RESUMEN
UNLABELLED: Abstract: Background. Abdominal wall repair after celiotomy is important because insufficient incisional wound strength results in wound failures such as fascial dehiscence and herniation. Ascorbic acid has been shown to play an important role in wound healing. The purpose of this study was to investigate whether ascorbic acid improves incisional wound healing in a diabetic rat. METHODS: Male Wistar-Albino streptozosin-induced diabetic rats (n = 20) were divided into two groups: control group (CG; n = 10), and daily 200 mg/kg ascorbic acid (study group, [SG], n = 10) given orally. Ten animals from each group were euthanized on postoperative day (POD) 14 after wounding; breaking strength, histologic examination, and tissue hydroxyproline levels were analyzed. RESULTS: The hydroxyproline tissue content of the abdominal fascia in the ascorbic acid treatment group was superior to the control group, and the difference was statistically significant (P < 0.05). The tensiometric analyses revealed that tensile strength for the midline incision was significantly higher in the study group compared to the control group (P < 0.05). Significant differences were found in the results of histologic examination of tissue specimens between the two groups regarding acute inflammation, chronic inflammation, granulation tissue fibroblast maturation, collagen deposition, and neovascularization on POD 14 (P < 0.05). CONCLUSION: The present study demonstrates that administration of ascorbic acid prior to laparotomy expedites wound healing in a rat. On the contrary, we suggest that it could confer benefits to tissue healing by significantly enhancing tissue hydroxyproline levels, neovascularization, fibroblast maturation, and collagen deposition.
RESUMEN
BACKGROUND: Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs), the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs) and factors that affect mortality. METHODS: Demographic characteristics; initial diagnoses; information from and complications of the first surgery received; durations and outcomes of UAR(s) performed in patients who received early RLs because of complicated abdominal surgeries in our clinic between 01.01.2000 and 31.12.2004 were investigated retrospectively. Statistical analyses were done using the chi-square and Fisher exact tests. RESULTS: Early UAR was performed in 81 out of 4410 cases (1.8%). Average patient age was 50.46 (13-81) years with a male-to-female ratio of 60/21. Fifty one (62.96%) patients had infection, 41 (50.61%) of them had an accompanying serious disease, 24 (29.62%) of them had various tumors and 57 (70.37%) patients were operated under emergency conditions during first operation. Causes of urgent abdominal re-explorations were as follows: leakage from intestinal repair site or from anostomosis (n:34; 41.97%); hemorrhage (n:15; 18.51%); intestinal perforation (n:8; 9.87%); intraabdominal infection or abscess (n:8; 9.87%); progressive intestinal necrosis (n:7; 8.64%); stomal complications (n:5; 6.17%); and postoperative ileus (n:4; 4.93%). Two or more UARs were performed in 18 (22.22%) cases, and overall mortality was 34.97% (n:30). Interval between the first laparotomy and UAR averaged as 6.95 (1-20) days, and average hospitalization period was 27.1 (3-78) days.Mortality rate was found to be higher among the patients who received multiple UARs. The most common (55.5%) cause of mortality was sepsis/multiple organ failure (MOF). The rates for common mortality and sepsis/MOF-dependent mortality that occured following UAR were significantly higher in patients who received GIS surgery than in those who received other types of surgeries (p:0.000 and 0.010, respectively). CONCLUSION: UARs that are performed following complicated abdominal surgeries have high mortality rates. In particular, UARs have higher mortality rates following GIS surgeries or when infectious complications occur. The possibility of efficiently lowering these high rates depends on the success of the first operations that the patient had received.