Title of Study/Article: Clinical Significance of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Predicting Postoperative Complications in Patients Undergoing Major Abdominal Surgery

Background: Major abdominal surgeries are those that require more than 30 minutes, are conducted under general anaesthesia, and need at least a six-day stay in the hospital Aim: To examine the clinical significance of pre-operative and postoperative NLR and PLR as separate morbidity parameters and the occurrence of surgical or non-operative complications in major abdominal operations. Objectives: To determine the possible postoperative association of the importance of Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) with postoperative complication. Methodology: This prospective study to find out the prediction postoperative complication after major abdominal surgery by nlr and plr values would be conducted in Acharya Vinobha Bhave Rural Hospital located in Central India in 30-50 participants between July 2019 to October 2021. Results: Thefindings obtained during the course of the study would be analysed using SPSS software version 25.0 by the statistician. Conclusion: The Nlr and Plr Ratio Is An Important Inflammatory Predictive Value In Assessing The Post-Operative Morbidity In Cases Of Major Abdominal Surgeries

A CLINICAL STUDY ON FACTORS RESPONSIBLE FOR SURGICAL SITE INFECTIONS FOLLOWING EMERGENCY NONTRAUMATIC ABDOMINAL OPERATIONS

This study aims at nding out the common organisms responsible for surgical site infections following emergency non - traumatic abdominal operations and their sensitivity patterns of the microorganisms were ascertained. Determination of factors responsible for infections to reduce the infection rate and thereby reduce the morbidity and mortality. The patients admitted to various surgical wards in KIMS General Hospital, who are operated for emergency non -traumatic abdominal operations are included in this study. A proforma for study of all consecutive patients of emergency non-traumatic abdominal operations will be used. Culture and sensitivity of the organism at the surgical site infection are documented. Various statistical and epidemiological parameters used will be are mean and standard deviation. It was revealed that, overall surgical site infection rate was17.14 per cent. It was observed that among the various host factors studied age, sex, and educational status of the patients were not statistically signicant, but presence of comorbidity played a signicant role in causing SSI. Among the perioperative / environmental factors category of operations, types of incisions, and delay to initiate operation did not play signicant role, but duration of operation and degree of wound contamination played statistically signicant role. It can be concluded from the ndings of the study that microorganisms that are normal inhabitants of our body are mainly responsible for surgical site infection (SSI). Various host factors like malnutrition, obesity, patients’ knowledge about hygiene, presence of co- morbidity etc. coupled with environmental factors such as condition of the wounds, delay to initiate operation, duration of operation, prolonged exposure of peritoneal cavity to environment, prophylactic use of antibiotics and factors associated with surgery like type of incision, type of operation greatly contribute to occurrences of SSI. So, quality of surgical care including immediate assessment of patients, resuscitative measures, adequate preparation of patients and aseptic environment are important for control of SSI.

P011 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: A CASE-CONTROL SERIES

Aim The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Material and Methods A prospective clinical trial started in 2016 and designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects. Results Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and a longer operative and anesthesia time. At 30-days, surgical site occurrences were observed in 18 (47.4%) AI vs. 17 (44.7%) CC; surgical site infection occurred in 4 (10.4%) AI vs. 6 (15.8%) CC, and a higher number of procedural interventions were required in the CC group, 15.8% AI vs. 28.9% CC. At 6-months follow-up, no chronic infections or hernia recurrences were observed in both groups. Conclusions The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.

P058 INCISIONAL HERNIA REPAIR IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Aim Patients with inflammatory bowel disease (IBD) are likely to undergo several abdominal operations and may thus be at increased risk for incisional hernia repair (IHR). The aim of the present study was to investigate risk and predictors of IHR in patients undergoing surgery for ulcerative colitis (UC) or Crohn’s disease (CD). Material and Methods Nationwide register-based study (1996-2018). Patients were followed from date of first abdominal operation until the date of the first IHR. Cumulative incidence proportion were estimated treating death as competing risk. Cox proportional hazard regression was used to explore pre-study defined predictors of IHR. Results Patients with inflammatory bowel disease (IBD) are likely to undergo several abdominal operations and may thus be at increased risk for incisional hernia repair (IHR). The present study analyzed the risk and predictors of IHR in patients undergoing surgery for ulcerative colitis (UC) or Crohn’s disease (CD). Conclusions The risk for incisional hernia repair is relatively low after IBD-surgery, although increased in UC compared with CD patients. Hernia repair predictors varied between UC and CD patients.

Experience of premedication and administration of anti-shock fluids during abdominal operations under local anesthesia

In 1959, we performed 18 operations (appendectomies - 4 laparotomies - 3, gastric resections - 6, other operations - 5) under local anesthesia with V-% novocaine solution according to the method of "creeping infiltrate" according to A.V. Vishnevsky with premedication with drugs phenothiazine series and the introduction of anti-shock fluids during the operation.

A one-stage, one-incision operation on the kidney, gallbladder and caecum under local anesthesia

The idea of the possibility of access from the lumbar incision to the liver, gallbladder and ducts is not new; there are numerous references to this in the literature (Fgapk, Meags, Tu ffieg, Wgight, Reboul, Trinkler, etc.). Frank, for example, even points to the benefits of a lumbar incision for surgery on the biliary tract in terms of convenience of postoperative treatment, convenience of drainage and less danger of postoperative hernias. Most recently, Hrtel) has been focusing the attention of surgeons on lumbar incisions for operations not only on retroperitoneal organs, but also for abdominal operations (spleen, pancreas, duodenum, colon, etc.). Without mentioning the whole issue here, I must say that the clinic has enough reasons for wanting to get operative access to the right kidney and gallbladder simultaneously. The first reason for this in normal conditions may be diagnostic difficulties. There are cases when the surgeon, exposing the kidney, simultaneously felt the stones in the gallbladder and was forced to continue the operation on the bile ducts from the same incision.

Surgical Site Infections; A Study of Incidence, Risk Factors and Causative Organisms in Emergency Abdominal Surgeries

Background Surgical site infection (SSI) is the most commonly reported nosocomial infection. Surgical site infections are responsible for increase in cost, morbidity, and mortality related to surgical operations. Surveillance with information feedback to surgeons and other medical staff has been shown to be an important element in the overall strategy to reduce the numbers of SSIs. Objectives To determine the incidence and factors responsible for, causative micro-organisms and effective antibiotics for surgical site infections following emergency abdominal operations. Patients and methods a total of 252 patients were enrolled in the current study and were retrospectively followed till the tenth day post-operatively. Data collection sheets were filled in for all the patients. If any symptom or sign of infection appear during this period then proper investigation was instituted for the diagnosis of infection and to assess the type and severity of the infection. If any collection of pus identified it was drained out and sent for culture and sensitivity test. Proper antibiotic was given to every patient both preoperative and post-operative periods. Antibiotic was changed where necessary after getting the report of culture and sensitivity test. Results Surveillance of SSIs in the current study revealed an SSI incidence of 21.4%. The most frequent organisms detected by wound swab cultures were E. coli (55.5%), followed by Klebsiella and coagulase negative staphylococci, with the emergence of resistant strains like MDR, AMPC, ESBL strains. Sensitivity to antiobiotics showed Colistin, Polymyxin B, Vancomycin and Tigecycline to be fully functional, next in sensitivity was piperacillin tazobactam, then meropenem, followed by imipenem and amikacin. SSI was found to be increased with the advancement in age, Smoking cigarettes and HCV positive cases. The fourth post-operative day was the commonest day for the occurrence of SSI with discharge from the wound being the most prevalent sign. Conclusion A surveillance system for SSI with feedback of appropriate data to surgeons and hospital authorities is highly recommended to reduce the SSI rate General Surgical Departments at Ain Shams Specialized Hospital - Police Hospital and other Departments as well.

Different strategies, equivalent treatment approaches in terms of mortality in four university hospitals: a retrospective multicenter study of gastroschisis in Finland

Purpose Optimal treatment of gastroschisis is not determined. The aim of the present study was to investigate treatment methods of gastroschisis in four university hospitals in Finland. Methods The data of neonates with gastroschisis born between 1993 and 2015 were collected. The primary outcomes were short and long-term mortality and the length of stay (LOS). Statistical analyses consisted of uni- and multivariate models. Results Total of 154 patients were included (range from 31 to 52 in each hospital). There were no statistically significant differences in mortality or LOS between centers. Significant differences were observed between the hospitals in the duration of mechanical ventilation (p = 0.046), time to full enteral nutrition (p = 0.043), delay until full defect closure (p = 0.003), central line sepsis (p = 0.025), abdominal compartment syndrome (p = 0.018), number of abdominal operations during initial hospitalization (p = 0.000) and follow-up (p = 0.000), and ventral hernia at follow-up (p = 0.000). In a Cox multivariate analysis, the treating hospital was not associated with mortality. Conclusion There were no differences in short or long-term mortality between four university hospitals in Finland. However, some inter-hospital variation in postoperative outcomes was present. Level of evidence Level III.

173 Long Term Analysis of The Evolution of Practice and Results of Abdominal Wall Reconstruction by A Single Surgeon

Background It is estimated that at least 12-15% of abdominal operations lead to incisional hernias, and Worldwide, evidence shows high rates of recurrence after surgical repair ranging from 12.7% in the Danish hernia registry to 23% in the Swedish registry. Method This is a retrospective analysis of the practice of a single surgeon at a tertiary centre. An electronic database provided all hernia surgeries done by the surgeon. A total of 185 patients with complete data were included who had open hernia repair. Electronic patient records were analysed to collect the data. Results 185 patients, with a median age of 57 years (IQR 68 – 49), and BMI of 31.14 (IQR 36.02 – 27.52), had a hernia recurrence rate of 15.6% (29/185). More than 80% of the cases were complex hernias with a European Hernia classification of M3 and/ or W3, with dense intestinal adhesions and multiple previous repairs. Variability in techniques and mesh evolved over this period, from anterior component separation to transversus abdominis release to achieve closure of the abdomen. Polypropylene meshes were used for non-contaminated or less complex cases. The use of biologics in the early years has been superseded by biosynthetic. Conclusions The creation of the abdominal wall unit and subsequent MDT at this centre resulted in a rise of total procedures, complexity of cases and patients with significant co-morbidities. Specialised abdominal wall surgeons are associated with better results when performing complex abdominal wall reconstructions.