Pharmacological management of postoperative ileus.

The duration of postoperative ileus following abdominal surgery is quite variable, and prolonged postoperative ileus is an iatrogenic phenomenon with important influence on patient morbidity, hospital costs and length of stay in hospital. Adequate treatment for prolonged postoperative ileus is important to improve patient morbidity and clinical efficiency. Both clinical and pharmacological management strategies have improved rapidly over the last decade, and appropriate and timely management using multimodal techniques should be used for optimal care. In this review, we define postoperative ileus, describe the pathogenesis and briefly discuss clinical management before detailing potential pharmacologic management options.

Effect of surgical wound classification on biologic graft performance in complex hernia repair: an experimental study.

BACKGROUND: Despite relatively sparse data regarding their outcomes in the setting of infection, biologic grafts have gained rapid acceptance by the surgical community for complex hernia repair. These materials are heterogeneous in their procurement and processing techniques, which may ultimately have an impact in their ability to withstand infection. The objective of this study is to evaluate the impact of varying levels of contamination on biologic graft performance in a chronic ventral hernia animal model. METHODS: Four commonly applied biologic grafts were used in the repair of a chronic ventral hernia rat model (n = 218). Each material was repaired in the setting of 1 of 4 surgical wound classifications (clean, clean contaminated, contaminated, dirty infected) with Staphylococcus aureus as our inoculum agent. After a 30-day survival, repairs underwent quantitative cultures, histological, and biomechanical testing. RESULTS: Marked differences were observed in biologic graft bacterial burden, biomechanical and histological responses at 30 days. Persistent bacterial burden varied among the biologic grafts and increased with increasing wound contamination (P < .05). Delays in wound healing were observed in the contaminated and dirty infected setting (P < .05). Increasing infection weakened the biomechanical strength of repairs (P < .05). CONCLUSION: The degree of bacterial contamination at the time of repair affected the rates of bacterial clearance, wound-healing ability, and subsequent repair strength. Material source and processing techniques might alter graft durability, biocompatibility, and ability to clear bacteria in a contaminated field. Clinical trials are warranted in contaminated settings.

Stepwise assessment tool of operative skills (SATOS): validity testing on a porcine training model of open gastrectomy.

BACKGROUND: The aim of this prospective study was to evaluate and compare operative performance and technical improvement of surgical trainees learning open gastrectomy using an objective structured stepwise assessment tool of operative skills (SATOS) previously validated for open surgery. STUDY DESIGN: Thirty residents in general surgery performed 2 open partial gastrectomy training events on a porcine model. Earlier instruction was provided for the critical operative steps, with additional intraoperative instruction when required. Performance was assessed by postgraduate year (PGY) according to operative time, technical skills using a 23-step objective structured tool, and error rate. RESULTS: There were 11 PGY-3, 11 PGY-4, and 8 PGY-5 residents. At the initial assessment, performance significantly differentiated the 3 PGY grades according to technical skills and error rate. At the second assessment, all 3 PGY classes were still significantly differentiable by technical skills, with no difference in error rate. Comparing performances, residents improved operative time (p < 0.001), technical skills (p < 0.001), and error rate (p = 0.019) over the 2 training events. CONCLUSIONS: SATOS demonstrated relevant and accurate objective assessment of trainees' operative skills and improvement for open gastrectomy in a porcine model. This tool may be useful to standardize instruction, to expose weaknesses of trainees, and to determine minimal technical standards in residency programs.