The role of allopurinol's timing in the ischemia reperfusion injury of small intestine.

INTRODUCTION: Allopurinol acts protectively in the ischemia reperfusion injury of the small intestine. The aim of this experimental study is to define the ideal time of administration of allopurinol, in experimental models of ischemia/reperfusion. MATERIALS AND METHODS: We used 46 rabbits that were divided into four groups. Group A was the control. In Group B allopurinol was administered 10 min before ischemia and in Group C 2 min before reperfusion. In Group D, allopurinol was administered before ischemia and before reperfusion in half doses. Blood samples were collected at three different moments: (t1) prior to ischemia, (t2) prior to reperfusion, and (t3) after the end of the reperfusion, in order to determine superoxide dismutase (SOD) and neopterin values. Specimens of the intestine were obtained for histological analysis and determination of malondialdehyde (MDA). RESULTS: In Group A, mucosal lesions were more extensive compared to those of the other three groups. Similarly, MDA, SOD and neopterin values were significantly higher. On the contrary, Group D showed the mildest mucosal lesions, as well as the lowest MDA, SOD and neopterin values. Finally, the lesions and the above mentioned values were bigger in Group C than in Group D. CONCLUSIONS: The administration of allopurinol attenuates the production and damage effect of free oxygen radicals during ischemia reperfusion of the small intestine, thus protecting the intestinal mucosa. Its maximum beneficial action is achieved when administered both before ischemia and before reperfusion of the small intestine.

Vacuum-assisted closure in severe abdominal sepsis with or without retention sutured sequential fascial closure: a clinical trial.

BACKGROUND: Multiple techniques have been introduced to obtain fascial closure for the open abdomen to minimize morbidity and cost of care. We hypothesized that a modification of the vacuum-assisted closure (VAC) technique that provides constant fascial tension and prevents abdominis rectis retraction would facilitate primary fascial closure and reduce morbidity. METHODS: In all, 53 patients with severe abdominal sepsis were allocated randomly into 2 groups, and 30 patients were analyzed. In the VAC group, we included patients managed only with the VAC device, whereas the retentions sutured sequential fascial closure (RSSFC) group included patients to whom RSSFC was performed. RESULTS: The abdomen was left open for 12 days (P = .0001) with 4.4 ± 1.35 changes per patient for the VAC group (P = .001) and 8 days with 2.87 ± 0.74 dressing changes per patient for the RSSFC group, respectively. Abdominal closure was possible in only 6 patients in the VAC group, whereas for the RSSFC group, abdominal closure was achieved in 14 patients (P = .005). Planned hernia was exclusively decided in patients in the VAC group (P = .001). The hospital stay was 17.53 ± 4.59 days for the VAC group and 11.93 ± 2.05 days for the RSSFC group (P = .0001). The median initial intra-abdominal pressure (IAP) was 12 mm Hg for the VAC group and 16 mm Hg for the RSSFC group (P < .0001). CONCLUSION: We demonstrated the superiority of RSSFC compared with the single use of the VAC device. In our opinion, sequential fascial closure can immediately begin when abdominal sepsis is controlled.

Minimally invasive video-assisted total thyroidectomy: an easy to learn technique for skillful surgeons.

BACKGROUND: Minimally invasive video-assisted total thyroidectomy (MIVATT) is a treating option for small thyroids that demands skills required for both traditional thyroidectomy and endoscopic surgery. This prospective study aims to define the learning curve for MIVATT for residents, with experience in traditional thyroid and laparoscopic surgery. METHODS: In all, 36 MIVATTs for benign disease were evenly divided among 4 residents. We recorded and analyzed: age, sex, pathology, thyroid weight, duration of the operation, ΔCa (postoperative minus preoperative calcemia), ΔWBC (postoperative minus preoperative white blood cell count), vocal motility, operative difficulty, postoperative vocal alteration, postoperative pain, complications, gram of gland excised per minute of the operation, conversion, and hospitalization. RESULTS: Statistically significant differences were observed in the different learning points, between duration of surgery (p < .001), operative difficulty (p = .022), grams of gland excised per minute of operation (p < .001), and WBC (p = .011). CONCLUSIONS: Surgeons that are experience in both thyroid and endoscopic surgery are subjects to a short learning curve concerning MIVATT.

Biliogastric diversion for the management of high-output duodenal fistula: report of two cases and literature review.

High-output duodenal fistula occurs as a result of a duodenal wall defect caused by gastroduodenal surgery, endoscopic sphincterotomy, duodenal injury, and tumors with high morbidity and mortality rate. A new technique for its management is reported along with literature review. This procedure consists of transection of the duodenum 2 cm distally to the pylorus, transection of the common bile duct, and end duodenostomy with or without suturing the duodenal wall defect. The continuity of the alimentary tract is reinstated by an end-to-end duodenojejunostomy, end-to-side choledochojejunostomy, and end-to-side Roux-en-Y jejunojejunostomy, obtaining biliogastric diversion from the duodenum and closure of the fistula. This technique was performed in two patients with excellent results.

Two different prosthetic materials in the treatment of large abdominal wall defects.

AIMS: The use of prosthetic material is a well-accepted practice for the treatment of large ventral defects. The aim of this study is to present the effectiveness of two different prosthetic materials for large ventral defects. METHODS: In this retrospective 3-year study, 41 patients (17 males, 24 females) underwent surgical correction of large abdominal wall defects. Two subgroups were formed based on the possibility of peritoneal preservation. In the first group (24 patients) the bifilament polypropylene mesh was used, while in the second group (17 patients) the expanded polytetrafluroethylene patches were used. RESULTS: The mean hospitalisation time was 7.8 days (SD 9.2 days) for the first and 10 days (SD 4.2 days) for the second group (p=ns). Group A presented the following complications: Two seromas, 1 fistula, 2 wound infections. Removal of the mesh was necessary in one case. Two recurrences were noticed during the 5-year follow-up period. Group B presented a seroma and an infection, but no recurrences. As for complications, no statistical difference exists between the two groups. Furthermore, 5 patients (20.83%) from group A complained of abdominal discomfort due to stiffness, especially when they were bending (p=0.029). CONCLUSIONS: Both prosthetic patches are safe and effective when used in the repair of large abdominal wall defects. Operative complications are within acceptable limits, and the reherniation rate is low.