Does laparoscopic approach impair T-tube-related sinus-tract formation?

PURPOSE: Postoperative morbidity after bile duct exploration with T-tube insertion is mainly related to tube removal and incomplete sinus-tract formation leading to serious complications. Laparoscopic surgery reduces abdominal adhesion formation and diminishes tissue trauma and inflammatory response to surgery, which is essential for sinus-tract formation. This study evaluates if complication rate of T-tube removal is increased after laparoscopic bile duct exploration. METHODS: Between January 2004 and January 2011, 94 patients underwent a T-tube insertion following choledocolithotomy (44 and 50 patients in the laparoscopic and open surgery group, respectively). Epidemiological data, preoperative characteristics, day of tube removal, and morbidity rates were analyzed. RESULTS: Global T-tube removal-related biliary complication rate was 14.9% (18.2% in the laparoscopic group vs. 12% in the open surgery group). Although the day of T-tube removal was significantly delayed, there was a slight increased incidence of biliary peritonitis requiring reintervention in the laparoscopic surgery group (6.9% vs. 2%). CONCLUSIONS: We reveal that T-tube removal is associated with significant morbidity. There was no statistical difference between the laparoscopic and the open surgery group, although global biliary complications after tube removal were slightly increased and bile spillage was worse delimited when T-tube was inserted laparoscopically. Laparoscopic approach may diminish inflammatory response and adherence development and impair, and therefore sinus-tract formation.

Heridas por armas de aire comprimido / Wounds due to compressed air weapons

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Sistema de cierre asistido por vacío en heridas complejas. Estudio retrospectivo / A vacuum assisted closure system in complex wounds: a retrospective study

Introducción La terapia de cierre asistido por vacío (VAC) es un sistema no invasivo y dinámico que ayuda a promover la cicatrización mediante la aplicación de presión negativa en el lugar de la herida, favoreciendo la reducción del área de la herida, eliminando el exceso de fluidos y estimulando la angiogénesis. Introducción El objetivo de este trabajo ha sido describir nuestra experiencia con la terapia VAC en heridas complejas. Material y método Analizamos de forma retrospectiva nuestra experiencia entre abril del 2007 y agosto del 2008. Empleamos 2 tipos de terapia VAC, la «suprafascial» y el dispositivo para abdomen abierto o «intraabdominal». Se aplicó estadística descriptiva con cálculo de porcentajes y medias. Resultados La terapia VAC fue empleada en un total de 20 pacientes con heridas complejas, de las cuales 16 (80%) tenían una localización abdominal y el resto 4 (20%) otras localizaciones. En 17 (85%) pacientes el dispositivo VAC empleado fue «suprafascial», mientras que en los otros 3 (15%) se utilizó el dispositivo VAC «intraabdominal». Durante la terapia VAC tuvimos 2 casos (10%) de fístula, una urinaria y otra entérica. En ambos casos, la modalidad VAC empleada fue la «intraabdominal» y las fístulas se resolvieron antes de la retirada de la terapia VAC. La estancia media hospitalaria fue de 38,3 días (7–136). No hubo mortalidad directamente relacionada con la terapia VAC. Dos pacientes (10%) fallecieron en situación de shock séptico refractario, mientras que el resto (90%) vive en la actualidad. El dispositivo VAC «suprafascial» se mantuvo una media de 29,17 días (1–77), y el «intraabdominal» 18 días (7–49). El coste por paciente se estimó en 3.197,97 € (119,1–10.780,25).Conclusiones La terapia VAC puede mejorar y acelerar la cicatrización de las heridas abdominales complicadas también en presencia de contaminación grave o fístulas intestinales (AU)

Introduction Vacuum-assisted closure (VAC) therapy is a dynamic and non-invasive system for improving wound healing. This novel therapy is based on applying air suction at a controlled sub-atmospheric pressure. The most important benefits of this therapy include, a reduction in the wound area together with induction of new granulation tissue formation, effective wound cleansing (removal of small tissue by suction), and the continuous removal of wound exudate. Introduction The aim of this study was to describe our experience with VAC therapy for complex wounds. Material and method We retrospectively evaluated our experience with VAC therapy between April 2007 and August 2008. We employed a “suprafascial” VAC system and an open abdomen VAC system. Descriptive statistical techniques were applied and percentages and means were calculated. Results VAC therapy was applied in 20 patients, of whom 16(80%) had abdominal complex wounds, and 4(20%) in other locations. We employed a “suprafascial” VAC system in 17 patients (85%) and an “intra-abdominal” VAC system in 3 patients (15%). Two patients (10%) developed fistula during “intra-abdominal” VAC therapy (urinary and enteric) but the closure was achieved before therapy was finished. Mean hospital stay was 38.3 days (7–136). No mortality was directly due to the VAC system. Two patients (10%) died due to their septic condition and the rest are still alive. Mean therapy length was 29.17 days (1–77) in the “suprafascial” group and 18 days (7–49) in the “intra-abdominal” group. Average costs were 3197.97 € (119.1–10780.25) per patient. Conclusions VAC therapy can improve and accelerate abdominal wound healing also in the presence of infection and bowel fistula (AU)

[A vacuum assisted closure system in complex wounds: a retrospective study]. / Sistema de cierre asistido por vacío en heridas complejas. Estudio retrospectivo.

INTRODUCTION: Vacuum-assisted closure (VAC) therapy is a dynamic and non-invasive system for improving wound healing. This novel therapy is based on applying air suction at a controlled sub-atmospheric pressure. The most important benefits of this therapy include, a reduction in the wound area together with induction of new granulation tissue formation, effective wound cleansing (removal of small tissue by suction), and the continuous removal of wound exudate. The aim of this study was to describe our experience with VAC therapy for complex wounds. MATERIAL AND METHOD: We retrospectively evaluated our experience with VAC therapy between April 2007 and August 2008. We employed a "suprafascial" VAC system and an open abdomen VAC system. Descriptive statistical techniques were applied and percentages and means were calculated. RESULTS: VAC therapy was applied in 20 patients, of whom 16(80%) had abdominal complex wounds, and 4(20%) in other locations. We employed a "suprafascial" VAC system in 17 patients (85%) and an "intra-abdominal" VAC system in 3 patients (15%). Two patients (10%) developed fistula during "intra-abdominal" VAC therapy (urinary and enteric) but the closure was achieved before therapy was finished. Mean hospital stay was 38.3 days (7-136). No mortality was directly due to the VAC system. Two patients (10%) died due to their septic condition and the rest are still alive. Mean therapy length was 29.17 days (1-77) in the "suprafascial" group and 18 days (7-49) in the "intra-abdominal" group. Average costs were 3197.97 euro (119.1-10780.25) per patient. CONCLUSIONS: VAC therapy can improve and accelerate abdominal wound healing also in the presence of infection and bowel fistula.

[Experience with the Bogota bag technique for temporary abdominal closure]. / Experiencia con la técnica de la bolsa de Bogotá para el cierre temporal del abdomen.

INTRODUCTION: The Bogota bag technique is a reliable method for open abdominal closure. The aim of this study was to describe our experience with this technique. MATERIAL AND METHOD: We retrospectively evaluated our experience with the Bogota Bag technique between January 2000 and March 2006. Descriptive statistical techniques were applied and percentages and means were calculated. RESULTS: The Bogota bag technique was applied in 12 patients. The technique was the preferred closure system to prevent abdominal compartment syndrome in 11 patients (91.66%) and was required to treat abdominal compartment syndrome in one patient (8.34%). No complications occurred in relation to placement or withdrawal of the Bogota bag. There were no intestinal fistulas or intra-abdominal abscesses. The mean length of hospital stay was 46.33 days and the mean length of stay in the intensive care unit was 16.58 days. The survival rate was 41.66%. CONCLUSIONS: In our experience, the Bogota bag is a useful technique and is the preferred closure system to prevent or treat abdominal compartment syndrome. The high mortality rates described are due to the underlying diseases leading to open abdominal closure and not directly to the Bogota bag technique itself.

Experiencia con la técnica de la bolsa de Bogotá para el cierre temporal del abdomen / Experience with the Bogota bag technique for temporary abdominal closure

Introducción. La bolsa de Bogotá es uno de los dispositivos que se han descrito para el cierre temporal del abdomen. El objetivo de este trabajo ha sido describir nuestra experiencia con la técnica de la bolsa de Bogotá. Material y método. Analizamos retrospectivamente nuestra experiencia entre enero de 2000 y marzo de 2006. Se aplicó estadística descriptiva con cálculo de porcentajes y medias. Resultados. En un total de 12 pacientes se empleó la bolsa de Bogotá. En 11 (91,66%) se colocó de forma preventiva por presentar riesgos de hipertensión intraabdominal y síndrome compartimental abdominal. En un paciente (8,34%) la descompresión con bolsa de Bogotá se realizó una vez el síndrome compartimental se había instaurado. No hemos tenido ninguna complicación en relación con la colocación ni la retirada de la bolsa de Bogotá. En ningún caso aparecieron fístulas intestinales ni colecciones infectadas intraabdominales. La estancia media hospitalaria fue de 46,33 días y en la unidad de cuidados intensivos, de 16,58 días. En la actualidad 7/12 (58,34%) han fallecido y 5/12 (41,66%) viven. Conclusiones. La bolsa de Bogotá para el open abdomen en nuestra serie ha sido un método útil para evitar o tratar el síndrome compartimental abdominal. La gran mortalidad descrita viene dada por el proceso inicial que presentan los pacientes y no por las complicaciones derivadas de la colocación de la bolsa de Bogotá (AU)

Introduction. The Bogota bag technique is a reliable method for open abdominal closure. The aim of this study was to describe our experience with this technique. Material and method. We retrospectively evaluated our experience with the Bogota Bag technique between January 2000 and March 2006. Descriptive statistical techniques were applied and percentages and means were calculated. Results. The Bogota bag technique was applied in 12 patients. The technique was the preferred closure system to prevent abdominal compartment syndrome in 11 patients (91.66%) and was required to treat abdominal compartment syndrome in one patient (8.34%). No complications occurred in relation to placement or withdrawal of the Bogota bag. There were no intestinal fistulas or intra-abdominal abscesses. The mean length of hospital stay was 46.33 days and the mean length of stay in the intensive care unit was 16.58 days. The survival rate was 41.66%. Conclusions. In our experience, the Bogota bag is a useful technique and is the preferred closure system to prevent or treat abdominal compartment syndrome. The high mortality rates described are due to the underlying diseases leading to open abdominal closure and not directly to the Bogota bag technique itself (AU)