Reduced wound infection in colorectal resection by using a wound auto-retractor.

Surgical site infection (SSI) remains an important problem in colorectal surgery. The aim of this study is to determine whether the use of a wound protection system can be effective in reducing the incidence of wound infection after colorectal resection. Ninety-five consecutive patients underwent colorectal resection, carried out by one single surgeon during a six-year period (2009-2015). A laparotomy auto-retractor was used in all cases (Alexis Wound Retractor; Applied Medical, Rancho Santa Margarita, CA). Forty-two resections (44%) were made by laparoscopy. Anastomoses for laparoscopic right colectomies, section of left colon and insertion of the anvil of CEEA for laparoscopic left colectomies were made extracorporeally. No colon cleansing was used in 67 patients (72%). The median age for those undergoing colectomy was 67 (range 41-90). The median Body Mass Index was 25.04 (range 18- 36.76). Three patients (3%) were operated on an emergency basis because of bowel obstruction or perforation. Fifty-three patients were classified ASA I-II (56%). There were six re-operations, for anastomotic dehiscence, peri-ostomal cellulitis and postoperative bleeding. The median postoperative stay was eight days (range 3-28). Only one patient (1%) developed wound infection. Due to the significantly reduced incidence of postoperative wound infection, this study suggests that the Alexis retractor be considered for routine use.

Abdominal surgery in nonagenarians: short-term results.

PURPOSE: To determine the short-term results of abdominal surgery in nonagenarians. METHODS: Retrospective analyses of 193 patients aged 90 and older operated on for abdominal complaints during a 15-year period (1990-2004) in a 500-bed tertiary care institutional hospital and 100-bed rural institutional hospital in Spain. The factors analyzed included the following: perioperative risk, diagnosis, operative procedures, timing of operation (elective or emergency), morbidity, mortality, and length of hospital stay. RESULTS: The most common diagnoses were hernia in 69 cases, colorectal cancer in 39, and biliary lithiasis in 24. One hundred and thirty-seven patients (71%) were operated on on an emergency basis. Forty-seven patients died (24%), with mortality rates of 9% (5/56) and 31% (42/137) respectively, for elective and emergency surgery. None of the 15 patients classified as grade I according to the criteria of the American Society of Anesthesiologists (ASA) died and only 3 out of 63 (5%) died who were ASA grade II. Eighty patients (41%) had postoperative complications. Local morbidity was 16% (n = 30), and systemic morbidity was 30% (n = 58). CONCLUSIONS: Our results support the notion that elective and acute abdominal surgery in nonagenarians can be performed with acceptable rates of mortality and morbidity. Mortality for surgery in nonagenarians is strongly related to the perianesthetic risk (ASA grade), emergency operation, and seriousness of the disease in question.

Mortality associated with emergency abdominal surgery in the elderly.

INTRODUCTION: Elderly patients with life-threatening abdominal disease are undergoing emergency surgery in increasing numbers, but emergency procedures generally are associated with increased morbidity and mortality. We carried out a retrospective and prospective study at a tertiary centre in Spain to analyze the factors contributing to death after emergency abdominal surgery in elderly patients and to determine whether there were differences in the death rate between those aged 70-79 years and those aged 80 years and older. METHODS: The study population comprised 710 patients aged 70 years or older who underwent emergency surgery for intra-abdominal disorders. Between 1986 and 1990, we reviewed the charts of 302 patients, and between 1991 and 1995, we collected prospective data on 408 patients. The patients were divided by age into 2 groups: group 1 - 364 patients aged 70-79 years; and group 2 - 346 patients aged 80 years or older. In the analysis, we considered patient age, sex, perioperative risk, the time between onset of symptoms and admission to hospital and between admission to hospital and surgery, diagnosis, type of operation, operative findings, morbidity, mortality and length of hospital stay. RESULTS: The overall mortality was 22% (19% in group 1 and 24% in group 2). Multiple regression analysis showed that American Society of Anesthesiologists (ASA) grading (p = 0.0001), interval from onset of symptoms to admission (p = 0.007), mesenteric infarction (p = 0.005), a defunctioning stoma and palliative bypass (p = 0.003) and nontherapeutic laparotomy (p = 0.0003) were predictive of death. CONCLUSIONS: Mortality in elderly patients operated on for an acute abdomen can be predicted by ASA grade (perioperative risk), delay in surgical treatment and conditions that permit only palliative surgery. Increasing age (70-79 yr or > or = 80 yr) does not affect mortality, morbidity or length of hospital stay.

Hernias of the abdominal wall in patients over the age of 70 years.

OBJECTIVE: To find out if the patients' age affects the treatment of abdominal hernias and the results in relation of the age increase. DESIGN: Retrospective and prospective study. SETTING: University hospital, Spain. SUBJECTS: 664 patients aged 70 years or more operated on for abdominal hernia between 1986-1998. Patients were divided into three groups: 443 aged 70-79; 202 aged 80-89; and 19 patients aged 90 years or more. MAIN OUTCOME MEASURES: Perioperative risk, type of surgery and deaths. RESULTS: 117 women (52%) had femoral hernias, compared with 32 men (7%) (p = 0.0001). The incidence of femoral hernia over 80 years of age was 79/221 (36%) compared with 70/443 (16%) among patients in their seventies (p = 0.0001). 97 of the patients aged 70-79 (22%) were operated on as emergencies, 107 of those aged 80-89 (53%), and 17 in patients 90 or older (89%, p = 0.0001). The mortality rate was 1% in the 70-79 group (n = 6), 5% (n = 10) in the 80-89 group, and 3/19 died in the over 90 group (p = 0.0001). No deaths were reported after elective surgery. CONCLUSION: Emergency operations in elderly patients with abdominal wall hernias are increasingly more common as the patient get older. As result, there is an unacceptable increase in postoperative mortality.