[Risk factors of abdominal wound dehiscence in abdominal surgery]. / Faktory riska razvitiya eventratsii v abdominal'noi khirurgii.

OBJECTIVE: To evaluate the role of various perioperative risk factors on the incidence of abdominal wound dehiscence. MATERIAL AND METHODS: A retrospective controlled randomized trial of the risk factors of abdominal wound dehiscence was conducted in 62 patients for the period 2013- 2018. The research was performed at the Perm City Clinical Hospital No. 4. All patients were divided into two groups: the main one (n=31) with abdominal wound dehiscence in early postoperative period and the control group (n=31) without this event. Both groups were comparable by gender, age and surgical abdominal diseases. Between-group differences in numerical indicators were analyzed using Mann-Whitney U-test, qualitative variables were analyzed using contingency tables. Differences were significant at p-value <0.05. RESULTS: Incidence of abdominal wound dehiscence was similar in patients who admitted in emergency and elective fashion (p=0.54). Anemia upon admission (p=0.71), diabetes mellitus type 2 (p=1.00), COPD (p=0.13) and obesity (p=0.76) were not significant predictors of abdominal wound dehiscence. There were significant between-group differences in CRP level (p=0.04). Among intraoperative risk factors, duration of surgery (p=0.78), surgical approach (p=1.00), aponeurosis suturing technique (p=0.39) and stoma (p=0.71) did not significantly affect the incidence of abdominal wound dehiscence. In early postoperative period, abdominal wound dehiscence correlated with peritonitis (p=0.04), SSI (p<0.01) and redo laparotomy (p=0.02). CONCLUSION: Despite the variety of pre-, intra- and postoperative risk factors, only infectious postoperative complications (SSI, peritonitis) and redo surgical interventions influenced the development of abdominal wound dehiscence. Thus, the concept of abdominal wound dehiscence prevention should be inextricably associated with the concept of prevention of postoperative infectious complications from the abdominal wall and abdominal cavity.

Comparison of Postsurgical Scars Between Vegan and Omnivore Patients.

BACKGROUND: Postsurgical skin healing can result in different scars types, ranging from a fine line to pathologic scars, in relation to patients' intrinsic and extrinsic factors. Although the role of nutrition in influencing skin healing is known, no previous studies investigated if the vegan diet may affect postsurgical wounds. OBJECTIVE: The aim of this study was to compare surgical scars between omnivore and vegan patients. METHODS AND MATERIALS: This is a prospective observational study. Twenty-one omnivore and 21 vegan patients who underwent surgical excision of a nonmelanoma skin cancer were enrolled. Postsurgical complications and scar quality were evaluated using the modified Scar Cosmesis Assessment and Rating (SCAR) scale. RESULTS: Vegans showed a significantly lower mean serum iron level (p < .001) and vitamin B12 (p < .001). Wound diastasis was more frequent in vegans (p = .008). After 6 months, vegan patients had a higher modified SCAR score than omnivores (p < .001), showing the worst scar spread (p < .001), more frequent atrophic scars (p < .001), and worse overall impression (p < .001). CONCLUSION: This study suggests that a vegan diet may negatively influence the outcome of surgical scars.

Comparison of negative-pressure incision management system in wound dehiscence: A prospective, randomized, observational study.

Wound dehiscence is a significant problem faced by surgeons after major abdominal surgery. In this study, it was aimed to select the best incision management system to keep the incision edges together and prevent wound opening, and infection by protecting the incision. In this study, 60 patients who underwent abdominal surgery were evaluated regarding their risk of wound dehiscence. In our clinic, high-risk cases of abdominal surgery are performed, the risk factors being ischemia along the incision line, dirty and contaminated wound, obesity, tension on the suture line, traumatization of the wound site, age at onset (> 65), body mass index (BMI) > 30, diabetes mellitus, chronic obstructive pulmonary disease (COPD), immunosuppressive drug users. A prospective study protocol was planned after ASA (American Society of Anesthesiologists) physical status class assignment. Patients were divided into three groups: patients who underwent a postoperative negative-pressure therapy dressing, patients who underwent subcutaneous aspiration drainage, and patients who received standard dressing. The aim of this study was to evaluate the decompensation, surgical site infection, seroma, hospital stay and costs and to evaluate the results in the postoperative period. Sixty patients were randomized (n = 20, for each group). Thirty-one (51%) of the patients were male, and the mean age was 64.3 ± 8.9 (46-85). The mean BMI was 30.45 ± 7.2. There was no statistically significant difference (p≥0.05) between groups in terms of sex, age, and BMI. The ASA score and surgical interventions were similar between the groups. Wound dehiscence rate was 25% (n = 8), 20% (n = 6) and 3% (n = 1) for the Standard Dressing (SD), Aspiration Drainage (AD) and Negative-Pressure (NP) groups, respectively (p <0.017). Duration of hospitalization was 16.45 ± 6.6, 14.3 ± 7.4 and 8.95 ± 2.8 days (p <0.001) for SD, AD and NP groups, respectively. No statistically significant difference was found between the groups regarding other variables (p≥0.05 for all variables). Negative-pressure wound treatment is an easy, fast and practical technique which reduces lateral tension and swelling. It provides perfusion support and helps to protect the surgical field against external sources of infection.

Red cell distribution width and mean platelet volume as predictors of anastomotic dehiscence in colorectal surgery A pilot multicenter case-match study.

AIM: One of the most serious complications in modern colorectal surgery is the occurrence of an anastomotic dehiscence. The aim of this study was to evaluate the role of preoperative red cell distribution width (RDW) and mean platelet volume (MPV) as predictors of anastomotic dehiscence in elective surgery for colorectal cancer. MATERIALS AND METHODS: Forty-two patients with a clinically manifested anastomotic dehiscence after oncological colorectal surgery, and 42 controls matched for age, sex, pathological stage and tumor localization were enrolled. Correlations between the preoperative RDW and MPV values and anastomotic dehiscence were investigated. RESULTS: Both the median RDW value (14.4 % vs 13.1%; p=0.007) and the median MPV value (8.0 fL vs 7.5 fL; p=0.037) were significantly higher in patients with anastomotic dehiscence than in those without. In multiple regression analysis only the RDW remained significantly associated with anastomotic dehiscence. CONCLUSIONS: The preoperative values of RDW may be useful in predicting anastomotic damage in elective oncological surgery. KEY WORDS: Anastomotic Dehiscence, MPV, RDW.

Albumin, Prealbumin, and Transferrin May Be Predictive of Wound Complications following Total Knee Arthroplasty.

Nutritional status has become increasingly important in optimizing surgical outcomes and preventing postoperative infection and wound complications. However, currently, there is a paucity in the orthopaedics literature investigating the relationship between nutritional status and wound complications following total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine the prevalence of (1) postoperative infections, (2) wound complications, (3) concomitant infection with wound (CoIW) complication, and (4) infection followed by wound complication by using (1) albumin, (2) prealbumin, and (3) transferrin levels as indicators of nutritional status. These four different outcome measures were chosen as they are encountered commonly in daily clinical practice. A retrospective review of a national private payer database for patients who underwent TKA with postoperative infections and wound complications stratified by preoperative serum albumin (normal: 3.5-5 g/dL), prealbumin (normal: 16-35 mg/dL), and transferrin levels (normal: 200-360 mg/dL) between 2007 and 2015 was conducted. Patients were identified by Current Procedural Terminology (CPT), International Classification of Disease, ninth revision (ICD-9) codes, and Logical Observation Identifiers Names and Codes (LOINC). Linear regression was performed to evaluate changes over times. Yearly rates of infection, as well as a correlation and odds ratio analysis of nutritional laboratory values to postoperative complications, were also performed. Our query returned a total of 161,625 TKAs, of which 11,047 (7%) had postoperative wound complications, 18,403 (11%) had infections, 6,296 (34%) had CoIW, and 4,877 (4%) patients with infection developed wound complications. Albumin was the most commonly ordered laboratory test when assessing complications (96%). Wound complications, infections, CoIW, and infection with wound complications after were higher in those below the normal range: albumin <3.5 g/dL (9, 14, 6, and 5%), prealbumin <15 mg/dL (20, 23, 13, and 12%), and transferrin <200 mg/dL (12, 17, 6, and 6%). Preoperative albumin, prealbumin, and transferrin values falling below the normal range represented an increased risk for postoperative complications. Those patients who were in the normal range, however, did not have an increased risk. Therefore, our results suggest that preoperative nutritional optimization can play an important role in reducing the risk for postoperative complications.

Hyperbaric oxygen therapy improves colorectal anastomotic healing.

PURPOSE: Hyperbaric oxygen treatment (HBOT) has been found to improve the healing of poorly oxygenated tissues. This study aimed to investigate the influence of HBOT on the healing in ischemic colorectal anastomosis. METHODS: Forty Wistar rats were randomly divided into a treatment group that received HBOT for 10 consecutive days (7 days before and 3 days after surgery), or in a control group, which did not receive the therapy. Colectomy with an ischemic anastomosis was performed in all rats. In each group, the rats were followed for 3 or 7 days after surgery to determine the influence of HBOT on anastomotic healing. RESULTS: Five rats from each group died during follow-up. No anastomotic dehiscence was seen in the HBOT group, compared to 37.5 % and 28.6 % dehiscence in the control group on postoperative day (POD) 3 and 7, respectively. The HBOT group had a significantly higher bursting pressure (130.9 ± 17.0 mmHg) than the control group (88.4 ± 46.7 mmHg; p = 0.03) on POD 3. On POD 3 and POD 7, the adhesion severity was significantly higher in the control groups than in the HBOT groups (p < 0.005). Kidney function (creatinine level) of the HBOT group was significantly better than of the control group on POD 7 (p = 0.001). Interestingly, a significantly higher number of CD206+ cells (marker for type 2 macrophages) was observed in the HBOT group at the anastomotic area on POD 3. CONCLUSION: Hyperbaric oxygen enhanced the healing of ischemic anastomoses in rats and improved the postoperative kidney function.

Procalcitonin Reveals Early Dehiscence in Colorectal Surgery: The PREDICS Study.

OBJECTIVES: We designed a multicentric, observational study to test if Procalcitonin (PCT) might be an early and reliable marker of anastomotic leak (AL) after colorectal surgery (ClinicalTrials.govIdentifier:NCT01817647). BACKGROUND: Procalcitonin is a biomarker used to monitor bacterial infections and guide antibiotic therapy. Anastomotic leak after colorectal surgery is a severe complication associated with relevant short and long-term sequelae. METHODS: Between January 2013 and September 2014, 504 patients underwent colorectal surgery, for malignant colorectal diseases, in elective setting. White blood count (WBC), C-reactive protein (CRP) and PCT levels were measured in 3rd and 5th postoperative day (POD). AL and all postoperative complications were recorded. RESULTS: We registered 28 (5.6%) anastomotic leaks. Specificity and negative predictive value for AL with PCT less than 2.7 and 2.3 ng/mL were, respectively, 91.7% and 96.9% in 3rd POD and 93% and 98.3% in 5th POD. Receiver operating characteristic curve for biomarkers shows that in 3rd POD, PCT and CRP have similar area under the curve (AUC) (0.775 vs 0.772), both better than WBC (0.601); in 5th POD, PCT has a better AUC than CRP and WBC (0.862 vs 0.806 vs 0.611). Measuring together PCT and CRP significantly improves AL diagnosis in 5th POD (AUC: 0.901). CONCLUSIONS: PCT and CRP demonstrated to have a good negative predictive value for AL, both in 3rd and in 5th POD. Low levels of PCT, together with low CRP values, seem to be early and reliable markers of AL after colorectal surgery. These biomarkers might be safely added as additional criteria of discharge protocols after colorectal surgery.

Predictive Value of Nutritional Markers for Wound Healing Complications in Bariatric Patients Undergoing Panniculectomy.

BACKGROUND: Hypoproteinemia and nutritional deficiencies are common after bariatric surgery, and although massive weight loss (MWL) patients experience increased wound complication rates, the association has not been causatively determined. OBJECTIVES: This study investigated preoperative nutritional parameters and wound complications in MWL patients (postbariatric and diet-controlled) undergoing panniculectomy at 2 academic institutions. METHODS: One hundred sixty-one consecutive patients undergoing elective panniculectomy after bariatric surgery or diet-controlled weight loss were identified. Patient demographics and nutritional indices (serum protein, albumin, and micronutrient levels) were analyzed. Complications including wound separation, infection, and operative debridements were compared. Post hoc comparisons tested for correlation between complications and nutritional markers. RESULTS: Postbariatric patients lost an average of 151 lb and presented at an average of 32 months after gastric bypass. Diet-controlled weight loss patients lost an average of 124 lb. Despite MWL, albumin levels were higher in the bariatric group (3.8 vs 3.4 g/dL, P < 0.05). Conversely, bariatric patients experienced increased wound complications (27% vs 14%; P < 0.05). Factors which were found to correlate to increased risk of wound dehiscence and infection were elevated body mass index at time of panniculectomy and amount of tissue removed. Multivariate analysis did not show serum albumin or percent weight loss to independently predict complications. CONCLUSIONS: Bariatric patients presenting for elective operations are at risk for protein and micronutrient deficiency. Despite aggressive replacement and normalization of nutritional markers, bariatric patients experience increased wound complications when compared to nonbariatric patients and traditional measures of nutritional evaluation for surgery may be insufficient in bariatric patients.

Impact of perioperative peripheral blood values on postoperative complications after esophageal surgery.

PURPOSE: Prediction of the postoperative course of esophagectomy is an important part of the strict perioperative management of patients undergoing surgery for esophageal cancer. METHODS: To evaluate their clinical importance, peripheral blood values, including white blood cell count (WBC), lymphocyte count, and the levels of total protein, transferrin, factor XIII, D-dimer, fibrin, and fibrinogen degradation products (FDP) were measured before and after esophagectomy for esophageal cancer in 24 patients. RESULTS: The preoperative WBC and the pre- and postoperative lymphocyte count were decreased remarkably in patients who received preoperative chemoradiotherapy. The values of perioperative serum transferrin were significantly lower in patients with postoperative pneumonia than in those without. The activity of plasma factor XIII was suppressed on postoperative day (POD) 7 in patients with pneumonia and on POD 14 in patients with leakage. CONCLUSIONS: These results suggest that patients who receive preoperative chemoradiotherapy are potentially immunosuppressed, the preoperative serum transferrin level is a possible predictive marker of postoperative pneumonia, and suppression of factor XIII activity is related to anastomotic insufficiency.

Serum cotinine concentration and wound complications in head and neck reconstruction.

BACKGROUND: The authors examined whether the preoperative serum concentrations of cotinine accurately predict the risk of complications in patients undergoing flap reconstruction of head and neck cancer defects. METHODS: Patients with incident stage III or IV squamous cell carcinoma of the head and neck undergoing resection with pedicled or free flap reconstruction were selected from an existing database of 500 patients with squamous cell carcinoma of the head and neck who participated in a prospective epidemiologic study and were reviewed retrospectively. Preoperative serum cotinine concentrations were determined using a competitive microplate immunoassay. Complications were defined as any adverse postoperative wound outcome at either the donor or recipient site. RESULTS: Eighty-nine patients underwent 101 flap reconstructions. Thirty-seven wound complications occurred in 33 patients. Forty of the 89 patients had a serum cotinine concentration greater than 10 ng/ml; twenty (50 percent) developed postoperative complications, whereas only 13 of 49 patients (27 percent) with a serum cotinine concentration of 10 ng/ml or less developed complications (p = 0.028). The relative risk of wound complications for those with a cotinine concentration greater than 10 ng/ml was approximately double that of patients with a lower cotinine concentration (relative risk, 1.9; 95 percent CI, 1.1 to 3.3). Patients with a cotinine concentration greater than 50 ng/ml had a particularly high risk (relative risk, 2.3; 95 percent CI, 1.1 to 16.7; p = 0.024). The relative risk of wound complications was not significantly associated with self-reported smoking status or history. CONCLUSION: A serum cotinine concentration greater than 10 ng/ml may predict an increased risk of wound complication in head and neck flap reconstruction and may serve as an objective, easily measured variable with which to identify patients who may benefit from an aggressive smoking cessation program before surgery.

Factor XIII therapy of anastomotic leak, and circulating growth factors.

Wound healing is far more rapid in the gastrointestinal tract than in the skin. Once dehiscence of a surgical anastomosis in the gastrointestinal tract occurs, the high collagenase activity in the gastrointestinal tract may delay wound healing and promote the formation of a nonhealing fistula. Because factor XIII promotes cross-linking of fibrin during the early phase of wound healing, we investigated the effect of factor XIII concentrate on 16 anastomotic leaks and a nonhealing fistula. A 240-U dose of factor XIII concentrate (Fibrogammin P) was administrated intravenously for 5 days. Factor XIII activity and plasma levels of epidermal growth factor (EGF), transforming growth factor (TGF)-beta, and interleukin-6 were measured before treatment and 1 day and 7 days after the end of treatment. Clinical outcomes were evaluated on the basis of the findings of contrast radiography, computed tomography, and drainage volume. Improvement relevant to the therapy was observed in 15 cases (88.2%). Factor XIII activity increased to more than 70% of the normal value in 11 cases (64.7%) but remained at 40% to 70% of the normal value in 6 cases (35.3%). Plasma EGF and TGF-betalevels increased in patients with improvement but were unchanged in patients without improvement. Our findings suggest that factor XIII significantly accelerates wound healing of anastomotic leaks and nonhealing fistulas by increasing circulating growth factors after systemic administration.

Systemic coagulation activation and anastomotic leakage after colorectal cancer surgery.

PURPOSE: The aim of the present study was to study whether patients developing anastomotic leakage after colorectal resections for colorectal cancer have laboratory signs of an altered hemostatic balance in the systemic circulation, preoperatively and postoperatively, causing an impaired healing process. METHODS: Patients operated on for colorectal cancer were studied. Seventeen consecutive patients with anastomotic leakage and 17 patients without anastomotic leakage were matched according to age, gender, tumor stage, and localization of tumor. Hemostatic balance was estimated preoperatively and at one, two, and seven days and at three months after surgery by plasma levels of sensitive markers of coagulation activation and fibrinolysis, i.e., prothrombin fragment 1 + 2, thrombin-antithrombin complexes, soluble fibrin, tissue-type plasminogen activator activity, and plasminogen activator inhibitor Type 1. RESULTS: Preoperatively, the hemostatic balance was comparable in patients with and without anastomotic leakage. In the early postoperative period, patients developing anastomotic leakage exhibited signs of systemic coagulation activation, i.e., elevated plasma levels of prothrombin fragment 1 + 2, thrombin-antithrombin complexes, soluble fibrin, and plasminogen activator inhibitor Type 1. The observed coagulation activation appeared before the anastomotic leakage became clinically evident. More patients with anastomotic leakage received perioperative blood transfusions than patients without leakage, despite the fact that duration of surgery and intraoperative blood loss were comparable in the two groups. CONCLUSIONS: Enhanced coagulation activity was observed postoperatively in patients developing anastomotic leakage after colorectal resections for colorectal cancer. Such a hypercoagulable state may contribute to the development of anastomotic leakage by facilitating formation of microthromboses in the perianastomotic area.

[Use of plasmapheresis in a 62-year-old patient with severe infection]. / Einsatz einer Plasmapherese bei einem 62jährigen Patienten mit schwerer Sepsis.

INTRODUCTION: The elimination of cytotoxic substances from blood as part of sepsis treatment has been controversely discussed so far. The following case report demonstrates the advantages and disadvantages of this therapy strategy. CASE REPORT: A 62-year-old male patient developed a paralytic ileus with wound dissection 3 days after elective sigma resection. A few hours after surgical revision he went into severe sepsis. A controlled ventilation was necessary as well as the use of catecholamines to maintain sufficient mean arterial pressure. Body temperature stayed between 39 and 40 degrees C (rectal). The patient's extremities and body showed severe marmorations due to the pathologic vasal alteration. A laparotomy one day after the operation revealed a massive generalized edema of the bowels without any evidence of insufficient anastomosis. The fulminant septic process could not be stopped with conservative treatment including continuous veno-venous hemofiltration. Under further deterioration of the pulmonary function (signs of beginning ARDS) and the generalized capillary leak syndrome we started plasmapheresis 2 days after operation in order to eliminate high-molecular cytokines. The plasmapheresis was done twice the following 2 days. Under this treatment the septic process was stopped. The pulmonary function and the circulation improved. The disturbed peripheral perfusion normalized. A laparotomy confirmed a significant decrease of the intestine wall edema. Unfortunately we could not repeat plasmapheresis. On the following days the patient worsened again and died 20 days later due to multiorgan failure. DISCUSSION: The temporary improvement during plasmapheresis suggests that the patient might have profited from plasmapheresis-related optimized oxygen delivery, controlled diuresis and decrease of oxygen consumption. In addition we hypothesized that elimination of high-molecular cytokines and toxines contributed to the improvement under plasmapheresis. Using plasmapheresis one has to consider the high costs, risk of infection, and the unexplained mode of action to the mediatory process. Therefore we cannot recommend this treatment in general. Further controlled studies should investigate the therapeutic benefits of plasmapheresis in patients with severe sepsis.

Platelet aggregability and the occurrence of anastomotic leakage after esophageal reconstruction.

In 21 patients who had undergone resection and reconstruction for esophageal carcinoma, the postoperative platelet aggregability was measured and the correlation between the occurrence of anastomotic leakage and platelet aggregability was investigated. There was no statistical difference in the clinical features of the patients between those with (n = 5) and without (n = 16) anastomotic leakage. Platelet aggregability was measured by the turbidimetric method from blood samples taken preoperatively, and at 1, 3, and 7 postoperative days (POD). The average values of platelet aggregability in patients without anastomotic leakage were 81.2, 70.4, 80.1, and 81.8%, while those with leakage were 81.3, 47.6, 52.3, 70.6% preoperatively, and 1, 3, and 7 POD, respectively. Thus, platelet aggregability significantly decreased in patients with anastomotic leakage on the first postoperative day (p < .05), and then gradually recovered postoperatively as time passed. Therefore, the measurement of platelet aggregability is considered to be one of the parameters predicting the occurrence of anastomotic leakage, and a prevention in the decrease of platelet aggregability as well as its activation could become a treatment for preventing anastomotic leakage.

Effects of early postoperative chemotherapy on wound healing.

Wound complications were investigated in 100 patients undergoing chemotherapy for epithelial ovarian cancer and compared with wound complications in patients with other gynecologic malignancy who did not receive chemotherapy but were operated on by the same gynecologic oncologists. The incidence of wound complications in the chemotherapy-treated population was 11%. Complications developed with equal frequency regardless of when postoperative chemotherapy was initiated. Thus, chemotherapy did not increase the risk of wound complications despite efforts to begin chemotherapy as soon as possible after cytoreductive surgery. Low postoperative albumin levels (P less than .01), postoperative hemoglobin of 10 g/dL or less (P less than .02), advanced stage of disease (P less than .004), and electrocautery use (P less than .05) were all risk factors for development of wound complications, whereas the frequency of bowel resection and type of fascial or skin closure did not adversely influence the risk. Patients who received chemotherapy and developed wound breakdown actually healed faster than our control population. They healed at the same rate as did obstetric and gynecologic patients from the literature. Because delays in administering chemotherapy postoperatively have been associated with decreased survival, we recommend that chemotherapy for advanced-stage epithelial cancer not be delayed solely because of concern for wound healing.

[The value of serum endotoxin determination after gastrointestinal interventions]. / Die Wertigkeit von Serum-Endotoxin-Bestimmungen nach gastrointestinalen Eingriffen.

Serumendotoxins were measured in 11 patients after gut surgery and compared with healthy people as a standard. In cases of uncomplicated course 3 to 4-fold raised serumendotoxin levels were observed in a typical two-peak pattern. It was not before the fifth day following operation that serum levels declined constantly. In contrast to these findings, patients suffering from septic complications showed a permanently raised endotoxin level, which correlated well with their clinical course. Therefore single peaks of serumendotoxin measured after operation should not be overvalued. Constantly raised levels following operation, however, may indicate some kind of septic complication.

[Changes in the concentration of hydroxyproline in plasma following anastomosis of the intestines]. / Die Veränderung der Konzentration von Hydroxyprolin im Plasma nach Anastomosen am Darm.

Hydroxyproline plasma levels were determined in 39 patients before and after operation of the gastrointestinal tract. In the immediate postoperative period a decreased collagen metabolism was detected. From the third and seventh postoperative day respectively a considerable increase of the plasma concentration prevailed to the termination of the measurement period. There was no significant difference in the quantitative change with regard to the type of operation, whereas there were differences in the time course of the reaction. These results support the theory that an injury induces an increase in collagen metabolism leading to an elevation of hydroxyproline plasma concentration.

[Postoperative hemoglobin course and septic complications following stomach resection]. / Postoperativer Hämoglobinverlauf und septische Komplikationen nach Magenresektion.

Preoperative and postoperative haemoglobin curves were studied in male patients, following two-third gastrectomy. A group with early septic complications was compared to one without. The groups were comparable for age distribution and pathological patterns (ulcer/gastric stenosis and carcinoma). Preoperative haemoglobin mean values were a the lower normal limit and dropped to 10.8 g/dl in the group with complications on the fifth day from surgery, but stayed constant at 12 g/dl in the control group, as of the second postoperative day. Haemoglobin dropped to mean values around 11 g/dl immediately after surgery in patients with severe complications, such as suture dehiscence. All groups deviated clearly from normal Hb.

[Pre- and postoperative fibronectin concentrations in the serum of patients with severe peritonitis in comparison with postoperative courses without complications]. / Prä- und postoperative Fibronectinkonzentrationen im Serum bei Patienten mit schwerer Peritonitis im Vergleich mit komplikationslosen postoperativen Verläufen.

Fibronectin in serum was determined in surgical patients with and without severe peritonitis. It could be observed that the infection induced an intense reduction of fibronectin, which could not be found in patients without postoperative complications. Extremely low values were detected in patients not surviving the infection. They remain unchanged during the observation time. Patients with severe infections, which survived, did show higher fibronectin values which significantly increased during the observation time. Together with other parameters and clinical symptoms fibronectin could be used to indicate the prognosis of severe infections.