Postoperative ileus-Establishing a porcine model.

BACKGROUND: Postoperative ileus (POI), characterized by absent gastrointestinal motility, is a frequent complication following major abdominal surgery, with no current effective treatment possibilities. For further research in the treatment of this condition, we aimed to establish a porcine model of POI. METHODS: A total of 12 Landrace pigs, weighing 60 kg, were included. Five animals were used as pilots to establish the surgical procedure, five animals received the same reproducible surgical procedure developed in the pilot experiments, while two animals were used as control. The primary endpoint was number of days to first stool. Intestinal motility was monitored using the SmartPill system. KEY RESULTS: Four of the five pigs who underwent the final surgical procedure passed first stool on the third postoperative day (POD), and one passed first stool on the fifth POD. SmartPill data showed retention of the capsule in the stomach in four of five pigs with usable traces. CONCLUSION AND INFERENCES: An experimental porcine model of POI was established, forming the basis for future studies in POI.

Palliative Surgery for Pseudomyxoma Peritonei.

INTRODUCTION: Pseudomyxoma peritonei is a rare disease causing peritoneal carcinomatosis. In patients with extensive carcinomatosis, curative treatment is unachievable. Palliative debulking therapy is the only treatment in relieving symptoms. We report our results from palliative debulking surgery at a national pseudomyxoma peritonei center in Denmark. METHODS: From January 2007 to October 2012, we performed 27 palliative operations for pseudomyxoma peritonei with debulking at our institution. All patients were evaluated and found eligible for palliative treatment only. Patients were prospectively registered, while perioperative data were collected retrospectively from patient records. RESULTS: The majority of patients (n = 25) received an omentectomy (93%) as the primary procedure. In total, 17 (63%) received additional surgery. Median operative time was 88 min (range: 33-160 min). Median stay at the recovery ward was 6 h (2-288 h). Median hospital stay was 8 days (4-105 days). In all, 23 (85%) patients had no in-hospital complications, whereas 4 patients experienced complications (15%). Two of the complications were mild (Clavien-Dindo grade II), and two experienced severe complications (grade III and IV). Thirty-day mortality was 0%. Median survival was 3.0 years (0.2-6.2 years). CONCLUSION: Palliative debulking is a safe procedure with an acceptable morbidity and mortality offering immediate disease control.

Influence of venous reservoir level on microbubbles in cardiopulmonary bypass.

Patients undergoing open-heart surgery may, post-operatively, suffer from neurological disorders due to microbubbles created during extracorporeal circulation. Venous air is not completely removed in open hard-shell venous reservoirs. We, therefore, investigated the relationship between venous reservoir blood level and the amount of microbubbles in different commercially available reservoirs for comparison and determination of safe level. An in vitro flow loop with a heart-lung machine was used to compare three different reservoirs (Maquet, Sorin and Medtronic) at different levels. Microbubbles were measured after the reservoir and after the arterial filter with a GAMPT BCC200 detector. Microbubble count and volume were significantly higher with decreasing reservoir level (p = 0.014), but not as much as earlier studies have shown. Reducing the level from 1000 ml to 250 ml resulted in a 12.4% increase in bubble volume after the reservoir and 40.2% after the arterial filter. There was an almost linear trend towards more bubble volume with decreasing reservoir level (R2 = 0.98-0.83). There was a significant difference in microbubbles between the 3 tested reservoirs, up to 32.6%, p < 0.001 measured after the reservoir. Bubble volume from the Sorin reservoir was markedly lower after the arterial filter than from the Medtronic and Maquet reservoirs (up to 60 times p < 0.001). A lower reservoir level results in a moderate rise in microbubbles passing the reservoir. The minimum levels recommended by the manufacturers are safe. There was a significant difference in bubbles between the different reservoirs, especially after the arterial filter.