2021, ten cases of strangulated diaphragmatic hernia were admitted to our Emergency Surgery Department of General Surgery with respiratory and abdominal symptoms. Patients' characteristics, operation details, and postoperative complications were retrospectively analyzed. Results There were 5 (50%) men and 5 (50%) women with a mean age of 66 years (range, 20–85 years). . Emergency surgery was performed by laparoscopic in 4(40%) patients and open in 6(60%) patients. Two patients had a history of penetrating trauma to the left thoracoabdominal region. Segmental bowel resection was performed in 3 patients and total gastrectomy in 1 patient. Reconstruction was not performed in the patient who underwent total gastrectomy due to ischemia and perforation. In the postoperative period, wound infection was observed in 2 patients. Anastomotic leakage was observed in 1 patient and treated with end enterostomy. Empyema was observed in one patient after discharge, the empyema was evacuated and thoracoscopic decortication was performed .The patient who underwent total gastrectomy died due to septic shock and comorbid diseases. Conclusions Strangulated diaphragmatic hernia is a life-threatening condition and requires emergency surgery. Laparoscopic techniques can also be used in treatment.

scholarly journals Esophagojejunal Anastomosis Fistula, Distal Esophageal Stenosis, and Metalic Stent Migration after Total Gastrectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Nadim Al Hajjar ◽  
Calin Popa ◽  
Tareg Al-Momani ◽  
Simona Margarit ◽  
Florin Graur ◽  
...  
Keyword(s):  
Anastomotic Leak ◽  
Total Gastrectomy ◽  
Stent Migration ◽  
Esophageal Stenosis ◽  
Surgical Removal ◽  
Esophagojejunal Anastomosis ◽  
Complex Procedure ◽  
Life Threatening ◽  
Stenting Procedure ◽  
Main Complication

Esophagojejunal anastomosis fistula is the main complication after a total gastrectomy. To avoid a complex procedure on friable inflamed perianastomotic tissues, a coated self-expandable stent is mounted at the site of the anastomotic leak. A complication of stenting procedure is that it might lead to distal esophageal stenosis. However, another frequently encountered complication of stenting is stent migration, which is treated nonsurgically. When the migrated stent creates life threatening complications, surgical removal is indicated. We present a case of a 67-year-old male patient who was treated at our facility for a gastric adenocarcinoma which developed, postoperatively, an esophagojejunostomy fistula, a distal esophageal stenosis, and a metallic coated self-expandable stent migration. To our knowledge, this is the first reported case of an esophagojejunostomy fistula combined with a distal esophageal stenosis as well as with a metallic coated self-expandable stent migration.

CD34 immunostain increases sensitivity of the diagnosis of fetal vascular malperfusion in placentas from ex-utero intrapartum treatment

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jerzy Stanek
Keyword(s):  
Statistical Significance ◽  
Treatment Procedure ◽  
Fetal Survival ◽  
Ex Utero Intrapartum Treatment ◽  
Life Threatening ◽  
Group 2 ◽  
Cd34 Immunostain ◽  
The Impact ◽  
Diaphragmatic Hernias ◽  
Group 1

AbstractShort CommunicationsEXIT (ex-utero intrapartum treatment) procedure is a fetal survival-increasing modification of cesarean section. Previously we found an increase incidence of fetal vascular malperfusion (FVM) in placentas from EXIT procedures which indicates the underlying stasis of fetal blood flow in such cases. This retrospective analysis analyzes the impact of the recently introduced CD34 immunostain for the FVM diagnosis in placentas from EXIT procedures.Objectives and MethodsA total of 105 placentas from EXIT procedures (48 to airway, 43 to ECMO and 14 to resection) were studied. In 73 older cases, the placental histological diagnosis of segmental FVM was made on H&E stained placental sections only (segmental villous avascularity) (Group 1), while in 32 most recent cases, the CD34 component of a double E-cadherin/CD34 immunostain slides was also routinely used to detect the early FVM (endothelial fragmentation, villous hypovascularity) (Group 2). 23 clinical and 47 independent placental phenotypes were compared by χ2 or ANOVA, where appropriate.ResultsThere was no statistical significance between the groups in rates of segmental villous avascularity (29 vs. 34%), but performing CD34 immunostain resulted in adding and/or upgrading 12 more cases of segmental FVM in Group 2, thus increasing the sensitivity of placental examination for FVM by 37%. There were no other statistically significantly differences in clinical (except for congenital diaphragmatic hernias statistically significantly more common in Group 2, 34 vs 56%, p=0.03) and placental phenotypes, proving the otherwise comparability of the groups.ConclusionsThe use of CD34 immunostain increases the sensitivity of placental examination for FVM by 1/3, which may improve the neonatal management by revealing the increased likelihood of the potentially life-threatening neonatal complications.

scholarly journals A simple nomogram for early postoperative risk prediction of clinically relevant pancreatic fistula after pancreatoduodenectomy

2021 ◽  
Author(s):  
K. C. Honselmann ◽  
C. Antoine ◽  
L. Frohneberg ◽  
S. Deichmann ◽  
L. Bolm ◽  
...  
Keyword(s):  
Delayed Gastric Emptying ◽  
Model Building ◽  
Pancreatic Head ◽  
Operation Time ◽  
Early Postoperative Period ◽  
Serum Lipase ◽  
Internal Validation ◽  
Model Method ◽  
Postoperative Risk ◽  
Life Threatening

Abstract Purpose Postoperative pancreatic fistulae (POPF) present a serious and life-threatening complication after pancreatic head resections (PD). Therefore, reliable risk stratification to identify those at risk is urgently needed. The aim of this study was to identify postoperative laboratory parameters for the prediction of POPF in the early postoperative period. Methods One hundred eighty-two patients who underwent PD from 2012 until 2017 were retrospectively analyzed. Multivariate logistic regression was performed using the GLM (general linear model) method for model building. Two nomograms were created based on the GLM models of postoperative day one and postoperative day one to five. A cohort of 48 patients operated between 2018 and 2019 served as internal validation. Results Clinically relevant pancreatic fistulae (CR-POPF) were present in 16% (n = 29) of patients. Patients with CR-POPF experienced significantly more insufficiencies of gastroenterostomies, delayed gastric emptying, and more extraluminal bleeding than patients without CR-POPF. Multivariate analysis revealed multiple postoperative predictive models, the best one including ASA, main pancreatic duct diameter, operation time, and serum lipase as well as leucocytes on day one. This model was able to predict CR-POPF with an accuracy of 90% and an AUC of 0.903. Two nomograms were created for easier use. Conclusion Clinically relevant fistula can be predicted using simple laboratory and clinical parameters. Not serum amylase, but serum lipase is an independent predictor of CR-POPF. Our simple nomograms may help in the identification of patients for early postoperative interventions.

Is Proximal Gastrectomy Superior to Total Gastrectomy for Proximal Gastric Carcinoma?

1992 ◽  
Vol 9 (1) ◽  
pp. 13-18
Author(s):  
Shunichi Tsujitani ◽  
Yoshihiro Kakeji ◽  
Akihiro Watanabe ◽  
Yoshihiko Maehara ◽  
Motonosuke Furusawa ◽  
...  
Keyword(s):  
Gastric Carcinoma ◽  
Total Gastrectomy ◽  
Proximal Gastrectomy ◽  
Proximal Gastric Carcinoma

scholarly journals Necrotizing fasciitis with group A Streptococci and Eggerthella lenta as a complication of Varicella in a child – case presentation –

2014 ◽  
Vol 20 (1) ◽  
pp. 35-39
Author(s):  
Cambrea Simona Claudia ◽  
Ilie Maria Margareta ◽  
Carp Dalia Sorina ◽  
Ionescu C.
Keyword(s):  
Necrotizing Fasciitis ◽  
Severe Disease ◽  
The Body ◽  
Group A Streptococci ◽  
Threatening Condition ◽  
Life Threatening ◽  
Group A ◽  
The Right ◽  
Surgery Department ◽  
Short Time

ABSTRACT Necrotizing fasciitis is a life threatening condition that can be quickly spread through the flesh surrounding the muscle. The disease can be polymicrobial, or caused by group A beta hemolytic Streptococci, or by Clostridium spp. We present a case of a 7 years old girl, which was hospitalized in Children Infectious Diseases Department in a 7th day of chickenpox (hematic crusts all over the body), high fever, asthenia, vomiting, oligoanuria, and tumefaction, pain and functio lessa in the right thigh. In a very short time in the right thigh swelling, edema and congestion have increased gradually, and in the third highest middle thigh the ecchymotic areas appeared evolving towards bubbles and blisters which included the right thigh and calf. After excluding the diagnosis of thrombophlebitis was raised suspicion of necrotizing fasciitis. CT pelvic scan evidenced pelvic asymmetry by maximus and medium right gluteal muscles swelling with important inflammatory infiltrate extended laterally in the subcutaneous adipose tissue. In blood culture was isolated Eggerthella lenta, and from throat swab was isolated group A Streptococci. Treatment consists of a combination of antibiotics associated with intravenous immunoglobulin administration. Despite medical treatment evolution worsened and required transfer in a pediatric surgery department where emergent surgical debridement associated with intensive antibiotic therapy was done. After this intervention evolution was slowly favorable without major limb dysfunction. Polymicrobial necrotizing fasciitis is a severe disease, which if recognized early can have a favorable outcome.

scholarly journals Successful treatment of false aneurysm of the subclavian artery

2019 ◽  
Vol 178 (2) ◽  
pp. 69-72
Author(s):  
A. N. Ryazanov ◽  
V. V. Soroka ◽  
S. P. Nokhrin ◽  
E. P. Mikhelson ◽  
I. D. Magamedov ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Minimally Invasive ◽  
Positive Result ◽  
Subclavian Artery ◽  
Successful Treatment ◽  
New Technologies ◽  
False Aneurysm ◽  
Life Threatening ◽  
Minimally Invasive Methods

The article describes the clinical experience of treatment of life-threatening pathology by minimally invasive methods. There is a long-term stable positive result after the operation. The introduction of new technologies in medicine minimizes the risk of postoperative complications, contributing to a favorable outcome of the disease.

scholarly journals Brain Catastrophe presented with endocrine disruption

2020 ◽  
Vol 8 (5) ◽  
pp. 104-110
Author(s):  
Saadi JS AlJadir
Keyword(s):  
Dynamic Testing ◽  
Hemodynamic Instability ◽  
Major Surgery ◽  
Initial Manifestation ◽  
Altered Level ◽  
Identifiable Risk Factor ◽  
Conflicting Evidence ◽  
Level Of Consciousness ◽  
Threatening Condition ◽  
Life Threatening

Pituitary Apoplexy (PA) is an acute critical endocrine condition that is infrequently encountered in daily medical practice. Its life-threatening condition that mandates prompt diagnosis and urgent treatment and may be neurosurgical intervention. Majority of cases are attributed to ischemic infarction or hemorrhage of the pituitary gland usually in the vicinity of pituitary adenoma, and in most cases could be the initial manifestation of these tumors! In reviewing the literatures there is conflicting evidence of which are the predominant, non-functional, or functional adenomas, some reports were showed that prolactin-secreting are at highest risk. There are recognizable risk factors that might precipitate this endocrine emergency like hypertension, medications, major surgery, head injury, radiation, or dynamic testing, but in majority of cases at presentation no identifiable risk factor could be detected. The typical clinical scenario includes persistent worsening headache, vomiting, and altered level of consciousness, visual defect or loss with extreme hormonal derangements which are shown by hemodynamic instability, adrenal crises with variable hormonal deficiencies.

scholarly journals Differential Diagnosis between Bone Metastasis and Osteomalacia to the Patient Undergone Total Gastrectomy for Gastric Carcinoma

2003 ◽  
Vol 36 (5) ◽  
pp. 363-368 ◽  
Author(s):  
Noboru Nakagawa ◽  
Tetsuro Yamane ◽  
Yasushi Takeda ◽  
Shouzou Kitai ◽  
Shinji Okano ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Bone Metastasis ◽  
Gastric Carcinoma ◽  
Total Gastrectomy
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