RESUMEN
INTRODUCTION: The aim of the present study was to evaluate the risk factors for postoperative complications after an appendectomy with special regard to both the time period from hospital admission to operation and night time surgery. PATIENTS AND METHODS: Patients who underwent an appendectomy due to acute appendicitis and were admitted to the University Hospital Aachen between January 2003 and January 2014 were included in this retrospective analysis. Regarding the occurrence of postoperative complications, patients were divided into the following two groups: the group with complications (group 1) and the group without complications (group 2). RESULTS: Of the 2136 patients who were included in this study, 165 patients (group 1) exhibited complications, and in 1971 patients (group 2), no complications appeared. After a univariate logistic regression analysis, six predictors for postoperative complications were found and are described as follows: (1) complicated appendicitis (odds ratio (OR) 4.8 (3.46-6.66), p < 0.001), (2) operation at night (OR 1.62 (1.17-2.24), p = 0.004), (3) conversion from laparoscopic to open access (OR 37.08 (12.95-106.17), p < 0.001), (4) an age > 70 years (OR 6.00 (3.64-9.89), p < 0.001), (5) elevated CRP (OR 1.01 (1.01-1.01), p < 0.001) and (6) increased WBC count (OR 1.04 (1.01-1.07), p = 0.003). After multivariate logistic regression analysis, a significant association was demonstrated for complicated appendicitis (1.88 (1.06-3.32), p < 0.031), conversion to open access (OR 16.33 (4.52-58.98), p < 0.001), elevated CRP (OR 1.00 (1.00-1.01), p = 0.017) and an age > 70 years (OR 3.91 (2.12-7.21), p < 0.001). The time interval between hospital admission and operation was not associated with postoperative complications in the univariate and multivariate logistic regression analyses, respectively. However, the interaction between complicated appendicitis and the time interval to operation was significant (OR 1.024 (1.00-1.05), p = 0.028). CONCLUSION: Based on our findings, surgical delay in the case of appendicitis and operation at night did not increase the risk for postoperative complications. However, the mean waiting time was less than 12 h and patients aged 70 years or older were at a higher risk for postoperative complications. Furthermore, for the subgroup of patients with complicated appendicitis, the time interval to surgery had a significant influence on the occurrence of postoperative complications. Therefore, the contemporary operation depending on the clinical symptoms and patient age remains our recommendation.
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Apendicectomía/efectos adversos , Apendicitis/cirugía , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Tiempo de Tratamiento , Adulto , Distribución por Edad , Análisis de Varianza , Apendicectomía/métodos , Apendicitis/diagnóstico , Estudios de Cohortes , Femenino , Alemania , Hospitales Universitarios , Humanos , Incidencia , Laparoscopía/métodos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Complicaciones Posoperatorias/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Esophageal dilation (ED) has been described as a long-term complication following laparoscopic adjustable gastric banding (LAGB) with an incidence of 0.5-50%. The purpose of this study was to evaluate the effect of major ED on weight loss and find methods to diagnose ED and possible treatment strategies based on a classification. MATERIALS AND METHODS: We performed a retrospective analysis of all patients undergoing LAGB between 2004 and 2008 in three community-based hospitals. ED was classified in four stages of dilation using gastrografin swallow. We report body mass index (BMI), failure rates and reoperations among these patients, with a mean follow-up period of 6.7 years. RESULTS: Nineteen (18.4%) of 103 patients who underwent LAGB presented with esophageal dilation. Band deflation failed for all nine patients (8.7%) with major ED. The mean BMI at LAGB (BMI 1), revision (BMI 2), and 1 year after conversion (BMI 3) were 45.9±3.2, 42.8±4.9 and 30.3±5.5 kg/m2, respectively. No significant difference was found comparing BMI 1 and BMI 2 (p=0,065, EWL1: 14.2±21.7 kg/m2). In contrast, the weight loss after the revision surgery was significant (p=0.001, EWL2: 67.1±30 kg/m2). No significant difference was found concerning age, gender, ASA, preoperative (LAGB) weight, and mean interval between LAGB and revision comparing patients with major ED (IV) to patients with milder forms (ED I-III). CONCLUSION: ED is a serious long-term complication after LAGB and seems to prevent effective weight loss in stage IV. Furthermore, untreated dilation could cause long-term damage to the esophagus. Therefore, we suggest routine radiographic follow-up after LAGB even in asymptomatic patients and a treatment based on a classification with an early surgical revision for major ED.
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Cirugía Bariátrica/métodos , Enfermedades del Esófago/fisiopatología , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/fisiopatología , Adulto , Índice de Masa Corporal , Dilatación Patológica/epidemiología , Dilatación Patológica/fisiopatología , Dilatación Patológica/terapia , Enfermedades del Esófago/epidemiología , Enfermedades del Esófago/terapia , Esófago/cirugía , Femenino , Estudios de Seguimiento , Gastroplastia/métodos , Humanos , Incidencia , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , Reoperación , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Pérdida de PesoRESUMEN
BACKGROUND: Intestinal stoma closure is associated with high risk of surgical site infection (SSI) at stoma reversal site. The aim of this retrospective cohort study was to determine the outcome of purse string approximation (PSA) compared to primary linear closure (PLC) of the skin after loop ileostomy reversal. METHODS: Data of 140 patients operated between 2005 and 2012 were analyzed in this two-center-study to determine the outcome of patients with either PSA (n = 44) or PLC (n = 96) after loop ileostomy reversal. RESULTS: Patients in the PSA group were significantly older than in the PLC group (64 ± 15 vs. 57 ± 18; p = 0.026). Cardiac diseases were significantly more present in the PSA group in comparison to the PLC group (59% vs. 38%; p = 0.017). Stoma creation was significantly more often due to malignancy in the PSA group in comparison to the PLC group (68% vs. 50%; p = 0.044). SSI occurred significantly more often in the PLC group in comparison to the PSA group (17% vs. 5%; p = 0.047). CONCLUSIONS: The risk for SSI is lower in patients with PSA in comparison to patients with PLC. In order to diminish SSI we recommend performing a PSA in patients with loop ileostomy reversal.
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Ileostomía/efectos adversos , Infección de la Herida Quirúrgica/etiología , Técnicas de Cierre de Heridas/efectos adversos , Técnicas de Cierre de Heridas/estadística & datos numéricos , Adulto , Anciano , Estudios de Cohortes , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Procedimientos Quirúrgicos Dermatologicos/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
To reduce infection rates after mesh implantation antibiotic-coated meshes were designed. The aim of the study was to analyze biocompatibility and in vitro efficiency of a modified gentamicin-supplemented polyvinylidenfluoride mesh. Twenty rats were randomized to two groups (PVDF group and Genta group). Mesh material was implanted subcutaneously. Blood samples were taken to determine the gentamicin serum concentration. Seven and 90 days after mesh implantation, animals were euthanized. The inflammatory tissue response was characterized by analyzing the foreign body granuloma. Cellular immune response was analyzed by immunohistochemical investigations. The collagen type I/III ratio was estimated by crosspolarization microscopy. In vitro agar diffusion test, suspension test, and gentamicin release were characterized. Agar diffusion and suspension test showed efficient antibiotic effects of the mesh in vitro. Serum concentrations of gentamicin showed a peak value 1 h postoperatively with a decline within the next day. The total size of the granuloma was significantly smaller in the Genta group compared to the PVDF group at both points of time. Except of a short period of increased expression of CD68 in the Genta group after 7 days, no further difference was found analyzing cellular immune response. The collagen type I/III ratio was widely constant analyzing the two mesh types without significant differences comparing both mesh materials. A significantly decreased foreign body granuloma formation compared to the pure PVDF mesh group was found. In vitro analysis showed efficient antibiotic effects of the Gentamicin supplementation compared to the pure PVDF mesh.
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Gentamicinas/farmacología , Ensayo de Materiales , Polivinilos/química , Mallas Quirúrgicas , Agar , Animales , Colágeno Tipo I/metabolismo , Colágeno Tipo III/metabolismo , Difusión , Gentamicinas/sangre , Granuloma de Cuerpo Extraño/patología , Inmunohistoquímica , Masculino , Pruebas de Sensibilidad Microbiana , Ratas , Ratas Wistar , Staphylococcus aureus/efectos de los fármacos , Factores de TiempoRESUMEN
BACKGROUND: Abdominal hernia repair is the most frequently performed operation in surgery. Mesh repair in hernia surgery has become an integral component. Although meshes made of PVDF are already in clinical use, so far no data of long-term biocompability are available. METHODS: In this study a PVDF mesh was compared to a polypropylene mesh with regard to its long-term biocompatibility. A total of 28 rats were randomized to two groups. Mesh material was implanted subcutaneously; animals were euthanized seven days and six months postoperatively. The quantity of inflammatory tissue response was characterized by measuring the diameter of the foreign body granuloma. Furthermore quality of cellular immune response (T-lymphocytes, macrophages, and neutrophils), and inflammation (COX-2) was analyzed by immunohistochemistry. Furthermore the collagen type I/III ratio was determined. RESULTS: Macrophages, T-lymphocytes, neutrophiles, and COX-2 declined significantly up to six months postoperatively in comparison to day 7 for both PVDF and PP meshes, and in both groups the collagen ratio increased significantly in the course of time. PVDF meshes showed a foreign body granuloma size significantly reduced compared to PP (7 days: 20 ± 2 µm vs. 27 ± 2 µm; 6 months 15 ± 2 µm vs. 22 ± 3 µm; p < .001). However no significant differences were found analyzing cellular response six months postoperatively. CONCLUSIONS: Our current data suggest that even in the long-term course after six months and despite a higher effective surface of the PVDF samples it showed a smaller foreign body granuloma than with PP whereas the cellular response was similar.