Tag Archives: Postoperative Complications

Aspiration versus peritoneal lavage in appendicitis

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“The management of IAA remains controversial with different strategies suggested to decrease its incidence: antibiotic prophylaxis, post-operative antibiotic therapy, peritoneal irrigation with saline solution or suction only of the abscess/purulent liquid without irrigation of the cavity during appendectomy. In the literature, many studies address this topic; however, currently there is no evidence to clearly demonstrate the effectiveness of peritoneal irrigation over suction only. Italian guidelines recommend thorough peritoneal lavage (6–8 L of warm saline) and aspiration to minimize the IAA rate in complicated appendicitis. The recent WSES (World Society of Emergency Surgery) guidelines report that “Peritoneal irrigation does not have any advantage over suction alone in complicated appendicitis in both adults and children. The performance of irrigation during laparoscopic appendectomy does not seem to prevent the development of IAA and wound infections
in neither adults nor paediatric patients”. WSES recommendation is “to perform suction only in complicated appendicitis patients with intra-abdominal collections undergoing laparoscopic appendectomy” [QoE: Moderate; Strength of recommendation: Strong; 1B]). The concern regarding irrigation and lavage is that these procedures might help spread the infectious material.”

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Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery

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“The development of an anastomotic stricture at the site of the gastrojejunostomy following Roux-en-Y gastric bypass (RYGBP) is associated with substantial morbidity. Various techniques are available for creating the gastrojejunal anastomosis, including hand-sewing and using a circular or linear stapler, to reduce complication rates. The aim of this study was to assess the incidence of gastrojejunal anastomotic strictures in patients who underwent antecolic antegastric Roux-en-Y gastric bypass (AA-RYGBP) with the use of a linear stapler and to evaluate the outcomes of endoscopic pneumatic dilatation as a treatment option for patients with anastomotic stricture.”

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Pancreatic fistula following pancreatoduodenectomy. Evaluation of different surgical approaches in the management of pancreatic stump.

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“Pancreatoduodenectomy (PD) is the gold standard surgical procedure performed for both benign and malignant diseases of the pancreas and periampullary region. Since the introduction of PD by Whipple in 1941, the treatment of the pancreatic stump was felt as
primary issue due to the frequency of the complications. Advances in medical and surgical care have made the mortality rate after PD declined dramatically (0e5%), even in centres with experienced surgeons. However, the morbidity rate remains quite high, approaching the 50%. The most common complications after PD are pancreatic fistula, late gastric empty, haemorrhage, hepatic-jejunostomy leakage, wound infection and intraabdominal abscess, which affect mortality rate, hospitalization and costs. At present, pancreatic fistula (PF) is the most significant complication, with a rate ranges from 5% to 40% even in tertiary centers. About the 40% of the patient deaths are the results of septic and haemorrhagic complication following PF. Although, attempting to reduce complications, many refinements of the cur-
rent surgical techniques, pancreatico-jejunostomy, pancreaticogastrostomy and duct occlusion, have been proposed. Nevertheless, the best method to manage the pancreatic stump is still debated.”

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Laparoscopic parastomal hernia repair: keyhole, Sugarbaker, sandwich, or hybrid technique with 3D mesh?

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“The most commonly reported approaches for stomal hernia repair include stoma relocation, fascial repair using sutures, and fascial repair using prosthetic mesh with either open or minimally invasive surgery. At present, suture repair for elective surgery is no longer recommended due to high recurrence rates, except in specific circumstances such as
strangulation and contamination of the surgical field, where the use of mesh application should be avoided. In the last decade, many minimally invasive procedures have been
reported in the literature with varying results. In a previous systematic review in 2015, DeAsis et al. investigated the role of laparoscopic surgery in parastomal hernia repair and
concluded that the modified Sugarbaker technique demonstrated superior performance compared to other techniques. Likewise, the sandwich technique showed positive outcomes with low recurrence rates. In another study published in 2015, Szczepkowski et al. described an alternative approach called hybrid with three-dimensional (3D) meshes with promising results.

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Acute Kidney Injury within an Enhanced Recovery after Surgery (ERAS) Program for Colorectal Surgery

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“Acute kidney injury (AKI) is a common complication following major abdominal surgery and is associated with increased length of hospital stay, the progression of chronic kidney disease (CKD), and increased long-term mortality. The rate of AKI amongst patients within different enhanced recovery programs (ERP) is reported to be between 3 and 23%. Patient-related risk factors for AKI include age, comorbidities such as hypertension and diabetes, a history of CKD, and use of angiotensin-converting enzyme inhibitors. Procedure-related factors that may impact on the prevalence of AKI include open surgery, the requirement for blood products, the use of intraoperative vasopressors, and a restrictive perioperative fluid regimen. The original guidelines published by the Enhanced Recovery After Surgery (ERAS) Society for colorectal surgery (CRS) as well as their recent update (2018 guidelines) promote a number of measures which aim to maintain near euvolaemia such as preoperative carbohydrate loading, avoidance of bowel preparation, minimisation of fasting times, minimally invasive surgery, and early resumption of oral fluid therapy.”

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Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients

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“The number of people over 65 years is increasing and will continue to do so over the coming decades. Similarly, the number of elderly patients requiring surgery is expected to increase.
Delirium is a common and serious problem in hospitalized patients, especially in the elderly.
Postoperative delirium is associated with an increase in postoperative complications, a decrease in functional capacity, a prolonged hospital stay and a direct increase of healthcare costs.
Early identification of patients at risk for delirium is important because adequate well timed
interventions could prevent occurrence of delirium and the related detrimental outcome.
Several prediction models have been developed, including multiple risk factors for postoperative delirium. However, these studies are of varying quality and each with a heterogeneous population.
Measuring frailty may be a more sensitive marker of determining post-operative delirium. However, to this date, there is no consensus on a clear definition and quantification of
frailty. Several assessment instruments have been developed for frailty during the last decades.
The most evidence based process to identify frail patients at this moment is comprehensive
geriatric assessment. However, this is a resource intensive, time consuming process and therefore not suitable for clinical practice”

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Comparing Outcomes Between “Pull” Versus “Push” Percutaneous Endoscopic Gastrostomy in Acute Care Surgery: Under-Reported Pull Percutaneous Endoscopic Gastrostomy Incidence of Tube Dislodgement

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“Percutaneous endoscopic gastrostomy (PEG) tube placement is a commonly performed procedure in trauma patients.Since the establishment of the acute care surgery (ACS)
model, the role of ACS in PEG tube placement in many institutions has expanded. The incidence of PEG tube complications has been under-reported in the literature and varies
widely among the patient populations studied and the definition of complications utilized. Major and minor complications may range from 3% to 26%. Our institution, under an ACS model, has previously reported an overall 25% complication rate with 10% major and 14% minor complications associated with pull PEG.”

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