[Laparoscopic treatment of deeply infiltrating colorectal endometriosis - ten years of single center experience]. / Mélyen infiltráló colorectalis endometriosis laparoszkópos kezelésével szerzett tízéves tapasztalataink.

INTRODUCTION: Deep infiltrating endometriosis penetrates the peritoneal surface beneath 5 mm. The bowel is affected in 3-37% of the cases. OBJECTIVE: The aim of the authors was to analyze the results of the surgical procedures performed for bowel endometriosis. METHOD: Between 2009 and 2020, 675 patients underwent bowel endometriosis surgery at the Department of Obstetrics and Gyanecology of Semmelweis University. Four surgical approaches were performed: shaving, discoid, segmental and NOSE resection. RESULTS: 182 shaving, 93 discoid, 130 NOSE and 270 segmental bowel resections were performed. Ultra-deep anastomosis was performed in 40 cases. The median operative time was 85 minutes, the shortest intervention lasted 25 minutes, the longest 585 minutes. The average operating time was 260 (± 161.3) minutes for the first, and 114 (± 47.0) minutes for the last ten operations. The average blood loss was 10 (± 20.3) mL. The average hospital stay was 6 (± 2.3) days. Serious surgical complication (Clavien-Dindo III or more severe) developed in 18 cases. In a total of 17 cases sigmoideo- or ileostomy were used. Conversion to laparotomy was necessary in 6 cases. DISCUSSION: The same team performed all the interventions, which can show the effectiveness of the surgical techniques instead of the technique of individual surgeons. The complication rate is low in the case of an experienced surgical team, and the operating time decreases significantly in proportion to the number of operations performed. CONCLUSION: Bowel endometriosis can be treated safely and effectively with both conservative (shaving or discoid) and radical (segmental or NOSE resection) approach. Orv Hetil. 2023; 164(9): 348-354.

Distinctive characteristics of granulation tissue in laparotomy wounds with underlying oncological processes.

This study aimed to investigate the effects of malignant neoplasms on the morphological characteristics of laparotomy wound granulation tissue in the muscular-aponeurotic layer. The study involved a sample of 34 deceased individuals who had undergone abdominal organ surgery. Biopsy samples were taken from the muscular-aponeurotic layer of the anterior abdominal wall and subjected to histological examination, including staining with hematoxylin and eosin and methylene blue/Chromotrope 2B using N.Z. Slinchenko's method. Descriptive methods and morphometry were used to evaluate pathomorphological changes. The results suggest that malignant neoplasms significantly impede and decelerate the maturation of laparotomy wound granulation tissue. Surgeries performed at the late stages of abdominal organ malignant neoplasms result in an uneven and slow maturation of the tissue, characterized by a higher prevalence of lymphoid cells, increased blood vessel volume, reduced optical density of stained collagen fibers, and pronounced chromotropophilia of collagen fibers. These distinct features should be considered to prevent postoperative eventration, a complication that is more likely to occur in this patient group. Clinicians should be aware of the possible consequences of malignant neoplasms on laparotomy wound granulation tissue, which may require additional measures to prevent postoperative complications in these patients.

MORPHOLOGICAL PECULIARITIES OF THE SKIN GRANULATION TISSUE IN PATIENTS WITH MALIGNANT NEOPLASMS OF THE ABDOMINAL ORGANS.

OBJECTIVE: The aim: To examine morphological peculiarities of the skin granulation tissue from the laparotomy wound in patients with malignant neoplasms of the abdominal organs. PATIENTS AND METHODS: Materials and methods: 36 bodies of deceased people were examined after midline laparotomy performed for surgical treatment of diseases of the abdominal organs. The main group included 22 bodies of deceased people suffering from malignant neoplasms of the abdominal organs, mostly in ІІІ-IV stages of diseases. The group of comparison included 14 bodies of deceased individuals suffering from acute surgical diseases of the abdominal organs. An average length of the laparotomy wound was 24,5 ± 0,28 cm. An average distance from the reticular elements to the external border of the granulation tissue was measured by means of computed histometry (mcm), the optical density (OD) of staining of the collagen fibers was determined by means of computed microdencitometry (expressed in OD absorbance coefficient - the absorbance of the solution per unit length per mole of solute), the specific volume of the blood vessels in the granulation tissue - by means of computed histostereometry (%), the granulation tissue cells were calculated by means of the score test (within eyeshot 10000 mcm2). The specimens were stained with hematoxylin, eosin and methylene blue/Chromotrop 2B. RESULTS: Results: The obtained results of the investigation conducted are indicative of more prominent chromotropic properties in the samples of the main group, confirming certain biochemical changes and features of the collagen fibers respectively. Moreover, slide mounts of the main group possess reliably lower optic density of staining of the collagen fibers which is indicative of their slow formation. It may suggest a reduced solidity of the postoperative scar on the laparotomy wound skin promoting easier wound disruption, that is, occurrence of subcutaneous eventration in patients with malignant neoplasms of the abdominal organs. CONCLUSION: Conclusions: Oncological process in the body results in the aggravation of swelling and chromotropophilia in the deep layers of derma during more remote terms after surgery and reduced optic density of the collagen fibers staining, which promotes easier laparotomy wound disruption and occurrence of true postoperative eventration.

Reduction of Surgical Site Infection After Trauma Laparotomy Through Use of a Specific Protocol for Antibiotic Prophylaxis.

Background: Emergency laparotomy for abdominal trauma is associated with high rates of surgical site infection (SSI). A protocol for antimicrobial prophylaxis (AMP) for trauma laparotomy was implemented to determine whether SSI could be reduced by adhering to established principles of AMP. Patients and Methods: A protocol utilizing ertapenem administered immediately before initiation of trauma laparotomy was adopted. Compliance with measures of adequate AMP were determined before and after protocol implementation, as were rates of SSI and other infections related to abdominal trauma. Univariable and multivariable analyses were performed to determine risk factors for development of infection related to trauma laparotomy. Results: Over a four-year period, 320 patient operations were reviewed. Ertapenem use for prophylaxis increased to 54% in the post-intervention cohort. Compliance with individual measures of appropriate AMP improved modestly. Overall, infections related to trauma laparotomy decreased by 46% (absolute decrease of 13%) in the post-intervention cohort. Multivariable analysis confirmed that treatment during the post-intervention phase was associated with this decrease, with a separate analysis suggesting that ertapenem use was an important factor in this decrease. Conclusions: Development of a standardized protocol for AMP in trauma laparotomy led to decreases in infectious complications after that procedure.

Factors associated with enteral nutrition tolerance after trauma laparotomy of the small bowel and mesenteric injuries by blunt trauma.

BACKGROUND: In patients with blunt injury due to abdominal trauma, the common cause for laparotomy is damage to the small bowel and mesentery. Recently, postoperative early enteral nutrition (EEN) has been recommended for abdominal surgery. However, EEN in patients with blunt bowel and/or mesenteric injury (BBMI) has not been established. Therefore, this study aimed to identify the factors that affect early postoperative small bowel obstruction (EPSBO) and the date of tolerance to solid food and defecation (SF + D) after surgery in patients with BBMI. METHODS: We retrospectively reviewed patients who underwent laparotomy for BBMI at a single regional trauma center between January 2013 and July 2021. A total of 257 patients were included to analyze the factors associated with enteral nutrition tolerance in patients with EPSBO and the postoperative day of tolerance to SF + D. RESULTS: The incidence of EPSBO in patients with BBMI was affected by male sex, small bowel organ injury scale (OIS) score, mesentery OIS score, amount of crystalloid, blood transfusion, and postoperative drain removal date. The higher the mesentery OIS score, the higher was the EPSBO incidence, whereas the small bowel OIS did not increase the incidence of EPSBO. The amount of crystalloid infused within 24 h; the amount of packed red blood cells, fresh frozen plasma, and platelet concentrate transfused; the time of drain removal; Injury Severity Score; and extremity abbreviated injury scale (AIS) score were correlated with the day of tolerance to SF + D. Multivariate analysis between the EPSBO and non-EPSBO groups identified mesentery and small bowel OIS scores as the factors related to EPSBO. CONCLUSION: Mesenteric injury has a greater impact on EPSBO than small bowel injury. Further research is needed to determine whether the mesentery OIS score should be considered during EEN in patients with BBMI. The amount of crystalloid infused and transfused blood components within 24 h, time of drain removal, injury severity score, and extremity AIS score are related to the postoperative day on which patients can tolerate SF + D.

Laparoscopic or laparoscopic-assisted cystopexy for pelvic bladder in 3 dogs.

The techniques and clinical outcomes of laparoscopic or laparoscopic-assisted cystopexy in 3 dogs diagnosed with pelvic bladder are reported herein. The medical records of 2 dogs with pelvic bladder which underwent laparoscopic cystopexy, and 1 dog which underwent laparoscopic-assisted cystopexy were reviewed. Data retrieved included signalment, clinical signs, diagnostic imaging, surgical technique, and clinical outcome. Long-term follow-up was obtained by verbal interviews with owners. Laparoscopic or laparoscopic-assisted cystopexy was successfully performed to reposition the urinary bladder within the abdominal cavity in all dogs. An intracorporeal suture technique was used in 2 dogs, whereas an extracorpreal technique was used in 1 dog. Two dogs with stranguria experienced complete resolution immediately following surgery and remained disease-free at 18 mo after cystopexy. A third dog with urinary incontinence subjectively improved (according to the owner) but had not resolved completely 2 d following surgery. Key clinical message: Laparoscopic or laparoscopic-assisted cystopexy may be an effective treatment for pelvic bladder in dogs and may offer a minimally invasive alternative to laparotomy. Male dogs with stranguria as the primary clinical sign may experience complete resolution following cystopexy.

Cystopexie laparoscopique ou assistée par laparoscopie pour une vessie pelvienne chez trois c hiens. Les techniques et les résultats cliniques de la cystopexie laparoscopique ou assistée par laparoscopie chez trois chiens diagnostiqués avec une vessie pelvienne sont rapportés ici.Les dossiers médicaux de deux chiens ayant une vessie pelvienne ayant subi une cystopexie laparoscopique et d'un chien ayant subi une cystopexie assistée par laparoscopie ont été examinés. Les données récupérées comprenaient le signalement, les signes cliniques, l'imagerie diagnostique, la technique chirurgicale et les résultats cliniques. Le suivi à long terme a été obtenu par des entrevues verbales avec les propriétaires.La cystopexie laparoscopique ou assistée par laparoscopie a été réalisée avec succès pour repositionner la vessie dans la cavité abdominale chez tous les chiens. Une technique de suture intracorporelle a été utilisée chez deux chiens, tandis qu'une technique extracorporelle a été utilisée chez un chien. Deux chiens atteints de strangurie ont connu une résolution complète immédiatement après la chirurgie et sont restés sans maladie à 18 mois après la cystopexie. Un troisième chien souffrant d'incontinence urinaire s'est amélioré subjectivement (selon le propriétaire) mais celle-ci n'a pas complètement disparu 2 jours après la chirurgie.Message clinique clé :La cystopexie laparoscopique ou assistée par laparoscopie peut être un traitement efficace pour une vessie pelvienne chez le chien et peut offrir une alternative peu invasive à la laparotomie. Les chiens mâles atteints de strangurie comme signe clinique principal peuvent connaître une résolution complète après la cystopexie.(Traduit par Dr Serge Messier).

Congenital Intestinal Malrotation in Newborns: Laparoscopic Ladd's Procedure versus Open Laparotomy.

OBJECTIVE: To assess the efficacy and safety of laparotomic or laparoscopic Ladd's procedure in newborns with congenital malrotation. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Pediatric Surgery, Ganzhou Maternal and Child Health Care Hospital, Ganzhou JiangXi province, China, from January 2015 to December 2021. METHODOLOGY: The clinical data of newborns with malcorrection were retrospectively analysed. Patients were divided into laparotomy group (64 cases) and laparoscopy group (30 cases), according to the surgery they had been subjected. The patients who had the severe malformations, underwent the laparoscopic Ladd's procedure at the first 10 cases, and had found bowel necrosis during operation were excluded. The general data such as lengths of operation, intraoperative blood loss, time-to-diet, lengths of hospital stay, and postoperative complications were compared between the two groups. RESULTS: Crude comparisons showed that the laparoscopy increased the lengths of operative time (70.0 vs. 110.0 minutes, p <0.001) but decreased the postoperative complications (25.0% vs. 6.7%, p=0.035). The intraoperative blood loss, time-to-diet, and lengths of hospital stay between the two groups were not statistically significant (p=0.109, 0.065, and 0.858 respectively). The intestinal volvulus in the two groups (43.8% vs. 80.0%, p=0.001) had statistical differences. Using modified Poisson regression analysis, adjusting for confounding differences of midgut volvulus, lengths of operation time and intraoperative blood loss, and laparoscopic Ladd's showed a significant decrease in postoperative complications (RR=0.13,95%CI 0.03-0.54, p=0.005). CONCLUSION: Laparoscopic Ladd's procedure is feasible to treat neonatal malrotation and is associated with lower postoperative complications of newborns with congenital malrotation. KEY WORDS: Newborns, Congenital malrotation, Laparoscopy, Laparotomy, Complications.

From damage control surgery to complex abdominal wall reconstruction It is possible even in the elderly in a Spoke Center?

AIM: To describe our Spoke Center experience in Damage Control Surgery (DCS) in a non traumatic patient and the possibility of delayed abdominal wall reconstruction (AWR). Material of Study The case of a 73 years old Caucasian male treated with DCS for a septic shock due to a duodenal perforation and his clinical course till the abdominal wall reconstruction. RESULTS: We made DCS with abbreviated laparotomy, suture of the ulcer and duodenostomy with a foley placed in right hypochondrium. Patiens was discharged with a low-flow fistula and with TPN. After 18 months we made an open cholecystectomy and a complete abdominal wall reconstruction with Fasciotens Hernia System® adding a biological mesh. DISCUSSION AND COMMENTS: Periodic training in emergency settings and in complex abdominal wall procedures is the right way to manage critic clinical case. Like Niebuhr's abbreviated laparotomy experience also in our case this procedure allows primary closure of complex hernias and is potentially less prone to complications than component separation methods. Unlike Fung's experience we didn' t use negative pressure wound therapy system (NPWT) equally achieving good results. CONCLUSIONS: Elective repair of abdominal wall disaster is possible even in elderly patients who have been treated by abbreviated laparotomy and DCS surgery. In order to obtain good results is fundamental to have a trained staff. KEY WORDS: Damage Control Surgery (DCS), Giant incisional Hernia, Abdominal Wall Repair.

Persistent mullerian duct syndrome in a dog.

INTRODUCTION: This case report describes a 14-year-old, male castrated York Shire Terrier, which was presented due to stranguria and tenesmus. An abdominal computed tomography (CT) scan raised a high suspicion of a persistent mullerian duct. During laparotomy structures were found that were suspected to be a persistent ovary and uterus. The abnormal uterus was filled with fluid and had a blind end on both sides. The abnormal structures were surgically removed and pathologically examined. Pathology confirmed a persistent mullerian duct. The patient recovered well from the surgery and was able to urinate spontaneously the same day and was discharged the next day.

INTRODUCTION: Ce rapport de cas décrit un York Shire Terrier mâle castré de 14 ans, qui a été présenté en raison d'une strangurie et d'un ténesme. Une tomodensitométrie (TDM) abdominale a soulevé une forte suspicion d'un canal de Müller persistant. Une laparotomie a été pratiquée, au cours de laquelle on a découvert des structures suspectées d'être un ovaire et un utérus persistants. L'utérus anormal était rempli de liquide et avait une extrémité aveugle des deux côtés. Les structures anormales ont été retirées chirurgicalement et ont fait l'objet d'un examen pathologique. La pathologie a confirmé la présence d'un canal de Müller persistant. Le patient s'est bien remis de l'opération et a pu uriner spontanément le jour même. Il a été autorisée à sortir le lendemain.

The preventive effect of omega-3 fish oil on peritoneal adhesion formation.

INTRODUCTION: Postoperative peritoneal adhesions formed after abdominal surgery still continue to exist as an unresolved health problem. AIM: The aim of the present study is to examine whether omega -3 fish oil has a preventive effect on postoperative peritoneal adhesions. METHODS: Twenty-one female Wistar-Albino rats were separated into 3 groups (sham, control, and experimental group), each consisting of 7 rats. In sham group, only laparotomy was performed. Both in control and experimental group rats; the right parietal peritoneum and cecum were traumatized to form petechiae. Following this procedure, unlike the control group, the abdomen was irrigated with omega-3 fish oil in the experimental group. Rats were re-explored on the 14th postoperative day and adhesions were scored. Tissue samples and blood samples were taken for histopathological and biochemical analysis. RESULTS: None of the omega-3 fish oil given rats developed macroscopically postoperative peritoneal adhesion (P=0.005). Omega-3 fish oil formed an anti-adhesive lipid barrier on injured tissue surfaces. Microscopic evaluation revealed diffuse inflammation with excessive connective tissue and fibroblastic activity in control group rats while foreign body reactions were common in omega-3 given rats. The mean amount of hydroxyproline in samples from injured tissues was significantly lower in omega-3 given rats than in control rats. (P=0.004). CONCLUSION: Intraperitoneal application of omega-3 fish oil prevents postoperative peritoneal adhesions by forming an anti-adhesive lipid barrier on injured tissue surfaces. However, further studies are needed to determine whether this adipose layer is permanent or will be resorbed over time.

Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy: a randomized controlled trial.

BACKGROUND: Previous observational studies showed higher rates of abdominal wall closure with the use of hypertonic saline in trauma patients with abdominal injuries. However, no randomized controlled trials have been performed on this matter. This double-blind randomized clinical trial assessed the effect of 3% hypertonic saline (HS) solution on primary fascial closure and the timing of abdominal wall closure among patients who underwent damage control laparotomy for bleeding control. METHODS: Double-blind randomized clinical trial. Patients with abdominal injuries requiring damage control laparotomy (DCL) were randomly allocated to receive a 72-h infusion (rate: 50 mL/h) of 3% HS or 0.9 N isotonic saline (NS) after the index DCL. The primary endpoint was the proportion of patients with abdominal wall closure in the first seven days after the index DCL. RESULTS: The study was suspended in the first interim analysis because of futility. A total of 52 patients were included. Of these, 27 and 25 were randomly allocated to NS and HS, respectively. There were no significant differences in the rates of abdominal wall closure between groups (HS: 19 [79.2%] vs. NS: 17 [70.8%]; p = 0.71). In contrast, significantly higher hypernatremia rates were observed in the HS group (HS: 11 [44%] vs. NS: 1 [3.7%]; p < 0.001). CONCLUSION: This double-blind randomized clinical trial showed no benefit of HS solution in primary fascial closure rates. Patients randomized to HS had higher sodium concentrations after the first day and were more likely to present hypernatremia. We do not recommend using HS in patients undergoing damage control laparotomy. Trial registration The trial protocol was registered in clinicaltrials.gov (identifier: NCT02542241).

THE INITIAL ION SHIFT INDEX AS A PROGNOSTIC INDICATOR TO PREDICT PATIENT SURVIVAL IN TRAUMATIC DAMAGE CONTROL LAPAROTOMY PATIENTS.

ABSTRACT: Objective: The ion shift index (ISI), which considers extracellular fluid ions such as phosphate, calcium, and magnesium, represents the ion shift following ischemia; concentrations of these ions are maintained within narrow normal ranges by adenosine triphosphate-dependent homeostasis. The ISI is defined as follows: {potassium (mmol/L-1) + phosphate (mmol/L-1) + Mg (mmol/L-1)}/calcium (mmol/L-1). This study investigated the possibility of predicting the 30-day survival rate of patients who underwent traumatic damage control laparotomy by comparing ISI and other laboratory findings, as well as the initial Trauma and Injury Severity Score (TRISS) and shock indices. Methods: Among the 134 patients who underwent damage control surgery between November 2012 and December 2021, 115 patients were enrolled in this study. Data regarding injury mechanism, age, sex, laboratory findings, vital signs, Glasgow Coma Scale score, Injury Severity Score, Abbreviated Injury Scale score, blood component transfusion, type of surgery, postoperative laboratory outcomes, morbidity, mortality rates, fluids administered, and volume of transfusions were collected and analyzed. Results: In univariate analysis, the odds ratio of the initial ISI was 2.875 (95% confidence interval, 1.52-5.43; P = 0.04), which showed a higher correlation with mortality compared with other indices. The receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were derived from different multivariable logistic regression models. The initial ISI had high sensitivity and specificity in predicting patient mortality (AUC, 0.7378). In addition, in the model combining the initial ISI, crystalloids, and TRISS, the AUC showed a high value (AUC, 0.8227). Conclusion: The ISI evaluated using electrolytes immediately after admission in patients undergoing traumatic damage control surgery may be a predictor of patient mortality.

Surgical stabilization of critical abdominal injuries in a mature rural trauma system: A retrospective study.

BACKGROUND: Worse outcomes following injuries are more likely in rural versus urban areas. In 2001, our state established an inclusive trauma system to improve mortality. In 2015, the trauma system had a consultation visit from the American College of Surgeons' Committee on Trauma, who made several recommendations. We hypothesized that continued maturation of this system would lead to more laparotomies prior to transfer to a higher level of care and better outcomes. METHODS: Our trauma registry was queried to identify all patients transferred between January 1, 2010, and December 31, 2020, who underwent laparotomy either before transfer or within 4 hours of arrival. The preconsultation (2010-2015) and postconsultation periods (2016-2020) were compared. Categorical and continuous variables were compared using χ2 and Mann-Whitney U tests, respectively. RESULTS: We included 213 patients; 63 had laparotomy before transfer and 150 within 4 hours after transfer. Age, injury severity scores, systolic blood pressure, and mechanism of injury were not different between periods. Proportions of laparotomy before and after transfer and outcomes (mortality, hospital length of stay, intensive care unit length of stay, ventilator days) were also similar (p = 0.368 for laparotomy, p = 0.840, 0.124, 0.286, 0.822 for outcomes). Compared with the preconsultation period, the proportion of laparotomy performed before transfer for severe injuries (abdominal Abbreviated Injury Scale score >3) significantly increased postconsultation (57.1% vs. 30.6%, p = 0.011). Incidence of damage-control laparotomies (43.9% vs. 23.6%; p = 0.020) and transfusion of plasma and platelets (33.6% vs. 13.2%; p < 0.001, 22.4% vs. 8.5%, p = 0.007, respectively) significantly increased. CONCLUSION: Identification and surgical stabilization of critical patients at the non-Level I facilities prior to transfer, as well as blood product use and damage-control techniques, improved postconsultation, suggesting a shift in the approaches to surgical stabilization and resuscitation efforts in our trauma system. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Retrocecal hernia with small bowel obstruction: a review of literature.

Retrocecal hernia, a type of internal hernia, is a rare cause of small bowel obstruction. It can come as a surprise to the operating surgeon if not diagnosed preoperatively. We hereby report a case of retrocecal hernia presenting with small bowel obstruction. A man in his early 60s presented to the emergency department with recurrent episodes of vomiting associated with abdominal pain for 3 days and the inability to pass flatus for 1 day. Preoperative imaging revealed multiple air-fluid levels with a transition point in the terminal ileum suggestive of small bowel obstruction. After adequate resuscitation, emergency laparotomy was performed, and intraoperatively, herniated ileal loop through a retrocecal defect was identified as a cause of obstruction. Herniated ileal loop was reduced, followed by the closure of the defect and cecopexy. The postoperative course was uneventful, and the patient was discharged in a stable condition. He was asymptomatic on follow-up.

Surgical mortality in patients in extremis: futility in emergency abdominal surgery.

BACKGROUND: The number of older patients with multiple comorbidities in the emergency service is increasingly frequent, which implies the risk of incurring in futile surgical interventions. Some interventions generate false expectations of survival or quality of life in patients and families and represent a negligible therapeutic benefit in patients whose chances of survival are minimal. In order to address this dilemma, we describe mortality in a cohort of patients undergoing emergency laparotomy with a risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator. METHODS: A retrospective observational study was designed to analyze postoperative mortality and factors associated with postoperative mortality in a cohort of patients undergoing emergency laparotomy between January 2018 and December 2021 in a high-complexity hospital who had a mortality risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator. RESULTS: A total of 890 emergency laparotomies were performed during the study period, and 50 patients were included for the analysis. Patient median age was 82.5 (IQR: 18.25) years old and 33 (66.00%) were male. The most frequent diagnoses were mesenteric ischemia 21 (42%) and secondary peritonitis 18 (36%). Mortality in the series was 92%. Twenty-four (54.34%) died within the first 24 h of the postoperative period; 11 (23.91%) within 72 h and 10 (21.73%) within 30 days. APACHE II and SOFA scores were statistically significantly higher in patients who died. CONCLUSIONS: All available tools should be used to make decisions, with the most reliable and objective information possible, and be particularly vigilant in patients at extreme risk (mortality risk greater than 75% according to ACS NSQIP Surgical Risk Calculator) to avoid futility and its consequences. The available information should be shared with the patient, the family, or their guardians through an assertive and empathetic communication strategy. It is necessary to insist on a culture of surgical ethics based on reflection and continuous improvement in patient care and to know how to accompany them in order to have a proper death.

Laparoscopy in high-risk emergency general surgery reduces intensive care stay, length of stay and mortality.

PURPOSE: Emergency general surgery patients undergoing laparoscopic surgery are at reduced risk of mortality and may require reduced length of critical care stay. This study investigated the effect of laparoscopy on high-risk patients' post-operative care requirements. METHODS: Data were retrieved for all patients entered into the NELA database between 2013 and 2018. Only high-risk surgical patients (P-POSSUM predicted mortality risk of ≥ 5%) were included. Patients undergoing laparoscopic and open emergency general surgical procedures were compared using a propensity score weighting approach. Outcome measures included total length of critical care (level 3) stay, overall length of stay and inpatient mortality. RESULTS: A total of 66,517 high-risk patients received emergency major abdominal surgery. A laparoscopic procedure was attempted in 6998 (10.5%); of these, the procedure was competed laparoscopically in 3492 (49.9%) and converted to open in 3506 (50.1%). Following inverse probability treatment weighting adjustment for patient disease and treatment characteristics, high-risk patients undergoing laparoscopic surgery had a shorter median ICU stay (1 day vs 2 days p < 0.001), overall hospital length of stay (11 days vs 14 days p < 0.001) and a lower inpatient mortality (16.0% vs 18.8%, p < 0.001). They were also less likely to have a prolonged ICU stay with an OR of 0.78 (95% CI 0.74-0.83, p < 0.001). CONCLUSION: The results of this study suggest that in patients at high risk of post-operative mortality, laparoscopic emergency bowel surgery leads to a reduced length of critical care stay, overall length of stay and inpatient mortality compared to traditional laparotomy.

Fascial dehiscence: predictable complication? Development and validation of a risk model: a retrospective cohort study.

PURPOSE: Fascial dehiscence is still an important cause of morbidity and mortality in the postoperative period of abdominal surgery. Different authors have sought to identify risk factors for this entity. Two risk scores have been developed, but they include postoperative variables, which hinder preventive decision-making during the early surgical period. Our aim is to identify preoperative and intraoperative risk factors for fascial dehiscence and to develop and validate a risk prediction score that allows taking preventive behaviors. METHODS: All adult patients, with no prior history of abdominal surgery, who underwent midline laparotomy by a general surgery division between January 2009 and December 2019 were included. Recognized preoperative risk factors for fascial dehiscence were evaluated in a univariate analysis and subsequently entered in a multivariate stepwise logistic regression model. A prognostic risk model was developed and posteriorly validated by bootstrapping. This study was conducted following the STROBE statement. RESULTS: A total of 594 patients were included. Fascial dehiscence was detected in 41 patients (6.9%). On multivariate analysis, eight factors were identified: chronic obstructive pulmonary disease (COPD), immunosuppression, smoking, prostatic hyperplasia, anticoagulation use, sepsis, and overweight. The resulting score ranges from 1 to 8. Scores above 3 are predictive of 18% risk of dehiscence with a sensitivity of 70% and specificity of 80% (ROC 0.88). CONCLUSIONS: We present a new preoperative prognostic score to identify patients with a high risk of fascial dehiscence. It can be a guide for decision-making that allows taking intraoperative preventive measures. External validation is still required.

Postoperative sinusitis and pneumonia following exploratory celiotomy for treatment of colic in horses.

Sinusitis and pneumonia following exploratory celiotomy in horses were studied, evaluating associations between these 2 respiratory complications and selected pre-, peri-, and post-operative variables. The incidence of sinusitis was 2.5% (8/318) and pneumonia 3.5% (11/318). These respiratory complications were associated with peri-operative reflux, longer antimicrobial treatment, and longer hospitalization.

Sinusite et pneumonie postopératoires suite á une coeliotomie exploratoire pour le traitement des coliques chez le cheval. La sinusite et la pneumonie consécutives á une coeliotomie exploratoire chez le cheval ont été étudiées, afin d'évaluer les associations entre ces deux complications respiratoires et certaines variables pré-, péri- et postopératoires. L'incidence des sinusites était de 2,5 % (8/318) et des pneumonies de 3,5 % (11/318). Ces complications respiratoires étaient associées á un reflux périopératoire, á un traitement antimicrobien plus long et á une hospitalisation plus longue.(Traduit par Dr Serge Messier).

Factors predicting surgical difficulties in congenital biliary dilatation in pediatric patients.

BACKGROUND: The effects of disease classification and the patient's preoperative condition on the difficulty of performing a laparotomy for pediatric congenital biliary dilatation (CBD) have not been fully elucidated. METHODS: The present study retrospectively analyzed 46 pediatric CBD laparotomies performed at the study center between March 2010 and December 2021 and predictors of operative time. The patients were separated into a short operative time group (SOT) (≤ 360 min, n = 27) and a long operative time group (LOT) (> 360 min, n = 19). RESULTS: The preoperative AST and ALT values were higher, and the bile duct anastomosis diameter was larger, in the LOT. Correlation analysis demonstrated that the maximum cyst diameter, preoperative neutrophil-to-lymphocyte ratio, AST, ALT, AMY, and bile duct anastomosis diameter correlated positively with operative time. Multivariate analysis identified the maximal cyst diameter, preoperative AST, and bile duct anastomosis diameter as significant factors affecting surgical time. Postoperatively, intrapancreatic stones and paralytic ileus were observed in one patient each in the SOT, and mild bile leakage was observed in one patient in the LOT. CONCLUSIONS: The maximum cyst diameter, preoperative AST, and bile duct anastomosis diameter have the potential to predict the difficulty of performing a pediatric CBD laparotomy.