Modified Makuuchi incision for major upper abdominal surgeries

2019 ◽  
Vol 91 (5) ◽  
pp. 1-5
Author(s):  
Narendra Pandit ◽  
Laligan Awale ◽  
Shailesh Adhikary ◽  
Jayant Kumar Banerjee ◽  
Sita Ghosh ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Correct Choice ◽  
Site Infection ◽  
Incisional Hernias ◽  
Surgical Ergonomics ◽  
Abdominal Operations ◽  
Upper Abdominal

Background: Numerous incisions are described for abdominal operations. However, opinion is divided regarding the correct choice of incision for major upper abdominal surgeries. Material & methods: Experience of 3 surgical centres with the use of modified Makuuchi incision, for major upper abdominal surgeries, from Mar 2014- Dec 2018, was audited. Results: 144 patients [76 Males: 68 Females] with an average age of 48.25 years underwent surgery using modified Makuuchi incision. ’J’ and ‘L’ incisions were used in 96 and 48 patients, respectively. Further extension of the incision was necessary in 2 patients. Adequate exposure and enhanced surgical ergonomics was observed in all cases. Surgical site infection was seen in 19 patients [13.2%]. Incisional hernias was observed in 6 patients [4.2%], on an average follow up of 27.78 months. Conclusions: Modified Makuuchi incision proves efficacious for major upper abdominal surgeries.

scholarly journals Long-term follow-up of prophylactic mesh reinforcement after emergency laparotomy. A retrospective controlled study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
A. Bravo-Salva ◽  
N. Argudo-Aguirre ◽  
A. M. González-Castillo ◽  
E. Membrilla-Fernandez ◽  
J. J. Sancho-Insenser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Incisional Hernia ◽  
Surgical Site Infection ◽  
Long Term Results ◽  
Site Infection ◽  
Prophylactic Mesh ◽  
Incisional Hernias ◽  
Mesh Reinforcement

Abstract Background Prevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies. Methods This study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared. Results From an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64.4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62 vs. 43.2%; P = 0.01) and operation due to a revision laparotomy (32.5 vs.13%; P = 0.02) in the M group. During follow-up, 29.9% of patients developed an incisional hernia (Group S 36.6% vs. Group M 14.3%; P = 0.002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR = 2.47; 95% CI 1.318–4.624; P = 0.05), contaminated surgery (HR = 2.98; 95% CI 1.142–7.8; P = 0.02), surgical site infection (SSI; HR = 3.83; 95% CI 1.86–7.86; P = 0.001), and no use of prophylactic mesh (HR = 5.09; 95% CI 2.1–12.2; P = 0.001). Conclusion Incidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and surgical site infection (SSI) benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate. Trial registration: NCT04578561. www.clinicaltrials.gov

scholarly journals Cerebrospinal Fluid Shunt-Associated Surgical Site Infection With Three- Versus Twelve-Month Follow-Up in Canadian Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s157-s157
Author(s):  
Kelly Baekyung Choi ◽  
John Conly ◽  
Blanda Chow ◽  
Joanne Embree ◽  
Bonita Lee ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Age Distribution ◽  
Patient Characteristics ◽  
Csf Shunt ◽  
Surveillance Program ◽  
Site Infection ◽  
Infection Surveillance ◽  
Surgical Manipulation ◽  
National Systems

Background: Surgical site infection (SSI) after cerebrospinal fluids (CSF) shunt surgery is thought to be acquired intraoperatively. Biomaterial-associated infection can present up to 1 year after surgery, but many national systems have shortened follow-up to 90 days. We compared 3- versus 12-month follow-up periods to determine the nature of case ascertainment in the 2 periods. Methods: Participants of any age with placement of an internal CSF shunt or revision surgical manipulation of an existing internal shunt identified in the Canadian Nosocomial Infection Surveillance Program (CNISP) participating hospitals between 2006 and 2018 were eligible. We excluded patients with external shunting devices or culture-positive CSF at the time of surgery. Patients were followed for 12 months after surgery for the primary outcome of a CSF infection with a positive CSF culture by review of laboratory and health records. Patients were categorized as adult (aged ≥18 years) or pediatric (aged < 18 years). The infection rate was expressed as the number of CSF shunt-associated infections divided by the number of shunt surgeries per 100 procedures. Results: In total, 325 patients (53% female) met inclusion criteria in 14 hospitals from 7 provinces were identified. Overall, 46.1% of surgeries were shunt revisions and 90.3% of shunts were ventriculoperitoneal. For pediatric patients, the median age was 0.7 years (IQR, 0.2–7.0). For adult patients, the median age was 47.9 years (IQR, 29.6–64.6). The SSI rates per 100 procedures were 3.69 for adults and 3.65 for pediatrics. The overall SSI rates per 100 procedures at 3 and 12 months were 2.74 (n = 265) and 3.48 (n = 323), respectively. By 3 months (90 days), 82% of infection cases were identified (Fig. 1). The median time from procedure to SSI detection was 30 days (IQR, 10–65). No difference was found in the microbiology of the shunt infections at 3- and 12-month follow-ups. The most common pathogens were coagulase-negative Staphylococcus (43.6 %), followed by S. aureus (24.8 %) and Propionibacterium spp (6.5 %). No differences in age distribution, gender, surgery type (new or revision), shunt type, or infecting organisms were observed when 3- and 12-month periods were compared. Conclusions: CSF-SSI surveillance for 3 versus 12 months would capture 82.0% (95% CI, 77.5–86.0) of cases, with no significant differences in the patient characteristics, surgery types, or pathogens. A 3-month follow-up can reduce resources and allow for more timely reporting of infection rates.Funding: NoneDisclosures: None

scholarly journals Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

2020 ◽  
pp. 219256822097822
Author(s):  
Muyi Wang ◽  
Liang Xu ◽  
Bo Yang ◽  
Changzhi Du ◽  
Zezhang Zhu ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Spinal Deformity ◽  
Recurrent Infection ◽  
Implant Removal ◽  
Site Infection ◽  
Initial Surgery ◽  
Spinal Deformity Surgery ◽  
Solid Fusion ◽  
Deep Surgical Site Infection

Study Design: A retrospective study. Objectives: To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. Methods: This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. Results: With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. Conclusions: Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.

Surgical Site Infection as a Surrogate Marker of Physician Impairment

2009 ◽  
Vol 30 (11) ◽  
pp. 1120-1122 ◽  
Author(s):  
Robert J. Sherertz ◽  
Tobi B. Karchmer
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Surgical Site Infection ◽  
Surrogate Marker ◽  
Surgical Site Infections ◽  
Baseline Period ◽  
Site Infection ◽  
Hepatitis C Virus Infection ◽  
Physician Impairment

Our report details an implant-associated outbreak of surgical site infections related to the adverse effects of treatment for hepatitis C virus infection administered to surgeon X. During the 12-month period of this outbreak, 14 (9.5%) of 148 of surgeon X's patients developed a surgical site infection, a rate of SSI that was 8-fold higher than the rate during the 14-month baseline period or the 14-month follow-up period (P = .001), and higher than the rate among peer surgeons (P = .02).

The incidence of complications in elective cranial neurosurgery associated with dural closure material

2014 ◽  
Vol 120 (1) ◽  
pp. 278-284 ◽  
Author(s):  
Brian P. Walcott ◽  
Jonathan B. Neal ◽  
Sameer A. Sheth ◽  
Kristopher T. Kahle ◽  
Emad N. Eskandar ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Corticosteroid Treatment ◽  
Csf Leak ◽  
Site Infection ◽  
Exclusion Criteria ◽  
Dural Closure ◽  
Estimated Blood Loss ◽  
Dural Graft ◽  
Synthetic Grafts

Object Dural closure with synthetic grafts has been suggested to contribute to the incidence of infection and CSF leak. The objective of this study was to assess the contribution of choice of dural closure material, as well as other factors, to the incidence of infection and CSF leak. Methods A retrospective, consecutive cohort study of adult patients undergoing elective craniotomy was established between April 2010 and March 2011 at a single center. Exclusion criteria consisted of trauma, bur hole placement alone, and temporary CSF fluid diversion. Results Three hundred ninety-nine patients were included (mean follow-up 396.6 days). Nonautologous (synthetic) dural substitute was more likely to be used (n = 106) in cases of reoperation (p = 0.001). Seventeen patients developed a surgical site infection and 12 patients developed a CSF leak. Multivariate logistic regression modeling identified estimated blood loss (OR 1.002, 95% CI 1.001–1.003; p < 0.001) and cigarette smoking (OR 2.198, 95% CI 1.109–4.238; p = 0.019) as significant predictors of infection. Synthetic dural graft was not a predictor of infection in multivariate analysis. Infratentorial surgery (OR 4.348, 95% CI 1.234–16.722; p = 0.024) and more than 8 days of postoperative corticosteroid treatment (OR 3.886, 95% CI 1.052–16.607; p = 0.048) were significant predictors for the development of CSF leak. Synthetic dural graft was associated with a lower likelihood of CSF leak (OR 0.072, 95% CI 0.003–0.552; p = 0.036). Conclusions The use of synthetic dural closure material is not associated with surgical site infection and is associated with a reduced incidence of CSF leak. Modifiable risk factors exist for craniotomy complications that warrant vigilance and further study.

The vacuum-assisted closure (V.A.C®) system for surgical site infection with involved vascular grafts

Vascular ◽  
2014 ◽  
Vol 23 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Karaca Saziye ◽  
Kalangos Afksendiyos
Keyword(s):  
Surgical Site Infection ◽  
Lower Limb ◽  
Vascular Grafts ◽  
Site Infection ◽  
Secondary Intention ◽  
Delayed Primary Closure ◽  
The Mean ◽  
Reoperation Rates ◽  
Mean Time

Background In vascular surgery, surgical site infection is the most common postoperative morbidity, occurring in 5–10% of vascular patients. The optimal management of surgical site infection with involved lower limb vascular grafts remains controversial. We present our 6-year results of using the V.A.C.® system in surgical site infection with involved vascular grafts. Methods A retrospective 6-year review of patient who underwent a VAC® therapy for postoperative surgical site infection in lower limb with involved vascular grafts in our department between January 2006 and December 2011. V.A.C therapy was used in 40 patients. All patients underwent surgical wound revision with VAC® therapy and antibiotics. Results The mean time of use of the V.A.C. system was 14.2 days. After mean of 12 days in 34 of 40 patients, in whom the use of VAC® therapy resulted in delayed primary closure or healing by secondary intention. The mean postoperative follow-up time was 61.67 months, during which 3 patients died. Conclusion We showed that the V.A.C.® system is valuable for managing specifically surgical site infection with involved vascular grafts. Using the V.A.C.® system, reoperation rates are reduced; 85% of patients avoided graft replacement.

scholarly journals Conversion of Failed Hip Resurfacings to Total Hip Arthroplasty- A Favorable Solution with Satisfactory Outcomes

2021 ◽  
Author(s):  
Abdel-hamid A Atalla ◽  
Abdel-hamid ◽  
Bahaa A Kornah ◽  
Mohamed Abdel-AAl ◽  
Abdel-Aleem Soltan
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Surgical Site Infection ◽  
Heterotopic Ossification ◽  
Hip Arthroplasty ◽  
Groin Pain ◽  
Hip Resurfacing ◽  
Site Infection ◽  
Total Hip

Abstract Background: Hip resurfacing had been utilized since the 1950s. The concept favored for young active patients owing to its proposed advantages. Revision rate of hip resurfacing in most national registries nearly 3.5%. Conversion to total hip replacement may be the correct option for old patients and those whose activity levels changed and the need for hip resurfacing no longer required.Purpose: The aim of this study is to assess the mid-term outcomes of converting failed hip resurfacing arthroplsty to total hip arthroplasty. Primary outcomes included improvement of Oxford, WOMAC, Harris and UCLA hip scores. Also; radiological follow-up has been evaluated for component stability or signs of loosening. Secondary outcomes included surgical site infection, residual groin pain, and heterotopic ossification. Most of patients (22 patients (88%) reported relief of pain and good to excellent patient satisfaction. Study design: Prospective case series study.Level of evidence: Therapeutic IV.Patients and Methods:Twenty–five patients (fifteen males) with failed hip resurfacing arthroplasty converted to total hip arthroplasty enrolled in this study. Mean age 56.8 years. Mean time to revision 36.8 months. Indications for revision included: femoral neck fractures (10 cases), femoral neck thinning (3 cases), component loosening (4 cases) component dislocation (2 cases) persistent groin pain and clicking (3 cases) and wear of components (3 cases). Nineteen patients revised both components while remaining six underwent revision of femoral component only. Results:The average duration of follow up was 26.8 months (28-48 months). The study was an intermediate term follow-up. Clinical outcome evaluated through Oxford, WOMAC, Harris and UCLA hip scores. Preoperative scores 21.3, 78.3, 35,7 and 2 respectively improved to 39.8, 11.1, 92.3 and 7 respectively at last follow-up representing statistically significant improvements over pre-operative scores (p < 0.0001 for each score) Radiological follow-up evaluated for component stability or signs of loosening. No cases of neurological, vascular, deep infection or implant failure. There were 3 cases (3%) with complications. one case complicated by surgical site infection with serous drainage for more than seven days and treated with oral antibiotics and daily dressings. One case had residual groin pain, and third case had mild heterotopic ossification. All patients were satisfied particularly by their pain relief. Average post operative Oxford, Harris and WOMAC hip scores were 17.4, 89.8 and 6.1 respec-tively. representing statistically significant improvements over pre operative scores (p < 0.0001 for each score)Conclusions: study shows conversion of hip resurfacing to THA has high satisfaction rates. These results compare favorably with those for revision total hip arthroplasty

scholarly journals Antimicrobial prophylaxis and the prevention of surgical site infection in cardiac surgery: an analysis of 21 007 patients in Switzerland†

2019 ◽  
Vol 56 (4) ◽  
pp. 800-806 ◽  
Author(s):  
Rami Sommerstein ◽  
Andrew Atkinson ◽  
Stefan P Kuster ◽  
Maurus Thurneysen ◽  
Michele Genoni ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Surgical Site Infection ◽  
Linear Models ◽  
Antimicrobial Prophylaxis ◽  
Optimal Timing ◽  
Site Infection ◽  
Confounding Variables ◽  
Surgical Antimicrobial Prophylaxis ◽  
National Surveillance System

AbstractOBJECTIVES:Our goal was to determine the optimal timing and choice of surgical antimicrobial prophylaxis (SAP) in patients having cardiac surgery.METHODS:The setting was the Swiss surgical site infection (SSI) national surveillance system with a follow-up rate of >94%. Participants were patients from 14 hospitals who had cardiac surgery from 2009 to 2017 with clean wounds, SAP with cefuroxime, cefazolin or a vancomycin/cefuroxime combination and timing of SAP within 120 min before the incision. Exposures were SAP timing and agents; the main outcome was the incidence of SSI. We fitted generalized additive and mixed-effects generalized linear models to describe effects predicting SSIs.RESULTS:A total of 21 007 patients were enrolled with an SSI incidence of 5.5%. Administration of SAP within 30 min before the incision was significantly associated with decreased deep/organ space SSI [adjusted odds ratio (OR) 0.73, 95% confidence interval (CI) 0.54–0.98; P = 0.035] compared to administration of SAP 60–120 min before the incision. Cefazolin (adjusted OR 0.64, 95% CI 0.49–0.84; P = 0.001) but not vancomycin/cefuroxime combination (adjusted OR 1.05, 95% CI 0.82–1.34; P = 0.689) was significantly associated with a lower risk of overall SSI compared to cefuroxime alone. Nevertheless, there were no statistically significant differences between the SAP agents and the risk of deep/organ space SSI.CONCLUSIONS:The results from this large prospective study provide substantial arguments that administration of SAP close to the time of the incision is more effective than earlier administration before cardiac surgery, making compliance with SAP administration easier. The choice of SAP appears to play a significant role in the prevention of all SSIs, even after adjusting for confounding variables.

Preoperative opioid use and incidence of surgical site infection after repair of ventral and incisional hernias

Surgery ◽  
2020 ◽  
Vol 168 (5) ◽  
pp. 921-925
Author(s):  
Zain Hassan ◽  
Michael J. Nisiewicz ◽  
Walker Ueland ◽  
Margaret A. Plymale ◽  
Mary C. Plymale ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Site Infection ◽  
Opioid Use ◽  
Incisional Hernias
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